HCIRNE · 0084 GSN
Galen College of Nursing
✚ ★
Excellence in Nursing Education
G
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Exam 2 Enrichment Topics
P R I O R I T I Z AT I O N · L E GA L / E T H I CS · P R O C E D U R E S · P H A R M ACO LO G Y · P E D I AT R I CS · O B
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Comp Exam 2 — Enrichment Topics Review TOTAL QUESTIONS 90 Questions
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 prioritization, legal/ethics, procedures, pharmacology, pediatrics, and obstetrics.
▸ 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 — PRIORITIZATION, DISCHARGE & CARE COORDINATION Questions 1 – 8
1. The nurse is prioritizing care for multiple patients using the ABC method. What does ABC stand for and which patient should be seen first?
A. Ambulation, Bathing, Comfort — the patient requesting pain medication
B. Airway, Breathing, Circulation — the patient with respiratory distress
C. Assessment, Bandaging, Charting — the newly admitted patient
D. Activity, Bowel sounds, Comfort — the post-operative patient
CORRECT ANSWER B — Airway, Breathing, Circulation — the patient with respiratory distress
RATIONALE ABC prioritization stands for Airway, Breathing, Circulation. This is the foundational triage and prioritization framework in nursing. The
patient with airway or breathing compromise (respiratory distress, airway obstruction, hypoxia) is always the highest priority. If the
airway is compromised, breathing and circulation cannot be maintained. This framework guides the nurse in rapidly identifying which
patient requires immediate intervention to prevent death. Priority diagnoses are those conditions requiring immediate intervention to
prevent death.
2. A patient is being evaluated for discharge. Which criteria indicate the patient is ready for discharge?
A. Patient is ambulating for the first time post-operatively
B. Stable lab values, tolerating oral medications, and at baseline functional status
C. Patient requests to leave and has transportation available
D. Vital signs are improving but still outside normal range
CORRECT ANSWER B — Stable lab values, tolerating oral medications, and at baseline functional status
RATIONALE Discharge criteria include: stable laboratory values, tolerating oral medications (transitioning from IV to PO), and return to baseline
functional status. The patient must be medically stable, able to manage their care (or have support), and have a safe discharge plan.
Discharging a patient before these criteria are met increases the risk of readmission and adverse outcomes. The nurse must coordinate
with the interdisciplinary team (care conference) for complex patients to ensure all discharge needs are addressed.
,3. A patient with a priority diagnosis requires immediate intervention. Which conditions are considered priority diagnoses?
A. Conditions that can be managed with routine follow-up in primary care
B. Conditions requiring immediate intervention to prevent death, such as airway obstruction, hemorrhage, or septic shock
C. Chronic conditions that have been stable for months
D. Elective surgical procedures with no urgency
CORRECT ANSWER B — Conditions requiring immediate intervention to prevent death, such as airway obstruction, hemorrhage, or septic shock
RATIONALE Priority diagnoses are those conditions that require immediate intervention to prevent death or irreversible harm. Examples include
airway obstruction, massive hemorrhage, septic shock, tension pneumothorax, and cardiac tamponade. The nurse must recognize these
conditions and act rapidly — delays of minutes can be fatal. ABC prioritization guides the identification of priority diagnoses. Stable
chronic conditions, elective procedures, and routine follow-up issues are lower priority.
4. The nurse is participating in a care conference for a patient with complex medical and social needs. What is the purpose of a care conference?
A. To allow the primary nurse to make all decisions independently
B. To involve multiple disciplines (nursing, medicine, social work, therapy, pharmacy) in developing a comprehensive care plan
C. To discuss the patient without the patient present
D. To delegate all care to unlicensed assistive personnel
CORRECT ANSWER B — To involve multiple disciplines (nursing, medicine, social work, therapy, pharmacy) in developing a comprehensive care plan
RATIONALE A care conference brings together multiple healthcare disciplines to collaboratively develop and coordinate a comprehensive care plan
for patients with complex needs. The interdisciplinary team may include nursing, medicine, social work, physical/occupational therapy,
pharmacy, nutrition, and case management. The patient and family should also be included when possible. This collaborative approach
ensures all aspects of care are addressed, reduces fragmentation, and improves outcomes for medically and socially complex patients.
5. The nurse is caring for a patient in Buck's traction. What is the purpose of this type of traction?
A. Internal fixation using surgical pins through the bone
B. External traction that reduces nerve pressure without the use of pins
C. Cervical spine immobilization after trauma
D. Post-operative compression to prevent deep vein thrombosis
CORRECT ANSWER B — External traction that reduces nerve pressure without the use of pins
RATIONALE Buck's traction is a type of skin traction (external) used to reduce muscle spasms, relieve nerve pressure, and immobilize fractures
temporarily — all without the use of surgical pins. Weights must hang freely at all times and never be released without a provider order.
Skin inspection must be performed at least every 8 hours to assess for breakdown under the traction apparatus. Buck's traction is
commonly used for hip fractures and femoral fractures as a temporary measure before surgical repair.
6. How frequently should the nurse inspect the skin of a patient in traction?
A. Once per shift — every 12 hours
B. At least every 8 hours
C. Once daily during morning care
D. Only when the patient complains of discomfort
CORRECT ANSWER B — At least every 8 hours
RATIONALE Skin inspection for a patient in any type of traction must be performed at least every 8 hours (once per nursing shift minimum). The nurse
must assess for pressure points, skin breakdown, irritation from the traction apparatus, and neurovascular status of the affected
extremity. Weights must hang freely, ropes must move through pulleys unobstructed, and alignment must be maintained. Documentation
of skin integrity and neurovascular checks (6 Ps) is essential. Any signs of breakdown require immediate intervention and provider
notification.
, 7. The nurse is managing a patient with traction. Which statement about weight management is correct?
A. Weights may be temporarily removed for bathing
B. Weights must hang freely at all times and never be released without a provider order
C. The nurse may adjust weights for patient comfort
D. Weights should rest on the floor when the patient is sleeping
CORRECT ANSWER B — Weights must hang freely at all times and never be released without a provider order
RATIONALE Traction weights must hang freely at all times — never resting on the floor or bed frame. The nurse must NEVER add, remove, or release
weights without a specific provider order. Weights are calculated to provide the precise countertraction force needed; unauthorized
changes compromise the therapeutic effect and can cause injury. The rope must move freely through the pulley, and the patient must
maintain proper body alignment. Traction must be continuous and uninterrupted for therapeutic effectiveness.
8. A patient with kidney disease is prescribed a dietary restriction. What does a "low sodium diet" for renal patients typically also restrict?
A. Only sodium — all other nutrients are unrestricted
B. Sodium, potassium, phosphorus, and protein
C. Only potassium and calcium
D. Only carbohydrates and fats
CORRECT ANSWER B — Sodium, potassium, phosphorus, and protein
RATIONALE A renal diet is low in sodium (fluid retention, hypertension), potassium (hyperkalemia risk due to reduced excretion), phosphorus
(hyperphosphatemia contributes to bone disease), and protein (reduces urea load on the kidneys — though some protein is still needed).
Fluid intake and output must be monitored closely with daily weights. The nurse must educate the patient about hidden sources of these
nutrients (salt substitutes are often high in potassium, dairy is high in phosphorus) and coordinate with dietary services for meal
planning.
SECTION II — CARDIAC, LEGAL/ETHICS & DRAINAGE TYPES Questions 9 – 22
9. The nurse is assessing a patient with suspected cardiac tamponade. What are the classic signs of this potentially fatal condition?
A. Bradycardia, hypertension, and crackles in the lung bases
B. Jugular venous distention (JVD), muffled heart sounds, and hypotension (Beck's triad)
C. Fever, productive cough, and pleuritic chest pain
D. Peripheral edema, ascites, and hepatomegaly
CORRECT ANSWER B — Jugular venous distention (JVD), muffled heart sounds, and hypotension (Beck's triad)
RATIONALE Cardiac tamponade is a life-threatening condition where fluid accumulates in the pericardial sac, compressing the heart and preventing
adequate filling. Beck's triad: Jugular venous distention (JVD — from increased venous pressure), muffled heart sounds (fluid dampens
sound transmission), and hypotension (decreased cardiac output). This is a fatal condition if not treated emergently with
pericardiocentesis. The nurse must recognize these signs immediately. Pericarditis presents differently — with sharp chest pain, shortness
of breath, and swelling.
Galen College of Nursing
✚ ★
Excellence in Nursing Education
G
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Exam 2 Enrichment Topics
P R I O R I T I Z AT I O N · L E GA L / E T H I CS · P R O C E D U R E S · P H A R M ACO LO G Y · P E D I AT R I CS · O B
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Comp Exam 2 — Enrichment Topics Review TOTAL QUESTIONS 90 Questions
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 prioritization, legal/ethics, procedures, pharmacology, pediatrics, and obstetrics.
▸ 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 — PRIORITIZATION, DISCHARGE & CARE COORDINATION Questions 1 – 8
1. The nurse is prioritizing care for multiple patients using the ABC method. What does ABC stand for and which patient should be seen first?
A. Ambulation, Bathing, Comfort — the patient requesting pain medication
B. Airway, Breathing, Circulation — the patient with respiratory distress
C. Assessment, Bandaging, Charting — the newly admitted patient
D. Activity, Bowel sounds, Comfort — the post-operative patient
CORRECT ANSWER B — Airway, Breathing, Circulation — the patient with respiratory distress
RATIONALE ABC prioritization stands for Airway, Breathing, Circulation. This is the foundational triage and prioritization framework in nursing. The
patient with airway or breathing compromise (respiratory distress, airway obstruction, hypoxia) is always the highest priority. If the
airway is compromised, breathing and circulation cannot be maintained. This framework guides the nurse in rapidly identifying which
patient requires immediate intervention to prevent death. Priority diagnoses are those conditions requiring immediate intervention to
prevent death.
2. A patient is being evaluated for discharge. Which criteria indicate the patient is ready for discharge?
A. Patient is ambulating for the first time post-operatively
B. Stable lab values, tolerating oral medications, and at baseline functional status
C. Patient requests to leave and has transportation available
D. Vital signs are improving but still outside normal range
CORRECT ANSWER B — Stable lab values, tolerating oral medications, and at baseline functional status
RATIONALE Discharge criteria include: stable laboratory values, tolerating oral medications (transitioning from IV to PO), and return to baseline
functional status. The patient must be medically stable, able to manage their care (or have support), and have a safe discharge plan.
Discharging a patient before these criteria are met increases the risk of readmission and adverse outcomes. The nurse must coordinate
with the interdisciplinary team (care conference) for complex patients to ensure all discharge needs are addressed.
,3. A patient with a priority diagnosis requires immediate intervention. Which conditions are considered priority diagnoses?
A. Conditions that can be managed with routine follow-up in primary care
B. Conditions requiring immediate intervention to prevent death, such as airway obstruction, hemorrhage, or septic shock
C. Chronic conditions that have been stable for months
D. Elective surgical procedures with no urgency
CORRECT ANSWER B — Conditions requiring immediate intervention to prevent death, such as airway obstruction, hemorrhage, or septic shock
RATIONALE Priority diagnoses are those conditions that require immediate intervention to prevent death or irreversible harm. Examples include
airway obstruction, massive hemorrhage, septic shock, tension pneumothorax, and cardiac tamponade. The nurse must recognize these
conditions and act rapidly — delays of minutes can be fatal. ABC prioritization guides the identification of priority diagnoses. Stable
chronic conditions, elective procedures, and routine follow-up issues are lower priority.
4. The nurse is participating in a care conference for a patient with complex medical and social needs. What is the purpose of a care conference?
A. To allow the primary nurse to make all decisions independently
B. To involve multiple disciplines (nursing, medicine, social work, therapy, pharmacy) in developing a comprehensive care plan
C. To discuss the patient without the patient present
D. To delegate all care to unlicensed assistive personnel
CORRECT ANSWER B — To involve multiple disciplines (nursing, medicine, social work, therapy, pharmacy) in developing a comprehensive care plan
RATIONALE A care conference brings together multiple healthcare disciplines to collaboratively develop and coordinate a comprehensive care plan
for patients with complex needs. The interdisciplinary team may include nursing, medicine, social work, physical/occupational therapy,
pharmacy, nutrition, and case management. The patient and family should also be included when possible. This collaborative approach
ensures all aspects of care are addressed, reduces fragmentation, and improves outcomes for medically and socially complex patients.
5. The nurse is caring for a patient in Buck's traction. What is the purpose of this type of traction?
A. Internal fixation using surgical pins through the bone
B. External traction that reduces nerve pressure without the use of pins
C. Cervical spine immobilization after trauma
D. Post-operative compression to prevent deep vein thrombosis
CORRECT ANSWER B — External traction that reduces nerve pressure without the use of pins
RATIONALE Buck's traction is a type of skin traction (external) used to reduce muscle spasms, relieve nerve pressure, and immobilize fractures
temporarily — all without the use of surgical pins. Weights must hang freely at all times and never be released without a provider order.
Skin inspection must be performed at least every 8 hours to assess for breakdown under the traction apparatus. Buck's traction is
commonly used for hip fractures and femoral fractures as a temporary measure before surgical repair.
6. How frequently should the nurse inspect the skin of a patient in traction?
A. Once per shift — every 12 hours
B. At least every 8 hours
C. Once daily during morning care
D. Only when the patient complains of discomfort
CORRECT ANSWER B — At least every 8 hours
RATIONALE Skin inspection for a patient in any type of traction must be performed at least every 8 hours (once per nursing shift minimum). The nurse
must assess for pressure points, skin breakdown, irritation from the traction apparatus, and neurovascular status of the affected
extremity. Weights must hang freely, ropes must move through pulleys unobstructed, and alignment must be maintained. Documentation
of skin integrity and neurovascular checks (6 Ps) is essential. Any signs of breakdown require immediate intervention and provider
notification.
, 7. The nurse is managing a patient with traction. Which statement about weight management is correct?
A. Weights may be temporarily removed for bathing
B. Weights must hang freely at all times and never be released without a provider order
C. The nurse may adjust weights for patient comfort
D. Weights should rest on the floor when the patient is sleeping
CORRECT ANSWER B — Weights must hang freely at all times and never be released without a provider order
RATIONALE Traction weights must hang freely at all times — never resting on the floor or bed frame. The nurse must NEVER add, remove, or release
weights without a specific provider order. Weights are calculated to provide the precise countertraction force needed; unauthorized
changes compromise the therapeutic effect and can cause injury. The rope must move freely through the pulley, and the patient must
maintain proper body alignment. Traction must be continuous and uninterrupted for therapeutic effectiveness.
8. A patient with kidney disease is prescribed a dietary restriction. What does a "low sodium diet" for renal patients typically also restrict?
A. Only sodium — all other nutrients are unrestricted
B. Sodium, potassium, phosphorus, and protein
C. Only potassium and calcium
D. Only carbohydrates and fats
CORRECT ANSWER B — Sodium, potassium, phosphorus, and protein
RATIONALE A renal diet is low in sodium (fluid retention, hypertension), potassium (hyperkalemia risk due to reduced excretion), phosphorus
(hyperphosphatemia contributes to bone disease), and protein (reduces urea load on the kidneys — though some protein is still needed).
Fluid intake and output must be monitored closely with daily weights. The nurse must educate the patient about hidden sources of these
nutrients (salt substitutes are often high in potassium, dairy is high in phosphorus) and coordinate with dietary services for meal
planning.
SECTION II — CARDIAC, LEGAL/ETHICS & DRAINAGE TYPES Questions 9 – 22
9. The nurse is assessing a patient with suspected cardiac tamponade. What are the classic signs of this potentially fatal condition?
A. Bradycardia, hypertension, and crackles in the lung bases
B. Jugular venous distention (JVD), muffled heart sounds, and hypotension (Beck's triad)
C. Fever, productive cough, and pleuritic chest pain
D. Peripheral edema, ascites, and hepatomegaly
CORRECT ANSWER B — Jugular venous distention (JVD), muffled heart sounds, and hypotension (Beck's triad)
RATIONALE Cardiac tamponade is a life-threatening condition where fluid accumulates in the pericardial sac, compressing the heart and preventing
adequate filling. Beck's triad: Jugular venous distention (JVD — from increased venous pressure), muffled heart sounds (fluid dampens
sound transmission), and hypotension (decreased cardiac output). This is a fatal condition if not treated emergently with
pericardiocentesis. The nurse must recognize these signs immediately. Pericarditis presents differently — with sharp chest pain, shortness
of breath, and swelling.
