NSG 4800 Comprehensive Exam 2026
Practice Questions with ANSWERs and
Rationales
SECTION 1: FUNDAMENTALS AND SAFETY
Question 1
The nurse is assisting with discharge planning for assigned clients. Which of the following referrals is
appropriate for the nurse to make?
a. A social worker referral for a client who has diabetes mellitus (type 2) and has neuropathy.
b. A physical therapy (PT) referral for a client who had a total knee replacement (TKR) and needs
instruction on the use of a walker.
c. An occupational therapy (OT) referral for a client who had an amputation and requires long-term IV
antibiotics.
d. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
ANSWER: B
Rationale:
Option A (Incorrect): A client with diabetes and neuropathy may benefit from a podiatry referral or
diabetes educator, not necessarily a social worker unless there are psychosocial or financial concerns
identified.
Option B (Correct): Physical therapy is appropriate for a client who had a total knee replacement and
needs mobility training, gait training, and instruction on assistive devices such as a walker. PT focuses on
gross motor skills and mobility.
Option C (Incorrect): Occupational therapy focuses on activities of daily living (ADLs) and fine motor
skills, not IV antibiotic administration. A client requiring long-term IV antibiotics would need a home
health nurse or IV therapy team referral.
,Option D (Incorrect): Speech therapy is indicated for swallowing disorders (dysphagia) or
communication issues. An EGD is a diagnostic procedure and does not automatically require speech
therapy unless swallowing difficulties are identified.
Question 2
The nurse has attended a continuing education program on legal issues in nursing practice. Which of the
following statements by the nurse indicates a correct understanding of the conference?
a. "Failure to communicate concerns about an older adult client who is confused and is being discharged
home is an example of neglect."
b. "Giving clients false assurance about a health care condition or expected outcome is an example of
libel."
c. "Threatening to touch a client without the client's consent is an example of battery."
d. "Posting information about a client on social media without the client's permission is an example of
slander."
ANSWER: A
Rationale:
Option A (Correct): Neglect is a form of malpractice that involves failure to provide appropriate care or
failure to act when action is needed. Failing to communicate concerns about an unsafe discharge for a
confused client constitutes neglect.
Option B (Incorrect): Giving false assurance is not libel. Libel is written defamation. False assurance may
be considered a form of misrepresentation but is not specifically libel.
Option C (Incorrect): Threatening to touch a client without consent is assault, not battery. Battery is the
actual unlawful touching or physical contact without consent.
Option D (Incorrect): Posting client information on social media without permission is a HIPAA violation
and breach of confidentiality, not slander. Slander is spoken defamation.
Question 3
The nurse working in a medical-surgical unit is caring for assigned clients. Which of the following tasks is
appropriate to delegate?
a. Asking an unlicensed assistive personnel (UAP) to turn off the tube feeding for a client who is
receiving continuous tube feedings and is vomiting.
b. Asking a licensed practical nurse (LPN/VN) to obtain a capillary blood glucose reading on a client who
has become diaphoretic.
c. Asking an unlicensed assistive personnel (UAP) to flush the closed-wound drainage system (JP) drain
of a client who is 2 days postoperative from an open appendectomy.
,d. Asking a licensed practical nurse (LPN/VN) to teach a client who has a newly created ileostomy how to
change the appliance.
ANSWER: B
Rationale:
Option A (Incorrect): Turning off tube feedings for a vomiting client requires nursing assessment and
judgment. This is not appropriate to delegate to UAP as it involves assessment and potential
modification of the care plan.
Option B (Correct): Obtaining a capillary blood glucose reading is a routine, standardized procedure that
an LPN/VN can perform. This is within the LPN/VN scope of practice and is appropriate delegation.
Option C (Incorrect): Flushing a JP drain requires sterile technique and assessment of the drainage. This
should be performed by a licensed nurse (RN or LPN), not UAP.
Option D (Incorrect): Teaching a client about a new ileostomy is complex patient education that requires
assessment, planning, and evaluation. This should be done by an RN, not delegated to an LPN/VN.
Question 4
The nurse working on the pediatric unit is caring for the following clients. It is most appropriate for the
nurse to initiate an interdisciplinary conference for a client who is:
a. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly-like
stools.
b. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
c. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
d. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, internal abduction of the
left hip, and asymmetry of the gluteal folds.
ANSWER: C
Rationale:
Option A (Incorrect): Intussusception is an acute emergency requiring immediate medical intervention,
not an interdisciplinary conference. This child needs urgent treatment.
Option B (Incorrect): RSV with wheezing requires respiratory support and medical management but does
not necessarily require an interdisciplinary conference unless there are complications.
Option C (Correct): A child newly diagnosed with cerebral palsy will benefit from an interdisciplinary
conference to coordinate long-term care involving physical therapy, occupational therapy, speech
therapy, social work, and other specialists for comprehensive developmental support.
Option D (Incorrect): Developmental dysplasia of the hip requires orthopedic intervention and possibly a
Pavlik harness, but this is typically managed by the orthopedic team without requiring a full
interdisciplinary conference.
, Question 5
The nurse working on the medical-surgical unit is caring for assigned clients. The nurse should initially
assess the client who:
a. Has pericarditis with a temperature (T) of 101.8° F and chest pain that is relieved when the client
leans forward.
b. Has atrial fibrillation (AFib) with a pulse (P) that varies from 110 to 140 and is refusing to take the
scheduled dose of warfarin.
c. Has status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
d. Had thoracic surgery 12 hours ago with a chest tube to water seal drainage and has drained 175 mL of
serosanguineous fluid in the past hour.
ANSWER: D
Rationale:
Option A (Incorrect): While the client has pericarditis with fever and chest pain, the pain being relieved
by leaning forward is a classic finding (not an emergency). This is expected and can be assessed after
more urgent clients.
Option B (Incorrect): The client with AFib has tachycardia and is refusing warfarin, which is concerning
but not immediately life-threatening. This requires assessment but is not the priority.
Option C (Incorrect): The client with status asthmaticus now has vesicular (normal) breath sounds after
treatment, indicating improvement. This client is stable and can be assessed later.
Option D (Correct): A chest tube drainage of 175 mL in one hour post-thoracic surgery is excessive and
may indicate hemorrhage. Normal chest tube drainage should be less than 100 mL/hr. This is a potential
emergency requiring immediate assessment.
Question 6
The nurse is caring for a client who weighs 150 lbs (68 kg) and has developed hepatic encephalopathy. It
is a priority for the nurse to notify the primary health care provider (PHCP) if the client develops:
a. The development of flaccidity to the lower extremities.
b. An increase in urine output to 1,450 mL/day.
c. A change in pupil size from 7 to 5 mm.
d. An increase in alanine aminotransferase (ALT) levels.
ANSWER: C
Rationale:
Practice Questions with ANSWERs and
Rationales
SECTION 1: FUNDAMENTALS AND SAFETY
Question 1
The nurse is assisting with discharge planning for assigned clients. Which of the following referrals is
appropriate for the nurse to make?
a. A social worker referral for a client who has diabetes mellitus (type 2) and has neuropathy.
b. A physical therapy (PT) referral for a client who had a total knee replacement (TKR) and needs
instruction on the use of a walker.
c. An occupational therapy (OT) referral for a client who had an amputation and requires long-term IV
antibiotics.
d. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
ANSWER: B
Rationale:
Option A (Incorrect): A client with diabetes and neuropathy may benefit from a podiatry referral or
diabetes educator, not necessarily a social worker unless there are psychosocial or financial concerns
identified.
Option B (Correct): Physical therapy is appropriate for a client who had a total knee replacement and
needs mobility training, gait training, and instruction on assistive devices such as a walker. PT focuses on
gross motor skills and mobility.
Option C (Incorrect): Occupational therapy focuses on activities of daily living (ADLs) and fine motor
skills, not IV antibiotic administration. A client requiring long-term IV antibiotics would need a home
health nurse or IV therapy team referral.
,Option D (Incorrect): Speech therapy is indicated for swallowing disorders (dysphagia) or
communication issues. An EGD is a diagnostic procedure and does not automatically require speech
therapy unless swallowing difficulties are identified.
Question 2
The nurse has attended a continuing education program on legal issues in nursing practice. Which of the
following statements by the nurse indicates a correct understanding of the conference?
a. "Failure to communicate concerns about an older adult client who is confused and is being discharged
home is an example of neglect."
b. "Giving clients false assurance about a health care condition or expected outcome is an example of
libel."
c. "Threatening to touch a client without the client's consent is an example of battery."
d. "Posting information about a client on social media without the client's permission is an example of
slander."
ANSWER: A
Rationale:
Option A (Correct): Neglect is a form of malpractice that involves failure to provide appropriate care or
failure to act when action is needed. Failing to communicate concerns about an unsafe discharge for a
confused client constitutes neglect.
Option B (Incorrect): Giving false assurance is not libel. Libel is written defamation. False assurance may
be considered a form of misrepresentation but is not specifically libel.
Option C (Incorrect): Threatening to touch a client without consent is assault, not battery. Battery is the
actual unlawful touching or physical contact without consent.
Option D (Incorrect): Posting client information on social media without permission is a HIPAA violation
and breach of confidentiality, not slander. Slander is spoken defamation.
Question 3
The nurse working in a medical-surgical unit is caring for assigned clients. Which of the following tasks is
appropriate to delegate?
a. Asking an unlicensed assistive personnel (UAP) to turn off the tube feeding for a client who is
receiving continuous tube feedings and is vomiting.
b. Asking a licensed practical nurse (LPN/VN) to obtain a capillary blood glucose reading on a client who
has become diaphoretic.
c. Asking an unlicensed assistive personnel (UAP) to flush the closed-wound drainage system (JP) drain
of a client who is 2 days postoperative from an open appendectomy.
,d. Asking a licensed practical nurse (LPN/VN) to teach a client who has a newly created ileostomy how to
change the appliance.
ANSWER: B
Rationale:
Option A (Incorrect): Turning off tube feedings for a vomiting client requires nursing assessment and
judgment. This is not appropriate to delegate to UAP as it involves assessment and potential
modification of the care plan.
Option B (Correct): Obtaining a capillary blood glucose reading is a routine, standardized procedure that
an LPN/VN can perform. This is within the LPN/VN scope of practice and is appropriate delegation.
Option C (Incorrect): Flushing a JP drain requires sterile technique and assessment of the drainage. This
should be performed by a licensed nurse (RN or LPN), not UAP.
Option D (Incorrect): Teaching a client about a new ileostomy is complex patient education that requires
assessment, planning, and evaluation. This should be done by an RN, not delegated to an LPN/VN.
Question 4
The nurse working on the pediatric unit is caring for the following clients. It is most appropriate for the
nurse to initiate an interdisciplinary conference for a client who is:
a. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly-like
stools.
b. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
c. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
d. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, internal abduction of the
left hip, and asymmetry of the gluteal folds.
ANSWER: C
Rationale:
Option A (Incorrect): Intussusception is an acute emergency requiring immediate medical intervention,
not an interdisciplinary conference. This child needs urgent treatment.
Option B (Incorrect): RSV with wheezing requires respiratory support and medical management but does
not necessarily require an interdisciplinary conference unless there are complications.
Option C (Correct): A child newly diagnosed with cerebral palsy will benefit from an interdisciplinary
conference to coordinate long-term care involving physical therapy, occupational therapy, speech
therapy, social work, and other specialists for comprehensive developmental support.
Option D (Incorrect): Developmental dysplasia of the hip requires orthopedic intervention and possibly a
Pavlik harness, but this is typically managed by the orthopedic team without requiring a full
interdisciplinary conference.
, Question 5
The nurse working on the medical-surgical unit is caring for assigned clients. The nurse should initially
assess the client who:
a. Has pericarditis with a temperature (T) of 101.8° F and chest pain that is relieved when the client
leans forward.
b. Has atrial fibrillation (AFib) with a pulse (P) that varies from 110 to 140 and is refusing to take the
scheduled dose of warfarin.
c. Has status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
d. Had thoracic surgery 12 hours ago with a chest tube to water seal drainage and has drained 175 mL of
serosanguineous fluid in the past hour.
ANSWER: D
Rationale:
Option A (Incorrect): While the client has pericarditis with fever and chest pain, the pain being relieved
by leaning forward is a classic finding (not an emergency). This is expected and can be assessed after
more urgent clients.
Option B (Incorrect): The client with AFib has tachycardia and is refusing warfarin, which is concerning
but not immediately life-threatening. This requires assessment but is not the priority.
Option C (Incorrect): The client with status asthmaticus now has vesicular (normal) breath sounds after
treatment, indicating improvement. This client is stable and can be assessed later.
Option D (Correct): A chest tube drainage of 175 mL in one hour post-thoracic surgery is excessive and
may indicate hemorrhage. Normal chest tube drainage should be less than 100 mL/hr. This is a potential
emergency requiring immediate assessment.
Question 6
The nurse is caring for a client who weighs 150 lbs (68 kg) and has developed hepatic encephalopathy. It
is a priority for the nurse to notify the primary health care provider (PHCP) if the client develops:
a. The development of flaccidity to the lower extremities.
b. An increase in urine output to 1,450 mL/day.
c. A change in pupil size from 7 to 5 mm.
d. An increase in alanine aminotransferase (ALT) levels.
ANSWER: C
Rationale:
