NUR2811 Nursing Capstone Midterm Exam Review
Comprehensive Practice Exam with 100+ Questions,
ANSWERs, and Rationales 2026
SECTION 1: PRIORITIZATION & CLINICAL DECISION-MAKING
Question 1
A nurse is caring for multiple clients on a medical-surgical unit. Which client is at the highest risk for
developing a nosocomial infection?
A. Client with alcohol use disorder admitted for detoxification
B. Client with Type 1 diabetes mellitus and peripheral neuropathy
C. Client recovering from a laparoscopic cholecystectomy
D. Client with full-thickness burns, NG tube, and Foley catheter
Correct ANSWER: D
Rationale: Patients with extensive burns have a severely compromised skin barrier, making them highly
susceptible to infection. The presence of invasive devices such as an NG tube and Foley catheter further
increases infection risk by providing entry points for microorganisms. Although diabetes and surgery
also increase risk, the combination of broken skin integrity and multiple invasive devices places the burn
patient at the greatest risk.
Question 2
Which client should the nurse prioritize for transfer from ICU to a step-down neurological unit?
A. Client with acute head injury and seizures
,B. Client with ischemic stroke 4 days ago and mild confusion
C. Client 1-day post-transsphenoidal craniotomy with CSF leak
D. Client with bacterial meningitis and Glasgow Coma Scale of 7
Correct ANSWER: B
Rationale: The most stable client is the one with an ischemic stroke who is several days post-event and
only mildly confused. The other clients are unstable due to CSF leak, decreased level of consciousness,
or active neurological compromise.
Question 3
After shift report, which client should the nurse assess first?
A. Ventilated client requiring sputum culture collection
B. COPD client with oxygen saturation of 90% from previous shift
C. Pneumonia client awaiting IV antibiotics
D. Asthma client reporting shortness of breath after bronchodilator use
Correct ANSWER: D
Rationale: Shortness of breath after bronchodilator use suggests worsening bronchospasm or treatment
failure. This is an airway priority (ABCs). The other clients are either stable or receiving routine care.
Question 4
Which postoperative client should the nurse assess first?
A. Client scheduled for laparoscopic cholecystectomy
B. Multiple trauma client from motor vehicle collision
C. Client scheduled for thyroidectomy
D. Client awaiting discharge after appendectomy
,Correct ANSWER: B
Rationale: Trauma patients are the most unstable and require immediate assessment due to risk of
internal injuries, hemorrhage, and airway compromise.
Question 5
During disaster triage, which client can be safely discharged first?
A. 24-hour post-hysterectomy client
B. 5-day post-total hip replacement client
C. 12-hour pyelonephritis admission
D. 5-day stage III pressure ulcer patient
Correct ANSWER: B
Rationale: This client is the most stable and least dependent on acute care services compared to
infection or surgical complications.
Question 6
Which client requires immediate assessment after shift change?
A. BP 90/60 with hot, dry skin
B. Sleeping client with stable vital signs
C. Fruity breath, polydipsia, and polyphagia
D. Irritable client with tremors
Correct ANSWER: C
, Rationale: These are classic signs of diabetic ketoacidosis (DKA), a life-threatening metabolic emergency.
Question 7
A client who had a cast applied to the right lower arm 48 hours ago presents with severe burning pain,
paresthesia, and a cool, pale extremity. What complication should the nurse suspect?
A. Fat embolism syndrome
B. Compartment syndrome
C. Deep vein thrombosis
D. Cellulitis
Correct ANSWER: B
Rationale: Compartment syndrome occurs when increased pressure within a closed muscle
compartment compromises circulation and nerve function. Classic signs include severe pain unrelieved
by medication, paresthesia, pallor, and coolness of the extremity. Fat embolism would present with
respiratory distress and petechiae, while DVT would present with warmth and swelling rather than
pallor.
Question 8
A patient with chronic heart failure reports increasing shortness of breath. Which finding should the
nurse expect?
A. Peripheral edema
B. Bradycardia
C. Hyperactive bowel sounds
D. Decreased respiratory rate
Correct ANSWER: A
Rationale: Heart failure causes fluid retention, leading to peripheral edema.
Comprehensive Practice Exam with 100+ Questions,
ANSWERs, and Rationales 2026
SECTION 1: PRIORITIZATION & CLINICAL DECISION-MAKING
Question 1
A nurse is caring for multiple clients on a medical-surgical unit. Which client is at the highest risk for
developing a nosocomial infection?
A. Client with alcohol use disorder admitted for detoxification
B. Client with Type 1 diabetes mellitus and peripheral neuropathy
C. Client recovering from a laparoscopic cholecystectomy
D. Client with full-thickness burns, NG tube, and Foley catheter
Correct ANSWER: D
Rationale: Patients with extensive burns have a severely compromised skin barrier, making them highly
susceptible to infection. The presence of invasive devices such as an NG tube and Foley catheter further
increases infection risk by providing entry points for microorganisms. Although diabetes and surgery
also increase risk, the combination of broken skin integrity and multiple invasive devices places the burn
patient at the greatest risk.
Question 2
Which client should the nurse prioritize for transfer from ICU to a step-down neurological unit?
A. Client with acute head injury and seizures
,B. Client with ischemic stroke 4 days ago and mild confusion
C. Client 1-day post-transsphenoidal craniotomy with CSF leak
D. Client with bacterial meningitis and Glasgow Coma Scale of 7
Correct ANSWER: B
Rationale: The most stable client is the one with an ischemic stroke who is several days post-event and
only mildly confused. The other clients are unstable due to CSF leak, decreased level of consciousness,
or active neurological compromise.
Question 3
After shift report, which client should the nurse assess first?
A. Ventilated client requiring sputum culture collection
B. COPD client with oxygen saturation of 90% from previous shift
C. Pneumonia client awaiting IV antibiotics
D. Asthma client reporting shortness of breath after bronchodilator use
Correct ANSWER: D
Rationale: Shortness of breath after bronchodilator use suggests worsening bronchospasm or treatment
failure. This is an airway priority (ABCs). The other clients are either stable or receiving routine care.
Question 4
Which postoperative client should the nurse assess first?
A. Client scheduled for laparoscopic cholecystectomy
B. Multiple trauma client from motor vehicle collision
C. Client scheduled for thyroidectomy
D. Client awaiting discharge after appendectomy
,Correct ANSWER: B
Rationale: Trauma patients are the most unstable and require immediate assessment due to risk of
internal injuries, hemorrhage, and airway compromise.
Question 5
During disaster triage, which client can be safely discharged first?
A. 24-hour post-hysterectomy client
B. 5-day post-total hip replacement client
C. 12-hour pyelonephritis admission
D. 5-day stage III pressure ulcer patient
Correct ANSWER: B
Rationale: This client is the most stable and least dependent on acute care services compared to
infection or surgical complications.
Question 6
Which client requires immediate assessment after shift change?
A. BP 90/60 with hot, dry skin
B. Sleeping client with stable vital signs
C. Fruity breath, polydipsia, and polyphagia
D. Irritable client with tremors
Correct ANSWER: C
, Rationale: These are classic signs of diabetic ketoacidosis (DKA), a life-threatening metabolic emergency.
Question 7
A client who had a cast applied to the right lower arm 48 hours ago presents with severe burning pain,
paresthesia, and a cool, pale extremity. What complication should the nurse suspect?
A. Fat embolism syndrome
B. Compartment syndrome
C. Deep vein thrombosis
D. Cellulitis
Correct ANSWER: B
Rationale: Compartment syndrome occurs when increased pressure within a closed muscle
compartment compromises circulation and nerve function. Classic signs include severe pain unrelieved
by medication, paresthesia, pallor, and coolness of the extremity. Fat embolism would present with
respiratory distress and petechiae, while DVT would present with warmth and swelling rather than
pallor.
Question 8
A patient with chronic heart failure reports increasing shortness of breath. Which finding should the
nurse expect?
A. Peripheral edema
B. Bradycardia
C. Hyperactive bowel sounds
D. Decreased respiratory rate
Correct ANSWER: A
Rationale: Heart failure causes fluid retention, leading to peripheral edema.
