**The Healer's Edge: NCLEX-RN Next
Generation Practice Exam B 2024 – Clinical
Judgment Edition**
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**Question 1**
A nurse in the emergency department is assessing a client with severe abdominal pain. Which finding
suggests a ruptured ectopic pregnancy?
A. Bradycardia and hypertension.
B. Unilateral lower quadrant pain with referred shoulder pain.
C. Pain relieved by lying supine.
D. Nausea and vomiting after meals.
💫RATIONALE✔️✔️: Ruptured ectopic: unilateral pain, referred shoulder pain (blood irritating diaphragm),
hypovolemic shock (tachycardia, hypotension).
💫ANSWER✔️✔️: B. Unilateral lower quadrant pain with referred shoulder pain.
---
**Question 2**
A nurse is caring for a client with a new diagnosis of type 1 diabetes. Which statement indicates
understanding of hypoglycemia treatment?
A. "I will drink 4 oz of orange juice and recheck in 15 minutes."
B. "I will eat a candy bar and wait 30 minutes."
C. "I will take an extra dose of insulin."
D. "I will drink diet soda."
,💫RATIONALE✔️✔️: Hypoglycemia: 15g rapid-acting carb (4 oz juice), recheck in 15 min. Candy bar has fat
(slows absorption). Diet soda no sugar.
💫ANSWER✔️✔️: A. "I will drink 4 oz of orange juice and recheck in 15 minutes."
---
**Question 3**
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding indicates
worsening respiratory status?
A. Productive cough with yellow sputum.
B. Use of accessory muscles and pursed-lip breathing.
C. SpO2 91% on 2 L nasal cannula.
D. Respiratory rate 18 breaths/min.
💫RATIONALE✔️✔️: Accessory muscle use and pursed-lip breathing indicate increased work of breathing,
worsening COPD. SpO2 91% on O2 is low but not as acute as muscle use.
💫ANSWER✔️✔️: B. Use of accessory muscles and pursed-lip breathing.
---
**Question 4**
A nurse is preparing to administer a blood transfusion. Which IV solution is compatible?
A. Lactated Ringer's.
B. 5% dextrose in water.
C. 0.9% sodium chloride.
D. 0.45% sodium chloride.
💫RATIONALE✔️✔️: Only 0.9% NaCl (normal saline) is compatible. LR contains calcium (clots). Dextrose
causes hemolysis.
,💫ANSWER✔️✔️: C. 0.9% sodium chloride.
---
**Question 5**
A client is receiving IV furosemide (Lasix). Which finding requires immediate intervention?
A. Serum potassium 3.8 mEq/L.
B. Tinnitus.
C. Increased urine output.
D. Blood pressure 110/70 mm Hg.
💫RATIONALE✔️✔️: Tinnitus indicates ototoxicity (dose-related, especially rapid IV push). Hypokalemia
common but 3.8 normal. Increased output expected.
💫ANSWER✔️✔️: B. Tinnitus.
---
**Question 6**
A nurse is caring for a client with a chest tube after a pneumothorax. The water seal chamber has
continuous bubbling. Which action should the nurse take?
A. Clamp the chest tube.
B. Assess for an air leak.
C. Increase suction pressure.
D. Document as normal.
💫RATIONALE✔️✔️: Continuous bubbling in water seal indicates air leak. Assess connections, insertion
site. Clamping risks tension pneumothorax.
💫ANSWER✔️✔️: B. Assess for an air leak.
, ---
**Question 7**
A client with heart failure has a prescription for metoprolol succinate (Toprol XL). Which finding
indicates the medication is effective?
A. Decreased heart rate and improved ejection fraction.
B. Increased blood pressure.
C. Weight gain of 2 lb in 2 days.
D. Crackles in lung bases.
💫RATIONALE✔️✔️: Beta-blockers in HF reduce HR, improve LV function over time. Weight gain and
crackles indicate worsening failure.
💫ANSWER✔️✔️: A. Decreased heart rate and improved ejection fraction.
---
**Question 8**
A nurse is assessing a client with a traumatic brain injury. Which finding indicates increased intracranial
pressure (ICP)?
A. Hypotension and tachycardia.
B. Hypertension and bradycardia.
C. Tachypnea and fever.
D. Hypothermia and bradycardia.
💫RATIONALE✔️✔️: Cushing's triad: hypertension (widening pulse pressure), bradycardia, irregular
respirations. Late sign of herniation.
💫ANSWER✔️✔️: B. Hypertension and bradycardia.
---
Generation Practice Exam B 2024 – Clinical
Judgment Edition**
---
**Question 1**
A nurse in the emergency department is assessing a client with severe abdominal pain. Which finding
suggests a ruptured ectopic pregnancy?
A. Bradycardia and hypertension.
B. Unilateral lower quadrant pain with referred shoulder pain.
C. Pain relieved by lying supine.
D. Nausea and vomiting after meals.
💫RATIONALE✔️✔️: Ruptured ectopic: unilateral pain, referred shoulder pain (blood irritating diaphragm),
hypovolemic shock (tachycardia, hypotension).
💫ANSWER✔️✔️: B. Unilateral lower quadrant pain with referred shoulder pain.
---
**Question 2**
A nurse is caring for a client with a new diagnosis of type 1 diabetes. Which statement indicates
understanding of hypoglycemia treatment?
A. "I will drink 4 oz of orange juice and recheck in 15 minutes."
B. "I will eat a candy bar and wait 30 minutes."
C. "I will take an extra dose of insulin."
D. "I will drink diet soda."
,💫RATIONALE✔️✔️: Hypoglycemia: 15g rapid-acting carb (4 oz juice), recheck in 15 min. Candy bar has fat
(slows absorption). Diet soda no sugar.
💫ANSWER✔️✔️: A. "I will drink 4 oz of orange juice and recheck in 15 minutes."
---
**Question 3**
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding indicates
worsening respiratory status?
A. Productive cough with yellow sputum.
B. Use of accessory muscles and pursed-lip breathing.
C. SpO2 91% on 2 L nasal cannula.
D. Respiratory rate 18 breaths/min.
💫RATIONALE✔️✔️: Accessory muscle use and pursed-lip breathing indicate increased work of breathing,
worsening COPD. SpO2 91% on O2 is low but not as acute as muscle use.
💫ANSWER✔️✔️: B. Use of accessory muscles and pursed-lip breathing.
---
**Question 4**
A nurse is preparing to administer a blood transfusion. Which IV solution is compatible?
A. Lactated Ringer's.
B. 5% dextrose in water.
C. 0.9% sodium chloride.
D. 0.45% sodium chloride.
💫RATIONALE✔️✔️: Only 0.9% NaCl (normal saline) is compatible. LR contains calcium (clots). Dextrose
causes hemolysis.
,💫ANSWER✔️✔️: C. 0.9% sodium chloride.
---
**Question 5**
A client is receiving IV furosemide (Lasix). Which finding requires immediate intervention?
A. Serum potassium 3.8 mEq/L.
B. Tinnitus.
C. Increased urine output.
D. Blood pressure 110/70 mm Hg.
💫RATIONALE✔️✔️: Tinnitus indicates ototoxicity (dose-related, especially rapid IV push). Hypokalemia
common but 3.8 normal. Increased output expected.
💫ANSWER✔️✔️: B. Tinnitus.
---
**Question 6**
A nurse is caring for a client with a chest tube after a pneumothorax. The water seal chamber has
continuous bubbling. Which action should the nurse take?
A. Clamp the chest tube.
B. Assess for an air leak.
C. Increase suction pressure.
D. Document as normal.
💫RATIONALE✔️✔️: Continuous bubbling in water seal indicates air leak. Assess connections, insertion
site. Clamping risks tension pneumothorax.
💫ANSWER✔️✔️: B. Assess for an air leak.
, ---
**Question 7**
A client with heart failure has a prescription for metoprolol succinate (Toprol XL). Which finding
indicates the medication is effective?
A. Decreased heart rate and improved ejection fraction.
B. Increased blood pressure.
C. Weight gain of 2 lb in 2 days.
D. Crackles in lung bases.
💫RATIONALE✔️✔️: Beta-blockers in HF reduce HR, improve LV function over time. Weight gain and
crackles indicate worsening failure.
💫ANSWER✔️✔️: A. Decreased heart rate and improved ejection fraction.
---
**Question 8**
A nurse is assessing a client with a traumatic brain injury. Which finding indicates increased intracranial
pressure (ICP)?
A. Hypotension and tachycardia.
B. Hypertension and bradycardia.
C. Tachypnea and fever.
D. Hypothermia and bradycardia.
💫RATIONALE✔️✔️: Cushing's triad: hypertension (widening pulse pressure), bradycardia, irregular
respirations. Late sign of herniation.
💫ANSWER✔️✔️: B. Hypertension and bradycardia.
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