RNSG 2539 FINAL EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
CORE DOMAINS
Cardiovascular and Hematologic Emergencies
Respiratory and Acid-Base Disorders
Neurological and Sensory Disorders
Endocrine and Metabolic Disorders
Renal and Genitourinary Disorders
Gastrointestinal and Hepatic Disorders
Musculoskeletal and Integumentary Disorders
Perioperative and Emergency Nursing
Pharmacology and Intravenous Therapy
Leadership, Delegation, and Prioritization
INTRODUCTION
The RNSG 2539 Final Examination assesses the nursing student's ability to integrate complex medical-
surgical, critical care, and professional nursing concepts. It evaluates clinical judgment, prioritization,
safety, pharmacology, and evidence-based decision-making across diverse adult health populations. The
examination uses multiple-choice and scenario-based questions to simulate real-world nursing practice.
Emphasis is placed on recognizing complications, interpreting laboratory data, applying the nursing
process, and delegating appropriately. This assessment prepares candidates for safe, effective entry-level
registered nursing practice.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client who develops sudden shortness of breath, pleuritic chest pain, and
tachycardia 3 days after total hip arthroplasty. Which complication should the nurse suspect first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Anxiety attack
🟢 B. Pulmonary embolism
🔴 RATIONALE: Pulmonary embolism is a life-threatening complication after orthopedic surgery due
to venous stasis and hypercoagulability. Sudden dyspnea, pleuritic chest pain, and tachycardia are
classic signs. Immediate provider notification and anticoagulation are priorities.
2. A client with acute heart failure is prescribed furosemide IV. Which assessment finding indicates a
therapeutic response?
A. Increased urine output and decreased dyspnea
B. Decreased urine output and increased JVD
C. Bradycardia and hypertension
D. Weight gain and crackles
🟢 A. Increased urine output and decreased dyspnea
🔴 RATIONALE: Loop diuretics such as furosemide promote diuresis, reducing preload and pulmonary
congestion. Improved urine output and reduced dyspnea indicate effective therapy. Weight gain and
crackles indicate worsening fluid retention.
,3. A nurse is interpreting arterial blood gases: pH 7.28, PaCO2 55 mm Hg, HCO3 24 mEq/L. Which
acid-base imbalance is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
🟢 B. Respiratory acidosis
🔴 RATIONALE: A low pH with an elevated PaCO2 indicates respiratory acidosis. The kidneys may
compensate over time by retaining bicarbonate, but the primary problem is alveolar hypoventilation.
Causes include COPD, sedation, and airway obstruction.
4. A client with diabetic ketoacidosis has a blood glucose of 520 mg/dL. Which finding should the
nurse expect?
A. Kussmaul respirations
B. Bradycardia
C. Hypertension
D. Constipation
🟢 A. Kussmaul respirations
🔴 RATIONALE: Diabetic ketoacidosis causes metabolic acidosis, leading to deep, rapid Kussmaul
respirations as the body attempts to blow off carbon dioxide. Other expected findings include fruity
breath, polyuria, and dehydration.
5. A nurse is caring for a client receiving heparin infusion. Which laboratory value should be
monitored to evaluate therapeutic effect?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
🟢 B. aPTT
🔴 RATIONALE: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT). The therapeutic range is usually 1.5 to 2.5 times the control value. INR is
used for warfarin monitoring.
6. A client is admitted with acute pancreatitis. Which intervention should the nurse include in the
plan of care?
A. Administer oral feedings high in fat
B. Maintain NPO status and provide IV fluids
C. Place the client in high Fowler's position only
D. Encourage ambulation immediately
🟢 B. Maintain NPO status and provide IV fluids
🔴 RATIONALE: Acute pancreatitis requires bowel rest to decrease pancreatic stimulation. IV fluids and
pain management are essential. Oral feedings, especially high-fat meals, can worsen pancreatic
inflammation.
, 7. A nurse is assessing a client with a new colostomy. Which stoma appearance requires immediate
provider notification?
A. Pink, moist stoma
B. Dusky, dark red stoma
C. Slightly edematous stoma
D. Small amount of serosanguineous drainage
🟢 B. Dusky, dark red stoma
🔴 RATIONALE: A healthy stoma is pink to red and moist. A dusky, dark red, or black stoma indicates
ischemia or necrosis and requires immediate evaluation. Edema and small serosanguineous drainage
are expected postoperatively.
8. A nurse is preparing to administer digoxin. Which finding should cause the nurse to withhold the
medication?
A. Heart rate 58/min
B. Potassium 4.2 mEq/L
C. Digoxin level 1.2 ng/mL
D. Blood pressure 118/72 mm Hg
🟢 A. Heart rate 58/min
🔴 RATIONALE: Digoxin slows the heart rate. The nurse should withhold digoxin if the adult apical
pulse is below 60 beats/min and notify the provider. Hypokalemia also increases digoxin toxicity risk.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which action should the
nurse take first?
A. Administer a potassium supplement
B. Prepare for emergency dialysis or administer prescribed calcium gluconate
C. Encourage a diet high in potassium
D. Document the finding and reassess in 4 hours
🟢 B. Prepare for emergency dialysis or administer prescribed calcium gluconate
🔴 RATIONALE: Hyperkalemia above 6.5 mEq/L is life-threatening due to cardiac dysrhythmias.
Calcium gluconate stabilizes the myocardium, and dialysis removes potassium. Potassium supplements
and high-potassium foods are contraindicated.
10. A nurse is teaching a client about warfarin. Which statement indicates understanding?
A. "I will increase my intake of leafy green vegetables."
B. "I will keep my vitamin K intake consistent."
C. "I will take aspirin for headaches without asking."
D. "I will stop the medication when my INR is normal."
🟢 B. "I will keep my vitamin K intake consistent."
🔴 RATIONALE: Warfarin is a vitamin K antagonist. Consistent vitamin K intake helps maintain a stable
INR. Clients should avoid aspirin unless prescribed and never stop warfarin abruptly without provider
guidance.
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
CORE DOMAINS
Cardiovascular and Hematologic Emergencies
Respiratory and Acid-Base Disorders
Neurological and Sensory Disorders
Endocrine and Metabolic Disorders
Renal and Genitourinary Disorders
Gastrointestinal and Hepatic Disorders
Musculoskeletal and Integumentary Disorders
Perioperative and Emergency Nursing
Pharmacology and Intravenous Therapy
Leadership, Delegation, and Prioritization
INTRODUCTION
The RNSG 2539 Final Examination assesses the nursing student's ability to integrate complex medical-
surgical, critical care, and professional nursing concepts. It evaluates clinical judgment, prioritization,
safety, pharmacology, and evidence-based decision-making across diverse adult health populations. The
examination uses multiple-choice and scenario-based questions to simulate real-world nursing practice.
Emphasis is placed on recognizing complications, interpreting laboratory data, applying the nursing
process, and delegating appropriately. This assessment prepares candidates for safe, effective entry-level
registered nursing practice.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client who develops sudden shortness of breath, pleuritic chest pain, and
tachycardia 3 days after total hip arthroplasty. Which complication should the nurse suspect first?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Anxiety attack
🟢 B. Pulmonary embolism
🔴 RATIONALE: Pulmonary embolism is a life-threatening complication after orthopedic surgery due
to venous stasis and hypercoagulability. Sudden dyspnea, pleuritic chest pain, and tachycardia are
classic signs. Immediate provider notification and anticoagulation are priorities.
2. A client with acute heart failure is prescribed furosemide IV. Which assessment finding indicates a
therapeutic response?
A. Increased urine output and decreased dyspnea
B. Decreased urine output and increased JVD
C. Bradycardia and hypertension
D. Weight gain and crackles
🟢 A. Increased urine output and decreased dyspnea
🔴 RATIONALE: Loop diuretics such as furosemide promote diuresis, reducing preload and pulmonary
congestion. Improved urine output and reduced dyspnea indicate effective therapy. Weight gain and
crackles indicate worsening fluid retention.
,3. A nurse is interpreting arterial blood gases: pH 7.28, PaCO2 55 mm Hg, HCO3 24 mEq/L. Which
acid-base imbalance is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
🟢 B. Respiratory acidosis
🔴 RATIONALE: A low pH with an elevated PaCO2 indicates respiratory acidosis. The kidneys may
compensate over time by retaining bicarbonate, but the primary problem is alveolar hypoventilation.
Causes include COPD, sedation, and airway obstruction.
4. A client with diabetic ketoacidosis has a blood glucose of 520 mg/dL. Which finding should the
nurse expect?
A. Kussmaul respirations
B. Bradycardia
C. Hypertension
D. Constipation
🟢 A. Kussmaul respirations
🔴 RATIONALE: Diabetic ketoacidosis causes metabolic acidosis, leading to deep, rapid Kussmaul
respirations as the body attempts to blow off carbon dioxide. Other expected findings include fruity
breath, polyuria, and dehydration.
5. A nurse is caring for a client receiving heparin infusion. Which laboratory value should be
monitored to evaluate therapeutic effect?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
🟢 B. aPTT
🔴 RATIONALE: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT). The therapeutic range is usually 1.5 to 2.5 times the control value. INR is
used for warfarin monitoring.
6. A client is admitted with acute pancreatitis. Which intervention should the nurse include in the
plan of care?
A. Administer oral feedings high in fat
B. Maintain NPO status and provide IV fluids
C. Place the client in high Fowler's position only
D. Encourage ambulation immediately
🟢 B. Maintain NPO status and provide IV fluids
🔴 RATIONALE: Acute pancreatitis requires bowel rest to decrease pancreatic stimulation. IV fluids and
pain management are essential. Oral feedings, especially high-fat meals, can worsen pancreatic
inflammation.
, 7. A nurse is assessing a client with a new colostomy. Which stoma appearance requires immediate
provider notification?
A. Pink, moist stoma
B. Dusky, dark red stoma
C. Slightly edematous stoma
D. Small amount of serosanguineous drainage
🟢 B. Dusky, dark red stoma
🔴 RATIONALE: A healthy stoma is pink to red and moist. A dusky, dark red, or black stoma indicates
ischemia or necrosis and requires immediate evaluation. Edema and small serosanguineous drainage
are expected postoperatively.
8. A nurse is preparing to administer digoxin. Which finding should cause the nurse to withhold the
medication?
A. Heart rate 58/min
B. Potassium 4.2 mEq/L
C. Digoxin level 1.2 ng/mL
D. Blood pressure 118/72 mm Hg
🟢 A. Heart rate 58/min
🔴 RATIONALE: Digoxin slows the heart rate. The nurse should withhold digoxin if the adult apical
pulse is below 60 beats/min and notify the provider. Hypokalemia also increases digoxin toxicity risk.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which action should the
nurse take first?
A. Administer a potassium supplement
B. Prepare for emergency dialysis or administer prescribed calcium gluconate
C. Encourage a diet high in potassium
D. Document the finding and reassess in 4 hours
🟢 B. Prepare for emergency dialysis or administer prescribed calcium gluconate
🔴 RATIONALE: Hyperkalemia above 6.5 mEq/L is life-threatening due to cardiac dysrhythmias.
Calcium gluconate stabilizes the myocardium, and dialysis removes potassium. Potassium supplements
and high-potassium foods are contraindicated.
10. A nurse is teaching a client about warfarin. Which statement indicates understanding?
A. "I will increase my intake of leafy green vegetables."
B. "I will keep my vitamin K intake consistent."
C. "I will take aspirin for headaches without asking."
D. "I will stop the medication when my INR is normal."
🟢 B. "I will keep my vitamin K intake consistent."
🔴 RATIONALE: Warfarin is a vitamin K antagonist. Consistent vitamin K intake helps maintain a stable
INR. Clients should avoid aspirin unless prescribed and never stop warfarin abruptly without provider
guidance.
