** The Rapid-Fire Nursing Accelerator: NCLEX-RN,
HESI & ATI Final Crossover 2025/2026**
Question 1
A nurse in the emergency department assesses a client with severe abdominal pain. The client’s
abdomen is rigid and board-like, and the client reports sudden, sharp pain that radiates to the shoulder.
What is the priority action?
A. Administer IV morphine
B. Place the client in high Fowler’s position
C. Prepare the client for emergency surgery
D. Insert a nasogastric tube
---
💫RATIONALE✔️✔️: Rigid abdomen with referred shoulder pain suggests a perforated viscus (e.g.,
perforated ulcer); emergency surgery is required.
💫ANSWER✔️✔️: C. Prepare the client for emergency surgery
---
Question 2
A client with a history of heart failure is prescribed carvedilol. The client’s heart rate is 52 bpm and
blood pressure is 90/60 mm Hg. Which action should the nurse take first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Give atropine per protocol
D. Increase the IV fluid rate
---
💫RATIONALE✔️✔️: Beta-blockers are held for HR <60 or SBP <100; withhold dose and notify provider for
potential dose adjustment.
💫ANSWER✔️✔️: B. Hold the dose and notify the provider
---
Question 3
,A client with a new ileostomy reports output of 1,500 mL in 12 hours. Which assessment finding
indicates the client is developing dehydration?
A. Blood pressure 130/80 mm Hg
B. Heart rate 110 bpm
C. Urine output 60 mL/hour
D. Skin turgor with immediate recoil
---
💫RATIONALE✔️✔️: High ileostomy output (>1,200 mL/12h) risks dehydration; tachycardia (HR >100) is an
early sign of hypovolemia.
💫ANSWER✔️✔️: B. Heart rate 110 bpm
---
Question 4
A nurse is teaching a client with a new prescription for nitroglycerin sublingual tablets. Which instruction
is correct?
A. “Swallow the tablet whole with a glass of water.”
B. “Take one tablet every 5 minutes for up to 3 doses for chest pain.”
C. “Store the tablets in a plastic container in the bathroom.”
D. “If you have a headache, stop taking the medication immediately.”
---
💫RATIONALE✔️✔️: Nitroglycerin is taken sublingually every 5 minutes for up to 3 doses; store in a cool,
dark, glass bottle; headache is common.
💫ANSWER✔️✔️: B. “Take one tablet every 5 minutes for up to 3 doses for chest pain.”
---
Question 5
A client with a history of alcohol use disorder is admitted with jaundice and ascites. Which laboratory
finding is most consistent with alcoholic liver disease?
A. AST:ALT ratio of 2.5:1
B. Albumin 5.0 g/dL
C. INR 1.0
D. Platelet count 400,000/mm³
, ---
💫RATIONALE✔️✔️: In alcoholic liver disease, AST is typically > ALT, often with ratio >2; other labs show
low albumin, high INR, low platelets.
💫ANSWER✔️✔️: A. AST:ALT ratio of 2.5:1
---
Question 6
A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the water seal
chamber. What is the priority action?
A. Increase the suction pressure
B. Clamp the tube near the insertion site
C. Assess the system for an air leak
D. Document the finding as normal
---
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak; assess the
system from the client to the drainage unit to locate it.
💫ANSWER✔️✔️: C. Assess the system for an air leak
---
Question 7
A client with a new diagnosis of type 1 diabetes has a blood glucose of 480 mg/dL and serum potassium
of 3.0 mEq/L. The nurse is preparing to start an insulin drip. Which action should the nurse take first?
A. Begin insulin drip at 0.1 units/kg/hour
B. Administer IV potassium chloride
C. Give 50% dextrose IV push
D. Start IV fluid with 0.9% normal saline
---
💫RATIONALE✔️✔️: Hypokalemia (K+ <3.5) must be corrected before starting insulin to prevent cardiac
arrhythmias; insulin drives potassium into cells, worsening hypokalemia.
💫ANSWER✔️✔️: B. Administer IV potassium chloride
---
Question 8
HESI & ATI Final Crossover 2025/2026**
Question 1
A nurse in the emergency department assesses a client with severe abdominal pain. The client’s
abdomen is rigid and board-like, and the client reports sudden, sharp pain that radiates to the shoulder.
What is the priority action?
A. Administer IV morphine
B. Place the client in high Fowler’s position
C. Prepare the client for emergency surgery
D. Insert a nasogastric tube
---
💫RATIONALE✔️✔️: Rigid abdomen with referred shoulder pain suggests a perforated viscus (e.g.,
perforated ulcer); emergency surgery is required.
💫ANSWER✔️✔️: C. Prepare the client for emergency surgery
---
Question 2
A client with a history of heart failure is prescribed carvedilol. The client’s heart rate is 52 bpm and
blood pressure is 90/60 mm Hg. Which action should the nurse take first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Give atropine per protocol
D. Increase the IV fluid rate
---
💫RATIONALE✔️✔️: Beta-blockers are held for HR <60 or SBP <100; withhold dose and notify provider for
potential dose adjustment.
💫ANSWER✔️✔️: B. Hold the dose and notify the provider
---
Question 3
,A client with a new ileostomy reports output of 1,500 mL in 12 hours. Which assessment finding
indicates the client is developing dehydration?
A. Blood pressure 130/80 mm Hg
B. Heart rate 110 bpm
C. Urine output 60 mL/hour
D. Skin turgor with immediate recoil
---
💫RATIONALE✔️✔️: High ileostomy output (>1,200 mL/12h) risks dehydration; tachycardia (HR >100) is an
early sign of hypovolemia.
💫ANSWER✔️✔️: B. Heart rate 110 bpm
---
Question 4
A nurse is teaching a client with a new prescription for nitroglycerin sublingual tablets. Which instruction
is correct?
A. “Swallow the tablet whole with a glass of water.”
B. “Take one tablet every 5 minutes for up to 3 doses for chest pain.”
C. “Store the tablets in a plastic container in the bathroom.”
D. “If you have a headache, stop taking the medication immediately.”
---
💫RATIONALE✔️✔️: Nitroglycerin is taken sublingually every 5 minutes for up to 3 doses; store in a cool,
dark, glass bottle; headache is common.
💫ANSWER✔️✔️: B. “Take one tablet every 5 minutes for up to 3 doses for chest pain.”
---
Question 5
A client with a history of alcohol use disorder is admitted with jaundice and ascites. Which laboratory
finding is most consistent with alcoholic liver disease?
A. AST:ALT ratio of 2.5:1
B. Albumin 5.0 g/dL
C. INR 1.0
D. Platelet count 400,000/mm³
, ---
💫RATIONALE✔️✔️: In alcoholic liver disease, AST is typically > ALT, often with ratio >2; other labs show
low albumin, high INR, low platelets.
💫ANSWER✔️✔️: A. AST:ALT ratio of 2.5:1
---
Question 6
A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the water seal
chamber. What is the priority action?
A. Increase the suction pressure
B. Clamp the tube near the insertion site
C. Assess the system for an air leak
D. Document the finding as normal
---
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak; assess the
system from the client to the drainage unit to locate it.
💫ANSWER✔️✔️: C. Assess the system for an air leak
---
Question 7
A client with a new diagnosis of type 1 diabetes has a blood glucose of 480 mg/dL and serum potassium
of 3.0 mEq/L. The nurse is preparing to start an insulin drip. Which action should the nurse take first?
A. Begin insulin drip at 0.1 units/kg/hour
B. Administer IV potassium chloride
C. Give 50% dextrose IV push
D. Start IV fluid with 0.9% normal saline
---
💫RATIONALE✔️✔️: Hypokalemia (K+ <3.5) must be corrected before starting insulin to prevent cardiac
arrhythmias; insulin drives potassium into cells, worsening hypokalemia.
💫ANSWER✔️✔️: B. Administer IV potassium chloride
---
Question 8
