**Title:** **Emergency & Critical Care Crucible: High-
Acuity NCLEX-RN Scenarios**
---
### Question 1 of 97
A nurse in the emergency department is triaging clients after a mass casualty event. Which of the
following clients should the nurse prioritize for immediate treatment?
A) A client with a partial-thickness burn to 30% of total body surface area who is conscious and talking
B) A client with an open femur fracture and palpable distal pulses
C) A client who is unconscious with a respiratory rate of 8 breaths per minute
D) A client with a sucking chest wound who is alert and has an SpO2 of 91%
💫RATIONALE✔️✔️: In mass casualty triage, immediate (red tag) clients have life-threatening conditions
but high survivability with intervention. An unconscious client with a respiratory rate of 8 (C) has airway
or breathing compromise and requires immediate intervention. The other clients are stable or can wait
(yellow or green tags).
💫ANSWER✔️✔️: C) A client who is unconscious with a respiratory rate of 8 breaths per minute
---
### Question 2 of 97
A nurse is caring for a client who was admitted with carbon monoxide poisoning. Which of the following
findings is most consistent with this diagnosis?
,A) Cherry-red skin color
B) Cyanosis of the lips and nail beds
C) Jaundice of the sclera
D) Pallor and diaphoresis
💫RATIONALE✔️✔️: Carbon monoxide poisoning causes cherry-red skin color (A) due to the formation of
carboxyhemoglobin. Cyanosis indicates hypoxemia from other causes. Jaundice suggests liver
dysfunction. Pallor and diaphoresis are non-specific.
💫ANSWER✔️✔️: A) Cherry-red skin color
---
### Question 3 of 97
**Select-All-That-Apply (SATA):** A nurse is assessing a client who has a tension pneumothorax
following blunt chest trauma. Which of the following findings should the nurse expect? (Select all that
apply.)
A) Absent breath sounds on the affected side
B) Tracheal deviation toward the affected side
C) Hypotension
D) Jugular vein distention
E) Hyperresonance on percussion
💫RATIONALE✔️✔️: Tension pneumothorax causes absent breath sounds (A), hypotension (C), JVD (D)
from decreased venous return, and hyperresonance (E). Tracheal deviation is away from, not toward,
the affected side (B is wrong).
💫ANSWER✔️✔️: A, C, D, E
---
, ### Question 4 of 97
A nurse in the intensive care unit is caring for a client who has a pulmonary artery catheter. The nurse
notes that the pulmonary artery wedge pressure (PAWP) is 4 mmHg. Which of the following conditions
should the nurse suspect?
A) Hypervolemia
B) Left ventricular failure
C) Hypovolemia
D) Pulmonary hypertension
💫RATIONALE✔️✔️: Normal PAWP is 4-12 mmHg. A PAWP of 4 mmHg is at the low end of normal but
trending toward hypovolemia (C). Hypovolemia decreases preload, lowering PAWP. Left ventricular
failure and hypervolemia increase PAWP (>12 mmHg).
💫ANSWER✔️✔️: C) Hypovolemia
---
### Question 5 of 97
A nurse is caring for a client who has a new diagnosis of acute respiratory distress syndrome (ARDS).
Which of the following findings is expected in the early phase?
A) Severe hypoxemia that does not improve with oxygen therapy
B) Hypercapnia and respiratory acidosis
C) Normal chest x-ray
D) Bradycardia and hypotension
Acuity NCLEX-RN Scenarios**
---
### Question 1 of 97
A nurse in the emergency department is triaging clients after a mass casualty event. Which of the
following clients should the nurse prioritize for immediate treatment?
A) A client with a partial-thickness burn to 30% of total body surface area who is conscious and talking
B) A client with an open femur fracture and palpable distal pulses
C) A client who is unconscious with a respiratory rate of 8 breaths per minute
D) A client with a sucking chest wound who is alert and has an SpO2 of 91%
💫RATIONALE✔️✔️: In mass casualty triage, immediate (red tag) clients have life-threatening conditions
but high survivability with intervention. An unconscious client with a respiratory rate of 8 (C) has airway
or breathing compromise and requires immediate intervention. The other clients are stable or can wait
(yellow or green tags).
💫ANSWER✔️✔️: C) A client who is unconscious with a respiratory rate of 8 breaths per minute
---
### Question 2 of 97
A nurse is caring for a client who was admitted with carbon monoxide poisoning. Which of the following
findings is most consistent with this diagnosis?
,A) Cherry-red skin color
B) Cyanosis of the lips and nail beds
C) Jaundice of the sclera
D) Pallor and diaphoresis
💫RATIONALE✔️✔️: Carbon monoxide poisoning causes cherry-red skin color (A) due to the formation of
carboxyhemoglobin. Cyanosis indicates hypoxemia from other causes. Jaundice suggests liver
dysfunction. Pallor and diaphoresis are non-specific.
💫ANSWER✔️✔️: A) Cherry-red skin color
---
### Question 3 of 97
**Select-All-That-Apply (SATA):** A nurse is assessing a client who has a tension pneumothorax
following blunt chest trauma. Which of the following findings should the nurse expect? (Select all that
apply.)
A) Absent breath sounds on the affected side
B) Tracheal deviation toward the affected side
C) Hypotension
D) Jugular vein distention
E) Hyperresonance on percussion
💫RATIONALE✔️✔️: Tension pneumothorax causes absent breath sounds (A), hypotension (C), JVD (D)
from decreased venous return, and hyperresonance (E). Tracheal deviation is away from, not toward,
the affected side (B is wrong).
💫ANSWER✔️✔️: A, C, D, E
---
, ### Question 4 of 97
A nurse in the intensive care unit is caring for a client who has a pulmonary artery catheter. The nurse
notes that the pulmonary artery wedge pressure (PAWP) is 4 mmHg. Which of the following conditions
should the nurse suspect?
A) Hypervolemia
B) Left ventricular failure
C) Hypovolemia
D) Pulmonary hypertension
💫RATIONALE✔️✔️: Normal PAWP is 4-12 mmHg. A PAWP of 4 mmHg is at the low end of normal but
trending toward hypovolemia (C). Hypovolemia decreases preload, lowering PAWP. Left ventricular
failure and hypervolemia increase PAWP (>12 mmHg).
💫ANSWER✔️✔️: C) Hypovolemia
---
### Question 5 of 97
A nurse is caring for a client who has a new diagnosis of acute respiratory distress syndrome (ARDS).
Which of the following findings is expected in the early phase?
A) Severe hypoxemia that does not improve with oxygen therapy
B) Hypercapnia and respiratory acidosis
C) Normal chest x-ray
D) Bradycardia and hypotension
