Nursing Capstone Comprehensive NCLEX-RN® – RN
Nursing Capstone Study Guide, Original Practice
Questions & Answers, Comprehensive NCLEX-RN®
Exam Preparation, NGN-Style Clinical Judgment,
Adult Medical-Surgical Nursing, Fundamentals,
Pharmacology, Maternal-Newborn, Pediatrics,
Mental Health, Leadership & Management,
Community Health, Critical Care, Prioritization,
Delegation, Patient Safety, Health Assessment &
Clinical Decision-Making
Question 1: A nurse is caring for a client with chronic kidney disease who is
prescribed calcium carbonate. The nurse understands that this medication is
primarily used to manage which of the following conditions?
A. Hyperkalemia
B. Metabolic acidosis
C. Hyperphosphatemia
D. Anemia of chronic disease
CORRECT ANSWER: C. Hyperphosphatemia
Rationale: Calcium carbonate is a phosphate binder that works by binding dietary
phosphate in the gastrointestinal tract, preventing its absorption and reducing serum
phosphate levels. It is not indicated for hyperkalemia, metabolic acidosis, or anemia. It is
used to manage hyperphosphatemia in chronic kidney disease to prevent bone
demineralization and metastatic calcification.
Question 2: A nurse is providing education to a client prescribed digoxin for
heart failure. Which of the following symptoms should the client be taught to
report immediately as a sign of digoxin toxicity?
A. Muscle cramps and dry skin
B. Blurred vision and gastrointestinal upset
C. Increased appetite and thirst
D. Night sweats and fever
CORRECT ANSWER: B. Blurred vision and gastrointestinal upset
Rationale: Digoxin toxicity often presents with visual disturbances (e.g., blurred vision,
yellow-green halos), gastrointestinal symptoms (e.g., nausea, vomiting, anorexia), and
cardiac dysrhythmias. The other options are not characteristic of digoxin toxicity. Early
recognition and reporting are essential to prevent severe cardiac complications.
,Question 3: A client who is 24 hours post-hip replacement surgery reports
sudden chest pain and shortness of breath. The nurse notes tachycardia and
tachypnea. What is the nurse's priority action?
A. Administer prescribed PRN pain medication
B. Encourage the client to take deep breaths
C. Apply oxygen and notify the healthcare provider
D. Assist the client to the bathroom to ambulate
CORRECT ANSWER: C. Apply oxygen and notify the healthcare provider
Rationale: The symptoms are classic for a pulmonary embolism, a life-threatening
complication following major surgery. The priority is to stabilize the client by
administering oxygen and immediately notifying the healthcare provider for further
orders. Pain medication, deep breathing, or ambulation would delay critical intervention
and could worsen the condition.
Question 4: A nurse is performing a medication reconciliation for a client being
admitted to the medical-surgical unit. Which of the following represents the
correct procedure for this process?
A. Comparing the client's current medications to the newly prescribed ones to identify
discrepancies
B. Discontinuing all home medications and starting new hospital prescriptions
C. Having the family list the client's medications from memory
D. Verifying medications only with the primary care provider's office
CORRECT ANSWER: A. Comparing the client's current medications to the
newly prescribed ones to identify discrepancies
Rationale: Medication reconciliation is a formal process of creating an accurate list of
all medications a client is taking and comparing it to newly prescribed medications to
prevent errors such as omissions, duplications, or interactions. It involves the client,
family, and all providers, not just memory or one source.
Question 5: A client with a new tracheostomy is being prepared for discharge.
The nurse is teaching the client's caregiver about emergency management.
Which statement indicates that the caregiver understands the priority action
for a tracheostomy tube obstruction?
A. "I will remove the inner cannula and try to suction the outer cannula."
B. "I will immediately call 911 before doing anything."
C. "I will place the client in a supine position and change the ties."
D. "I will cut the tracheostomy ties and attempt to reinsert a new tube."
,CORRECT ANSWER: A. "I will remove the inner cannula and try to suction the
outer cannula."
Rationale: The priority for a tracheostomy tube obstruction is to remove the inner
cannula to clear the airway. If the obstruction is in the outer cannula, suctioning should
be attempted. If unsuccessful, the entire tube may need to be replaced, but the
immediate first step is removing the inner cannula. Calling 911 or cutting ties are
secondary actions.
Question 6: A nurse is assessing a client who is receiving a continuous
morphine infusion via patient-controlled analgesia (PCA). Which finding
requires the nurse's immediate intervention?
A. The client reports pain rated as 3 on a 0-10 scale
B. The client's respiratory rate is 10 breaths per minute
C. The client's heart rate is 88 beats per minute
D. The client is sleeping quietly with eyes closed
CORRECT ANSWER: B. The client's respiratory rate is 10 breaths per minute
Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression,
a life-threatening adverse effect of opioid therapy. The nurse must immediately stop or
reduce the infusion, stimulate the client, and possibly administer naloxone. Pain of 3,
heart rate of 88, and quiet sleeping are expected findings unless the client is difficult to
arouse.
Question 7: The nurse is caring for a client with a chest tube to water-seal
drainage for a pneumothorax. The nurse observes continuous bubbling in the
water-seal chamber. Which is the correct interpretation and action?
A. This is an expected finding indicating proper lung expansion
B. This indicates a leak in the system and the nurse should assess for air leaks
C. This indicates the suction pressure is too high and should be decreased
D. This indicates the tube is functioning properly and no action is needed
CORRECT ANSWER: B. This indicates a leak in the system and the nurse
should assess for air leaks
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system, such as from the chest tube insertion site, connections, or the patient's lung.
Intermittent bubbling is normal and reflects air escaping from the pleural space. The
nurse should assess the system for leaks and notify the provider if indicated.
, Question 8: A nurse is caring for a client with a full-thickness burn injury who
is in the acute phase of burn care. Which laboratory value is the most critical
to monitor for early detection of acute kidney injury?
A. Serum sodium
B. Blood urea nitrogen (BUN) and creatinine
C. White blood cell count
D. Serum albumin
CORRECT ANSWER: B. Blood urea nitrogen (BUN) and creatinine
Rationale: BUN and creatinine are the primary indicators of renal function. In the acute
phase of burn injury, hypovolemia and massive fluid shifts can lead to prerenal azotemia
and acute kidney injury. Monitoring these values is critical for early detection and
guiding fluid resuscitation. Sodium, WBC, and albumin are also monitored but are not
the primary indicators for acute kidney injury.
Question 9: A client with type 1 diabetes mellitus is exhibiting signs of diabetic
ketoacidosis (DKA). The nurse expects which of the following arterial blood
gas (ABG) results?
A. pH 7.38, PaCO2 42, HCO3 24
B. pH 7.25, PaCO2 30, HCO3 16
C. pH 7.50, PaCO2 50, HCO3 32
D. pH 7.30, PaCO2 55, HCO3 28
CORRECT ANSWER: B. pH 7.25, PaCO2 30, HCO3 16
Rationale: DKA is characterized by metabolic acidosis with a low pH and low
bicarbonate (HCO3). The low PaCO2 reflects respiratory compensation (Kussmaul
respirations) to blow off carbon dioxide. Option A is normal, C is metabolic alkalosis,
and D is respiratory acidosis with metabolic compensation.
Question 10: A nurse is providing discharge teaching to a client who has had a
myocardial infarction and is prescribed sublingual nitroglycerin. Which
instruction is correct regarding the storage and use of this medication?
A. Store the tablets in a clear glass container for easy access
B. Replace the tablets every 12 months regardless of use
C. Keep the medication in the original dark bottle and replace every 6 months
D. Carry the tablets in a plastic pillbox for convenience
CORRECT ANSWER: C. Keep the medication in the original dark bottle and
replace every 6 months
Nursing Capstone Study Guide, Original Practice
Questions & Answers, Comprehensive NCLEX-RN®
Exam Preparation, NGN-Style Clinical Judgment,
Adult Medical-Surgical Nursing, Fundamentals,
Pharmacology, Maternal-Newborn, Pediatrics,
Mental Health, Leadership & Management,
Community Health, Critical Care, Prioritization,
Delegation, Patient Safety, Health Assessment &
Clinical Decision-Making
Question 1: A nurse is caring for a client with chronic kidney disease who is
prescribed calcium carbonate. The nurse understands that this medication is
primarily used to manage which of the following conditions?
A. Hyperkalemia
B. Metabolic acidosis
C. Hyperphosphatemia
D. Anemia of chronic disease
CORRECT ANSWER: C. Hyperphosphatemia
Rationale: Calcium carbonate is a phosphate binder that works by binding dietary
phosphate in the gastrointestinal tract, preventing its absorption and reducing serum
phosphate levels. It is not indicated for hyperkalemia, metabolic acidosis, or anemia. It is
used to manage hyperphosphatemia in chronic kidney disease to prevent bone
demineralization and metastatic calcification.
Question 2: A nurse is providing education to a client prescribed digoxin for
heart failure. Which of the following symptoms should the client be taught to
report immediately as a sign of digoxin toxicity?
A. Muscle cramps and dry skin
B. Blurred vision and gastrointestinal upset
C. Increased appetite and thirst
D. Night sweats and fever
CORRECT ANSWER: B. Blurred vision and gastrointestinal upset
Rationale: Digoxin toxicity often presents with visual disturbances (e.g., blurred vision,
yellow-green halos), gastrointestinal symptoms (e.g., nausea, vomiting, anorexia), and
cardiac dysrhythmias. The other options are not characteristic of digoxin toxicity. Early
recognition and reporting are essential to prevent severe cardiac complications.
,Question 3: A client who is 24 hours post-hip replacement surgery reports
sudden chest pain and shortness of breath. The nurse notes tachycardia and
tachypnea. What is the nurse's priority action?
A. Administer prescribed PRN pain medication
B. Encourage the client to take deep breaths
C. Apply oxygen and notify the healthcare provider
D. Assist the client to the bathroom to ambulate
CORRECT ANSWER: C. Apply oxygen and notify the healthcare provider
Rationale: The symptoms are classic for a pulmonary embolism, a life-threatening
complication following major surgery. The priority is to stabilize the client by
administering oxygen and immediately notifying the healthcare provider for further
orders. Pain medication, deep breathing, or ambulation would delay critical intervention
and could worsen the condition.
Question 4: A nurse is performing a medication reconciliation for a client being
admitted to the medical-surgical unit. Which of the following represents the
correct procedure for this process?
A. Comparing the client's current medications to the newly prescribed ones to identify
discrepancies
B. Discontinuing all home medications and starting new hospital prescriptions
C. Having the family list the client's medications from memory
D. Verifying medications only with the primary care provider's office
CORRECT ANSWER: A. Comparing the client's current medications to the
newly prescribed ones to identify discrepancies
Rationale: Medication reconciliation is a formal process of creating an accurate list of
all medications a client is taking and comparing it to newly prescribed medications to
prevent errors such as omissions, duplications, or interactions. It involves the client,
family, and all providers, not just memory or one source.
Question 5: A client with a new tracheostomy is being prepared for discharge.
The nurse is teaching the client's caregiver about emergency management.
Which statement indicates that the caregiver understands the priority action
for a tracheostomy tube obstruction?
A. "I will remove the inner cannula and try to suction the outer cannula."
B. "I will immediately call 911 before doing anything."
C. "I will place the client in a supine position and change the ties."
D. "I will cut the tracheostomy ties and attempt to reinsert a new tube."
,CORRECT ANSWER: A. "I will remove the inner cannula and try to suction the
outer cannula."
Rationale: The priority for a tracheostomy tube obstruction is to remove the inner
cannula to clear the airway. If the obstruction is in the outer cannula, suctioning should
be attempted. If unsuccessful, the entire tube may need to be replaced, but the
immediate first step is removing the inner cannula. Calling 911 or cutting ties are
secondary actions.
Question 6: A nurse is assessing a client who is receiving a continuous
morphine infusion via patient-controlled analgesia (PCA). Which finding
requires the nurse's immediate intervention?
A. The client reports pain rated as 3 on a 0-10 scale
B. The client's respiratory rate is 10 breaths per minute
C. The client's heart rate is 88 beats per minute
D. The client is sleeping quietly with eyes closed
CORRECT ANSWER: B. The client's respiratory rate is 10 breaths per minute
Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression,
a life-threatening adverse effect of opioid therapy. The nurse must immediately stop or
reduce the infusion, stimulate the client, and possibly administer naloxone. Pain of 3,
heart rate of 88, and quiet sleeping are expected findings unless the client is difficult to
arouse.
Question 7: The nurse is caring for a client with a chest tube to water-seal
drainage for a pneumothorax. The nurse observes continuous bubbling in the
water-seal chamber. Which is the correct interpretation and action?
A. This is an expected finding indicating proper lung expansion
B. This indicates a leak in the system and the nurse should assess for air leaks
C. This indicates the suction pressure is too high and should be decreased
D. This indicates the tube is functioning properly and no action is needed
CORRECT ANSWER: B. This indicates a leak in the system and the nurse
should assess for air leaks
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system, such as from the chest tube insertion site, connections, or the patient's lung.
Intermittent bubbling is normal and reflects air escaping from the pleural space. The
nurse should assess the system for leaks and notify the provider if indicated.
, Question 8: A nurse is caring for a client with a full-thickness burn injury who
is in the acute phase of burn care. Which laboratory value is the most critical
to monitor for early detection of acute kidney injury?
A. Serum sodium
B. Blood urea nitrogen (BUN) and creatinine
C. White blood cell count
D. Serum albumin
CORRECT ANSWER: B. Blood urea nitrogen (BUN) and creatinine
Rationale: BUN and creatinine are the primary indicators of renal function. In the acute
phase of burn injury, hypovolemia and massive fluid shifts can lead to prerenal azotemia
and acute kidney injury. Monitoring these values is critical for early detection and
guiding fluid resuscitation. Sodium, WBC, and albumin are also monitored but are not
the primary indicators for acute kidney injury.
Question 9: A client with type 1 diabetes mellitus is exhibiting signs of diabetic
ketoacidosis (DKA). The nurse expects which of the following arterial blood
gas (ABG) results?
A. pH 7.38, PaCO2 42, HCO3 24
B. pH 7.25, PaCO2 30, HCO3 16
C. pH 7.50, PaCO2 50, HCO3 32
D. pH 7.30, PaCO2 55, HCO3 28
CORRECT ANSWER: B. pH 7.25, PaCO2 30, HCO3 16
Rationale: DKA is characterized by metabolic acidosis with a low pH and low
bicarbonate (HCO3). The low PaCO2 reflects respiratory compensation (Kussmaul
respirations) to blow off carbon dioxide. Option A is normal, C is metabolic alkalosis,
and D is respiratory acidosis with metabolic compensation.
Question 10: A nurse is providing discharge teaching to a client who has had a
myocardial infarction and is prescribed sublingual nitroglycerin. Which
instruction is correct regarding the storage and use of this medication?
A. Store the tablets in a clear glass container for easy access
B. Replace the tablets every 12 months regardless of use
C. Keep the medication in the original dark bottle and replace every 6 months
D. Carry the tablets in a plastic pillbox for convenience
CORRECT ANSWER: C. Keep the medication in the original dark bottle and
replace every 6 months
