GALEN COLLEGE OF NURSING
NSG 4800: Transition to Professional Nursing Practice
Comprehensive Examination #2 — Fall 2026 Final Review
Student Name: ____________________________________ Date: ______________ Score: _______ / 100
GENERAL EXAM DIRECTIONS: Read each clinical question carefully. Select the single best answer among
choices (A, B, C, D). All 100 questions are grounded strictly in NSG 4800 course content. For review purposes, each
item features the correct answer marked with a green checkmark (✔) and a detailed rationale in a yellow highlight
block.
1. A nurse is caring for a client with Myasthenia Gravis who is prescribed oral
pyridostigmine. Which administration instruction is essential to include in the client's
discharge teaching?
(A) Administer the medication on an empty stomach 2 hours before eating meals.
(B) Take the medication only as needed when severe muscle weakness occurs.
(C) Take the medication strictly at bedtime to prevent nocturnal muscle weakness.
(D) Take the medication at the exact same time each day to maintain blood levels.
✔ Correct Answer: (D) Take the medication at the exact same time each day to maintain blood
levels.
Rationale: Pyridostigmine must be taken at the exact same time each day because muscle weakness associated with
Myasthenia Gravis can impair the client's ability to breathe and swallow if blood levels drop.
2. The nurse is reviewing morning clinical assignments. Which client with Myasthenia Gravis
should the nurse assess first?
(A) A client who reports mild fatigue after ambulating down the hallway.
(B) A client who expresses concern about needing lifelong drug therapy.
(C) A client who requests assistance with morning hygiene activities.
(D) A client who is coughing while eating breakfast.
✔ Correct Answer: (D) A client who is coughing while eating breakfast.
Rationale: Coughing while eating indicates impaired swallowing and places the client with Myasthenia Gravis at
immediate risk for aspiration, making this the highest priority assessment.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 1 of 28
,GALEN COLLEGE OF NURSING — NSG 4800: TRANSITION TO PROFESSIONAL NURSING
COMPREHENSIVE
PRACTICE EXAM #2 (FALL 2026)
3. A client with Myasthenia Gravis is receiving pyridostigmine. To prevent aspiration during
meals, the nurse should instruct the client to eat at which time?
(A) Immediately before taking the medication.
(B) 45 to 60 minutes after taking the medication.
(C) 2 hours after taking the medication.
(D) 30 minutes prior to taking the medication.
✔ Correct Answer: (B) 45 to 60 minutes after taking the medication.
Rationale: Clients taking pyridostigmine should eat meals 45 to 60 minutes after medication administration when blood
levels and muscle strength are optimal, thereby preventing aspiration.
4. A nurse is monitoring a client with Myasthenia Gravis for acute complications. Which
medication and equipment should the nurse ensure are immediately available at the bedside
to treat a cholinergic crisis?
(A) Naloxone and a tracheostomy set.
(B) Protamine sulfate and a chest tube insertion tray.
(C) Flumazenil and a bag-valve-mask.
(D) Atropine sulfate and emergency resuscitation equipment.
✔ Correct Answer: (D) Atropine sulfate and emergency resuscitation equipment.
Rationale: In a cholinergic crisis, emergency resuscitation equipment and Atropine Sulfate must be kept on hand as the
antidote for anticholinesterase overdose.
5. A nurse is preparing to administer intravenous furosemide to a client with hypervolemia.
Which adverse effect should the nurse monitor for if the medication is injected too rapidly?
(A) Achilles tendon rupture.
(B) Central nervous system excitation and tremors.
(C) Severe hypertension and bradycardia.
(D) Tinnitus and hearing loss.
✔ Correct Answer: (D) Tinnitus and hearing loss.
Rationale: Rapid intravenous injection of furosemide (Lasix) can cause ototoxicity, manifested by tinnitus (ringing in the
ears) or hearing loss; therefore, it must be administered slowly.
6. The nurse is providing discharge teaching to a client prescribed daily oral furosemide. To
minimize the risk of dizziness and injury from orthostatic hypotension, what instruction
should the nurse provide?
(A) Take the medication with milk at bedtime.
(B) Restrict daily fluid intake to less than 1,000 mL.
(C) Reposition slowly and get up over 1 to 2 minutes.
(D) Avoid green leafy vegetables while taking this medication.
✔ Correct Answer: (C) Reposition slowly and get up over 1 to 2 minutes.
Rationale: Furosemide causes reduced blood volume and orthostatic hypotension. Clients should be taught to reposition
slowly, taking 1 to 2 minutes to stand up, to prevent dizziness and falls.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 2 of 28
, GALEN COLLEGE OF NURSING — NSG 4800: TRANSITION TO PROFESSIONAL NURSING
COMPREHENSIVE
PRACTICE EXAM #2 (FALL 2026)
7. A client receiving furosemide therapy develops severe hyponatremia. The nurse should
recognize that severe hyponatremia increases the client's risk for which life-threatening
event?
(A) Achilles tendon rupture.
(B) Tendinitis.
(C) Seizures.
(D) Glaucoma crisis.
✔ Correct Answer: (C) Seizures.
Rationale: Furosemide enhances renal excretion of sodium and water; severe hyponatremia resulting from diuretic
therapy can lead directly to seizures.
8. A nurse is reviewing the chart of a pregnant client in labor. Which condition represents an
absolute contraindication to the administration of oxytocin?
(A) Active genital herpes infection.
(B) Mild swelling of the lower extremities.
(C) Maternal history of iron deficiency anemia.
(D) Gestational age of 39 weeks.
✔ Correct Answer: (A) Active genital herpes infection.
Rationale: Oxytocin is contraindicated when vaginal delivery cannot occur, during hypertonic uterine contractions, or
when the client has active genital herpes.
9. A nurse is monitoring a client undergoing labor induction with intravenous oxytocin.
Which uterine contraction pattern requires the nurse to immediately stop the oxytocin
infusion?
(A) Contractions lasting longer than 90 seconds.
(B) Contractions occurring every 3 to 4 minutes lasting 60 seconds.
(C) Contractions with a duration of 45 seconds and moderate intensity.
(D) Two contractions occurring within a 10-minute period.
✔ Correct Answer: (A) Contractions lasting longer than 90 seconds.
Rationale: Oxytocin must be stopped immediately if uterine hyperstimulation occurs, defined as contractions lasting
longer than 90 seconds, contractions 2 minutes or less apart, or 3-5+ contractions in 10 minutes over a 30-minute
window.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 3 of 28
NSG 4800: Transition to Professional Nursing Practice
Comprehensive Examination #2 — Fall 2026 Final Review
Student Name: ____________________________________ Date: ______________ Score: _______ / 100
GENERAL EXAM DIRECTIONS: Read each clinical question carefully. Select the single best answer among
choices (A, B, C, D). All 100 questions are grounded strictly in NSG 4800 course content. For review purposes, each
item features the correct answer marked with a green checkmark (✔) and a detailed rationale in a yellow highlight
block.
1. A nurse is caring for a client with Myasthenia Gravis who is prescribed oral
pyridostigmine. Which administration instruction is essential to include in the client's
discharge teaching?
(A) Administer the medication on an empty stomach 2 hours before eating meals.
(B) Take the medication only as needed when severe muscle weakness occurs.
(C) Take the medication strictly at bedtime to prevent nocturnal muscle weakness.
(D) Take the medication at the exact same time each day to maintain blood levels.
✔ Correct Answer: (D) Take the medication at the exact same time each day to maintain blood
levels.
Rationale: Pyridostigmine must be taken at the exact same time each day because muscle weakness associated with
Myasthenia Gravis can impair the client's ability to breathe and swallow if blood levels drop.
2. The nurse is reviewing morning clinical assignments. Which client with Myasthenia Gravis
should the nurse assess first?
(A) A client who reports mild fatigue after ambulating down the hallway.
(B) A client who expresses concern about needing lifelong drug therapy.
(C) A client who requests assistance with morning hygiene activities.
(D) A client who is coughing while eating breakfast.
✔ Correct Answer: (D) A client who is coughing while eating breakfast.
Rationale: Coughing while eating indicates impaired swallowing and places the client with Myasthenia Gravis at
immediate risk for aspiration, making this the highest priority assessment.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 1 of 28
,GALEN COLLEGE OF NURSING — NSG 4800: TRANSITION TO PROFESSIONAL NURSING
COMPREHENSIVE
PRACTICE EXAM #2 (FALL 2026)
3. A client with Myasthenia Gravis is receiving pyridostigmine. To prevent aspiration during
meals, the nurse should instruct the client to eat at which time?
(A) Immediately before taking the medication.
(B) 45 to 60 minutes after taking the medication.
(C) 2 hours after taking the medication.
(D) 30 minutes prior to taking the medication.
✔ Correct Answer: (B) 45 to 60 minutes after taking the medication.
Rationale: Clients taking pyridostigmine should eat meals 45 to 60 minutes after medication administration when blood
levels and muscle strength are optimal, thereby preventing aspiration.
4. A nurse is monitoring a client with Myasthenia Gravis for acute complications. Which
medication and equipment should the nurse ensure are immediately available at the bedside
to treat a cholinergic crisis?
(A) Naloxone and a tracheostomy set.
(B) Protamine sulfate and a chest tube insertion tray.
(C) Flumazenil and a bag-valve-mask.
(D) Atropine sulfate and emergency resuscitation equipment.
✔ Correct Answer: (D) Atropine sulfate and emergency resuscitation equipment.
Rationale: In a cholinergic crisis, emergency resuscitation equipment and Atropine Sulfate must be kept on hand as the
antidote for anticholinesterase overdose.
5. A nurse is preparing to administer intravenous furosemide to a client with hypervolemia.
Which adverse effect should the nurse monitor for if the medication is injected too rapidly?
(A) Achilles tendon rupture.
(B) Central nervous system excitation and tremors.
(C) Severe hypertension and bradycardia.
(D) Tinnitus and hearing loss.
✔ Correct Answer: (D) Tinnitus and hearing loss.
Rationale: Rapid intravenous injection of furosemide (Lasix) can cause ototoxicity, manifested by tinnitus (ringing in the
ears) or hearing loss; therefore, it must be administered slowly.
6. The nurse is providing discharge teaching to a client prescribed daily oral furosemide. To
minimize the risk of dizziness and injury from orthostatic hypotension, what instruction
should the nurse provide?
(A) Take the medication with milk at bedtime.
(B) Restrict daily fluid intake to less than 1,000 mL.
(C) Reposition slowly and get up over 1 to 2 minutes.
(D) Avoid green leafy vegetables while taking this medication.
✔ Correct Answer: (C) Reposition slowly and get up over 1 to 2 minutes.
Rationale: Furosemide causes reduced blood volume and orthostatic hypotension. Clients should be taught to reposition
slowly, taking 1 to 2 minutes to stand up, to prevent dizziness and falls.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 2 of 28
, GALEN COLLEGE OF NURSING — NSG 4800: TRANSITION TO PROFESSIONAL NURSING
COMPREHENSIVE
PRACTICE EXAM #2 (FALL 2026)
7. A client receiving furosemide therapy develops severe hyponatremia. The nurse should
recognize that severe hyponatremia increases the client's risk for which life-threatening
event?
(A) Achilles tendon rupture.
(B) Tendinitis.
(C) Seizures.
(D) Glaucoma crisis.
✔ Correct Answer: (C) Seizures.
Rationale: Furosemide enhances renal excretion of sodium and water; severe hyponatremia resulting from diuretic
therapy can lead directly to seizures.
8. A nurse is reviewing the chart of a pregnant client in labor. Which condition represents an
absolute contraindication to the administration of oxytocin?
(A) Active genital herpes infection.
(B) Mild swelling of the lower extremities.
(C) Maternal history of iron deficiency anemia.
(D) Gestational age of 39 weeks.
✔ Correct Answer: (A) Active genital herpes infection.
Rationale: Oxytocin is contraindicated when vaginal delivery cannot occur, during hypertonic uterine contractions, or
when the client has active genital herpes.
9. A nurse is monitoring a client undergoing labor induction with intravenous oxytocin.
Which uterine contraction pattern requires the nurse to immediately stop the oxytocin
infusion?
(A) Contractions lasting longer than 90 seconds.
(B) Contractions occurring every 3 to 4 minutes lasting 60 seconds.
(C) Contractions with a duration of 45 seconds and moderate intensity.
(D) Two contractions occurring within a 10-minute period.
✔ Correct Answer: (A) Contractions lasting longer than 90 seconds.
Rationale: Oxytocin must be stopped immediately if uterine hyperstimulation occurs, defined as contractions lasting
longer than 90 seconds, contractions 2 minutes or less apart, or 3-5+ contractions in 10 minutes over a 30-minute
window.
CONFIDENTIAL & PROPRIETARY — GALEN COLLEGE OF NURSING COURSE COMPREHENSIVE REVIEW Page 3 of 28
