NSG 3800 Actual Exams Binder 2026 – Galen College
of Nursing (U.S.) | Complete Course Review & Verified
Answers | Comprehensive Nursing Assessment
Q001: A 67-year-old with COPD, CHF, and newly diagnosed type 2 DM is admitted with
acute hypercapnic exacerbation. While initiating BiPAP, the client becomes increasingly
agitated, pulling at the mask and shouting. ABG on arrival: pH 7.28, PaCO₂ 68 mmHg,
HCO₃⁻ 32 mEq/L, PaO₂ 54 mmHg on 4 L nasal cannula. Current SpO₂ 88 %, BP 162/94
mmHg, HR 118 beats/min, RR 26 breaths/min, tympanic temp 37.2 °C. Which nursing
action best supports safety and therapeutic effectiveness?
Options:
A. Administer lorazepam 2 mg IV push
B. Increase FiO₂ to 100 % via non-rebreather
C. Coach the client using calm, short phrases and apply soft wrist restraints if necessary
- CORRECT
D. Discontinue BiPAP and begin high-flow nasal cannula
(Correct Answer: C)
Q002: A 34-week primigravida with class III obesity and gestational hypertension on
labetalol 200 mg PO q8h arrives to L&D reporting a "splitting" frontal headache and
blurred vision for 2 h. VS: BP 174/106 mmHg, HR 92 beats/min, RR 20 breaths/min,
SpO₂ 97 % RA. Urine dipstick 3+ protein. Fetal heart tracing: baseline 150 beats/min,
moderate variability, no accelerations in 20 min, one late deceleration noted. Which
order should the nurse implement first?
Options:
A. Start magnesium sulfate 4 g IV load over 30 min - CORRECT
B. Administer betamethasone 12 mg IM
C. Obtain CBC and 24-h urine protein
D. Place indwelling urinary catheter
(Correct Answer: A)
Q003: A 4-day-old neonate born at 39 weeks presents with poor feeding, high-pitched
cry, and temperature instability. Mother had an untreated UTI at 36 weeks. Current temp
,38.7 °C (axillary), HR 184 beats/min, RR 62 breaths/min, BP 58/34 mmHg, cap refill 4 s,
glucose 38 mg/dL. IV access is attempted ×2 without success. Which immediate action
is most appropriate?
Options:
A. Obtain intraosseous access and begin D10W 10 mL/kg - CORRECT
B. Apply topical lidocaine and attempt umbilical vein catheter
C. Give acetaminophen 15 mg/kg PO
D. Draw blood cultures from heel stick
(Correct Answer: A)
Q004: A 17-year-old with sickle-cell disease vaso-occlusive crisis rates pain 9/10
despite hydromorphone PCA ( basal 0.2 mg/h, demand 0.2 mg q10 min ). Overnight
PCA use: 32 attempts, 12 deliveries. Current VS stable, O₂ sat 93 % on 2 L. Which
adjustment best demonstrates evidence-based pain management?
Options:
A. Increase basal to 0.4 mg/h
B. Increase demand dose to 0.3 mg q8 min - CORRECT
C. Switch to morphine 2 mg IV q4h PRN
D. Add ketorolac 30 mg IV q6h
(Correct Answer: B)
Q005: A 72-hour post-MI client receiving heparin 18 units/kg/h has aPTT 112 s ( control
30 s ), platelets drop from 210 k to 95 k/μL. HIT antibody positive. Which replacement
anticoagulant should the nurse prepare?
Options:
A. Bivalirudin - CORRECT
B. Enoxaparin
C. Warfarin
D. Fondaparinux 2.5 mg SC
(Correct Answer: A)
Q006: An 8-year-old with new-onset type 1 DM is learning self-injection. Parents ask if
they should draw up backup syringes for school. Which response by the nurse best
supports safe self-management?
Options:
A. "Prefilled insulin pens are safer and allowed in most schools" - CORRECT
,B. "Glass syringes can be pre-filled for 1 week if refrigerated"
C. "Only the school nurse should administer insulin"
D. "Mix insulin in one syringe to reduce injections"
(Correct Answer: A)
Q007: A 28-year-old primipara at 40 weeks requests hydrotherapy for labor pain. Cervix
5 cm/90 %/-1, fetal position LOA, membranes intact, FHR category I. Which criterion
must be met for safe immersion?
Options:
A. Baseline fetal heart rate 110–160 with variability present - CORRECT
B. rupture of membranes
C. Epidural catheter in place
D. Platelet count ≥ 50 k/μL
(Correct Answer: A)
Q008: A 55-year-old with cirrhosis and ascites develops sudden confusion, asterixis,
and ammonia 142 µg/dL. Lactulose 30 mL q6h is prescribed. Which outcome best
indicates medication effectiveness?
Options:
A. Two soft stools daily - CORRECT
B. Serum ammonia < 50 µg/dL within 12 h
C. Clear mentation within 2 h
D. Urine output > 0.5 mL/kg/h
(Correct Answer: A)
Q009: A 15-year-old with anorexia nervosa (BMI 15) refuses breakfast, stating, "I'm too
fat to eat." Which nursing statement best supports therapeutic communication?
Options:
A. "You are not fat; you are underweight"
B. "Let's explore what 'fat' means to you" - CORRECT
C. "If you don't eat, you will get an NG tube"
D. "I weigh more than you and I eat"
(Correct Answer: B)
, Q010: A 6-week-old with bronchopulmonary dysplasia is discharged home on 0.25
L/min nasal cannula O₂. Parents ask about traveling by car for 3 h. Which instruction is
priority?
Options:
A. "Keep oxygen tubing away from cigarette smoke" - CORRECT
B. "Increase flow to 0.5 L/min during travel"
C. "Lay the infant flat to prevent reflux"
D. "Turn oxygen off every 30 min to conserve"
(Correct Answer: A)
Q011: A 62-year-old with heart failure (EF 30 %) and ICD receives furosemide 80 mg IV
q12h. Morning labs: K 3.1 mEq/L, Mg 1.4 mg/dL, creatinine 1.6 mg/dL (baseline 1.1).
Which action should the nurse take first?
Options:
A. Hold furosemide and give potassium 40 mEq PO
B. Administer furosemide with potassium 20 mEq IV and magnesium sulfate 2 g IV -
CORRECT
C. Switch to bumetanide 2 mg PO
D. Call physician to request ACE inhibitor hold
(Correct Answer: B)
Q012: A 78-year-old with advanced Parkinson’s disease experiences "on-off"
phenomenon. During "off" periods, the client is rigid, drooling, and unable to initiate
swallowing. Which nursing intervention best supports nutrition?
Options:
A. Provide pureed foods during "off" periods and schedule meds 30 min before meals -
CORRECT
B. Offer thin liquids to prevent aspiration
C. Feed client only during "on" periods regardless of medication schedule
D. Insert NG tube for all nutrition
(Correct Answer: A)
Q013: A 32-week twin gestation presents with active labor. Twin A is cephalic, twin B is
transverse. Cervix 8 cm/100 %/0. FHR category I for both. Which nursing action is
priority?
Options:
of Nursing (U.S.) | Complete Course Review & Verified
Answers | Comprehensive Nursing Assessment
Q001: A 67-year-old with COPD, CHF, and newly diagnosed type 2 DM is admitted with
acute hypercapnic exacerbation. While initiating BiPAP, the client becomes increasingly
agitated, pulling at the mask and shouting. ABG on arrival: pH 7.28, PaCO₂ 68 mmHg,
HCO₃⁻ 32 mEq/L, PaO₂ 54 mmHg on 4 L nasal cannula. Current SpO₂ 88 %, BP 162/94
mmHg, HR 118 beats/min, RR 26 breaths/min, tympanic temp 37.2 °C. Which nursing
action best supports safety and therapeutic effectiveness?
Options:
A. Administer lorazepam 2 mg IV push
B. Increase FiO₂ to 100 % via non-rebreather
C. Coach the client using calm, short phrases and apply soft wrist restraints if necessary
- CORRECT
D. Discontinue BiPAP and begin high-flow nasal cannula
(Correct Answer: C)
Q002: A 34-week primigravida with class III obesity and gestational hypertension on
labetalol 200 mg PO q8h arrives to L&D reporting a "splitting" frontal headache and
blurred vision for 2 h. VS: BP 174/106 mmHg, HR 92 beats/min, RR 20 breaths/min,
SpO₂ 97 % RA. Urine dipstick 3+ protein. Fetal heart tracing: baseline 150 beats/min,
moderate variability, no accelerations in 20 min, one late deceleration noted. Which
order should the nurse implement first?
Options:
A. Start magnesium sulfate 4 g IV load over 30 min - CORRECT
B. Administer betamethasone 12 mg IM
C. Obtain CBC and 24-h urine protein
D. Place indwelling urinary catheter
(Correct Answer: A)
Q003: A 4-day-old neonate born at 39 weeks presents with poor feeding, high-pitched
cry, and temperature instability. Mother had an untreated UTI at 36 weeks. Current temp
,38.7 °C (axillary), HR 184 beats/min, RR 62 breaths/min, BP 58/34 mmHg, cap refill 4 s,
glucose 38 mg/dL. IV access is attempted ×2 without success. Which immediate action
is most appropriate?
Options:
A. Obtain intraosseous access and begin D10W 10 mL/kg - CORRECT
B. Apply topical lidocaine and attempt umbilical vein catheter
C. Give acetaminophen 15 mg/kg PO
D. Draw blood cultures from heel stick
(Correct Answer: A)
Q004: A 17-year-old with sickle-cell disease vaso-occlusive crisis rates pain 9/10
despite hydromorphone PCA ( basal 0.2 mg/h, demand 0.2 mg q10 min ). Overnight
PCA use: 32 attempts, 12 deliveries. Current VS stable, O₂ sat 93 % on 2 L. Which
adjustment best demonstrates evidence-based pain management?
Options:
A. Increase basal to 0.4 mg/h
B. Increase demand dose to 0.3 mg q8 min - CORRECT
C. Switch to morphine 2 mg IV q4h PRN
D. Add ketorolac 30 mg IV q6h
(Correct Answer: B)
Q005: A 72-hour post-MI client receiving heparin 18 units/kg/h has aPTT 112 s ( control
30 s ), platelets drop from 210 k to 95 k/μL. HIT antibody positive. Which replacement
anticoagulant should the nurse prepare?
Options:
A. Bivalirudin - CORRECT
B. Enoxaparin
C. Warfarin
D. Fondaparinux 2.5 mg SC
(Correct Answer: A)
Q006: An 8-year-old with new-onset type 1 DM is learning self-injection. Parents ask if
they should draw up backup syringes for school. Which response by the nurse best
supports safe self-management?
Options:
A. "Prefilled insulin pens are safer and allowed in most schools" - CORRECT
,B. "Glass syringes can be pre-filled for 1 week if refrigerated"
C. "Only the school nurse should administer insulin"
D. "Mix insulin in one syringe to reduce injections"
(Correct Answer: A)
Q007: A 28-year-old primipara at 40 weeks requests hydrotherapy for labor pain. Cervix
5 cm/90 %/-1, fetal position LOA, membranes intact, FHR category I. Which criterion
must be met for safe immersion?
Options:
A. Baseline fetal heart rate 110–160 with variability present - CORRECT
B. rupture of membranes
C. Epidural catheter in place
D. Platelet count ≥ 50 k/μL
(Correct Answer: A)
Q008: A 55-year-old with cirrhosis and ascites develops sudden confusion, asterixis,
and ammonia 142 µg/dL. Lactulose 30 mL q6h is prescribed. Which outcome best
indicates medication effectiveness?
Options:
A. Two soft stools daily - CORRECT
B. Serum ammonia < 50 µg/dL within 12 h
C. Clear mentation within 2 h
D. Urine output > 0.5 mL/kg/h
(Correct Answer: A)
Q009: A 15-year-old with anorexia nervosa (BMI 15) refuses breakfast, stating, "I'm too
fat to eat." Which nursing statement best supports therapeutic communication?
Options:
A. "You are not fat; you are underweight"
B. "Let's explore what 'fat' means to you" - CORRECT
C. "If you don't eat, you will get an NG tube"
D. "I weigh more than you and I eat"
(Correct Answer: B)
, Q010: A 6-week-old with bronchopulmonary dysplasia is discharged home on 0.25
L/min nasal cannula O₂. Parents ask about traveling by car for 3 h. Which instruction is
priority?
Options:
A. "Keep oxygen tubing away from cigarette smoke" - CORRECT
B. "Increase flow to 0.5 L/min during travel"
C. "Lay the infant flat to prevent reflux"
D. "Turn oxygen off every 30 min to conserve"
(Correct Answer: A)
Q011: A 62-year-old with heart failure (EF 30 %) and ICD receives furosemide 80 mg IV
q12h. Morning labs: K 3.1 mEq/L, Mg 1.4 mg/dL, creatinine 1.6 mg/dL (baseline 1.1).
Which action should the nurse take first?
Options:
A. Hold furosemide and give potassium 40 mEq PO
B. Administer furosemide with potassium 20 mEq IV and magnesium sulfate 2 g IV -
CORRECT
C. Switch to bumetanide 2 mg PO
D. Call physician to request ACE inhibitor hold
(Correct Answer: B)
Q012: A 78-year-old with advanced Parkinson’s disease experiences "on-off"
phenomenon. During "off" periods, the client is rigid, drooling, and unable to initiate
swallowing. Which nursing intervention best supports nutrition?
Options:
A. Provide pureed foods during "off" periods and schedule meds 30 min before meals -
CORRECT
B. Offer thin liquids to prevent aspiration
C. Feed client only during "on" periods regardless of medication schedule
D. Insert NG tube for all nutrition
(Correct Answer: A)
Q013: A 32-week twin gestation presents with active labor. Twin A is cephalic, twin B is
transverse. Cervix 8 cm/100 %/0. FHR category I for both. Which nursing action is
priority?
Options:
