,RN ATI Comprehensive Predictor
Advanced Prep: Master Clinical
Judgment & NCLEX-RN Practice
Questions
Subject: NCLEX-RN Clinical Judgment & Complex Nursing Management
Question 1: A nurse is caring for a client who is 2 hours post-operative following a
thyroidectomy. The nurse notes the client has developed stridor, restlessness, and a tingling
sensation around the mouth. Which of the following is the priority nursing intervention?
A) Administer intravenous calcium gluconate.
B) Notify the surgeon to prepare for an emergency tracheostomy.
C) Elevate the head of the bed to 45 degrees.
D) Perform a Chvostek’s sign assessment.
Correct Answer: B) Notify the surgeon to prepare for an emergency tracheostomy.
Explanation: The client is exhibiting signs of airway compromise (stridor) and hypocalcemia
(tingling sensation, which suggests accidental removal or damage to the parathyroid glands).
While calcium gluconate (A) is necessary to treat the hypocalcemia, the airway is the absolute
priority. Stridor indicates an impending airway obstruction, likely due to laryngeal edema or
hematoma, necessitating immediate surgical intervention or airway support. Elevating the head
(C) and performing assessments (D) are secondary to securing the airway.
Question 2: A nurse is caring for a client receiving a continuous infusion of heparin for a
pulmonary embolism. The client’s aPTT is 120 seconds. What is the nurse's first action?
A) Decrease the infusion rate by 20%.
B) Obtain a stat serum fibrinogen level.
C) Stop the heparin infusion.
D) Prepare to administer protamine sulfate.
Correct Answer: C) Stop the heparin infusion.
,Explanation: The normal aPTT range is typically 25-35 seconds, with a therapeutic range for
heparin usually being 1.5 to 2.5 times the control. An aPTT of 120 seconds is significantly above
the therapeutic range, placing the client at a high risk for life-threatening hemorrhage. Stopping
the infusion is the immediate action to prevent further escalation. Protamine sulfate (D) is the
antidote, but it is typically reserved for severe bleeding or extreme toxicity, not as the first step
for a high lab value. Decreasing the rate (A) is insufficient given the critical elevation.
Question 3: A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
Following aggressive fluid resuscitation and the initiation of a regular insulin drip, the nurse
notes the client’s serum potassium has dropped from 4.8 mEq/L to 3.2 mEq/L. Which action
should the nurse take?
A) Increase the insulin infusion rate.
B) Hold the insulin infusion and notify the provider.
C) Administer a rapid-acting insulin bolus.
D) Increase the rate of the saline infusion.
Correct Answer: B) Hold the insulin infusion and notify the provider.
Explanation: Insulin shifts potassium from the extracellular space into the cells, which causes a
decrease in serum potassium levels. A level of 3.2 mEq/L is hypokalemic and dangerous,
potentially leading to cardiac arrhythmias. Insulin must be held until the potassium level is
stabilized, usually through potassium replacement as ordered by the provider. Increasing insulin
(A) or administering a bolus (C) would further drop the potassium. Saline (D) does not address
the hypokalemia.
Question 4: A nurse is managing a client with increased intracranial pressure (ICP). Which of the
following positions is most appropriate for this client?
A) Trendelenburg position.
B) Prone position with the head turned to the side.
C) Side-lying with the head of the bed flat.
D) Semi-Fowler’s position with the head in a neutral midline position.
Correct Answer: D) Semi-Fowler’s position with the head in a neutral midline position.
Explanation: To facilitate venous drainage from the brain and reduce ICP, the head of the bed
should be elevated (typically 30 degrees). The head must be kept in a neutral midline position to
prevent obstruction of the jugular veins, which would impede venous return and increase ICP.
Trendelenburg (A) increases ICP, and the prone or flat positions (B, C) hinder venous outflow.
, Question 5: A nurse is caring for a client with Addisonian crisis. Which of the following findings
should the nurse expect?
A) Hypernatremia and hypertension.
B) Hypotension and hyperkalemia.
C) Hypokalemia and tachycardia.
D) Hyperglycemia and weight gain.
Correct Answer: B) Hypotension and hyperkalemia.
Explanation: Addisonian crisis is a life-threatening deficiency of cortisol and aldosterone.
Aldosterone deficiency leads to sodium and water loss (hyponatremia, leading to hypotension)
and potassium retention (hyperkalemia). Options A, C, and D describe manifestations of
Cushing's syndrome or other endocrine imbalances, which are the opposite of an Addisonian
crisis.
Question 6: A client with schizophrenia is being treated with clozapine. Which of the following
assessments is the highest priority?
A) Assessing for symptoms of orthostatic hypotension.
B) Monitoring the client’s intake and output.
C) Reviewing the absolute neutrophil count (ANC).
D) Evaluating the client for signs of tardive dyskinesia.
Correct Answer: C) Reviewing the absolute neutrophil count (ANC).
Explanation: Clozapine carries a black box warning for agranulocytosis, a life-threatening
reduction in white blood cells. Regular monitoring of the ANC is mandatory to detect this
potential complication early. While orthostatic hypotension (A) and tardive dyskinesia (D) are
concerns with antipsychotics, the risk of agranulocytosis with clozapine is the most immediate
safety priority.
Question 7: A nurse is preparing to administer phenytoin to a client. Which of the following
should the nurse include in the client's care?
A) Administer with a glass of milk to prevent gastric irritation.
B) Monitor for gingival hyperplasia and provide oral hygiene instructions.
C) Increase the dose if the client develops a rash.
Advanced Prep: Master Clinical
Judgment & NCLEX-RN Practice
Questions
Subject: NCLEX-RN Clinical Judgment & Complex Nursing Management
Question 1: A nurse is caring for a client who is 2 hours post-operative following a
thyroidectomy. The nurse notes the client has developed stridor, restlessness, and a tingling
sensation around the mouth. Which of the following is the priority nursing intervention?
A) Administer intravenous calcium gluconate.
B) Notify the surgeon to prepare for an emergency tracheostomy.
C) Elevate the head of the bed to 45 degrees.
D) Perform a Chvostek’s sign assessment.
Correct Answer: B) Notify the surgeon to prepare for an emergency tracheostomy.
Explanation: The client is exhibiting signs of airway compromise (stridor) and hypocalcemia
(tingling sensation, which suggests accidental removal or damage to the parathyroid glands).
While calcium gluconate (A) is necessary to treat the hypocalcemia, the airway is the absolute
priority. Stridor indicates an impending airway obstruction, likely due to laryngeal edema or
hematoma, necessitating immediate surgical intervention or airway support. Elevating the head
(C) and performing assessments (D) are secondary to securing the airway.
Question 2: A nurse is caring for a client receiving a continuous infusion of heparin for a
pulmonary embolism. The client’s aPTT is 120 seconds. What is the nurse's first action?
A) Decrease the infusion rate by 20%.
B) Obtain a stat serum fibrinogen level.
C) Stop the heparin infusion.
D) Prepare to administer protamine sulfate.
Correct Answer: C) Stop the heparin infusion.
,Explanation: The normal aPTT range is typically 25-35 seconds, with a therapeutic range for
heparin usually being 1.5 to 2.5 times the control. An aPTT of 120 seconds is significantly above
the therapeutic range, placing the client at a high risk for life-threatening hemorrhage. Stopping
the infusion is the immediate action to prevent further escalation. Protamine sulfate (D) is the
antidote, but it is typically reserved for severe bleeding or extreme toxicity, not as the first step
for a high lab value. Decreasing the rate (A) is insufficient given the critical elevation.
Question 3: A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
Following aggressive fluid resuscitation and the initiation of a regular insulin drip, the nurse
notes the client’s serum potassium has dropped from 4.8 mEq/L to 3.2 mEq/L. Which action
should the nurse take?
A) Increase the insulin infusion rate.
B) Hold the insulin infusion and notify the provider.
C) Administer a rapid-acting insulin bolus.
D) Increase the rate of the saline infusion.
Correct Answer: B) Hold the insulin infusion and notify the provider.
Explanation: Insulin shifts potassium from the extracellular space into the cells, which causes a
decrease in serum potassium levels. A level of 3.2 mEq/L is hypokalemic and dangerous,
potentially leading to cardiac arrhythmias. Insulin must be held until the potassium level is
stabilized, usually through potassium replacement as ordered by the provider. Increasing insulin
(A) or administering a bolus (C) would further drop the potassium. Saline (D) does not address
the hypokalemia.
Question 4: A nurse is managing a client with increased intracranial pressure (ICP). Which of the
following positions is most appropriate for this client?
A) Trendelenburg position.
B) Prone position with the head turned to the side.
C) Side-lying with the head of the bed flat.
D) Semi-Fowler’s position with the head in a neutral midline position.
Correct Answer: D) Semi-Fowler’s position with the head in a neutral midline position.
Explanation: To facilitate venous drainage from the brain and reduce ICP, the head of the bed
should be elevated (typically 30 degrees). The head must be kept in a neutral midline position to
prevent obstruction of the jugular veins, which would impede venous return and increase ICP.
Trendelenburg (A) increases ICP, and the prone or flat positions (B, C) hinder venous outflow.
, Question 5: A nurse is caring for a client with Addisonian crisis. Which of the following findings
should the nurse expect?
A) Hypernatremia and hypertension.
B) Hypotension and hyperkalemia.
C) Hypokalemia and tachycardia.
D) Hyperglycemia and weight gain.
Correct Answer: B) Hypotension and hyperkalemia.
Explanation: Addisonian crisis is a life-threatening deficiency of cortisol and aldosterone.
Aldosterone deficiency leads to sodium and water loss (hyponatremia, leading to hypotension)
and potassium retention (hyperkalemia). Options A, C, and D describe manifestations of
Cushing's syndrome or other endocrine imbalances, which are the opposite of an Addisonian
crisis.
Question 6: A client with schizophrenia is being treated with clozapine. Which of the following
assessments is the highest priority?
A) Assessing for symptoms of orthostatic hypotension.
B) Monitoring the client’s intake and output.
C) Reviewing the absolute neutrophil count (ANC).
D) Evaluating the client for signs of tardive dyskinesia.
Correct Answer: C) Reviewing the absolute neutrophil count (ANC).
Explanation: Clozapine carries a black box warning for agranulocytosis, a life-threatening
reduction in white blood cells. Regular monitoring of the ANC is mandatory to detect this
potential complication early. While orthostatic hypotension (A) and tardive dyskinesia (D) are
concerns with antipsychotics, the risk of agranulocytosis with clozapine is the most immediate
safety priority.
Question 7: A nurse is preparing to administer phenytoin to a client. Which of the following
should the nurse include in the client's care?
A) Administer with a glass of milk to prevent gastric irritation.
B) Monitor for gingival hyperplasia and provide oral hygiene instructions.
C) Increase the dose if the client develops a rash.
