NSG 4800 Comprehensive Exam Study Guide |
2026/27 Update with complete solutions
NSG 4800 Comprehensive Exam Study Guide – Practice Exam
Part 1: Prioritization & Delegation
1. A nurse receives report on the following clients. Which client should the nurse
assess first?
A) A client with pneumonia who has an oxygen saturation of 94% on room air
B) A client with a chest tube who reports sudden severe pain at the insertion site
C) A client with a new diabetes diagnosis and a blood glucose of 220 mg/dL
D) A postoperative client who has not had a bowel movement in 2 days
Correct Answer: B) A client with a chest tube who reports sudden severe pain at
the insertion site
Explanation: Sudden severe pain at a chest tube insertion site suggests possible
tube dislodgement, tension pneumothorax, or infection—all of which are
immediately life-threatening. The ABC framework (Airway, Breathing, Circulation)
makes respiratory compromise the priority. The other clients are stable and do not
require immediate intervention.
2. The charge nurse is making assignments for the upcoming shift. Which client
should be assigned to the most experienced RN?
A) A client 24 hours post-appendectomy
B) A client with newly diagnosed hypertension being discharged later today
C) A client receiving her first round of chemotherapy
D) A client with stable angina awaiting a stress test
,Correct Answer: C) A client receiving her first round of chemotherapy
Explanation: A client receiving chemotherapy for the first time requires extensive
teaching, close monitoring for hypersensitivity reactions, and possible
management of life-threatening complications. This level of complexity demands
an experienced nurse with strong clinical judgment, delegation skills, and
knowledge of oncology protocols.
3. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A) Assessing a newly admitted client's pain level
B) Teaching a client how to use an incentive spirometer
C) Ambulating a stable client who had a stroke 3 days ago
D) Evaluating a client's response to a diuretic
Correct Answer: C) Ambulating a stable client who had a stroke 3 days ago
Explanation: Ambulating a stable client is a routine, predictable task with minimal
risk, making it appropriate for delegation. Assessment, teaching, and evaluation
require nursing judgment and cannot be delegated.
4. A nurse manager is implementing a new patient safety initiative. Which
leadership style is most effective for promoting staff buy-in and sustained
change?
A) Autocratic leadership
B) Laissez-faire leadership
C) Transformational leadership
D) Bureaucratic leadership
Correct Answer: C) Transformational leadership
, Explanation: Transformational leadership uses inspiration, shared vision, and
empowerment to motivate staff to embrace change. This approach is most
effective for lasting change and improved patient safety.
5. A nurse is caring for a client who is angry about a long wait time. Which
response is most therapeutic?
A) "If you would calm down, I can help you faster."
B) "Yelling at me is not going to solve anything."
C) "I can see that you are very upset. Tell me more about what is frustrating you."
D) "It's not my fault—I just started my shift."
Correct Answer: C) "I can see that you are very upset. Tell me more about what is
frustrating you."
Explanation: This response uses therapeutic communication: validating the
client's feelings and offering a general lead to encourage expression of concerns.
The other responses are defensive or dismissive.
6. A nurse discovers a colleague has been documenting vital signs without
actually assessing the client. What is the nurse's first action?
A) Ignore the situation
B) Confront the colleague in private
C) Report the behavior to the charge nurse or nurse manager
D) Document the colleague's behavior in the client's chart
Correct Answer: C) Report the behavior to the charge nurse or nurse manager
Explanation: Falsifying medical records is illegal, unethical, and compromises
patient safety. The nurse must report the behavior to the charge nurse or
manager immediately.
2026/27 Update with complete solutions
NSG 4800 Comprehensive Exam Study Guide – Practice Exam
Part 1: Prioritization & Delegation
1. A nurse receives report on the following clients. Which client should the nurse
assess first?
A) A client with pneumonia who has an oxygen saturation of 94% on room air
B) A client with a chest tube who reports sudden severe pain at the insertion site
C) A client with a new diabetes diagnosis and a blood glucose of 220 mg/dL
D) A postoperative client who has not had a bowel movement in 2 days
Correct Answer: B) A client with a chest tube who reports sudden severe pain at
the insertion site
Explanation: Sudden severe pain at a chest tube insertion site suggests possible
tube dislodgement, tension pneumothorax, or infection—all of which are
immediately life-threatening. The ABC framework (Airway, Breathing, Circulation)
makes respiratory compromise the priority. The other clients are stable and do not
require immediate intervention.
2. The charge nurse is making assignments for the upcoming shift. Which client
should be assigned to the most experienced RN?
A) A client 24 hours post-appendectomy
B) A client with newly diagnosed hypertension being discharged later today
C) A client receiving her first round of chemotherapy
D) A client with stable angina awaiting a stress test
,Correct Answer: C) A client receiving her first round of chemotherapy
Explanation: A client receiving chemotherapy for the first time requires extensive
teaching, close monitoring for hypersensitivity reactions, and possible
management of life-threatening complications. This level of complexity demands
an experienced nurse with strong clinical judgment, delegation skills, and
knowledge of oncology protocols.
3. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which
task is appropriate to delegate?
A) Assessing a newly admitted client's pain level
B) Teaching a client how to use an incentive spirometer
C) Ambulating a stable client who had a stroke 3 days ago
D) Evaluating a client's response to a diuretic
Correct Answer: C) Ambulating a stable client who had a stroke 3 days ago
Explanation: Ambulating a stable client is a routine, predictable task with minimal
risk, making it appropriate for delegation. Assessment, teaching, and evaluation
require nursing judgment and cannot be delegated.
4. A nurse manager is implementing a new patient safety initiative. Which
leadership style is most effective for promoting staff buy-in and sustained
change?
A) Autocratic leadership
B) Laissez-faire leadership
C) Transformational leadership
D) Bureaucratic leadership
Correct Answer: C) Transformational leadership
, Explanation: Transformational leadership uses inspiration, shared vision, and
empowerment to motivate staff to embrace change. This approach is most
effective for lasting change and improved patient safety.
5. A nurse is caring for a client who is angry about a long wait time. Which
response is most therapeutic?
A) "If you would calm down, I can help you faster."
B) "Yelling at me is not going to solve anything."
C) "I can see that you are very upset. Tell me more about what is frustrating you."
D) "It's not my fault—I just started my shift."
Correct Answer: C) "I can see that you are very upset. Tell me more about what is
frustrating you."
Explanation: This response uses therapeutic communication: validating the
client's feelings and offering a general lead to encourage expression of concerns.
The other responses are defensive or dismissive.
6. A nurse discovers a colleague has been documenting vital signs without
actually assessing the client. What is the nurse's first action?
A) Ignore the situation
B) Confront the colleague in private
C) Report the behavior to the charge nurse or nurse manager
D) Document the colleague's behavior in the client's chart
Correct Answer: C) Report the behavior to the charge nurse or nurse manager
Explanation: Falsifying medical records is illegal, unethical, and compromises
patient safety. The nurse must report the behavior to the charge nurse or
manager immediately.
