2026/2027
Galen College NUR 283 Comp 1–3
Advanced Nursing Exam Study
Guide with Practice Tests and Test
Bank Review for 2026/2027
Question 1:
A nurse is reviewing newly prescribed medications for several clients admitted to the
medical-surgical unit. Which prescription should the nurse identify as requiring
immediate follow-up with the healthcare provider?
A. A client with heart failure prescribed furosemide and potassium supplements
B. A client with chronic kidney disease prescribed calcium carbonate
C. A client with a serum potassium level of 4.0 mEq/L prescribed sodium polystyrene
sulfonate (Kayexalate)
D. A client with diabetes mellitus prescribed insulin glargine at bedtime
Correct Answer: C. Sodium polystyrene sulfonate (Kayexalate) for a client with
a serum potassium level of 4.0 mEq/L
Rationale: Kayexalate is administered to lower dangerously elevated potassium levels.
A potassium level of 4.0 mEq/L is within the normal range; therefore, administering
Kayexalate could place the client at risk for hypokalemia and cardiac dysrhythmias.
The nurse should clarify the prescription before administration. Potassium
supplementation with loop diuretics, calcium carbonate for kidney disease, and
bedtime insulin are appropriate therapies depending on the client’s condition. Nurses
must evaluate laboratory values carefully before administering electrolyte-altering
medications.
Question 2:
The nurse observes a staff member preparing to administer lorazepam to a
hospitalized client. Which action by the staff member requires immediate nursing
intervention?
A. Confirming the client’s identity using two identifiers
B. Explaining the medication’s expected effects to the client
C. Obtaining informed consent from the client before administering lorazepam
D. Assessing the client’s respiratory rate before medication administration
Correct Answer: C. Obtaining informed consent from the client before
administering lorazepam
,2026/2027
Rationale: Nurses are responsible for ensuring that medications are administered
according to provider prescriptions and institutional policy. Informed consent is not
required for routine administration of prescribed medications such as lorazepam.
Attempting to obtain formal consent demonstrates misunderstanding of legal
responsibilities and requires correction. The other actions are appropriate nursing
interventions that promote safe medication administration and client education.
Question 3:
A community health nurse is evaluating several clients for additional support services.
Which client should the nurse identify as the highest priority for initiating a
multidisciplinary care conference?
A. A 45-year-old client with controlled hypertension and reliable transportation
B. A 60-year-old client recovering from knee replacement surgery with family
support
C. A 17-year-old client with type 1 diabetes mellitus, unemployment, and a recent
hemoglobin A1C of 13%
D. A 28-year-old client with seasonal allergies and occasional asthma symptoms
Correct Answer: C. A 17-year-old client with type 1 diabetes mellitus,
unemployment, and a recent hemoglobin A1C of 13%
Rationale: This client demonstrates significant medical and psychosocial risk factors.
An A1C of 13% reflects severely uncontrolled diabetes and substantially increases the
risk of complications such as diabetic ketoacidosis, neuropathy, nephropathy, and
retinopathy. Additionally, unemployment and adolescent age may affect access to
medications, nutrition, and follow-up care. A multidisciplinary conference involving
nursing, endocrinology, social services, nutrition, and mental health professionals is
appropriate. The other clients are more stable and do not demonstrate the same degree
of complex healthcare needs.
Question 4:
A postpartum nurse has been temporarily reassigned to a medical-surgical unit. Which
client assignment would be most appropriate for this nurse?
A. A client admitted with diabetic ketoacidosis requiring insulin infusion
B. A client who underwent an appendectomy two hours ago
C. A client receiving chemotherapy for acute leukemia
D. A client with unstable angina requiring continuous cardiac monitoring
Correct Answer: B. A client who underwent an appendectomy two hours ago
Rationale: When assigning float nurses, the charge nurse should consider the nurse’s
previous experience and assign clients with predictable outcomes and minimal
complexity. A postoperative appendectomy client is generally stable and appropriate
for a postpartum nurse with general surgical care experience. Clients requiring critical
,2026/2027
care skills, chemotherapy administration, or advanced cardiac monitoring require
specialized expertise beyond the likely competency of the float nurse.
Question 5:
During a well-child clinic visit, which child should the nurse recommend for
additional developmental evaluation?
A. A 2-month-old infant who smiles socially
B. An 8-month-old infant who transfers objects between hands
C. An 18-month-old toddler who requires support to ambulate
D. A 3-year-old child who engages in parallel play
Correct Answer: C. An 18-month-old toddler who requires support to ambulate
Rationale: By 18 months of age, toddlers should be able to walk independently and
often begin running and climbing. Requiring support for ambulation at this age
suggests a developmental delay that warrants further assessment. The other
developmental milestones listed are appropriate for the stated ages. Early
identification of developmental delays allows timely intervention and improved long-
term outcomes.
Question 6:
A mechanically ventilated client has been declared brain dead. The medical record
does not contain an advance directive regarding organ donation. From whom should
the nurse anticipate consent for organ donation will be obtained?
A. The attending physician
B. The hospital ethics committee
C. The client’s closest family member
D. The nursing supervisor
Correct Answer: C. The client’s closest family member
Rationale: When a client has not documented wishes regarding organ donation,
consent is typically obtained from the legally authorized next of kin or closest family
member according to state laws and institutional policy. Physicians and ethics
committees may provide guidance, but they do not independently authorize organ
donation. Nurses should provide compassionate support to family members during
this difficult process while ensuring legal and ethical standards are followed.
Question 7:
The nurse receives report on four clients at the beginning of the shift. Which client
should the nurse assess first?
, 2026/2027
A. A client with rheumatoid arthritis requesting pain medication
B. A client with Guillain-Barré syndrome who has recently begun plasmapheresis
therapy
C. A client recovering from cataract surgery reporting mild nausea
D. A client with chronic obstructive pulmonary disease awaiting discharge
instructions
Correct Answer: B. A client with Guillain-Barré syndrome who has recently
begun plasmapheresis therapy
Rationale: Guillain-Barré syndrome can rapidly progress to respiratory failure and
autonomic instability. Clients beginning plasmapheresis require close monitoring for
complications such as hypotension, electrolyte imbalances, and respiratory
compromise. Airway and circulation concerns take priority over pain management,
discharge planning, or mild postoperative symptoms. Early assessment allows the
nurse to promptly identify life-threatening deterioration.
Question 8:
Which task is appropriate for the nurse to delegate to a certified nursing assistant
(CNA)?
A. Assessing pain in a postoperative client
B. Reinforcing teaching regarding insulin injections
C. One-to-one observation of a client at risk for injury
D. Evaluating a client’s response to medication
Correct Answer: C. One-to-one observation of a client at risk for injury
Rationale: CNAs may safely perform tasks that do not require nursing judgment,
assessment, teaching, or evaluation. One-to-one observation for client safety is within
the CNA’s scope of practice. Assessment, client education, and evaluation remain the
responsibility of the licensed nurse. Delegation decisions should always consider the
complexity of the task, the client’s condition, and the competence of the assistive
personnel.
Question 9:
The nurse should intervene immediately if a staff member is observed engaging in
which behavior?
A. Discussing a client’s diagnosis with visiting family members without client
permission
B. Wearing gloves while performing wound care
C. Performing hand hygiene before client contact
D. Documenting medication administration after completion
Galen College NUR 283 Comp 1–3
Advanced Nursing Exam Study
Guide with Practice Tests and Test
Bank Review for 2026/2027
Question 1:
A nurse is reviewing newly prescribed medications for several clients admitted to the
medical-surgical unit. Which prescription should the nurse identify as requiring
immediate follow-up with the healthcare provider?
A. A client with heart failure prescribed furosemide and potassium supplements
B. A client with chronic kidney disease prescribed calcium carbonate
C. A client with a serum potassium level of 4.0 mEq/L prescribed sodium polystyrene
sulfonate (Kayexalate)
D. A client with diabetes mellitus prescribed insulin glargine at bedtime
Correct Answer: C. Sodium polystyrene sulfonate (Kayexalate) for a client with
a serum potassium level of 4.0 mEq/L
Rationale: Kayexalate is administered to lower dangerously elevated potassium levels.
A potassium level of 4.0 mEq/L is within the normal range; therefore, administering
Kayexalate could place the client at risk for hypokalemia and cardiac dysrhythmias.
The nurse should clarify the prescription before administration. Potassium
supplementation with loop diuretics, calcium carbonate for kidney disease, and
bedtime insulin are appropriate therapies depending on the client’s condition. Nurses
must evaluate laboratory values carefully before administering electrolyte-altering
medications.
Question 2:
The nurse observes a staff member preparing to administer lorazepam to a
hospitalized client. Which action by the staff member requires immediate nursing
intervention?
A. Confirming the client’s identity using two identifiers
B. Explaining the medication’s expected effects to the client
C. Obtaining informed consent from the client before administering lorazepam
D. Assessing the client’s respiratory rate before medication administration
Correct Answer: C. Obtaining informed consent from the client before
administering lorazepam
,2026/2027
Rationale: Nurses are responsible for ensuring that medications are administered
according to provider prescriptions and institutional policy. Informed consent is not
required for routine administration of prescribed medications such as lorazepam.
Attempting to obtain formal consent demonstrates misunderstanding of legal
responsibilities and requires correction. The other actions are appropriate nursing
interventions that promote safe medication administration and client education.
Question 3:
A community health nurse is evaluating several clients for additional support services.
Which client should the nurse identify as the highest priority for initiating a
multidisciplinary care conference?
A. A 45-year-old client with controlled hypertension and reliable transportation
B. A 60-year-old client recovering from knee replacement surgery with family
support
C. A 17-year-old client with type 1 diabetes mellitus, unemployment, and a recent
hemoglobin A1C of 13%
D. A 28-year-old client with seasonal allergies and occasional asthma symptoms
Correct Answer: C. A 17-year-old client with type 1 diabetes mellitus,
unemployment, and a recent hemoglobin A1C of 13%
Rationale: This client demonstrates significant medical and psychosocial risk factors.
An A1C of 13% reflects severely uncontrolled diabetes and substantially increases the
risk of complications such as diabetic ketoacidosis, neuropathy, nephropathy, and
retinopathy. Additionally, unemployment and adolescent age may affect access to
medications, nutrition, and follow-up care. A multidisciplinary conference involving
nursing, endocrinology, social services, nutrition, and mental health professionals is
appropriate. The other clients are more stable and do not demonstrate the same degree
of complex healthcare needs.
Question 4:
A postpartum nurse has been temporarily reassigned to a medical-surgical unit. Which
client assignment would be most appropriate for this nurse?
A. A client admitted with diabetic ketoacidosis requiring insulin infusion
B. A client who underwent an appendectomy two hours ago
C. A client receiving chemotherapy for acute leukemia
D. A client with unstable angina requiring continuous cardiac monitoring
Correct Answer: B. A client who underwent an appendectomy two hours ago
Rationale: When assigning float nurses, the charge nurse should consider the nurse’s
previous experience and assign clients with predictable outcomes and minimal
complexity. A postoperative appendectomy client is generally stable and appropriate
for a postpartum nurse with general surgical care experience. Clients requiring critical
,2026/2027
care skills, chemotherapy administration, or advanced cardiac monitoring require
specialized expertise beyond the likely competency of the float nurse.
Question 5:
During a well-child clinic visit, which child should the nurse recommend for
additional developmental evaluation?
A. A 2-month-old infant who smiles socially
B. An 8-month-old infant who transfers objects between hands
C. An 18-month-old toddler who requires support to ambulate
D. A 3-year-old child who engages in parallel play
Correct Answer: C. An 18-month-old toddler who requires support to ambulate
Rationale: By 18 months of age, toddlers should be able to walk independently and
often begin running and climbing. Requiring support for ambulation at this age
suggests a developmental delay that warrants further assessment. The other
developmental milestones listed are appropriate for the stated ages. Early
identification of developmental delays allows timely intervention and improved long-
term outcomes.
Question 6:
A mechanically ventilated client has been declared brain dead. The medical record
does not contain an advance directive regarding organ donation. From whom should
the nurse anticipate consent for organ donation will be obtained?
A. The attending physician
B. The hospital ethics committee
C. The client’s closest family member
D. The nursing supervisor
Correct Answer: C. The client’s closest family member
Rationale: When a client has not documented wishes regarding organ donation,
consent is typically obtained from the legally authorized next of kin or closest family
member according to state laws and institutional policy. Physicians and ethics
committees may provide guidance, but they do not independently authorize organ
donation. Nurses should provide compassionate support to family members during
this difficult process while ensuring legal and ethical standards are followed.
Question 7:
The nurse receives report on four clients at the beginning of the shift. Which client
should the nurse assess first?
, 2026/2027
A. A client with rheumatoid arthritis requesting pain medication
B. A client with Guillain-Barré syndrome who has recently begun plasmapheresis
therapy
C. A client recovering from cataract surgery reporting mild nausea
D. A client with chronic obstructive pulmonary disease awaiting discharge
instructions
Correct Answer: B. A client with Guillain-Barré syndrome who has recently
begun plasmapheresis therapy
Rationale: Guillain-Barré syndrome can rapidly progress to respiratory failure and
autonomic instability. Clients beginning plasmapheresis require close monitoring for
complications such as hypotension, electrolyte imbalances, and respiratory
compromise. Airway and circulation concerns take priority over pain management,
discharge planning, or mild postoperative symptoms. Early assessment allows the
nurse to promptly identify life-threatening deterioration.
Question 8:
Which task is appropriate for the nurse to delegate to a certified nursing assistant
(CNA)?
A. Assessing pain in a postoperative client
B. Reinforcing teaching regarding insulin injections
C. One-to-one observation of a client at risk for injury
D. Evaluating a client’s response to medication
Correct Answer: C. One-to-one observation of a client at risk for injury
Rationale: CNAs may safely perform tasks that do not require nursing judgment,
assessment, teaching, or evaluation. One-to-one observation for client safety is within
the CNA’s scope of practice. Assessment, client education, and evaluation remain the
responsibility of the licensed nurse. Delegation decisions should always consider the
complexity of the task, the client’s condition, and the competence of the assistive
personnel.
Question 9:
The nurse should intervene immediately if a staff member is observed engaging in
which behavior?
A. Discussing a client’s diagnosis with visiting family members without client
permission
B. Wearing gloves while performing wound care
C. Performing hand hygiene before client contact
D. Documenting medication administration after completion
