Fundamentals of Nursing Comprehensive Exam 6: Advanced NCLEX
Practice Edition — Critical Thinking, Prioritization, Emergency Care,
Pharmacology Safety & Complex Patient Scenarios Questions with
Answers and Rationales
Question 1
A nurse receives report on four patients at the beginning of the shift. Which patient should the
nurse assess first?
A. A patient with chronic arthritis requesting pain medication
B. A patient with sudden shortness of breath and oxygen saturation of 86%
C. A patient waiting for discharge instructions
D. A patient requesting assistance with a bath
Answer: B. A patient with sudden shortness of breath and oxygen saturation of
86%
Rationale:
A patient experiencing acute respiratory distress and hypoxemia has the highest priority
according to the ABCs (Airway, Breathing, Circulation). Immediate assessment and intervention
are necessary to prevent respiratory failure.
Question 2
A nurse is caring for a postoperative patient who suddenly becomes restless and confused. What
should the nurse do first?
A. Administer prescribed pain medication
B. Assess oxygen saturation and vital signs
C. Notify the patient's family
D. Encourage the patient to rest
Answer: B. Assess oxygen saturation and vital signs
Rationale:
,Restlessness and confusion may be early signs of hypoxia. The nurse should assess the patient's
respiratory and circulatory status before implementing additional interventions.
Question 3
A nurse is assessing a patient with chest pain. Which assessment finding requires immediate
intervention?
A. Pain rated 3/10 after medication
B. Chest pain accompanied by diaphoresis and nausea
C. Pain that improves with repositioning
D. Mild tenderness over the chest wall
Answer: B. Chest pain accompanied by diaphoresis and nausea
Rationale:
Chest pain with diaphoresis and nausea may indicate acute coronary syndrome and requires
immediate evaluation and treatment.
Question 4
A nurse is caring for a patient receiving intravenous potassium chloride. Which action is
appropriate?
A. Administer the medication by IV push
B. Verify the infusion rate before administration
C. Mix the medication immediately before injection without checking compatibility
D. Stop monitoring the IV site after initiation
Answer: B. Verify the infusion rate before administration
Rationale:
Potassium chloride is a high-alert medication. It should never be administered by IV push and
requires careful verification of the prescribed infusion rate and frequent monitoring.
Question 5
,A nurse identifies that a patient has an oxygen saturation of 82%. Which action should the nurse
perform first?
A. Encourage the patient to drink fluids
B. Assess airway patency and respiratory effort
C. Document the oxygen saturation
D. Notify dietary services
Answer: B. Assess airway patency and respiratory effort
Rationale:
The nurse should first assess the patient's airway and breathing to determine the cause of
hypoxemia before implementing further interventions.
Question 6
A nurse is caring for a patient with suspected dehydration. Which assessment finding supports
this diagnosis?
A. Moist mucous membranes and bounding pulse
B. Dry mucous membranes and decreased urine output
C. Bradycardia and weight gain
D. Peripheral edema and crackles
Answer: B. Dry mucous membranes and decreased urine output
Rationale:
Dry mucous membranes, concentrated urine, decreased urine output, and poor skin turgor are
common signs of dehydration.
Question 7
A nurse is caring for a patient receiving morphine. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 8 breaths/minute
B. Pain decreased from 8/10 to 3/10
C. Patient reports mild nausea
D. Blood pressure of 128/78 mm Hg
, Answer: A. Respiratory rate of 8 breaths/minute
Rationale:
Morphine can cause respiratory depression. A respiratory rate below normal requires immediate
assessment and intervention.
Question 8
A nurse is caring for a patient experiencing a tonic-clonic seizure. Which action is appropriate?
A. Place a tongue blade in the patient's mouth
B. Protect the patient's head and maintain safety
C. Restrain the patient's arms and legs
D. Force the patient to drink water immediately afterward
Answer: B. Protect the patient's head and maintain safety
Rationale:
The nurse should protect the patient from injury during a seizure. Objects should never be placed
in the mouth, and restraints should not be used.
Question 9
A nurse is reviewing laboratory results. Which potassium level requires immediate notification
of the provider?
A. 4.0 mEq/L
B. 3.9 mEq/L
C. 2.6 mEq/L
D. 4.5 mEq/L
Answer: C. 2.6 mEq/L
Rationale:
Severe hypokalemia increases the risk of life-threatening cardiac dysrhythmias and requires
prompt intervention.
Practice Edition — Critical Thinking, Prioritization, Emergency Care,
Pharmacology Safety & Complex Patient Scenarios Questions with
Answers and Rationales
Question 1
A nurse receives report on four patients at the beginning of the shift. Which patient should the
nurse assess first?
A. A patient with chronic arthritis requesting pain medication
B. A patient with sudden shortness of breath and oxygen saturation of 86%
C. A patient waiting for discharge instructions
D. A patient requesting assistance with a bath
Answer: B. A patient with sudden shortness of breath and oxygen saturation of
86%
Rationale:
A patient experiencing acute respiratory distress and hypoxemia has the highest priority
according to the ABCs (Airway, Breathing, Circulation). Immediate assessment and intervention
are necessary to prevent respiratory failure.
Question 2
A nurse is caring for a postoperative patient who suddenly becomes restless and confused. What
should the nurse do first?
A. Administer prescribed pain medication
B. Assess oxygen saturation and vital signs
C. Notify the patient's family
D. Encourage the patient to rest
Answer: B. Assess oxygen saturation and vital signs
Rationale:
,Restlessness and confusion may be early signs of hypoxia. The nurse should assess the patient's
respiratory and circulatory status before implementing additional interventions.
Question 3
A nurse is assessing a patient with chest pain. Which assessment finding requires immediate
intervention?
A. Pain rated 3/10 after medication
B. Chest pain accompanied by diaphoresis and nausea
C. Pain that improves with repositioning
D. Mild tenderness over the chest wall
Answer: B. Chest pain accompanied by diaphoresis and nausea
Rationale:
Chest pain with diaphoresis and nausea may indicate acute coronary syndrome and requires
immediate evaluation and treatment.
Question 4
A nurse is caring for a patient receiving intravenous potassium chloride. Which action is
appropriate?
A. Administer the medication by IV push
B. Verify the infusion rate before administration
C. Mix the medication immediately before injection without checking compatibility
D. Stop monitoring the IV site after initiation
Answer: B. Verify the infusion rate before administration
Rationale:
Potassium chloride is a high-alert medication. It should never be administered by IV push and
requires careful verification of the prescribed infusion rate and frequent monitoring.
Question 5
,A nurse identifies that a patient has an oxygen saturation of 82%. Which action should the nurse
perform first?
A. Encourage the patient to drink fluids
B. Assess airway patency and respiratory effort
C. Document the oxygen saturation
D. Notify dietary services
Answer: B. Assess airway patency and respiratory effort
Rationale:
The nurse should first assess the patient's airway and breathing to determine the cause of
hypoxemia before implementing further interventions.
Question 6
A nurse is caring for a patient with suspected dehydration. Which assessment finding supports
this diagnosis?
A. Moist mucous membranes and bounding pulse
B. Dry mucous membranes and decreased urine output
C. Bradycardia and weight gain
D. Peripheral edema and crackles
Answer: B. Dry mucous membranes and decreased urine output
Rationale:
Dry mucous membranes, concentrated urine, decreased urine output, and poor skin turgor are
common signs of dehydration.
Question 7
A nurse is caring for a patient receiving morphine. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 8 breaths/minute
B. Pain decreased from 8/10 to 3/10
C. Patient reports mild nausea
D. Blood pressure of 128/78 mm Hg
, Answer: A. Respiratory rate of 8 breaths/minute
Rationale:
Morphine can cause respiratory depression. A respiratory rate below normal requires immediate
assessment and intervention.
Question 8
A nurse is caring for a patient experiencing a tonic-clonic seizure. Which action is appropriate?
A. Place a tongue blade in the patient's mouth
B. Protect the patient's head and maintain safety
C. Restrain the patient's arms and legs
D. Force the patient to drink water immediately afterward
Answer: B. Protect the patient's head and maintain safety
Rationale:
The nurse should protect the patient from injury during a seizure. Objects should never be placed
in the mouth, and restraints should not be used.
Question 9
A nurse is reviewing laboratory results. Which potassium level requires immediate notification
of the provider?
A. 4.0 mEq/L
B. 3.9 mEq/L
C. 2.6 mEq/L
D. 4.5 mEq/L
Answer: C. 2.6 mEq/L
Rationale:
Severe hypokalemia increases the risk of life-threatening cardiac dysrhythmias and requires
prompt intervention.
