RNSG 2539 FINAL EXAM – QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
*CORE DOMAINS*
*Advanced Medical-Surgical Nursing*
*Mental Health Interventions*
*Pediatric Care and Development*
*Maternal and Newborn Complications*
*Leadership and Management Principles*
*Pharmacology and Dosage Calculation*
*Community and Public Health Nursing*
*Ethical and Legal Scope of Practice*
*Pathophysiology and Homeostasis*
*Evidence-Based Clinical Practice*
*INTRODUCTION*
*The purpose of this comprehensive assessment is to evaluate the student’s mastery of advanced nursing
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes the patient's oxygen saturation is 88% and the patient is experiencing increased
dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Assist the patient into a high-Fowler’s position
C. Administer a PRN dose of albuterol
D. Notify the health care provider immediately
,🟢 B. Assist the patient into a high-Fowler’s position
🔴 RATIONALE: High-Fowler’s position maximizes lung expansion and improves gas exchange. This is a non-
invasive nursing intervention that should be performed first for a patient with dyspnea before escalating oxygen
therapy or calling the provider.
2. A nurse is caring for a client with a chest tube. The nurse notices continuous bubbling in the water-seal
chamber. What does this finding indicate?
A. The system is functioning normally
B. The lung has fully re-expanded
C. There is an air leak in the system
D. The suction pressure is set too high
🟢 C. There is an air leak in the system
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent bubbling is
expected in a patient with a pneumothorax, but continuous bubbling requires immediate assessment of the
connections and the patient's status.
3. Which of the following patients should the nurse see first after receiving the change-of-shift report?
A. A patient with a history of heart failure who has 2+ pitting edema
B. A patient who underwent an appendectomy 4 hours ago and reports pain as 6/10
C. A patient with pneumonia who is newly confused and restless
D. A patient with diabetes whose fasting blood glucose was 150 mg/dL
🟢 C. A patient with pneumonia who is newly confused and restless
🔴 RATIONALE: New-onset confusion and restlessness are early signs of hypoxia. This patient is the most
unstable and requires immediate assessment of oxygenation and respiratory status.
, 4. A patient is admitted with a suspected myocardial infarction. Which laboratory value is most specific for
myocardial damage?
A. Creatine kinase (CK-MB)
B. Myoglobin
C. Troponin I
D. C-reactive protein
🟢 C. Troponin I
🔴 RATIONALE: Troponin I is highly specific to cardiac muscle and is the gold standard biomarker for diagnosing
myocardial infarction, as it remains elevated longer than CK-MB.
5. A nurse is preparing to administer digoxin to a patient with heart failure. Which assessment finding would
require the nurse to hold the medication?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Potassium level of 4.8 mEq/L
🟢 C. Apical pulse of 52 beats per minute
🔴 RATIONALE: Digoxin is a negative chronotrope that slows the heart rate. It should be held if the apical pulse is
less than 60 beats per minute in an adult to prevent further bradycardia.
6. A patient is prescribed warfarin for atrial fibrillation. Which food item should the nurse instruct the patient to
consume in consistent amounts?
, A. Bananas
B. Spinach
C. Whole grain bread
D. Red meat
🟢 B. Spinach
🔴 RATIONALE: Spinach is high in Vitamin K, which is the antagonist for warfarin. Sudden changes in Vitamin K
intake can alter the effectiveness of the medication and the patient's INR.
7. A patient is diagnosed with right-sided heart failure. Which clinical manifestation should the nurse expect to
find?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular venous distention
D. Orthopnea
🟢 C. Jugular venous distention
🔴 RATIONALE: Right-sided heart failure leads to systemic venous congestion, causing symptoms such as
jugular venous distention, peripheral edema, and hepatomegaly. Pulmonary symptoms are associated with left-
sided failure.
8. When teaching a patient about the use of a dry powder inhaler (DPI), which instruction is correct?
A. Shake the inhaler vigorously before use
B. Breathe in slowly and deeply
C. Exhale into the inhaler before inhaling
D. Breathe in quickly and forcefully
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
*CORE DOMAINS*
*Advanced Medical-Surgical Nursing*
*Mental Health Interventions*
*Pediatric Care and Development*
*Maternal and Newborn Complications*
*Leadership and Management Principles*
*Pharmacology and Dosage Calculation*
*Community and Public Health Nursing*
*Ethical and Legal Scope of Practice*
*Pathophysiology and Homeostasis*
*Evidence-Based Clinical Practice*
*INTRODUCTION*
*The purpose of this comprehensive assessment is to evaluate the student’s mastery of advanced nursing
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes the patient's oxygen saturation is 88% and the patient is experiencing increased
dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Assist the patient into a high-Fowler’s position
C. Administer a PRN dose of albuterol
D. Notify the health care provider immediately
,🟢 B. Assist the patient into a high-Fowler’s position
🔴 RATIONALE: High-Fowler’s position maximizes lung expansion and improves gas exchange. This is a non-
invasive nursing intervention that should be performed first for a patient with dyspnea before escalating oxygen
therapy or calling the provider.
2. A nurse is caring for a client with a chest tube. The nurse notices continuous bubbling in the water-seal
chamber. What does this finding indicate?
A. The system is functioning normally
B. The lung has fully re-expanded
C. There is an air leak in the system
D. The suction pressure is set too high
🟢 C. There is an air leak in the system
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent bubbling is
expected in a patient with a pneumothorax, but continuous bubbling requires immediate assessment of the
connections and the patient's status.
3. Which of the following patients should the nurse see first after receiving the change-of-shift report?
A. A patient with a history of heart failure who has 2+ pitting edema
B. A patient who underwent an appendectomy 4 hours ago and reports pain as 6/10
C. A patient with pneumonia who is newly confused and restless
D. A patient with diabetes whose fasting blood glucose was 150 mg/dL
🟢 C. A patient with pneumonia who is newly confused and restless
🔴 RATIONALE: New-onset confusion and restlessness are early signs of hypoxia. This patient is the most
unstable and requires immediate assessment of oxygenation and respiratory status.
, 4. A patient is admitted with a suspected myocardial infarction. Which laboratory value is most specific for
myocardial damage?
A. Creatine kinase (CK-MB)
B. Myoglobin
C. Troponin I
D. C-reactive protein
🟢 C. Troponin I
🔴 RATIONALE: Troponin I is highly specific to cardiac muscle and is the gold standard biomarker for diagnosing
myocardial infarction, as it remains elevated longer than CK-MB.
5. A nurse is preparing to administer digoxin to a patient with heart failure. Which assessment finding would
require the nurse to hold the medication?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Potassium level of 4.8 mEq/L
🟢 C. Apical pulse of 52 beats per minute
🔴 RATIONALE: Digoxin is a negative chronotrope that slows the heart rate. It should be held if the apical pulse is
less than 60 beats per minute in an adult to prevent further bradycardia.
6. A patient is prescribed warfarin for atrial fibrillation. Which food item should the nurse instruct the patient to
consume in consistent amounts?
, A. Bananas
B. Spinach
C. Whole grain bread
D. Red meat
🟢 B. Spinach
🔴 RATIONALE: Spinach is high in Vitamin K, which is the antagonist for warfarin. Sudden changes in Vitamin K
intake can alter the effectiveness of the medication and the patient's INR.
7. A patient is diagnosed with right-sided heart failure. Which clinical manifestation should the nurse expect to
find?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular venous distention
D. Orthopnea
🟢 C. Jugular venous distention
🔴 RATIONALE: Right-sided heart failure leads to systemic venous congestion, causing symptoms such as
jugular venous distention, peripheral edema, and hepatomegaly. Pulmonary symptoms are associated with left-
sided failure.
8. When teaching a patient about the use of a dry powder inhaler (DPI), which instruction is correct?
A. Shake the inhaler vigorously before use
B. Breathe in slowly and deeply
C. Exhale into the inhaler before inhaling
D. Breathe in quickly and forcefully
