Professional Nursing
Practice & Clinical
Decision-Making
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute liver failure. Which laboratory finding is most
concerning for the development of hepatic encephalopathy?
A. Elevated serum ammonia
B. Elevated serum bilirubin
C. Decreased serum albumin
D. Elevated serum ALT and AST
,💫RATIONALE✔️✔️: Hepatic encephalopathy is caused by the buildup of ammonia in the blood,
which crosses the blood-brain barrier and affects brain function. Elevated serum ammonia is the most
specific laboratory finding associated with hepatic encephalopathy. Elevated bilirubin, decreased
albumin, and elevated liver enzymes are also seen in liver failure but are not directly associated with
encephalopathy.
💫ANSWER✔️✔️: A. Elevated serum ammonia
---
**Question 2**
A client is prescribed clopidogrel (Plavix) following a coronary stent placement. Which instruction should
the nurse include in the teaching plan?
A. "Take this medication with a full glass of grapefruit juice."
B. "You may stop taking this medication after 6 months."
C. "Do not stop taking this medication without consulting your healthcare provider."
D. "This medication will dissolve any clots that have already formed."
💫RATIONALE✔️✔️: Clopidogrel is an antiplatelet medication that prevents clot formation. It should
not be stopped abruptly without provider guidance due to the risk of stent thrombosis. Grapefruit juice
should be avoided, and the medication does not dissolve existing clots (thrombolytics do that).
💫ANSWER✔️✔️: C. "Do not stop taking this medication without consulting your healthcare
provider."
,---
**Question 3**
The nurse is assessing a client who is 4 hours post-operative after a thyroidectomy. The client's voice is
hoarse, and the client reports difficulty swallowing. Which action should the nurse take first?
A. Notify the healthcare provider immediately
B. Assess the client's oxygen saturation
C. Administer a PRN dose of pain medication
D. Document the finding as expected
💫RATIONALE✔️✔️: Hoarseness and difficulty swallowing after a thyroidectomy may indicate
laryngeal nerve damage or hematoma formation. The nurse should first assess the client's oxygen
saturation to determine the severity of the respiratory compromise. This assessment will guide the
urgency of the provider notification.
💫ANSWER✔️✔️: B. Assess the client's oxygen saturation
---
**Question 4**
A client with a history of bipolar disorder is in the manic phase. The nurse observes the client pacing the
unit and talking rapidly. Which nursing intervention is most appropriate?
A. Encourage the client to sit down and rest
, B. Provide high-calorie finger foods to eat while walking
C. Place the client in seclusion to prevent exhaustion
D. Allow the client to continue pacing without interruption
💫RATIONALE✔️✔️: Clients in the manic phase have increased energy and difficulty sitting still.
Providing high-calorie finger foods that can be eaten while walking helps meet nutritional needs without
forcing the client to sit still. The client should be monitored for exhaustion and redirected as needed.
💫ANSWER✔️✔️: B. Provide high-calorie finger foods to eat while walking
---
**Question 5**
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, and
notify the provider if the leak cannot be resolved. Clamping the chest tube is not recommended as it can
lead to a tension pneumothorax.
💫ANSWER✔️✔️: B. Assess the system for an air leak
Practice & Clinical
Decision-Making
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute liver failure. Which laboratory finding is most
concerning for the development of hepatic encephalopathy?
A. Elevated serum ammonia
B. Elevated serum bilirubin
C. Decreased serum albumin
D. Elevated serum ALT and AST
,💫RATIONALE✔️✔️: Hepatic encephalopathy is caused by the buildup of ammonia in the blood,
which crosses the blood-brain barrier and affects brain function. Elevated serum ammonia is the most
specific laboratory finding associated with hepatic encephalopathy. Elevated bilirubin, decreased
albumin, and elevated liver enzymes are also seen in liver failure but are not directly associated with
encephalopathy.
💫ANSWER✔️✔️: A. Elevated serum ammonia
---
**Question 2**
A client is prescribed clopidogrel (Plavix) following a coronary stent placement. Which instruction should
the nurse include in the teaching plan?
A. "Take this medication with a full glass of grapefruit juice."
B. "You may stop taking this medication after 6 months."
C. "Do not stop taking this medication without consulting your healthcare provider."
D. "This medication will dissolve any clots that have already formed."
💫RATIONALE✔️✔️: Clopidogrel is an antiplatelet medication that prevents clot formation. It should
not be stopped abruptly without provider guidance due to the risk of stent thrombosis. Grapefruit juice
should be avoided, and the medication does not dissolve existing clots (thrombolytics do that).
💫ANSWER✔️✔️: C. "Do not stop taking this medication without consulting your healthcare
provider."
,---
**Question 3**
The nurse is assessing a client who is 4 hours post-operative after a thyroidectomy. The client's voice is
hoarse, and the client reports difficulty swallowing. Which action should the nurse take first?
A. Notify the healthcare provider immediately
B. Assess the client's oxygen saturation
C. Administer a PRN dose of pain medication
D. Document the finding as expected
💫RATIONALE✔️✔️: Hoarseness and difficulty swallowing after a thyroidectomy may indicate
laryngeal nerve damage or hematoma formation. The nurse should first assess the client's oxygen
saturation to determine the severity of the respiratory compromise. This assessment will guide the
urgency of the provider notification.
💫ANSWER✔️✔️: B. Assess the client's oxygen saturation
---
**Question 4**
A client with a history of bipolar disorder is in the manic phase. The nurse observes the client pacing the
unit and talking rapidly. Which nursing intervention is most appropriate?
A. Encourage the client to sit down and rest
, B. Provide high-calorie finger foods to eat while walking
C. Place the client in seclusion to prevent exhaustion
D. Allow the client to continue pacing without interruption
💫RATIONALE✔️✔️: Clients in the manic phase have increased energy and difficulty sitting still.
Providing high-calorie finger foods that can be eaten while walking helps meet nutritional needs without
forcing the client to sit still. The client should be monitored for exhaustion and redirected as needed.
💫ANSWER✔️✔️: B. Provide high-calorie finger foods to eat while walking
---
**Question 5**
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, and
notify the provider if the leak cannot be resolved. Clamping the chest tube is not recommended as it can
lead to a tension pneumothorax.
💫ANSWER✔️✔️: B. Assess the system for an air leak
