NUR210 Exam 2 Transition to Practice-Capstone
Guide | Fortis College | 2026/2027 Updated | 450+
Q&A with Verified Solutions | Grade A+
Comprehensive NCLEX-RN Integration & Clinical Judgment Study System | 2026/2027
Curriculum | Exam 2 Focus
Fortis College | Department of Nursing | NUR 210 Capstone - Exam 2 Mastery Guide
PART 1 – MASTERY FRAMEWORK FOR CAPSTONE EXAM 2 (2026/2027)
Section A: Clinical Judgment & Prioritization Framework for Complex Patients
Step 1: Recognize Cues (abnormal VS, labs, behavior)
Step 2: Analyze Cues (link to pathophysiology)
Step 3: Prioritize Hypotheses (life-threatening first: ABCs, acute vs chronic, Maslow)
Step 4: Generate Solutions (evidence-based actions)
Step 5: Take Action (delegate/perform)
Step 6: Evaluate Outcomes (reassess VS, labs, patient response)
Complex Patient Template:
● Multi-system: always check drug interactions (e.g., warfarin + amiodarone → ↑
INR)
, ● Acute-on-chronic: treat acute first while stabilizing chronic (e.g., COPD
exacerbation on CHF: balance fluids/O₂)
● Geriatric nuances: delirium risk, fall risk, polypharmacy, Beers Criteria
Section B: Content Synthesis Maps
Map 1: “Sepsis → ARDS → AKI Cascade”
Sepsis bundle (2026 Surviving Sepsis): lactate, cultures, abx <1 h, 30 mL/kg crystalloid,
vasopressor MAP <65
ARDS: low tidal volume (6 mL/kg), plateau <30 cmH₂O, prone if severe, conservative
fluid
AKI: avoid nephrotoxins, monitor UO <0.5 mL/kg/h, creatinine trends, dialysis if
refractory acidosis/hyperkalemia/pulmonary edema
Map 2: “Heart Failure Exacerbation: Precipitants & Interventions”
Precipitants: infection, arrhythmia, non-adherence, uncontrolled HTN, NSAIDs, high Na
diet
Interventions: O₂, IV diuretics (double PO dose), daily wt ±2 lb, monitor K/Mg, SGLT2
continue, afterload reduction if HTN, avoid CCB (except amlodipine), digoxin if low EF &
symptomatic
Map 3: “Delirium vs. Dementia in Med-Surg”
Delirium: acute, fluctuating, altered consciousness, inattention, hallucinations; CAM-ICU
positive
Triggers: infection, hypoxia, pain, drugs (benzos, anticholinergics), sleep deprivation
, Management: treat underlying, reorient, family present, sleep hygiene, low-dose
antipsychotic if dangerous, avoid restraints
Dementia: chronic, stable baseline, no altered consciousness; manage with routines,
simplify instructions
Section C: Leadership & Delegation Protocols
Decision Tree:
1. Assess patient acuity & stability
2. Match task to scope:
● RN only: initial assessment, IV push, blood, teaching, care plan, titrate
drips
● LPN (varies by state): stable patients, PO/IM/SC meds (no IV push),
wound care, Foley insertion (some states)
● UAP: ADLs, vitals, transport, simple dressing (non-sterile), stock supplies
3. Provide clear directions & expected outcomes
4. Supervise: initial, periodic, evaluate
5. Document performance & escalate concerns up chain of command
Conflict Example: UAP refuses assignment → clarify task within scope, if still refuses
notify charge nurse, document, ensure patient safety first.
PART 2 – INTEGRATED MASTERY PRACTICE EXAMINATION
Complex Scenario Questions & MASTERY Solutions
Instructions: This practice exam requires synthesis of nursing knowledge for Exam 2.
Use the frameworks from Part 1. Read each MASTERY RATIONALE thoroughly to train
your expert clinical judgment. Select the SINGLE BEST answer.
1. A 69-year-old male with COPD (FEV₁ 38 %), CHF (EF 25 %), and CKD stage 4
(baseline Cr 2.6 mg/dL) is admitted with pneumonia and acute hypoxemic
respiratory failure. He is on BiPAP, ceftriaxone 2 g IV daily, azithromycin 500 mg
IV daily, furosemide 80 mg IV BID, digoxin 0.125 mg PO daily, and methadone 60
Guide | Fortis College | 2026/2027 Updated | 450+
Q&A with Verified Solutions | Grade A+
Comprehensive NCLEX-RN Integration & Clinical Judgment Study System | 2026/2027
Curriculum | Exam 2 Focus
Fortis College | Department of Nursing | NUR 210 Capstone - Exam 2 Mastery Guide
PART 1 – MASTERY FRAMEWORK FOR CAPSTONE EXAM 2 (2026/2027)
Section A: Clinical Judgment & Prioritization Framework for Complex Patients
Step 1: Recognize Cues (abnormal VS, labs, behavior)
Step 2: Analyze Cues (link to pathophysiology)
Step 3: Prioritize Hypotheses (life-threatening first: ABCs, acute vs chronic, Maslow)
Step 4: Generate Solutions (evidence-based actions)
Step 5: Take Action (delegate/perform)
Step 6: Evaluate Outcomes (reassess VS, labs, patient response)
Complex Patient Template:
● Multi-system: always check drug interactions (e.g., warfarin + amiodarone → ↑
INR)
, ● Acute-on-chronic: treat acute first while stabilizing chronic (e.g., COPD
exacerbation on CHF: balance fluids/O₂)
● Geriatric nuances: delirium risk, fall risk, polypharmacy, Beers Criteria
Section B: Content Synthesis Maps
Map 1: “Sepsis → ARDS → AKI Cascade”
Sepsis bundle (2026 Surviving Sepsis): lactate, cultures, abx <1 h, 30 mL/kg crystalloid,
vasopressor MAP <65
ARDS: low tidal volume (6 mL/kg), plateau <30 cmH₂O, prone if severe, conservative
fluid
AKI: avoid nephrotoxins, monitor UO <0.5 mL/kg/h, creatinine trends, dialysis if
refractory acidosis/hyperkalemia/pulmonary edema
Map 2: “Heart Failure Exacerbation: Precipitants & Interventions”
Precipitants: infection, arrhythmia, non-adherence, uncontrolled HTN, NSAIDs, high Na
diet
Interventions: O₂, IV diuretics (double PO dose), daily wt ±2 lb, monitor K/Mg, SGLT2
continue, afterload reduction if HTN, avoid CCB (except amlodipine), digoxin if low EF &
symptomatic
Map 3: “Delirium vs. Dementia in Med-Surg”
Delirium: acute, fluctuating, altered consciousness, inattention, hallucinations; CAM-ICU
positive
Triggers: infection, hypoxia, pain, drugs (benzos, anticholinergics), sleep deprivation
, Management: treat underlying, reorient, family present, sleep hygiene, low-dose
antipsychotic if dangerous, avoid restraints
Dementia: chronic, stable baseline, no altered consciousness; manage with routines,
simplify instructions
Section C: Leadership & Delegation Protocols
Decision Tree:
1. Assess patient acuity & stability
2. Match task to scope:
● RN only: initial assessment, IV push, blood, teaching, care plan, titrate
drips
● LPN (varies by state): stable patients, PO/IM/SC meds (no IV push),
wound care, Foley insertion (some states)
● UAP: ADLs, vitals, transport, simple dressing (non-sterile), stock supplies
3. Provide clear directions & expected outcomes
4. Supervise: initial, periodic, evaluate
5. Document performance & escalate concerns up chain of command
Conflict Example: UAP refuses assignment → clarify task within scope, if still refuses
notify charge nurse, document, ensure patient safety first.
PART 2 – INTEGRATED MASTERY PRACTICE EXAMINATION
Complex Scenario Questions & MASTERY Solutions
Instructions: This practice exam requires synthesis of nursing knowledge for Exam 2.
Use the frameworks from Part 1. Read each MASTERY RATIONALE thoroughly to train
your expert clinical judgment. Select the SINGLE BEST answer.
1. A 69-year-old male with COPD (FEV₁ 38 %), CHF (EF 25 %), and CKD stage 4
(baseline Cr 2.6 mg/dL) is admitted with pneumonia and acute hypoxemic
respiratory failure. He is on BiPAP, ceftriaxone 2 g IV daily, azithromycin 500 mg
IV daily, furosemide 80 mg IV BID, digoxin 0.125 mg PO daily, and methadone 60
