Advanced Clinical
Nursing Practice &
Critical Thinking
Examinatio 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute pancreatitis. Which assessment finding is most
indicative of severe pancreatitis?
A. Nausea and vomiting
B. Abdominal pain radiating to the back
,C. Gray-Turner's sign
D. Elevated serum lipase
💫RATIONALE✔️✔️: Gray-Turner's sign (ecchymosis in the flank area) indicates retroperitoneal
bleeding and is a sign of severe, hemorrhagic pancreatitis. This is a life-threatening complication.
Nausea, vomiting, and radiating pain are common findings but not indicators of severity. Elevated lipase
confirms pancreatitis but does not indicate severity.
💫ANSWER✔️✔️: C. Gray-Turner's sign
---
**Question 2**
A client is prescribed amiodarone for the treatment of ventricular arrhythmias. Which adverse effect
should the nurse include in the teaching plan?
A. Photosensitivity and blue-gray skin discoloration
B. Dry cough and angioedema
C. Hypokalemia and hyperglycemia
D. Tachycardia and palpitations
💫RATIONALE✔️✔️: Amiodarone has several unique adverse effects, including photosensitivity, blue-
gray skin discoloration, pulmonary toxicity, and corneal microdeposits. A dry cough and angioedema are
associated with ACE inhibitors. Hypokalemia is associated with diuretics. The nurse should teach the
client to use sunscreen and avoid direct sunlight.
💫ANSWER✔️✔️: A. Photosensitivity and blue-gray skin discoloration
,---
**Question 3**
The nurse is assessing a client who has been diagnosed with major depressive disorder. The client states,
"I just can't do anything anymore. I'm worthless." Which nursing response is most therapeutic?
A. "You shouldn't say that. You have so much to live for."
B. "I understand you're feeling worthless right now. Tell me more about that."
C. "Everyone feels that way sometimes. You'll get through it."
D. "Let's focus on the positive things in your life."
💫RATIONALE✔️✔️: Acknowledging the client's feelings without judgment is the most therapeutic
response. Saying "I understand you're feeling worthless right now. Tell me more about that" validates
the client's experience and encourages further communication. Dismissing or minimizing the client's
feelings is not therapeutic and can shut down communication.
💫ANSWER✔️✔️: B. "I understand you're feeling worthless right now. Tell me more about that."
---
**Question 4**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
, A. Document the finding as expected
B. Assess the system for an air leak
C. Increase the suction pressure
D. Clamp the chest tube immediately
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak in the
system. The nurse should assess the system for the source of the leak, such as loose connections or a
dislodged tube. Clamping the chest tube is not recommended as it can lead to a tension pneumothorax.
The provider should be notified if the leak cannot be resolved.
💫ANSWER✔️✔️: B. Assess the system for an air leak
---
**Question 5**
The nurse is providing education to a client with a new diagnosis of heart failure. Which statement
indicates the client understands the importance of daily weights?
A. "I should weigh myself at the same time each day, before breakfast."
B. "I can weigh myself at any time of the day."
C. "I should weigh myself weekly to monitor my fluid status."
D. "I don't need to weigh myself if I feel well."
💫RATIONALE✔️✔️: Daily weights should be taken at the same time each day, before breakfast, and
after voiding, using the same scale with similar clothing. This provides the most accurate assessment of
fluid status. Weekly weights are not sufficient for early detection of fluid retention. A weight gain of 2-3
pounds in one day should be reported to the provider.
Nursing Practice &
Critical Thinking
Examinatio 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute pancreatitis. Which assessment finding is most
indicative of severe pancreatitis?
A. Nausea and vomiting
B. Abdominal pain radiating to the back
,C. Gray-Turner's sign
D. Elevated serum lipase
💫RATIONALE✔️✔️: Gray-Turner's sign (ecchymosis in the flank area) indicates retroperitoneal
bleeding and is a sign of severe, hemorrhagic pancreatitis. This is a life-threatening complication.
Nausea, vomiting, and radiating pain are common findings but not indicators of severity. Elevated lipase
confirms pancreatitis but does not indicate severity.
💫ANSWER✔️✔️: C. Gray-Turner's sign
---
**Question 2**
A client is prescribed amiodarone for the treatment of ventricular arrhythmias. Which adverse effect
should the nurse include in the teaching plan?
A. Photosensitivity and blue-gray skin discoloration
B. Dry cough and angioedema
C. Hypokalemia and hyperglycemia
D. Tachycardia and palpitations
💫RATIONALE✔️✔️: Amiodarone has several unique adverse effects, including photosensitivity, blue-
gray skin discoloration, pulmonary toxicity, and corneal microdeposits. A dry cough and angioedema are
associated with ACE inhibitors. Hypokalemia is associated with diuretics. The nurse should teach the
client to use sunscreen and avoid direct sunlight.
💫ANSWER✔️✔️: A. Photosensitivity and blue-gray skin discoloration
,---
**Question 3**
The nurse is assessing a client who has been diagnosed with major depressive disorder. The client states,
"I just can't do anything anymore. I'm worthless." Which nursing response is most therapeutic?
A. "You shouldn't say that. You have so much to live for."
B. "I understand you're feeling worthless right now. Tell me more about that."
C. "Everyone feels that way sometimes. You'll get through it."
D. "Let's focus on the positive things in your life."
💫RATIONALE✔️✔️: Acknowledging the client's feelings without judgment is the most therapeutic
response. Saying "I understand you're feeling worthless right now. Tell me more about that" validates
the client's experience and encourages further communication. Dismissing or minimizing the client's
feelings is not therapeutic and can shut down communication.
💫ANSWER✔️✔️: B. "I understand you're feeling worthless right now. Tell me more about that."
---
**Question 4**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
, A. Document the finding as expected
B. Assess the system for an air leak
C. Increase the suction pressure
D. Clamp the chest tube immediately
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak in the
system. The nurse should assess the system for the source of the leak, such as loose connections or a
dislodged tube. Clamping the chest tube is not recommended as it can lead to a tension pneumothorax.
The provider should be notified if the leak cannot be resolved.
💫ANSWER✔️✔️: B. Assess the system for an air leak
---
**Question 5**
The nurse is providing education to a client with a new diagnosis of heart failure. Which statement
indicates the client understands the importance of daily weights?
A. "I should weigh myself at the same time each day, before breakfast."
B. "I can weigh myself at any time of the day."
C. "I should weigh myself weekly to monitor my fluid status."
D. "I don't need to weigh myself if I feel well."
💫RATIONALE✔️✔️: Daily weights should be taken at the same time each day, before breakfast, and
after voiding, using the same scale with similar clothing. This provides the most accurate assessment of
fluid status. Weekly weights are not sufficient for early detection of fluid retention. A weight gain of 2-3
pounds in one day should be reported to the provider.
