NR 452 | Capstone Course | Multi-System Case Studies Practice Pack
2026/2027 Chamberlain College
1. A nurse is caring for a client with multiple trauma. Which assessment finding
should the nurse address first?
A. A blood pressure of 100/60 mmHg
B. An open fracture of the right radius
C. Pain level of 8 on a 1-10 scale
D. Oxygen saturation of 88% on room air
Answer: D
Rationale: According to the ABC (Airway, Breathing, Circulation) priority framework,
oxygenation and ventilation are the highest priority. An SpO2 of 88% indicates significant
hypoxia.
2. When implementing the 1-hour bundle for a client in septic shock, which
action is the nurse’s priority?
A. Administering a broad-spectrum antibiotic
B. Obtaining blood cultures
C. Starting a vasopressor infusion
D. Measuring the serum lactate level
Answer: D
Rationale: While all are part of the bundle, measuring lactate helps identify the severity of
tissue hypoperfusion immediately. However, clinically, cultures must be drawn before
antibiotics, but lactate is often cited as the first identifying lab.
,3. Which task is most appropriate for the RN to delegate to an unlicensed
assistive personnel (UAP)?
A. Taking vital signs on a stable post-operative client
B. Feeding a client with dysphagia for the first time
C. Teaching a client how to use an incentive spirometer
D. Assessing a client’s surgical incision
Answer: A
Rationale: UAPs can perform tasks that are routine and do not require clinical judgment,
such as vital signs on stable patients. Assessment, teaching, and high-risk feeding require
an RN.
4. An arterial blood gas (ABG) report shows: pH 7.30, PaCO2 55 mmHg, and
HCO3 26 mEq/L. How should the nurse interpret these results?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: A pH below 7.35 is acidosis. A PaCO2 above 45 mmHg indicates a respiratory
cause. Since the HCO3 is normal, it is uncompensated respiratory acidosis.
5. A client has burns on the entire left leg and the entire left arm. Using the Rule
of Nines, what is the estimated total body surface area (TBSA) burned?
A. 18%
B. 36%
C. 27%
D. 45%
Answer: C
, Rationale: According to the Rule of Nines, an entire leg is 18% and an entire arm is 9%.
18% + 9% = 27%.
6. Which medication should the nurse anticipate for a client experiencing
symptomatic sinus bradycardia?
A. Amiodarone
B. Atropine
C. Adenosine
D. Dopamine
Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia to increase
the heart rate.
7. The nurse is caring for a client with Acute Respiratory Distress Syndrome
(ARDS). Which position is most effective in improving oxygenation?
A. Prone
B. High-Fowler’s
C. Semi-Fowler’s
D. Supine
Answer: A
Rationale: Prone positioning helps recruit collapsed alveoli in the posterior lung fields and
improves V/Q matching in ARDS patients.
8. A client with a spinal cord injury at T4 reports a sudden, severe headache and
is found to be hypertensive. What is the nurse’s first action?
A. Administer antihypertensive medication
B. Call the healthcare provider
C. Lower the head of the bed
D. Check for bladder distension
Answer: D
2026/2027 Chamberlain College
1. A nurse is caring for a client with multiple trauma. Which assessment finding
should the nurse address first?
A. A blood pressure of 100/60 mmHg
B. An open fracture of the right radius
C. Pain level of 8 on a 1-10 scale
D. Oxygen saturation of 88% on room air
Answer: D
Rationale: According to the ABC (Airway, Breathing, Circulation) priority framework,
oxygenation and ventilation are the highest priority. An SpO2 of 88% indicates significant
hypoxia.
2. When implementing the 1-hour bundle for a client in septic shock, which
action is the nurse’s priority?
A. Administering a broad-spectrum antibiotic
B. Obtaining blood cultures
C. Starting a vasopressor infusion
D. Measuring the serum lactate level
Answer: D
Rationale: While all are part of the bundle, measuring lactate helps identify the severity of
tissue hypoperfusion immediately. However, clinically, cultures must be drawn before
antibiotics, but lactate is often cited as the first identifying lab.
,3. Which task is most appropriate for the RN to delegate to an unlicensed
assistive personnel (UAP)?
A. Taking vital signs on a stable post-operative client
B. Feeding a client with dysphagia for the first time
C. Teaching a client how to use an incentive spirometer
D. Assessing a client’s surgical incision
Answer: A
Rationale: UAPs can perform tasks that are routine and do not require clinical judgment,
such as vital signs on stable patients. Assessment, teaching, and high-risk feeding require
an RN.
4. An arterial blood gas (ABG) report shows: pH 7.30, PaCO2 55 mmHg, and
HCO3 26 mEq/L. How should the nurse interpret these results?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: A pH below 7.35 is acidosis. A PaCO2 above 45 mmHg indicates a respiratory
cause. Since the HCO3 is normal, it is uncompensated respiratory acidosis.
5. A client has burns on the entire left leg and the entire left arm. Using the Rule
of Nines, what is the estimated total body surface area (TBSA) burned?
A. 18%
B. 36%
C. 27%
D. 45%
Answer: C
, Rationale: According to the Rule of Nines, an entire leg is 18% and an entire arm is 9%.
18% + 9% = 27%.
6. Which medication should the nurse anticipate for a client experiencing
symptomatic sinus bradycardia?
A. Amiodarone
B. Atropine
C. Adenosine
D. Dopamine
Answer: B
Rationale: Atropine is the first-line medication for symptomatic bradycardia to increase
the heart rate.
7. The nurse is caring for a client with Acute Respiratory Distress Syndrome
(ARDS). Which position is most effective in improving oxygenation?
A. Prone
B. High-Fowler’s
C. Semi-Fowler’s
D. Supine
Answer: A
Rationale: Prone positioning helps recruit collapsed alveoli in the posterior lung fields and
improves V/Q matching in ARDS patients.
8. A client with a spinal cord injury at T4 reports a sudden, severe headache and
is found to be hypertensive. What is the nurse’s first action?
A. Administer antihypertensive medication
B. Call the healthcare provider
C. Lower the head of the bed
D. Check for bladder distension
Answer: D
