Capstone Post-Assessment

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Sample questions from Capstone Post-Assessment

This material has 60 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client arrives in the emergency department with fever, confusion, and dysuria. Temperature is 39.2 C, heart rate is 124/min, blood pressure is 82/46 mm Hg, respiratory rate is 28/min, and lactate is 4.6 mmol/L. Blood cultures have been collected and antibiotics prescribed. Which intervention should the nurse initiate first?

   • A.Administer the prescribed IV isotonic crystalloid bolus.
   • B.Administer prescribed acetaminophen.
   • C.Obtain a clean-catch urine specimen.
   • D.Provide teaching about preventing urinary tract infections.

   Rationale: Hypotension and elevated lactate indicate impaired perfusion requiring immediate fluid resuscitation while other sepsis treatments proceed. Acetaminophen may improve comfort but does not correct shock. A urine specimen and prevention teaching must not delay stabilization or antibiotics. The priority is restoring circulation when infection is accompanied by shock.

2. 2.A 57-year-old client in the emergency department reports crushing chest pain that began 40 minutes ago. The ECG shows ST elevation in leads II, III, and aVF; blood pressure is 88/56 mm Hg, heart rate is 52/min, and oxygen saturation is 96% on room air. Which prescription should the nurse question?

   • A.Chew aspirin 324 mg.
   • B.Activate the cardiac catheterization team.
   • C.Give sublingual nitroglycerin 0.4 mg.
   • D.Establish a second peripheral IV line.

   Rationale: Nitroglycerin can worsen this client's existing hypotension, particularly if right ventricular involvement makes cardiac output preload dependent. Aspirin and rapid reperfusion are appropriate for an acute ST-elevation myocardial infarction. A second IV provides access for urgent treatment and is not contraindicated. Assess blood pressure and contraindications before administering nitrates.

3. 3.A 73-year-old client arrives at a stroke center 70 minutes after sudden right arm weakness and difficulty speaking. Blood pressure is 174/92 mm Hg, glucose is 108 mg/dL, and the client takes no anticoagulants. Which action has the highest priority before determining eligibility for IV thrombolytic therapy?

   • A.Perform a bedside swallow screen.
   • B.Obtain an urgent noncontrast head CT.
   • C.Administer aspirin 325 mg orally.
   • D.Lower systolic blood pressure to less than 140 mm Hg.

   Rationale: An urgent noncontrast head CT distinguishes ischemic stroke from hemorrhage before thrombolytic treatment. A swallow screen is necessary before oral intake but must not delay imaging. Aspirin is withheld until hemorrhage is excluded and the reperfusion plan is established, and aggressive lowering to below 140 mm Hg is not indicated here. Stroke priorities include rapid imaging, glucose assessment, and time-sensitive reperfusion screening.

4. 4.A 24-year-old client in the emergency department has diabetic ketoacidosis. Glucose is 486 mg/dL, arterial pH is 7.19, potassium is 2.9 mEq/L, and blood pressure is 102/64 mm Hg after initial fluids. Which action is most appropriate before starting the prescribed insulin infusion?

   • A.Administer sodium bicarbonate.
   • B.Restrict additional IV fluids.
   • C.Give a subcutaneous long-acting insulin dose.
   • D.Replace potassium according to the prescribed protocol.

   Answer and rationale are in the full material.

5. 5.A 61-year-old client receiving hemodialysis missed two treatments and presents to the emergency department with weakness. Potassium is 6.9 mEq/L, and the cardiac monitor shows peaked T waves and widening QRS complexes. Which prescribed medication should the nurse administer first?

   • A.IV calcium gluconate.
   • B.Oral sodium zirconium cyclosilicate.
   • C.IV regular insulin with dextrose.
   • D.Nebulized albuterol.

   Answer and rationale are in the full material.