NSG 4800 COMPREHENSIVE EXAMINATION
2026
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."
Rationale: This response does not directly address the client's right to refuse treatment. While family
support is important, the client's autonomy should be prioritized, and this response may imply the client
needs permission from family to make a healthcare decision.
b. "Having this treatment can be scary, but it is going to help you feel better."
Rationale: This response dismisses the client's valid question and provides false reassurance. The nurse
cannot guarantee the treatment will help, and this response fails to acknowledge the client's legal right
to refuse treatment.
c. "Let's talk with your doctor before you make a final decision."
Rationale: While involving the healthcare provider is appropriate, this response does not directly answer
the client's question about their right to refuse. The client has already made a decision and is seeking
validation of their rights.
d. "You have a right to refuse even though you have signed the consent."
,Rationale: ANSWER. This response appropriately acknowledges the client's legal right to withdraw
consent at any time, even after signing the consent form. It respects client autonomy and provides
accurate information about their rights. Clients have the right to refuse treatment at any point, and
informed consent can be withdrawn.
2. The nurse has attended a conference on informed consent. It indicates a ANSWER 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.
Rationale: This statement is inANSWER. Informed consent can be revoked at any time by the client, even
after signing. Consent is an ongoing process, not a one-time irreversible agreement.
b. forms must be signed when a client is competent to make an informed decision.
Rationale: ANSWER. Informed consent requires that the client be competent to make decisions and
understand the information provided. The consent form must be signed when the client demonstrates
capacity to understand the procedure, risks, benefits, and alternatives.
c. is signed by the nurse to indicate that the client understands the procedure.
Rationale: This is inANSWER. The nurse may witness the client's signature, but the nurse's signature
indicates that the client signed the form, not that the nurse confirms the client's understanding. The
healthcare provider performing the procedure is responsible for explaining the procedure and obtaining
consent.
d. is the nurse's responsibility to explain the risks, benefits, and alternative treatments.
Rationale: This is inANSWER. While the nurse may reinforce information and clarify questions, the
primary responsibility for explaining risks, benefits, and alternatives lies with the healthcare provider
performing the procedure or treatment.
,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.
Rationale: Right shoulder pain after laparoscopic surgery is a common expected finding due to
diaphragmatic irritation from carbon dioxide used during the procedure. While this requires assessment,
it is not the most urgent priority compared to other clients.
b. had a cardiac catheterization one hour ago and has been drowsy since returning from the procedure.
Rationale: Drowsiness after cardiac catheterization may be related to sedation or pain medications, but
it could also indicate complications such as stroke, hypotension, or hypoxia. However, another client has
a more immediately life-threatening concern.
c. is scheduled for an echocardiogram in one hour and is eating food brought in by a visitor.
Rationale: Eating before an echocardiogram is generally not contraindicated unless specified. This
situation requires education but is not the highest priority for immediate assessment.
d. had an endoscopic retrograde cholangiopancreatography (ERCP) 1 hour ago and is reporting difficulty
swallowing.
Rationale: ANSWER. Difficulty swallowing after ERCP is a priority concern that may indicate esophageal
perforation, a serious complication. This requires immediate assessment and intervention, as
perforation can lead to mediastinitis, sepsis, and death. The nurse should assess the client immediately
and notify the healthcare provider.
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.
Rationale: This describes normal progress in the second stage of labor. Complete cervical dilation (10
cm) with moderate contractions of appropriate duration (40-50 seconds) is expected and does not
indicate an urgent problem.
b. The client whose fetal heart rate (FHR) remains consistent at 132 beats per minute.
Rationale: A fetal heart rate of 132 beats per minute is within the normal range of 110-160 beats per
minute. A consistent, reassuring fetal heart rate pattern does not indicate an urgent concern.
c. The client whose bloody show is dark red with active pushing.
Rationale: ANSWER. Dark red bloody show during active pushing in the second stage of labor may
indicate placental abruption, which is an emergency. Placental abruption can lead to fetal distress,
hemorrhage, and maternal complications. This requires immediate assessment and intervention.
d. The client whose contractions are lasting 60 seconds with a 3-minute interval.
Rationale: Contractions lasting 60 seconds with a 3-minute interval are within normal parameters for
the second stage of labor. This pattern indicates effective uterine activity and does not represent an
urgent concern.
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.
Rationale: Collection of past medical history requires comprehensive assessment and clinical judgment
that falls within the RN's scope of practice. This task is not appropriate to delegate to an LPN/VN.
2026
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."
Rationale: This response does not directly address the client's right to refuse treatment. While family
support is important, the client's autonomy should be prioritized, and this response may imply the client
needs permission from family to make a healthcare decision.
b. "Having this treatment can be scary, but it is going to help you feel better."
Rationale: This response dismisses the client's valid question and provides false reassurance. The nurse
cannot guarantee the treatment will help, and this response fails to acknowledge the client's legal right
to refuse treatment.
c. "Let's talk with your doctor before you make a final decision."
Rationale: While involving the healthcare provider is appropriate, this response does not directly answer
the client's question about their right to refuse. The client has already made a decision and is seeking
validation of their rights.
d. "You have a right to refuse even though you have signed the consent."
,Rationale: ANSWER. This response appropriately acknowledges the client's legal right to withdraw
consent at any time, even after signing the consent form. It respects client autonomy and provides
accurate information about their rights. Clients have the right to refuse treatment at any point, and
informed consent can be withdrawn.
2. The nurse has attended a conference on informed consent. It indicates a ANSWER 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.
Rationale: This statement is inANSWER. Informed consent can be revoked at any time by the client, even
after signing. Consent is an ongoing process, not a one-time irreversible agreement.
b. forms must be signed when a client is competent to make an informed decision.
Rationale: ANSWER. Informed consent requires that the client be competent to make decisions and
understand the information provided. The consent form must be signed when the client demonstrates
capacity to understand the procedure, risks, benefits, and alternatives.
c. is signed by the nurse to indicate that the client understands the procedure.
Rationale: This is inANSWER. The nurse may witness the client's signature, but the nurse's signature
indicates that the client signed the form, not that the nurse confirms the client's understanding. The
healthcare provider performing the procedure is responsible for explaining the procedure and obtaining
consent.
d. is the nurse's responsibility to explain the risks, benefits, and alternative treatments.
Rationale: This is inANSWER. While the nurse may reinforce information and clarify questions, the
primary responsibility for explaining risks, benefits, and alternatives lies with the healthcare provider
performing the procedure or treatment.
,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.
Rationale: Right shoulder pain after laparoscopic surgery is a common expected finding due to
diaphragmatic irritation from carbon dioxide used during the procedure. While this requires assessment,
it is not the most urgent priority compared to other clients.
b. had a cardiac catheterization one hour ago and has been drowsy since returning from the procedure.
Rationale: Drowsiness after cardiac catheterization may be related to sedation or pain medications, but
it could also indicate complications such as stroke, hypotension, or hypoxia. However, another client has
a more immediately life-threatening concern.
c. is scheduled for an echocardiogram in one hour and is eating food brought in by a visitor.
Rationale: Eating before an echocardiogram is generally not contraindicated unless specified. This
situation requires education but is not the highest priority for immediate assessment.
d. had an endoscopic retrograde cholangiopancreatography (ERCP) 1 hour ago and is reporting difficulty
swallowing.
Rationale: ANSWER. Difficulty swallowing after ERCP is a priority concern that may indicate esophageal
perforation, a serious complication. This requires immediate assessment and intervention, as
perforation can lead to mediastinitis, sepsis, and death. The nurse should assess the client immediately
and notify the healthcare provider.
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.
Rationale: This describes normal progress in the second stage of labor. Complete cervical dilation (10
cm) with moderate contractions of appropriate duration (40-50 seconds) is expected and does not
indicate an urgent problem.
b. The client whose fetal heart rate (FHR) remains consistent at 132 beats per minute.
Rationale: A fetal heart rate of 132 beats per minute is within the normal range of 110-160 beats per
minute. A consistent, reassuring fetal heart rate pattern does not indicate an urgent concern.
c. The client whose bloody show is dark red with active pushing.
Rationale: ANSWER. Dark red bloody show during active pushing in the second stage of labor may
indicate placental abruption, which is an emergency. Placental abruption can lead to fetal distress,
hemorrhage, and maternal complications. This requires immediate assessment and intervention.
d. The client whose contractions are lasting 60 seconds with a 3-minute interval.
Rationale: Contractions lasting 60 seconds with a 3-minute interval are within normal parameters for
the second stage of labor. This pattern indicates effective uterine activity and does not represent an
urgent concern.
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.
Rationale: Collection of past medical history requires comprehensive assessment and clinical judgment
that falls within the RN's scope of practice. This task is not appropriate to delegate to an LPN/VN.
