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NUR 283 COMP 1 EXAM – Complete Study
Guide
Transition to Registered Nursing Practice |
Galen College of Nursing (2025/2026)
SECTION 1: PRIORITIZATION – ABCs AND MASLOW Q1. The nurse is prioritizing patient care after a change-of-shift report. The nurse should first plan to see the patient who: A) Had an endoscopic retrograde cholangiopancreatography (ERCP) 30 minutes ago and is reporting difficulty swallowing B) Is scheduled for discharge later today and needs final medication teaching C) Had a knee arthroscopy yesterday and reports pain at 4/ D) Is NPO for an abdominal ultrasound this morning Correct Answer: A Rationale: ABC framework – Difficulty swallowing (airway compromise) is the priority. After ERCP, the gag reflex may still be absent, placing the patient at risk for aspiration. This requires immediate assessment before the gag reflex returns. Why the other options are wrong:
- B (Discharge teaching): Important but not urgent. Teaching can be completed before discharge.
- C (Pain 4/10): Moderate pain is expected post-arthroscopy and not life-threatening.
- D (NPO status): Routine preoperative status does not require immediate intervention. Q2. The nurse working on a medical-surgical unit has just received a handoff report on the following clients. The nurse should FIRST plan to assess the client who has: A) Acute pancreatitis and is reporting the development of pain on deep inspiration B) COPD and is on 2 L/min oxygen with SpO₂ of 93% C) Type 2 diabetes with a blood glucose of 220 mg/dL before dinner D) A stage II pressure injury needing a dressing change Correct Answer: A Rationale: Pain on deep inspiration in acute pancreatitis may indicate pleural effusion, atelectasis, or worsening inflammation. This could progress to ARDS or respiratory failure. Acute changes require immediate assessment. Why the other options are wrong:
- B (COPD, SpO₂ 93%): Acceptable for COPD (target 88-92% to avoid CO₂ retention). Stable.
- C (Glucose 220): Hyperglycemia requires treatment but is not life- threatening in the short term.
- D (Stage II pressure injury): Chronic wound care is not urgent. Q3. The nurse working on the mother-baby unit has become aware of the following client situations. Which client should the nurse INITIALLY assess?
weakness, and respiratory failure. This is a critical lab value requiring immediate intervention. Why the other options are wrong:
- A (Glucose 180): Mild hyperglycemia; not an emergency.
- B (Foley catheter): Important but not urgent compared to critical hypokalemia.
- C (Chest x-ray): Important but not urgent. Q5. The nurse has been made aware of the following client situations. The nurse should first plan to see the client who has: A) Cervical cancer, is receiving internal radiation therapy, and whose partner has been visiting at the bedside for the past 2 hours B) COPD and is on 2 L/min oxygen with an SpO₂ of 93% C) Type 2 diabetes with a glucose of 220 mg/dL before dinner D) A stage II pressure injury needing a dressing change Correct Answer: A Rationale: Visitors to clients with internal radiation must be limited in time (usually 30 minutes/day) and distance (6 feet). The partner has been at the bedside for 2 hours, exceeding safety limits. The nurse must assess and enforce radiation safety precautions immediately to prevent unnecessary radiation exposure. Why the other options are wrong:
- B (COPD, SpO₂ 93%): Acceptable for COPD.
- C (Glucose 220): Elevated but not immediately life-threatening.
- D (Stage II pressure injury): Chronic wound care is not urgent.
Q6. A nurse in a community health clinic is assessing clients who are waiting to be seen. Which client should the nurse have the primary health care provider see FIRST? A) A 57-year-old with Graves' disease and a temperature of 100.5°F (38.1°C) B) A 28-year-old with a sprained ankle and mild swelling C) A 32-year-old with seasonal allergies and nasal congestion D) A 55-year-old with chronic low back pain requesting a medication refill Correct Answer: A Rationale: Fever in a client with Graves' disease may indicate thyroid storm, a life-threatening complication characterized by fever, tachycardia, hypertension, and altered mental status. This requires immediate evaluation. Why the other options are wrong:
- B (Sprained ankle): Minor injury; can wait.
- C (Seasonal allergies): Non-urgent.
- D (Chronic back pain): Stable chronic condition. Q7. The nurse is caring for a client who is currently prescribed bed rest. Which action should the nurse take to help prevent the development of pulmonary embolism? A) Encourage the use of an incentive spirometer B) Apply sequential compression devices (SCDs)
- A (Bronchiolitis, room air, mild wheezing): Stable, not on oxygen.
- C (Otitis media awaiting discharge): Stable, ready for discharge.
- D (Simple fracture in cast): Stable orthopedic injury. Q9. The nurse is assessing a client in the emergency department. Which finding requires immediate intervention? A) Blood pressure 150/90 mm Hg B) Heart rate 100 bpm C) Respiratory rate 32 breaths per minute with use of accessory muscles D) Temperature 99.8°F (37.7°C) Correct Answer: C Rationale: Tachypnea (RR 32) with accessory muscle use indicates respiratory distress. This is an airway/breathing priority requiring immediate intervention. The other vital signs are not immediately life- threatening. Why the other options are wrong:
- A (BP 150/90): Mild hypertension; not emergent.
- B (HR 100): Mild tachycardia; not emergent.
- D (Temp 99.8°F): Low-grade fever; not emergent. Q10. The triage nurse in the emergency department is assessing four clients. Which client should the nurse see FIRST? A) A client with chest pain radiating to the left arm and diaphoresis B) A client with a simple laceration of the finger
C) A client requesting a prescription refill for hypertension medication D) A client with a non-productive cough for 2 weeks Correct Answer: A Rationale: Chest pain radiating to the left arm with diaphoresis is classic for acute myocardial infarction. This is an emergency requiring immediate evaluation and intervention. The ABC framework and prioritizing life-threatening conditions apply. Why the other options are wrong:
- B (Simple laceration): Minor injury; can wait.
- C (Prescription refill): Stable chronic condition; not urgent.
- D (Chronic cough): Non-urgent outpatient issue. SECTION 2: DELEGATION – RN, LPN, and UAP SCOPE Q11. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which delegated task would REQUIRE FOLLOW-UP by the charge nurse? A) Assisting a client who had a paracentesis 2 hours ago to get out of bed for the first time B) Obtaining vital signs on a stable postoperative client C) Assisting a client with toileting and hygiene D) Recording intake and output for a client on fluid restriction Correct Answer: A Rationale: Anytime a client is doing something for the first time (first ambulation, first void, first meal after procedure), the RN should perform or directly supervise the activity. The RN needs to assess the
- D (VS for surgery): Important but not urgent. Q13. Which tasks can the nurse delegate to an LPN/LVN? (Select all that apply) A) Administer PO medications to stable patients B) Perform an initial admission assessment C) Reinforce teaching previously provided by the RN D) Insert a urinary catheter E) Develop the initial plan of care F) Administer enteral feedings via NG tube Correct Answers: A, C, D, F Rationale: LPNs can administer medications (PO, SQ, IM, some IV), reinforce teaching, insert urinary catheters, and administer enteral feedings. RN responsibility includes initial assessment, diagnosis, planning, and evaluation (ADPIE). LPNs cannot perform initial assessments or develop care plans. Q14. Which tasks can the nurse delegate to UAP? (Select all that apply) A) Assist with ambulation if patient is cleared for weight bearing B) Perform a sterile dressing change C) Document intake and output D) Perform glucose checks via finger stick E) Develop the patient's discharge plan F) Turn and reposition patients Correct Answers: A, C, D, F
Rationale: UAP can perform basic care: ambulation (stable patients), I&O, glucose finger sticks, and turning/repositioning. Sterile procedures and discharge planning require licensed nursing judgment and cannot be delegated to UAP. Q15. The nurse preceptor is observing a newly hired nurse care for assigned clients. Which action by the newly hired nurse requires INTERVENTION by the preceptor? A) The nurse uses a 23-gauge, 1-inch needle when administering a medication in the deltoid muscle B) The nurse delegates vital signs on a stable client to the UAP C) The nurse uses a family member as an interpreter for a client who does not speak English D) The nurse documents intake and output in the patient's chart Correct Answer: C Rationale: Using family members as interpreters risks inaccuracies and breaches confidentiality. Professional standards require a qualified interpreter for teaching and informed consent. The preceptor must correct this to align with ethical and legal practice. Why the other options are wrong:
- A (23-gauge, 1-inch needle): Appropriate for deltoid IM injection in adults.
- B (Vital signs to UAP): Appropriate delegation.
- D (Documenting I&O): Appropriate nursing action.
deceleration. This is the least invasive intervention and should be attempted first. If not resolved, oxygen, IV fluids, and provider notification follow. Q18. The nurse is caring for a pregnant client whose last menstrual period began on October 21st. Using Naegele's rule, which date would be the expected due date? A) July 28th B) July 14th C) August 7th D) August 21st Correct Answer: A Rationale: Naegele's rule: subtract 3 months from the first day of the LMP and add 7 days. October 21 minus 3 months = July 21; plus 7 days = July 28. Q19. The nurse is caring for a client in the fourth stage of labor (postpartum recovery). Which assessment finding requires immediate intervention? A) Fundus firm at the umbilicus B) Lochia rubra with small clots C) Perineal pad saturated within 1 hour D) Temperature 99.8°F (37.7°C) Correct Answer: C Rationale: Saturating a perineal pad within 1 hour indicates postpartum hemorrhage. Normal lochia does not saturate more than 1 pad per hour.
This finding requires immediate intervention (fundal massage, oxytocin, provider notification). Q20. The nurse is teaching a female client about positive signs of pregnancy. Which client statement indicates correct understanding of the teaching? A) "A missed period is a positive sign of pregnancy" B) "Feeling the baby move is a positive sign" C) "Hearing the fetal heartbeat is a positive sign" D) "Breast tenderness is a positive sign" Correct Answer: C Rationale: Positive signs of pregnancy definitively confirm pregnancy: ultrasound visualization of the fetus, audible fetal heart tones, and fetal movement felt by the examiner. Missed period, breast tenderness, and quickening are presumptive (subjective) signs. Q21. The nurse is caring for a client in the transition phase of the first stage of labor. Which finding is expected? A) Cervical dilation from 8-10 cm B) Contractions every 5-10 minutes C) Client reports an urge to push D) Cervical effacement 0-50% Correct Answer: A Rationale: The transition phase is the final phase of the first stage of labor, characterized by cervical dilation from 8-10 cm. Contractions are strong and frequent (every 2-3 minutes). Effacement is complete (100%). The urge to push occurs in the second stage, not transition.
A) Intramuscular (IM) B) Subcutaneous (SubQ) C) Intravenous (IV) D) Oral (PO) Correct Answer: C Rationale: IV administration provides 100% bioavailability and immediate absorption because the drug enters the systemic circulation directly, bypassing absorption barriers and the first-pass effect. Q24. The nurse is caring for a client who had an endoscopic retrograde cholangiopancreatography (ERCP) 30 minutes ago. Which assessment finding is most concerning? A) The client reports a sore throat B) The client reports difficulty swallowing C) The client's gag reflex is intact D) The client's vital signs are stable Correct Answer: B Rationale: Difficulty swallowing after ERCP may indicate a compromised gag reflex, placing the client at risk for aspiration. The nurse should keep the client NPO until the gag reflex returns (usually 1- 2 hours). This is an ABC priority. Q25. The nurse is instructing a client who must ambulate with a cane. Which client statement indicates correct understanding of the teaching?
A) "I will place the cane on the side of the unaffected limb and walk with the weaker leg first" B) "I will place the cane on the same side as my weaker leg" C) "I will advance the cane and the stronger leg together" D) "I will hold the cane on the side of my weaker leg" Correct Answer: A Rationale: The cane should be held on the strong side to shift weight away from the weak side. The client should advance the cane and the weak leg simultaneously, then advance the strong leg. This provides the most stable gait pattern. Q26. The nurse has provided dietary teaching to a client who recently had a surgical colostomy placed. Which statement indicates correct understanding of the instructions? A) "Eating yogurt can help decrease the amount of gas that I have" B) "I should eat my largest meal in the evening" C) "I should empty my pouch immediately after eating" D) "I should avoid all foods that cause gas" Correct Answer: A Rationale: Yogurt contains probiotics that may help reduce gas and odor. The largest meal should not be in the evening (pouch will fill overnight). Pouches should be emptied when ⅓ to ½ full, not immediately after eating. Gas-forming foods can be reintroduced gradually.
Q29. The nurse is caring for a client who has a sealed radiation implant. Which precautions should the nurse implement? A) Assign a different nurse to care for the client each day B) Limit visitors to 30 minutes per day and have them stay at least 6 feet away C) Place the client in a semiprivate room with another stable client D) Allow pregnant staff to provide care if they wear lead aprons Correct Answer: B Rationale: Radiation safety includes time, distance, and shielding: minimize time, maximize distance, and use shielding as appropriate. Visitor time and proximity must be limited to reduce exposure. Pregnant staff should avoid these clients entirely. The client requires a private room. Q30. The nurse is caring for a client who had a paracentesis 2 hours ago. The nurse should delegate which task to the UAP? A) Assess the insertion site for bleeding B) Assist the client to get out of bed for the first time C) Remind the client to remain in bed as ordered D) Evaluate the client's pain level Correct Answer: C Rationale: Reminding a stable patient to follow activity orders can be delegated to UAP. First-time ambulation requires RN assessment and supervision. Assessment and evaluation cannot be delegated. SECTION 5: LABORATORY VALUES AND DIAGNOSTICS
Q31. The nurse is reviewing laboratory results. Which finding requires immediate intervention? A) Serum potassium of 3.5 mEq/L B) Serum potassium of 2.9 mEq/L C) Serum sodium of 138 mEq/L D) Hemoglobin of 12 g/dL Correct Answer: B Rationale: Potassium 2.9 mEq/L is severely low (hypokalemia), which can cause cardiac arrhythmias, muscle weakness, and respiratory depression. This is a critical lab value requiring immediate intervention. Q32. The Allen's test is performed before which procedure? A) Lumbar puncture B) Arterial blood gas (ABG) draw from the radial artery C) Venipuncture for blood cultures D) Insertion of a peripheral IV line Correct Answer: B Rationale: The Allen's test assesses collateral circulation in the hand before radial artery puncture for ABG sampling. It ensures adequate blood flow via the ulnar artery if the radial artery is occluded. Q33. A client's serum potassium level is 2.9 mEq/L. Which ECG change should the nurse expect to see? A) Tall, peaked T waves B) Flattened T waves and prominent U waves
