1
Greenlight ACTUAL Examination 2026/2027 |
Comprehensive Practice Assessment | 150
Multiple-Choice Q&A
This comprehensive practice assessment is designed to prepare candidates for the Greenlight/VATI
Predictor Examination. Questions cover medical-surgical nursing, pharmacology, fundamentals,
maternal-newborn, pediatrics, mental health, leadership, and critical care concepts. Each question
includes the correct answer with a detailed rationale. Use this resource to identify knowledge gaps and
strengthen clinical judgment skills.
Section 1: Medical-Surgical Nursing (Questions 1–40)
1. A nurse is caring for a client who has a newly inserted chest tube following a thoracotomy. Which
finding requires immediate intervention?
A) Fluctuation of fluid in the water seal chamber with respiration
B) Continuous bubbling in the suction control chamber
C) Continuous bubbling in the water seal chamber
D) Drainage of 75 mL of serosanguineous fluid in the first hour
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the chest tube system.
This requires immediate assessment to locate and seal the leak to prevent tension pneumothorax.
Fluctuation (tidaling) in the water seal chamber is normal and indicates the system is patent. Continuous
bubbling in the suction control chamber is expected when suction is applied. Drainage of up to 100
mL/hour is acceptable in the immediate postoperative period.
2. A client with heart failure is receiving furosemide 40 mg IV push. Which assessment finding
indicates a therapeutic response to the medication?
A) Decreased heart rate from 110 to 88 bpm
B) Increased urine output of 200 mL in 2 hours
C) Decreased blood pressure from 148/92 to 130/80 mmHg
D) Clear lung sounds on auscultation
Answer: B
,2
Rationale: Furosemide is a loop diuretic. The primary therapeutic effect is increased urine output
(diuresis). While decreased blood pressure and clear lung sounds are desired outcomes of heart failure
treatment, they are indirect effects. The direct therapeutic response to furosemide is diuresis.
3. A nurse is caring for a client who is 24 hours postoperative following an open cholecystectomy. The
client reports sudden onset of shortness of breath and pleuritic chest pain. Vital signs: HR 118, RR 28,
BP 138/86, SpO2 88% on room air. What is the priority nursing action?
A) Administer prescribed morphine 2 mg IV
B) Place the client in Trendelenburg position
C) Apply oxygen and notify the provider immediately
D) Encourage the client to cough and deep breathe
Answer: C
Rationale: The client's presentation (sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea,
hypoxemia) is highly suggestive of pulmonary embolism, a life-threatening postoperative complication.
The priority is to apply oxygen to improve oxygenation and notify the provider immediately for further
diagnostic testing and treatment. Morphine may be given later for pain but does not address the
underlying emergency.
4. A nurse is assessing a client who has chronic kidney disease and is receiving hemodialysis. Which
finding should the nurse report to the provider immediately?
A) Temperature of 100.2°F (37.9°C)
B) Blood pressure of 150/90 mmHg
C) Weight gain of 2 kg since the last dialysis session
D) Potassium level of 5.2 mEq/L
Answer: A
Rationale: Fever in a client receiving hemodialysis may indicate a bloodstream infection related to the
vascular access site, which can rapidly progress to sepsis. This requires immediate notification. The other
findings are common in CKD and can be managed with routine interventions: hypertension and mild
hyperkalemia are expected, and 2 kg fluid gain between sessions is within typical range.
5. A nurse is providing discharge teaching to a client who has a new diagnosis of hypertension and a
prescription for lisinopril. Which statement by the client indicates an understanding of the teaching?
A) "I can switch to a salt substitute to flavor my food."
B) "I should report any dry, hacking cough to my provider."
C) "I can stop taking this medication once my blood pressure is normal."
D) "I should take this medication with a high-potassium food."
Answer: B
,3
Rationale: Lisinopril is an ACE inhibitor. A persistent dry, hacking cough is a common adverse effect
caused by increased bradykinin. The client should report this to the provider, who may switch to an ARB.
Salt substitutes often contain potassium, which can cause hyperkalemia when combined with ACE
inhibitors. Antihypertensives are typically lifelong therapy. High-potassium foods should be avoided with
ACE inhibitors.
6. A nurse is caring for a client who is receiving a blood transfusion. Fifteen minutes after initiation,
the client reports chills and low back pain. Vital signs: temperature 101.2°F (38.4°C), HR 118, BP 88/54.
What is the priority nursing action?
A) Slow the infusion rate and reassess in 15 minutes
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen as prescribed
D) Notify the blood bank
Answer: B
Rationale: Chills, fever, hypotension, and low back pain are classic signs of an acute hemolytic
transfusion reaction. The priority is to immediately stop the transfusion and maintain IV access with
normal saline to support blood pressure and prevent acute kidney injury from hemoglobinuria.
Notification of the provider and blood bank occurs after stopping the infusion.
7. A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH).
Which laboratory finding should the nurse expect?
A) Serum sodium 130 mEq/L
B) Serum osmolality 295 mOsm/kg
C) Urine specific gravity 1.002
D) Serum potassium 3.2 mEq/L
Answer: A
Rationale: SIADH causes excessive release of ADH, leading to water retention, dilutional hyponatremia,
and concentrated urine. Serum sodium is typically low (<135 mEq/L). Serum osmolality is decreased
(diluted), urine specific gravity is high (>1.030), and urine osmolality is inappropriately elevated.
Potassium is not primarily affected.
8. A nurse is providing care for a client who is 12 hours postoperative following a total hip
arthroplasty. Which assessment finding requires immediate intervention?
A) Pain rating of 6 on a 0-10 scale
B) Serosanguineous drainage on the dressing
C) Calf pain with dorsiflexion of the foot
D) Urinary output of 240 mL in 8 hours
, 4
Answer: C
Rationale: Calf pain with dorsiflexion (positive Homans' sign) may indicate deep vein thrombosis, a
serious postoperative complication of orthopedic surgery. This requires immediate notification and
further evaluation. Pain is expected postoperatively. Serosanguineous drainage is normal. Urine output
of 30 mL/hour is acceptable (240 mL/8 hours).
9. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which laboratory value is the
priority to monitor during insulin infusion therapy?
A) Serum glucose
B) Serum potassium
C) Serum bicarbonate
D) Anion gap
Answer: B
Rationale: During DKA treatment, insulin drives potassium back into cells, which can cause life-
threatening hypokalemia. Cardiac arrhythmias from hypokalemia can occur before glucose normalizes.
Serum potassium must be monitored frequently (every 1-2 hours initially). Insulin should not be started
if potassium is <3.3 mEq/L.
10. A nurse is assessing a client who has hypocalcemia. Which finding should the nurse expect?
A) Decreased deep tendon reflexes
B) Positive Chvostek's sign
C) Bradycardia
D) Muscle weakness
Answer: B
Rationale: Hypocalcemia increases neuromuscular excitability. Positive Chvostek's sign (facial muscle
twitching when tapping the facial nerve) and positive Trousseau's sign (carpal spasm with blood
pressure cuff inflation) are classic findings. Hypercalcemia causes decreased reflexes, bradycardia, and
muscle weakness.
11. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) via a central venous
catheter. The TPN infusion is completed, but the new bag has not arrived from pharmacy. What is the
appropriate nursing action?
A) Discontinue the infusion and flush the line with normal saline
B) Infuse 10% dextrose in water at the same rate
C) Infuse 0.9% sodium chloride at a keep-vein-open rate
D) Clamp the catheter until the new TPN bag arrives
Greenlight ACTUAL Examination 2026/2027 |
Comprehensive Practice Assessment | 150
Multiple-Choice Q&A
This comprehensive practice assessment is designed to prepare candidates for the Greenlight/VATI
Predictor Examination. Questions cover medical-surgical nursing, pharmacology, fundamentals,
maternal-newborn, pediatrics, mental health, leadership, and critical care concepts. Each question
includes the correct answer with a detailed rationale. Use this resource to identify knowledge gaps and
strengthen clinical judgment skills.
Section 1: Medical-Surgical Nursing (Questions 1–40)
1. A nurse is caring for a client who has a newly inserted chest tube following a thoracotomy. Which
finding requires immediate intervention?
A) Fluctuation of fluid in the water seal chamber with respiration
B) Continuous bubbling in the suction control chamber
C) Continuous bubbling in the water seal chamber
D) Drainage of 75 mL of serosanguineous fluid in the first hour
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the chest tube system.
This requires immediate assessment to locate and seal the leak to prevent tension pneumothorax.
Fluctuation (tidaling) in the water seal chamber is normal and indicates the system is patent. Continuous
bubbling in the suction control chamber is expected when suction is applied. Drainage of up to 100
mL/hour is acceptable in the immediate postoperative period.
2. A client with heart failure is receiving furosemide 40 mg IV push. Which assessment finding
indicates a therapeutic response to the medication?
A) Decreased heart rate from 110 to 88 bpm
B) Increased urine output of 200 mL in 2 hours
C) Decreased blood pressure from 148/92 to 130/80 mmHg
D) Clear lung sounds on auscultation
Answer: B
,2
Rationale: Furosemide is a loop diuretic. The primary therapeutic effect is increased urine output
(diuresis). While decreased blood pressure and clear lung sounds are desired outcomes of heart failure
treatment, they are indirect effects. The direct therapeutic response to furosemide is diuresis.
3. A nurse is caring for a client who is 24 hours postoperative following an open cholecystectomy. The
client reports sudden onset of shortness of breath and pleuritic chest pain. Vital signs: HR 118, RR 28,
BP 138/86, SpO2 88% on room air. What is the priority nursing action?
A) Administer prescribed morphine 2 mg IV
B) Place the client in Trendelenburg position
C) Apply oxygen and notify the provider immediately
D) Encourage the client to cough and deep breathe
Answer: C
Rationale: The client's presentation (sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea,
hypoxemia) is highly suggestive of pulmonary embolism, a life-threatening postoperative complication.
The priority is to apply oxygen to improve oxygenation and notify the provider immediately for further
diagnostic testing and treatment. Morphine may be given later for pain but does not address the
underlying emergency.
4. A nurse is assessing a client who has chronic kidney disease and is receiving hemodialysis. Which
finding should the nurse report to the provider immediately?
A) Temperature of 100.2°F (37.9°C)
B) Blood pressure of 150/90 mmHg
C) Weight gain of 2 kg since the last dialysis session
D) Potassium level of 5.2 mEq/L
Answer: A
Rationale: Fever in a client receiving hemodialysis may indicate a bloodstream infection related to the
vascular access site, which can rapidly progress to sepsis. This requires immediate notification. The other
findings are common in CKD and can be managed with routine interventions: hypertension and mild
hyperkalemia are expected, and 2 kg fluid gain between sessions is within typical range.
5. A nurse is providing discharge teaching to a client who has a new diagnosis of hypertension and a
prescription for lisinopril. Which statement by the client indicates an understanding of the teaching?
A) "I can switch to a salt substitute to flavor my food."
B) "I should report any dry, hacking cough to my provider."
C) "I can stop taking this medication once my blood pressure is normal."
D) "I should take this medication with a high-potassium food."
Answer: B
,3
Rationale: Lisinopril is an ACE inhibitor. A persistent dry, hacking cough is a common adverse effect
caused by increased bradykinin. The client should report this to the provider, who may switch to an ARB.
Salt substitutes often contain potassium, which can cause hyperkalemia when combined with ACE
inhibitors. Antihypertensives are typically lifelong therapy. High-potassium foods should be avoided with
ACE inhibitors.
6. A nurse is caring for a client who is receiving a blood transfusion. Fifteen minutes after initiation,
the client reports chills and low back pain. Vital signs: temperature 101.2°F (38.4°C), HR 118, BP 88/54.
What is the priority nursing action?
A) Slow the infusion rate and reassess in 15 minutes
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen as prescribed
D) Notify the blood bank
Answer: B
Rationale: Chills, fever, hypotension, and low back pain are classic signs of an acute hemolytic
transfusion reaction. The priority is to immediately stop the transfusion and maintain IV access with
normal saline to support blood pressure and prevent acute kidney injury from hemoglobinuria.
Notification of the provider and blood bank occurs after stopping the infusion.
7. A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH).
Which laboratory finding should the nurse expect?
A) Serum sodium 130 mEq/L
B) Serum osmolality 295 mOsm/kg
C) Urine specific gravity 1.002
D) Serum potassium 3.2 mEq/L
Answer: A
Rationale: SIADH causes excessive release of ADH, leading to water retention, dilutional hyponatremia,
and concentrated urine. Serum sodium is typically low (<135 mEq/L). Serum osmolality is decreased
(diluted), urine specific gravity is high (>1.030), and urine osmolality is inappropriately elevated.
Potassium is not primarily affected.
8. A nurse is providing care for a client who is 12 hours postoperative following a total hip
arthroplasty. Which assessment finding requires immediate intervention?
A) Pain rating of 6 on a 0-10 scale
B) Serosanguineous drainage on the dressing
C) Calf pain with dorsiflexion of the foot
D) Urinary output of 240 mL in 8 hours
, 4
Answer: C
Rationale: Calf pain with dorsiflexion (positive Homans' sign) may indicate deep vein thrombosis, a
serious postoperative complication of orthopedic surgery. This requires immediate notification and
further evaluation. Pain is expected postoperatively. Serosanguineous drainage is normal. Urine output
of 30 mL/hour is acceptable (240 mL/8 hours).
9. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which laboratory value is the
priority to monitor during insulin infusion therapy?
A) Serum glucose
B) Serum potassium
C) Serum bicarbonate
D) Anion gap
Answer: B
Rationale: During DKA treatment, insulin drives potassium back into cells, which can cause life-
threatening hypokalemia. Cardiac arrhythmias from hypokalemia can occur before glucose normalizes.
Serum potassium must be monitored frequently (every 1-2 hours initially). Insulin should not be started
if potassium is <3.3 mEq/L.
10. A nurse is assessing a client who has hypocalcemia. Which finding should the nurse expect?
A) Decreased deep tendon reflexes
B) Positive Chvostek's sign
C) Bradycardia
D) Muscle weakness
Answer: B
Rationale: Hypocalcemia increases neuromuscular excitability. Positive Chvostek's sign (facial muscle
twitching when tapping the facial nerve) and positive Trousseau's sign (carpal spasm with blood
pressure cuff inflation) are classic findings. Hypercalcemia causes decreased reflexes, bradycardia, and
muscle weakness.
11. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) via a central venous
catheter. The TPN infusion is completed, but the new bag has not arrived from pharmacy. What is the
appropriate nursing action?
A) Discontinue the infusion and flush the line with normal saline
B) Infuse 10% dextrose in water at the same rate
C) Infuse 0.9% sodium chloride at a keep-vein-open rate
D) Clamp the catheter until the new TPN bag arrives
