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,
Evidence-Based Practice, Clinical Decision-Making, Leadership and
Management, Patient Safety, Quality Improvement, Care Coordination,
Interprofessional Collaboration, NCLEX-RN Readiness, Detailed Rationales
and Complete Revision Material
Question 1: A nurse is precepting a new graduate on the medical-surgical unit.
The preceptor observes the new graduate preparing to administer a
subcutaneous injection of heparin. Which action by the new graduate would
indicate a need for further teaching?
A. Administering the injection into the abdomen at least 2 inches away from the
umbilicus.
B. Pinching the skin fold throughout the entire injection process.
C. Aspirating for blood return before slowly injecting the medication.
D. Using a 25-gauge, 5/8-inch needle for the injection.
CORRECT ANSWER: C. Aspirating for blood return before slowly injecting the
medication.
Rationale: Aspiration is not recommended for subcutaneous heparin injections as it can
cause tissue trauma, bleeding, and bruising. The other options (A, B, D) are correct
techniques for subcutaneous heparin administration. The abdomen is the preferred site,
a skin fold should be pinched to inject into the subcutaneous tissue, and a small gauge
needle is appropriate.
Question 2: A patient with end-stage chronic obstructive pulmonary disease
(COPD) is receiving palliative care. The patient's family expresses concern that
the patient's respiratory rate is decreasing. What is the nurse's best response?
A. "We should immediately increase the patient's oxygen flow rate."
B. "This is a sign that the patient is becoming more comfortable and is part of the
natural dying process."
C. "I will call the doctor to see if we can start the patient on a BiPAP machine."
D. "The patient needs to be encouraged to take deeper breaths."
CORRECT ANSWER: B. "This is a sign that the patient is becoming more
comfortable and is part of the natural dying process."
Rationale: In the terminal phase of a disease, a decreasing respiratory rate is a normal
physiological change as the body's systems begin to shut down. It is often accompanied
by a decreased need for oxygen and increased comfort. Increasing oxygen, using BiPAP,
or encouraging deep breaths would be aggressive interventions not aligned with the
goals of palliative care.
,Question 3: A patient is being discharged with a new prescription for
metoprolol succinate (Toprol-XL). Which statement by the patient indicates an
accurate understanding of the medication teaching?
A. "I can stop taking this if my blood pressure feels normal."
B. "I will take my pulse every morning before taking the medication and hold it if it is
below 60."
C. "I should take this medication with a high-fat meal to increase absorption."
D. "I can crush the extended-release tablet if I have trouble swallowing it."
CORRECT ANSWER: B. "I will take my pulse every morning before taking the
medication and hold it if it is below 60."
Rationale: Metoprolol is a beta-blocker that decreases heart rate and contractility.
Patients must monitor their pulse daily and hold the medication and contact their
provider for bradycardia (generally a heart rate <60 bpm). The medication should not be
stopped abruptly, should not be taken with high-fat meals (to avoid erratic absorption),
and should not be crushed if it is an extended-release formulation.
Question 4: A nurse is caring for a patient with a central venous catheter
(CVC). During a dressing change, the nurse notes purulent drainage at the
insertion site. The patient's temperature is 38.5°C (101.3°F). What is the
nurse's priority action?
A. Obtain a culture of the drainage and the catheter tip.
B. Administer prescribed PRN antibiotics.
C. Remove the central line immediately.
D. Apply a new sterile dressing with antimicrobial ointment.
CORRECT ANSWER: C. Remove the central line immediately.
Rationale: Signs of a central line infection, such as purulent drainage and fever, indicate
a catheter-related bloodstream infection. The priority is to remove the source of
infection. The catheter tip should then be sent for culture. Antibiotics will be ordered
after cultures are obtained, not before.
Question 5: A nurse is providing discharge education to a patient post-
myocardial infarction (MI). The patient asks, "What is the purpose of taking
aspirin every day?" Which response is most accurate?
A. "It helps to decrease your blood pressure."
B. "It prevents further clot formation by making your platelets less sticky."
C. "It reduces the cholesterol levels in your blood."
D. "It helps to dilate your coronary arteries."
CORRECT ANSWER: B. "It prevents further clot formation by making your
platelets less sticky."
Rationale: Daily low-dose aspirin is a standard antiplatelet therapy post-MI. It works by
inhibiting platelet aggregation, thereby reducing the risk of thrombus formation and
,future cardiovascular events. It does not directly affect blood pressure, cholesterol, or
cause vasodilation.
Question 6: A patient with a history of severe liver cirrhosis is exhibiting
confusion, slurred speech, and asterixis. Which of the following dietary
modifications is the nurse most likely to expect in the patient's plan of care?
A. A high-protein, high-calorie diet.
B. A low-sodium diet with fluid restriction.
C. A low-fat, low-cholesterol diet.
D. A low-protein diet with a focus on vegetable and dairy proteins.
CORRECT ANSWER: D. A low-protein diet with a focus on vegetable and dairy
proteins.
Rationale: The patient is showing signs of hepatic encephalopathy due to the liver's
inability to clear ammonia, a byproduct of protein metabolism. A low-protein diet, often
with a focus on vegetable and dairy proteins, is indicated to minimize the production of
ammonia. High-protein diets would exacerbate the condition.
Question 7: During a home health visit, a nurse is assessing an elderly patient
for fall risk. Which of the following findings would be the most significant
indicator of a high fall risk?
A. The patient reports using a walker occasionally.
B. The patient has a history of two falls in the last six months.
C. The patient has uncorrected vision problems and uses throw rugs.
D. The patient's blood pressure is 145/85 mmHg.
CORRECT ANSWER: C. The patient has uncorrected vision problems and uses
throw rugs.
Rationale: While all options can contribute to fall risk, the combination of uncorrected
vision problems (leading to misjudgment of depth and obstacles) and environmental
hazards (throw rugs) creates a highly significant immediate risk for falls. This is a
modifiable factor and a direct cause of falls.
Question 8: A nurse is preparing a patient for a colonoscopy. The patient is on
warfarin for atrial fibrillation. Which action is most important for the nurse to
take?
A. Administer the prescribed bowel prep as ordered.
B. Instruct the patient to take their morning dose of warfarin with a sip of water.
C. Notify the provider to determine if the warfarin should be held.
D. Ensure the patient has nothing by mouth (NPO) for 8 hours.
CORRECT ANSWER: C. Notify the provider to determine if the warfarin should
be held.
, Rationale: Colonoscopy often involves biopsies or polypectomies, which have a risk of
bleeding. Patients on anticoagulants like warfarin are at increased risk for hemorrhage.
The nurse's priority is to collaborate with the provider to manage the warfarin, which
may need to be held or bridged to minimize the risk of bleeding during the procedure.
Question 9: A nurse is providing post-operative care to a patient following a
total hip replacement. Which intervention is essential to prevent dislocation of
the new hip joint?
A. Keep the patient's legs crossed while in bed.
B. Encourage the patient to bend at the waist to pick up objects.
C. Maintain the patient in a position of adduction and internal rotation.
D. Place a pillow between the patient's legs when turning.
CORRECT ANSWER: D. Place a pillow between the patient's legs when turning.
Rationale: After a total hip replacement, the hip is at risk for dislocation. A pillow
between the legs maintains the hip in a position of abduction and neutral rotation, which
is the safest position. The patient should avoid crossing legs, excessive bending at the
waist, and adduction/internal rotation.
Question 10: A nurse is administering IV potassium chloride (KCl) to a patient
with hypokalemia. Which assessment finding requires the most immediate
action by the nurse?
A. Patient's serum potassium level is now 3.8 mEq/L.
B. The patient reports a burning sensation at the IV site.
C. The patient's urine output is 30 mL/hr.
D. The patient's heart rate is 88 bpm and regular.
CORRECT ANSWER: B. The patient reports a burning sensation at the IV site.
Rationale: A burning sensation at the IV site is a classic sign of phlebitis or tissue
irritation, which can indicate that the potassium is infiltrating or causing venous
irritation. Potassium is a vesicant and can cause severe tissue necrosis if it extravasates.
The IV should be stopped immediately and the site assessed. The other findings are
either within normal limits or acceptable.
Question 11: A patient with active tuberculosis (TB) is placed on a 4-drug
regimen. The nurse's teaching plan should emphasize that the patient will be
considered non-infectious after which criteria are met?
A. Three consecutive negative sputum smears.
B. Two weeks of consistent, effective pharmacotherapy.
C. A negative chest x-ray.
D. The completion of the full 6-month course of therapy.
CORRECT ANSWER: B. Two weeks of consistent, effective pharmacotherapy.
190+ Questions and Answers | NURS450 Clinical Capstone
Comprehensive Study Guide, Practice Exam, Exam Prep Test Bank,
Evidence-Based Practice, Clinical Decision-Making, Leadership and
Management, Patient Safety, Quality Improvement, Care Coordination,
Interprofessional Collaboration, NCLEX-RN Readiness, Detailed Rationales
and Complete Revision Material
Question 1: A nurse is precepting a new graduate on the medical-surgical unit.
The preceptor observes the new graduate preparing to administer a
subcutaneous injection of heparin. Which action by the new graduate would
indicate a need for further teaching?
A. Administering the injection into the abdomen at least 2 inches away from the
umbilicus.
B. Pinching the skin fold throughout the entire injection process.
C. Aspirating for blood return before slowly injecting the medication.
D. Using a 25-gauge, 5/8-inch needle for the injection.
CORRECT ANSWER: C. Aspirating for blood return before slowly injecting the
medication.
Rationale: Aspiration is not recommended for subcutaneous heparin injections as it can
cause tissue trauma, bleeding, and bruising. The other options (A, B, D) are correct
techniques for subcutaneous heparin administration. The abdomen is the preferred site,
a skin fold should be pinched to inject into the subcutaneous tissue, and a small gauge
needle is appropriate.
Question 2: A patient with end-stage chronic obstructive pulmonary disease
(COPD) is receiving palliative care. The patient's family expresses concern that
the patient's respiratory rate is decreasing. What is the nurse's best response?
A. "We should immediately increase the patient's oxygen flow rate."
B. "This is a sign that the patient is becoming more comfortable and is part of the
natural dying process."
C. "I will call the doctor to see if we can start the patient on a BiPAP machine."
D. "The patient needs to be encouraged to take deeper breaths."
CORRECT ANSWER: B. "This is a sign that the patient is becoming more
comfortable and is part of the natural dying process."
Rationale: In the terminal phase of a disease, a decreasing respiratory rate is a normal
physiological change as the body's systems begin to shut down. It is often accompanied
by a decreased need for oxygen and increased comfort. Increasing oxygen, using BiPAP,
or encouraging deep breaths would be aggressive interventions not aligned with the
goals of palliative care.
,Question 3: A patient is being discharged with a new prescription for
metoprolol succinate (Toprol-XL). Which statement by the patient indicates an
accurate understanding of the medication teaching?
A. "I can stop taking this if my blood pressure feels normal."
B. "I will take my pulse every morning before taking the medication and hold it if it is
below 60."
C. "I should take this medication with a high-fat meal to increase absorption."
D. "I can crush the extended-release tablet if I have trouble swallowing it."
CORRECT ANSWER: B. "I will take my pulse every morning before taking the
medication and hold it if it is below 60."
Rationale: Metoprolol is a beta-blocker that decreases heart rate and contractility.
Patients must monitor their pulse daily and hold the medication and contact their
provider for bradycardia (generally a heart rate <60 bpm). The medication should not be
stopped abruptly, should not be taken with high-fat meals (to avoid erratic absorption),
and should not be crushed if it is an extended-release formulation.
Question 4: A nurse is caring for a patient with a central venous catheter
(CVC). During a dressing change, the nurse notes purulent drainage at the
insertion site. The patient's temperature is 38.5°C (101.3°F). What is the
nurse's priority action?
A. Obtain a culture of the drainage and the catheter tip.
B. Administer prescribed PRN antibiotics.
C. Remove the central line immediately.
D. Apply a new sterile dressing with antimicrobial ointment.
CORRECT ANSWER: C. Remove the central line immediately.
Rationale: Signs of a central line infection, such as purulent drainage and fever, indicate
a catheter-related bloodstream infection. The priority is to remove the source of
infection. The catheter tip should then be sent for culture. Antibiotics will be ordered
after cultures are obtained, not before.
Question 5: A nurse is providing discharge education to a patient post-
myocardial infarction (MI). The patient asks, "What is the purpose of taking
aspirin every day?" Which response is most accurate?
A. "It helps to decrease your blood pressure."
B. "It prevents further clot formation by making your platelets less sticky."
C. "It reduces the cholesterol levels in your blood."
D. "It helps to dilate your coronary arteries."
CORRECT ANSWER: B. "It prevents further clot formation by making your
platelets less sticky."
Rationale: Daily low-dose aspirin is a standard antiplatelet therapy post-MI. It works by
inhibiting platelet aggregation, thereby reducing the risk of thrombus formation and
,future cardiovascular events. It does not directly affect blood pressure, cholesterol, or
cause vasodilation.
Question 6: A patient with a history of severe liver cirrhosis is exhibiting
confusion, slurred speech, and asterixis. Which of the following dietary
modifications is the nurse most likely to expect in the patient's plan of care?
A. A high-protein, high-calorie diet.
B. A low-sodium diet with fluid restriction.
C. A low-fat, low-cholesterol diet.
D. A low-protein diet with a focus on vegetable and dairy proteins.
CORRECT ANSWER: D. A low-protein diet with a focus on vegetable and dairy
proteins.
Rationale: The patient is showing signs of hepatic encephalopathy due to the liver's
inability to clear ammonia, a byproduct of protein metabolism. A low-protein diet, often
with a focus on vegetable and dairy proteins, is indicated to minimize the production of
ammonia. High-protein diets would exacerbate the condition.
Question 7: During a home health visit, a nurse is assessing an elderly patient
for fall risk. Which of the following findings would be the most significant
indicator of a high fall risk?
A. The patient reports using a walker occasionally.
B. The patient has a history of two falls in the last six months.
C. The patient has uncorrected vision problems and uses throw rugs.
D. The patient's blood pressure is 145/85 mmHg.
CORRECT ANSWER: C. The patient has uncorrected vision problems and uses
throw rugs.
Rationale: While all options can contribute to fall risk, the combination of uncorrected
vision problems (leading to misjudgment of depth and obstacles) and environmental
hazards (throw rugs) creates a highly significant immediate risk for falls. This is a
modifiable factor and a direct cause of falls.
Question 8: A nurse is preparing a patient for a colonoscopy. The patient is on
warfarin for atrial fibrillation. Which action is most important for the nurse to
take?
A. Administer the prescribed bowel prep as ordered.
B. Instruct the patient to take their morning dose of warfarin with a sip of water.
C. Notify the provider to determine if the warfarin should be held.
D. Ensure the patient has nothing by mouth (NPO) for 8 hours.
CORRECT ANSWER: C. Notify the provider to determine if the warfarin should
be held.
, Rationale: Colonoscopy often involves biopsies or polypectomies, which have a risk of
bleeding. Patients on anticoagulants like warfarin are at increased risk for hemorrhage.
The nurse's priority is to collaborate with the provider to manage the warfarin, which
may need to be held or bridged to minimize the risk of bleeding during the procedure.
Question 9: A nurse is providing post-operative care to a patient following a
total hip replacement. Which intervention is essential to prevent dislocation of
the new hip joint?
A. Keep the patient's legs crossed while in bed.
B. Encourage the patient to bend at the waist to pick up objects.
C. Maintain the patient in a position of adduction and internal rotation.
D. Place a pillow between the patient's legs when turning.
CORRECT ANSWER: D. Place a pillow between the patient's legs when turning.
Rationale: After a total hip replacement, the hip is at risk for dislocation. A pillow
between the legs maintains the hip in a position of abduction and neutral rotation, which
is the safest position. The patient should avoid crossing legs, excessive bending at the
waist, and adduction/internal rotation.
Question 10: A nurse is administering IV potassium chloride (KCl) to a patient
with hypokalemia. Which assessment finding requires the most immediate
action by the nurse?
A. Patient's serum potassium level is now 3.8 mEq/L.
B. The patient reports a burning sensation at the IV site.
C. The patient's urine output is 30 mL/hr.
D. The patient's heart rate is 88 bpm and regular.
CORRECT ANSWER: B. The patient reports a burning sensation at the IV site.
Rationale: A burning sensation at the IV site is a classic sign of phlebitis or tissue
irritation, which can indicate that the potassium is infiltrating or causing venous
irritation. Potassium is a vesicant and can cause severe tissue necrosis if it extravasates.
The IV should be stopped immediately and the site assessed. The other findings are
either within normal limits or acceptable.
Question 11: A patient with active tuberculosis (TB) is placed on a 4-drug
regimen. The nurse's teaching plan should emphasize that the patient will be
considered non-infectious after which criteria are met?
A. Three consecutive negative sputum smears.
B. Two weeks of consistent, effective pharmacotherapy.
C. A negative chest x-ray.
D. The completion of the full 6-month course of therapy.
CORRECT ANSWER: B. Two weeks of consistent, effective pharmacotherapy.
