NSG 4800 COMPS EXAM 2 – 2026/2027
210 ORIGINAL PRACTICE QUESTIONS WITH CORRECT
ANSWERS & RATIONALES
COMPREHENSIVE NURSING REVIEW | ADVANCED CLINICAL
JUDGMENT | NCLEX-STYLE Q&A
SECTION 1 — ADVANCED MEDICAL-SURGICAL NURSING & COMPLEX
CARE
Questions 1–21
1. A patient with acute decompensated heart failure develops severe
dyspnea, crackles, and an oxygen saturation of 82%. Which action
should the nurse take first?
A. Encourage oral fluids
B. Place the patient in high-Fowler's position
C. Obtain a daily weight
D. Administer a stool softener
Correct Answer: B
Rationale: High-Fowler's positioning decreases venous return and
improves lung expansion, helping relieve acute pulmonary congestion.
2. A patient with COPD is receiving oxygen therapy. Which finding
requires the most immediate attention?
,A. Respiratory rate of 18/min
B. Oxygen saturation of 90%
C. New onset of increasing somnolence and confusion
D. Mild productive cough
Correct Answer: C
Rationale: New somnolence and confusion may indicate worsening
hypercapnia or respiratory failure.
3. Which assessment finding is most concerning in a patient with
suspected sepsis?
A. Temperature of 37.2°C
B. Capillary refill of 4 seconds with hypotension
C. Heart rate of 78/min
D. Urine output of 60 mL/hr
Correct Answer: B
Rationale: Hypotension with delayed capillary refill suggests inadequate
tissue perfusion and possible septic shock.
4. A patient with a bowel obstruction has persistent vomiting. Which
electrolyte imbalance is most likely?
A. Hypercalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hyperphosphatemia
,Correct Answer: C
Rationale: Prolonged gastrointestinal losses can cause significant
potassium depletion.
5. A patient develops sudden unilateral weakness and aphasia. What
is the nurse's priority?
A. Give oral fluids
B. Determine the exact time symptoms began
C. Place the patient in Trendelenburg position
D. Encourage ambulation
Correct Answer: B
Rationale: Determining symptom onset is critical for determining
eligibility for time-sensitive stroke interventions.
6. Which finding is characteristic of worsening renal function?
A. Increased urine output with falling creatinine
B. Rising serum creatinine and decreasing urine output
C. Decreased BUN
D. Increased glomerular filtration rate
Correct Answer: B
Rationale: Acute or progressive renal dysfunction commonly produces
rising creatinine and reduced filtration/urine production.
7. A patient with cirrhosis becomes increasingly confused and has
asterixis. Which complication should the nurse suspect?
, A. Hepatic encephalopathy
B. Acute pancreatitis
C. Diabetes insipidus
D. Nephrotic syndrome
Correct Answer: A
Rationale: Accumulation of neurotoxins such as ammonia can produce
confusion and asterixis in hepatic encephalopathy.
8. Which patient should the nurse assess first?
A. Patient with chronic arthritis reporting pain 6/10
B. Patient awaiting discharge instructions
C. Patient with new stridor after thyroid surgery
D. Patient requesting a snack
Correct Answer: C
Rationale: Stridor indicates possible upper-airway obstruction and is an
immediate airway emergency.
9. A patient receiving chemotherapy has a temperature of 38.4°C.
What is the priority concern?
A. Constipation
B. Neutropenic infection
C. Hypercalcemia
D. Fluid overload
Correct Answer: B
Rationale: Fever in a potentially neutropenic patient may represent a
life-threatening infection requiring rapid evaluation.
210 ORIGINAL PRACTICE QUESTIONS WITH CORRECT
ANSWERS & RATIONALES
COMPREHENSIVE NURSING REVIEW | ADVANCED CLINICAL
JUDGMENT | NCLEX-STYLE Q&A
SECTION 1 — ADVANCED MEDICAL-SURGICAL NURSING & COMPLEX
CARE
Questions 1–21
1. A patient with acute decompensated heart failure develops severe
dyspnea, crackles, and an oxygen saturation of 82%. Which action
should the nurse take first?
A. Encourage oral fluids
B. Place the patient in high-Fowler's position
C. Obtain a daily weight
D. Administer a stool softener
Correct Answer: B
Rationale: High-Fowler's positioning decreases venous return and
improves lung expansion, helping relieve acute pulmonary congestion.
2. A patient with COPD is receiving oxygen therapy. Which finding
requires the most immediate attention?
,A. Respiratory rate of 18/min
B. Oxygen saturation of 90%
C. New onset of increasing somnolence and confusion
D. Mild productive cough
Correct Answer: C
Rationale: New somnolence and confusion may indicate worsening
hypercapnia or respiratory failure.
3. Which assessment finding is most concerning in a patient with
suspected sepsis?
A. Temperature of 37.2°C
B. Capillary refill of 4 seconds with hypotension
C. Heart rate of 78/min
D. Urine output of 60 mL/hr
Correct Answer: B
Rationale: Hypotension with delayed capillary refill suggests inadequate
tissue perfusion and possible septic shock.
4. A patient with a bowel obstruction has persistent vomiting. Which
electrolyte imbalance is most likely?
A. Hypercalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hyperphosphatemia
,Correct Answer: C
Rationale: Prolonged gastrointestinal losses can cause significant
potassium depletion.
5. A patient develops sudden unilateral weakness and aphasia. What
is the nurse's priority?
A. Give oral fluids
B. Determine the exact time symptoms began
C. Place the patient in Trendelenburg position
D. Encourage ambulation
Correct Answer: B
Rationale: Determining symptom onset is critical for determining
eligibility for time-sensitive stroke interventions.
6. Which finding is characteristic of worsening renal function?
A. Increased urine output with falling creatinine
B. Rising serum creatinine and decreasing urine output
C. Decreased BUN
D. Increased glomerular filtration rate
Correct Answer: B
Rationale: Acute or progressive renal dysfunction commonly produces
rising creatinine and reduced filtration/urine production.
7. A patient with cirrhosis becomes increasingly confused and has
asterixis. Which complication should the nurse suspect?
, A. Hepatic encephalopathy
B. Acute pancreatitis
C. Diabetes insipidus
D. Nephrotic syndrome
Correct Answer: A
Rationale: Accumulation of neurotoxins such as ammonia can produce
confusion and asterixis in hepatic encephalopathy.
8. Which patient should the nurse assess first?
A. Patient with chronic arthritis reporting pain 6/10
B. Patient awaiting discharge instructions
C. Patient with new stridor after thyroid surgery
D. Patient requesting a snack
Correct Answer: C
Rationale: Stridor indicates possible upper-airway obstruction and is an
immediate airway emergency.
9. A patient receiving chemotherapy has a temperature of 38.4°C.
What is the priority concern?
A. Constipation
B. Neutropenic infection
C. Hypercalcemia
D. Fluid overload
Correct Answer: B
Rationale: Fever in a potentially neutropenic patient may represent a
life-threatening infection requiring rapid evaluation.
