1
NSG 4800: COMPREHENSIVE NURSING CAPSTONE (COMPS) – ACTUAL
EXAM SIMULATION WITH NGN | 100 Questions with Verified Answers
and Comprehensive Rationales
SECTION 1: MEDICAL-SURGICAL NURSING & CRITICAL CARE (Questions 1-25)
1. A nurse is caring for a client who is 4 hours postoperative following a total abdominal
hysterectomy. The client reports sudden onset of shortness of breath and chest pain. The nurse notes
the client's oxygen saturation has dropped from 98% to 86% on room air. The client's heart rate is 118
bpm, respiratory rate is 28/min, and blood pressure is 102/68 mmHg. Which of the following actions
should the nurse take first?
A. Notify the rapid response team
B. Administer oxygen at 10 L/min via non-rebreather mask
C. Place the client in high Fowler's position
D. Obtain a stat 12-lead ECG
Answer: B. Administer oxygen at 10 L/min via non-rebreather mask
Rationale: The client is exhibiting signs of a pulmonary embolism (sudden dyspnea, chest pain,
hypoxemia, tachycardia). The first priority according to the ABC (Airway, Breathing, Circulation)
framework is to administer oxygen to address hypoxemia. The rapid response team (A) should be
notified, but oxygenation is the immediate nursing action. Positioning (C) and ECG (D) are secondary to
ensuring adequate oxygenation.
2. A nurse is caring for a client who has heart failure and is receiving furosemide 40 mg IV push. Which
of the following assessment findings indicates the medication is having the desired therapeutic effect?
A. The client's blood pressure decreases from 148/92 to 128/78 mmHg
B. The client's urine output increases from 20 mL/hour to 60 mL/hour
C. The client's potassium level remains at 4.0 mEq/L
D. The client's crackles clear from lung bases bilaterally
Answer: D. The client's crackles clear from lung bases bilaterally
Rationale: While furosemide does lower blood pressure (A) and increase urine output (B),
the therapeutic goal in heart failure is to reduce fluid overload and improve pulmonary
congestion. Clearing of lung crackles is the most direct indicator that the diuretic is effectively reducing
pulmonary edema. Urine output is a measure of diuresis but does not directly confirm improved
pulmonary status.
,2
3. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system
following a right pneumothorax. The nurse notes that the water in the water-seal chamber is not
fluctuating with respirations (no tidaling). Which of the following actions should the nurse take first?
A. Clamp the chest tube and notify the provider
B. Assess the client's lung sounds and oxygen saturation
C. Strip the chest tube tubing toward the drainage chamber
D. Add more sterile water to the water-seal chamber
Answer: B. Assess the client's lung sounds and oxygen saturation
Rationale: Absence of tidaling (fluctuation in the water-seal chamber with respirations) may indicate
that the lung has re-expanded (a positive finding) OR that there is an obstruction in the system.
The first action is to assess the client—check lung sounds and oxygen saturation—to determine which
scenario is occurring. If the client is stable with clear breath sounds, lung re-expansion is likely. Clamping
(A) should never be done routinely. Stripping the tubing (C) creates excessive negative pressure and can
damage tissue. Adding water (D) is not indicated.
4. A nurse is caring for a client who is receiving a blood transfusion of packed red blood cells. Thirty
minutes into the transfusion, the client reports chills, flank pain, and a feeling of impending doom.
The client's temperature is 101.8°F (38.8°C). Which of the following actions should the nurse take
first?
A. Slow the transfusion rate and notify the provider
B. Administer acetaminophen as prescribed for the fever
C. Stop the transfusion immediately and maintain the IV line with normal saline
D. Obtain a urine specimen to assess for hemoglobinuria
Answer: C. Stop the transfusion immediately and maintain the IV line with normal saline
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction (chills, fever, flank
pain, impending doom), which is a life-threatening emergency. The first action is to stop the transfusion
immediately and maintain IV access with normal saline to prevent further incompatibility and maintain
vascular access for emergency medications. Slowing the rate (A) is insufficient. Acetaminophen (B) and
urine specimen (D) are appropriate but after stopping the transfusion.
5. A nurse is caring for a client who has a new diagnosis of syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following laboratory findings should the nurse expect?
A. Serum sodium 128 mEq/L, urine specific gravity 1.035
B. Serum sodium 152 mEq/L, urine specific gravity 1.002
C. Serum potassium 3.2 mEq/L, urine specific gravity 1.015
D. Serum calcium 8.2 mg/dL, urine specific gravity 1.020
Answer: A. Serum sodium 128 mEq/L, urine specific gravity 1.035
,3
Rationale: SIADH is characterized by excessive release of ADH, leading to water retention, dilutional
hyponatremia (serum sodium <135 mEq/L), and concentrated urine (urine specific gravity >1.030).
Option B describes diabetes insipidus (hypernatremia with dilute urine). Options C and D describe other
electrolyte imbalances not characteristic of SIADH.
6. A nurse is monitoring a client who has a closed head injury. Which of the following assessment
findings indicates increasing intracranial pressure (ICP)? (Select all that apply)
A. Widening pulse pressure (increasing systolic, decreasing diastolic)
B. Bradycardia
C. Tachycardia with hypotension
D. Irregular respiratory pattern (Cheyne-Stokes)
E. Ipsilateral pupillary dilation
Correct Answers: A, B, D, E
Rationale: Cushing's triad is a late sign of increased ICP and includes widening pulse
pressure (A), bradycardia (B), and irregular respirations (D). Ipsilateral pupillary dilation (E) indicates
pressure on cranial nerve III (oculomotor) and is a sign of uncal herniation. Tachycardia with
hypotension (C) indicates hypovolemic shock, not increased ICP.
7. A nurse is caring for a client who is 24 hours post-percutaneous coronary intervention (PCI) with
stent placement via the right femoral artery. The nurse notes a pulsating mass with a palpable thrill
and audible bruit at the groin insertion site. The client reports pain at the site. Which of the following
actions should the nurse take first?
A. Apply manual pressure directly over the site
B. Notify the provider immediately and prepare the client for vascular surgery
C. Apply a cold compress and elevate the extremity
D. Document the finding as an expected post-procedural outcome
Answer: B. Notify the provider immediately and prepare the client for vascular surgery
Rationale: The client is exhibiting signs of a pseudoaneurysm (pulsatile mass, thrill, bruit) or
possible arteriovenous fistula, which are complications of femoral artery access. This
requires immediate provider notification and may necessitate surgical repair or ultrasound-guided
compression. Manual pressure (A) should not be applied without a provider order, as it may worsen the
injury. Cold compress (C) is insufficient. This is not an expected finding (D).
8. A nurse is caring for a client who has acute pancreatitis. Which of the following laboratory values
should the nurse monitor most closely during the first 48 hours of admission?
A. Serum amylase and lipase
B. Serum calcium
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C. Blood glucose
D. White blood cell count
Answer: B. Serum calcium
Rationale: In acute pancreatitis, hypocalcemia is a serious complication that occurs due
to saponification (calcium binding with fatty acids in necrotic pancreatic tissue). A decreasing serum
calcium level is a poor prognostic indicator and can lead to tetany and cardiac arrhythmias. While
amylase/lipase (A) confirm the diagnosis, they do not predict severity. Blood glucose (C) and WBC (D)
are also monitored, but calcium is the most critical prognostic marker.
9. A nurse is caring for a client who has a new tracheostomy. The client is restless, has increased work
of breathing, and the nurse notes that air movement through the tracheostomy tube is diminished.
Which of the following actions should the nurse take first?
A. Suction the tracheostomy tube
B. Deflate the cuff and assess for tube dislodgement
C. Remove the inner cannula and assess for obstruction
D. Administer oxygen via tracheostomy collar
Answer: C. Remove the inner cannula and assess for obstruction
Rationale: In a client with a tracheostomy who exhibits signs of airway obstruction, the first action is
to remove the inner cannula and assess for mucus plugging or obstruction. This is a simple, rapid
intervention that can be performed by the nurse. If removing the inner cannula does not resolve the
issue, suctioning (A), assessing for dislodgement (B), and oxygen (D) are subsequent steps.
10. A nurse is caring for a client who has cirrhosis and is experiencing hepatic encephalopathy. The
client is prescribed lactulose. Which of the following assessment findings indicates the medication is
having the desired therapeutic effect?
A. The client's serum ammonia level decreases from 110 mcg/dL to 45 mcg/dL
B. The client has 2-3 soft stools per day
C. The client's abdominal distention decreases
D. The client's asterixis resolves
Answer: B. The client has 2-3 soft stools per day
Rationale: Lactulose works by acidifying the colon, which traps ammonia (converting NH3 to NH4+) and
promotes its excretion in stool. The therapeutic goal is 2-3 soft stools per day. This is the clinical
indicator that the medication is being dosed correctly. While decreased ammonia (A) and resolution of
asterixis (D) are ultimate goals, stool frequency is the direct measure of lactulose efficacy.
11. A nurse is assessing a client who has hypoparathyroidism following a total thyroidectomy. Which
of the following findings should the nurse expect? (Select all that apply)
NSG 4800: COMPREHENSIVE NURSING CAPSTONE (COMPS) – ACTUAL
EXAM SIMULATION WITH NGN | 100 Questions with Verified Answers
and Comprehensive Rationales
SECTION 1: MEDICAL-SURGICAL NURSING & CRITICAL CARE (Questions 1-25)
1. A nurse is caring for a client who is 4 hours postoperative following a total abdominal
hysterectomy. The client reports sudden onset of shortness of breath and chest pain. The nurse notes
the client's oxygen saturation has dropped from 98% to 86% on room air. The client's heart rate is 118
bpm, respiratory rate is 28/min, and blood pressure is 102/68 mmHg. Which of the following actions
should the nurse take first?
A. Notify the rapid response team
B. Administer oxygen at 10 L/min via non-rebreather mask
C. Place the client in high Fowler's position
D. Obtain a stat 12-lead ECG
Answer: B. Administer oxygen at 10 L/min via non-rebreather mask
Rationale: The client is exhibiting signs of a pulmonary embolism (sudden dyspnea, chest pain,
hypoxemia, tachycardia). The first priority according to the ABC (Airway, Breathing, Circulation)
framework is to administer oxygen to address hypoxemia. The rapid response team (A) should be
notified, but oxygenation is the immediate nursing action. Positioning (C) and ECG (D) are secondary to
ensuring adequate oxygenation.
2. A nurse is caring for a client who has heart failure and is receiving furosemide 40 mg IV push. Which
of the following assessment findings indicates the medication is having the desired therapeutic effect?
A. The client's blood pressure decreases from 148/92 to 128/78 mmHg
B. The client's urine output increases from 20 mL/hour to 60 mL/hour
C. The client's potassium level remains at 4.0 mEq/L
D. The client's crackles clear from lung bases bilaterally
Answer: D. The client's crackles clear from lung bases bilaterally
Rationale: While furosemide does lower blood pressure (A) and increase urine output (B),
the therapeutic goal in heart failure is to reduce fluid overload and improve pulmonary
congestion. Clearing of lung crackles is the most direct indicator that the diuretic is effectively reducing
pulmonary edema. Urine output is a measure of diuresis but does not directly confirm improved
pulmonary status.
,2
3. A nurse is assessing a client who has a chest tube connected to a water-seal drainage system
following a right pneumothorax. The nurse notes that the water in the water-seal chamber is not
fluctuating with respirations (no tidaling). Which of the following actions should the nurse take first?
A. Clamp the chest tube and notify the provider
B. Assess the client's lung sounds and oxygen saturation
C. Strip the chest tube tubing toward the drainage chamber
D. Add more sterile water to the water-seal chamber
Answer: B. Assess the client's lung sounds and oxygen saturation
Rationale: Absence of tidaling (fluctuation in the water-seal chamber with respirations) may indicate
that the lung has re-expanded (a positive finding) OR that there is an obstruction in the system.
The first action is to assess the client—check lung sounds and oxygen saturation—to determine which
scenario is occurring. If the client is stable with clear breath sounds, lung re-expansion is likely. Clamping
(A) should never be done routinely. Stripping the tubing (C) creates excessive negative pressure and can
damage tissue. Adding water (D) is not indicated.
4. A nurse is caring for a client who is receiving a blood transfusion of packed red blood cells. Thirty
minutes into the transfusion, the client reports chills, flank pain, and a feeling of impending doom.
The client's temperature is 101.8°F (38.8°C). Which of the following actions should the nurse take
first?
A. Slow the transfusion rate and notify the provider
B. Administer acetaminophen as prescribed for the fever
C. Stop the transfusion immediately and maintain the IV line with normal saline
D. Obtain a urine specimen to assess for hemoglobinuria
Answer: C. Stop the transfusion immediately and maintain the IV line with normal saline
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction (chills, fever, flank
pain, impending doom), which is a life-threatening emergency. The first action is to stop the transfusion
immediately and maintain IV access with normal saline to prevent further incompatibility and maintain
vascular access for emergency medications. Slowing the rate (A) is insufficient. Acetaminophen (B) and
urine specimen (D) are appropriate but after stopping the transfusion.
5. A nurse is caring for a client who has a new diagnosis of syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following laboratory findings should the nurse expect?
A. Serum sodium 128 mEq/L, urine specific gravity 1.035
B. Serum sodium 152 mEq/L, urine specific gravity 1.002
C. Serum potassium 3.2 mEq/L, urine specific gravity 1.015
D. Serum calcium 8.2 mg/dL, urine specific gravity 1.020
Answer: A. Serum sodium 128 mEq/L, urine specific gravity 1.035
,3
Rationale: SIADH is characterized by excessive release of ADH, leading to water retention, dilutional
hyponatremia (serum sodium <135 mEq/L), and concentrated urine (urine specific gravity >1.030).
Option B describes diabetes insipidus (hypernatremia with dilute urine). Options C and D describe other
electrolyte imbalances not characteristic of SIADH.
6. A nurse is monitoring a client who has a closed head injury. Which of the following assessment
findings indicates increasing intracranial pressure (ICP)? (Select all that apply)
A. Widening pulse pressure (increasing systolic, decreasing diastolic)
B. Bradycardia
C. Tachycardia with hypotension
D. Irregular respiratory pattern (Cheyne-Stokes)
E. Ipsilateral pupillary dilation
Correct Answers: A, B, D, E
Rationale: Cushing's triad is a late sign of increased ICP and includes widening pulse
pressure (A), bradycardia (B), and irregular respirations (D). Ipsilateral pupillary dilation (E) indicates
pressure on cranial nerve III (oculomotor) and is a sign of uncal herniation. Tachycardia with
hypotension (C) indicates hypovolemic shock, not increased ICP.
7. A nurse is caring for a client who is 24 hours post-percutaneous coronary intervention (PCI) with
stent placement via the right femoral artery. The nurse notes a pulsating mass with a palpable thrill
and audible bruit at the groin insertion site. The client reports pain at the site. Which of the following
actions should the nurse take first?
A. Apply manual pressure directly over the site
B. Notify the provider immediately and prepare the client for vascular surgery
C. Apply a cold compress and elevate the extremity
D. Document the finding as an expected post-procedural outcome
Answer: B. Notify the provider immediately and prepare the client for vascular surgery
Rationale: The client is exhibiting signs of a pseudoaneurysm (pulsatile mass, thrill, bruit) or
possible arteriovenous fistula, which are complications of femoral artery access. This
requires immediate provider notification and may necessitate surgical repair or ultrasound-guided
compression. Manual pressure (A) should not be applied without a provider order, as it may worsen the
injury. Cold compress (C) is insufficient. This is not an expected finding (D).
8. A nurse is caring for a client who has acute pancreatitis. Which of the following laboratory values
should the nurse monitor most closely during the first 48 hours of admission?
A. Serum amylase and lipase
B. Serum calcium
, 4
C. Blood glucose
D. White blood cell count
Answer: B. Serum calcium
Rationale: In acute pancreatitis, hypocalcemia is a serious complication that occurs due
to saponification (calcium binding with fatty acids in necrotic pancreatic tissue). A decreasing serum
calcium level is a poor prognostic indicator and can lead to tetany and cardiac arrhythmias. While
amylase/lipase (A) confirm the diagnosis, they do not predict severity. Blood glucose (C) and WBC (D)
are also monitored, but calcium is the most critical prognostic marker.
9. A nurse is caring for a client who has a new tracheostomy. The client is restless, has increased work
of breathing, and the nurse notes that air movement through the tracheostomy tube is diminished.
Which of the following actions should the nurse take first?
A. Suction the tracheostomy tube
B. Deflate the cuff and assess for tube dislodgement
C. Remove the inner cannula and assess for obstruction
D. Administer oxygen via tracheostomy collar
Answer: C. Remove the inner cannula and assess for obstruction
Rationale: In a client with a tracheostomy who exhibits signs of airway obstruction, the first action is
to remove the inner cannula and assess for mucus plugging or obstruction. This is a simple, rapid
intervention that can be performed by the nurse. If removing the inner cannula does not resolve the
issue, suctioning (A), assessing for dislodgement (B), and oxygen (D) are subsequent steps.
10. A nurse is caring for a client who has cirrhosis and is experiencing hepatic encephalopathy. The
client is prescribed lactulose. Which of the following assessment findings indicates the medication is
having the desired therapeutic effect?
A. The client's serum ammonia level decreases from 110 mcg/dL to 45 mcg/dL
B. The client has 2-3 soft stools per day
C. The client's abdominal distention decreases
D. The client's asterixis resolves
Answer: B. The client has 2-3 soft stools per day
Rationale: Lactulose works by acidifying the colon, which traps ammonia (converting NH3 to NH4+) and
promotes its excretion in stool. The therapeutic goal is 2-3 soft stools per day. This is the clinical
indicator that the medication is being dosed correctly. While decreased ammonia (A) and resolution of
asterixis (D) are ultimate goals, stool frequency is the direct measure of lactulose efficacy.
11. A nurse is assessing a client who has hypoparathyroidism following a total thyroidectomy. Which
of the following findings should the nurse expect? (Select all that apply)
