NSG 4800 Comprehensive Exam
Questions with ANSWERs and Rationales 2026
1. The nurse has been made aware of the following client situations. It is necessary for the nurse to
initially assess the client who has:
A. Diabetes mellitus (type 1), is difficult to arouse, and has a blood glucose of 38 mg/dL
B. A urinary tract infection (UTI), is receiving oral (PO) cephalexin, and reports urinary frequency
C. Community-acquired pneumonia (CAP), has a white blood cell (WBC) count of 18,400/mm³, and is
scheduled to receive IV vancomycin
D. Appendicitis, reports pain rated 3 on a scale of 0 (no pain) to 10 (severe pain), and needs assistance
ambulating to the bathroom
ANSWER: A
Rationale for Option A: Correct. A blood glucose of 38 mg/dL represents severe hypoglycemia requiring
immediate intervention. The client who is difficult to arouse with this glucose level is at risk for seizures,
coma, and permanent brain damage. This is a life-threatening emergency that requires immediate
assessment and treatment with IV dextrose or glucagon.
Rationale for Option B: Incorrect. While urinary frequency is a symptom of UTI, this client is stable and
receiving appropriate antibiotic therapy. This is not an emergent situation requiring immediate
assessment.
,Rationale for Option C: Incorrect. Although an elevated WBC indicates infection, the client is scheduled
to receive IV vancomycin and is stable. The elevated WBC is expected with CAP and does not represent
an immediate life-threatening emergency.
Rationale for Option D: Incorrect. Pain rated 3/10 is mild to moderate and the client needs assistance
ambulating, but this does not present an immediate safety threat. This client can wait while the nurse
addresses the hypoglycemic client.
2. The nurse has received the hand-off report and is assigning tasks to unlicensed assistive personnel
(UAP). Which of the following tasks should the nurse instruct the UAP to perform first?
A. Obtain a sputum specimen from a client who has suspected pulmonary tuberculosis (TB)
B. Turn and reposition a client who was last turned 2 hours ago
C. Deliver a lunch tray to a client who is returning from radiology and has been NPO since breakfast
D. Obtain a capillary blood glucose on a client who had a hypoglycemia episode 30 minutes ago and
received dextrose IV
ANSWER: D
Rationale for Option A: Incorrect. Obtaining a sputum specimen for suspected TB is important for
diagnosis and infection control, but it is not the priority over evaluating a client who recently
experienced hypoglycemia.
Rationale for Option B: Incorrect. Turning and repositioning every 2 hours is important to prevent skin
breakdown, but this client was just turned 2 hours ago and can wait a short period.
Rationale for Option C: Incorrect. Delivering a lunch tray is a routine task that can be delegated, but it is
not the priority over checking a client's blood glucose after a hypoglycemic episode.
,Rationale for Option D: Correct. The client who had hypoglycemia 30 minutes ago and received IV
dextrose needs immediate evaluation of blood glucose to determine if treatment was effective and to
prevent recurrent hypoglycemia. This is the priority task for the UAP to perform first.
3. The nurse working on a pediatric unit has received the hand-off report and is reviewing client data
and orders. Which of the following clients should the nurse plan to see first?
A. The toddler who has bilateral arm casts and needs to be fed their breakfast
B. The school-aged child who has diabetes mellitus (type 1) and requires blood glucose monitoring
C. The infant who has a diagnosis of pertussis and is receiving oxygen via nasal cannula
D. The adolescent who was admitted with sickle cell crisis and is being discharged home
ANSWER: C
Rationale for Option A: Incorrect. The toddler with bilateral arm casts needs assistance with feeding, but
this is a routine need that can be delayed while the nurse addresses the client with an airway concern.
Rationale for Option B: Incorrect. Blood glucose monitoring in a child with type 1 diabetes is important
and expected, but it is a routine intervention that does not take priority over airway management.
Rationale for Option C: Correct. The infant with pertussis receiving oxygen via nasal cannula has an
airway/breathing priority. Pertussis causes severe coughing spasms that can compromise oxygenation,
and the infant is already requiring oxygen supplementation. This client requires immediate assessment
to ensure airway patency and adequate oxygenation.
Rationale for Option D: Incorrect. The adolescent in sickle cell crisis being discharged is stable and
requires routine discharge teaching. This client can wait while the nurse addresses the client with
respiratory compromise.
, 4. The nurse who normally works on the maternity unit has been floated to work on an adult medical
surgical unit for the shift. It is appropriate to assign the float nurse the client who:
A. Is being discharged home and needs teaching about dressing changes to a wound
B. Is 24 hours postoperative from having an appendectomy
C. Was admitted the night before with chronic obstructive pulmonary disease (COPD)
D. Is scheduled to have an above-the-knee amputation (AKA) that morning
ANSWER: A
Rationale for Option A: Correct. A stable client being discharged with wound care teaching is
appropriate for a float nurse from a different specialty. This client is medically stable and the task of
discharge teaching with wound care is within the scope of any RN.
Rationale for Option B: Incorrect. A client 24 hours post-appendectomy requires specialized
postoperative assessment and care that may be beyond the expertise of a maternity nurse. This client is
more complex and should be assigned to a nurse familiar with surgical care.
Rationale for Option C: Incorrect. A client admitted with COPD requires respiratory assessments,
monitoring of oxygen therapy, and knowledge of COPD management that a maternity nurse may not
possess.
Rationale for Option D: Incorrect. A client scheduled for an AKA requires extensive preoperative
preparation, teaching, and psychological support that a maternity nurse is not prepared to provide.
5. The nurse preceptor is observing a newly hired nurse teach a client who has pelvic inflammatory
disease about self-care. The client does not speak English. Which of the following actions by the newly
hired nurse requires intervention by the nurse preceptor?
Questions with ANSWERs and Rationales 2026
1. The nurse has been made aware of the following client situations. It is necessary for the nurse to
initially assess the client who has:
A. Diabetes mellitus (type 1), is difficult to arouse, and has a blood glucose of 38 mg/dL
B. A urinary tract infection (UTI), is receiving oral (PO) cephalexin, and reports urinary frequency
C. Community-acquired pneumonia (CAP), has a white blood cell (WBC) count of 18,400/mm³, and is
scheduled to receive IV vancomycin
D. Appendicitis, reports pain rated 3 on a scale of 0 (no pain) to 10 (severe pain), and needs assistance
ambulating to the bathroom
ANSWER: A
Rationale for Option A: Correct. A blood glucose of 38 mg/dL represents severe hypoglycemia requiring
immediate intervention. The client who is difficult to arouse with this glucose level is at risk for seizures,
coma, and permanent brain damage. This is a life-threatening emergency that requires immediate
assessment and treatment with IV dextrose or glucagon.
Rationale for Option B: Incorrect. While urinary frequency is a symptom of UTI, this client is stable and
receiving appropriate antibiotic therapy. This is not an emergent situation requiring immediate
assessment.
,Rationale for Option C: Incorrect. Although an elevated WBC indicates infection, the client is scheduled
to receive IV vancomycin and is stable. The elevated WBC is expected with CAP and does not represent
an immediate life-threatening emergency.
Rationale for Option D: Incorrect. Pain rated 3/10 is mild to moderate and the client needs assistance
ambulating, but this does not present an immediate safety threat. This client can wait while the nurse
addresses the hypoglycemic client.
2. The nurse has received the hand-off report and is assigning tasks to unlicensed assistive personnel
(UAP). Which of the following tasks should the nurse instruct the UAP to perform first?
A. Obtain a sputum specimen from a client who has suspected pulmonary tuberculosis (TB)
B. Turn and reposition a client who was last turned 2 hours ago
C. Deliver a lunch tray to a client who is returning from radiology and has been NPO since breakfast
D. Obtain a capillary blood glucose on a client who had a hypoglycemia episode 30 minutes ago and
received dextrose IV
ANSWER: D
Rationale for Option A: Incorrect. Obtaining a sputum specimen for suspected TB is important for
diagnosis and infection control, but it is not the priority over evaluating a client who recently
experienced hypoglycemia.
Rationale for Option B: Incorrect. Turning and repositioning every 2 hours is important to prevent skin
breakdown, but this client was just turned 2 hours ago and can wait a short period.
Rationale for Option C: Incorrect. Delivering a lunch tray is a routine task that can be delegated, but it is
not the priority over checking a client's blood glucose after a hypoglycemic episode.
,Rationale for Option D: Correct. The client who had hypoglycemia 30 minutes ago and received IV
dextrose needs immediate evaluation of blood glucose to determine if treatment was effective and to
prevent recurrent hypoglycemia. This is the priority task for the UAP to perform first.
3. The nurse working on a pediatric unit has received the hand-off report and is reviewing client data
and orders. Which of the following clients should the nurse plan to see first?
A. The toddler who has bilateral arm casts and needs to be fed their breakfast
B. The school-aged child who has diabetes mellitus (type 1) and requires blood glucose monitoring
C. The infant who has a diagnosis of pertussis and is receiving oxygen via nasal cannula
D. The adolescent who was admitted with sickle cell crisis and is being discharged home
ANSWER: C
Rationale for Option A: Incorrect. The toddler with bilateral arm casts needs assistance with feeding, but
this is a routine need that can be delayed while the nurse addresses the client with an airway concern.
Rationale for Option B: Incorrect. Blood glucose monitoring in a child with type 1 diabetes is important
and expected, but it is a routine intervention that does not take priority over airway management.
Rationale for Option C: Correct. The infant with pertussis receiving oxygen via nasal cannula has an
airway/breathing priority. Pertussis causes severe coughing spasms that can compromise oxygenation,
and the infant is already requiring oxygen supplementation. This client requires immediate assessment
to ensure airway patency and adequate oxygenation.
Rationale for Option D: Incorrect. The adolescent in sickle cell crisis being discharged is stable and
requires routine discharge teaching. This client can wait while the nurse addresses the client with
respiratory compromise.
, 4. The nurse who normally works on the maternity unit has been floated to work on an adult medical
surgical unit for the shift. It is appropriate to assign the float nurse the client who:
A. Is being discharged home and needs teaching about dressing changes to a wound
B. Is 24 hours postoperative from having an appendectomy
C. Was admitted the night before with chronic obstructive pulmonary disease (COPD)
D. Is scheduled to have an above-the-knee amputation (AKA) that morning
ANSWER: A
Rationale for Option A: Correct. A stable client being discharged with wound care teaching is
appropriate for a float nurse from a different specialty. This client is medically stable and the task of
discharge teaching with wound care is within the scope of any RN.
Rationale for Option B: Incorrect. A client 24 hours post-appendectomy requires specialized
postoperative assessment and care that may be beyond the expertise of a maternity nurse. This client is
more complex and should be assigned to a nurse familiar with surgical care.
Rationale for Option C: Incorrect. A client admitted with COPD requires respiratory assessments,
monitoring of oxygen therapy, and knowledge of COPD management that a maternity nurse may not
possess.
Rationale for Option D: Incorrect. A client scheduled for an AKA requires extensive preoperative
preparation, teaching, and psychological support that a maternity nurse is not prepared to provide.
5. The nurse preceptor is observing a newly hired nurse teach a client who has pelvic inflammatory
disease about self-care. The client does not speak English. Which of the following actions by the newly
hired nurse requires intervention by the nurse preceptor?
