SPIT YDUTS · 0084 GSN
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Exam 1 Study Tips
D E L E GAT I O N · O BST E T R I CS · P E D I AT R I CS · L A B VA LU E S · T R I AG E · S A F E TY ·
P H A R M ACO LO G Y
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Exam 1 — Study TOTAL QUESTIONS 90 Questions
Tips & Review
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans delegation, scope of practice, obstetrics, pediatrics, lab values, triage, fire safety, and
pharmacology.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical values and guidelines reflect current evidence-based practice standards.
, SECTION I — BLOOD PRESSURE, DELEGATION & SCOPE OF
Questions 1 – 8
PRACTICE
1. The nurse is assessing a patient whose baseline blood pressure was 138/86. Today the
reading is 116/72. What would be considered a significant and potentially concerning drop
in blood pressure?
A. A drop of 5 points in systolic from baseline
B. A drop of 10 points in diastolic from baseline
C. A drop of 20 points from where it was originally
D. Any drop below 140/90
CORRECT ANSWER C — A drop of 20 points from where it was originally
RATIONALE A drop of 20 mm Hg (or "points") from baseline systolic or diastolic pressure is
clinically significant and warrants investigation. This patient dropped from 138/86
to 116/72 — a decrease of 22 systolic and 14 diastolic. The systolic drop exceeds
20 points, which is the threshold for concern. Potential causes include
hemorrhage, dehydration, medication effects, position change, or sepsis. The
nurse must assess for symptoms of hypotension and notify the provider.
2. The registered nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which
task falls within the UAP scope of practice?
A. Performing the initial set of vital signs on a newly admitted patient
B. Administering oral medications
C. Assisting with activities of daily living (ADLs) and cleaning up patients
D. Providing initial patient education on a new diagnosis
CORRECT ANSWER C — Assisting with activities of daily living (ADLs) and cleaning up patients
RATIONALE UAP scope of practice includes assisting with ADLs, providing hygiene care,
cleaning up patients, and taking vital signs only after the RN has performed the
first set and the patient is determined to be stable. The RN is responsible for the
initial assessment, medication administration, and patient education — none of
these can be delegated to UAP. Understanding delegation boundaries is critical
for patient safety and NCLEX success.
,3. The nurse is working with a licensed practical nurse (LPN). Which task is within the LPN
scope of practice?
A. Initiating the initial nursing assessment on a new admission
B. Starting a blood transfusion
C. Monitoring RN findings, reinforcing education, and performing routine procedures such
as catheterization
D. Developing the nursing care plan
CORRECT ANSWER C — Monitoring RN findings, reinforcing education, and performing routine
procedures such as catheterization
RATIONALE LPNs can monitor RN findings, reinforce previously provided education, perform
routine procedures (catheterization, ostomy care, tube patency and enteral
feeding), administer most medications, and perform specific assessments (lung,
bowel, neurovascular checks). LPNs cannot initiate the initial assessment,
provide first-time patient education, start blood transfusions, or administer
certain medications. The RN retains responsibility for the nursing process, care
planning, and initial assessments.
4. The charge nurse is reviewing LPN scope of practice limitations. Which task may an LPN
NOT perform?
A. Administering routine oral medications
B. Providing ostomy care and checking tube patency
C. Starting a blood transfusion
D. Performing lung, bowel, and neurovascular checks
CORRECT ANSWER C — Starting a blood transfusion
RATIONALE LPNs cannot initiate blood transfusions. This task requires RN-level assessment
and monitoring for transfusion reactions. LPNs also cannot initiate initial
assessments, provide first-time patient education, or administer certain restricted
medications. LPNs can administer most routine medications, provide ostomy
care, check tube patency, manage enteral feedings, and perform focused
assessments such as lung, bowel, and neurovascular checks. The RN must know
these boundaries for safe delegation.
, 5. A nurse is caring for a patient who speaks only Mandarin. The patient's adult child is
present and offers to translate. What is the nurse's most appropriate action?
A. Allow the child to translate since they are immediately available
B. Use Google Translate on the nurse's phone for efficiency
C. Request a certified medical interpreter through the hospital system
D. Ask another patient's family member who appears to speak Mandarin
CORRECT ANSWER C — Request a certified medical interpreter through the hospital system
RATIONALE A certified medical interpreter should always be used for patients with limited
English proficiency. Family members should not be used as interpreters due to
issues of confidentiality, accuracy of medical translation, emotional involvement,
and potential filtering of information. Google Translate and other machine
translation tools are not approved for medical interpretation as they lack the
accuracy required for clinical communication. Federal law (Title VI of the Civil
Rights Act) requires healthcare facilities to provide language access services.
6. An Rh-negative pregnant patient at 28 weeks gestation is scheduled to receive Rho(D)
immune globulin (RhoGAM). The patient asks the nurse why this injection is necessary.
What is the correct response?
A. RhoGAM boosts the mother's immune system to protect the fetus from infections
B. RhoGAM prevents the mother's body from making Rh antibodies against the baby's Rh-
positive blood
C. RhoGAM treats anemia in the fetus caused by Rh incompatibility
D. RhoGAM converts the mother's blood type from Rh-negative to Rh-positive
CORRECT ANSWER B — RhoGAM prevents the mother's body from making Rh antibodies
against the baby's Rh-positive blood
RATIONALE Rho(D) immune globulin (RhoGAM) contains anti-Rh antibodies
(immunoglobulin) that bind to and destroy any fetal Rh-positive red blood cells
that may have entered the maternal circulation. This prevents the mother's
immune system from producing her own permanent Rh antibodies, which could
attack a future Rh-positive fetus (hemolytic disease of the newborn). It is given at
28 weeks gestation, within 72 hours after delivery of an Rh-positive infant, after
abortion, after amniocentesis, or after any bleeding episode during pregnancy.
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Exam 1 Study Tips
D E L E GAT I O N · O BST E T R I CS · P E D I AT R I CS · L A B VA LU E S · T R I AG E · S A F E TY ·
P H A R M ACO LO G Y
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Exam 1 — Study TOTAL QUESTIONS 90 Questions
Tips & Review
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans delegation, scope of practice, obstetrics, pediatrics, lab values, triage, fire safety, and
pharmacology.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical values and guidelines reflect current evidence-based practice standards.
, SECTION I — BLOOD PRESSURE, DELEGATION & SCOPE OF
Questions 1 – 8
PRACTICE
1. The nurse is assessing a patient whose baseline blood pressure was 138/86. Today the
reading is 116/72. What would be considered a significant and potentially concerning drop
in blood pressure?
A. A drop of 5 points in systolic from baseline
B. A drop of 10 points in diastolic from baseline
C. A drop of 20 points from where it was originally
D. Any drop below 140/90
CORRECT ANSWER C — A drop of 20 points from where it was originally
RATIONALE A drop of 20 mm Hg (or "points") from baseline systolic or diastolic pressure is
clinically significant and warrants investigation. This patient dropped from 138/86
to 116/72 — a decrease of 22 systolic and 14 diastolic. The systolic drop exceeds
20 points, which is the threshold for concern. Potential causes include
hemorrhage, dehydration, medication effects, position change, or sepsis. The
nurse must assess for symptoms of hypotension and notify the provider.
2. The registered nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which
task falls within the UAP scope of practice?
A. Performing the initial set of vital signs on a newly admitted patient
B. Administering oral medications
C. Assisting with activities of daily living (ADLs) and cleaning up patients
D. Providing initial patient education on a new diagnosis
CORRECT ANSWER C — Assisting with activities of daily living (ADLs) and cleaning up patients
RATIONALE UAP scope of practice includes assisting with ADLs, providing hygiene care,
cleaning up patients, and taking vital signs only after the RN has performed the
first set and the patient is determined to be stable. The RN is responsible for the
initial assessment, medication administration, and patient education — none of
these can be delegated to UAP. Understanding delegation boundaries is critical
for patient safety and NCLEX success.
,3. The nurse is working with a licensed practical nurse (LPN). Which task is within the LPN
scope of practice?
A. Initiating the initial nursing assessment on a new admission
B. Starting a blood transfusion
C. Monitoring RN findings, reinforcing education, and performing routine procedures such
as catheterization
D. Developing the nursing care plan
CORRECT ANSWER C — Monitoring RN findings, reinforcing education, and performing routine
procedures such as catheterization
RATIONALE LPNs can monitor RN findings, reinforce previously provided education, perform
routine procedures (catheterization, ostomy care, tube patency and enteral
feeding), administer most medications, and perform specific assessments (lung,
bowel, neurovascular checks). LPNs cannot initiate the initial assessment,
provide first-time patient education, start blood transfusions, or administer
certain medications. The RN retains responsibility for the nursing process, care
planning, and initial assessments.
4. The charge nurse is reviewing LPN scope of practice limitations. Which task may an LPN
NOT perform?
A. Administering routine oral medications
B. Providing ostomy care and checking tube patency
C. Starting a blood transfusion
D. Performing lung, bowel, and neurovascular checks
CORRECT ANSWER C — Starting a blood transfusion
RATIONALE LPNs cannot initiate blood transfusions. This task requires RN-level assessment
and monitoring for transfusion reactions. LPNs also cannot initiate initial
assessments, provide first-time patient education, or administer certain restricted
medications. LPNs can administer most routine medications, provide ostomy
care, check tube patency, manage enteral feedings, and perform focused
assessments such as lung, bowel, and neurovascular checks. The RN must know
these boundaries for safe delegation.
, 5. A nurse is caring for a patient who speaks only Mandarin. The patient's adult child is
present and offers to translate. What is the nurse's most appropriate action?
A. Allow the child to translate since they are immediately available
B. Use Google Translate on the nurse's phone for efficiency
C. Request a certified medical interpreter through the hospital system
D. Ask another patient's family member who appears to speak Mandarin
CORRECT ANSWER C — Request a certified medical interpreter through the hospital system
RATIONALE A certified medical interpreter should always be used for patients with limited
English proficiency. Family members should not be used as interpreters due to
issues of confidentiality, accuracy of medical translation, emotional involvement,
and potential filtering of information. Google Translate and other machine
translation tools are not approved for medical interpretation as they lack the
accuracy required for clinical communication. Federal law (Title VI of the Civil
Rights Act) requires healthcare facilities to provide language access services.
6. An Rh-negative pregnant patient at 28 weeks gestation is scheduled to receive Rho(D)
immune globulin (RhoGAM). The patient asks the nurse why this injection is necessary.
What is the correct response?
A. RhoGAM boosts the mother's immune system to protect the fetus from infections
B. RhoGAM prevents the mother's body from making Rh antibodies against the baby's Rh-
positive blood
C. RhoGAM treats anemia in the fetus caused by Rh incompatibility
D. RhoGAM converts the mother's blood type from Rh-negative to Rh-positive
CORRECT ANSWER B — RhoGAM prevents the mother's body from making Rh antibodies
against the baby's Rh-positive blood
RATIONALE Rho(D) immune globulin (RhoGAM) contains anti-Rh antibodies
(immunoglobulin) that bind to and destroy any fetal Rh-positive red blood cells
that may have entered the maternal circulation. This prevents the mother's
immune system from producing her own permanent Rh antibodies, which could
attack a future Rh-positive fetus (hemolytic disease of the newborn). It is given at
28 weeks gestation, within 72 hours after delivery of an Rh-positive infant, after
abortion, after amniocentesis, or after any bleeding episode during pregnancy.
