,CJE Benchmark Exam #2 Advanced
Prep: Master NCLEx
Style Nursing Practice Questions &
Detailed Explanations
Subject: CJE Benchmark Exam #2 | Advanced Nursing Clinical Judgement &
Pathophysiology
Question 1: A client with severe acute pancreatitis is receiving total parenteral nutrition (TPN)
via a central venous catheter. The nurse notes the infusion pump has stopped, and the TPN bag is
empty, but the new bag has not yet arrived from the pharmacy. What is the most appropriate
immediate action to prevent a life-threatening complication?
A) Infuse normal saline at the current TPN rate.
B) Hang a bag of 5% Dextrose in water (D5W) at the same rate.
C) Flush the line with heparinized saline and clamp it.
D) Increase the rate of the maintenance IV fluids to compensate for volume.
Correct Answer: B) Hang a bag of 5% Dextrose in water (D5W) at the same rate.
Explanation: TPN solutions have a high concentration of glucose. Abrupt cessation of TPN can
cause rebound hypoglycemia because the pancreas may still be secreting high levels of insulin in
response to the prior high glucose load. Infusing D5W at the same rate provides enough glucose
to prevent hypoglycemia while waiting for the new TPN bag. Normal saline (Option A) does not
provide the necessary glucose, and simply flushing and clamping the line (Option C) fails to
address the risk of hypoglycemia.
Question 2: An elderly patient with chronic heart failure (CHF) presents with acute confusion,
muscle weakness, and new-onset EKG changes showing flattened T waves and a prominent U
wave. Which laboratory result is the most likely cause?
A) Serum potassium 2.8 mEq/L
B) Serum potassium 6.2 mEq/L
,C) Serum sodium 125 mEq/L
D) Serum calcium 7.0 mg/dL
Correct Answer: A) Serum potassium 2.8 mEq/L
Explanation: Hypokalemia (potassium < 3.5 mEq/L) is characterized by muscle weakness,
fatigue, confusion, and specific EKG findings, including flattened or inverted T waves and the
appearance of a U wave. Hyperkalemia (Option B) typically presents with peaked T waves and
widened QRS complexes. Hyponatremia (Option C) often presents with neurological symptoms
but not the specific EKG changes noted. Hypocalcemia (Option D) typically manifests as tetany,
Chvostek’s sign, or Trousseau’s sign, rather than these specific EKG patterns.
Question 3: A patient is admitted with a diagnosis of pheochromocytoma. During the physical
assessment, the nurse should avoid which action?
A) Assessing the patient’s blood pressure in both arms.
B) Palpating the abdomen for masses or tenderness.
C) Monitoring the patient's heart rate and rhythm.
D) Obtaining a 24-hour urine collection for catecholamines.
Correct Answer: B) Palpating the abdomen for masses or tenderness.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla.
Palpating the abdomen can trigger a sudden release of catecholamines, potentially inducing a
hypertensive crisis, which is life-threatening. The other options are standard nursing
assessments for patients with this condition that do not involve stimulating the tumor.
Question 4: A client with Myasthenia Gravis is undergoing a Tensilon (edrophonium) test to
differentiate between a myasthenic crisis and a cholinergic crisis. After the administration of
edrophonium, the patient's muscle strength improves significantly. What is the appropriate
nursing intervention?
A) Prepare to administer atropine sulfate immediately.
B) Instruct the client to increase their dose of anticholinesterase medication.
C) Ventilate the client and prepare for emergency intubation.
D) Reduce the frequency of the client's current anticholinesterase medication.
Correct Answer: B) Instruct the client to increase their dose of anticholinesterase
medication.
, Explanation: The Tensilon test uses edrophonium, a short-acting anticholinesterase. An
improvement in strength indicates a myasthenic crisis (under-medication), which warrants
increasing the dosage of the prescribed anticholinesterase medication. If the patient had
experienced a cholinergic crisis (over-medication), the symptoms would have worsened,
requiring the administration of atropine (Option A) and potential ventilation (Option C).
Question 5: A patient with Systemic Lupus Erythematosus (SLE) is prescribed
hydroxychloroquine. Which instruction is most critical for the nurse to provide regarding long-
term safety?
A) "Take the medication with food to prevent gastrointestinal upset."
B) "Monitor your blood pressure daily and report any elevations."
C) "Schedule an annual ophthalmological examination."
D) "Avoid exposure to direct sunlight while on this medication."
Correct Answer: C) Schedule an annual ophthalmological examination.
Explanation: Hydroxychloroquine, while effective for SLE, carries a risk of retinopathy, which
can lead to permanent vision loss. Regular, thorough eye examinations are required to detect
early retinal changes. While the other options (A and D) are good general advice for many
medications or SLE management, the risk of retinal toxicity makes the eye exam the most critical
safety instruction.
Question 6: A nurse is caring for a patient experiencing an acute asthma exacerbation. The
patient’s arterial blood gas (ABG) results are: pH 7.48, $PaCO_2$ 30 mmHg, $PaO_2$ 85
mmHg, and $HCO_3^-$ 24 mEq/L. How should the nurse interpret these results?
A) Uncompensated respiratory acidosis.
B) Compensated metabolic alkalosis.
C) Acute respiratory alkalosis.
D) Normal blood gases.
Correct Answer: C) Acute respiratory alkalosis.
Explanation: The pH is elevated (> 7.45), indicating alkalosis. The $PaCO_2$ is decreased (<
35 mmHg), indicating a respiratory origin for the alkalosis (hyperventilation common in
asthma). The $HCO_3^-$ is within the normal range (22-26 mEq/L), meaning there is no
compensation yet. Thus, this is an acute respiratory alkalosis.
Prep: Master NCLEx
Style Nursing Practice Questions &
Detailed Explanations
Subject: CJE Benchmark Exam #2 | Advanced Nursing Clinical Judgement &
Pathophysiology
Question 1: A client with severe acute pancreatitis is receiving total parenteral nutrition (TPN)
via a central venous catheter. The nurse notes the infusion pump has stopped, and the TPN bag is
empty, but the new bag has not yet arrived from the pharmacy. What is the most appropriate
immediate action to prevent a life-threatening complication?
A) Infuse normal saline at the current TPN rate.
B) Hang a bag of 5% Dextrose in water (D5W) at the same rate.
C) Flush the line with heparinized saline and clamp it.
D) Increase the rate of the maintenance IV fluids to compensate for volume.
Correct Answer: B) Hang a bag of 5% Dextrose in water (D5W) at the same rate.
Explanation: TPN solutions have a high concentration of glucose. Abrupt cessation of TPN can
cause rebound hypoglycemia because the pancreas may still be secreting high levels of insulin in
response to the prior high glucose load. Infusing D5W at the same rate provides enough glucose
to prevent hypoglycemia while waiting for the new TPN bag. Normal saline (Option A) does not
provide the necessary glucose, and simply flushing and clamping the line (Option C) fails to
address the risk of hypoglycemia.
Question 2: An elderly patient with chronic heart failure (CHF) presents with acute confusion,
muscle weakness, and new-onset EKG changes showing flattened T waves and a prominent U
wave. Which laboratory result is the most likely cause?
A) Serum potassium 2.8 mEq/L
B) Serum potassium 6.2 mEq/L
,C) Serum sodium 125 mEq/L
D) Serum calcium 7.0 mg/dL
Correct Answer: A) Serum potassium 2.8 mEq/L
Explanation: Hypokalemia (potassium < 3.5 mEq/L) is characterized by muscle weakness,
fatigue, confusion, and specific EKG findings, including flattened or inverted T waves and the
appearance of a U wave. Hyperkalemia (Option B) typically presents with peaked T waves and
widened QRS complexes. Hyponatremia (Option C) often presents with neurological symptoms
but not the specific EKG changes noted. Hypocalcemia (Option D) typically manifests as tetany,
Chvostek’s sign, or Trousseau’s sign, rather than these specific EKG patterns.
Question 3: A patient is admitted with a diagnosis of pheochromocytoma. During the physical
assessment, the nurse should avoid which action?
A) Assessing the patient’s blood pressure in both arms.
B) Palpating the abdomen for masses or tenderness.
C) Monitoring the patient's heart rate and rhythm.
D) Obtaining a 24-hour urine collection for catecholamines.
Correct Answer: B) Palpating the abdomen for masses or tenderness.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla.
Palpating the abdomen can trigger a sudden release of catecholamines, potentially inducing a
hypertensive crisis, which is life-threatening. The other options are standard nursing
assessments for patients with this condition that do not involve stimulating the tumor.
Question 4: A client with Myasthenia Gravis is undergoing a Tensilon (edrophonium) test to
differentiate between a myasthenic crisis and a cholinergic crisis. After the administration of
edrophonium, the patient's muscle strength improves significantly. What is the appropriate
nursing intervention?
A) Prepare to administer atropine sulfate immediately.
B) Instruct the client to increase their dose of anticholinesterase medication.
C) Ventilate the client and prepare for emergency intubation.
D) Reduce the frequency of the client's current anticholinesterase medication.
Correct Answer: B) Instruct the client to increase their dose of anticholinesterase
medication.
, Explanation: The Tensilon test uses edrophonium, a short-acting anticholinesterase. An
improvement in strength indicates a myasthenic crisis (under-medication), which warrants
increasing the dosage of the prescribed anticholinesterase medication. If the patient had
experienced a cholinergic crisis (over-medication), the symptoms would have worsened,
requiring the administration of atropine (Option A) and potential ventilation (Option C).
Question 5: A patient with Systemic Lupus Erythematosus (SLE) is prescribed
hydroxychloroquine. Which instruction is most critical for the nurse to provide regarding long-
term safety?
A) "Take the medication with food to prevent gastrointestinal upset."
B) "Monitor your blood pressure daily and report any elevations."
C) "Schedule an annual ophthalmological examination."
D) "Avoid exposure to direct sunlight while on this medication."
Correct Answer: C) Schedule an annual ophthalmological examination.
Explanation: Hydroxychloroquine, while effective for SLE, carries a risk of retinopathy, which
can lead to permanent vision loss. Regular, thorough eye examinations are required to detect
early retinal changes. While the other options (A and D) are good general advice for many
medications or SLE management, the risk of retinal toxicity makes the eye exam the most critical
safety instruction.
Question 6: A nurse is caring for a patient experiencing an acute asthma exacerbation. The
patient’s arterial blood gas (ABG) results are: pH 7.48, $PaCO_2$ 30 mmHg, $PaO_2$ 85
mmHg, and $HCO_3^-$ 24 mEq/L. How should the nurse interpret these results?
A) Uncompensated respiratory acidosis.
B) Compensated metabolic alkalosis.
C) Acute respiratory alkalosis.
D) Normal blood gases.
Correct Answer: C) Acute respiratory alkalosis.
Explanation: The pH is elevated (> 7.45), indicating alkalosis. The $PaCO_2$ is decreased (<
35 mmHg), indicating a respiratory origin for the alkalosis (hyperventilation common in
asthma). The $HCO_3^-$ is within the normal range (22-26 mEq/L), meaning there is no
compensation yet. Thus, this is an acute respiratory alkalosis.
