COMPREHENSIVE NURSING CAPSTONE PRACTICE
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is caring for a client with acute pancreatitis who is NPO and
receiving IV fluids. Which laboratory finding is the best indicator of
nutritional improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a level of 22
mg/dL indicates adequate protein synthesis. Amylase and lipase reflect pancreatic
inflammation, not nutrition. Blood glucose indicates glucose control.
2. A nurse is reviewing a client’s telemetry strip. The PR interval progressively
lengthens until a QRS complex is dropped. The pattern repeats. What
rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach (Mobitz I) is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has constant prolonged PR without dropped
beats. Mobitz II has constant PR with sudden dropped QRS. Third-degree has AV
dissociation.
, 3. A client with heart failure is prescribed furosemide 40 mg IV push. Which
laboratory value requires immediate notification before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is hypokalemic and
increases the risk of cardiac dysrhythmias. The provider should be notified before
giving the dose. Other values are normal.
4. A nurse is teaching a client with a new colostomy about stoma care. Which
observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply. Dark purple,
pale, or blue-tinged indicates poor perfusion or ischemia.
5. A client is receiving a continuous heparin infusion. The aPTT is 105 seconds
(therapeutic 60–80 seconds). The client has no bleeding. What should the
nurse do?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6 hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per protocol.
,Protamine is for severe bleeding. Vitamin K reverses warfarin. Continuing the rate
increases bleeding risk.
6. A postpartum client delivered a 9-pound infant 2 hours ago. The uterus is
boggy, displaced to the right, and there is heavy lochia rubra. What is the
priority nursing action?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder distention.
Empty the bladder first, then massage the fundus. Methylergonovine may be given
if massage fails. Trendelenburg and ice are not priorities.
7. A nurse is caring for a client 24 hours after a femoral-popliteal bypass graft.
The client reports severe pain in the affected leg, and the foot is pale, cool,
and mottled with absent pedal pulses. What should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the surgeon immediately of suspected graft occlusion
C) Document findings and reassess in 30 minutes
D) Apply warm compresses to the foot
Correct Answer: B
Sudden severe pain, pallor, pulselessness, and coolness indicate acute arterial
occlusion, a surgical emergency requiring immediate intervention. Elevation
reduces arterial flow. Delay risks limb loss. Warm compresses do not restore
perfusion.
8. A client with major depressive disorder suddenly becomes more energetic,
gives away possessions, and states, “I have a plan to end my pain.” What is
the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
, C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; continuous observation is the immediate priority. A no-suicide
contract does not replace supervision. Group therapy and anxiolytics do not
address acute risk.
9. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes respirations have decreased to 8 breaths per minute and the
client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler’s position and administer naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the hypoxic
drive. Reduce oxygen to minimum to maintain SpO₂ 88–92% and notify provider.
Increasing oxygen worsens hypoventilation. Naloxone is for opioid overdose.
10.A nurse is preparing to administer digoxin to a client with heart failure. The
apical pulse is 54 bpm and irregular. Digoxin level yesterday was 2.3 ng/mL.
What is the best action?
A) Administer the digoxin with a small sip of water
B) Hold the digoxin, assess for toxicity, and notify the provider
C) Give half the prescribed dose
D) Administer atropine as prescribed before giving digoxin
Correct Answer: B
A pulse <60 bpm and digoxin level above therapeutic range indicate possible
toxicity. Hold the drug and notify provider. Administering risks worsening
bradycardia. The nurse cannot alter the dose. Atropine is not indicated without an
order.
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is caring for a client with acute pancreatitis who is NPO and
receiving IV fluids. Which laboratory finding is the best indicator of
nutritional improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a level of 22
mg/dL indicates adequate protein synthesis. Amylase and lipase reflect pancreatic
inflammation, not nutrition. Blood glucose indicates glucose control.
2. A nurse is reviewing a client’s telemetry strip. The PR interval progressively
lengthens until a QRS complex is dropped. The pattern repeats. What
rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach (Mobitz I) is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has constant prolonged PR without dropped
beats. Mobitz II has constant PR with sudden dropped QRS. Third-degree has AV
dissociation.
, 3. A client with heart failure is prescribed furosemide 40 mg IV push. Which
laboratory value requires immediate notification before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is hypokalemic and
increases the risk of cardiac dysrhythmias. The provider should be notified before
giving the dose. Other values are normal.
4. A nurse is teaching a client with a new colostomy about stoma care. Which
observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply. Dark purple,
pale, or blue-tinged indicates poor perfusion or ischemia.
5. A client is receiving a continuous heparin infusion. The aPTT is 105 seconds
(therapeutic 60–80 seconds). The client has no bleeding. What should the
nurse do?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6 hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per protocol.
,Protamine is for severe bleeding. Vitamin K reverses warfarin. Continuing the rate
increases bleeding risk.
6. A postpartum client delivered a 9-pound infant 2 hours ago. The uterus is
boggy, displaced to the right, and there is heavy lochia rubra. What is the
priority nursing action?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder distention.
Empty the bladder first, then massage the fundus. Methylergonovine may be given
if massage fails. Trendelenburg and ice are not priorities.
7. A nurse is caring for a client 24 hours after a femoral-popliteal bypass graft.
The client reports severe pain in the affected leg, and the foot is pale, cool,
and mottled with absent pedal pulses. What should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the surgeon immediately of suspected graft occlusion
C) Document findings and reassess in 30 minutes
D) Apply warm compresses to the foot
Correct Answer: B
Sudden severe pain, pallor, pulselessness, and coolness indicate acute arterial
occlusion, a surgical emergency requiring immediate intervention. Elevation
reduces arterial flow. Delay risks limb loss. Warm compresses do not restore
perfusion.
8. A client with major depressive disorder suddenly becomes more energetic,
gives away possessions, and states, “I have a plan to end my pain.” What is
the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
, C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; continuous observation is the immediate priority. A no-suicide
contract does not replace supervision. Group therapy and anxiolytics do not
address acute risk.
9. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes respirations have decreased to 8 breaths per minute and the
client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler’s position and administer naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the hypoxic
drive. Reduce oxygen to minimum to maintain SpO₂ 88–92% and notify provider.
Increasing oxygen worsens hypoventilation. Naloxone is for opioid overdose.
10.A nurse is preparing to administer digoxin to a client with heart failure. The
apical pulse is 54 bpm and irregular. Digoxin level yesterday was 2.3 ng/mL.
What is the best action?
A) Administer the digoxin with a small sip of water
B) Hold the digoxin, assess for toxicity, and notify the provider
C) Give half the prescribed dose
D) Administer atropine as prescribed before giving digoxin
Correct Answer: B
A pulse <60 bpm and digoxin level above therapeutic range indicate possible
toxicity. Hold the drug and notify provider. Administering risks worsening
bradycardia. The nurse cannot alter the dose. Atropine is not indicated without an
order.
