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Galen NSG 4800 Comprehensive Exam 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
Latest Already Graded A+
1. A patient with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and a productive cough. Arterial
blood gas (ABG) analysis reveals a pH of 7.28, PaCO2 of 68 mm Hg, and
HCO3- of 28 mEq/L. Which acid-base imbalance is present?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B) Chronic respiratory acidosis with metabolic compensation
Explanation: The low pH indicates acidosis. The elevated PaCO2
indicates a respiratory cause. The HCO3- is elevated above the normal
range (22-26 mEq/L), suggesting metabolic compensation. In acute
respiratory acidosis, the HCO3- would increase by only 1 mEq/L for
every 10 mm Hg rise in PaCO2, yielding an expected HCO3- of about 26
mEq/L. Here, the HCO3- of 28 mEq/L indicates chronic compensation
because the kidneys have had time to retain bicarbonate.
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2. A nurse is caring for a patient with heart failure who is receiving
digoxin. Which assessment finding is most indicative of digoxin toxicity?
A) Heart rate of 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Serum digoxin level of 1.8 ng/mL
D) Presence of halos around lights
Answer: B) Serum potassium level of 3.2 mEq/L
Explanation: Hypokalemia (serum potassium below 3.5 mEq/L)
potentiates digoxin toxicity by increasing the binding of digoxin to
cardiac sodium-potassium ATPase pumps. A digoxin level of 1.8 ng/mL
is within the therapeutic range (0.8-2.0 ng/mL). A heart rate of 62 is not
necessarily toxic. Halos around lights are classic for digoxin toxicity, but
hypokalemia is a more objective and direct precipitating factor.
3. A patient is receiving heparin infusion for a pulmonary embolism.
The nurse notes petechiae on the patient's trunk and a drop in platelet
count from 250,000 to 100,000 cells/mcL. What is the priority nursing
action?
A) Administer vitamin K
B) Stop the heparin infusion
C) Increase the heparin rate
D) Apply pressure to bleeding sites
Answer: B) Stop the heparin infusion
Explanation: This presentation is consistent with heparin-induced
thrombocytopenia (HIT), a life-threatening immune-mediated reaction.
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The priority is to stop all heparin products immediately to prevent
further platelet aggregation and thrombosis. Vitamin K is the antidote
for warfarin, not heparin. Increasing the rate would exacerbate the
condition.
4. A patient with acute pancreatitis reports severe abdominal pain
radiating to the back. Which serum enzyme level is most specific for
this diagnosis?
A) Amylase
B) Lipase
C) Alanine aminotransferase (ALT)
D) Aspartate aminotransferase (AST)
Answer: B) Lipase
Explanation: Lipase is more specific and sensitive for acute pancreatitis
than amylase. It remains elevated longer (up to 14 days) and is not
affected by renal dysfunction or salivary gland disorders, making it the
preferred diagnostic marker. Amylase can be elevated in other
conditions such as mumps or renal failure.
5. A patient with chronic kidney disease is scheduled for hemodialysis.
Which laboratory value should the nurse report to the provider before
the procedure?
A) Serum potassium of 5.8 mEq/L
B) Serum sodium of 136 mEq/L
C) Serum calcium of 9.5 mg/dL
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D) Serum phosphorus of 4.8 mg/dL
Answer: A) Serum potassium of 5.8 mEq/L
Explanation: Hyperkalemia (potassium >5.5 mEq/L) is a common
indication for dialysis, but a level of 5.8 mEq/L is dangerously high and
can cause life-threatening cardiac arrhythmias. While dialysis will
correct it, the nurse must report this critical value immediately. The
other values are within normal limits.
6. A patient is prescribed warfarin for atrial fibrillation. Which dietary
instruction is most important for the nurse to provide?
A) Increase intake of green leafy vegetables
B) Avoid foods high in vitamin K
C) Limit sodium intake
D) Increase fluid intake
Answer: B) Avoid foods high in vitamin K
Explanation: Warfarin is a vitamin K antagonist. Consistent vitamin K
intake is essential, but large fluctuations—especially sudden increases—
can reduce warfarin's anticoagulant effect. The patient should be
advised to maintain a consistent diet and avoid large amounts of foods
rich in vitamin K (e.g., spinach, kale, broccoli).
7. A patient with diabetes mellitus type 2 has a blood glucose level of
55 mg/dL and is unconscious. Which of the following is the priority
intervention?
A) Administer 50% dextrose IV push
Galen NSG 4800 Comprehensive Exam 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
Latest Already Graded A+
1. A patient with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and a productive cough. Arterial
blood gas (ABG) analysis reveals a pH of 7.28, PaCO2 of 68 mm Hg, and
HCO3- of 28 mEq/L. Which acid-base imbalance is present?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B) Chronic respiratory acidosis with metabolic compensation
Explanation: The low pH indicates acidosis. The elevated PaCO2
indicates a respiratory cause. The HCO3- is elevated above the normal
range (22-26 mEq/L), suggesting metabolic compensation. In acute
respiratory acidosis, the HCO3- would increase by only 1 mEq/L for
every 10 mm Hg rise in PaCO2, yielding an expected HCO3- of about 26
mEq/L. Here, the HCO3- of 28 mEq/L indicates chronic compensation
because the kidneys have had time to retain bicarbonate.
,2|Page
2. A nurse is caring for a patient with heart failure who is receiving
digoxin. Which assessment finding is most indicative of digoxin toxicity?
A) Heart rate of 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Serum digoxin level of 1.8 ng/mL
D) Presence of halos around lights
Answer: B) Serum potassium level of 3.2 mEq/L
Explanation: Hypokalemia (serum potassium below 3.5 mEq/L)
potentiates digoxin toxicity by increasing the binding of digoxin to
cardiac sodium-potassium ATPase pumps. A digoxin level of 1.8 ng/mL
is within the therapeutic range (0.8-2.0 ng/mL). A heart rate of 62 is not
necessarily toxic. Halos around lights are classic for digoxin toxicity, but
hypokalemia is a more objective and direct precipitating factor.
3. A patient is receiving heparin infusion for a pulmonary embolism.
The nurse notes petechiae on the patient's trunk and a drop in platelet
count from 250,000 to 100,000 cells/mcL. What is the priority nursing
action?
A) Administer vitamin K
B) Stop the heparin infusion
C) Increase the heparin rate
D) Apply pressure to bleeding sites
Answer: B) Stop the heparin infusion
Explanation: This presentation is consistent with heparin-induced
thrombocytopenia (HIT), a life-threatening immune-mediated reaction.
,3|Page
The priority is to stop all heparin products immediately to prevent
further platelet aggregation and thrombosis. Vitamin K is the antidote
for warfarin, not heparin. Increasing the rate would exacerbate the
condition.
4. A patient with acute pancreatitis reports severe abdominal pain
radiating to the back. Which serum enzyme level is most specific for
this diagnosis?
A) Amylase
B) Lipase
C) Alanine aminotransferase (ALT)
D) Aspartate aminotransferase (AST)
Answer: B) Lipase
Explanation: Lipase is more specific and sensitive for acute pancreatitis
than amylase. It remains elevated longer (up to 14 days) and is not
affected by renal dysfunction or salivary gland disorders, making it the
preferred diagnostic marker. Amylase can be elevated in other
conditions such as mumps or renal failure.
5. A patient with chronic kidney disease is scheduled for hemodialysis.
Which laboratory value should the nurse report to the provider before
the procedure?
A) Serum potassium of 5.8 mEq/L
B) Serum sodium of 136 mEq/L
C) Serum calcium of 9.5 mg/dL
, 4|Page
D) Serum phosphorus of 4.8 mg/dL
Answer: A) Serum potassium of 5.8 mEq/L
Explanation: Hyperkalemia (potassium >5.5 mEq/L) is a common
indication for dialysis, but a level of 5.8 mEq/L is dangerously high and
can cause life-threatening cardiac arrhythmias. While dialysis will
correct it, the nurse must report this critical value immediately. The
other values are within normal limits.
6. A patient is prescribed warfarin for atrial fibrillation. Which dietary
instruction is most important for the nurse to provide?
A) Increase intake of green leafy vegetables
B) Avoid foods high in vitamin K
C) Limit sodium intake
D) Increase fluid intake
Answer: B) Avoid foods high in vitamin K
Explanation: Warfarin is a vitamin K antagonist. Consistent vitamin K
intake is essential, but large fluctuations—especially sudden increases—
can reduce warfarin's anticoagulant effect. The patient should be
advised to maintain a consistent diet and avoid large amounts of foods
rich in vitamin K (e.g., spinach, kale, broccoli).
7. A patient with diabetes mellitus type 2 has a blood glucose level of
55 mg/dL and is unconscious. Which of the following is the priority
intervention?
A) Administer 50% dextrose IV push
