NUR280 Comprehensive Exam Review | Transition
to RN Practice | Galen College | 2026/2027 Updated
| A+ Rated Guide with 500+ Verified Q&A | 100%
Correct
Premium Mastery Guide with Expert Rationales | NCLEX-RN Clinical Judgment Focus |
2026/2027 Standards
Galen College of Nursing | NUR 280 Transition to RN Practice | Rated A Guide by Faculty
PART 1 – THE “A” STUDENT’S FRAMEWORK FOR MASTERY
SECTION 1 – CLINICAL JUDGMENT META-SKILLS
The 4-Second Assessment for ANY complex item:
1. Task – What must I DO? (prioritize, delegate, teach, intervene)
2. Patient – WHO is the patient? (age, chronic conditions, social determinants)
3. Problem – WHAT is the immediate threat? (ABCDE, safety, legal, ethical)
4. Timeframe – WHEN must I act? (STAT, within 1 h, today, ongoing)
Rapid-filter questions:
● Does this choice keep the patient SAFE?
● Does this choice reflect 2026 EVIDENCE?
● Does this choice stay within my SCOPE?
If any answer is “NO,” eliminate.
,SECTION 2 – HIGH-YIELD CONTENT MAPS
Map 1: The Sepsis-ARDS-AKI Cascade
Sepsis → capillary leak → pulmonary edema → ARDS (PaO₂/FiO₂ ≤ 300) → proning,
lung-protective ventilation (Vt 4–6 mL/kg IBW, Pplat ≤ 30 cmH₂O) → ↓ renal perfusion →
AKI (KDIGO 2026: ↑Cr ≥ 0.3 mg/dL in 48 h or urine < 0.5 mL/kg × 6 h) → avoid
nephrotoxins, early CRRT if refractory acidosis/pulmonary edema.
Priority bridge: maintain MAP ≥ 65 mmHg with norepinephrine first-line (SSC 2026) →
renal perfusion improves → may avoid RRT.
Map 2: Postpartum Hemorrhage with Coagulopathy
Tone (atony) → Trauma (lacerations) → Tissue (retained placenta) → Thrombin (DIC,
vWD) → 4-T approach.
If Hb drop > 2 g/dL despite 2 units PRBC → consider factor replacement (fibrinogen <
200 mg/dL → cryoprecipitate 1 unit/10 kg), tranexamic acid 1 g IV over 10 min
(WOMAN-2 2026).
If vWD suspected → give vWF-containing factor (Humate-P) 40–60 IU/kg.
Integrate mental health: rapid response can trigger PTSD; keep mother informed, allow
support person.
Map 3: AI-Driven Diagnostic Suggestions – Ethical Use
2026 AHRQ guideline: RN must verify AI output against patient assessment.
Example: AI suggests “pulmonary embolism likely” on CXR report → RN correlates with
Wells score, vitals, D-dimer before escalating.
,Document: “AI suggestion reviewed; patient denies SOB, Wells low, D-dimer negative →
PE unlikely, will monitor.”
SECTION 3 – TEST-TAKING EXCELLENCE
SATA Mastery:
● Cover the options with your finger → turn each into a True/False statement.
● If you can defend “True” with a guideline, select it.
Ordered Response:
● Visualize the real-time sequence; never skip a safety step.
Managing Anxiety:
● 3-breath reset: inhale 4 s, hold 4 s, exhale 6 s → lowers cortisol, restores working
memory.
● Positive self-talk: “I have trained for this; I will recognize the cues.”
PART 2 – GUARANTEED PRACTICE WITH EXPERT ANALYSIS
65 High-Stakes Questions with RATED A Rationales
1. A 32-year-old G2P1 at 38 weeks gestation arrives with heavy vaginal bleeding
and abdominal pain. FHR 90 bpm, BP 80/50, HR 120, RR 26, SpO₂ 94% RA.
Ultrasound shows a hyper-echoic retro-placental clot. Hemoglobin 6.8 g/dL. The
patient states, “I feel like I’m dying.” Which action represents the RATED A
priority?
A. Start magnesium sulfate 4 g IV load
B. Obtain Type & Cross for 2 units PRBC
C. Apply oxygen via non-rebreather and start second large-bore IV
*D. Activate massive transfusion protocol and prepare for immediate cesarean
section <-- RATED A ANSWER
RATED A RATIONALE:
Step 1 – Unpack: Task = immediate life-saving action; Patient = term pregnant,
hemorrhagic shock + fetal bradycardia; Problem = placental abruption with DIC
risk; Timeframe = NOW.
Step 2 – Expert Path: An “A” student recognizes abruption + fetal bradycardia +
maternal instability = category III FHR and class III hemorrhage. Massive
, transfusion (O-negative or type-specific) and delivery within 15 min prevents fetal
asphyxia and maternal coagulopathy.
Step 3 – Authority: ACOG 2026 Practice Bulletin: cesarean within 15 min when
maternal instability or persistent bradycardia; MTG goal fibrinogen > 150 mg/dL.
Step 4 – Distractors: A – Mag sulfate is for seizure prophylaxis in preeclampsia,
not abruption shock. B – 2 units insufficient for massive bleed. C – Oxygen and
access are necessary but not sufficient; delivery is definitive.
Step 5 – Connection: Same principle applies to any massive obstetric
hemorrhage—delivery source control + blood products save both lives.
2. A 68-year-old with DM-2, HF (EF 30%), and CKD stage 4 is admitted with sepsis.
cultures are pending. VS: BP 78/40, HR 115, RR 28, SpO₂ 90% on 4 L NC, temp
39.2 °C, lactate 5.2 mmol/L, creatinine 3.1 mg/dL (baseline 2.6), glucose 410
mg/dL. The resident asks which fluid to start. Which response demonstrates
RATED A clinical judgment?
A. “Give 0.45% saline at 200 mL/h to avoid fluid overload.”
B. “Use D5W to prevent hypoglycemia.”
C. “Start 0.9% NaCl 30 mL/kg rapid bolus; we’ll coordinate with nephrology for
urgent HD if pulmonary edema develops.” <-- RATED A ANSWER
D. “Avoid fluids; start norepinephrine immediately.”
RATED A RATIONALE:
Step 1 – Unpack: Task = select resuscitation fluid; Patient = septic shock +
multi-morbidity; Problem = hypoperfusion + hyperglycemia + anuria; Timeframe =
within 1 h.
Step 2 – Expert Path: An “A” student knows 2026 SSC still mandates 30 mL/kg
crystalloid even with CKD/CHF because mortality benefit outweighs pulmonary
edema risk. Isotonic saline is isotonic—no red-cell swelling. Coordinate HD as
safety net.
Step 3 – Authority: SSC 2026 update: “Do not withhold fluids for fear of fluid
overload; use CRRT if needed.”
Step 4 – Distractors: A – Hypotonic saline causes hyponatremia and is too slow.
B – D5W is hypotonic and provides free water without volume. D – Fluids
precede pressors in septic shock unless overt pulmonary edema.
Step 5 – Connection: Same risk-benefit analysis applies to any patient with
cardiorenal comorbidities in shock—volume first, de-escalate with dialysis if
needed.
3. The same patient develops acute confusion, asterixis, and ammonia 180 µg/dL.
He is tremulous and smells of alcohol. CIWA-Ar is 26. Which ordered intervention
is RATED A priority?
A. Start lactulose 30 mL PO q2 h until diarrhea
to RN Practice | Galen College | 2026/2027 Updated
| A+ Rated Guide with 500+ Verified Q&A | 100%
Correct
Premium Mastery Guide with Expert Rationales | NCLEX-RN Clinical Judgment Focus |
2026/2027 Standards
Galen College of Nursing | NUR 280 Transition to RN Practice | Rated A Guide by Faculty
PART 1 – THE “A” STUDENT’S FRAMEWORK FOR MASTERY
SECTION 1 – CLINICAL JUDGMENT META-SKILLS
The 4-Second Assessment for ANY complex item:
1. Task – What must I DO? (prioritize, delegate, teach, intervene)
2. Patient – WHO is the patient? (age, chronic conditions, social determinants)
3. Problem – WHAT is the immediate threat? (ABCDE, safety, legal, ethical)
4. Timeframe – WHEN must I act? (STAT, within 1 h, today, ongoing)
Rapid-filter questions:
● Does this choice keep the patient SAFE?
● Does this choice reflect 2026 EVIDENCE?
● Does this choice stay within my SCOPE?
If any answer is “NO,” eliminate.
,SECTION 2 – HIGH-YIELD CONTENT MAPS
Map 1: The Sepsis-ARDS-AKI Cascade
Sepsis → capillary leak → pulmonary edema → ARDS (PaO₂/FiO₂ ≤ 300) → proning,
lung-protective ventilation (Vt 4–6 mL/kg IBW, Pplat ≤ 30 cmH₂O) → ↓ renal perfusion →
AKI (KDIGO 2026: ↑Cr ≥ 0.3 mg/dL in 48 h or urine < 0.5 mL/kg × 6 h) → avoid
nephrotoxins, early CRRT if refractory acidosis/pulmonary edema.
Priority bridge: maintain MAP ≥ 65 mmHg with norepinephrine first-line (SSC 2026) →
renal perfusion improves → may avoid RRT.
Map 2: Postpartum Hemorrhage with Coagulopathy
Tone (atony) → Trauma (lacerations) → Tissue (retained placenta) → Thrombin (DIC,
vWD) → 4-T approach.
If Hb drop > 2 g/dL despite 2 units PRBC → consider factor replacement (fibrinogen <
200 mg/dL → cryoprecipitate 1 unit/10 kg), tranexamic acid 1 g IV over 10 min
(WOMAN-2 2026).
If vWD suspected → give vWF-containing factor (Humate-P) 40–60 IU/kg.
Integrate mental health: rapid response can trigger PTSD; keep mother informed, allow
support person.
Map 3: AI-Driven Diagnostic Suggestions – Ethical Use
2026 AHRQ guideline: RN must verify AI output against patient assessment.
Example: AI suggests “pulmonary embolism likely” on CXR report → RN correlates with
Wells score, vitals, D-dimer before escalating.
,Document: “AI suggestion reviewed; patient denies SOB, Wells low, D-dimer negative →
PE unlikely, will monitor.”
SECTION 3 – TEST-TAKING EXCELLENCE
SATA Mastery:
● Cover the options with your finger → turn each into a True/False statement.
● If you can defend “True” with a guideline, select it.
Ordered Response:
● Visualize the real-time sequence; never skip a safety step.
Managing Anxiety:
● 3-breath reset: inhale 4 s, hold 4 s, exhale 6 s → lowers cortisol, restores working
memory.
● Positive self-talk: “I have trained for this; I will recognize the cues.”
PART 2 – GUARANTEED PRACTICE WITH EXPERT ANALYSIS
65 High-Stakes Questions with RATED A Rationales
1. A 32-year-old G2P1 at 38 weeks gestation arrives with heavy vaginal bleeding
and abdominal pain. FHR 90 bpm, BP 80/50, HR 120, RR 26, SpO₂ 94% RA.
Ultrasound shows a hyper-echoic retro-placental clot. Hemoglobin 6.8 g/dL. The
patient states, “I feel like I’m dying.” Which action represents the RATED A
priority?
A. Start magnesium sulfate 4 g IV load
B. Obtain Type & Cross for 2 units PRBC
C. Apply oxygen via non-rebreather and start second large-bore IV
*D. Activate massive transfusion protocol and prepare for immediate cesarean
section <-- RATED A ANSWER
RATED A RATIONALE:
Step 1 – Unpack: Task = immediate life-saving action; Patient = term pregnant,
hemorrhagic shock + fetal bradycardia; Problem = placental abruption with DIC
risk; Timeframe = NOW.
Step 2 – Expert Path: An “A” student recognizes abruption + fetal bradycardia +
maternal instability = category III FHR and class III hemorrhage. Massive
, transfusion (O-negative or type-specific) and delivery within 15 min prevents fetal
asphyxia and maternal coagulopathy.
Step 3 – Authority: ACOG 2026 Practice Bulletin: cesarean within 15 min when
maternal instability or persistent bradycardia; MTG goal fibrinogen > 150 mg/dL.
Step 4 – Distractors: A – Mag sulfate is for seizure prophylaxis in preeclampsia,
not abruption shock. B – 2 units insufficient for massive bleed. C – Oxygen and
access are necessary but not sufficient; delivery is definitive.
Step 5 – Connection: Same principle applies to any massive obstetric
hemorrhage—delivery source control + blood products save both lives.
2. A 68-year-old with DM-2, HF (EF 30%), and CKD stage 4 is admitted with sepsis.
cultures are pending. VS: BP 78/40, HR 115, RR 28, SpO₂ 90% on 4 L NC, temp
39.2 °C, lactate 5.2 mmol/L, creatinine 3.1 mg/dL (baseline 2.6), glucose 410
mg/dL. The resident asks which fluid to start. Which response demonstrates
RATED A clinical judgment?
A. “Give 0.45% saline at 200 mL/h to avoid fluid overload.”
B. “Use D5W to prevent hypoglycemia.”
C. “Start 0.9% NaCl 30 mL/kg rapid bolus; we’ll coordinate with nephrology for
urgent HD if pulmonary edema develops.” <-- RATED A ANSWER
D. “Avoid fluids; start norepinephrine immediately.”
RATED A RATIONALE:
Step 1 – Unpack: Task = select resuscitation fluid; Patient = septic shock +
multi-morbidity; Problem = hypoperfusion + hyperglycemia + anuria; Timeframe =
within 1 h.
Step 2 – Expert Path: An “A” student knows 2026 SSC still mandates 30 mL/kg
crystalloid even with CKD/CHF because mortality benefit outweighs pulmonary
edema risk. Isotonic saline is isotonic—no red-cell swelling. Coordinate HD as
safety net.
Step 3 – Authority: SSC 2026 update: “Do not withhold fluids for fear of fluid
overload; use CRRT if needed.”
Step 4 – Distractors: A – Hypotonic saline causes hyponatremia and is too slow.
B – D5W is hypotonic and provides free water without volume. D – Fluids
precede pressors in septic shock unless overt pulmonary edema.
Step 5 – Connection: Same risk-benefit analysis applies to any patient with
cardiorenal comorbidities in shock—volume first, de-escalate with dialysis if
needed.
3. The same patient develops acute confusion, asterixis, and ammonia 180 µg/dL.
He is tremulous and smells of alcohol. CIWA-Ar is 26. Which ordered intervention
is RATED A priority?
A. Start lactulose 30 mL PO q2 h until diarrhea
