RNSG 2539 FINAL EXAM – QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
*CORE DOMAINS*
*Advanced Medical-Surgical Nursing Concepts*
*Complex Multi-System Organ Failure*
*Emergency and Trauma Care Management*
*Pharmacological Interventions and IV*
*Professional Leadership and Delegation*
*Legal and Ethical Nursing Practice*
*Health Promotion and Chronic Disease*
*Evidence-Based Clinical Decision Making*
*INTRODUCTION*
*The purpose of this comprehensive assessment is to evaluate the clinical competency and theoretical kn
SECTION ONE
1. A patient presents to the emergency department with a suspected tension pneumothorax. Which clinical
finding should the nurse prioritize for immediate intervention?
A. Diminished breath sounds on the affected side
B. Heart rate of 105 beats per minute
🟢 C. Tracheal deviation toward the unaffected side
D. SpO2 reading of 92% on room air
,🔴 RATIONALE: Tracheal deviation is a late and life-threatening sign of tension pneumothorax indicating
significant mediastinal shift and impending cardiovascular collapse, requiring immediate needle decompression.
2. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). Which electrolyte imbalance
is the highest priority for the nurse to monitor?
A. Hypocalcemia
🟢 B. Hyperkalemia
C. Hyponatremia
D. Hypophosphatemia
🔴 RATIONALE: Hyperkalemia is a common and lethal complication of the oliguric phase in AKI, as the kidneys
fail to excrete potassium, potentially leading to cardiac dysrhythmias and arrest.
3. Which legal document should the nurse refer to when determining if a specific task can be delegated to an
Unlicensed Assistive Personnel (UAP)?
A. The facility’s Policy and Procedure Manual
🟢 B. The State Nurse Practice Act
C. The American Nurses Association (ANA) Code of Ethics
D. The Patient’s Bill of Rights
🔴 RATIONALE: The State Nurse Practice Act is the primary legal authority that defines the scope of practice and
delegation guidelines for licensed and unlicensed personnel within a specific jurisdiction.
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal cannula.
Which flow rate is most appropriate to maintain the hypoxic drive?
,🟢 A. 1–2 L/min
B. 4–6 L/min
C. 8–10 L/min
D. 12–15 L/min
🔴 RATIONALE: High concentrations of oxygen can suppress the hypoxic drive in some COPD patients who rely
on low oxygen levels to stimulate breathing; therefore, low-flow oxygen is typically initiated.
5. A nurse observes a colleague documenting a procedure that was not performed. What is the most
appropriate initial action?
A. Ignore the incident to maintain professional harmony
B. Report the colleague to the State Board of Nursing
🟢 C. Confront the colleague privately to discuss the observation
D. Inform the Unit Manager immediately
🔴 RATIONALE: Ethical practice dictates addressing professional misconduct directly and promptly. If the
behavior is not corrected or is part of a pattern, it should then be escalated through the chain of command.
6. A client is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the nurse anticipate
administering first?
A. D5W with 20 mEq KCl
B. 0.45% Sodium Chloride
🟢 C. 0.9% Sodium Chloride
D. D5 1/2 Normal Saline
🔴 RATIONALE: Initial treatment for DKA focuses on volume resuscitation to treat dehydration and improve
perfusion, making isotonic 0.9% Normal Saline the fluid of choice.
, 7. Which assessment finding is most indicative of increased intracranial pressure (ICP) in a patient following
a head injury?
A. Tachycardia and hypotension
🟢 B. Widening pulse pressure and bradycardia
C. Increased Glasgow Coma Scale score
D. Bilateral constricted pupils
🔴 RATIONALE: Cushing’s Triad (widening pulse pressure, bradycardia, and irregular respirations) is a classic
sign of late-stage increased intracranial pressure.
8. When administering Adenosine for supraventricular tachycardia (SVT), the nurse should prepare for which
expected temporary side effect?
A. Prolonged hypertension
🟢 B. A short period of asystole
C. Severe peripheral edema
D. Persistent tachypnea
🔴 RATIONALE: Adenosine slows conduction through the AV node and often causes a brief period of asystole or
"flatline" on the monitor before the heart returns to a normal rhythm.
9. A patient is scheduled for a cholecystectomy. During the preoperative assessment, the patient expresses
fear about the surgery. What is the nurse's best response?
🟢 A. "Can you tell me more about what specifically concerns you regarding the surgery?"
B. "Don't worry, your surgeon has performed hundreds of these procedures."
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
*CORE DOMAINS*
*Advanced Medical-Surgical Nursing Concepts*
*Complex Multi-System Organ Failure*
*Emergency and Trauma Care Management*
*Pharmacological Interventions and IV*
*Professional Leadership and Delegation*
*Legal and Ethical Nursing Practice*
*Health Promotion and Chronic Disease*
*Evidence-Based Clinical Decision Making*
*INTRODUCTION*
*The purpose of this comprehensive assessment is to evaluate the clinical competency and theoretical kn
SECTION ONE
1. A patient presents to the emergency department with a suspected tension pneumothorax. Which clinical
finding should the nurse prioritize for immediate intervention?
A. Diminished breath sounds on the affected side
B. Heart rate of 105 beats per minute
🟢 C. Tracheal deviation toward the unaffected side
D. SpO2 reading of 92% on room air
,🔴 RATIONALE: Tracheal deviation is a late and life-threatening sign of tension pneumothorax indicating
significant mediastinal shift and impending cardiovascular collapse, requiring immediate needle decompression.
2. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). Which electrolyte imbalance
is the highest priority for the nurse to monitor?
A. Hypocalcemia
🟢 B. Hyperkalemia
C. Hyponatremia
D. Hypophosphatemia
🔴 RATIONALE: Hyperkalemia is a common and lethal complication of the oliguric phase in AKI, as the kidneys
fail to excrete potassium, potentially leading to cardiac dysrhythmias and arrest.
3. Which legal document should the nurse refer to when determining if a specific task can be delegated to an
Unlicensed Assistive Personnel (UAP)?
A. The facility’s Policy and Procedure Manual
🟢 B. The State Nurse Practice Act
C. The American Nurses Association (ANA) Code of Ethics
D. The Patient’s Bill of Rights
🔴 RATIONALE: The State Nurse Practice Act is the primary legal authority that defines the scope of practice and
delegation guidelines for licensed and unlicensed personnel within a specific jurisdiction.
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal cannula.
Which flow rate is most appropriate to maintain the hypoxic drive?
,🟢 A. 1–2 L/min
B. 4–6 L/min
C. 8–10 L/min
D. 12–15 L/min
🔴 RATIONALE: High concentrations of oxygen can suppress the hypoxic drive in some COPD patients who rely
on low oxygen levels to stimulate breathing; therefore, low-flow oxygen is typically initiated.
5. A nurse observes a colleague documenting a procedure that was not performed. What is the most
appropriate initial action?
A. Ignore the incident to maintain professional harmony
B. Report the colleague to the State Board of Nursing
🟢 C. Confront the colleague privately to discuss the observation
D. Inform the Unit Manager immediately
🔴 RATIONALE: Ethical practice dictates addressing professional misconduct directly and promptly. If the
behavior is not corrected or is part of a pattern, it should then be escalated through the chain of command.
6. A client is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should the nurse anticipate
administering first?
A. D5W with 20 mEq KCl
B. 0.45% Sodium Chloride
🟢 C. 0.9% Sodium Chloride
D. D5 1/2 Normal Saline
🔴 RATIONALE: Initial treatment for DKA focuses on volume resuscitation to treat dehydration and improve
perfusion, making isotonic 0.9% Normal Saline the fluid of choice.
, 7. Which assessment finding is most indicative of increased intracranial pressure (ICP) in a patient following
a head injury?
A. Tachycardia and hypotension
🟢 B. Widening pulse pressure and bradycardia
C. Increased Glasgow Coma Scale score
D. Bilateral constricted pupils
🔴 RATIONALE: Cushing’s Triad (widening pulse pressure, bradycardia, and irregular respirations) is a classic
sign of late-stage increased intracranial pressure.
8. When administering Adenosine for supraventricular tachycardia (SVT), the nurse should prepare for which
expected temporary side effect?
A. Prolonged hypertension
🟢 B. A short period of asystole
C. Severe peripheral edema
D. Persistent tachypnea
🔴 RATIONALE: Adenosine slows conduction through the AV node and often causes a brief period of asystole or
"flatline" on the monitor before the heart returns to a normal rhythm.
9. A patient is scheduled for a cholecystectomy. During the preoperative assessment, the patient expresses
fear about the surgery. What is the nurse's best response?
🟢 A. "Can you tell me more about what specifically concerns you regarding the surgery?"
B. "Don't worry, your surgeon has performed hundreds of these procedures."
