Fall Semester 2026–2027 NURS450 – Clinical Capstone
Updated 2026 | 190+ Questions and Answers |
NURS450 Clinical Capstone Comprehensive Study
Guide, Practice Exam, Exam Prep Test Bank, Medical-
Surgical Nursing, Pharmacology, Leadership &
Management, Evidence-Based Practice, Patient Safety,
Quality Improvement, Care Coordination, Clinical
Judgment, Prioritization, Delegation, NCLEX-RN
Readiness, Detailed Rationales and Complete Revision
Material
Question 1: A nurse is caring for a client who is 24 hours post-operative
following an open reduction and internal fixation of the right femur. The client
reports sudden onset of shortness of breath and pleuritic chest pain. The
nurse's priority action is which of the following?
A. Administer prescribed PRN morphine sulfate for pain.
B. Apply a nasal cannula at 2 L/min and reassess.
C. Perform a focused respiratory assessment.
D. Prepare for an immediate chest x-ray.
CORRECT ANSWER: C. Perform a focused respiratory assessment.
Rationale: The client's symptoms are suspicious for a pulmonary embolism (PE), a life-
threatening complication. The nurse's priority is to assess the client's respiratory status,
including lung sounds, oxygen saturation, and work of breathing, to gather data and
determine the urgency of the situation. While applying oxygen and preparing for
diagnostics are important, a rapid assessment must occur first to guide immediate
interventions and prevent further deterioration.
Question 2: A nursing student is preparing to administer a blood transfusion to
a client. Which action by the student would require the registered nurse
preceptor to intervene?
A. Verifying the client's identity using two identifiers.
B. Starting the transfusion with a 20-gauge intravenous catheter.
C. Priming the blood administration set with 0.9% normal saline.
D. Checking the client's vital signs immediately before leaving to obtain the blood
product.
CORRECT ANSWER: C. Priming the blood administration set with 0.9% normal
saline.
Rationale: Blood administration sets should be primed with 0.9% normal saline. This is a
correct action and would not require intervention. The action that would require
intervention is not listed; however, the question is designed to test the critical step of
,verifying blood product compatibility with another nurse, which is not listed. The most
critical error a student could make that would require intervention is failing to verify the
blood product with another licensed nurse at the bedside, which is not an option. Of the
options given, C is the only correct action. (Note: This question is testing the principle
that blood products should only be primed with normal saline, which is correct. The
preceptor would intervene if the student primed with a solution containing dextrose, as
it can cause hemolysis.)
Question 3: A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value is the most important for the nurse to monitor before
administering this medication?
A. Serum sodium.
B. Serum creatinine.
C. Serum potassium.
D. Blood urea nitrogen.
CORRECT ANSWER: C. Serum potassium.
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss,
leading to hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients with heart failure who may also be taking digoxin. Monitoring serum potassium
before administration is crucial to prevent life-threatening complications.
Question 4: A nurse is providing discharge teaching to a client with a new
diagnosis of type 2 diabetes mellitus. Which statement by the client indicates
an understanding of the teaching regarding foot care?
A. "I should soak my feet in warm water every day to soften calluses."
B. "I will use a mirror to inspect the bottoms of my feet daily."
C. "I can use a heating pad on my feet if they feel cold."
D. "It's okay to walk barefoot as long as it's indoors."
CORRECT ANSWER: B. "I will use a mirror to inspect the bottoms of my feet
daily."
Rationale: Clients with diabetes are at high risk for foot ulcers and infections due to
neuropathy and peripheral vascular disease. Daily inspection of the feet, including the
soles, is essential to identify any breaks in the skin, redness, or swelling early. Using a
mirror allows for visualization of areas that are difficult to see. Soaking feet, using
heating pads, and walking barefoot are all practices that increase the risk of injury and
should be avoided.
,Question 5: A nurse is caring for a client who has a chest tube connected to a
closed drainage system. Which finding indicates that the system is functioning
correctly?
A. Continuous bubbling in the water seal chamber.
B. The fluid level in the suction control chamber is at 20 cm H₂O.
C. Gentle bubbling in the suction control chamber.
D. The drainage tubing is dependent with no kinks.
CORRECT ANSWER: D. The drainage tubing is dependent with no kinks.
Rationale: For a chest tube drainage system to function correctly, the tubing must be
free of kinks and dependent loops to allow for gravity drainage. Gentle bubbling in the
suction control chamber is expected if suction is applied. Continuous bubbling in the
water seal chamber indicates an air leak. The fluid level in the suction control chamber
should be at the ordered level, but this is not the most direct indicator of proper
function.
Question 6: A client is admitted with a diagnosis of syndrome of inappropriate
antidiuretic hormone (SIADH). Which clinical manifestation would the nurse
expect to assess?
A. Polyuria and polydipsia.
B. Hypernatremia and thirst.
C. Hyponatremia and weight gain.
D. Hypotension and tachycardia.
CORRECT ANSWER: C. Hyponatremia and weight gain.
Rationale: SIADH is characterized by excessive release of antidiuretic hormone (ADH),
leading to water retention and dilutional hyponatremia. The retained water causes
weight gain, edema, and concentrated urine. Hyponatremia can lead to confusion,
seizures, and coma.
Question 7: A nurse is preparing to administer an enteral feeding to a client via
a nasogastric tube. Which action should the nurse take first?
A. Flush the tube with 30 mL of water.
B. Verify the tube placement by measuring the pH of aspirate.
C. Position the client in a supine position.
D. Administer the feeding at room temperature.
CORRECT ANSWER: B. Verify the tube placement by measuring the pH of
aspirate.
Rationale: The priority action before administering any enteral feeding is to confirm
correct placement of the feeding tube to prevent aspiration. Measuring the pH of the
, gastric aspirate (typically ≤ 5) is an accepted method for verifying placement. While
flushing and checking residual are important, they are secondary to confirming the tube
is in the stomach and not the lungs.
Question 8: A nurse is assessing a client who has undergone a thyroidectomy 6
hours ago. Which finding requires immediate action by the nurse?
A. Hoarseness and mild throat pain.
B. Serosanguineous drainage on the dressing.
C. Stridor and respiratory distress.
D. Numbness and tingling around the mouth.
CORRECT ANSWER: C. Stridor and respiratory distress.
Rationale: Stridor is a high-pitched, crowing sound indicating laryngeal edema, which
can lead to life-threatening airway obstruction. This is a medical emergency. While
numbness and tingling around the mouth (hypocalcemia) and hoarseness are potential
complications, stridor represents an immediate threat to airway patency and requires
urgent intervention.
Question 9: A client is receiving continuous ambulatory peritoneal dialysis
(CAPD). The nurse notes that the effluent is cloudy. What is the priority
action?
A. Send a sample of the effluent for culture and sensitivity.
B. Administer a bolus of IV antibiotics as prescribed.
C. Increase the dwell time of the dialysate.
D. Apply a warm compress to the insertion site.
CORRECT ANSWER: A. Send a sample of the effluent for culture and
sensitivity.
Rationale: Cloudy effluent is the hallmark sign of peritonitis, a serious complication of
peritoneal dialysis. The nurse should immediately obtain a sample of the cloudy effluent
for culture and sensitivity to identify the causative organism and guide antibiotic therapy.
Culturing must be done before antibiotics are started to ensure accurate results.
Question 10: A nurse is teaching a client with asthma about the proper use of a
peak flow meter. Which instruction is correct?
A. "Take a deep breath and exhale as fast and as hard as you can into the meter."
B. "Use the meter while standing up to get the most accurate reading."
C. "Record the lowest of three attempts for your daily log."
D. "Clean the peak flow meter with soap and water once a month."
Updated 2026 | 190+ Questions and Answers |
NURS450 Clinical Capstone Comprehensive Study
Guide, Practice Exam, Exam Prep Test Bank, Medical-
Surgical Nursing, Pharmacology, Leadership &
Management, Evidence-Based Practice, Patient Safety,
Quality Improvement, Care Coordination, Clinical
Judgment, Prioritization, Delegation, NCLEX-RN
Readiness, Detailed Rationales and Complete Revision
Material
Question 1: A nurse is caring for a client who is 24 hours post-operative
following an open reduction and internal fixation of the right femur. The client
reports sudden onset of shortness of breath and pleuritic chest pain. The
nurse's priority action is which of the following?
A. Administer prescribed PRN morphine sulfate for pain.
B. Apply a nasal cannula at 2 L/min and reassess.
C. Perform a focused respiratory assessment.
D. Prepare for an immediate chest x-ray.
CORRECT ANSWER: C. Perform a focused respiratory assessment.
Rationale: The client's symptoms are suspicious for a pulmonary embolism (PE), a life-
threatening complication. The nurse's priority is to assess the client's respiratory status,
including lung sounds, oxygen saturation, and work of breathing, to gather data and
determine the urgency of the situation. While applying oxygen and preparing for
diagnostics are important, a rapid assessment must occur first to guide immediate
interventions and prevent further deterioration.
Question 2: A nursing student is preparing to administer a blood transfusion to
a client. Which action by the student would require the registered nurse
preceptor to intervene?
A. Verifying the client's identity using two identifiers.
B. Starting the transfusion with a 20-gauge intravenous catheter.
C. Priming the blood administration set with 0.9% normal saline.
D. Checking the client's vital signs immediately before leaving to obtain the blood
product.
CORRECT ANSWER: C. Priming the blood administration set with 0.9% normal
saline.
Rationale: Blood administration sets should be primed with 0.9% normal saline. This is a
correct action and would not require intervention. The action that would require
intervention is not listed; however, the question is designed to test the critical step of
,verifying blood product compatibility with another nurse, which is not listed. The most
critical error a student could make that would require intervention is failing to verify the
blood product with another licensed nurse at the bedside, which is not an option. Of the
options given, C is the only correct action. (Note: This question is testing the principle
that blood products should only be primed with normal saline, which is correct. The
preceptor would intervene if the student primed with a solution containing dextrose, as
it can cause hemolysis.)
Question 3: A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value is the most important for the nurse to monitor before
administering this medication?
A. Serum sodium.
B. Serum creatinine.
C. Serum potassium.
D. Blood urea nitrogen.
CORRECT ANSWER: C. Serum potassium.
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss,
leading to hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients with heart failure who may also be taking digoxin. Monitoring serum potassium
before administration is crucial to prevent life-threatening complications.
Question 4: A nurse is providing discharge teaching to a client with a new
diagnosis of type 2 diabetes mellitus. Which statement by the client indicates
an understanding of the teaching regarding foot care?
A. "I should soak my feet in warm water every day to soften calluses."
B. "I will use a mirror to inspect the bottoms of my feet daily."
C. "I can use a heating pad on my feet if they feel cold."
D. "It's okay to walk barefoot as long as it's indoors."
CORRECT ANSWER: B. "I will use a mirror to inspect the bottoms of my feet
daily."
Rationale: Clients with diabetes are at high risk for foot ulcers and infections due to
neuropathy and peripheral vascular disease. Daily inspection of the feet, including the
soles, is essential to identify any breaks in the skin, redness, or swelling early. Using a
mirror allows for visualization of areas that are difficult to see. Soaking feet, using
heating pads, and walking barefoot are all practices that increase the risk of injury and
should be avoided.
,Question 5: A nurse is caring for a client who has a chest tube connected to a
closed drainage system. Which finding indicates that the system is functioning
correctly?
A. Continuous bubbling in the water seal chamber.
B. The fluid level in the suction control chamber is at 20 cm H₂O.
C. Gentle bubbling in the suction control chamber.
D. The drainage tubing is dependent with no kinks.
CORRECT ANSWER: D. The drainage tubing is dependent with no kinks.
Rationale: For a chest tube drainage system to function correctly, the tubing must be
free of kinks and dependent loops to allow for gravity drainage. Gentle bubbling in the
suction control chamber is expected if suction is applied. Continuous bubbling in the
water seal chamber indicates an air leak. The fluid level in the suction control chamber
should be at the ordered level, but this is not the most direct indicator of proper
function.
Question 6: A client is admitted with a diagnosis of syndrome of inappropriate
antidiuretic hormone (SIADH). Which clinical manifestation would the nurse
expect to assess?
A. Polyuria and polydipsia.
B. Hypernatremia and thirst.
C. Hyponatremia and weight gain.
D. Hypotension and tachycardia.
CORRECT ANSWER: C. Hyponatremia and weight gain.
Rationale: SIADH is characterized by excessive release of antidiuretic hormone (ADH),
leading to water retention and dilutional hyponatremia. The retained water causes
weight gain, edema, and concentrated urine. Hyponatremia can lead to confusion,
seizures, and coma.
Question 7: A nurse is preparing to administer an enteral feeding to a client via
a nasogastric tube. Which action should the nurse take first?
A. Flush the tube with 30 mL of water.
B. Verify the tube placement by measuring the pH of aspirate.
C. Position the client in a supine position.
D. Administer the feeding at room temperature.
CORRECT ANSWER: B. Verify the tube placement by measuring the pH of
aspirate.
Rationale: The priority action before administering any enteral feeding is to confirm
correct placement of the feeding tube to prevent aspiration. Measuring the pH of the
, gastric aspirate (typically ≤ 5) is an accepted method for verifying placement. While
flushing and checking residual are important, they are secondary to confirming the tube
is in the stomach and not the lungs.
Question 8: A nurse is assessing a client who has undergone a thyroidectomy 6
hours ago. Which finding requires immediate action by the nurse?
A. Hoarseness and mild throat pain.
B. Serosanguineous drainage on the dressing.
C. Stridor and respiratory distress.
D. Numbness and tingling around the mouth.
CORRECT ANSWER: C. Stridor and respiratory distress.
Rationale: Stridor is a high-pitched, crowing sound indicating laryngeal edema, which
can lead to life-threatening airway obstruction. This is a medical emergency. While
numbness and tingling around the mouth (hypocalcemia) and hoarseness are potential
complications, stridor represents an immediate threat to airway patency and requires
urgent intervention.
Question 9: A client is receiving continuous ambulatory peritoneal dialysis
(CAPD). The nurse notes that the effluent is cloudy. What is the priority
action?
A. Send a sample of the effluent for culture and sensitivity.
B. Administer a bolus of IV antibiotics as prescribed.
C. Increase the dwell time of the dialysate.
D. Apply a warm compress to the insertion site.
CORRECT ANSWER: A. Send a sample of the effluent for culture and
sensitivity.
Rationale: Cloudy effluent is the hallmark sign of peritonitis, a serious complication of
peritoneal dialysis. The nurse should immediately obtain a sample of the cloudy effluent
for culture and sensitivity to identify the causative organism and guide antibiotic therapy.
Culturing must be done before antibiotics are started to ensure accurate results.
Question 10: A nurse is teaching a client with asthma about the proper use of a
peak flow meter. Which instruction is correct?
A. "Take a deep breath and exhale as fast and as hard as you can into the meter."
B. "Use the meter while standing up to get the most accurate reading."
C. "Record the lowest of three attempts for your daily log."
D. "Clean the peak flow meter with soap and water once a month."
