NUR 223 CAPSTONE PRACTICUM EXAM GUIDE UPDATED
EDITION 2026 Q&A
A nurse is caring for a patient with septic shock who is receiving
norepinephrine. The patient's blood pressure drops from 110/70 mmHg
to 82/48 mmHg despite fluid resuscitation. What is the nurse's priority
action?
A. Decrease the norepinephrine infusion rate
B. Administer a 500 mL bolus of normal saline
C. Notify the provider immediately and prepare for additional
vasopressors
D. Reassess blood pressure in 15 minutes
Correct Answer: C
Explanation: In septic shock with persistent hypotension despite fluids,
immediate provider notification and preparation for additional
vasopressors is critical. Delaying (D) or decreasing vasopressors (A)
would worsen perfusion. While additional fluids (B) may be needed, the
priority is rapid escalation of care given the severity of hypotension.
A postoperative patient on day 2 after abdominal surgery develops
sudden shortness of breath, chest pain, and oxygen saturation of 86%
on room air. Which assessment finding would most strongly support a
diagnosis of pulmonary embolism?
A. Bilateral crackles on lung auscultation
B. Unilateral leg swelling and calf tenderness
C. Fever of 38.5°C (101.3°F)
D. Purulent sputum production
Correct Answer: B
,Explanation: Unilateral leg swelling and calf tenderness suggest deep
vein thrombosis (DVT), the most common source of pulmonary
embolism. Bilateral crackles suggest heart failure/pulmonary edema
(A), fever suggests infection (C), and purulent sputum suggests
pneumonia (D).
A nurse is administering IV vancomycin and notes the patient develops
flushing, tachycardia, and hypotension during the infusion. What is the
most appropriate immediate action?
A. Stop the infusion immediately and notify the provider
B. Slow the infusion rate and administer diphenhydramine
C. Continue the infusion at the same rate and monitor closely
D. Administer epinephrine intramuscularly
Correct Answer: A
Explanation: These symptoms indicate red man syndrome, ahistamine-
mediated reaction to rapid vancomycin infusion. The infusion must be
stopped immediately. Slowing (B) is appropriate after stopping but not
as initial action. Continuing (C) would worsen the reaction. Epinephrine
(D) is for anaphylaxis, not red man syndrome.
A patient with type 1 diabetes presents with blood glucose of 420
mg/dL, pH 7.22, bicarbonate 12 mEq/L, and positive serum ketones.
Which intervention should the nurse prioritize?
A. Administer subcutaneous glargine insulin
B. Start IV regular insulin infusion and IV fluids
C. Give oral glucose tablets
D. Administer IV dextrose 50%
,Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). IV regular
insulin infusion and IV fluids are the cornerstone of DKA treatment.
Subcutaneous insulin (A) is too slow. Glucose (C, D) would worsen
hyperglycemia.
During a code blue, the nurse notes the patient is in ventricular
fibrillation. After delivering the first shock, what is the nurse's next
priority action?
A. Check for a pulse
B. Resume chest compressions immediately
C. Administer epinephrine 1 mg IV
D. Intubate the patient
Correct Answer: B
Explanation: According to ACLS guidelines, chest compressions should
resume immediately after defibrillation without checking for a pulse.
Pulse check occurs after 2 minutes of CPR. Epinephrine (C) is given after
the second shock. Intubation (D) is not the immediate priority.
A pregnant patient at 34 weeks gestation presents with severe
headache, visual disturbances, and blood pressure of 168/110 mmHg.
Which laboratory value is most critical to assess for preeclampsia with
severe features?
A. Hemoglobin level
B. Serum creatinine and liver enzymes
C. Thyroid-stimulating hormone
D. Blood glucose
, Correct Answer: B
Explanation: Preeclampsia with severe features can cause renal and
hepatic dysfunction. Elevated creatinine and liver enzymes indicate end-
organ damage. Hemoglobin (A) assesses anemia, TSH (C) assesses
thyroid function, and glucose (D) assesses diabetes.
A nurse is caring for a patient with a central venous catheter. Which
action is most effective in preventing catheter-related bloodstream
infections?
A. Changing the dressing every 7 days
B. Using chlorhexidine for skin antisepsis during dressing changes
C. Flushing the line with normal saline daily
D. Keeping the infusion pump at bedside
Correct Answer: B
Explanation: Chlorhexidine is the gold standard for skin antisepsis before
central line access and dressing changes, significantly reducing infection
rates. Dressings should be changed every 7 days or when soiled (A is
incomplete), flushing (C) maintains patency but doesn't prevent
infection, and pump location (D) is irrelevant.
A patient with chronic kidney disease (CKD) stage 4 has a serum
potassium of 6.2 mEq/L. Which medication should the nurse anticipate
administering first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin 10 units regular IV with dextrose
C. Furosemide 40 mg IV
D. Calcium gluconate 10% 10 mL IV
EDITION 2026 Q&A
A nurse is caring for a patient with septic shock who is receiving
norepinephrine. The patient's blood pressure drops from 110/70 mmHg
to 82/48 mmHg despite fluid resuscitation. What is the nurse's priority
action?
A. Decrease the norepinephrine infusion rate
B. Administer a 500 mL bolus of normal saline
C. Notify the provider immediately and prepare for additional
vasopressors
D. Reassess blood pressure in 15 minutes
Correct Answer: C
Explanation: In septic shock with persistent hypotension despite fluids,
immediate provider notification and preparation for additional
vasopressors is critical. Delaying (D) or decreasing vasopressors (A)
would worsen perfusion. While additional fluids (B) may be needed, the
priority is rapid escalation of care given the severity of hypotension.
A postoperative patient on day 2 after abdominal surgery develops
sudden shortness of breath, chest pain, and oxygen saturation of 86%
on room air. Which assessment finding would most strongly support a
diagnosis of pulmonary embolism?
A. Bilateral crackles on lung auscultation
B. Unilateral leg swelling and calf tenderness
C. Fever of 38.5°C (101.3°F)
D. Purulent sputum production
Correct Answer: B
,Explanation: Unilateral leg swelling and calf tenderness suggest deep
vein thrombosis (DVT), the most common source of pulmonary
embolism. Bilateral crackles suggest heart failure/pulmonary edema
(A), fever suggests infection (C), and purulent sputum suggests
pneumonia (D).
A nurse is administering IV vancomycin and notes the patient develops
flushing, tachycardia, and hypotension during the infusion. What is the
most appropriate immediate action?
A. Stop the infusion immediately and notify the provider
B. Slow the infusion rate and administer diphenhydramine
C. Continue the infusion at the same rate and monitor closely
D. Administer epinephrine intramuscularly
Correct Answer: A
Explanation: These symptoms indicate red man syndrome, ahistamine-
mediated reaction to rapid vancomycin infusion. The infusion must be
stopped immediately. Slowing (B) is appropriate after stopping but not
as initial action. Continuing (C) would worsen the reaction. Epinephrine
(D) is for anaphylaxis, not red man syndrome.
A patient with type 1 diabetes presents with blood glucose of 420
mg/dL, pH 7.22, bicarbonate 12 mEq/L, and positive serum ketones.
Which intervention should the nurse prioritize?
A. Administer subcutaneous glargine insulin
B. Start IV regular insulin infusion and IV fluids
C. Give oral glucose tablets
D. Administer IV dextrose 50%
,Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). IV regular
insulin infusion and IV fluids are the cornerstone of DKA treatment.
Subcutaneous insulin (A) is too slow. Glucose (C, D) would worsen
hyperglycemia.
During a code blue, the nurse notes the patient is in ventricular
fibrillation. After delivering the first shock, what is the nurse's next
priority action?
A. Check for a pulse
B. Resume chest compressions immediately
C. Administer epinephrine 1 mg IV
D. Intubate the patient
Correct Answer: B
Explanation: According to ACLS guidelines, chest compressions should
resume immediately after defibrillation without checking for a pulse.
Pulse check occurs after 2 minutes of CPR. Epinephrine (C) is given after
the second shock. Intubation (D) is not the immediate priority.
A pregnant patient at 34 weeks gestation presents with severe
headache, visual disturbances, and blood pressure of 168/110 mmHg.
Which laboratory value is most critical to assess for preeclampsia with
severe features?
A. Hemoglobin level
B. Serum creatinine and liver enzymes
C. Thyroid-stimulating hormone
D. Blood glucose
, Correct Answer: B
Explanation: Preeclampsia with severe features can cause renal and
hepatic dysfunction. Elevated creatinine and liver enzymes indicate end-
organ damage. Hemoglobin (A) assesses anemia, TSH (C) assesses
thyroid function, and glucose (D) assesses diabetes.
A nurse is caring for a patient with a central venous catheter. Which
action is most effective in preventing catheter-related bloodstream
infections?
A. Changing the dressing every 7 days
B. Using chlorhexidine for skin antisepsis during dressing changes
C. Flushing the line with normal saline daily
D. Keeping the infusion pump at bedside
Correct Answer: B
Explanation: Chlorhexidine is the gold standard for skin antisepsis before
central line access and dressing changes, significantly reducing infection
rates. Dressings should be changed every 7 days or when soiled (A is
incomplete), flushing (C) maintains patency but doesn't prevent
infection, and pump location (D) is irrelevant.
A patient with chronic kidney disease (CKD) stage 4 has a serum
potassium of 6.2 mEq/L. Which medication should the nurse anticipate
administering first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin 10 units regular IV with dextrose
C. Furosemide 40 mg IV
D. Calcium gluconate 10% 10 mL IV
