COMPREHENSIVE RNSG 2539 FINAL
PRACTICE: CRITICAL THINKING AND
CLINICAL APPLICATION 2026/2027
RATED A+
Which medication may be used for rate control in a stable client with atrial fibrillation
and RVR?
Diltiazem
What rhythm is indicated by telemetry showing a sawtooth baseline with more atrial
waves than QRS complexes?
Atrial flutter
What is the nurse's priority action for a client developing pulseless ventricular
tachycardia?
Begin CPR and prepare defibrillation
Which rhythm is indicated by a rhythm strip showing P waves and QRS complexes with
no relationship?
Third-degree AV block
Which findings require urgent assessment in a client with a dysrhythmia? (Select all that
apply)
Chest pain, Syncope, New confusion, O2 saturation 88%
Which treatment should the nurse anticipate for a client with chest pressure and ST
elevation in II, III, and aVF?
Emergent PCI
What is the priority intervention for a client with Addison's disease in crisis?
IV hydrocortisone and IV fluids as ordered.
What should the nurse anticipate if a client with sepsis has a MAP of 58 mmHg after a
fluid bolus?
Start/adjust vasopressor therapy as ordered
What is the MAP for BP 90/54 using MAP = (SBP + 2(DBP))/3?
66 mmHg
Which intervention best addresses a client with a CVP of 1 mmHg and signs of
dehydration?
Administer prescribed isotonic fluids
Which provider order should the nurse question for a client with high PAWP?
Fluid bolus
What medication effect would help decrease afterload in a client with severe
hypertension?
Vasodilation
Which findings suggest decreased cardiac output? (Select all that apply)
Confusion, Cool clammy skin, Urine output 15 mL/hr, Weak thready pulse
Which medication should the nurse prepare to give for a client with sinus bradycardia at
38 bpm?
,Atropine
What is the priority concern for a client with an irregularly irregular rhythm and no
measurable P waves?
Stroke
What teaching is needed for patients with Addison's disease?
Lifelong steroid therapy may be required, increase steroid dose during major stress,
wear medical alert identification, carry emergency steroid kit if prescribed.
Which disorder is characterized by moon face, buffalo hump, and bruising?
Cushing syndrome.
What statement about steroid management after adrenalectomy needs correction?
I should stop steroids suddenly when I feel strong.
Which tool is most appropriate for assessing pain in a ventilated client?
CPOT.
What should a nurse do first if a client receiving propofol becomes hypotensive?
Assess hemodynamics and notify provider per protocol.
Which scale is used to assess the depth of sedation?
RASS.
Which interventions may support comfort in the ICU?
Repositioning, noise reduction, pre-medication before painful procedures, guided
imagery/music if appropriate.
What task is safest to delegate to experienced UAP?
Obtain routine vital signs on a stable client.
Which client should the charge nurse assess first?
Client with new chest pain and diaphoresis.
What clinical judgment step is used when recognizing a decline in urine output and
confusion in a septic client?
Recognizing cues.
Which PICOT question is best written?
In adults with hypertension, does daily home BP monitoring compared with no
monitoring improve BP control over 3 months?
What is the highest level of evidence for a medication intervention question?
Systematic review of randomized controlled trials.
What are common barriers to evidence-based practice?
Lack of time, limited access to databases, resistance to change, poor appraisal skills.
Match the leadership style: Autocratic, Democratic, Laissez-faire, Transformational.
1-B: Leader makes decisions with little input; 2-C: Team input is encouraged; 3-D:
Minimal direction; team acts independently; 4-A: Inspires change and shared vision.
What action reflects leadership rather than management only?
Inspiring staff to adopt a safer handoff process.
In PICOT, what does the letter O stand for?
Outcome.
What finding best explains fatigue and shortness of breath in a client with chronic
anemia?
Decreased oxygen-carrying capacity.
What findings should the nurse expect with anemia?
,Pallor, Tachycardia, Fatigue, Shortness of breath with exertion
What condition is suspected in a client with severe pneumonia and worsening
hypoxemia?
ARDS
Which ventilator strategy is commonly used in ARDS to reduce lung injury?
Low tidal volume ventilation
What does a low P/F ratio indicate in an ARDS client?
Severe oxygenation impairment
What is the P/F ratio for PaO2 80 mmHg on FiO2 0.40?
200
Which disorder is most likely in a postoperative client with sudden dyspnea and pleuritic
chest pain?
Pulmonary embolism
Which orders are expected for suspected pulmonary embolism?
Oxygen, D-dimer/CT angiography, Anticoagulation, Assess for bleeding
Which statement by a client taking warfarin for PE requires follow-up?
I will double my dose if I miss one.
Which diagnostic test supports a diagnosis of cystic fibrosis?
Sweat chloride test
Which medication should be taken with meals by a client with cystic fibrosis?
Pancreatic enzymes
Which teaching is appropriate for cystic fibrosis?
Airway clearance therapy, High-calorie/high-protein nutrition, Fat-soluble vitamin
supplementation, Take enzymes with meals/snacks
Which client is the highest priority?
ARDS client with SpO2 84% on high-flow oxygen
What is the purpose of PEEP in ARDS?
Keeps alveoli open to improve oxygenation
How should the nurse interpret mild CO2 retention in an ARDS client on lung-protective
ventilation?
Permissive hypercapnia may be accepted to prevent lung injury
What should the nurse do first for a client reporting new crushing chest pain?
Obtain a 12-lead ECG
How should the nurse interpret elevated troponin with no ST elevation and ongoing
chest discomfort?
NSTEMI is possible
Which teaching should be included for a client prescribed sublingual nitroglycerin?
(Select all that apply)
Sit down before taking it, Call 911 if chest pain is not relieved after the prescribed
doses, Store tablets in original dark container, Expect possible headache or dizziness
Which finding is most urgent for a STEMI client receiving thrombolytic therapy?
Sudden severe headache and neuro changes
Match the medication with its expected use: Adenosine
Slows AV nodal conduction briefly for SVT
Match the medication with its expected use: Amiodarone
, Antidysrhythmic for ventricular/atrial rhythms
Match the medication with its expected use: Digoxin
Increases contractility and slows AV conduction
Match the medication with its expected use: Epinephrine
Supports BP/bronchodilation in emergencies
Which shock type is most likely for a client after MI with hypotension and pulmonary
congestion?
Cardiogenic
What is the priority intervention for a trauma client with tachycardia and hypotension?
Control bleeding and start rapid fluid/blood replacement
What is the priority action for a client with hypotension, bradycardia, and warm dry skin
due to spinal cord injury?
Administer epinephrine as ordered
What type of shock is indicated by tracheal deviation, severe dyspnea, JVD, and
hypotension?
Obstructive shock
What is the initial crystalloid resuscitation volume for a 70-kg adult with sepsis at 30
mL/kg?
2100 mL
What nursing action is unsafe for a client with suspected abdominal aortic aneurysm
(AAA)?
Palpate the mass to confirm size
What is the priority concern for a known AAA client who suddenly reports tearing back
pain and becomes hypotensive?
Rupture with hypovolemic shock
What is the most important teaching for a client with a small stable aneurysm?
Control BP and stop smoking
What assessment is priority after endovascular AAA repair?
Pedal pulses and urine output
Which congenital heart defect is indicated by a continuous machinery-like murmur and
bounding pulses?
Patent ductus arteriosus
What defect is suspected in a child with higher BP in the arms than legs and weak
femoral pulses?
Coarctation of the aorta
What compensatory action does a toddler with Tetralogy of Fallot exhibit during play?
Squatting to improve pulmonary blood flow
Which findings may suggest heart failure in an infant with congenital heart disease?
Poor feeding, diaphoresis with feeds, tachypnea, poor weight gain
What nursing intervention helps decrease oxygen demand in an infant with congenital
heart disease?
Cluster care with rest periods
What lab value is most related to confusion and asterixis in a liver failure client?
Ammonia
Which medication should be expected for elevated ammonia in liver failure?
Lactulose
PRACTICE: CRITICAL THINKING AND
CLINICAL APPLICATION 2026/2027
RATED A+
Which medication may be used for rate control in a stable client with atrial fibrillation
and RVR?
Diltiazem
What rhythm is indicated by telemetry showing a sawtooth baseline with more atrial
waves than QRS complexes?
Atrial flutter
What is the nurse's priority action for a client developing pulseless ventricular
tachycardia?
Begin CPR and prepare defibrillation
Which rhythm is indicated by a rhythm strip showing P waves and QRS complexes with
no relationship?
Third-degree AV block
Which findings require urgent assessment in a client with a dysrhythmia? (Select all that
apply)
Chest pain, Syncope, New confusion, O2 saturation 88%
Which treatment should the nurse anticipate for a client with chest pressure and ST
elevation in II, III, and aVF?
Emergent PCI
What is the priority intervention for a client with Addison's disease in crisis?
IV hydrocortisone and IV fluids as ordered.
What should the nurse anticipate if a client with sepsis has a MAP of 58 mmHg after a
fluid bolus?
Start/adjust vasopressor therapy as ordered
What is the MAP for BP 90/54 using MAP = (SBP + 2(DBP))/3?
66 mmHg
Which intervention best addresses a client with a CVP of 1 mmHg and signs of
dehydration?
Administer prescribed isotonic fluids
Which provider order should the nurse question for a client with high PAWP?
Fluid bolus
What medication effect would help decrease afterload in a client with severe
hypertension?
Vasodilation
Which findings suggest decreased cardiac output? (Select all that apply)
Confusion, Cool clammy skin, Urine output 15 mL/hr, Weak thready pulse
Which medication should the nurse prepare to give for a client with sinus bradycardia at
38 bpm?
,Atropine
What is the priority concern for a client with an irregularly irregular rhythm and no
measurable P waves?
Stroke
What teaching is needed for patients with Addison's disease?
Lifelong steroid therapy may be required, increase steroid dose during major stress,
wear medical alert identification, carry emergency steroid kit if prescribed.
Which disorder is characterized by moon face, buffalo hump, and bruising?
Cushing syndrome.
What statement about steroid management after adrenalectomy needs correction?
I should stop steroids suddenly when I feel strong.
Which tool is most appropriate for assessing pain in a ventilated client?
CPOT.
What should a nurse do first if a client receiving propofol becomes hypotensive?
Assess hemodynamics and notify provider per protocol.
Which scale is used to assess the depth of sedation?
RASS.
Which interventions may support comfort in the ICU?
Repositioning, noise reduction, pre-medication before painful procedures, guided
imagery/music if appropriate.
What task is safest to delegate to experienced UAP?
Obtain routine vital signs on a stable client.
Which client should the charge nurse assess first?
Client with new chest pain and diaphoresis.
What clinical judgment step is used when recognizing a decline in urine output and
confusion in a septic client?
Recognizing cues.
Which PICOT question is best written?
In adults with hypertension, does daily home BP monitoring compared with no
monitoring improve BP control over 3 months?
What is the highest level of evidence for a medication intervention question?
Systematic review of randomized controlled trials.
What are common barriers to evidence-based practice?
Lack of time, limited access to databases, resistance to change, poor appraisal skills.
Match the leadership style: Autocratic, Democratic, Laissez-faire, Transformational.
1-B: Leader makes decisions with little input; 2-C: Team input is encouraged; 3-D:
Minimal direction; team acts independently; 4-A: Inspires change and shared vision.
What action reflects leadership rather than management only?
Inspiring staff to adopt a safer handoff process.
In PICOT, what does the letter O stand for?
Outcome.
What finding best explains fatigue and shortness of breath in a client with chronic
anemia?
Decreased oxygen-carrying capacity.
What findings should the nurse expect with anemia?
,Pallor, Tachycardia, Fatigue, Shortness of breath with exertion
What condition is suspected in a client with severe pneumonia and worsening
hypoxemia?
ARDS
Which ventilator strategy is commonly used in ARDS to reduce lung injury?
Low tidal volume ventilation
What does a low P/F ratio indicate in an ARDS client?
Severe oxygenation impairment
What is the P/F ratio for PaO2 80 mmHg on FiO2 0.40?
200
Which disorder is most likely in a postoperative client with sudden dyspnea and pleuritic
chest pain?
Pulmonary embolism
Which orders are expected for suspected pulmonary embolism?
Oxygen, D-dimer/CT angiography, Anticoagulation, Assess for bleeding
Which statement by a client taking warfarin for PE requires follow-up?
I will double my dose if I miss one.
Which diagnostic test supports a diagnosis of cystic fibrosis?
Sweat chloride test
Which medication should be taken with meals by a client with cystic fibrosis?
Pancreatic enzymes
Which teaching is appropriate for cystic fibrosis?
Airway clearance therapy, High-calorie/high-protein nutrition, Fat-soluble vitamin
supplementation, Take enzymes with meals/snacks
Which client is the highest priority?
ARDS client with SpO2 84% on high-flow oxygen
What is the purpose of PEEP in ARDS?
Keeps alveoli open to improve oxygenation
How should the nurse interpret mild CO2 retention in an ARDS client on lung-protective
ventilation?
Permissive hypercapnia may be accepted to prevent lung injury
What should the nurse do first for a client reporting new crushing chest pain?
Obtain a 12-lead ECG
How should the nurse interpret elevated troponin with no ST elevation and ongoing
chest discomfort?
NSTEMI is possible
Which teaching should be included for a client prescribed sublingual nitroglycerin?
(Select all that apply)
Sit down before taking it, Call 911 if chest pain is not relieved after the prescribed
doses, Store tablets in original dark container, Expect possible headache or dizziness
Which finding is most urgent for a STEMI client receiving thrombolytic therapy?
Sudden severe headache and neuro changes
Match the medication with its expected use: Adenosine
Slows AV nodal conduction briefly for SVT
Match the medication with its expected use: Amiodarone
, Antidysrhythmic for ventricular/atrial rhythms
Match the medication with its expected use: Digoxin
Increases contractility and slows AV conduction
Match the medication with its expected use: Epinephrine
Supports BP/bronchodilation in emergencies
Which shock type is most likely for a client after MI with hypotension and pulmonary
congestion?
Cardiogenic
What is the priority intervention for a trauma client with tachycardia and hypotension?
Control bleeding and start rapid fluid/blood replacement
What is the priority action for a client with hypotension, bradycardia, and warm dry skin
due to spinal cord injury?
Administer epinephrine as ordered
What type of shock is indicated by tracheal deviation, severe dyspnea, JVD, and
hypotension?
Obstructive shock
What is the initial crystalloid resuscitation volume for a 70-kg adult with sepsis at 30
mL/kg?
2100 mL
What nursing action is unsafe for a client with suspected abdominal aortic aneurysm
(AAA)?
Palpate the mass to confirm size
What is the priority concern for a known AAA client who suddenly reports tearing back
pain and becomes hypotensive?
Rupture with hypovolemic shock
What is the most important teaching for a client with a small stable aneurysm?
Control BP and stop smoking
What assessment is priority after endovascular AAA repair?
Pedal pulses and urine output
Which congenital heart defect is indicated by a continuous machinery-like murmur and
bounding pulses?
Patent ductus arteriosus
What defect is suspected in a child with higher BP in the arms than legs and weak
femoral pulses?
Coarctation of the aorta
What compensatory action does a toddler with Tetralogy of Fallot exhibit during play?
Squatting to improve pulmonary blood flow
Which findings may suggest heart failure in an infant with congenital heart disease?
Poor feeding, diaphoresis with feeds, tachypnea, poor weight gain
What nursing intervention helps decrease oxygen demand in an infant with congenital
heart disease?
Cluster care with rest periods
What lab value is most related to confusion and asterixis in a liver failure client?
Ammonia
Which medication should be expected for elevated ammonia in liver failure?
Lactulose
