,Master High-Yield Mark Klimek Nursing Principles
NCLEX-RN Advanced Prep: & Clinical Judgment
Subject: Mark Klimek High-Yield Nursing Concepts and Test-Taking Strategies
Question 1: A client with heart failure is receiving digoxin. The nurse reviews the lab results and
notes a potassium level of 3.2 mEq/L. What is the most immediate clinical priority for the nurse?
A) Administer the digoxin as scheduled.
B) Hold the digoxin and notify the healthcare provider.
C) Increase the client’s dietary intake of potassium-rich foods.
D) Administer a dose of spironolactone.
Correct Answer: B) Hold the digoxin and notify the healthcare provider.
Explanation: Hypokalemia potentiates the effect of digoxin, significantly increasing the risk of
digitalis toxicity, which can lead to life-threatening arrhythmias. The nurse must withhold the
medication to prevent toxicity. While potassium replacement (C, D) may be ordered, the
immediate safety priority is preventing the administration of a drug that could cause a cardiac
arrest in this clinical state.
Question 2: A client is diagnosed with hyperthyroidism and is being managed with
propylthiouracil (PTU). The nurse should prioritize monitoring for which rare but life-
threatening side effect?
A) Bradycardia and weight gain.
B) Agranulocytosis.
C) Exophthalmos.
D) Tachycardia and diaphoresis.
Correct Answer: B) Agranulocytosis.
Explanation: PTU is associated with the risk of agranulocytosis (a severe decrease in white
blood cell count). The nurse must teach the client to report signs of infection immediately (e.g.,
fever, sore throat). Bradycardia (A) is a sign of hypothyroidism (the opposite of the target effect),
and exophthalmos (C) is a symptom of Graves’ disease, not a side effect of the drug.
Question 3: A nurse is caring for a client with diabetes insipidus (DI). Which clinical
manifestation would the nurse expect to find?
,A) Urine specific gravity of 1.035.
B) Serum sodium level of 130 mEq/L.
C) Serum osmolality of 310 mOsm/kg.
D) Decreased urine output.
Correct Answer: C) Serum osmolality of 310 mOsm/kg.
Explanation: DI is characterized by a deficiency of ADH, leading to the excretion of large
volumes of dilute urine. This results in hemoconcentration, which manifests as high serum
osmolality and hypernatremia (high serum sodium). Option A and D describe SIADH, the
opposite condition.
Question 4: A nurse is caring for a client with Addison’s disease. The client is suddenly admitted
with hypotension and tachycardia after failing to take their scheduled steroid medication. Which
action is the priority?
A) Administer 50% dextrose IV.
B) Administer IV hydrocortisone.
C) Start a potassium-sparing diuretic.
D) Increase the client’s oral sodium intake.
Correct Answer: B) Administer IV hydrocortisone.
Explanation: This client is experiencing an Addisonian crisis. The priority is replacing the
deficient glucocorticoids immediately with IV corticosteroids. Potassium-sparing diuretics (C)
would worsen the potential hyperkalemia associated with Addison's disease.
Question 5: A client is receiving a continuous heparin infusion for a DVT. Which laboratory
finding most accurately reflects the effectiveness of heparin therapy?
A) PT/INR of 2.5.
B) PTT of 70 seconds.
C) Platelet count of 150,000/mm³.
D) Serum creatinine of 1.0 mg/dL.
Correct Answer: B) PTT of 70 seconds.
, Explanation: Heparin therapy is monitored using the Partial Thromboplastin Time (PTT). A
therapeutic range is typically 1.5 to 2.5 times the control, making 70 seconds a therapeutic
result. PT/INR (A) is used to monitor warfarin.
Question 6: A nurse is teaching a client about the use of Lithium. Which statement by the client
indicates an understanding of the medication's therapeutic management?
A) "I should restrict my sodium intake to avoid fluid retention."
B) "I need to maintain a consistent fluid and sodium intake."
C) "I can stop the medication if I feel 'normal' for a month."
D) "I should take this medication on an empty stomach."
Correct Answer: B) "I need to maintain a consistent fluid and sodium intake."
Explanation: Lithium is a salt; if sodium intake is low or erratic, the kidneys will retain lithium,
leading to toxicity. Maintaining a steady intake of both sodium and fluids is crucial for safe
therapeutic levels. Restricting sodium (A) is dangerous as it increases lithium levels.
Question 7: A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The nurse
notices the client's respiratory rate has decreased to 8 breaths/min. What is the nurse's priority
action?
A) Increase the oxygen flow rate to 4 L/min.
B) Immediately stop the oxygen flow.
C) Assess the client's LOC and oxygen saturation.
D) Notify the provider to request an ABG.
Correct Answer: C) Assess the client's LOC and oxygen saturation.
Explanation: The nurse must first assess the clinical status of the patient. If the oxygen is
suppressing the hypoxic drive, the patient will show signs of CO2 retention, such as confusion or
decreased LOC. Rushing to change settings (A, B) without assessment is not the standard
nursing process.
Question 8: A nurse is caring for a client with a history of Myasthenia Gravis. The nurse
recognizes that a "cholinergic crisis" is occurring. What is the most appropriate action?
A) Administer more pyridostigmine.
B) Prepare for immediate intubation.
NCLEX-RN Advanced Prep: & Clinical Judgment
Subject: Mark Klimek High-Yield Nursing Concepts and Test-Taking Strategies
Question 1: A client with heart failure is receiving digoxin. The nurse reviews the lab results and
notes a potassium level of 3.2 mEq/L. What is the most immediate clinical priority for the nurse?
A) Administer the digoxin as scheduled.
B) Hold the digoxin and notify the healthcare provider.
C) Increase the client’s dietary intake of potassium-rich foods.
D) Administer a dose of spironolactone.
Correct Answer: B) Hold the digoxin and notify the healthcare provider.
Explanation: Hypokalemia potentiates the effect of digoxin, significantly increasing the risk of
digitalis toxicity, which can lead to life-threatening arrhythmias. The nurse must withhold the
medication to prevent toxicity. While potassium replacement (C, D) may be ordered, the
immediate safety priority is preventing the administration of a drug that could cause a cardiac
arrest in this clinical state.
Question 2: A client is diagnosed with hyperthyroidism and is being managed with
propylthiouracil (PTU). The nurse should prioritize monitoring for which rare but life-
threatening side effect?
A) Bradycardia and weight gain.
B) Agranulocytosis.
C) Exophthalmos.
D) Tachycardia and diaphoresis.
Correct Answer: B) Agranulocytosis.
Explanation: PTU is associated with the risk of agranulocytosis (a severe decrease in white
blood cell count). The nurse must teach the client to report signs of infection immediately (e.g.,
fever, sore throat). Bradycardia (A) is a sign of hypothyroidism (the opposite of the target effect),
and exophthalmos (C) is a symptom of Graves’ disease, not a side effect of the drug.
Question 3: A nurse is caring for a client with diabetes insipidus (DI). Which clinical
manifestation would the nurse expect to find?
,A) Urine specific gravity of 1.035.
B) Serum sodium level of 130 mEq/L.
C) Serum osmolality of 310 mOsm/kg.
D) Decreased urine output.
Correct Answer: C) Serum osmolality of 310 mOsm/kg.
Explanation: DI is characterized by a deficiency of ADH, leading to the excretion of large
volumes of dilute urine. This results in hemoconcentration, which manifests as high serum
osmolality and hypernatremia (high serum sodium). Option A and D describe SIADH, the
opposite condition.
Question 4: A nurse is caring for a client with Addison’s disease. The client is suddenly admitted
with hypotension and tachycardia after failing to take their scheduled steroid medication. Which
action is the priority?
A) Administer 50% dextrose IV.
B) Administer IV hydrocortisone.
C) Start a potassium-sparing diuretic.
D) Increase the client’s oral sodium intake.
Correct Answer: B) Administer IV hydrocortisone.
Explanation: This client is experiencing an Addisonian crisis. The priority is replacing the
deficient glucocorticoids immediately with IV corticosteroids. Potassium-sparing diuretics (C)
would worsen the potential hyperkalemia associated with Addison's disease.
Question 5: A client is receiving a continuous heparin infusion for a DVT. Which laboratory
finding most accurately reflects the effectiveness of heparin therapy?
A) PT/INR of 2.5.
B) PTT of 70 seconds.
C) Platelet count of 150,000/mm³.
D) Serum creatinine of 1.0 mg/dL.
Correct Answer: B) PTT of 70 seconds.
, Explanation: Heparin therapy is monitored using the Partial Thromboplastin Time (PTT). A
therapeutic range is typically 1.5 to 2.5 times the control, making 70 seconds a therapeutic
result. PT/INR (A) is used to monitor warfarin.
Question 6: A nurse is teaching a client about the use of Lithium. Which statement by the client
indicates an understanding of the medication's therapeutic management?
A) "I should restrict my sodium intake to avoid fluid retention."
B) "I need to maintain a consistent fluid and sodium intake."
C) "I can stop the medication if I feel 'normal' for a month."
D) "I should take this medication on an empty stomach."
Correct Answer: B) "I need to maintain a consistent fluid and sodium intake."
Explanation: Lithium is a salt; if sodium intake is low or erratic, the kidneys will retain lithium,
leading to toxicity. Maintaining a steady intake of both sodium and fluids is crucial for safe
therapeutic levels. Restricting sodium (A) is dangerous as it increases lithium levels.
Question 7: A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The nurse
notices the client's respiratory rate has decreased to 8 breaths/min. What is the nurse's priority
action?
A) Increase the oxygen flow rate to 4 L/min.
B) Immediately stop the oxygen flow.
C) Assess the client's LOC and oxygen saturation.
D) Notify the provider to request an ABG.
Correct Answer: C) Assess the client's LOC and oxygen saturation.
Explanation: The nurse must first assess the clinical status of the patient. If the oxygen is
suppressing the hypoxic drive, the patient will show signs of CO2 retention, such as confusion or
decreased LOC. Rushing to change settings (A, B) without assessment is not the standard
nursing process.
Question 8: A nurse is caring for a client with a history of Myasthenia Gravis. The nurse
recognizes that a "cholinergic crisis" is occurring. What is the most appropriate action?
A) Administer more pyridostigmine.
B) Prepare for immediate intubation.
