Capstone Exit Exam

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Sample questions from Capstone Exit Exam

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a client with crushing chest pain has a 12-lead ECG showing ST elevation in leads II, III, and aVF. Which action should the nurse anticipate first?

   • A.Prepare the client for an exercise stress test
   • B.Obtain a fasting lipid panel before treatment
   • C.Administer prescribed chewable aspirin
   • D.Give sublingual nitroglycerin without checking blood pressure

   Rationale: Chewable aspirin should be given promptly for suspected acute myocardial infarction because it inhibits platelet aggregation. An exercise stress test and a fasting lipid panel must not delay acute treatment. Nitroglycerin may be appropriate, but blood pressure and contraindications must be assessed first.

2. 2.A client's potassium is 6.2 mEq/L (reference range 3.5-5.0 mEq/L), and the ECG shows peaked T waves. Which actions should the nurse anticipate? Select all that apply.

   • A.Hold prescribed potassium supplements
   • B.Place the client on continuous cardiac monitoring
   • C.Prepare to administer IV regular insulin with dextrose as prescribed
   • D.Administer IV calcium gluconate as prescribed
   • E.Encourage the client to eat a potassium-rich snack

   Rationale: Continuous monitoring is indicated because hyperkalemia with ECG changes can cause lethal dysrhythmias. IV calcium gluconate stabilizes the myocardium, while insulin with dextrose shifts potassium into cells; potassium supplements should be held. A potassium-rich snack would worsen the hyperkalemia.

3. 3.A client with chronic obstructive pulmonary disease is receiving oxygen at 2 L/min by nasal cannula. Which finding requires immediate follow-up?

   • A.New confusion and increasing drowsiness
   • B.Chronic productive cough with clear sputum
   • C.Oxygen saturation of 90% while resting
   • D.Barrel-shaped chest with prolonged expiration

   Rationale: New confusion and drowsiness may indicate worsening hypercapnia or hypoxemia and require immediate assessment. A saturation of 90% may be within the prescribed target for some clients with COPD. Chronic cough and barrel chest are common manifestations and are not acute changes by themselves.

4. 4.A client states, "My left calf is swollen and sore after surgery." Which nursing action is most appropriate?

   • A.Massage the calf to relieve discomfort
   • B.Encourage vigorous ankle exercises before assessment
   • C.Apply a sequential compression device to the affected leg
   • D.Measure both calves and notify the health care provider

   Answer and rationale are in the full material.

5. 5.A client with diabetes is awake, diaphoretic, and shaky; capillary blood glucose is 54 mg/dL. Which action should the nurse take first?

   • A.Administer the scheduled long-acting insulin
   • B.Give 15 g of a rapid-acting carbohydrate
   • C.Recheck the glucose in 1 hour
   • D.Provide a high-protein meal only

   Answer and rationale are in the full material.