KAPLAN RN EXIT EXAM 2026 – EXAM-STYLE QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A nurse is preparing to administer a scheduled dose of enoxaparin to a
patient who is post-operative day one following a total hip arthroplasty. The
patient's platelet count is 145,000/mm³, a decrease from 210,000/mm³ pre-
operatively. Which action should the nurse take?
A. Administer the enoxaparin as prescribed and monitor the patient for signs of
bleeding.
B. Hold the enoxaparin and notify the healthcare provider of the platelet count.
C. Notify the healthcare provider of a potential anaphylactic reaction to the
medication.
D. Administer the enoxaparin and prepare to administer a platelet transfusion.
Correct Answer: B. Hold the enoxaparin and notify the healthcare provider of
the platelet count.
Rationale: A significant drop in platelet count (often defined as a decrease of >50%
from baseline or a value below 150,000/mm³) in a patient receiving low-molecular-
weight heparin (LMWH) like enoxaparin is a hallmark sign of Heparin-Induced
Thrombocytopenia (HIT). HIT is a serious, immune-mediated adverse reaction that
paradoxically increases the risk of thrombosis. The immediate and correct nursing
action is to hold the medication and notify the provider to prevent further
complications. Option A is incorrect because administering the drug could
exacerbate the HIT and increase the risk of life-threatening thromboembolic events.
,Option C is incorrect because this presentation is not consistent with anaphylaxis.
Option D is incorrect because the pathophysiology of HIT is not a deficiency of
platelets that would be corrected by a transfusion; rather, it is an immune-mediated
destruction that requires stopping the offending agent and starting an alternative
anticoagulant.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which assessment finding would be the
most reliable indicator that the current oxygen therapy is effective?
A. The patient's respiratory rate has decreased from 28 to 22 breaths per minute.
B. The patient's pulse oximetry reading is 94% on room air.
C. The patient's arterial blood gas (ABG) shows a PaO2 of 78 mmHg.
D. The patient reports that their breathing is "a little bit easier."
Correct Answer: C. The patient's arterial blood gas (ABG) shows a PaO2 of 78
mmHg.
Rationale: The most objective and reliable indicator of the effectiveness of oxygen
therapy is the measurement of arterial oxygen tension (PaO2) via an ABG analysis.
While a pulse oximetry reading (Option B) is a good non-invasive indicator, it is less
reliable than a direct ABG measurement, especially in patients with COPD who
may have conditions like methemoglobinemia or poor peripheral perfusion that can
affect the reading. Option A is a supportive finding but can be influenced by other
factors, including fatigue or the patient's own respiratory effort. Option D is a
subjective report that is valuable but cannot be solely relied upon to titrate oxygen
therapy; it is not as objective or precise as an ABG measurement for determining
the effectiveness of oxygenation.
,3. A nurse is providing teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a correct understanding of
the medication's dietary restrictions?
A. "I need to avoid foods that are high in vitamin K, like broccoli and spinach."
B. "It is important to increase my intake of foods high in vitamin B12, like red
meat."
C. "I should take an aspirin with my warfarin to prevent blood clots."
D. "I can stop taking the medication if I experience any bruising."
Correct Answer: A. "I need to avoid foods that are high in vitamin K, like
broccoli and spinach."
Rationale: Warfarin is a vitamin K antagonist. It works by interfering with the
synthesis of vitamin K-dependent clotting factors. Therefore, a consistent intake of
vitamin K is crucial to maintain a stable INR. Foods rich in vitamin K, such as leafy
green vegetables (broccoli, spinach, kale), can directly counteract the effect of
warfarin and decrease the INR, increasing the risk of clot formation. Option B is
incorrect because warfarin does not interact with vitamin B12. Option C is incorrect
as taking aspirin with warfarin significantly increases the risk of bleeding due to
their additive antiplatelet and anticoagulant effects. Option D is incorrect because
patients should never stop taking an anticoagulant like warfarin without consulting
their healthcare provider, as it can precipitate a life-threatening thrombotic event.
4. A nurse is caring for a patient with a central venous catheter (CVC). During a
routine dressing change, the nurse notes a small amount of purulent drainage
, at the insertion site. The patient's temperature is 38.2°C (100.8°F). What is the
nurse's priority action?
A. Cleanse the site with chlorhexidine and apply a new sterile dressing.
B. Obtain cultures from the CVC insertion site and both peripheral blood culture
sites.
C. Remove the CVC immediately and apply a sterile pressure dressing.
D. Notify the healthcare provider and request an order for a stat chest x-ray.
Correct Answer: B. Obtain cultures from the CVC insertion site and both
peripheral blood culture sites.
Rationale: The presence of purulent drainage and fever in a patient with a CVC is
highly suggestive of a catheter-related bloodstream infection (CRBSI). The priority is
to obtain cultures to confirm the diagnosis and guide appropriate antibiotic
therapy. Standard practice involves drawing blood cultures from the CVC itself and
from a peripheral vein, as well as culturing the insertion site if purulent drainage is
present. This helps differentiate between a catheter infection and a systemic
infection from another source. Option A is incorrect because it does not address the
potential for a systemic infection and focuses solely on local care. Option C is
incorrect because routine removal of a CVC is not the initial step; cultures should be
obtained before removing the catheter if possible. Option D is incorrect because a
chest x-ray is not the primary diagnostic tool for a suspected CRBSI; it would be
more appropriate if complications like a pneumothorax or catheter tip migration
were suspected.
5. A patient with heart failure is receiving a continuous infusion of furosemide.
The patient's urine output over the last hour is 30 mL. The nurse notes that the
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A nurse is preparing to administer a scheduled dose of enoxaparin to a
patient who is post-operative day one following a total hip arthroplasty. The
patient's platelet count is 145,000/mm³, a decrease from 210,000/mm³ pre-
operatively. Which action should the nurse take?
A. Administer the enoxaparin as prescribed and monitor the patient for signs of
bleeding.
B. Hold the enoxaparin and notify the healthcare provider of the platelet count.
C. Notify the healthcare provider of a potential anaphylactic reaction to the
medication.
D. Administer the enoxaparin and prepare to administer a platelet transfusion.
Correct Answer: B. Hold the enoxaparin and notify the healthcare provider of
the platelet count.
Rationale: A significant drop in platelet count (often defined as a decrease of >50%
from baseline or a value below 150,000/mm³) in a patient receiving low-molecular-
weight heparin (LMWH) like enoxaparin is a hallmark sign of Heparin-Induced
Thrombocytopenia (HIT). HIT is a serious, immune-mediated adverse reaction that
paradoxically increases the risk of thrombosis. The immediate and correct nursing
action is to hold the medication and notify the provider to prevent further
complications. Option A is incorrect because administering the drug could
exacerbate the HIT and increase the risk of life-threatening thromboembolic events.
,Option C is incorrect because this presentation is not consistent with anaphylaxis.
Option D is incorrect because the pathophysiology of HIT is not a deficiency of
platelets that would be corrected by a transfusion; rather, it is an immune-mediated
destruction that requires stopping the offending agent and starting an alternative
anticoagulant.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which assessment finding would be the
most reliable indicator that the current oxygen therapy is effective?
A. The patient's respiratory rate has decreased from 28 to 22 breaths per minute.
B. The patient's pulse oximetry reading is 94% on room air.
C. The patient's arterial blood gas (ABG) shows a PaO2 of 78 mmHg.
D. The patient reports that their breathing is "a little bit easier."
Correct Answer: C. The patient's arterial blood gas (ABG) shows a PaO2 of 78
mmHg.
Rationale: The most objective and reliable indicator of the effectiveness of oxygen
therapy is the measurement of arterial oxygen tension (PaO2) via an ABG analysis.
While a pulse oximetry reading (Option B) is a good non-invasive indicator, it is less
reliable than a direct ABG measurement, especially in patients with COPD who
may have conditions like methemoglobinemia or poor peripheral perfusion that can
affect the reading. Option A is a supportive finding but can be influenced by other
factors, including fatigue or the patient's own respiratory effort. Option D is a
subjective report that is valuable but cannot be solely relied upon to titrate oxygen
therapy; it is not as objective or precise as an ABG measurement for determining
the effectiveness of oxygenation.
,3. A nurse is providing teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a correct understanding of
the medication's dietary restrictions?
A. "I need to avoid foods that are high in vitamin K, like broccoli and spinach."
B. "It is important to increase my intake of foods high in vitamin B12, like red
meat."
C. "I should take an aspirin with my warfarin to prevent blood clots."
D. "I can stop taking the medication if I experience any bruising."
Correct Answer: A. "I need to avoid foods that are high in vitamin K, like
broccoli and spinach."
Rationale: Warfarin is a vitamin K antagonist. It works by interfering with the
synthesis of vitamin K-dependent clotting factors. Therefore, a consistent intake of
vitamin K is crucial to maintain a stable INR. Foods rich in vitamin K, such as leafy
green vegetables (broccoli, spinach, kale), can directly counteract the effect of
warfarin and decrease the INR, increasing the risk of clot formation. Option B is
incorrect because warfarin does not interact with vitamin B12. Option C is incorrect
as taking aspirin with warfarin significantly increases the risk of bleeding due to
their additive antiplatelet and anticoagulant effects. Option D is incorrect because
patients should never stop taking an anticoagulant like warfarin without consulting
their healthcare provider, as it can precipitate a life-threatening thrombotic event.
4. A nurse is caring for a patient with a central venous catheter (CVC). During a
routine dressing change, the nurse notes a small amount of purulent drainage
, at the insertion site. The patient's temperature is 38.2°C (100.8°F). What is the
nurse's priority action?
A. Cleanse the site with chlorhexidine and apply a new sterile dressing.
B. Obtain cultures from the CVC insertion site and both peripheral blood culture
sites.
C. Remove the CVC immediately and apply a sterile pressure dressing.
D. Notify the healthcare provider and request an order for a stat chest x-ray.
Correct Answer: B. Obtain cultures from the CVC insertion site and both
peripheral blood culture sites.
Rationale: The presence of purulent drainage and fever in a patient with a CVC is
highly suggestive of a catheter-related bloodstream infection (CRBSI). The priority is
to obtain cultures to confirm the diagnosis and guide appropriate antibiotic
therapy. Standard practice involves drawing blood cultures from the CVC itself and
from a peripheral vein, as well as culturing the insertion site if purulent drainage is
present. This helps differentiate between a catheter infection and a systemic
infection from another source. Option A is incorrect because it does not address the
potential for a systemic infection and focuses solely on local care. Option C is
incorrect because routine removal of a CVC is not the initial step; cultures should be
obtained before removing the catheter if possible. Option D is incorrect because a
chest x-ray is not the primary diagnostic tool for a suspected CRBSI; it would be
more appropriate if complications like a pneumothorax or catheter tip migration
were suspected.
5. A patient with heart failure is receiving a continuous infusion of furosemide.
The patient's urine output over the last hour is 30 mL. The nurse notes that the
