NSG 4800 COMPREHENSIVE EXAM 2026
Practice Questions with Complete
Rationales
1. A nurse is caring for a client who is 2 hours postoperative following a total hip arthroplasty. Which
finding requires immediate intervention?
a. The client reports pain at a level of 6 on a scale of 0 to 10.
b. The client's operative leg appears 2 cm shorter than the non-operative leg.
c. The client has not voided since returning from the recovery room.
d. The client's dressing has a small amount of serosanguinous drainage.
ANSWER: B
Rationale:
Option A: Pain level of 6 is expected after major orthopedic surgery and should be managed with
analgesics, but it is not an immediate emergency requiring urgent intervention.
Option B: A leg that appears shorter after total hip arthroplasty indicates possible dislocation of the
prosthesis, which is a surgical emergency requiring immediate notification of the surgeon and
intervention to prevent complications.
Option C: Not voiding 2 hours postoperatively is concerning but not unexpected; the nurse should
continue to monitor and encourage voiding, but this is not an immediate emergency.
Option D: Small amount of serosanguinous drainage is an expected finding in the immediate
postoperative period and does not require immediate intervention.
2. The nurse is assessing four clients. Which client should the nurse see first?
a. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL.
b. A client with chronic obstructive pulmonary disease (COPD) who has an oxygen saturation of 89%.
c. A client with heart failure who has +2 pitting edema in the lower extremities.
d. A client with pneumonia who has a temperature of 100.4°F (38°C).
,ANSWER: B
Rationale:
Option A: A blood glucose of 180 mg/dL is elevated but not in a critical range requiring immediate
intervention; this can be addressed after more urgent situations.
Option B: An oxygen saturation of 89% in a client with COPD indicates hypoxemia and respiratory
compromise, which takes priority according to the ABCs (airway, breathing, circulation) and requires
immediate assessment and intervention.
Option C: +2 pitting edema is an expected finding in heart failure and, while it should be monitored, it
does not indicate an immediate life-threatening situation.
Option D: A temperature of 100.4°F is a low-grade fever that is expected with pneumonia and does not
require immediate intervention over respiratory compromise.
3. A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
a. Assessing the vital signs of a client who just returned from surgery.
b. Teaching a client how to use an incentive spirometer.
c. Obtaining a routine blood pressure on a stable client.
d. Evaluating the effectiveness of pain medication.
ANSWER: C
Rationale:
Option A: Assessing vital signs of a postoperative client requires nursing judgment to interpret findings
and identify complications; this assessment should be performed by the nurse, not delegated to UAP.
Option B: Teaching is a nursing responsibility that requires professional knowledge and cannot be
delegated to unlicensed personnel.
Option C: Obtaining routine vital signs on a stable client is an appropriate task to delegate to UAP as it is
a routine, standardized procedure that does not require nursing judgment.
Option D: Evaluation of medication effectiveness requires nursing assessment and clinical judgment and
cannot be delegated to UAP.
4. The nurse is caring for a client receiving heparin infusion. The activated partial thromboplastin time
(aPTT) is 98 seconds. What is the priority action?
a. Continue the infusion as prescribed.
b. Increase the infusion rate.
c. Stop the infusion and notify the provider.
d. Administer vitamin K.
,ANSWER: C
Rationale:
Option A: Continuing the infusion with an aPTT of 98 seconds is unsafe as this value is significantly above
the therapeutic range (usually 1.5-2.5 times normal, approximately 46-80 seconds), placing the client at
high risk for bleeding.
Option B: Increasing the infusion rate would further elevate the aPTT and increase bleeding risk; this is
contraindicated.
Option C: An aPTT of 98 seconds indicates excessive anticoagulation and high bleeding risk; the infusion
should be stopped immediately and the provider notified for further orders, which may include holding
heparin or administering protamine sulfate.
Option D: Vitamin K is the antidote for warfarin, not heparin; protamine sulfate is the antidote for
heparin overdose.
5. A nurse is caring for an infant with respiratory syncytial virus (RSV). Which precaution should the
nurse implement?
a. Airborne precautions.
b. Droplet precautions.
c. Contact precautions.
d. Standard precautions only.
ANSWER: C
Rationale:
Option A: Airborne precautions are used for diseases transmitted through small particles that remain
suspended in the air (e.g., tuberculosis, measles, varicella); RSV is not transmitted this way.
Option B: Droplet precautions are used for diseases transmitted through large droplets from coughing,
sneezing, or talking (e.g., influenza, pertussis, meningitis); while RSV can spread through droplets,
contact precautions are the primary precaution.
Option C: Contact precautions are required for RSV because the virus is primarily transmitted through
direct contact with contaminated secretions or surfaces; this includes wearing gloves and gown, and
using dedicated equipment.
Option D: Standard precautions alone are insufficient for RSV; contact precautions must be added to
prevent transmission to other vulnerable patients.
6. The nurse is reviewing laboratory results for a client with liver cirrhosis. Which finding should the
nurse report to the provider immediately?
a. Albumin 3.0 g/dL.
b. Ammonia 85 mcg/dL.
, c. Prothrombin time (PT) 18 seconds.
d. Platelet count 75,000/mm³.
ANSWER: B
Rationale:
Option A: Albumin of 3.0 g/dL is low (normal 3.5-5.0 g/dL) and expected in cirrhosis due to decreased
liver synthesis, but it is not an immediate emergency.
Option B: Ammonia level of 85 mcg/dL is elevated (normal 15-45 mcg/dL) and indicates risk for hepatic
encephalopathy, a serious complication that requires immediate intervention to prevent neurological
deterioration.
Option C: PT of 18 seconds is prolonged (normal 11-12.5 seconds) and expected in cirrhosis due to
decreased clotting factor production, but it is not as immediately life-threatening as elevated ammonia.
Option D: Platelet count of 75,000/mm³ is low (normal 150,000-400,000/mm³) due to splenic
sequestration in cirrhosis, but it is not an immediate emergency requiring urgent reporting.
7. A nurse is caring for a client who is experiencing an acute asthma attack. Which medication should
the nurse administer first?
a. Intravenous methylprednisolone.
b. Inhaled albuterol.
c. Oral montelukast.
d. Subcutaneous omalizumab.
ANSWER: B
Rationale:
Option A: Intravenous methylprednisolone is a corticosteroid that reduces inflammation but has a
delayed onset; it is important for acute asthma but not the first medication to administer.
Option B: Inhaled albuterol is a rapid-acting beta-2 agonist bronchodilator that provides immediate
relief of bronchospasm and is the first-line treatment for acute asthma exacerbations.
Option C: Oral montelukast is a leukotriene modifier used for long-term asthma control, not for acute
exacerbations; it has no role in immediate treatment.
Option D: Subcutaneous omalizumab is a monoclonal antibody used for long-term management of
moderate to severe allergic asthma, not for acute attacks.
8. The nurse is assessing a client with suspected appendicitis. Which finding would the nurse expect?
a. Pain in the left lower quadrant.
b. Rebound tenderness at McBurney's point.
Practice Questions with Complete
Rationales
1. A nurse is caring for a client who is 2 hours postoperative following a total hip arthroplasty. Which
finding requires immediate intervention?
a. The client reports pain at a level of 6 on a scale of 0 to 10.
b. The client's operative leg appears 2 cm shorter than the non-operative leg.
c. The client has not voided since returning from the recovery room.
d. The client's dressing has a small amount of serosanguinous drainage.
ANSWER: B
Rationale:
Option A: Pain level of 6 is expected after major orthopedic surgery and should be managed with
analgesics, but it is not an immediate emergency requiring urgent intervention.
Option B: A leg that appears shorter after total hip arthroplasty indicates possible dislocation of the
prosthesis, which is a surgical emergency requiring immediate notification of the surgeon and
intervention to prevent complications.
Option C: Not voiding 2 hours postoperatively is concerning but not unexpected; the nurse should
continue to monitor and encourage voiding, but this is not an immediate emergency.
Option D: Small amount of serosanguinous drainage is an expected finding in the immediate
postoperative period and does not require immediate intervention.
2. The nurse is assessing four clients. Which client should the nurse see first?
a. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL.
b. A client with chronic obstructive pulmonary disease (COPD) who has an oxygen saturation of 89%.
c. A client with heart failure who has +2 pitting edema in the lower extremities.
d. A client with pneumonia who has a temperature of 100.4°F (38°C).
,ANSWER: B
Rationale:
Option A: A blood glucose of 180 mg/dL is elevated but not in a critical range requiring immediate
intervention; this can be addressed after more urgent situations.
Option B: An oxygen saturation of 89% in a client with COPD indicates hypoxemia and respiratory
compromise, which takes priority according to the ABCs (airway, breathing, circulation) and requires
immediate assessment and intervention.
Option C: +2 pitting edema is an expected finding in heart failure and, while it should be monitored, it
does not indicate an immediate life-threatening situation.
Option D: A temperature of 100.4°F is a low-grade fever that is expected with pneumonia and does not
require immediate intervention over respiratory compromise.
3. A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
a. Assessing the vital signs of a client who just returned from surgery.
b. Teaching a client how to use an incentive spirometer.
c. Obtaining a routine blood pressure on a stable client.
d. Evaluating the effectiveness of pain medication.
ANSWER: C
Rationale:
Option A: Assessing vital signs of a postoperative client requires nursing judgment to interpret findings
and identify complications; this assessment should be performed by the nurse, not delegated to UAP.
Option B: Teaching is a nursing responsibility that requires professional knowledge and cannot be
delegated to unlicensed personnel.
Option C: Obtaining routine vital signs on a stable client is an appropriate task to delegate to UAP as it is
a routine, standardized procedure that does not require nursing judgment.
Option D: Evaluation of medication effectiveness requires nursing assessment and clinical judgment and
cannot be delegated to UAP.
4. The nurse is caring for a client receiving heparin infusion. The activated partial thromboplastin time
(aPTT) is 98 seconds. What is the priority action?
a. Continue the infusion as prescribed.
b. Increase the infusion rate.
c. Stop the infusion and notify the provider.
d. Administer vitamin K.
,ANSWER: C
Rationale:
Option A: Continuing the infusion with an aPTT of 98 seconds is unsafe as this value is significantly above
the therapeutic range (usually 1.5-2.5 times normal, approximately 46-80 seconds), placing the client at
high risk for bleeding.
Option B: Increasing the infusion rate would further elevate the aPTT and increase bleeding risk; this is
contraindicated.
Option C: An aPTT of 98 seconds indicates excessive anticoagulation and high bleeding risk; the infusion
should be stopped immediately and the provider notified for further orders, which may include holding
heparin or administering protamine sulfate.
Option D: Vitamin K is the antidote for warfarin, not heparin; protamine sulfate is the antidote for
heparin overdose.
5. A nurse is caring for an infant with respiratory syncytial virus (RSV). Which precaution should the
nurse implement?
a. Airborne precautions.
b. Droplet precautions.
c. Contact precautions.
d. Standard precautions only.
ANSWER: C
Rationale:
Option A: Airborne precautions are used for diseases transmitted through small particles that remain
suspended in the air (e.g., tuberculosis, measles, varicella); RSV is not transmitted this way.
Option B: Droplet precautions are used for diseases transmitted through large droplets from coughing,
sneezing, or talking (e.g., influenza, pertussis, meningitis); while RSV can spread through droplets,
contact precautions are the primary precaution.
Option C: Contact precautions are required for RSV because the virus is primarily transmitted through
direct contact with contaminated secretions or surfaces; this includes wearing gloves and gown, and
using dedicated equipment.
Option D: Standard precautions alone are insufficient for RSV; contact precautions must be added to
prevent transmission to other vulnerable patients.
6. The nurse is reviewing laboratory results for a client with liver cirrhosis. Which finding should the
nurse report to the provider immediately?
a. Albumin 3.0 g/dL.
b. Ammonia 85 mcg/dL.
, c. Prothrombin time (PT) 18 seconds.
d. Platelet count 75,000/mm³.
ANSWER: B
Rationale:
Option A: Albumin of 3.0 g/dL is low (normal 3.5-5.0 g/dL) and expected in cirrhosis due to decreased
liver synthesis, but it is not an immediate emergency.
Option B: Ammonia level of 85 mcg/dL is elevated (normal 15-45 mcg/dL) and indicates risk for hepatic
encephalopathy, a serious complication that requires immediate intervention to prevent neurological
deterioration.
Option C: PT of 18 seconds is prolonged (normal 11-12.5 seconds) and expected in cirrhosis due to
decreased clotting factor production, but it is not as immediately life-threatening as elevated ammonia.
Option D: Platelet count of 75,000/mm³ is low (normal 150,000-400,000/mm³) due to splenic
sequestration in cirrhosis, but it is not an immediate emergency requiring urgent reporting.
7. A nurse is caring for a client who is experiencing an acute asthma attack. Which medication should
the nurse administer first?
a. Intravenous methylprednisolone.
b. Inhaled albuterol.
c. Oral montelukast.
d. Subcutaneous omalizumab.
ANSWER: B
Rationale:
Option A: Intravenous methylprednisolone is a corticosteroid that reduces inflammation but has a
delayed onset; it is important for acute asthma but not the first medication to administer.
Option B: Inhaled albuterol is a rapid-acting beta-2 agonist bronchodilator that provides immediate
relief of bronchospasm and is the first-line treatment for acute asthma exacerbations.
Option C: Oral montelukast is a leukotriene modifier used for long-term asthma control, not for acute
exacerbations; it has no role in immediate treatment.
Option D: Subcutaneous omalizumab is a monoclonal antibody used for long-term management of
moderate to severe allergic asthma, not for acute attacks.
8. The nurse is assessing a client with suspected appendicitis. Which finding would the nurse expect?
a. Pain in the left lower quadrant.
b. Rebound tenderness at McBurney's point.
