NUR 222 TRANSITION TO PRACTICE COMPEREHENSIVE EXAM
GUIDE 2026 EDITION
1. A newly graduated nurse is preparing for the transition from student to registered nurse.
Which action best demonstrates preparation for professional identity formation?
A. Requesting to work only with experienced preceptors for the first six months
B. Participating in nurse residency programs and continuing education opportunities
C. Avoiding situations where clinical judgment is required until feeling completely
confident
D. Relying primarily on task checklists rather than developing independent decision-
making skills
Correct Answer: B
Explanation: Nurse residency programs and continuing education support professional
identity formation during the transition to practice. Options A, C, and D demonstrate
avoidance behaviors that hinder development of autonomous practice.
2. During a handoff report, a nurse notices discrepancies in the medication administration
record. According to QSEN competencies, what is the most appropriate initial action?
A. Administer the medications as ordered and document the discrepancy later
B. Contact the pharmacy immediately without verifying the orders
C. Clarify the discrepancies with the prescribing provider before administration
D. Ask a colleague to review the orders while proceeding with administration
Correct Answer: C
Explanation: Safety competency requires minimizing harm through clarification of
discrepancies before medication administration. Option A risks patient harm, B skips
verification, and D delays necessary clarification.
3. A nurse is caring for a patient with an endotracheal tube. Which assessment finding
requires immediate intervention?
A. Breath sounds equal bilaterally with saturation of 94%
B. Tube marked at 23 cm at the lips with secure taping
C. Sudden decrease in breath sounds on the right side with increased work of breathing
D. Oral care completed 90 minutes ago with moist mucous membranes
Correct Answer: C
Explanation: Decreased breath sounds on one side suggests tube displacement or
, pneumothorax requiring immediate intervention. Options A, B, and D represent normal
findings or appropriate care timing.
4. When delegating tasks to unlicensed assistive personnel (UAP), which task is most
appropriate for the nurse to delegate?
A. Assessing pain level in a postoperative patient
B. Teaching a patient about new diabetes medications
C. Obtaining vital signs on a stable patient 24 hours post-admission
D. Evaluating the effectiveness of diuretic therapy
Correct Answer: C
Explanation: UAP can obtain vital signs on stable patients; assessment, teaching, and
evaluation require RN scope. Options A, B, and D involve nursing process components
requiring licensed practice.
5. A patient with COPD is experiencing status asthmaticus. Which pharmacological agent
should the nurse anticipate administering first?
A. Systemic corticosteroids
B. Short-acting beta-adrenergic agonist
C. Leukotriene modifier
D. Theophylline
Correct Answer: B
Explanation: Short-acting beta-agonists provide immediate bronchodilation in acute
asthma exacerbations. Corticosteroids (A) take hours to work; leukotriene modifiers (C)
and theophylline (D) are not first-line for acute relief.
6. During hemodynamic monitoring, a nurse notes a central venous pressure (CVP) of 2
mmHg. What does this finding indicate?
A. Hypervolemia
B. Normal volume status
C. Hypovolemia
D. Right heart failure
Correct Answer: C
Explanation: Normal CVP is 2-8 mmHg; a reading of 2 mmHg indicates hypovolemia
requiring fluid resuscitation. Options A and D would show elevated CVP; B would be in
the middle of normal range.
, 7. A nurse is caring for a patient with a chest tube. Which finding requires immediate
notification of the provider?
A. Continuous bubbling in the water seal chamber
B. Drainage of 50 mL hour of serosanguinous fluid
C. Fluctuation of fluid in the water seal chamber with breathing
D. Intermittent bubbling in the suction control chamber
Correct Answer: A
Explanation: Continuous bubbling in the water seal chamber indicates an air leak
requiring immediate intervention. Option B is normal (<100 mL/hr initially); C is
expected; D indicates proper suction function.
8. Which nursing action best demonstrates evidence-based practice (EBP) in clinical
decision-making?
A. Following hospital policy without questioning its origin
B. Integrating current research, clinical expertise, and patient preferences
C. Using only interventions that have been standard practice for decades
D. Implementing treatments based solely on physician orders
Correct Answer: B
Explanation: EBP combines best current evidence, clinical expertise, and patient
preferences/values. Options A, C, and D ignore critical components of evidence-based
decision-making.
9. A patient with acute myocardial infarction develops ventricular tachycardia. What is the
priority nursing intervention?
A. Administer amiodarone 150 mg IV push
B. Assess pulse and prepare for defibrillation if pulseless
C. Call the rapid response team and wait for their arrival
D. Place the patient in high-Fowler's position and administer oxygen
Correct Answer: B
Explanation: Assessing pulse determines if VT is perfusing; pulseless VT requires
immediate defibrillation. A is appropriate for perfusing VT but not first priority; C delays
critical intervention; D is supportive but not definitive.
GUIDE 2026 EDITION
1. A newly graduated nurse is preparing for the transition from student to registered nurse.
Which action best demonstrates preparation for professional identity formation?
A. Requesting to work only with experienced preceptors for the first six months
B. Participating in nurse residency programs and continuing education opportunities
C. Avoiding situations where clinical judgment is required until feeling completely
confident
D. Relying primarily on task checklists rather than developing independent decision-
making skills
Correct Answer: B
Explanation: Nurse residency programs and continuing education support professional
identity formation during the transition to practice. Options A, C, and D demonstrate
avoidance behaviors that hinder development of autonomous practice.
2. During a handoff report, a nurse notices discrepancies in the medication administration
record. According to QSEN competencies, what is the most appropriate initial action?
A. Administer the medications as ordered and document the discrepancy later
B. Contact the pharmacy immediately without verifying the orders
C. Clarify the discrepancies with the prescribing provider before administration
D. Ask a colleague to review the orders while proceeding with administration
Correct Answer: C
Explanation: Safety competency requires minimizing harm through clarification of
discrepancies before medication administration. Option A risks patient harm, B skips
verification, and D delays necessary clarification.
3. A nurse is caring for a patient with an endotracheal tube. Which assessment finding
requires immediate intervention?
A. Breath sounds equal bilaterally with saturation of 94%
B. Tube marked at 23 cm at the lips with secure taping
C. Sudden decrease in breath sounds on the right side with increased work of breathing
D. Oral care completed 90 minutes ago with moist mucous membranes
Correct Answer: C
Explanation: Decreased breath sounds on one side suggests tube displacement or
, pneumothorax requiring immediate intervention. Options A, B, and D represent normal
findings or appropriate care timing.
4. When delegating tasks to unlicensed assistive personnel (UAP), which task is most
appropriate for the nurse to delegate?
A. Assessing pain level in a postoperative patient
B. Teaching a patient about new diabetes medications
C. Obtaining vital signs on a stable patient 24 hours post-admission
D. Evaluating the effectiveness of diuretic therapy
Correct Answer: C
Explanation: UAP can obtain vital signs on stable patients; assessment, teaching, and
evaluation require RN scope. Options A, B, and D involve nursing process components
requiring licensed practice.
5. A patient with COPD is experiencing status asthmaticus. Which pharmacological agent
should the nurse anticipate administering first?
A. Systemic corticosteroids
B. Short-acting beta-adrenergic agonist
C. Leukotriene modifier
D. Theophylline
Correct Answer: B
Explanation: Short-acting beta-agonists provide immediate bronchodilation in acute
asthma exacerbations. Corticosteroids (A) take hours to work; leukotriene modifiers (C)
and theophylline (D) are not first-line for acute relief.
6. During hemodynamic monitoring, a nurse notes a central venous pressure (CVP) of 2
mmHg. What does this finding indicate?
A. Hypervolemia
B. Normal volume status
C. Hypovolemia
D. Right heart failure
Correct Answer: C
Explanation: Normal CVP is 2-8 mmHg; a reading of 2 mmHg indicates hypovolemia
requiring fluid resuscitation. Options A and D would show elevated CVP; B would be in
the middle of normal range.
, 7. A nurse is caring for a patient with a chest tube. Which finding requires immediate
notification of the provider?
A. Continuous bubbling in the water seal chamber
B. Drainage of 50 mL hour of serosanguinous fluid
C. Fluctuation of fluid in the water seal chamber with breathing
D. Intermittent bubbling in the suction control chamber
Correct Answer: A
Explanation: Continuous bubbling in the water seal chamber indicates an air leak
requiring immediate intervention. Option B is normal (<100 mL/hr initially); C is
expected; D indicates proper suction function.
8. Which nursing action best demonstrates evidence-based practice (EBP) in clinical
decision-making?
A. Following hospital policy without questioning its origin
B. Integrating current research, clinical expertise, and patient preferences
C. Using only interventions that have been standard practice for decades
D. Implementing treatments based solely on physician orders
Correct Answer: B
Explanation: EBP combines best current evidence, clinical expertise, and patient
preferences/values. Options A, C, and D ignore critical components of evidence-based
decision-making.
9. A patient with acute myocardial infarction develops ventricular tachycardia. What is the
priority nursing intervention?
A. Administer amiodarone 150 mg IV push
B. Assess pulse and prepare for defibrillation if pulseless
C. Call the rapid response team and wait for their arrival
D. Place the patient in high-Fowler's position and administer oxygen
Correct Answer: B
Explanation: Assessing pulse determines if VT is perfusing; pulseless VT requires
immediate defibrillation. A is appropriate for perfusing VT but not first priority; C delays
critical intervention; D is supportive but not definitive.
