NUR 254 Nursing Capstone and Comprehensive Review 2026 Updated
Questions and Answers | Complete Nursing Exit Exam Study Guide with
Verified Solutions, Detailed Rationales, Medical-Surgical Nursing,
Pharmacology, Maternal-Newborn Nursing, Pediatric Nursing, Mental
Health Nursing, Leadership and Management, Community Health,
Prioritization and Delegation, NGN Clinical Judgment and NCLEX-RN
Preparation
Question 1: Which telemetry rhythm requires immediate defibrillation? A. Sinus
bradycardia B. Atrial fibrillation C. Ventricular fibrillation D. Supraventricular
tachycardia CORRECT ANSWER: C. Ventricular fibrillation Rationale: V-fib is a lethal
rhythm causing no cardiac output, requiring immediate unsynchronized defibrillation.
Question 2: What is the priority assessment for a patient with new-onset atrial
fibrillation? A. Bowel sounds B. Apical pulse and hemodynamics C. Skin temperature
D. Pupillary response CORRECT ANSWER: B. Apical pulse and hemodynamics
Rationale: A-fib reduces atrial kick and cardiac output; assessing pulse deficit and BP
is the priority.
Question 3: Which medication is the specific antidote for heparin overdose? A.
Vitamin K B. Protamine sulfate C. Aminocaproic acid D. Desmopressin CORRECT
ANSWER: B. Protamine sulfate Rationale: Protamine sulfate is a heparin antagonist
that binds to heparin to neutralize its anticoagulant effect.
Question 4: A patient with heart failure has a serum potassium of 3.2 mEq/L. Which
medication should the nurse hold? A. Furosemide B. Digoxin C. Metoprolol D.
Lisinopril CORRECT ANSWER: B. Digoxin Rationale: Hypokalemia increases the risk of
digoxin toxicity; the dose should be held and potassium replaced.
Question 5: Which ECG change is characteristic of hyperkalemia? A. U waves B.
Prolonged QT interval C. Peaked T waves D. ST depression CORRECT ANSWER: C.
Peaked T waves Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS,
and eventually a sine wave pattern.
Question 6: What is the primary purpose of a tissue plasminogen activator (tPA) in
acute MI? A. Prevent platelet aggregation B. Dissolve existing coronary thrombi C.
Reduce myocardial oxygen demand D. Dilate coronary arteries CORRECT ANSWER: B.
Dissolve existing coronary thrombi Rationale: tPA is a fibrinolytic that breaks down
the clot causing the myocardial infarction.
Question 7: Which finding indicates a complication of right-sided heart failure? A.
Crackles in lung bases B. Jugular venous distention C. Orthopnea D. Pink frothy sputum
CORRECT ANSWER: B. Jugular venous distention Rationale: Right-sided heart failure
causes systemic venous congestion, leading to JVD, peripheral edema, and
hepatomegaly.
Question 8: A patient on a telemetry unit develops torsades de pointes. Which
electrolyte imbalance is most likely responsible? A. Hypercalcemia B.
,Hypomagnesemia C. Hypernatremia D. Hypophosphatemia CORRECT ANSWER: B.
Hypomagnesemia Rationale: Hypomagnesemia and hypokalemia prolong the QT
interval, predisposing the patient to torsades de pointes.
Question 9: Which class of antiarrhythmics blocks sodium channels? A. Class I B.
Class II C. Class III D. Class IV CORRECT ANSWER: A. Class I Rationale: Class I
antiarrhythmics (e.g., lidocaine, procainamide) block fast sodium channels in the heart.
Question 10: What is the target blood pressure for most patients with hypertension
according to ACC/AHA guidelines? A. < 120/80 mmHg B. < 130/80 mmHg C. < 140/90
mmHg D. < 150/90 mmHg CORRECT ANSWER: B. < 130/80 mmHg Rationale: Current
guidelines recommend a target BP of less than 130/80 mmHg for most adults with
hypertension.
Question 11: Which symptom is the hallmark of stable angina? A. Chest pain at rest
B. Chest pain relieved by rest or nitroglycerin C. Chest pain lasting more than 30
minutes D. Chest pain accompanied by ST elevation CORRECT ANSWER: B. Chest
pain relieved by rest or nitroglycerin Rationale: Stable angina is predictable chest
pain triggered by exertion and relieved by rest or nitroglycerin.
Question 12: A patient with a permanent pacemaker should avoid which of the
following? A. Walking B. Strong magnetic fields C. Eating grapefruit D. Taking
acetaminophen CORRECT ANSWER: B. Strong magnetic fields Rationale: Strong
magnetic fields can interfere with pacemaker function and alter its programming.
Question 13: Which laboratory test is most specific for diagnosing an acute
myocardial infarction? A. CK-MB B. Troponin I C. Myoglobin D. LDH CORRECT
ANSWER: B. Troponin I Rationale: Troponin I and T are highly sensitive and specific
biomarkers for myocardial necrosis.
Question 14: What is the primary mechanism of action of beta-blockers? A. Block
calcium influx B. Decrease heart rate and contractility C. Inhibit ACE D. Block
aldosterone receptors CORRECT ANSWER: B. Decrease heart rate and contractility
Rationale: Beta-blockers block beta-adrenergic receptors, reducing sympathetic
stimulation to the heart.
Question 15: Which position is best for a patient experiencing acute pulmonary
edema? A. Supine B. Prone C. High Fowler's D. Trendelenburg CORRECT ANSWER: C.
High Fowler's Rationale: High Fowler's position with dangling legs reduces venous
return and improves lung expansion.
Question 16: A patient with infective endocarditis is most likely to present with
which finding? A. Jaundice B. New heart murmur C. Calf pain D. Hematuria CORRECT
ANSWER: B. New heart murmur Rationale: Vegetations on heart valves in infective
endocarditis often cause a new or changing heart murmur.
Question 17: Which complication is most feared after an abdominal aortic
aneurysm repair? A. Pulmonary embolism B. Renal failure C. Graft infection D. All of
, the above CORRECT ANSWER: D. All of the above Rationale: AAA repair carries risks
of renal failure (due to clamp placement), graft infection, and thromboembolism.
Question 18: What is the normal range for the PR interval on an ECG? A. 0.04 to 0.10
seconds B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. 0.30 to 0.40 seconds
CORRECT ANSWER: B. 0.12 to 0.20 seconds Rationale: The normal PR interval is 0.12
to 0.20 seconds, representing atrial depolarization and AV node delay.
Question 19: Which medication is contraindicated in patients with right ventricular
infarction? A. Aspirin B. Nitroglycerin C. Morphine D. Oxygen CORRECT ANSWER: B.
Nitroglycerin Rationale: Nitrates reduce preload, which can cause severe hypotension
in right ventricular infarction.
Question 20: What does the QRS complex represent on an ECG? A. Atrial
depolarization B. Ventricular depolarization C. Atrial repolarization D. Ventricular
repolarization CORRECT ANSWER: B. Ventricular depolarization Rationale: The QRS
complex represents the depolarization of the ventricles, triggering ventricular
contraction.
Question 21: Which ABG value indicates respiratory acidosis? A. pH 7.48, PaCO2 30
B. pH 7.30, PaCO2 55 C. pH 7.30, HCO3 18 D. pH 7.48, HCO3 28 CORRECT ANSWER:
B. pH 7.30, PaCO2 55 Rationale: Respiratory acidosis is characterized by a low pH and
an elevated PaCO2 due to hypoventilation.
Question 22: What is the primary treatment for a patient with a tension
pneumothorax? A. Oxygen therapy B. Needle decompression C. Chest physiotherapy
D. Bronchodilators CORRECT ANSWER: B. Needle decompression Rationale: Tension
pneumothorax is a medical emergency requiring immediate needle decompression
followed by a chest tube.
Question 23: Which finding is expected in a patient with chronic obstructive
pulmonary disease (COPD)? A. Respiratory alkalosis B. Barrel chest C. Decreased
anterior-posterior diameter D. Productive cough with clear sputum CORRECT
ANSWER: B. Barrel chest Rationale: Air trapping in COPD increases the anterior-
posterior chest diameter, creating a barrel chest.
Question 24: A patient with asthma is prescribed a short-acting beta-agonist
(SABA). What is the primary purpose? A. Reduce airway inflammation B. Provide rapid
bronchodilation C. Prevent exercise-induced asthma D. Thin respiratory secretions
CORRECT ANSWER: B. Provide rapid bronchodilation Rationale: SABAs like albuterol
provide rapid relief of acute bronchospasm.
Question 25: Which chest tube drainage finding requires immediate notification of
the provider? A. 20 mL/hr of serous fluid B. Continuous bubbling in the water seal
chamber C. Tidaling in the water seal chamber D. 50 mL/hr of sanguineous fluid initially
CORRECT ANSWER: B. Continuous bubbling in the water seal chamber Rationale:
Continuous bubbling in the water seal chamber indicates an air leak in the system.
Questions and Answers | Complete Nursing Exit Exam Study Guide with
Verified Solutions, Detailed Rationales, Medical-Surgical Nursing,
Pharmacology, Maternal-Newborn Nursing, Pediatric Nursing, Mental
Health Nursing, Leadership and Management, Community Health,
Prioritization and Delegation, NGN Clinical Judgment and NCLEX-RN
Preparation
Question 1: Which telemetry rhythm requires immediate defibrillation? A. Sinus
bradycardia B. Atrial fibrillation C. Ventricular fibrillation D. Supraventricular
tachycardia CORRECT ANSWER: C. Ventricular fibrillation Rationale: V-fib is a lethal
rhythm causing no cardiac output, requiring immediate unsynchronized defibrillation.
Question 2: What is the priority assessment for a patient with new-onset atrial
fibrillation? A. Bowel sounds B. Apical pulse and hemodynamics C. Skin temperature
D. Pupillary response CORRECT ANSWER: B. Apical pulse and hemodynamics
Rationale: A-fib reduces atrial kick and cardiac output; assessing pulse deficit and BP
is the priority.
Question 3: Which medication is the specific antidote for heparin overdose? A.
Vitamin K B. Protamine sulfate C. Aminocaproic acid D. Desmopressin CORRECT
ANSWER: B. Protamine sulfate Rationale: Protamine sulfate is a heparin antagonist
that binds to heparin to neutralize its anticoagulant effect.
Question 4: A patient with heart failure has a serum potassium of 3.2 mEq/L. Which
medication should the nurse hold? A. Furosemide B. Digoxin C. Metoprolol D.
Lisinopril CORRECT ANSWER: B. Digoxin Rationale: Hypokalemia increases the risk of
digoxin toxicity; the dose should be held and potassium replaced.
Question 5: Which ECG change is characteristic of hyperkalemia? A. U waves B.
Prolonged QT interval C. Peaked T waves D. ST depression CORRECT ANSWER: C.
Peaked T waves Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS,
and eventually a sine wave pattern.
Question 6: What is the primary purpose of a tissue plasminogen activator (tPA) in
acute MI? A. Prevent platelet aggregation B. Dissolve existing coronary thrombi C.
Reduce myocardial oxygen demand D. Dilate coronary arteries CORRECT ANSWER: B.
Dissolve existing coronary thrombi Rationale: tPA is a fibrinolytic that breaks down
the clot causing the myocardial infarction.
Question 7: Which finding indicates a complication of right-sided heart failure? A.
Crackles in lung bases B. Jugular venous distention C. Orthopnea D. Pink frothy sputum
CORRECT ANSWER: B. Jugular venous distention Rationale: Right-sided heart failure
causes systemic venous congestion, leading to JVD, peripheral edema, and
hepatomegaly.
Question 8: A patient on a telemetry unit develops torsades de pointes. Which
electrolyte imbalance is most likely responsible? A. Hypercalcemia B.
,Hypomagnesemia C. Hypernatremia D. Hypophosphatemia CORRECT ANSWER: B.
Hypomagnesemia Rationale: Hypomagnesemia and hypokalemia prolong the QT
interval, predisposing the patient to torsades de pointes.
Question 9: Which class of antiarrhythmics blocks sodium channels? A. Class I B.
Class II C. Class III D. Class IV CORRECT ANSWER: A. Class I Rationale: Class I
antiarrhythmics (e.g., lidocaine, procainamide) block fast sodium channels in the heart.
Question 10: What is the target blood pressure for most patients with hypertension
according to ACC/AHA guidelines? A. < 120/80 mmHg B. < 130/80 mmHg C. < 140/90
mmHg D. < 150/90 mmHg CORRECT ANSWER: B. < 130/80 mmHg Rationale: Current
guidelines recommend a target BP of less than 130/80 mmHg for most adults with
hypertension.
Question 11: Which symptom is the hallmark of stable angina? A. Chest pain at rest
B. Chest pain relieved by rest or nitroglycerin C. Chest pain lasting more than 30
minutes D. Chest pain accompanied by ST elevation CORRECT ANSWER: B. Chest
pain relieved by rest or nitroglycerin Rationale: Stable angina is predictable chest
pain triggered by exertion and relieved by rest or nitroglycerin.
Question 12: A patient with a permanent pacemaker should avoid which of the
following? A. Walking B. Strong magnetic fields C. Eating grapefruit D. Taking
acetaminophen CORRECT ANSWER: B. Strong magnetic fields Rationale: Strong
magnetic fields can interfere with pacemaker function and alter its programming.
Question 13: Which laboratory test is most specific for diagnosing an acute
myocardial infarction? A. CK-MB B. Troponin I C. Myoglobin D. LDH CORRECT
ANSWER: B. Troponin I Rationale: Troponin I and T are highly sensitive and specific
biomarkers for myocardial necrosis.
Question 14: What is the primary mechanism of action of beta-blockers? A. Block
calcium influx B. Decrease heart rate and contractility C. Inhibit ACE D. Block
aldosterone receptors CORRECT ANSWER: B. Decrease heart rate and contractility
Rationale: Beta-blockers block beta-adrenergic receptors, reducing sympathetic
stimulation to the heart.
Question 15: Which position is best for a patient experiencing acute pulmonary
edema? A. Supine B. Prone C. High Fowler's D. Trendelenburg CORRECT ANSWER: C.
High Fowler's Rationale: High Fowler's position with dangling legs reduces venous
return and improves lung expansion.
Question 16: A patient with infective endocarditis is most likely to present with
which finding? A. Jaundice B. New heart murmur C. Calf pain D. Hematuria CORRECT
ANSWER: B. New heart murmur Rationale: Vegetations on heart valves in infective
endocarditis often cause a new or changing heart murmur.
Question 17: Which complication is most feared after an abdominal aortic
aneurysm repair? A. Pulmonary embolism B. Renal failure C. Graft infection D. All of
, the above CORRECT ANSWER: D. All of the above Rationale: AAA repair carries risks
of renal failure (due to clamp placement), graft infection, and thromboembolism.
Question 18: What is the normal range for the PR interval on an ECG? A. 0.04 to 0.10
seconds B. 0.12 to 0.20 seconds C. 0.20 to 0.30 seconds D. 0.30 to 0.40 seconds
CORRECT ANSWER: B. 0.12 to 0.20 seconds Rationale: The normal PR interval is 0.12
to 0.20 seconds, representing atrial depolarization and AV node delay.
Question 19: Which medication is contraindicated in patients with right ventricular
infarction? A. Aspirin B. Nitroglycerin C. Morphine D. Oxygen CORRECT ANSWER: B.
Nitroglycerin Rationale: Nitrates reduce preload, which can cause severe hypotension
in right ventricular infarction.
Question 20: What does the QRS complex represent on an ECG? A. Atrial
depolarization B. Ventricular depolarization C. Atrial repolarization D. Ventricular
repolarization CORRECT ANSWER: B. Ventricular depolarization Rationale: The QRS
complex represents the depolarization of the ventricles, triggering ventricular
contraction.
Question 21: Which ABG value indicates respiratory acidosis? A. pH 7.48, PaCO2 30
B. pH 7.30, PaCO2 55 C. pH 7.30, HCO3 18 D. pH 7.48, HCO3 28 CORRECT ANSWER:
B. pH 7.30, PaCO2 55 Rationale: Respiratory acidosis is characterized by a low pH and
an elevated PaCO2 due to hypoventilation.
Question 22: What is the primary treatment for a patient with a tension
pneumothorax? A. Oxygen therapy B. Needle decompression C. Chest physiotherapy
D. Bronchodilators CORRECT ANSWER: B. Needle decompression Rationale: Tension
pneumothorax is a medical emergency requiring immediate needle decompression
followed by a chest tube.
Question 23: Which finding is expected in a patient with chronic obstructive
pulmonary disease (COPD)? A. Respiratory alkalosis B. Barrel chest C. Decreased
anterior-posterior diameter D. Productive cough with clear sputum CORRECT
ANSWER: B. Barrel chest Rationale: Air trapping in COPD increases the anterior-
posterior chest diameter, creating a barrel chest.
Question 24: A patient with asthma is prescribed a short-acting beta-agonist
(SABA). What is the primary purpose? A. Reduce airway inflammation B. Provide rapid
bronchodilation C. Prevent exercise-induced asthma D. Thin respiratory secretions
CORRECT ANSWER: B. Provide rapid bronchodilation Rationale: SABAs like albuterol
provide rapid relief of acute bronchospasm.
Question 25: Which chest tube drainage finding requires immediate notification of
the provider? A. 20 mL/hr of serous fluid B. Continuous bubbling in the water seal
chamber C. Tidaling in the water seal chamber D. 50 mL/hr of sanguineous fluid initially
CORRECT ANSWER: B. Continuous bubbling in the water seal chamber Rationale:
Continuous bubbling in the water seal chamber indicates an air leak in the system.
