GALEN COLLEGE OF NURSING
NSG 4800: TRANSITION TO PROFESSIONAL NURSING PRACTICE
COMPREHENSIVE EXAM 3 (COMP 3) — FINAL EXAM REVIEW & ASSESSMENT
TERM: FALL 2026 | 100 NCLEX-STYLE QUESTIONS WITH RATIONALES
Student Name: ___________________________ Date: Fall 2026
Student ID: _____________________________ Score: _____ / 100 (____%)
EXAM INSTRUCTIONS & DIRECTIONS:
1. This exam contains 100 multiple-choice questions synthesized strictly from Galen College of Nursing NSG
4800 Comp 3 curriculum, review notes, and clinical protocols.
2. Each question presents four options (A, B, C, D). Read each clinical scenario thoroughly to select the single best
NCLEX-style answer.
3. Correct answers are indicated with a green checkmark (✔) and bold green text.
4. Detailed clinical rationales for each question are highlighted in the yellow rationale boxes to reinforce critical
thinking and lecturer focus areas for Fall 2026.
Question 1. The nurse is caring for a client following lumbar spinal surgery. Which postoperative
intervention should the nurse implement to maintain proper body alignment?
[A] Elevate the head of the bed 45 degrees before pivoting the client to a sitting position.
[B] Instruct the client to flex their hips and knees while pulling on the side rails to turn.
[C] Place the client in a high-Fowler's position and encourage dangling feet at the bedside.
[D] ✔ Logroll the client from side to back to side using turning sheets and pillows between the legs.
Rationale (Correct Answer: Option D): Following lumbar spinal surgery, the nurse turns and repositions the client
by logrolling side to back to side, using turning sheets and pillows between the legs to maintain strict anatomical
alignment and prevent spinal twisting.
Question 2. A nurse is caring for a client with a spinal cord injury who suddenly demonstrates
signs of autonomic dysreflexia. Which action should the nurse take first?
[A] Document the vital signs and notify the primary health care provider.
[B] Administer an antihypertensive medication intravenously.
[C] ✔ Raise the head of the bed to a high position.
[D] Check the client's urinary drainage tubing for kinks.
Rationale (Correct Answer: Option C): The initial action for a client experiencing autonomic dysreflexia is to raise
the head of the bed to a high position to help lower blood pressure. The nurse then notifies the primary health care
provider, loosens tight clothing, checks for bladder distention or other noxious stimuli, and documents.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 1
, Question 3. A client experiencing sudden onset of chest pain and dyspnea is diagnosed with a
pulmonary embolism (PE). Which primary health care provider prescription should the nurse
implement first?
[A] Administer morphine sulfate intravenously.
[B] Obtain a 12-lead electrocardiogram (ECG).
[C] Start an intravenous (IV) infusion line.
[D] ✔ Apply supplemental oxygen.
Rationale (Correct Answer: Option D): The priority action for a client with a suspected or confirmed pulmonary
embolism is to apply supplemental oxygen immediately to treat hypoxemia. After applying oxygen, the nurse
establishes IV access, administers analgesics such as morphine sulfate, and obtains an ECG as prescribed.
Question 4. The nurse is positioning a client diagnosed with a pulmonary embolism (PE). Which
position is expected for this client?
[A] High Fowler's position.
[B] Flat supine position.
[C] ✔ Semi-Fowler's position.
[D] Left Trendelenburg's position.
Rationale (Correct Answer: Option C): The head of the bed is placed in semi-Fowler's position for a client with PE.
High Fowler's position is avoided because extreme hip flexure slows venous return from the lower extremities and
increases the risk of new thrombi formation.
Question 5. Which statement made by a client who experienced a pulmonary embolism indicates
an understanding of discharge teaching regarding recurrence prevention?
[A] “I will limit my daily fluid intake to 1 liter.”
[B] “I will sit down whenever possible throughout the day.”
[C] “I will cross my legs only at the knees when resting.”
[D] ✔ “I am planning to continue to wear supportive hose.”
Rationale (Correct Answer: Option D): Wearing supportive or elastic hose minimizes the recurrence of pulmonary
embolism by promoting venous return and preventing venous stasis in the lower extremities.
Question 6. The nurse is preparing to cut the opening in a colostomy pouch appliance for a client
who underwent surgery. How large should the appliance opening be cut?
[A] 1/4 inch larger than the size of the client’s stoma.
[B] Exact size with no additional margin around the stoma.
[C] 1/2 inch larger than the size of the client’s stoma.
[D] ✔ 1/8 inch larger than the size of the client’s stoma.
Rationale (Correct Answer: Option D): The size of the opening for the colostomy appliance is generally cut 1/8 inch
larger than the stoma size. This minimizes exposed skin while preventing pressure or friction on the stoma. Larger
openings leave too much skin exposed to gastrointestinal contents.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 2
, Question 7. The nurse assesses a client's colostomy stoma and notes a pale pink stoma color. How
should the nurse interpret this finding?
[A] The stoma is healthy and demonstrating optimal tissue perfusion.
[B] The stoma has compromised arterial blood supply requiring immediate surgery.
[C] ✔ The client most likely has a low hemoglobin and hematocrit level.
[D] The client is developing an acute gastrointestinal infection.
Rationale (Correct Answer: Option C): A pale pink colostomy stoma indicates that the client has a low hemoglobin
and hematocrit level (anemia). A dark blue, purple, or black stoma indicates compromised circulation requiring
immediate provider notification.
Question 8. When inspecting a client's colostomy stoma, the nurse observes that the stoma
appears dark purple and black. Which action should the nurse take immediately?
[A] Document the finding as a normal expected postoperative variation.
[B] Apply a tight warm compress over the stoma appliance.
[C] ✔ Notify the primary health care provider immediately.
[D] Gently massage the stoma with warm normal saline gauze.
Rationale (Correct Answer: Option C): A dark blue, purple, or black stoma indicates compromised circulation or
ischemia to the stoma tissue. This is a medical emergency requiring immediate notification of the primary health care
provider.
Question 9. A client with multiple sclerosis (MS) asks the nurse about precipitating factors that
can trigger disease exacerbations. Which factors should the nurse include in the response?
[A] ✔ Pregnancy, fatigue, stress, infection, and trauma.
[B] Sedentary lifestyle, high sodium intake, and hyperocalcemia.
[C] High-protein diet, weight loss, and hypothermia.
[D] Alcohol consumption, hypoglycemia, and hypothyroidism.
Rationale (Correct Answer: Option A): Multiple sclerosis is a chronic progressive demyelinating disease of the CNS
characterized by remissions and exacerbations. Precipitating factors that trigger exacerbations include pregnancy,
fatigue, stress, infection, and trauma.
Question 10. Which nursing intervention is a priority when caring for a client with multiple
sclerosis experiencing an acute exacerbation?
[A] Apply hot heating pads to spastic muscles in lower extremities.
[B] Restrict fluid intake to prevent bladder urgency and incontinence.
[C] ✔ Provide energy conservation measures and balance activity with rest periods.
[D] Encourage vigorous aerobic exercise to maintain muscle tone.
Rationale (Correct Answer: Option C): During an acute exacerbation of MS, the nurse provides energy conservation
measures, assists the client to establish a regular exercise and rest program, and instructs the client to avoid fatigue,
stress, infection, overheating, and chilling.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 3
NSG 4800: TRANSITION TO PROFESSIONAL NURSING PRACTICE
COMPREHENSIVE EXAM 3 (COMP 3) — FINAL EXAM REVIEW & ASSESSMENT
TERM: FALL 2026 | 100 NCLEX-STYLE QUESTIONS WITH RATIONALES
Student Name: ___________________________ Date: Fall 2026
Student ID: _____________________________ Score: _____ / 100 (____%)
EXAM INSTRUCTIONS & DIRECTIONS:
1. This exam contains 100 multiple-choice questions synthesized strictly from Galen College of Nursing NSG
4800 Comp 3 curriculum, review notes, and clinical protocols.
2. Each question presents four options (A, B, C, D). Read each clinical scenario thoroughly to select the single best
NCLEX-style answer.
3. Correct answers are indicated with a green checkmark (✔) and bold green text.
4. Detailed clinical rationales for each question are highlighted in the yellow rationale boxes to reinforce critical
thinking and lecturer focus areas for Fall 2026.
Question 1. The nurse is caring for a client following lumbar spinal surgery. Which postoperative
intervention should the nurse implement to maintain proper body alignment?
[A] Elevate the head of the bed 45 degrees before pivoting the client to a sitting position.
[B] Instruct the client to flex their hips and knees while pulling on the side rails to turn.
[C] Place the client in a high-Fowler's position and encourage dangling feet at the bedside.
[D] ✔ Logroll the client from side to back to side using turning sheets and pillows between the legs.
Rationale (Correct Answer: Option D): Following lumbar spinal surgery, the nurse turns and repositions the client
by logrolling side to back to side, using turning sheets and pillows between the legs to maintain strict anatomical
alignment and prevent spinal twisting.
Question 2. A nurse is caring for a client with a spinal cord injury who suddenly demonstrates
signs of autonomic dysreflexia. Which action should the nurse take first?
[A] Document the vital signs and notify the primary health care provider.
[B] Administer an antihypertensive medication intravenously.
[C] ✔ Raise the head of the bed to a high position.
[D] Check the client's urinary drainage tubing for kinks.
Rationale (Correct Answer: Option C): The initial action for a client experiencing autonomic dysreflexia is to raise
the head of the bed to a high position to help lower blood pressure. The nurse then notifies the primary health care
provider, loosens tight clothing, checks for bladder distention or other noxious stimuli, and documents.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 1
, Question 3. A client experiencing sudden onset of chest pain and dyspnea is diagnosed with a
pulmonary embolism (PE). Which primary health care provider prescription should the nurse
implement first?
[A] Administer morphine sulfate intravenously.
[B] Obtain a 12-lead electrocardiogram (ECG).
[C] Start an intravenous (IV) infusion line.
[D] ✔ Apply supplemental oxygen.
Rationale (Correct Answer: Option D): The priority action for a client with a suspected or confirmed pulmonary
embolism is to apply supplemental oxygen immediately to treat hypoxemia. After applying oxygen, the nurse
establishes IV access, administers analgesics such as morphine sulfate, and obtains an ECG as prescribed.
Question 4. The nurse is positioning a client diagnosed with a pulmonary embolism (PE). Which
position is expected for this client?
[A] High Fowler's position.
[B] Flat supine position.
[C] ✔ Semi-Fowler's position.
[D] Left Trendelenburg's position.
Rationale (Correct Answer: Option C): The head of the bed is placed in semi-Fowler's position for a client with PE.
High Fowler's position is avoided because extreme hip flexure slows venous return from the lower extremities and
increases the risk of new thrombi formation.
Question 5. Which statement made by a client who experienced a pulmonary embolism indicates
an understanding of discharge teaching regarding recurrence prevention?
[A] “I will limit my daily fluid intake to 1 liter.”
[B] “I will sit down whenever possible throughout the day.”
[C] “I will cross my legs only at the knees when resting.”
[D] ✔ “I am planning to continue to wear supportive hose.”
Rationale (Correct Answer: Option D): Wearing supportive or elastic hose minimizes the recurrence of pulmonary
embolism by promoting venous return and preventing venous stasis in the lower extremities.
Question 6. The nurse is preparing to cut the opening in a colostomy pouch appliance for a client
who underwent surgery. How large should the appliance opening be cut?
[A] 1/4 inch larger than the size of the client’s stoma.
[B] Exact size with no additional margin around the stoma.
[C] 1/2 inch larger than the size of the client’s stoma.
[D] ✔ 1/8 inch larger than the size of the client’s stoma.
Rationale (Correct Answer: Option D): The size of the opening for the colostomy appliance is generally cut 1/8 inch
larger than the stoma size. This minimizes exposed skin while preventing pressure or friction on the stoma. Larger
openings leave too much skin exposed to gastrointestinal contents.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 2
, Question 7. The nurse assesses a client's colostomy stoma and notes a pale pink stoma color. How
should the nurse interpret this finding?
[A] The stoma is healthy and demonstrating optimal tissue perfusion.
[B] The stoma has compromised arterial blood supply requiring immediate surgery.
[C] ✔ The client most likely has a low hemoglobin and hematocrit level.
[D] The client is developing an acute gastrointestinal infection.
Rationale (Correct Answer: Option C): A pale pink colostomy stoma indicates that the client has a low hemoglobin
and hematocrit level (anemia). A dark blue, purple, or black stoma indicates compromised circulation requiring
immediate provider notification.
Question 8. When inspecting a client's colostomy stoma, the nurse observes that the stoma
appears dark purple and black. Which action should the nurse take immediately?
[A] Document the finding as a normal expected postoperative variation.
[B] Apply a tight warm compress over the stoma appliance.
[C] ✔ Notify the primary health care provider immediately.
[D] Gently massage the stoma with warm normal saline gauze.
Rationale (Correct Answer: Option C): A dark blue, purple, or black stoma indicates compromised circulation or
ischemia to the stoma tissue. This is a medical emergency requiring immediate notification of the primary health care
provider.
Question 9. A client with multiple sclerosis (MS) asks the nurse about precipitating factors that
can trigger disease exacerbations. Which factors should the nurse include in the response?
[A] ✔ Pregnancy, fatigue, stress, infection, and trauma.
[B] Sedentary lifestyle, high sodium intake, and hyperocalcemia.
[C] High-protein diet, weight loss, and hypothermia.
[D] Alcohol consumption, hypoglycemia, and hypothyroidism.
Rationale (Correct Answer: Option A): Multiple sclerosis is a chronic progressive demyelinating disease of the CNS
characterized by remissions and exacerbations. Precipitating factors that trigger exacerbations include pregnancy,
fatigue, stress, infection, and trauma.
Question 10. Which nursing intervention is a priority when caring for a client with multiple
sclerosis experiencing an acute exacerbation?
[A] Apply hot heating pads to spastic muscles in lower extremities.
[B] Restrict fluid intake to prevent bladder urgency and incontinence.
[C] ✔ Provide energy conservation measures and balance activity with rest periods.
[D] Encourage vigorous aerobic exercise to maintain muscle tone.
Rationale (Correct Answer: Option C): During an acute exacerbation of MS, the nurse provides energy conservation
measures, assists the client to establish a regular exercise and rest program, and instructs the client to avoid fatigue,
stress, infection, overheating, and chilling.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING NSG 4800 Page 3
