,Mark Klimek NCLEX Prep: Master Nursing
Fundamentals, Pharmacotherapy, &
Prioritization Practice Questions
Subject: Nursing Fundamentals (Based on Mark Klimek Nursing Lecture Series
1-12)
Question 1: A client with Type 1 Diabetes Mellitus presents with a blood glucose of 450 mg/dL,
Kussmaul respirations, and fruity-smelling breath. Which intravenous fluid order should the
nurse anticipate as the highest priority to correct the underlying metabolic abnormality?
A) D5W (5% Dextrose in water)
B) 0.45% Normal Saline
C) 0.9% Normal Saline
D) Lactated Ringer’s
Correct Answer: C) 0.9% Normal Saline
Explanation: In Diabetic Ketoacidosis (DKA), the client is profoundly dehydrated due to osmotic
diuresis. Fluid resuscitation is the absolute priority to restore tissue perfusion and renal
clearance of glucose. 0.9% Normal Saline is the standard initial isotonic bolus. 0.45% NS (B) is
used later for rehydration after hemodynamic stability is achieved. D5W (A) is contraindicated
in hyperglycemic crises.
Question 2: A nurse is managing a client with a continuous heparin infusion for DVT. The nurse
notes the aPTT is 105 seconds (Control: 30 seconds). What is the nurse's priority action based on
"Klimek-style" prioritization?
A) Continue the infusion as ordered.
B) Discontinue the infusion immediately and call the provider.
C) Increase the infusion rate to reach the therapeutic goal.
D) Administer Vitamin K.
Correct Answer: B) Discontinue the infusion immediately and call the provider.
Explanation: Klimek teaches to prioritize safety in anticoagulation therapy. A therapeutic aPTT
is generally 1.5 to 2.5 times the control (approx. 45–75 seconds). An aPTT of 105 indicates a
, high risk for spontaneous hemorrhage. Immediate cessation is required to prevent life-
threatening bleeding. Vitamin K (D) is the antidote for Warfarin, not Heparin (Protamine Sulfate
is the antidote for Heparin).
Question 3: A client is taking Lithium for Bipolar Disorder. Which laboratory result necessitates
immediate nursing intervention?
A) Serum sodium 135 mEq/L
B) Serum creatinine 0.8 mg/dL
C) Serum lithium level 2.2 mEq/L
D) Serum glucose 105 mg/dL
Correct Answer: C) Serum lithium level 2.2 mEq/L
Explanation: Lithium has a narrow therapeutic range (0.6–1.2 mEq/L). A level of 2.2 is clearly
toxic (toxic range typically >1.5). Signs of toxicity include tremors, confusion, and
cardiovascular compromise. Sodium levels (A) and creatinine (B) are within or near normal
limits.
Question 4: A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic
Hormone). Which nursing intervention is essential to prevent a secondary neurological
complication?
A) Increase oral fluid intake to 3000 mL/day.
B) Administer high-dose corticosteroids.
C) Monitor for serum sodium levels and implement seizure precautions.
D) Encourage a high-sodium, low-protein diet.
Correct Answer: C) Monitor for serum sodium levels and implement seizure precautions.
Explanation: SIADH causes water retention and dilutional hyponatremia. Severe hyponatremia
can lead to cerebral edema and seizures. Seizure precautions are a vital safety intervention.
Increasing fluids (A) is the opposite of the required treatment, which is fluid restriction.
Question 5: A client is prescribed Digoxin 0.25 mg daily. The client’s apical pulse is 58 bpm.
What is the priority nursing action?
A) Administer the dose as ordered.
B) Withhold the dose and check the client's potassium level.
Fundamentals, Pharmacotherapy, &
Prioritization Practice Questions
Subject: Nursing Fundamentals (Based on Mark Klimek Nursing Lecture Series
1-12)
Question 1: A client with Type 1 Diabetes Mellitus presents with a blood glucose of 450 mg/dL,
Kussmaul respirations, and fruity-smelling breath. Which intravenous fluid order should the
nurse anticipate as the highest priority to correct the underlying metabolic abnormality?
A) D5W (5% Dextrose in water)
B) 0.45% Normal Saline
C) 0.9% Normal Saline
D) Lactated Ringer’s
Correct Answer: C) 0.9% Normal Saline
Explanation: In Diabetic Ketoacidosis (DKA), the client is profoundly dehydrated due to osmotic
diuresis. Fluid resuscitation is the absolute priority to restore tissue perfusion and renal
clearance of glucose. 0.9% Normal Saline is the standard initial isotonic bolus. 0.45% NS (B) is
used later for rehydration after hemodynamic stability is achieved. D5W (A) is contraindicated
in hyperglycemic crises.
Question 2: A nurse is managing a client with a continuous heparin infusion for DVT. The nurse
notes the aPTT is 105 seconds (Control: 30 seconds). What is the nurse's priority action based on
"Klimek-style" prioritization?
A) Continue the infusion as ordered.
B) Discontinue the infusion immediately and call the provider.
C) Increase the infusion rate to reach the therapeutic goal.
D) Administer Vitamin K.
Correct Answer: B) Discontinue the infusion immediately and call the provider.
Explanation: Klimek teaches to prioritize safety in anticoagulation therapy. A therapeutic aPTT
is generally 1.5 to 2.5 times the control (approx. 45–75 seconds). An aPTT of 105 indicates a
, high risk for spontaneous hemorrhage. Immediate cessation is required to prevent life-
threatening bleeding. Vitamin K (D) is the antidote for Warfarin, not Heparin (Protamine Sulfate
is the antidote for Heparin).
Question 3: A client is taking Lithium for Bipolar Disorder. Which laboratory result necessitates
immediate nursing intervention?
A) Serum sodium 135 mEq/L
B) Serum creatinine 0.8 mg/dL
C) Serum lithium level 2.2 mEq/L
D) Serum glucose 105 mg/dL
Correct Answer: C) Serum lithium level 2.2 mEq/L
Explanation: Lithium has a narrow therapeutic range (0.6–1.2 mEq/L). A level of 2.2 is clearly
toxic (toxic range typically >1.5). Signs of toxicity include tremors, confusion, and
cardiovascular compromise. Sodium levels (A) and creatinine (B) are within or near normal
limits.
Question 4: A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic
Hormone). Which nursing intervention is essential to prevent a secondary neurological
complication?
A) Increase oral fluid intake to 3000 mL/day.
B) Administer high-dose corticosteroids.
C) Monitor for serum sodium levels and implement seizure precautions.
D) Encourage a high-sodium, low-protein diet.
Correct Answer: C) Monitor for serum sodium levels and implement seizure precautions.
Explanation: SIADH causes water retention and dilutional hyponatremia. Severe hyponatremia
can lead to cerebral edema and seizures. Seizure precautions are a vital safety intervention.
Increasing fluids (A) is the opposite of the required treatment, which is fluid restriction.
Question 5: A client is prescribed Digoxin 0.25 mg daily. The client’s apical pulse is 58 bpm.
What is the priority nursing action?
A) Administer the dose as ordered.
B) Withhold the dose and check the client's potassium level.
