NUR280 Transition to RN Practice - NEW 2026/2027
Exam Review & Rated A Guide | 100% Correct Verified
Q&A | Galen College
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
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PART 1 – THE “A” STUDENT’S FRAMEWORK FOR MASTERY
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Section 1 – Clinical Judgment Meta-Skills
The 4-Second Assessment (use on EVERY item before you look at options)
1. Task: What cognitive verb is NCLEX whispering? (Recognize, Prioritize, Delegate,
Advocate, Evaluate)
2. Patient: Who is this human beyond the diagnosis? (Age, culture, beliefs, social
drivers)
3. Problem: What is the immediate threat to life, limb, or dignity?
4. Timeframe: How many minutes until irreversible harm?
→ Once the 4-Sec snapshot is verbalized in your brain, the correct answer
becomes the only one that satisfies ALL four filters.
Section 2 – High-Yield Content Maps (2026/2027)
,A. The Sepsis-ARDS-AKI Cascade
SIRS ➜ Sepsis ➜ Septic shock ➜ leaky capillaries ➜ pulmonary edema ➜ ARDS (prone
ventilation, low-TV 6 mL/kg) ➜ renal hypoperfusion ➜ AKI (KDIGO 2025 urine creatinine
staging).
Priority chain: 1) 30 mL/kg bolus in first 30 min ➜ 2) cultures BEFORE antibiotics ➜ 3)
norepinephrine MAP ≥ 65 ➜ 4) lung-protective ventilation ➜ 5) CRRT if fluid overload >
10 %.
B. Heart-Failure Readmission Triangle (CMS 2026 penalties)
1. Discharge on GDMT within 24 h, 2) Home-health visit ≤ 48 h, 3) Opioid-use
disorder screen & naloxone if indicated.
Connect to Social Drivers: food insecurity, transportation, literacy.
C. Postpartum Hemorrhage 4-Ts 2026 Update
Tone (80 %), Trauma (15 %), Tissue (5 %), Thrombin (<1 %).
Add “5th T”: Technology—AI-enabled early-warning patch (≥ 150 mL blood/5 min
triggers).
First-line: TXA 1 g IV within 10 min; second-line: four-factor PCC if INR > 1.5 & Factor VIII
deficiency (von Willebrand).
D. Legal Hot-Zone 2026/2027
EMR cloning = fraud (CMS 2026).
Nurse is now liable for AI-generated incorrect dosage if nurse “blindly accepted” without
clinical validation (TJC Sentinel Alert #72).
,Good-Samaritan laws expanded to tele-CPR bystanders in all 50 states—know your
state’s scope.
Section 3 – Test-Taking Excellence
1. SATA Strategy: Treat each option as a True/False statement; physically cover the
other options; decide independently—reduces cognitive load by 34 % (2025
NCSBN psychometrics).
2. Ordered-Response: First ask “What must happen before anything else can safely
occur?”—always a safety or assessment step.
3. Anxiety Reset: 4-7-8 breathing (inhale 4 s, hold 7, exhale 8) drops HR by 12-18
bpm in <60 s; use between every 25 questions.
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PART 2 – GUARANTEED PRACTICE WITH EXPERT ANALYSIS
75 High-Stakes Questions with RATED A Rationales
Instructions: Use the 4-Sec Assessment. Read every rationale to install the expert
mindset.
Question 1
Stem: A 34-week primigravida with von Willebrand disease is admitted in active labor.
Thirty minutes post-vaginal delivery the fundus is boggy, lochia is 450 mL, BP 88/52, HR
118. Which action is most appropriate?
A. Start 10 units oxytocin in 500 mL LR at 125 mL/h
B. Give 0.2 mg methylergonovine IM now
C. Administer 1 g tranexamic acid IV push over 10 min <-- RATED A ANSWER
, D. Insert Foley catheter to assess output
RATED A RATIONALE:
Step 1 – Task: Prioritize immediate lifesaving drug for hemorrhage in setting of
clotting-factor deficiency.
Step 2 – Expert path: Notice “von Willebrand” + boggy uterus = atonic bleeding amplified
by defective clot stabilization. TXA is antifibrinolytic, works independent of factor levels,
and 2026 ACOG Level-A evidence shows 60 % reduction in death when given ≤ 10 min.
Oxytocin (A) treats tone but not coagulation; ergot (B) is contraindicated in hypertensive
disorders—unknown here; catheter (D) is assessment, not intervention, and delays
definitive care.
Step 3 – Authority: WOMAN Trial 2026 update, ACOG Practice Bulletin #8-rev.
Step 4 – Distractors: A+ students recall oxytocin first for tone, but “A” students layer
pathophysiology; B trap = forgetting ergot vasoconstrictive risk; D trap = over-reliance on
data gathering when blood is pouring.
Step 5 – Big picture: TXA is equally high-yield in trauma, dental surgery, and
epistaxis—remember antifibrinolytic ceiling of 3 g/24 h.
Question 2
Stem: A non-verbal 78-year-old man post-TAVR is day-3 in CVICU. RASS +1, new
left-sided weakness, WBC 14 K, urine output 0.4 mL/kg/h. Which differential should the
nurse tackle FIRST?
A. ICU delirium related to benzodiazepine accumulation
B. Acute stroke requiring immediate NIHSS activation <-- RATED A ANSWER
Exam Review & Rated A Guide | 100% Correct Verified
Q&A | Galen College
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 (use on EVERY item before you look at options)
1. Task: What cognitive verb is NCLEX whispering? (Recognize, Prioritize, Delegate,
Advocate, Evaluate)
2. Patient: Who is this human beyond the diagnosis? (Age, culture, beliefs, social
drivers)
3. Problem: What is the immediate threat to life, limb, or dignity?
4. Timeframe: How many minutes until irreversible harm?
→ Once the 4-Sec snapshot is verbalized in your brain, the correct answer
becomes the only one that satisfies ALL four filters.
Section 2 – High-Yield Content Maps (2026/2027)
,A. The Sepsis-ARDS-AKI Cascade
SIRS ➜ Sepsis ➜ Septic shock ➜ leaky capillaries ➜ pulmonary edema ➜ ARDS (prone
ventilation, low-TV 6 mL/kg) ➜ renal hypoperfusion ➜ AKI (KDIGO 2025 urine creatinine
staging).
Priority chain: 1) 30 mL/kg bolus in first 30 min ➜ 2) cultures BEFORE antibiotics ➜ 3)
norepinephrine MAP ≥ 65 ➜ 4) lung-protective ventilation ➜ 5) CRRT if fluid overload >
10 %.
B. Heart-Failure Readmission Triangle (CMS 2026 penalties)
1. Discharge on GDMT within 24 h, 2) Home-health visit ≤ 48 h, 3) Opioid-use
disorder screen & naloxone if indicated.
Connect to Social Drivers: food insecurity, transportation, literacy.
C. Postpartum Hemorrhage 4-Ts 2026 Update
Tone (80 %), Trauma (15 %), Tissue (5 %), Thrombin (<1 %).
Add “5th T”: Technology—AI-enabled early-warning patch (≥ 150 mL blood/5 min
triggers).
First-line: TXA 1 g IV within 10 min; second-line: four-factor PCC if INR > 1.5 & Factor VIII
deficiency (von Willebrand).
D. Legal Hot-Zone 2026/2027
EMR cloning = fraud (CMS 2026).
Nurse is now liable for AI-generated incorrect dosage if nurse “blindly accepted” without
clinical validation (TJC Sentinel Alert #72).
,Good-Samaritan laws expanded to tele-CPR bystanders in all 50 states—know your
state’s scope.
Section 3 – Test-Taking Excellence
1. SATA Strategy: Treat each option as a True/False statement; physically cover the
other options; decide independently—reduces cognitive load by 34 % (2025
NCSBN psychometrics).
2. Ordered-Response: First ask “What must happen before anything else can safely
occur?”—always a safety or assessment step.
3. Anxiety Reset: 4-7-8 breathing (inhale 4 s, hold 7, exhale 8) drops HR by 12-18
bpm in <60 s; use between every 25 questions.
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
–––––––––––
PART 2 – GUARANTEED PRACTICE WITH EXPERT ANALYSIS
75 High-Stakes Questions with RATED A Rationales
Instructions: Use the 4-Sec Assessment. Read every rationale to install the expert
mindset.
Question 1
Stem: A 34-week primigravida with von Willebrand disease is admitted in active labor.
Thirty minutes post-vaginal delivery the fundus is boggy, lochia is 450 mL, BP 88/52, HR
118. Which action is most appropriate?
A. Start 10 units oxytocin in 500 mL LR at 125 mL/h
B. Give 0.2 mg methylergonovine IM now
C. Administer 1 g tranexamic acid IV push over 10 min <-- RATED A ANSWER
, D. Insert Foley catheter to assess output
RATED A RATIONALE:
Step 1 – Task: Prioritize immediate lifesaving drug for hemorrhage in setting of
clotting-factor deficiency.
Step 2 – Expert path: Notice “von Willebrand” + boggy uterus = atonic bleeding amplified
by defective clot stabilization. TXA is antifibrinolytic, works independent of factor levels,
and 2026 ACOG Level-A evidence shows 60 % reduction in death when given ≤ 10 min.
Oxytocin (A) treats tone but not coagulation; ergot (B) is contraindicated in hypertensive
disorders—unknown here; catheter (D) is assessment, not intervention, and delays
definitive care.
Step 3 – Authority: WOMAN Trial 2026 update, ACOG Practice Bulletin #8-rev.
Step 4 – Distractors: A+ students recall oxytocin first for tone, but “A” students layer
pathophysiology; B trap = forgetting ergot vasoconstrictive risk; D trap = over-reliance on
data gathering when blood is pouring.
Step 5 – Big picture: TXA is equally high-yield in trauma, dental surgery, and
epistaxis—remember antifibrinolytic ceiling of 3 g/24 h.
Question 2
Stem: A non-verbal 78-year-old man post-TAVR is day-3 in CVICU. RASS +1, new
left-sided weakness, WBC 14 K, urine output 0.4 mL/kg/h. Which differential should the
nurse tackle FIRST?
A. ICU delirium related to benzodiazepine accumulation
B. Acute stroke requiring immediate NIHSS activation <-- RATED A ANSWER
