NR 667 CHAMBERLAIN CEA FINAL EXAM
(LATEST ): MOST COMPREHENSIVE
QUESTIONS &RATIONALES ; 100% PASS..
1. A healthcare organization is implementing a new policy to reduce hospital readmissions for
heart failure patients. The policy includes a 7-day post-discharge follow-up call, a medication
reconciliation, and a telehealth monitoring program. Using the Donabedian model for quality
improvement, which of the following is the best classification for the 'telehealth monitoring
program'?
A. Structure
B. Process
C. Outcome
D. Context
Answer: B
Rationale: The Donabedian model classifies quality measures into structure (resources), process
(actions), and outcome (results). Telehealth monitoring is an action or intervention, hence it is a process
measure. Structure would refer to the equipment or staff, outcomes to readmission rates. Context is not a
category in the model.
2. In a meta-analysis of randomized controlled trials examining the effect of nurse-led transitional
care on 30-day readmission rates, the pooled odds ratio is 0.78 (95% CI 0.68-0.89). Which of the
following is the most accurate interpretation of this finding?
A. Nurse-led care reduces the odds of readmission by 22% compared to usual care, and the result is statistically
significant.
B. Nurse-led care increases the odds of readmission by 22% compared to usual care, and the result is not
statistically significant.
C. The odds of readmission are 0.78 times lower in the control group, but the confidence interval suggests no
effect.
D. Nurse-led care reduces the odds of readmission by 78% compared to usual care, and the result is statistically
significant.
Answer: A
Rationale: An odds ratio of 0.78 indicates a 22% reduction in odds (1 - 0.78 = 0.22). The 95% CI
(0.68-0.89) does not include 1, so the result is statistically significant at alpha=0.05. Option B
misinterprets the direction; C misstates the control group; D incorrectly states a 78% reduction.
3. A nurse executive is leading a task force to address disparities in diabetes outcomes among racial
and ethnic minorities in a community health center. Which of the following strategies aligns most
closely with the principles of cultural competence and health equity?
Page 1
,A. Implementing a standardized diabetes education program in English for all patients
B. Hiring a diverse staff and providing interpreter services, but maintaining the same clinical protocols
C. Conducting community-based participatory research to co-design interventions with affected populations
D. Focusing on individual-level behavior change without addressing systemic barriers
Answer: C
Rationale: Community-based participatory research (CBPR) involves community members as equal
partners, addressing power imbalances and incorporating cultural context. This aligns with health
equity by addressing systemic and social determinants. Option A ignores language barriers; B adds
diversity but doesn't adapt care; D ignores systemic factors.
4. A patient with chronic kidney disease (CKD) stage 4 is prescribed enalapril. The nurse notes a
serum creatinine increase of 30% from baseline two weeks after initiation. Which of the following
is the most appropriate nursing action based on current guidelines?
A. Discontinue enalapril immediately and notify the provider
B. Continue enalapril and monitor renal function weekly, as a 30% increase is acceptable
C. Hold enalapril and administer a loop diuretic to reduce creatinine
D. Reduce the dose of enalapril by half and recheck creatinine in 24 hours
Answer: B
Rationale: ACE inhibitors can cause a transient increase in serum creatinine up to 30% due to
hemodynamic effects. Current guidelines (KDIGO) recommend continuing the medication and
monitoring renal function if the increase is less than 30% and stable. Discontinuation is not warranted
unless hyperkalemia or >30% rise occurs. Loop diuretics are not indicated for this.
5. A nursing researcher plans a study to compare the effectiveness of two pain management
protocols (standard vs. multimodal) in postoperative patients. The researcher assigns participants
to groups based on the last digit of their medical record number (even = standard, odd =
multimodal). Which type of bias is most likely to affect this study?
A. Selection bias
B. Information bias
C. Confounding
D. Recall bias
Answer: A
Rationale: Using an arbitrary rule like last digit of medical record number does not ensure random
assignment and can introduce selection bias if the digit correlates with patient characteristics. This is
not true randomization. Information bias relates to measurement errors; confounding is a mixing of
effects; recall bias is specific to retrospective studies.
6. A hospital is implementing a 'just culture' model after a serious medication error. The error
occurred when a nurse administered a high-alert medication despite an alert in the electronic
health record. Investigation reveals that the alert was overridden due to 'alert fatigue' from
frequent irrelevant alerts. Which of the following system-level changes best addresses the root
cause?
A. Retraining the nurse on proper alert response
Page 2
,B. Disciplining the nurse to deter future errors
C. Reducing the number of low-priority alerts through evidence-based optimization
D. Requiring a second nurse to verify all high-alert medications
Answer: C
Rationale: Just culture focuses on system improvements rather than individual blame. Alert fatigue from
excessive alerts is a known system issue. Optimizing alert frequency and relevance reduces fatigue and
improves response. Retraining or discipline does not address the root cause. Double-checking may help
but does not solve the alert fatigue problem.
7. A nurse is caring for a patient with a diagnosis of sepsis secondary to pneumonia. The patient's
blood pressure is 85/50 mmHg, heart rate 110 bpm, and lactate 4.2 mmol/L. According to the
Surviving Sepsis Campaign 2026 guidelines, which of the following is the priority intervention?
A. Administer broad-spectrum antibiotics within 3 hours of recognition
B. Start vasopressors to maintain mean arterial pressure (MAP) "e 65 mmHg
C. Initiate 30 mL/kg of crystalloid fluid resuscitation within the first 3 hours
D. Obtain blood cultures before administering antibiotics
Answer: C
Rationale: The patient has septic shock (hypotension and lactate >2). The 2026 guidelines recommend
starting with 30 mL/kg crystalloid within 3 hours. Vasopressors are indicated if fluid resuscitation fails
to achieve MAP "e65. Antibiotics should be given within 1 hour, not 3 hours. Blood cultures should not
delay antibiotics.
8. A nurse manager is evaluating the financial performance of a nursing unit. The unit has a
variable cost of $200 per patient day and fixed costs of $500,000 per year. If the unit provides
10,000 patient days per year, and the reimbursement rate is $300 per patient day, what is the profit
or loss for the year?
A. $500,000 profit
B. $500,000 loss
C. $1,000,000 profit
D. $1,000,000 loss
Answer: B
Rationale: Revenue = 10,000 days × $300 = $3,000,000. Variable costs = 10,000 × $200 = $2,000,000.
Total costs = $2,000,000 + $500,000 = $2,500,000. Profit = $3,000,000 - $2,500,000 = $500,000. Wait,
that is profit. Recalculate: Fixed costs $500,000 + variable $2,000,000 = $2,500,000. Revenue
$3,000,000. Profit $500,000. But the correct answer is B? Let's check: Actually, the reimbursement rate
is $300 per day, so revenue is $3M. Costs: variable $2M + fixed $0.5M = $2.5M. Profit $0.5M. So
answer should be A. I made an error. Correct: A.
9. A nurse manager is evaluating the financial performance of a nursing unit. The unit has a
variable cost of $200 per patient day and fixed costs of $500,000 per year. If the unit provides
10,000 patient days per year, and the reimbursement rate is $300 per patient day, what is the profit
or loss for the year?
Page 3
, A. $500,000 profit
B. $500,000 loss
C. $1,000,000 profit
D. $1,000,000 loss
Answer: A
Rationale: Revenue = 10,000 × $300 = $3,000,000. Total costs = variable ($2,000,000) + fixed
($500,000) = $2,500,000. Profit = $3,000,000 - $2,500,000 = $500,000. Options B, C, D are incorrect
due to miscalculation of either revenue or costs.
10. A nurse is involved in a conflict with a physician regarding a patient's plan of care. The nurse
believes the current order is unsafe, but the physician insists on continuing. Using the
'Interest-Based Relational' approach to conflict resolution, which of the following is the first step
the nurse should take?
A. Assertively state the nurse's position and demand a change
B. Seek mediation from a third party
C. Separate the people from the problem by focusing on the issue, not personalities
D. Compromise by agreeing to a modified order that partially addresses both concerns
Answer: C
Rationale: Interest-Based Relational approach emphasizes separating people from the problem to reduce
emotional tension and focus on mutual interests. The first step is to depersonalize the conflict.
Assertiveness (A) may escalate conflict; mediation (B) is later if needed; compromise (D) may be a
solution but not the first step.
11. A nursing student is preparing a presentation on the ethical principle of nonmaleficence. Which
of the following scenarios best exemplifies a violation of this principle?
A. A nurse respects a patient's refusal of a life-saving blood transfusion due to religious beliefs
B. A nurse administers a higher dose of morphine than prescribed to manage severe pain, causing respiratory
depression
C. A nurse distributes limited flu vaccine to the most vulnerable patients first
D. A nurse discloses a patient's HIV status to the patient's partner without consent to prevent harm
Answer: B
Rationale: Nonmaleficence means 'do no harm.' Administering an excessive dose that causes harm
directly violates this principle. Option A respects autonomy; C is distributive justice; D is a breach of
confidentiality, though it may be justified under duty to warn, but it is not a direct harm from the nurse's
action.
12. A 48-year-old individual with a history of chronic kidney disease stage 3 is being evaluated for
a new medication. The drug is primarily eliminated by the kidneys and has a narrow therapeutic
index. Which pharmacokinetic parameter is most critically altered in this patient, and how should
the dosing be adjusted?
A. Increased volume of distribution; increase loading dose
B. Decreased clearance; reduce maintenance dose and/or extend dosing interval
C. Increased half-life; increase maintenance dose
Page 4
(LATEST ): MOST COMPREHENSIVE
QUESTIONS &RATIONALES ; 100% PASS..
1. A healthcare organization is implementing a new policy to reduce hospital readmissions for
heart failure patients. The policy includes a 7-day post-discharge follow-up call, a medication
reconciliation, and a telehealth monitoring program. Using the Donabedian model for quality
improvement, which of the following is the best classification for the 'telehealth monitoring
program'?
A. Structure
B. Process
C. Outcome
D. Context
Answer: B
Rationale: The Donabedian model classifies quality measures into structure (resources), process
(actions), and outcome (results). Telehealth monitoring is an action or intervention, hence it is a process
measure. Structure would refer to the equipment or staff, outcomes to readmission rates. Context is not a
category in the model.
2. In a meta-analysis of randomized controlled trials examining the effect of nurse-led transitional
care on 30-day readmission rates, the pooled odds ratio is 0.78 (95% CI 0.68-0.89). Which of the
following is the most accurate interpretation of this finding?
A. Nurse-led care reduces the odds of readmission by 22% compared to usual care, and the result is statistically
significant.
B. Nurse-led care increases the odds of readmission by 22% compared to usual care, and the result is not
statistically significant.
C. The odds of readmission are 0.78 times lower in the control group, but the confidence interval suggests no
effect.
D. Nurse-led care reduces the odds of readmission by 78% compared to usual care, and the result is statistically
significant.
Answer: A
Rationale: An odds ratio of 0.78 indicates a 22% reduction in odds (1 - 0.78 = 0.22). The 95% CI
(0.68-0.89) does not include 1, so the result is statistically significant at alpha=0.05. Option B
misinterprets the direction; C misstates the control group; D incorrectly states a 78% reduction.
3. A nurse executive is leading a task force to address disparities in diabetes outcomes among racial
and ethnic minorities in a community health center. Which of the following strategies aligns most
closely with the principles of cultural competence and health equity?
Page 1
,A. Implementing a standardized diabetes education program in English for all patients
B. Hiring a diverse staff and providing interpreter services, but maintaining the same clinical protocols
C. Conducting community-based participatory research to co-design interventions with affected populations
D. Focusing on individual-level behavior change without addressing systemic barriers
Answer: C
Rationale: Community-based participatory research (CBPR) involves community members as equal
partners, addressing power imbalances and incorporating cultural context. This aligns with health
equity by addressing systemic and social determinants. Option A ignores language barriers; B adds
diversity but doesn't adapt care; D ignores systemic factors.
4. A patient with chronic kidney disease (CKD) stage 4 is prescribed enalapril. The nurse notes a
serum creatinine increase of 30% from baseline two weeks after initiation. Which of the following
is the most appropriate nursing action based on current guidelines?
A. Discontinue enalapril immediately and notify the provider
B. Continue enalapril and monitor renal function weekly, as a 30% increase is acceptable
C. Hold enalapril and administer a loop diuretic to reduce creatinine
D. Reduce the dose of enalapril by half and recheck creatinine in 24 hours
Answer: B
Rationale: ACE inhibitors can cause a transient increase in serum creatinine up to 30% due to
hemodynamic effects. Current guidelines (KDIGO) recommend continuing the medication and
monitoring renal function if the increase is less than 30% and stable. Discontinuation is not warranted
unless hyperkalemia or >30% rise occurs. Loop diuretics are not indicated for this.
5. A nursing researcher plans a study to compare the effectiveness of two pain management
protocols (standard vs. multimodal) in postoperative patients. The researcher assigns participants
to groups based on the last digit of their medical record number (even = standard, odd =
multimodal). Which type of bias is most likely to affect this study?
A. Selection bias
B. Information bias
C. Confounding
D. Recall bias
Answer: A
Rationale: Using an arbitrary rule like last digit of medical record number does not ensure random
assignment and can introduce selection bias if the digit correlates with patient characteristics. This is
not true randomization. Information bias relates to measurement errors; confounding is a mixing of
effects; recall bias is specific to retrospective studies.
6. A hospital is implementing a 'just culture' model after a serious medication error. The error
occurred when a nurse administered a high-alert medication despite an alert in the electronic
health record. Investigation reveals that the alert was overridden due to 'alert fatigue' from
frequent irrelevant alerts. Which of the following system-level changes best addresses the root
cause?
A. Retraining the nurse on proper alert response
Page 2
,B. Disciplining the nurse to deter future errors
C. Reducing the number of low-priority alerts through evidence-based optimization
D. Requiring a second nurse to verify all high-alert medications
Answer: C
Rationale: Just culture focuses on system improvements rather than individual blame. Alert fatigue from
excessive alerts is a known system issue. Optimizing alert frequency and relevance reduces fatigue and
improves response. Retraining or discipline does not address the root cause. Double-checking may help
but does not solve the alert fatigue problem.
7. A nurse is caring for a patient with a diagnosis of sepsis secondary to pneumonia. The patient's
blood pressure is 85/50 mmHg, heart rate 110 bpm, and lactate 4.2 mmol/L. According to the
Surviving Sepsis Campaign 2026 guidelines, which of the following is the priority intervention?
A. Administer broad-spectrum antibiotics within 3 hours of recognition
B. Start vasopressors to maintain mean arterial pressure (MAP) "e 65 mmHg
C. Initiate 30 mL/kg of crystalloid fluid resuscitation within the first 3 hours
D. Obtain blood cultures before administering antibiotics
Answer: C
Rationale: The patient has septic shock (hypotension and lactate >2). The 2026 guidelines recommend
starting with 30 mL/kg crystalloid within 3 hours. Vasopressors are indicated if fluid resuscitation fails
to achieve MAP "e65. Antibiotics should be given within 1 hour, not 3 hours. Blood cultures should not
delay antibiotics.
8. A nurse manager is evaluating the financial performance of a nursing unit. The unit has a
variable cost of $200 per patient day and fixed costs of $500,000 per year. If the unit provides
10,000 patient days per year, and the reimbursement rate is $300 per patient day, what is the profit
or loss for the year?
A. $500,000 profit
B. $500,000 loss
C. $1,000,000 profit
D. $1,000,000 loss
Answer: B
Rationale: Revenue = 10,000 days × $300 = $3,000,000. Variable costs = 10,000 × $200 = $2,000,000.
Total costs = $2,000,000 + $500,000 = $2,500,000. Profit = $3,000,000 - $2,500,000 = $500,000. Wait,
that is profit. Recalculate: Fixed costs $500,000 + variable $2,000,000 = $2,500,000. Revenue
$3,000,000. Profit $500,000. But the correct answer is B? Let's check: Actually, the reimbursement rate
is $300 per day, so revenue is $3M. Costs: variable $2M + fixed $0.5M = $2.5M. Profit $0.5M. So
answer should be A. I made an error. Correct: A.
9. A nurse manager is evaluating the financial performance of a nursing unit. The unit has a
variable cost of $200 per patient day and fixed costs of $500,000 per year. If the unit provides
10,000 patient days per year, and the reimbursement rate is $300 per patient day, what is the profit
or loss for the year?
Page 3
, A. $500,000 profit
B. $500,000 loss
C. $1,000,000 profit
D. $1,000,000 loss
Answer: A
Rationale: Revenue = 10,000 × $300 = $3,000,000. Total costs = variable ($2,000,000) + fixed
($500,000) = $2,500,000. Profit = $3,000,000 - $2,500,000 = $500,000. Options B, C, D are incorrect
due to miscalculation of either revenue or costs.
10. A nurse is involved in a conflict with a physician regarding a patient's plan of care. The nurse
believes the current order is unsafe, but the physician insists on continuing. Using the
'Interest-Based Relational' approach to conflict resolution, which of the following is the first step
the nurse should take?
A. Assertively state the nurse's position and demand a change
B. Seek mediation from a third party
C. Separate the people from the problem by focusing on the issue, not personalities
D. Compromise by agreeing to a modified order that partially addresses both concerns
Answer: C
Rationale: Interest-Based Relational approach emphasizes separating people from the problem to reduce
emotional tension and focus on mutual interests. The first step is to depersonalize the conflict.
Assertiveness (A) may escalate conflict; mediation (B) is later if needed; compromise (D) may be a
solution but not the first step.
11. A nursing student is preparing a presentation on the ethical principle of nonmaleficence. Which
of the following scenarios best exemplifies a violation of this principle?
A. A nurse respects a patient's refusal of a life-saving blood transfusion due to religious beliefs
B. A nurse administers a higher dose of morphine than prescribed to manage severe pain, causing respiratory
depression
C. A nurse distributes limited flu vaccine to the most vulnerable patients first
D. A nurse discloses a patient's HIV status to the patient's partner without consent to prevent harm
Answer: B
Rationale: Nonmaleficence means 'do no harm.' Administering an excessive dose that causes harm
directly violates this principle. Option A respects autonomy; C is distributive justice; D is a breach of
confidentiality, though it may be justified under duty to warn, but it is not a direct harm from the nurse's
action.
12. A 48-year-old individual with a history of chronic kidney disease stage 3 is being evaluated for
a new medication. The drug is primarily eliminated by the kidneys and has a narrow therapeutic
index. Which pharmacokinetic parameter is most critically altered in this patient, and how should
the dosing be adjusted?
A. Increased volume of distribution; increase loading dose
B. Decreased clearance; reduce maintenance dose and/or extend dosing interval
C. Increased half-life; increase maintenance dose
Page 4
