Fall Semester 2026–2027 NURS450 – Clinical Capstone
Updated 2026 | 190+ Questions and Answers | NURS450
Clinical Capstone Comprehensive Study Guide, Practice Exam,
Exam Prep Test Bank, Medical-Surgical Nursing,
Fundamentals of Nursing, Pharmacology, Maternal-Newborn
Nursing, Pediatric Nursing, Mental Health Nursing,
Leadership & Management, Community Health, Evidence-
Based Practice, Clinical Judgment, Prioritization, Delegation,
Next Generation NCLEX (NGN), Detailed Rationales and
Complete Revision Material
Question 1: A nurse is caring for a client with a chest tube connected to a
water-seal drainage system. Which observation indicates a normal and
expected finding?
A. Continuous bubbling in the water-seal chamber
B. Intermittent bubbling in the suction control chamber
C. Constant bubbling in the water-seal chamber during inspiration
D. Fluctuation (tidaling) of the water level in the water-seal chamber
CORRECT ANSWER: D. Fluctuation (tidaling) of the water level in the water-
seal chamber
Rationale: Tidaling, or fluctuation of the water level in the water-seal chamber with
respirations, is a normal and expected finding. It indicates that the chest tube is patent
and the system is functioning correctly. Continuous bubbling in the water-seal chamber
indicates an air leak, while intermittent bubbling in the suction control chamber is
normal if suction is applied. The absence of tidaling can indicate an obstruction or lung
re-expansion.
Question 2: A client who is 24 hours post-operative following a total hip
arthroplasty reports sudden shortness of breath and pleuritic chest pain. What
is the nurse's priority action?
A. Apply oxygen via nasal cannula and reassess.
B. Administer prescribed PRN pain medication.
C. Assist the client to a high-Fowler's position.
D. Assess the surgical incision for signs of bleeding.
CORRECT ANSWER: C. Assist the client to a high-Fowler's position.
Rationale: The client's symptoms are classic signs of a pulmonary embolism (PE), a life-
threatening complication. The priority nursing action is to position the client in a high-
Fowler's position to facilitate breathing and maximize lung expansion. While applying
oxygen and reassessing are important, positioning is the immediate first step to improve
ventilation. Pain management is a later intervention, and the incision site is less relevant
to the acute respiratory distress.
,Question 3: The nurse is preparing to administer an enteral feeding via a
nasogastric (NG) tube. Which action is most important to verify tube
placement before beginning the feeding?
A. Checking the pH of the gastric aspirate.
B. Measuring the length of the external tube.
C. Auscultating for air over the epigastric region.
D. Checking for a cough reflex.
CORRECT ANSWER: A. Checking the pH of the gastric aspirate.
Rationale: The most reliable method to verify NG tube placement is to check the pH of
the gastric aspirate, which should be acidic (typically less than 5.5) if the tube is in the
stomach. Auscultation is an unreliable method. Measuring external tube length provides
a baseline for dislodgement but does not confirm placement. A cough reflex may be
absent and is not a standard method for verification.
Question 4: A client is prescribed intravenous (IV) vancomycin. The nurse
should closely monitor for which adverse effect most associated with rapid
infusion of this medication?
A. Hepatotoxicity
B. Nephrotoxicity
C. Red Man Syndrome
D. Cardiotoxicity
CORRECT ANSWER: C. Red Man Syndrome
Rationale: Red Man Syndrome is a histamine-release reaction characterized by flushing,
rash, and hypotension, often occurring when vancomycin is infused too rapidly (faster
than 60 minutes). While nephrotoxicity and ototoxicity are also adverse effects of
vancomycin, they are more related to high trough levels and prolonged use, not rapid
infusion.
Question 5: A client with heart failure has a new prescription for furosemide.
The nurse identifies that this medication is effective by monitoring for which
primary therapeutic outcome?
A. Increased cardiac output
B. Decreased peripheral edema
C. Improved respiratory rate
D. Decreased serum potassium
CORRECT ANSWER: B. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic. Its primary therapeutic outcome is the
reduction of fluid volume overload, which manifests as decreased peripheral edema,
decreased pulmonary congestion, and weight loss. While it may indirectly improve
cardiac output and respiratory rate, these are secondary effects. A decrease in serum
potassium is an adverse effect, not a therapeutic outcome.
,Question 6: The nurse is caring for a client on continuous cardiac monitoring.
Which rhythm should the nurse immediately report to the healthcare provider
as a life-threatening ventricular dysrhythmia?
A. Premature Ventricular Contractions (PVCs)
B. Ventricular Tachycardia (VT) without a pulse
C. Atrial Fibrillation with a controlled rate
D. Ventricular Fibrillation (V-Fib)
CORRECT ANSWER: D. Ventricular Fibrillation (V-Fib)
Rationale: Ventricular Fibrillation is a life-threatening, chaotic rhythm where the
ventricles quiver and do not pump blood, leading to immediate cardiac arrest. It
requires immediate defibrillation. While pulseless Ventricular Tachycardia is also life-
threatening and requires immediate CPR and defibrillation, V-Fib is the most well-
known and immediate rhythm requiring shock. The key distinction is that both V-Fib
and pulseless VT are medical emergencies, but V-Fib is the classic 'code blue' rhythm.
Question 7: A nurse is providing discharge instructions to a client prescribed
warfarin. Which client statement indicates a need for further teaching
regarding dietary intake?
A. "I will have a consistent amount of green leafy vegetables each week."
B. "I should avoid drinking alcohol while taking this medication."
C. "I can take ibuprofen if I get a headache."
D. "I will inform my dentist that I am taking this medication."
CORRECT ANSWER: C. "I can take ibuprofen if I get a headache."
Rationale: Warfarin interacts with many medications. Ibuprofen and other NSAIDs
increase the risk of gastrointestinal bleeding. The client should use acetaminophen for
pain as it has less effect on bleeding risk. Consistent Vitamin K intake (found in leafy
greens) is recommended to maintain stable INR levels, so statement A is correct. The
other statements are also correct.
Question 8: A nurse is performing a sterile wound dressing change. After
cleaning the wound from the center outward, which action should the nurse
take next?
A. Apply the new sterile dressing.
B. Place the old dressing in the designated waste container.
C. Apply sterile gloves.
D. Remove the soiled gloves and perform hand hygiene.
CORRECT ANSWER: D. Remove the soiled gloves and perform hand hygiene.
Rationale: The correct sequence for a sterile dressing change is to first apply clean
gloves and remove the old dressing. After removing the soiled dressing and before
applying sterile gloves to do the new dressing, the nurse must remove the soiled gloves
, and perform hand hygiene to prevent contamination. Applying sterile gloves is the next
step after hand hygiene.
Question 9: A client with a new diagnosis of type 1 diabetes mellitus is
learning to self-administer insulin. The client asks if they can reuse their
insulin syringes. What is the nurse's best response?
A. "Reusing syringes is acceptable if you clean the needle with alcohol before each use."
B. "You can reuse the syringe up to three times as long as you use it for yourself."
C. "Syringes are for single-use only to prevent infection and ensure accurate dosing."
D. "You may reuse the syringe only if you store it in the refrigerator between uses."
CORRECT ANSWER: C. "Syringes are for single-use only to prevent infection
and ensure accurate dosing."
Rationale: Insulin syringes are designed for single-use only. Reusing them can lead to
infection, needle blunting, and inaccurate dosing due to the needle's degradation.
Alcohol can degrade the needle's silicone coating. It is not safe to store or reuse them.
Question 10: The nurse is caring for a client with a central venous catheter
(CVC). Which action is most important to prevent catheter-related
bloodstream infections (CRBSI)?
A. Changing the transparent dressing every 48 hours.
B. Using sterile technique for all catheter accesses.
C. Flushing the catheter with normal saline daily.
D. Covering the catheter hub with a sterile cap when not in use.
CORRECT ANSWER: B. Using sterile technique for all catheter accesses.
Rationale: The primary prevention strategy for CRBSIs is to maintain strict sterile
technique during catheter insertion, access, and dressing changes. This is the most
critical step in preventing the introduction of pathogens. The dressing should be
changed per facility protocol (often every 7 days or when soiled), and while flushing and
capping are important, sterile technique is the cornerstone of prevention.
Question 11: A client is admitted with a suspected acute myocardial infarction
(MI). Which laboratory value is the most specific and sensitive indicator of
cardiac muscle damage?
A. Creatine Kinase (CK)
B. Myoglobin
C. Troponin I or T
D. Aspartate Aminotransferase (AST)
CORRECT ANSWER: C. Troponin I or T
Rationale: Troponin I and T are proteins found exclusively in cardiac muscle. Their
elevation is the most specific and sensitive marker for myocardial damage. They rise and
remain elevated for days, making them ideal for diagnosing MI. CK and AST are less
Updated 2026 | 190+ Questions and Answers | NURS450
Clinical Capstone Comprehensive Study Guide, Practice Exam,
Exam Prep Test Bank, Medical-Surgical Nursing,
Fundamentals of Nursing, Pharmacology, Maternal-Newborn
Nursing, Pediatric Nursing, Mental Health Nursing,
Leadership & Management, Community Health, Evidence-
Based Practice, Clinical Judgment, Prioritization, Delegation,
Next Generation NCLEX (NGN), Detailed Rationales and
Complete Revision Material
Question 1: A nurse is caring for a client with a chest tube connected to a
water-seal drainage system. Which observation indicates a normal and
expected finding?
A. Continuous bubbling in the water-seal chamber
B. Intermittent bubbling in the suction control chamber
C. Constant bubbling in the water-seal chamber during inspiration
D. Fluctuation (tidaling) of the water level in the water-seal chamber
CORRECT ANSWER: D. Fluctuation (tidaling) of the water level in the water-
seal chamber
Rationale: Tidaling, or fluctuation of the water level in the water-seal chamber with
respirations, is a normal and expected finding. It indicates that the chest tube is patent
and the system is functioning correctly. Continuous bubbling in the water-seal chamber
indicates an air leak, while intermittent bubbling in the suction control chamber is
normal if suction is applied. The absence of tidaling can indicate an obstruction or lung
re-expansion.
Question 2: A client who is 24 hours post-operative following a total hip
arthroplasty reports sudden shortness of breath and pleuritic chest pain. What
is the nurse's priority action?
A. Apply oxygen via nasal cannula and reassess.
B. Administer prescribed PRN pain medication.
C. Assist the client to a high-Fowler's position.
D. Assess the surgical incision for signs of bleeding.
CORRECT ANSWER: C. Assist the client to a high-Fowler's position.
Rationale: The client's symptoms are classic signs of a pulmonary embolism (PE), a life-
threatening complication. The priority nursing action is to position the client in a high-
Fowler's position to facilitate breathing and maximize lung expansion. While applying
oxygen and reassessing are important, positioning is the immediate first step to improve
ventilation. Pain management is a later intervention, and the incision site is less relevant
to the acute respiratory distress.
,Question 3: The nurse is preparing to administer an enteral feeding via a
nasogastric (NG) tube. Which action is most important to verify tube
placement before beginning the feeding?
A. Checking the pH of the gastric aspirate.
B. Measuring the length of the external tube.
C. Auscultating for air over the epigastric region.
D. Checking for a cough reflex.
CORRECT ANSWER: A. Checking the pH of the gastric aspirate.
Rationale: The most reliable method to verify NG tube placement is to check the pH of
the gastric aspirate, which should be acidic (typically less than 5.5) if the tube is in the
stomach. Auscultation is an unreliable method. Measuring external tube length provides
a baseline for dislodgement but does not confirm placement. A cough reflex may be
absent and is not a standard method for verification.
Question 4: A client is prescribed intravenous (IV) vancomycin. The nurse
should closely monitor for which adverse effect most associated with rapid
infusion of this medication?
A. Hepatotoxicity
B. Nephrotoxicity
C. Red Man Syndrome
D. Cardiotoxicity
CORRECT ANSWER: C. Red Man Syndrome
Rationale: Red Man Syndrome is a histamine-release reaction characterized by flushing,
rash, and hypotension, often occurring when vancomycin is infused too rapidly (faster
than 60 minutes). While nephrotoxicity and ototoxicity are also adverse effects of
vancomycin, they are more related to high trough levels and prolonged use, not rapid
infusion.
Question 5: A client with heart failure has a new prescription for furosemide.
The nurse identifies that this medication is effective by monitoring for which
primary therapeutic outcome?
A. Increased cardiac output
B. Decreased peripheral edema
C. Improved respiratory rate
D. Decreased serum potassium
CORRECT ANSWER: B. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic. Its primary therapeutic outcome is the
reduction of fluid volume overload, which manifests as decreased peripheral edema,
decreased pulmonary congestion, and weight loss. While it may indirectly improve
cardiac output and respiratory rate, these are secondary effects. A decrease in serum
potassium is an adverse effect, not a therapeutic outcome.
,Question 6: The nurse is caring for a client on continuous cardiac monitoring.
Which rhythm should the nurse immediately report to the healthcare provider
as a life-threatening ventricular dysrhythmia?
A. Premature Ventricular Contractions (PVCs)
B. Ventricular Tachycardia (VT) without a pulse
C. Atrial Fibrillation with a controlled rate
D. Ventricular Fibrillation (V-Fib)
CORRECT ANSWER: D. Ventricular Fibrillation (V-Fib)
Rationale: Ventricular Fibrillation is a life-threatening, chaotic rhythm where the
ventricles quiver and do not pump blood, leading to immediate cardiac arrest. It
requires immediate defibrillation. While pulseless Ventricular Tachycardia is also life-
threatening and requires immediate CPR and defibrillation, V-Fib is the most well-
known and immediate rhythm requiring shock. The key distinction is that both V-Fib
and pulseless VT are medical emergencies, but V-Fib is the classic 'code blue' rhythm.
Question 7: A nurse is providing discharge instructions to a client prescribed
warfarin. Which client statement indicates a need for further teaching
regarding dietary intake?
A. "I will have a consistent amount of green leafy vegetables each week."
B. "I should avoid drinking alcohol while taking this medication."
C. "I can take ibuprofen if I get a headache."
D. "I will inform my dentist that I am taking this medication."
CORRECT ANSWER: C. "I can take ibuprofen if I get a headache."
Rationale: Warfarin interacts with many medications. Ibuprofen and other NSAIDs
increase the risk of gastrointestinal bleeding. The client should use acetaminophen for
pain as it has less effect on bleeding risk. Consistent Vitamin K intake (found in leafy
greens) is recommended to maintain stable INR levels, so statement A is correct. The
other statements are also correct.
Question 8: A nurse is performing a sterile wound dressing change. After
cleaning the wound from the center outward, which action should the nurse
take next?
A. Apply the new sterile dressing.
B. Place the old dressing in the designated waste container.
C. Apply sterile gloves.
D. Remove the soiled gloves and perform hand hygiene.
CORRECT ANSWER: D. Remove the soiled gloves and perform hand hygiene.
Rationale: The correct sequence for a sterile dressing change is to first apply clean
gloves and remove the old dressing. After removing the soiled dressing and before
applying sterile gloves to do the new dressing, the nurse must remove the soiled gloves
, and perform hand hygiene to prevent contamination. Applying sterile gloves is the next
step after hand hygiene.
Question 9: A client with a new diagnosis of type 1 diabetes mellitus is
learning to self-administer insulin. The client asks if they can reuse their
insulin syringes. What is the nurse's best response?
A. "Reusing syringes is acceptable if you clean the needle with alcohol before each use."
B. "You can reuse the syringe up to three times as long as you use it for yourself."
C. "Syringes are for single-use only to prevent infection and ensure accurate dosing."
D. "You may reuse the syringe only if you store it in the refrigerator between uses."
CORRECT ANSWER: C. "Syringes are for single-use only to prevent infection
and ensure accurate dosing."
Rationale: Insulin syringes are designed for single-use only. Reusing them can lead to
infection, needle blunting, and inaccurate dosing due to the needle's degradation.
Alcohol can degrade the needle's silicone coating. It is not safe to store or reuse them.
Question 10: The nurse is caring for a client with a central venous catheter
(CVC). Which action is most important to prevent catheter-related
bloodstream infections (CRBSI)?
A. Changing the transparent dressing every 48 hours.
B. Using sterile technique for all catheter accesses.
C. Flushing the catheter with normal saline daily.
D. Covering the catheter hub with a sterile cap when not in use.
CORRECT ANSWER: B. Using sterile technique for all catheter accesses.
Rationale: The primary prevention strategy for CRBSIs is to maintain strict sterile
technique during catheter insertion, access, and dressing changes. This is the most
critical step in preventing the introduction of pathogens. The dressing should be
changed per facility protocol (often every 7 days or when soiled), and while flushing and
capping are important, sterile technique is the cornerstone of prevention.
Question 11: A client is admitted with a suspected acute myocardial infarction
(MI). Which laboratory value is the most specific and sensitive indicator of
cardiac muscle damage?
A. Creatine Kinase (CK)
B. Myoglobin
C. Troponin I or T
D. Aspartate Aminotransferase (AST)
CORRECT ANSWER: C. Troponin I or T
Rationale: Troponin I and T are proteins found exclusively in cardiac muscle. Their
elevation is the most specific and sensitive marker for myocardial damage. They rise and
remain elevated for days, making them ideal for diagnosing MI. CK and AST are less
