NUR 283 Comp 4 Exam | Transition to RN Practice (2026) Q&A |
Galen College
1. A nurse working on a pediatric unit has received the hand-off report. Which client should the
nurse plan to see first?
A) A toddler with bronchiolitis on room air and mild wheezing
B) An infant with pertussis who is receiving oxygen via nasal cannula
C) A preschooler with otitis media awaiting discharge
D) A school-age child with a simple fracture in a cast
Correct Answer: B) An infant with pertussis who is receiving oxygen via nasal cannula
Rationale: Infants with pertussis are at high risk for apnea and severe respiratory compromise.
Any child on supplemental oxygen with a respiratory diagnosis is a higher priority than stable
conditions. Using the ABC framework, the child requiring supplemental oxygen has an active
respiratory compromise that must be addressed first .
2. A nurse is prioritizing patient care after a change-of-shift report. Which patient should the
nurse plan to see first?
A) A patient scheduled for discharge later today who needs final medication teaching
B) A patient who had a knee arthroscopy yesterday and reports pain at 4/10
C) A patient who had an ERCP 30 minutes ago and is reporting difficulty swallowing
D) A patient who is NPO for an abdominal ultrasound this morning
Correct Answer: C) A patient who had an ERCP 30 minutes ago and is reporting difficulty
swallowing
,Rationale: According to the ABC framework, airway is the priority. Difficulty swallowing after an
ERCP indicates a potentially depressed gag reflex, placing the patient at high risk for aspiration.
This requires immediate bedside assessment. The other patients are stable and can be seen
later .
3. A nurse working on a medical-surgical unit has been made aware of the following client
situations. The nurse should first plan to assess the client who:
A) Has diabetes mellitus type 2 and had a premeal blood glucose of 85 mg/dL and now has a
postmeal blood glucose of 220 mg/dL
B) Is 24 hours postoperative from abdominal surgery and has wound drainage that has changed
from sanguineous to serosanguineous
C) Is receiving preparation for a colonoscopy and whose blood pressure was 128/74 mm Hg and
is now 106/60 mm Hg
D) Has acute pancreatitis and reports an unchanged pain level of 7 out of 10
Correct Answer: C) Is receiving preparation for a colonoscopy and whose blood pressure was
128/74 mm Hg and is now 106/60 mm Hg
Rationale: A drop in blood pressure may indicate hypovolemia from bowel prep or other
hemodynamic instability and can quickly progress to shock if not addressed. Recognizing
unstable trends and prioritizing potentially unstable clients is critical in the transition-to-RN role.
The other clients are more stable .
4. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is within the
scope of practice for a UAP?
A) Suctioning a tracheostomy
B) Inserting a Foley catheter
C) Assisting a patient with ambulation after a fall risk assessment
,D) Administering a tube feeding
Correct Answer: C) Assisting a patient with ambulation after a fall risk assessment
Rationale: Ambulation assistance, after the RN determines the patient is stable and safe, is
within UAP scope. UAPs can perform tasks such as changing linens, obtaining vital signs, and
assisting with ADLs. Suctioning, catheter insertion, and tube feedings require licensed nursing
judgment .
5. A charge nurse is making client assignments on a medical-surgical unit. Which client should
the nurse assign to a licensed practical nurse (LPN)?
A) A client who is 24 hours post-operative following a total knee replacement with stable vital
signs
B) A client with a chest tube who requires assessment of breath sounds every 2 hours
C) A client with a new diagnosis of diabetes requiring initial insulin pump education
D) A client with a newly placed tracheostomy
Correct Answer: A) A client who is 24 hours post-operative following a total knee replacement
with stable vital signs
Rationale: LPNs can provide care for clients with stable, predictable conditions, reinforce
teaching, administer PO/SQ/IM medications, and perform wound care. A client with stable vital
signs post-operatively is appropriate for LPN assignment. Chest tube assessment, initial insulin
pump education, and new tracheostomy care require RN-level assessment and judgment .
6. A nurse is caring for a postpartum client who is 1 hour post-delivery. The nurse notes that the
client's perineal pad is saturated with lochia rubra in 15 minutes. What is the priority nursing
action?
, A) Document the finding and continue monitoring
B) Assess the fundus for atony and perform fundal massage
C) Administer a prescribed oxytocin infusion
D) Notify the healthcare provider immediately
Correct Answer: B) Assess the fundus for atony and perform fundal massage
Rationale: Saturation of a pad in 15 minutes indicates excessive bleeding. The priority is to
assess the fundus for atony and perform fundal massage to stimulate uterine contraction. This is
the first intervention to control postpartum hemorrhage .
7. A nurse is caring for a client with a boggy uterus that is deviated to the right. What is the
priority nursing action?
A) Administer methergine
B) Perform fundal massage
C) Assist the client to empty her bladder
D) Notify the healthcare provider
Correct Answer: C) Assist the client to empty her bladder
Rationale: A boggy uterus deviated to the side (usually right) is a classic sign of a full bladder
displacing the uterus. Emptying the bladder allows the uterus to return to midline and contract
effectively. Fundal massage will not resolve displacement caused by a full bladder .
8. A nurse is planning care for a client in the active phase of the first stage of labor. Which
finding should the nurse expect?
Galen College
1. A nurse working on a pediatric unit has received the hand-off report. Which client should the
nurse plan to see first?
A) A toddler with bronchiolitis on room air and mild wheezing
B) An infant with pertussis who is receiving oxygen via nasal cannula
C) A preschooler with otitis media awaiting discharge
D) A school-age child with a simple fracture in a cast
Correct Answer: B) An infant with pertussis who is receiving oxygen via nasal cannula
Rationale: Infants with pertussis are at high risk for apnea and severe respiratory compromise.
Any child on supplemental oxygen with a respiratory diagnosis is a higher priority than stable
conditions. Using the ABC framework, the child requiring supplemental oxygen has an active
respiratory compromise that must be addressed first .
2. A nurse is prioritizing patient care after a change-of-shift report. Which patient should the
nurse plan to see first?
A) A patient scheduled for discharge later today who needs final medication teaching
B) A patient who had a knee arthroscopy yesterday and reports pain at 4/10
C) A patient who had an ERCP 30 minutes ago and is reporting difficulty swallowing
D) A patient who is NPO for an abdominal ultrasound this morning
Correct Answer: C) A patient who had an ERCP 30 minutes ago and is reporting difficulty
swallowing
,Rationale: According to the ABC framework, airway is the priority. Difficulty swallowing after an
ERCP indicates a potentially depressed gag reflex, placing the patient at high risk for aspiration.
This requires immediate bedside assessment. The other patients are stable and can be seen
later .
3. A nurse working on a medical-surgical unit has been made aware of the following client
situations. The nurse should first plan to assess the client who:
A) Has diabetes mellitus type 2 and had a premeal blood glucose of 85 mg/dL and now has a
postmeal blood glucose of 220 mg/dL
B) Is 24 hours postoperative from abdominal surgery and has wound drainage that has changed
from sanguineous to serosanguineous
C) Is receiving preparation for a colonoscopy and whose blood pressure was 128/74 mm Hg and
is now 106/60 mm Hg
D) Has acute pancreatitis and reports an unchanged pain level of 7 out of 10
Correct Answer: C) Is receiving preparation for a colonoscopy and whose blood pressure was
128/74 mm Hg and is now 106/60 mm Hg
Rationale: A drop in blood pressure may indicate hypovolemia from bowel prep or other
hemodynamic instability and can quickly progress to shock if not addressed. Recognizing
unstable trends and prioritizing potentially unstable clients is critical in the transition-to-RN role.
The other clients are more stable .
4. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is within the
scope of practice for a UAP?
A) Suctioning a tracheostomy
B) Inserting a Foley catheter
C) Assisting a patient with ambulation after a fall risk assessment
,D) Administering a tube feeding
Correct Answer: C) Assisting a patient with ambulation after a fall risk assessment
Rationale: Ambulation assistance, after the RN determines the patient is stable and safe, is
within UAP scope. UAPs can perform tasks such as changing linens, obtaining vital signs, and
assisting with ADLs. Suctioning, catheter insertion, and tube feedings require licensed nursing
judgment .
5. A charge nurse is making client assignments on a medical-surgical unit. Which client should
the nurse assign to a licensed practical nurse (LPN)?
A) A client who is 24 hours post-operative following a total knee replacement with stable vital
signs
B) A client with a chest tube who requires assessment of breath sounds every 2 hours
C) A client with a new diagnosis of diabetes requiring initial insulin pump education
D) A client with a newly placed tracheostomy
Correct Answer: A) A client who is 24 hours post-operative following a total knee replacement
with stable vital signs
Rationale: LPNs can provide care for clients with stable, predictable conditions, reinforce
teaching, administer PO/SQ/IM medications, and perform wound care. A client with stable vital
signs post-operatively is appropriate for LPN assignment. Chest tube assessment, initial insulin
pump education, and new tracheostomy care require RN-level assessment and judgment .
6. A nurse is caring for a postpartum client who is 1 hour post-delivery. The nurse notes that the
client's perineal pad is saturated with lochia rubra in 15 minutes. What is the priority nursing
action?
, A) Document the finding and continue monitoring
B) Assess the fundus for atony and perform fundal massage
C) Administer a prescribed oxytocin infusion
D) Notify the healthcare provider immediately
Correct Answer: B) Assess the fundus for atony and perform fundal massage
Rationale: Saturation of a pad in 15 minutes indicates excessive bleeding. The priority is to
assess the fundus for atony and perform fundal massage to stimulate uterine contraction. This is
the first intervention to control postpartum hemorrhage .
7. A nurse is caring for a client with a boggy uterus that is deviated to the right. What is the
priority nursing action?
A) Administer methergine
B) Perform fundal massage
C) Assist the client to empty her bladder
D) Notify the healthcare provider
Correct Answer: C) Assist the client to empty her bladder
Rationale: A boggy uterus deviated to the side (usually right) is a classic sign of a full bladder
displacing the uterus. Emptying the bladder allows the uterus to return to midline and contract
effectively. Fundal massage will not resolve displacement caused by a full bladder .
8. A nurse is planning care for a client in the active phase of the first stage of labor. Which
finding should the nurse expect?
