CAPSTONE FINAL EXAM WITH CORRECT ANSWERS
2025 - 240 Questions
This exam assesses advanced competency in the management of care, including delegation, supervision,
prioritization, resource allocation, ethical decision-making, and interprofessional collaboration. Designed for
graduate-level nursing students preparing for leadership roles. It contains 240 multiple-choice questions, each
with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 8 focused sections: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, Physiological Adaptation. Targeted learning outcomes include: Apply ethical and legal frameworks to
delegation and supervision decisions.; Prioritize patient care in complex, multi-patient scenarios.; Evaluate
quality improvement initiatives and resource management strategies.. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 80%. Aligned with Meets AACN and CCNE standards for graduate nursing education in the
United States. standards and reflects the question style commonly seen on accredited program examinations.
Students consistently achieving above the cut score on this bank have historically gone on to earn A+ on the
Section 1: Management of Care (Questions 1-32)
1 A charge nurse is assigning care for four patients on a medical-surgical unit.
Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with pneumonia requiring IV antibiotics every 6 hours.
B) A patient with diabetes mellitus type 2 requiring insulin dose adjustments
based on sliding scale.
C) A patient with acute kidney injury (AKI) requiring continuous venovenous
hemofiltration (CVVH).
D) A patient with a hip fracture awaiting surgical repair, who is stable and
ambulatory with assistance.
Answer: C
Rationale: The patient with AKI requiring CVVH is the most unstable and
requires continuous monitoring and advanced critical care skills. The other
patients are more stable and can be managed by less experienced RNs or
licensed practical nurses.
2 A nurse manager is reviewing incident reports and notes a trend of
medication errors occurring during shift handoffs. Which quality
improvement strategy is most effective to reduce these errors?
A) Increase the number of RNs on each shift.
,B) Implement a standardized handoff tool (e.g., SBAR).
C) Require double-checking of all medications by two nurses.
D) Provide additional training on medication administration.
Answer: B
Rationale: Standardized handoff tools improve communication and reduce
information loss during transitions, which is a root cause of many medication
errors. The other options address other factors but do not directly target the
handoff process.
3 A nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate to delegate?
A) Administering a scheduled oral medication.
B) Assessing a patient's post-operative wound.
C) Measuring and recording a patient's blood pressure.
D) Evaluating the effectiveness of pain medication.
Answer: C
Rationale: Measuring vital signs is a routine, non-invasive task that can be
safely delegated to a UAP. Administering medications and
assessment/evaluation require the clinical judgment of a licensed nurse.
4 A nurse is leading an interprofessional team meeting to develop a discharge
plan for a patient with complex needs. Which team member's input is most
critical for ensuring safe transition to home?
A) Social worker.
B) Physical therapist.
C) Pharmacist.
D) All team members contribute equally.
Answer: D
Rationale: Complex discharge planning requires input from all disciplines to
address medical, functional, social, and medication needs. No single member
dominates; collaboration is essential.
5 A nurse is caring for a patient who refuses a life-saving blood transfusion
due to religious beliefs. The nurse's first action should be to:
A) Respect the patient's decision and document the refusal.
B) Notify the healthcare provider to obtain a court order.
,C) Explain the risks of refusal and attempt to persuade the patient.
D) Consult the hospital ethics committee.
Answer: A
Rationale: Autonomy is a core ethical principle; competent adults have the right
to refuse treatment. The nurse must respect the decision and document it.
Further steps (B, C, D) may be taken only after respecting the initial refusal.
6 A nurse is prioritizing care for four patients on a medical unit. Which patient
should the nurse assess first?
A) A patient with a history of asthma reporting mild wheezing.
B) A patient with chest pain and diaphoresis.
C) A patient with a fever of 38.5°C (101.3°F) and cough.
D) A patient with a blood pressure of 90/60 mm Hg and dizziness.
Answer: B
Rationale: Chest pain with diaphoresis suggests a possible myocardial
infarction, which is life-threatening and requires immediate assessment. The
other patients are less acute.
7 A nurse is evaluating the effectiveness of a new protocol to reduce central
line-associated bloodstream infections (CLABSI). Which outcome measure
is most indicative of success?
A) Decreased length of hospital stay.
B) Reduced number of central line insertions.
C) Lower CLABSI rate per 1,000 central line days.
D) Improved patient satisfaction scores.
Answer: C
Rationale: CLABSI rate per 1,000 central line days is the standard metric for
infection prevention. Other measures may be indirectly affected but do not
directly reflect the protocol's impact on infections.
8 A charge nurse is supervising a team that includes a new graduate RN. The
new graduate is unsure how to insert a urinary catheter. What is the charge
nurse's best action?
A) Perform the catheter insertion for the patient.
B) Provide step-by-step instructions and observe the new graduate.
C) Assign the task to an experienced LPN.
, D) Tell the new graduate to review the policy manual and try again.
Answer: B
Rationale: Supervision includes teaching and supporting staff development.
Performing the task (A) does not develop the new graduate's skills. Assigning
to an LPN (C) avoids the issue. Option D is unsafe without guidance.
9 A nurse is managing a conflict between two staff members who disagree
about the best way to care for a patient. Which conflict resolution strategy is
most appropriate first step?
A) Mediate a discussion between the two staff members.
B) Enforce a policy that dictates the care approach.
C) Transfer one staff member to another unit.
D) Escalate the issue to the unit manager.
Answer: A
Rationale: Mediation allows both parties to express their views and work
toward a collaborative solution. This is less disruptive than imposing a solution
(B) or transferring staff (C). Escalation (D) should be reserved if mediation
fails.
10 A nurse is preparing to delegate a task to a licensed practical nurse (LPN).
Which task is within the LPN's scope of practice?
A) Administering a blood transfusion.
B) Performing a comprehensive admission assessment.
C) Inserting a nasogastric tube for decompression.
D) Evaluating a patient's response to a new medication.
Answer: C
Rationale: Inserting a nasogastric tube is a technical skill that LPNs are
typically trained to perform under the supervision of an RN. Administering
blood products (A) and performing assessments/evaluations (B, D) require
RN-level judgment.
11 A hospital is implementing a new patient safety program based on
high-reliability organization principles. Which leadership action best
promotes a culture of safety?
A) Rewarding staff for reporting near misses without penalty.
B) Conducting root cause analyses only for sentinel events.
2025 - 240 Questions
This exam assesses advanced competency in the management of care, including delegation, supervision,
prioritization, resource allocation, ethical decision-making, and interprofessional collaboration. Designed for
graduate-level nursing students preparing for leadership roles. It contains 240 multiple-choice questions, each
with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 8 focused sections: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, Physiological Adaptation. Targeted learning outcomes include: Apply ethical and legal frameworks to
delegation and supervision decisions.; Prioritize patient care in complex, multi-patient scenarios.; Evaluate
quality improvement initiatives and resource management strategies.. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 80%. Aligned with Meets AACN and CCNE standards for graduate nursing education in the
United States. standards and reflects the question style commonly seen on accredited program examinations.
Students consistently achieving above the cut score on this bank have historically gone on to earn A+ on the
Section 1: Management of Care (Questions 1-32)
1 A charge nurse is assigning care for four patients on a medical-surgical unit.
Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with pneumonia requiring IV antibiotics every 6 hours.
B) A patient with diabetes mellitus type 2 requiring insulin dose adjustments
based on sliding scale.
C) A patient with acute kidney injury (AKI) requiring continuous venovenous
hemofiltration (CVVH).
D) A patient with a hip fracture awaiting surgical repair, who is stable and
ambulatory with assistance.
Answer: C
Rationale: The patient with AKI requiring CVVH is the most unstable and
requires continuous monitoring and advanced critical care skills. The other
patients are more stable and can be managed by less experienced RNs or
licensed practical nurses.
2 A nurse manager is reviewing incident reports and notes a trend of
medication errors occurring during shift handoffs. Which quality
improvement strategy is most effective to reduce these errors?
A) Increase the number of RNs on each shift.
,B) Implement a standardized handoff tool (e.g., SBAR).
C) Require double-checking of all medications by two nurses.
D) Provide additional training on medication administration.
Answer: B
Rationale: Standardized handoff tools improve communication and reduce
information loss during transitions, which is a root cause of many medication
errors. The other options address other factors but do not directly target the
handoff process.
3 A nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate to delegate?
A) Administering a scheduled oral medication.
B) Assessing a patient's post-operative wound.
C) Measuring and recording a patient's blood pressure.
D) Evaluating the effectiveness of pain medication.
Answer: C
Rationale: Measuring vital signs is a routine, non-invasive task that can be
safely delegated to a UAP. Administering medications and
assessment/evaluation require the clinical judgment of a licensed nurse.
4 A nurse is leading an interprofessional team meeting to develop a discharge
plan for a patient with complex needs. Which team member's input is most
critical for ensuring safe transition to home?
A) Social worker.
B) Physical therapist.
C) Pharmacist.
D) All team members contribute equally.
Answer: D
Rationale: Complex discharge planning requires input from all disciplines to
address medical, functional, social, and medication needs. No single member
dominates; collaboration is essential.
5 A nurse is caring for a patient who refuses a life-saving blood transfusion
due to religious beliefs. The nurse's first action should be to:
A) Respect the patient's decision and document the refusal.
B) Notify the healthcare provider to obtain a court order.
,C) Explain the risks of refusal and attempt to persuade the patient.
D) Consult the hospital ethics committee.
Answer: A
Rationale: Autonomy is a core ethical principle; competent adults have the right
to refuse treatment. The nurse must respect the decision and document it.
Further steps (B, C, D) may be taken only after respecting the initial refusal.
6 A nurse is prioritizing care for four patients on a medical unit. Which patient
should the nurse assess first?
A) A patient with a history of asthma reporting mild wheezing.
B) A patient with chest pain and diaphoresis.
C) A patient with a fever of 38.5°C (101.3°F) and cough.
D) A patient with a blood pressure of 90/60 mm Hg and dizziness.
Answer: B
Rationale: Chest pain with diaphoresis suggests a possible myocardial
infarction, which is life-threatening and requires immediate assessment. The
other patients are less acute.
7 A nurse is evaluating the effectiveness of a new protocol to reduce central
line-associated bloodstream infections (CLABSI). Which outcome measure
is most indicative of success?
A) Decreased length of hospital stay.
B) Reduced number of central line insertions.
C) Lower CLABSI rate per 1,000 central line days.
D) Improved patient satisfaction scores.
Answer: C
Rationale: CLABSI rate per 1,000 central line days is the standard metric for
infection prevention. Other measures may be indirectly affected but do not
directly reflect the protocol's impact on infections.
8 A charge nurse is supervising a team that includes a new graduate RN. The
new graduate is unsure how to insert a urinary catheter. What is the charge
nurse's best action?
A) Perform the catheter insertion for the patient.
B) Provide step-by-step instructions and observe the new graduate.
C) Assign the task to an experienced LPN.
, D) Tell the new graduate to review the policy manual and try again.
Answer: B
Rationale: Supervision includes teaching and supporting staff development.
Performing the task (A) does not develop the new graduate's skills. Assigning
to an LPN (C) avoids the issue. Option D is unsafe without guidance.
9 A nurse is managing a conflict between two staff members who disagree
about the best way to care for a patient. Which conflict resolution strategy is
most appropriate first step?
A) Mediate a discussion between the two staff members.
B) Enforce a policy that dictates the care approach.
C) Transfer one staff member to another unit.
D) Escalate the issue to the unit manager.
Answer: A
Rationale: Mediation allows both parties to express their views and work
toward a collaborative solution. This is less disruptive than imposing a solution
(B) or transferring staff (C). Escalation (D) should be reserved if mediation
fails.
10 A nurse is preparing to delegate a task to a licensed practical nurse (LPN).
Which task is within the LPN's scope of practice?
A) Administering a blood transfusion.
B) Performing a comprehensive admission assessment.
C) Inserting a nasogastric tube for decompression.
D) Evaluating a patient's response to a new medication.
Answer: C
Rationale: Inserting a nasogastric tube is a technical skill that LPNs are
typically trained to perform under the supervision of an RN. Administering
blood products (A) and performing assessments/evaluations (B, D) require
RN-level judgment.
11 A hospital is implementing a new patient safety program based on
high-reliability organization principles. Which leadership action best
promotes a culture of safety?
A) Rewarding staff for reporting near misses without penalty.
B) Conducting root cause analyses only for sentinel events.
