**Walden University Nursing Revision Notes | 2025/2026 – Complete
Study Bundle for NCLEX**
*Your student-crafted, comprehensive review resource covering
essential nursing concepts, pharmacology, and prioritization
strategies.*
Compiled from student notes and practice resources — not an official
exam.
---
**💫QUESTION 1:**
A client with a history of type 2 diabetes is prescribed metformin (Glucophage). Which finding would
cause the nurse to question this prescription?
A) Serum creatinine of 1.0 mg/dL
B) Hemoglobin A1c of 7.2%
C) Serum creatinine of 2.4 mg/dL
D) Fasting blood glucose of 150 mg/dL
💫ANSWER✔️✔️: C) Serum creatinine of 2.4 mg/dL
💫RATIONALE✔️✔️: Metformin is contraindicated in clients with significant renal impairment (creatinine ≥
1.5 in men, ≥ 1.4 in women) due to the risk of lactic acidosis. A creatinine of 2.4 indicates severe renal
dysfunction. Option A is normal; Option B indicates poor glycemic control but is not a contraindication;
Option D is elevated but not a contraindication. *I remember: "Metformin and kidneys – don't push it
beyond the limits."* This nursing exam prep question is crucial for pharmacology safety. *(SEO: nursing
exam prep, study guide, practice questions, pharmacology)*
---
,**💫QUESTION 2:**
The nurse is assessing a client with a suspected pulmonary embolism (PE). Which finding is most
concerning and requires immediate intervention?
A) Pleuritic chest pain and mild dyspnea
B) Tachycardia and tachypnea
C) Sudden onset of hypotension and syncope
D) Hemoptysis and crackles
💫ANSWER✔️✔️: C) Sudden onset of hypotension and syncope
💫RATIONALE✔️✔️: Sudden hypotension and syncope indicate a massive PE causing obstructive shock – a
life-threatening emergency. Option A and B are classic symptoms but not as immediately critical; Option
D can occur but is less emergent. *I remember: "PE + hypotension = take action."* This critical care
question is vital for nursing exam prep. *(SEO: critical care, study guide, nursing exam prep)*
---
**💫QUESTION 3:**
A client with schizophrenia is taking haloperidol (Haldol). Which adverse effect is most likely to occur
early in treatment?
A) Tardive dyskinesia
B) Acute dystonia
C) Weight gain
D) Metabolic syndrome
💫ANSWER✔️✔️: B) Acute dystonia
💫RATIONALE✔️✔️: Acute dystonia (muscle spasms, oculogyric crisis) is an early extrapyramidal symptom
(EPS) that can occur within days of starting haloperidol. Tardive dyskinesia occurs after long-term use;
weight gain and metabolic syndrome are more common with atypical antipsychotics. *I remember:
"Dystonia early – treat with Benadryl or Cogentin."* This mental health/pharmacology question is
essential for nursing exam prep. *(SEO: mental health, pharmacology, nursing exam prep)*
, ---
**💫QUESTION 4:**
The nurse is preparing to infuse 1000 mL of 0.9% normal saline over 6 hours. The drop factor is 20
gtt/mL. What is the drip rate in drops per minute?
A) 33 gtt/min
B) 56 gtt/min
C) 83 gtt/min
D) 111 gtt/min
💫ANSWER✔️✔️: B) 56 gtt/min
💫RATIONALE✔️✔️: Formula: (1000 × 20) ÷ (6 × 60) = 20,000 ÷ 360 = 55.55 → 56 gtt/min. Option A is too
low; Option C and D are incorrect calculations. *I double-check: "Slow and steady – 56 is ready."* This
dosage calculation question is a staple for nursing exam prep. *(SEO: dosage calculations, nursing exam
prep, student success)*
---
**💫QUESTION 5:**
A client with a permanent colostomy asks the nurse, "Will I ever be able to control my bowel
movements again?" Which response is most appropriate?
A) "You will learn to irrigate your colostomy to schedule bowel movements."
B) "No, you'll need to wear a pouch at all times."
C) "It depends on the type of colostomy you have."
D) "Let's talk about how the pouch works first."
💫ANSWER✔️✔️: A) "You will learn to irrigate your colostomy to schedule bowel movements."
Study Bundle for NCLEX**
*Your student-crafted, comprehensive review resource covering
essential nursing concepts, pharmacology, and prioritization
strategies.*
Compiled from student notes and practice resources — not an official
exam.
---
**💫QUESTION 1:**
A client with a history of type 2 diabetes is prescribed metformin (Glucophage). Which finding would
cause the nurse to question this prescription?
A) Serum creatinine of 1.0 mg/dL
B) Hemoglobin A1c of 7.2%
C) Serum creatinine of 2.4 mg/dL
D) Fasting blood glucose of 150 mg/dL
💫ANSWER✔️✔️: C) Serum creatinine of 2.4 mg/dL
💫RATIONALE✔️✔️: Metformin is contraindicated in clients with significant renal impairment (creatinine ≥
1.5 in men, ≥ 1.4 in women) due to the risk of lactic acidosis. A creatinine of 2.4 indicates severe renal
dysfunction. Option A is normal; Option B indicates poor glycemic control but is not a contraindication;
Option D is elevated but not a contraindication. *I remember: "Metformin and kidneys – don't push it
beyond the limits."* This nursing exam prep question is crucial for pharmacology safety. *(SEO: nursing
exam prep, study guide, practice questions, pharmacology)*
---
,**💫QUESTION 2:**
The nurse is assessing a client with a suspected pulmonary embolism (PE). Which finding is most
concerning and requires immediate intervention?
A) Pleuritic chest pain and mild dyspnea
B) Tachycardia and tachypnea
C) Sudden onset of hypotension and syncope
D) Hemoptysis and crackles
💫ANSWER✔️✔️: C) Sudden onset of hypotension and syncope
💫RATIONALE✔️✔️: Sudden hypotension and syncope indicate a massive PE causing obstructive shock – a
life-threatening emergency. Option A and B are classic symptoms but not as immediately critical; Option
D can occur but is less emergent. *I remember: "PE + hypotension = take action."* This critical care
question is vital for nursing exam prep. *(SEO: critical care, study guide, nursing exam prep)*
---
**💫QUESTION 3:**
A client with schizophrenia is taking haloperidol (Haldol). Which adverse effect is most likely to occur
early in treatment?
A) Tardive dyskinesia
B) Acute dystonia
C) Weight gain
D) Metabolic syndrome
💫ANSWER✔️✔️: B) Acute dystonia
💫RATIONALE✔️✔️: Acute dystonia (muscle spasms, oculogyric crisis) is an early extrapyramidal symptom
(EPS) that can occur within days of starting haloperidol. Tardive dyskinesia occurs after long-term use;
weight gain and metabolic syndrome are more common with atypical antipsychotics. *I remember:
"Dystonia early – treat with Benadryl or Cogentin."* This mental health/pharmacology question is
essential for nursing exam prep. *(SEO: mental health, pharmacology, nursing exam prep)*
, ---
**💫QUESTION 4:**
The nurse is preparing to infuse 1000 mL of 0.9% normal saline over 6 hours. The drop factor is 20
gtt/mL. What is the drip rate in drops per minute?
A) 33 gtt/min
B) 56 gtt/min
C) 83 gtt/min
D) 111 gtt/min
💫ANSWER✔️✔️: B) 56 gtt/min
💫RATIONALE✔️✔️: Formula: (1000 × 20) ÷ (6 × 60) = 20,000 ÷ 360 = 55.55 → 56 gtt/min. Option A is too
low; Option C and D are incorrect calculations. *I double-check: "Slow and steady – 56 is ready."* This
dosage calculation question is a staple for nursing exam prep. *(SEO: dosage calculations, nursing exam
prep, student success)*
---
**💫QUESTION 5:**
A client with a permanent colostomy asks the nurse, "Will I ever be able to control my bowel
movements again?" Which response is most appropriate?
A) "You will learn to irrigate your colostomy to schedule bowel movements."
B) "No, you'll need to wear a pouch at all times."
C) "It depends on the type of colostomy you have."
D) "Let's talk about how the pouch works first."
💫ANSWER✔️✔️: A) "You will learn to irrigate your colostomy to schedule bowel movements."
