Holistic Nursing
Practice & Advanced
Clinical Reasoning
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute respiratory distress syndrome (ARDS). Which
assessment finding is most consistent with this condition?
A. Bilateral crackles and hypoxemia refractory to oxygen therapy
B. Wheezing and prolonged expiratory phase
C. Diminished breath sounds and barrel chest
D. Stridor and use of accessory muscles
,💫RATIONALE✔️✔️: ARDS is characterized by diffuse alveolar damage leading to pulmonary edema,
bilateral crackles, and severe hypoxemia that does not improve with oxygen therapy. Wheezing and
prolonged expiration are more consistent with asthma or COPD. Stridor is associated with upper airway
obstruction.
💫ANSWER✔️✔️: A. Bilateral crackles and hypoxemia refractory to oxygen therapy
---
**Question 2**
A client is prescribed enalapril (Vasotec) for the treatment of hypertension. Which adverse effect should
the nurse include in the teaching plan?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. All of the above
💫RATIONALE✔️✔️: Enalapril is an ACE inhibitor. Common adverse effects include a persistent dry
cough, hyperkalemia, and angioedema (a rare but serious adverse effect). The client should be taught to
report signs of angioedema such as swelling of the face, lips, or tongue.
💫ANSWER✔️✔️: D. All of the above
---
,**Question 3**
The nurse is assessing a client with a new diagnosis of Addison's disease. Which finding is most
consistent with this condition?
A. Hypertension and hyperglycemia
B. Hyperpigmentation and hypotension
C. Moon face and buffalo hump
D. Weight gain and tachycardia
💫RATIONALE✔️✔️: Addison's disease is characterized by adrenal insufficiency, leading to
hypotension, hyperpigmentation (due to increased ACTH), hyponatremia, and hyperkalemia.
Hypertension, moon face, and buffalo hump are signs of Cushing's syndrome (excess cortisol).
💫ANSWER✔️✔️: B. Hyperpigmentation and hypotension
---
**Question 4**
The nurse is providing education to a client with a new diagnosis of epilepsy who is prescribed
phenytoin (Dilantin). Which instruction is most important?
A. "Take this medication with a full glass of milk."
B. "You will need to have your blood levels monitored regularly."
C. "This medication will work immediately to prevent seizures."
D. "You can stop taking this medication if you are seizure-free."
, 💫RATIONALE✔️✔️: Phenytoin has a narrow therapeutic range, and blood levels must be monitored
to ensure therapeutic efficacy and prevent toxicity. It takes time to reach therapeutic levels. It should
not be stopped abruptly due to the risk of status epilepticus.
💫ANSWER✔️✔️: B. "You will need to have your blood levels monitored regularly."
---
**Question 5**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates an air leak?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the water seal chamber
C. Tidaling with respirations
D. Constant drainage of 50 mL/hour
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak in the
system. Intermittent bubbling is expected with expiration. Tidaling indicates a patent chest tube.
Drainage should be monitored, but constant drainage is not necessarily indicative of an air leak.
💫ANSWER✔️✔️: A. Continuous bubbling in the water seal chamber
---
Practice & Advanced
Clinical Reasoning
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute respiratory distress syndrome (ARDS). Which
assessment finding is most consistent with this condition?
A. Bilateral crackles and hypoxemia refractory to oxygen therapy
B. Wheezing and prolonged expiratory phase
C. Diminished breath sounds and barrel chest
D. Stridor and use of accessory muscles
,💫RATIONALE✔️✔️: ARDS is characterized by diffuse alveolar damage leading to pulmonary edema,
bilateral crackles, and severe hypoxemia that does not improve with oxygen therapy. Wheezing and
prolonged expiration are more consistent with asthma or COPD. Stridor is associated with upper airway
obstruction.
💫ANSWER✔️✔️: A. Bilateral crackles and hypoxemia refractory to oxygen therapy
---
**Question 2**
A client is prescribed enalapril (Vasotec) for the treatment of hypertension. Which adverse effect should
the nurse include in the teaching plan?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. All of the above
💫RATIONALE✔️✔️: Enalapril is an ACE inhibitor. Common adverse effects include a persistent dry
cough, hyperkalemia, and angioedema (a rare but serious adverse effect). The client should be taught to
report signs of angioedema such as swelling of the face, lips, or tongue.
💫ANSWER✔️✔️: D. All of the above
---
,**Question 3**
The nurse is assessing a client with a new diagnosis of Addison's disease. Which finding is most
consistent with this condition?
A. Hypertension and hyperglycemia
B. Hyperpigmentation and hypotension
C. Moon face and buffalo hump
D. Weight gain and tachycardia
💫RATIONALE✔️✔️: Addison's disease is characterized by adrenal insufficiency, leading to
hypotension, hyperpigmentation (due to increased ACTH), hyponatremia, and hyperkalemia.
Hypertension, moon face, and buffalo hump are signs of Cushing's syndrome (excess cortisol).
💫ANSWER✔️✔️: B. Hyperpigmentation and hypotension
---
**Question 4**
The nurse is providing education to a client with a new diagnosis of epilepsy who is prescribed
phenytoin (Dilantin). Which instruction is most important?
A. "Take this medication with a full glass of milk."
B. "You will need to have your blood levels monitored regularly."
C. "This medication will work immediately to prevent seizures."
D. "You can stop taking this medication if you are seizure-free."
, 💫RATIONALE✔️✔️: Phenytoin has a narrow therapeutic range, and blood levels must be monitored
to ensure therapeutic efficacy and prevent toxicity. It takes time to reach therapeutic levels. It should
not be stopped abruptly due to the risk of status epilepticus.
💫ANSWER✔️✔️: B. "You will need to have your blood levels monitored regularly."
---
**Question 5**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates an air leak?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the water seal chamber
C. Tidaling with respirations
D. Constant drainage of 50 mL/hour
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak in the
system. Intermittent bubbling is expected with expiration. Tidaling indicates a patent chest tube.
Drainage should be monitored, but constant drainage is not necessarily indicative of an air leak.
💫ANSWER✔️✔️: A. Continuous bubbling in the water seal chamber
---
