NCLEX NURSING SCHOOL SURVIVAL
KIT - COMPREHENSIVE HIGH-
DIFFICULTY PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a pH of 7.28, PaCO2
of 30 mmHg, and HCO3 of 18 mEq/L. Which compensatory mechanism is the client
exhibiting?
A. Renal retention of bicarbonate
B. Respiratory alkalosis via Kussmaul respirations
C. Metabolic compensation through the buffer system
D. Renal excretion of hydrogen ions
Answer: B
Conceptual Explanation: In DKA (metabolic acidosis), the lungs compensate by increasing
the rate and depth of breathing (Kussmaul respirations) to blow off CO2, which is an acid,
to increase pH.
2. Which assessment finding in a patient receiving Magnesium Sulfate for preeclampsia
indicates immediate toxicity?
A. Blood pressure of 150/90 mmHg
,B. Presence of a mild headache
C. Urine output of 40 mL/hr
D. Deep tendon reflexes (DTR) of 0+
Answer: D
Conceptual Explanation: Loss of deep tendon reflexes is an early sign of magnesium
toxicity. Other signs include respiratory depression and decreased urine output (below 30
mL/hr).
3. A nurse is caring for a child with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask
B. Notify the pediatric cardiologist
C. Prepare for immediate administration of Morphine
D. Place the child in a knee-chest position
Answer: D
Conceptual Explanation: Placing the child in a knee-chest position increases systemic
vascular resistance, which reduces the right-to-left shunt and improves oxygenation during
a ‘tet spell’.
4. The nurse identifies which EKG change as the most characteristic of Hypokalemia?
A. Tall, peaked T waves
, B. Prominent U waves
C. Widened QRS complexes
D. Shortened ST segment
Answer: B
Conceptual Explanation: Hypokalemia typically presents with flat or inverted T waves
and the appearance of prominent U waves. Peaked T waves are associated with
hyperkalemia.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via a
nasal cannula at 2L/min. The patient’s SpO2 is 89%. What is the most appropriate nursing
action?
A. Increase the oxygen flow to 6L/min
B. Continue to monitor as this is an expected finding
C. Switch the patient to a Non-rebreather mask
D. Encourage the patient to take rapid, shallow breaths
Answer: B
Conceptual Explanation: For patients with COPD, a target SpO2 of 88-92% is often
acceptable because high oxygen levels can suppress their hypoxic drive to breathe.
KIT - COMPREHENSIVE HIGH-
DIFFICULTY PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a pH of 7.28, PaCO2
of 30 mmHg, and HCO3 of 18 mEq/L. Which compensatory mechanism is the client
exhibiting?
A. Renal retention of bicarbonate
B. Respiratory alkalosis via Kussmaul respirations
C. Metabolic compensation through the buffer system
D. Renal excretion of hydrogen ions
Answer: B
Conceptual Explanation: In DKA (metabolic acidosis), the lungs compensate by increasing
the rate and depth of breathing (Kussmaul respirations) to blow off CO2, which is an acid,
to increase pH.
2. Which assessment finding in a patient receiving Magnesium Sulfate for preeclampsia
indicates immediate toxicity?
A. Blood pressure of 150/90 mmHg
,B. Presence of a mild headache
C. Urine output of 40 mL/hr
D. Deep tendon reflexes (DTR) of 0+
Answer: D
Conceptual Explanation: Loss of deep tendon reflexes is an early sign of magnesium
toxicity. Other signs include respiratory depression and decreased urine output (below 30
mL/hr).
3. A nurse is caring for a child with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask
B. Notify the pediatric cardiologist
C. Prepare for immediate administration of Morphine
D. Place the child in a knee-chest position
Answer: D
Conceptual Explanation: Placing the child in a knee-chest position increases systemic
vascular resistance, which reduces the right-to-left shunt and improves oxygenation during
a ‘tet spell’.
4. The nurse identifies which EKG change as the most characteristic of Hypokalemia?
A. Tall, peaked T waves
, B. Prominent U waves
C. Widened QRS complexes
D. Shortened ST segment
Answer: B
Conceptual Explanation: Hypokalemia typically presents with flat or inverted T waves
and the appearance of prominent U waves. Peaked T waves are associated with
hyperkalemia.
5. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via a
nasal cannula at 2L/min. The patient’s SpO2 is 89%. What is the most appropriate nursing
action?
A. Increase the oxygen flow to 6L/min
B. Continue to monitor as this is an expected finding
C. Switch the patient to a Non-rebreather mask
D. Encourage the patient to take rapid, shallow breaths
Answer: B
Conceptual Explanation: For patients with COPD, a target SpO2 of 88-92% is often
acceptable because high oxygen levels can suppress their hypoxic drive to breathe.
