NSG 4800 COMPREHENSIVE EXAM 3
2026 Edition -Questions with Detailed
Rationales
Question 1
The nurse working in a mental health unit is caring for a client who is scheduled to have
electroconvulsive therapy (ECT) treatment the next day. The client asks, "Can I refuse the ECT treatment
tomorrow?" Which of the following responses should the nurse make?
A. "You should consider discussing this decision with your family first."
B. "Having this treatment can be scary, but it is going to help you feel better."
C. "Let's talk with your doctor before you make a final decision."
D. "You have a right to refuse even though you have signed the consent."
ANSWER: D
Rationale:
Option A is incorrect because while family involvement may be helpful, this response does not address
the client's legal right to refuse treatment. The client has autonomy and does not need family
permission to refuse.
Option B is incorrect because this response is dismissive of the client's concerns and attempts to
persuade rather than inform. It does not acknowledge the client's legal right to refuse treatment.
Option C is incorrect because while discussing with the provider is appropriate, this response does not
directly ANSWER the client's question about their right to refuse. The client can refuse without
additional discussion.
Option D is correct because it accurately informs the client that informed consent is an ongoing process
and clients retain the right to withdraw consent at any time, even after signing. This respects patient
autonomy and promotes trust in the patient-provider relationship.
www.ncbi.nlm.nih.gov
Question 2
The nurse has attended a conference on informed consent. It indicates a correct understanding of the
teaching if the nurse states that informed consent:
,A. Is an agreement to receive medical treatment that can't be revoked once signed.
B. Forms must be signed when a client is competent to make an informed decision.
C. Is signed by the nurse to indicate that the client understands the procedure.
D. Is the nurse's responsibility to explain the risks, benefits, and alternative treatments.
ANSWER: B
Rationale:
Option A is incorrect because informed consent CAN be revoked at any time, even after signing. Consent
is an ongoing process, not a one-time irreversible agreement.
Option B is correct because informed consent must be obtained when the client is competent and has
the capacity to understand the information provided, weigh the risks and benefits, and make an
informed decision.
code-medical-ethics.ama-assn.org
Option C is incorrect because the nurse does not sign to indicate client understanding. The client signs
the consent form, and the healthcare provider who will perform the procedure is responsible for
obtaining informed consent.
Option D is incorrect because it is the physician's or licensed independent provider's responsibility to
explain the risks, benefits, and alternatives, not the nurse's. The nurse may witness the signature and
reinforce teaching, but the provider must obtain the consent.
www.aorn.org
Question 3
The nurse is prioritizing client care after receiving the change-of-shift report. The nurse should first plan
to see the client who:
A. Had laparoscopic surgery 12 hours ago and is reporting right shoulder pain.
B. Had a cardiac catheterization one hour ago and has been drowsy since returning from the procedure.
C. Is scheduled for an echocardiogram in one hour and is eating food brought in by a visitor.
D. Has an endoscopic retrograde cholangiopancreatography (ERCP) 1 hour ago and is reporting difficulty
swallowing.
ANSWER: D
Rationale:
Option A is incorrect because right shoulder pain after laparoscopic surgery is an expected finding due to
carbon dioxide insufflation during the procedure. This is not an emergency and can be addressed after
more urgent concerns.
,Option B is incorrect because while drowsiness after cardiac catheterization requires monitoring, it may
be expected due to sedation. However, this is less urgent than airway compromise.
Option C is incorrect because while eating before an echocardiogram may need to be addressed, this is
not life-threatening. The echocardiogram may need to be rescheduled, but this is not the priority.
Option D is correct because difficulty swallowing after ERCP could indicate airway compromise,
bleeding, or perforation. This requires immediate assessment following the ABCs (Airway, Breathing,
Circulation) priority framework.
simplenursing.com
Airway issues always take priority.
Question 4
The nurse working in the labor and delivery (L&D) unit has become aware of the following clients who
are in the second stage of labor and are being monitored with external fetal monitors. The nurse
identifies which client as a priority for follow-up?
A. The client whose cervix has dilated to 10 cm with moderately intense contractions of 40 to 50
seconds.
B. The client whose fetal heart rate (FHR) remains consistent at 132 beats per minute.
C. The client whose bloody show is dark red with active pushing.
D. The client whose contractions are lasting 60 seconds with a 3-minute interval.
ANSWER: C
Rationale:
Option A is incorrect because 10 cm dilation with moderate contractions of 40-50 seconds is normal for
the second stage of labor. This is expected progress.
Option B is incorrect because a fetal heart rate of 132 bpm is within the normal range of 110-160 bpm.
This indicates fetal well-being.
Option C is correct because dark red bloody show during the second stage of labor could indicate
placental abruption or other complications. Normal bloody show should be pink or light red. Dark red
blood requires immediate evaluation as it may indicate fetal or maternal compromise.
Option D is incorrect because contractions lasting 60 seconds with 3-minute intervals are within normal
parameters for active labor and the second stage. This pattern is acceptable.
Question 5
The registered nurse (RN) is planning care for clients and is assigning tasks to a licensed
practical/vocational nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Which of the following
tasks is best for the RN to assign to the LPN/VN?
A. Collection of past medical history for a client who is admitted for cellulitis.
, B. Recording the output for a client who just urinated in the collection container of the toilet.
C. Assisting with the delivery of the breakfast trays to the clients.
D. Development of a plan of care for a client who is postoperative from a cholecystitis.
ANSWER: A
Rationale:
Option A is correct because LPN/VNs can collect data and past medical history on stable clients. This is
within their scope of practice as they can gather information and report findings to the RN.
www.ncbi.nlm.nih.gov
Option B is incorrect because this task (recording urine output) can be delegated to UAP. It is a routine
task that does not require LPN-level skills. Using an LPN for this would be an inappropriate use of
resources.
Option C is incorrect because delivering breakfast trays is a non-nursing task that can be performed by
UAP or even dietary staff. This does not require LPN education or licensure.
Option D is incorrect because development of a plan of care requires nursing judgment, critical thinking,
and the nursing process, which cannot be delegated to an LPN/VN. This is the responsibility of the RN.
www.nasn.org
Question 6
The nurse working in the emergency department (ED) has been made aware of the following client
situations. Which client information requires reporting by the nurse to an outside agency?
A. 18-year-old female who has abdominal pain and is 4 months pregnant.
B. 27-year-old who has a history of gonorrhea and chlamydia infection from 1 year ago.
C. 45-year-old who was involved in a local factory fire and has 50% total body surface area (TBSA) burns.
D. 72-year-old who lives with their daughter and has several pressure ulcers (stage 3).
ANSWER: D
Rationale:
Option A is incorrect because an 18-year-old is a legal adult, and pregnancy alone does not require
reporting to outside agencies. The patient can make their own healthcare decisions.
Option B is incorrect because a history of STIs from 1 year ago that have been treated does not require
reporting. Only current, active cases of certain communicable diseases require reporting to health
departments.
Option C is incorrect because while this is a serious injury requiring specialized care, a factory fire injury
does not automatically require reporting to outside agencies unless there are suspicious circumstances.
2026 Edition -Questions with Detailed
Rationales
Question 1
The nurse working in a mental health unit is caring for a client who is scheduled to have
electroconvulsive therapy (ECT) treatment the next day. The client asks, "Can I refuse the ECT treatment
tomorrow?" Which of the following responses should the nurse make?
A. "You should consider discussing this decision with your family first."
B. "Having this treatment can be scary, but it is going to help you feel better."
C. "Let's talk with your doctor before you make a final decision."
D. "You have a right to refuse even though you have signed the consent."
ANSWER: D
Rationale:
Option A is incorrect because while family involvement may be helpful, this response does not address
the client's legal right to refuse treatment. The client has autonomy and does not need family
permission to refuse.
Option B is incorrect because this response is dismissive of the client's concerns and attempts to
persuade rather than inform. It does not acknowledge the client's legal right to refuse treatment.
Option C is incorrect because while discussing with the provider is appropriate, this response does not
directly ANSWER the client's question about their right to refuse. The client can refuse without
additional discussion.
Option D is correct because it accurately informs the client that informed consent is an ongoing process
and clients retain the right to withdraw consent at any time, even after signing. This respects patient
autonomy and promotes trust in the patient-provider relationship.
www.ncbi.nlm.nih.gov
Question 2
The nurse has attended a conference on informed consent. It indicates a correct understanding of the
teaching if the nurse states that informed consent:
,A. Is an agreement to receive medical treatment that can't be revoked once signed.
B. Forms must be signed when a client is competent to make an informed decision.
C. Is signed by the nurse to indicate that the client understands the procedure.
D. Is the nurse's responsibility to explain the risks, benefits, and alternative treatments.
ANSWER: B
Rationale:
Option A is incorrect because informed consent CAN be revoked at any time, even after signing. Consent
is an ongoing process, not a one-time irreversible agreement.
Option B is correct because informed consent must be obtained when the client is competent and has
the capacity to understand the information provided, weigh the risks and benefits, and make an
informed decision.
code-medical-ethics.ama-assn.org
Option C is incorrect because the nurse does not sign to indicate client understanding. The client signs
the consent form, and the healthcare provider who will perform the procedure is responsible for
obtaining informed consent.
Option D is incorrect because it is the physician's or licensed independent provider's responsibility to
explain the risks, benefits, and alternatives, not the nurse's. The nurse may witness the signature and
reinforce teaching, but the provider must obtain the consent.
www.aorn.org
Question 3
The nurse is prioritizing client care after receiving the change-of-shift report. The nurse should first plan
to see the client who:
A. Had laparoscopic surgery 12 hours ago and is reporting right shoulder pain.
B. Had a cardiac catheterization one hour ago and has been drowsy since returning from the procedure.
C. Is scheduled for an echocardiogram in one hour and is eating food brought in by a visitor.
D. Has an endoscopic retrograde cholangiopancreatography (ERCP) 1 hour ago and is reporting difficulty
swallowing.
ANSWER: D
Rationale:
Option A is incorrect because right shoulder pain after laparoscopic surgery is an expected finding due to
carbon dioxide insufflation during the procedure. This is not an emergency and can be addressed after
more urgent concerns.
,Option B is incorrect because while drowsiness after cardiac catheterization requires monitoring, it may
be expected due to sedation. However, this is less urgent than airway compromise.
Option C is incorrect because while eating before an echocardiogram may need to be addressed, this is
not life-threatening. The echocardiogram may need to be rescheduled, but this is not the priority.
Option D is correct because difficulty swallowing after ERCP could indicate airway compromise,
bleeding, or perforation. This requires immediate assessment following the ABCs (Airway, Breathing,
Circulation) priority framework.
simplenursing.com
Airway issues always take priority.
Question 4
The nurse working in the labor and delivery (L&D) unit has become aware of the following clients who
are in the second stage of labor and are being monitored with external fetal monitors. The nurse
identifies which client as a priority for follow-up?
A. The client whose cervix has dilated to 10 cm with moderately intense contractions of 40 to 50
seconds.
B. The client whose fetal heart rate (FHR) remains consistent at 132 beats per minute.
C. The client whose bloody show is dark red with active pushing.
D. The client whose contractions are lasting 60 seconds with a 3-minute interval.
ANSWER: C
Rationale:
Option A is incorrect because 10 cm dilation with moderate contractions of 40-50 seconds is normal for
the second stage of labor. This is expected progress.
Option B is incorrect because a fetal heart rate of 132 bpm is within the normal range of 110-160 bpm.
This indicates fetal well-being.
Option C is correct because dark red bloody show during the second stage of labor could indicate
placental abruption or other complications. Normal bloody show should be pink or light red. Dark red
blood requires immediate evaluation as it may indicate fetal or maternal compromise.
Option D is incorrect because contractions lasting 60 seconds with 3-minute intervals are within normal
parameters for active labor and the second stage. This pattern is acceptable.
Question 5
The registered nurse (RN) is planning care for clients and is assigning tasks to a licensed
practical/vocational nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Which of the following
tasks is best for the RN to assign to the LPN/VN?
A. Collection of past medical history for a client who is admitted for cellulitis.
, B. Recording the output for a client who just urinated in the collection container of the toilet.
C. Assisting with the delivery of the breakfast trays to the clients.
D. Development of a plan of care for a client who is postoperative from a cholecystitis.
ANSWER: A
Rationale:
Option A is correct because LPN/VNs can collect data and past medical history on stable clients. This is
within their scope of practice as they can gather information and report findings to the RN.
www.ncbi.nlm.nih.gov
Option B is incorrect because this task (recording urine output) can be delegated to UAP. It is a routine
task that does not require LPN-level skills. Using an LPN for this would be an inappropriate use of
resources.
Option C is incorrect because delivering breakfast trays is a non-nursing task that can be performed by
UAP or even dietary staff. This does not require LPN education or licensure.
Option D is incorrect because development of a plan of care requires nursing judgment, critical thinking,
and the nursing process, which cannot be delegated to an LPN/VN. This is the responsibility of the RN.
www.nasn.org
Question 6
The nurse working in the emergency department (ED) has been made aware of the following client
situations. Which client information requires reporting by the nurse to an outside agency?
A. 18-year-old female who has abdominal pain and is 4 months pregnant.
B. 27-year-old who has a history of gonorrhea and chlamydia infection from 1 year ago.
C. 45-year-old who was involved in a local factory fire and has 50% total body surface area (TBSA) burns.
D. 72-year-old who lives with their daughter and has several pressure ulcers (stage 3).
ANSWER: D
Rationale:
Option A is incorrect because an 18-year-old is a legal adult, and pregnancy alone does not require
reporting to outside agencies. The patient can make their own healthcare decisions.
Option B is incorrect because a history of STIs from 1 year ago that have been treated does not require
reporting. Only current, active cases of certain communicable diseases require reporting to health
departments.
Option C is incorrect because while this is a serious injury requiring specialized care, a factory fire injury
does not automatically require reporting to outside agencies unless there are suspicious circumstances.
