WCU NURS 493 Comprehensive Exit Exam (pdf) | 2026/2027 | ATI
Proctored NGN NCLEX-RN Q&A | Nursing
1. A nurse in a pediatric unit is preparing to insert an IV catheter for a 7-year-
old child. Which of the following actions should the nurse take to minimize
the child's pain and anxiety?
A) Tell the child the procedure will not hurt
B) Use a topical anesthetic cream prior to the procedure
C) Restrain the child's arm firmly to prevent movement
D) Explain the procedure in detail after it is completed
Correct Answer: Use a topical anesthetic cream prior to the procedure
Rationale: Using a topical anesthetic cream (such as EMLA) prior to IV
insertion numbs the skin and reduces pain, which is a key component of
atraumatic care for children. The nurse should provide developmentally
appropriate explanations before the procedure and avoid restraining
whenever possible.
2. A nurse is caring for a client with heart failure who is receiving furosemide.
Which of the following findings indicates that the medication is having the
desired therapeutic effect?
A) Decreased blood pressure
B) Increased urine output and decreased peripheral edema
C) Increased heart rate
D) Elevated serum potassium level
Correct Answer: Increased urine output and decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. The desired therapeutic effect is increased urine output leading to a
,reduction in peripheral edema and pulmonary congestion. Decreased blood
pressure is an expected effect but not the primary therapeutic indicator.
Furosemide can cause hypokalemia, not hyperkalemia.
3. A nurse is planning care for a client who is postoperative following a total
hip arthroplasty. Which of the following interventions should the nurse
include to prevent venous thromboembolism (VTE)?
A) Apply sequential compression devices (SCDs) to the lower extremities
B) Keep the client in a supine position with the legs straight
C) Massage the client's calves to promote circulation
D) Restrict the client's fluid intake
Correct Answer: Apply sequential compression devices (SCDs) to the lower
extremities
Rationale: SCDs promote venous return and are a key mechanical
prophylaxis measure to prevent VTE in postoperative clients. Leg massage is
contraindicated as it can dislodge a clot. Early ambulation and adequate
hydration are also recommended.
4. A nurse is assessing a client who is 24 hours postoperative following a
cholecystectomy. Which of the following findings should the nurse report to
the provider?
A) Serosanguineous drainage on the surgical dressing
B) Pain rated 4 on a 0-to-10 scale
C) Temperature of 38.4°C (101.1°F)
D) Hypoactive bowel sounds in all four quadrants
Correct Answer: Temperature of 38.4°C (101.1°F)
,Rationale: A fever of 38.4°C on the first postoperative day may indicate an
infection or other complication and should be reported to the provider.
Serosanguineous drainage, mild pain, and hypoactive bowel sounds are
expected findings in the immediate postoperative period.
5. A client with diabetes mellitus is prescribed metformin. The nurse should
instruct the client to monitor for which of the following adverse effects?
A) Weight gain
B) Hypoglycemia
C) Lactic acidosis
D) Hypertension
Correct Answer: Lactic acidosis
Rationale: Metformin is a biguanide that can cause lactic acidosis, a rare but
serious adverse effect, particularly in clients with renal impairment or
conditions that predispose to hypoxia. It does not typically cause
hypoglycemia when used alone and may promote weight loss, not gain.
6. A nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who is receiving oxygen at 2 L/min via nasal cannula. Which of the
following findings indicates the client is experiencing oxygen toxicity?
A) Headache and confusion
B) Increased respiratory rate
C) Bradycardia
D) Cyanosis of the lips
Correct Answer: Headache and confusion
, Rationale: Oxygen toxicity can occur with prolonged administration of high
concentrations of oxygen, but even at lower concentrations, signs include
headache, confusion, and restlessness. Increased respiratory rate,
bradycardia, and cyanosis are signs of hypoxia, not oxygen toxicity.
7. A nurse is preparing to administer a blood transfusion to a client. Which of
the following actions should the nurse take first?
A) Verify the client's identity and blood product with another licensed
professional
B) Obtain the client's baseline vital signs
C) Prime the IV tubing with 0.9% sodium chloride
D) Explain the procedure to the client
Correct Answer: Verify the client's identity and blood product with another
licensed professional
Rationale: The most critical action to prevent a transfusion reaction is to
verify the correct client and blood product with another licensed professional.
This is a two-person verification process to ensure ABO compatibility.
8. A nurse is caring for a client with major depressive disorder who is
prescribed fluoxetine. Which of the following adverse effects should the
nurse monitor for?
A) Weight gain
B) Sexual dysfunction
C) Sedation
D) Hypertensive crisis
Correct Answer: Sexual dysfunction
Proctored NGN NCLEX-RN Q&A | Nursing
1. A nurse in a pediatric unit is preparing to insert an IV catheter for a 7-year-
old child. Which of the following actions should the nurse take to minimize
the child's pain and anxiety?
A) Tell the child the procedure will not hurt
B) Use a topical anesthetic cream prior to the procedure
C) Restrain the child's arm firmly to prevent movement
D) Explain the procedure in detail after it is completed
Correct Answer: Use a topical anesthetic cream prior to the procedure
Rationale: Using a topical anesthetic cream (such as EMLA) prior to IV
insertion numbs the skin and reduces pain, which is a key component of
atraumatic care for children. The nurse should provide developmentally
appropriate explanations before the procedure and avoid restraining
whenever possible.
2. A nurse is caring for a client with heart failure who is receiving furosemide.
Which of the following findings indicates that the medication is having the
desired therapeutic effect?
A) Decreased blood pressure
B) Increased urine output and decreased peripheral edema
C) Increased heart rate
D) Elevated serum potassium level
Correct Answer: Increased urine output and decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. The desired therapeutic effect is increased urine output leading to a
,reduction in peripheral edema and pulmonary congestion. Decreased blood
pressure is an expected effect but not the primary therapeutic indicator.
Furosemide can cause hypokalemia, not hyperkalemia.
3. A nurse is planning care for a client who is postoperative following a total
hip arthroplasty. Which of the following interventions should the nurse
include to prevent venous thromboembolism (VTE)?
A) Apply sequential compression devices (SCDs) to the lower extremities
B) Keep the client in a supine position with the legs straight
C) Massage the client's calves to promote circulation
D) Restrict the client's fluid intake
Correct Answer: Apply sequential compression devices (SCDs) to the lower
extremities
Rationale: SCDs promote venous return and are a key mechanical
prophylaxis measure to prevent VTE in postoperative clients. Leg massage is
contraindicated as it can dislodge a clot. Early ambulation and adequate
hydration are also recommended.
4. A nurse is assessing a client who is 24 hours postoperative following a
cholecystectomy. Which of the following findings should the nurse report to
the provider?
A) Serosanguineous drainage on the surgical dressing
B) Pain rated 4 on a 0-to-10 scale
C) Temperature of 38.4°C (101.1°F)
D) Hypoactive bowel sounds in all four quadrants
Correct Answer: Temperature of 38.4°C (101.1°F)
,Rationale: A fever of 38.4°C on the first postoperative day may indicate an
infection or other complication and should be reported to the provider.
Serosanguineous drainage, mild pain, and hypoactive bowel sounds are
expected findings in the immediate postoperative period.
5. A client with diabetes mellitus is prescribed metformin. The nurse should
instruct the client to monitor for which of the following adverse effects?
A) Weight gain
B) Hypoglycemia
C) Lactic acidosis
D) Hypertension
Correct Answer: Lactic acidosis
Rationale: Metformin is a biguanide that can cause lactic acidosis, a rare but
serious adverse effect, particularly in clients with renal impairment or
conditions that predispose to hypoxia. It does not typically cause
hypoglycemia when used alone and may promote weight loss, not gain.
6. A nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who is receiving oxygen at 2 L/min via nasal cannula. Which of the
following findings indicates the client is experiencing oxygen toxicity?
A) Headache and confusion
B) Increased respiratory rate
C) Bradycardia
D) Cyanosis of the lips
Correct Answer: Headache and confusion
, Rationale: Oxygen toxicity can occur with prolonged administration of high
concentrations of oxygen, but even at lower concentrations, signs include
headache, confusion, and restlessness. Increased respiratory rate,
bradycardia, and cyanosis are signs of hypoxia, not oxygen toxicity.
7. A nurse is preparing to administer a blood transfusion to a client. Which of
the following actions should the nurse take first?
A) Verify the client's identity and blood product with another licensed
professional
B) Obtain the client's baseline vital signs
C) Prime the IV tubing with 0.9% sodium chloride
D) Explain the procedure to the client
Correct Answer: Verify the client's identity and blood product with another
licensed professional
Rationale: The most critical action to prevent a transfusion reaction is to
verify the correct client and blood product with another licensed professional.
This is a two-person verification process to ensure ABO compatibility.
8. A nurse is caring for a client with major depressive disorder who is
prescribed fluoxetine. Which of the following adverse effects should the
nurse monitor for?
A) Weight gain
B) Sexual dysfunction
C) Sedation
D) Hypertensive crisis
Correct Answer: Sexual dysfunction
