NSG 4800 Comprehensive Exam Study Guide + 160
NCLEX-Style Questions, Correct ANSWERs &
Rationales | Galen College of Nursing | Summer
2026
SECTION 1: FUNDAMENTALS (Questions 1-200+)
VITAL SIGNS - SIGNIFICANT BLOOD PRESSURE DROP
Question 1
A nurse is assessing a patient who moved from lying to standing position. Which blood pressure change
would indicate orthostatic hypotension?
A. Drop of 15 mmHg systolic and 5 mmHg diastolic
B. Drop of 20 mmHg systolic and 10 mmHg diastolic
C. Drop of 10 mmHg systolic and 15 mmHg diastolic
D. Drop of 5 mmHg systolic and 8 mmHg diastolic
Correct ANSWER: B
Rationale:
Option A is incorrect because a drop of 15 mmHg systolic and 5 mmHg diastolic does not meet the
clinical criteria for orthostatic hypotension, which requires a drop of at least 20 mmHg systolic OR 10
mmHg diastolic.
Option B is correct because orthostatic (postural) hypotension is defined as a drop of 20 mmHg systolic
OR 10 mmHg diastolic from baseline when moving from lying to standing position. This is the hallmark
finding that indicates clinically significant orthostatic hypotension.
Option C is incorrect because while the diastolic drop of 15 mmHg exceeds the threshold, the question
asks for the specific criteria, and the standard definition emphasizes the 20 mmHg systolic OR 10 mmHg
diastolic drop as the key indicators.
,Option D is incorrect because a drop of 5 mmHg systolic and 8 mmHg diastolic is within normal variation
and does not indicate orthostatic hypotension.
Question 2
When assessing a patient for orthostatic hypotension, what is the appropriate time interval between
position changes when measuring blood pressure?
A. Immediately upon position change
B. 30 seconds between positions
C. 1-3 minutes between position changes
D. 5-10 minutes between position changes
Correct ANSWER: C
Rationale:
Option A is incorrect because measuring immediately upon position change does not allow adequate
time for the cardiovascular system to respond to the positional change, potentially missing the
orthostatic response.
Option B is incorrect because 30 seconds is insufficient time to accurately assess the body's
compensatory mechanisms and may not reveal the full extent of orthostatic changes.
Option C is correct because the standard protocol for assessing orthostatic hypotension requires
measuring blood pressure lying, sitting, and standing with 1-3 minutes between position changes. This
allows adequate time for the cardiovascular system to respond and reveals true orthostatic changes.
Option D is incorrect because waiting 5-10 minutes between positions is unnecessarily long and may
allow compensatory mechanisms to normalize the blood pressure, potentially missing the orthostatic
response.
Question 3
A patient experiences a sustained blood pressure drop of 25/12 mmHg upon standing. What is the
nurse's priority action?
A. Document the findings in the patient's chart
B. Report the findings to the healthcare provider
C. Encourage the patient to walk to improve circulation
D. Administer antihypertensive medication as scheduled
Correct ANSWER: B
Rationale:
,Option A is incorrect because while documentation is important, it is not the priority action when a
patient has a clinically significant sustained drop in blood pressure that requires immediate provider
notification.
Option B is correct because a sustained drop ≥20/10 mmHg should be reported to the healthcare
provider immediately. This represents clinically significant orthostatic hypotension that may require
intervention or medication adjustment.
Option C is incorrect because encouraging walking when a patient is experiencing orthostatic
hypotension increases fall risk and is contraindicated. The patient should be kept safe in a lying or sitting
position.
Option D is incorrect because administering antihypertensive medication would worsen the
hypotension. The nurse should HOLD antihypertensives, not administer them, when orthostatic
hypotension is present.
Question 4
Which nursing intervention is most appropriate for a patient diagnosed with orthostatic hypotension?
A. Encourage rapid position changes to build tolerance
B. Hold antihypertensive medications
C. Restrict fluid intake to prevent fluid overload
D. Keep the patient on strict bed rest
Correct ANSWER: B
Rationale:
Option A is incorrect because rapid position changes increase fall risk in patients with orthostatic
hypotension. Patients should be encouraged to change positions slowly, not rapidly.
Option B is correct because holding antihypertensive medications is a key nursing action for orthostatic
hypotension. These medications can worsen the condition and should be held until the healthcare
provider can reassess the patient's medication regimen.
Option C is incorrect because fluid restriction would worsen orthostatic hypotension. Adequate
hydration is essential to maintain blood volume and blood pressure. Patients should be encouraged to
increase fluid intake.
Option D is incorrect because strict bed rest is not necessary and can lead to deconditioning. The patient
should be encouraged to move with appropriate safety measures and slow position changes.
Question 5
A nurse is caring for a patient with orthostatic hypotension. Which intervention should be included in
the plan of care to ensure patient safety?
A. Implement fall precautions
, B. Encourage standing quickly to test tolerance
C. Administer diuretics as prescribed
D. Limit fluid intake to 1000 mL per day
Correct ANSWER: A
Rationale:
Option A is correct because ensuring safety through fall precautions is a key nursing action for patients
with orthostatic hypotension. These patients are at high risk for falls due to dizziness and blood pressure
drops with position changes.
Option B is incorrect because encouraging quick standing increases fall risk and worsens orthostatic
symptoms. Patients should be taught to change positions slowly.
Option C is incorrect because diuretics can worsen orthostatic hypotension by reducing blood volume.
Diuretics should be used cautiously and may need to be held or adjusted.
Option D is incorrect because limiting fluids would worsen orthostatic hypotension. Adequate hydration
(often 2000-3000 mL/day unless contraindicated) helps maintain blood volume and blood pressure.
Question 6
When teaching a patient with orthostatic hypotension about position changes, which instruction is most
appropriate?
A. "Stand up as quickly as possible to minimize dizziness"
B. "Move slowly from lying to sitting, then to standing"
C. "Remain in bed at all times to prevent falls"
D. "Skip your morning fluids to prevent blood pressure drops"
Correct ANSWER: B
Rationale:
Option A is incorrect because standing quickly worsens orthostatic hypotension and increases fall risk.
Rapid position changes do not allow time for cardiovascular compensation.
Option B is correct because encouraging slow position changes is a key nursing intervention for
orthostatic hypotension. Moving slowly from lying to sitting, waiting, then moving to standing allows the
cardiovascular system time to compensate and reduces symptoms.
Option C is incorrect because remaining in bed at all times leads to deconditioning and is unnecessary.
Patients can be mobile with appropriate precautions and slow position changes.
Option D is incorrect because skipping fluids worsens orthostatic hypotension. Adequate hydration is
essential to maintain blood volume. Patients should be encouraged to increase fluid intake.
Question 7
NCLEX-Style Questions, Correct ANSWERs &
Rationales | Galen College of Nursing | Summer
2026
SECTION 1: FUNDAMENTALS (Questions 1-200+)
VITAL SIGNS - SIGNIFICANT BLOOD PRESSURE DROP
Question 1
A nurse is assessing a patient who moved from lying to standing position. Which blood pressure change
would indicate orthostatic hypotension?
A. Drop of 15 mmHg systolic and 5 mmHg diastolic
B. Drop of 20 mmHg systolic and 10 mmHg diastolic
C. Drop of 10 mmHg systolic and 15 mmHg diastolic
D. Drop of 5 mmHg systolic and 8 mmHg diastolic
Correct ANSWER: B
Rationale:
Option A is incorrect because a drop of 15 mmHg systolic and 5 mmHg diastolic does not meet the
clinical criteria for orthostatic hypotension, which requires a drop of at least 20 mmHg systolic OR 10
mmHg diastolic.
Option B is correct because orthostatic (postural) hypotension is defined as a drop of 20 mmHg systolic
OR 10 mmHg diastolic from baseline when moving from lying to standing position. This is the hallmark
finding that indicates clinically significant orthostatic hypotension.
Option C is incorrect because while the diastolic drop of 15 mmHg exceeds the threshold, the question
asks for the specific criteria, and the standard definition emphasizes the 20 mmHg systolic OR 10 mmHg
diastolic drop as the key indicators.
,Option D is incorrect because a drop of 5 mmHg systolic and 8 mmHg diastolic is within normal variation
and does not indicate orthostatic hypotension.
Question 2
When assessing a patient for orthostatic hypotension, what is the appropriate time interval between
position changes when measuring blood pressure?
A. Immediately upon position change
B. 30 seconds between positions
C. 1-3 minutes between position changes
D. 5-10 minutes between position changes
Correct ANSWER: C
Rationale:
Option A is incorrect because measuring immediately upon position change does not allow adequate
time for the cardiovascular system to respond to the positional change, potentially missing the
orthostatic response.
Option B is incorrect because 30 seconds is insufficient time to accurately assess the body's
compensatory mechanisms and may not reveal the full extent of orthostatic changes.
Option C is correct because the standard protocol for assessing orthostatic hypotension requires
measuring blood pressure lying, sitting, and standing with 1-3 minutes between position changes. This
allows adequate time for the cardiovascular system to respond and reveals true orthostatic changes.
Option D is incorrect because waiting 5-10 minutes between positions is unnecessarily long and may
allow compensatory mechanisms to normalize the blood pressure, potentially missing the orthostatic
response.
Question 3
A patient experiences a sustained blood pressure drop of 25/12 mmHg upon standing. What is the
nurse's priority action?
A. Document the findings in the patient's chart
B. Report the findings to the healthcare provider
C. Encourage the patient to walk to improve circulation
D. Administer antihypertensive medication as scheduled
Correct ANSWER: B
Rationale:
,Option A is incorrect because while documentation is important, it is not the priority action when a
patient has a clinically significant sustained drop in blood pressure that requires immediate provider
notification.
Option B is correct because a sustained drop ≥20/10 mmHg should be reported to the healthcare
provider immediately. This represents clinically significant orthostatic hypotension that may require
intervention or medication adjustment.
Option C is incorrect because encouraging walking when a patient is experiencing orthostatic
hypotension increases fall risk and is contraindicated. The patient should be kept safe in a lying or sitting
position.
Option D is incorrect because administering antihypertensive medication would worsen the
hypotension. The nurse should HOLD antihypertensives, not administer them, when orthostatic
hypotension is present.
Question 4
Which nursing intervention is most appropriate for a patient diagnosed with orthostatic hypotension?
A. Encourage rapid position changes to build tolerance
B. Hold antihypertensive medications
C. Restrict fluid intake to prevent fluid overload
D. Keep the patient on strict bed rest
Correct ANSWER: B
Rationale:
Option A is incorrect because rapid position changes increase fall risk in patients with orthostatic
hypotension. Patients should be encouraged to change positions slowly, not rapidly.
Option B is correct because holding antihypertensive medications is a key nursing action for orthostatic
hypotension. These medications can worsen the condition and should be held until the healthcare
provider can reassess the patient's medication regimen.
Option C is incorrect because fluid restriction would worsen orthostatic hypotension. Adequate
hydration is essential to maintain blood volume and blood pressure. Patients should be encouraged to
increase fluid intake.
Option D is incorrect because strict bed rest is not necessary and can lead to deconditioning. The patient
should be encouraged to move with appropriate safety measures and slow position changes.
Question 5
A nurse is caring for a patient with orthostatic hypotension. Which intervention should be included in
the plan of care to ensure patient safety?
A. Implement fall precautions
, B. Encourage standing quickly to test tolerance
C. Administer diuretics as prescribed
D. Limit fluid intake to 1000 mL per day
Correct ANSWER: A
Rationale:
Option A is correct because ensuring safety through fall precautions is a key nursing action for patients
with orthostatic hypotension. These patients are at high risk for falls due to dizziness and blood pressure
drops with position changes.
Option B is incorrect because encouraging quick standing increases fall risk and worsens orthostatic
symptoms. Patients should be taught to change positions slowly.
Option C is incorrect because diuretics can worsen orthostatic hypotension by reducing blood volume.
Diuretics should be used cautiously and may need to be held or adjusted.
Option D is incorrect because limiting fluids would worsen orthostatic hypotension. Adequate hydration
(often 2000-3000 mL/day unless contraindicated) helps maintain blood volume and blood pressure.
Question 6
When teaching a patient with orthostatic hypotension about position changes, which instruction is most
appropriate?
A. "Stand up as quickly as possible to minimize dizziness"
B. "Move slowly from lying to sitting, then to standing"
C. "Remain in bed at all times to prevent falls"
D. "Skip your morning fluids to prevent blood pressure drops"
Correct ANSWER: B
Rationale:
Option A is incorrect because standing quickly worsens orthostatic hypotension and increases fall risk.
Rapid position changes do not allow time for cardiovascular compensation.
Option B is correct because encouraging slow position changes is a key nursing intervention for
orthostatic hypotension. Moving slowly from lying to sitting, waiting, then moving to standing allows the
cardiovascular system time to compensate and reduces symptoms.
Option C is incorrect because remaining in bed at all times leads to deconditioning and is unnecessary.
Patients can be mobile with appropriate precautions and slow position changes.
Option D is incorrect because skipping fluids worsens orthostatic hypotension. Adequate hydration is
essential to maintain blood volume. Patients should be encouraged to increase fluid intake.
Question 7
