1
NSG 4800: COMPREHENSIVE NURSING CAPSTONE
(COMPS) – ACTUAL EXAM SIMULATION |200 Questions
with Verified Answers and Comprehensive Rationales
SECTION 1: MEDICAL-SURGICAL NURSING & CRITICAL CARE (Questions 1-30)
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. Oxygen
saturation drops from 98% to 86% on room air. Heart rate 118 bpm, respiratory rate 28/min, blood
pressure 102/68 mmHg. Which action 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 exhibits signs of pulmonary embolism (sudden dyspnea, chest pain, hypoxemia,
tachycardia). Following ABC priority, the nurse must first address oxygenation. Rapid response
notification is important but secondary to oxygen administration.
2. A nurse is caring for a client with heart failure receiving furosemide 40 mg IV push. Which
assessment finding indicates the medication is having the DESIRED therapeutic effect?
A. Blood pressure decreases from 148/92 to 128/78 mmHg
B. Urine output increases from 20 mL/hour to 60 mL/hour
C. Potassium level remains at 4.0 mEq/L
D. Crackles clear from lung bases bilaterally
Answer: D. Crackles clear from lung bases bilaterally
Rationale: While furosemide lowers BP and increases urine output, the therapeutic goal in heart failure
is reducing fluid overload and pulmonary congestion. Clearing lung crackles directly indicates reduced
pulmonary edema.
3. A nurse assesses a client with a chest tube connected to water-seal drainage following right
pneumothorax. The water in the water-seal chamber is NOT fluctuating with respirations (no tidaling).
Which action should the nurse take FIRST?
,2
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 may indicate lung re-expansion (positive) OR system obstruction. The
nurse must first assess the client to determine the cause. If breath sounds are clear and SpO2 is stable,
re-expansion is likely. Clamping is never routine. Stripping creates dangerous negative pressure.
4. A nurse is caring for a client 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.
Temperature 101.8°F (38.8°C). Which action should the nurse take FIRST?
A. Slow the transfusion rate and notify the provider
B. Administer acetaminophen as prescribed
C. Stop the transfusion immediately and maintain IV line with normal saline
D. Obtain a urine specimen to assess for hemoglobinuria
Answer: C. Stop the transfusion immediately and maintain IV line with normal saline
Rationale: The client exhibits signs of acute hemolytic transfusion reaction (chills, fever, flank pain,
impending doom)—a life-threatening emergency. First action: stop the transfusion immediately and
maintain IV access with normal saline to prevent further incompatibility and preserve vascular access.
5. A nurse is caring for a client with a new diagnosis of SIADH. Which 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
Rationale: SIADH causes excessive ADH release → water retention → dilutional hyponatremia (<135
mEq/L) and concentrated urine (>1.030 specific gravity). Option B describes diabetes insipidus
(hypernatremia with dilute urine).
6. A nurse monitors a client with closed head injury. Which assessment findings indicate increasing
intracranial pressure (ICP)? (Select all that apply)
A. Widening pulse pressure (increasing systolic, decreasing diastolic)
B. Bradycardia
,3
C. Tachycardia with hypotension
D. Irregular respiratory pattern (Cheyne-Stokes)
E. Ipsilateral pupillary dilation
Answer: A, B, D, E
Rationale: Cushing's triad—widening pulse pressure, bradycardia, irregular respirations—is a late sign of
increased ICP. Ipsilateral pupillary dilation indicates pressure on CN III (uncal herniation). Tachycardia
with hypotension indicates hypovolemic shock, not increased ICP.
7. A nurse is caring for a client 24 hours post-percutaneous coronary intervention (PCI) with stent
placement via right femoral artery. The nurse notes a pulsating mass with palpable thrill and audible
bruit at the groin insertion site. The client reports pain at the site. Which action should the nurse take
FIRST?
A. Apply manual pressure directly over the site
B. Notify the provider immediately and prepare 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 for vascular surgery
Rationale: The client exhibits signs of pseudoaneurysm (pulsatile mass, thrill, bruit) or possible
arteriovenous fistula—complications of femoral artery access. This requires immediate provider
notification and may need surgical repair. Manual pressure should not be applied without an order.
8. A nurse is caring for a client with acute pancreatitis. Which laboratory value should the nurse
monitor MOST closely during the first 48 hours?
A. Serum amylase and lipase
B. Serum calcium
C. Blood glucose
D. White blood cell count
Answer: B. Serum calcium
Rationale: In acute pancreatitis, hypocalcemia occurs due to saponification (calcium binding with fatty
acids in necrotic pancreatic tissue). Decreasing serum calcium is a poor prognostic indicator and can lead
to tetany and cardiac arrhythmias.
9. A nurse is caring for a client with a new tracheostomy. The client is restless, has increased work of
breathing, and diminished air movement through the tracheostomy tube. Which action should the
nurse take FIRST?
, 4
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 tracheostomy and signs of airway obstruction, the first action is to remove the
inner cannula and check for mucus plugging. This is a simple, rapid nursing intervention. If obstruction
persists, suctioning, assessing for dislodgement, and oxygen are subsequent steps.
10. A nurse is caring for a client with cirrhosis experiencing hepatic encephalopathy. The client is
prescribed lactulose. Which assessment finding indicates the medication is having the DESIRED
therapeutic effect?
A. Serum ammonia level decreases from 110 mcg/dL to 45 mcg/dL
B. The client has 2-3 soft stools per day
C. Abdominal distention decreases
D. Asterixis resolves
Answer: B. The client has 2-3 soft stools per day
Rationale: Lactulose acidifies the colon, trapping ammonia and promoting its excretion in stool. The
therapeutic goal is 2-3 soft stools per day. While decreased ammonia and resolution of asterixis are
ultimate goals, stool frequency is the direct measure of lactulose efficacy.
11. A nurse assesses a client with hypoparathyroidism following total thyroidectomy. Which findings
should the nurse expect? (Select all that apply)
A. Positive Chvostek's sign
B. Positive Trousseau's sign
C. Hyperactive deep tendon reflexes
D. Decreased serum calcium
E. Decreased serum phosphorus
Answer: A, B, C, D
Rationale: Hypoparathyroidism causes hypocalcemia (D) and hyperphosphatemia (E is incorrect). Signs
of hypocalcemia include positive Chvostek's sign (A), positive Trousseau's sign (B), and hyperactive
reflexes (C) due to neuromuscular irritability.
12. A nurse is caring for a client receiving total parenteral nutrition (TPN) via central venous catheter.
The current TPN bag is empty, and the new bag will not arrive from pharmacy for 2 hours. Which
action should the nurse take?
NSG 4800: COMPREHENSIVE NURSING CAPSTONE
(COMPS) – ACTUAL EXAM SIMULATION |200 Questions
with Verified Answers and Comprehensive Rationales
SECTION 1: MEDICAL-SURGICAL NURSING & CRITICAL CARE (Questions 1-30)
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. Oxygen
saturation drops from 98% to 86% on room air. Heart rate 118 bpm, respiratory rate 28/min, blood
pressure 102/68 mmHg. Which action 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 exhibits signs of pulmonary embolism (sudden dyspnea, chest pain, hypoxemia,
tachycardia). Following ABC priority, the nurse must first address oxygenation. Rapid response
notification is important but secondary to oxygen administration.
2. A nurse is caring for a client with heart failure receiving furosemide 40 mg IV push. Which
assessment finding indicates the medication is having the DESIRED therapeutic effect?
A. Blood pressure decreases from 148/92 to 128/78 mmHg
B. Urine output increases from 20 mL/hour to 60 mL/hour
C. Potassium level remains at 4.0 mEq/L
D. Crackles clear from lung bases bilaterally
Answer: D. Crackles clear from lung bases bilaterally
Rationale: While furosemide lowers BP and increases urine output, the therapeutic goal in heart failure
is reducing fluid overload and pulmonary congestion. Clearing lung crackles directly indicates reduced
pulmonary edema.
3. A nurse assesses a client with a chest tube connected to water-seal drainage following right
pneumothorax. The water in the water-seal chamber is NOT fluctuating with respirations (no tidaling).
Which action should the nurse take FIRST?
,2
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 may indicate lung re-expansion (positive) OR system obstruction. The
nurse must first assess the client to determine the cause. If breath sounds are clear and SpO2 is stable,
re-expansion is likely. Clamping is never routine. Stripping creates dangerous negative pressure.
4. A nurse is caring for a client 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.
Temperature 101.8°F (38.8°C). Which action should the nurse take FIRST?
A. Slow the transfusion rate and notify the provider
B. Administer acetaminophen as prescribed
C. Stop the transfusion immediately and maintain IV line with normal saline
D. Obtain a urine specimen to assess for hemoglobinuria
Answer: C. Stop the transfusion immediately and maintain IV line with normal saline
Rationale: The client exhibits signs of acute hemolytic transfusion reaction (chills, fever, flank pain,
impending doom)—a life-threatening emergency. First action: stop the transfusion immediately and
maintain IV access with normal saline to prevent further incompatibility and preserve vascular access.
5. A nurse is caring for a client with a new diagnosis of SIADH. Which 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
Rationale: SIADH causes excessive ADH release → water retention → dilutional hyponatremia (<135
mEq/L) and concentrated urine (>1.030 specific gravity). Option B describes diabetes insipidus
(hypernatremia with dilute urine).
6. A nurse monitors a client with closed head injury. Which assessment findings indicate increasing
intracranial pressure (ICP)? (Select all that apply)
A. Widening pulse pressure (increasing systolic, decreasing diastolic)
B. Bradycardia
,3
C. Tachycardia with hypotension
D. Irregular respiratory pattern (Cheyne-Stokes)
E. Ipsilateral pupillary dilation
Answer: A, B, D, E
Rationale: Cushing's triad—widening pulse pressure, bradycardia, irregular respirations—is a late sign of
increased ICP. Ipsilateral pupillary dilation indicates pressure on CN III (uncal herniation). Tachycardia
with hypotension indicates hypovolemic shock, not increased ICP.
7. A nurse is caring for a client 24 hours post-percutaneous coronary intervention (PCI) with stent
placement via right femoral artery. The nurse notes a pulsating mass with palpable thrill and audible
bruit at the groin insertion site. The client reports pain at the site. Which action should the nurse take
FIRST?
A. Apply manual pressure directly over the site
B. Notify the provider immediately and prepare 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 for vascular surgery
Rationale: The client exhibits signs of pseudoaneurysm (pulsatile mass, thrill, bruit) or possible
arteriovenous fistula—complications of femoral artery access. This requires immediate provider
notification and may need surgical repair. Manual pressure should not be applied without an order.
8. A nurse is caring for a client with acute pancreatitis. Which laboratory value should the nurse
monitor MOST closely during the first 48 hours?
A. Serum amylase and lipase
B. Serum calcium
C. Blood glucose
D. White blood cell count
Answer: B. Serum calcium
Rationale: In acute pancreatitis, hypocalcemia occurs due to saponification (calcium binding with fatty
acids in necrotic pancreatic tissue). Decreasing serum calcium is a poor prognostic indicator and can lead
to tetany and cardiac arrhythmias.
9. A nurse is caring for a client with a new tracheostomy. The client is restless, has increased work of
breathing, and diminished air movement through the tracheostomy tube. Which action should the
nurse take FIRST?
, 4
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 tracheostomy and signs of airway obstruction, the first action is to remove the
inner cannula and check for mucus plugging. This is a simple, rapid nursing intervention. If obstruction
persists, suctioning, assessing for dislodgement, and oxygen are subsequent steps.
10. A nurse is caring for a client with cirrhosis experiencing hepatic encephalopathy. The client is
prescribed lactulose. Which assessment finding indicates the medication is having the DESIRED
therapeutic effect?
A. Serum ammonia level decreases from 110 mcg/dL to 45 mcg/dL
B. The client has 2-3 soft stools per day
C. Abdominal distention decreases
D. Asterixis resolves
Answer: B. The client has 2-3 soft stools per day
Rationale: Lactulose acidifies the colon, trapping ammonia and promoting its excretion in stool. The
therapeutic goal is 2-3 soft stools per day. While decreased ammonia and resolution of asterixis are
ultimate goals, stool frequency is the direct measure of lactulose efficacy.
11. A nurse assesses a client with hypoparathyroidism following total thyroidectomy. Which findings
should the nurse expect? (Select all that apply)
A. Positive Chvostek's sign
B. Positive Trousseau's sign
C. Hyperactive deep tendon reflexes
D. Decreased serum calcium
E. Decreased serum phosphorus
Answer: A, B, C, D
Rationale: Hypoparathyroidism causes hypocalcemia (D) and hyperphosphatemia (E is incorrect). Signs
of hypocalcemia include positive Chvostek's sign (A), positive Trousseau's sign (B), and hyperactive
reflexes (C) due to neuromuscular irritability.
12. A nurse is caring for a client receiving total parenteral nutrition (TPN) via central venous catheter.
The current TPN bag is empty, and the new bag will not arrive from pharmacy for 2 hours. Which
action should the nurse take?
