NCLEX NURSING SCHOOL SURVIVAL
KIT - HIGH DIFFICULTY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient’s arterial blood gas results are: pH 7.30, PaCO2 52 mmHg, and HCO3 27 mEq/L.
How should the nurse interpret these findings?
A. Metabolic acidosis, fully compensated
B. Metabolic alkalosis, partially compensated
C. Respiratory alkalosis, uncompensated
D. Respiratory acidosis, partially compensated
Answer: D
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is high (indicating the kidneys are attempting to compensate), but the pH is
not yet in the normal range, indicating partial compensation.
,2. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which EKG change is most
characteristic of this condition?
A. U waves
B. Prominent ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia (K+ > 5.0) typically causes tall peaked T waves,
widened QRS complexes, and potentially P-wave flattening.
3. Which assessment finding should the nurse prioritize in a patient diagnosed with
Autonomic Dysreflexia?
A. Tachycardia and hypotension
B. Flaccid paralysis below the level of injury
C. Pounding headache and severe hypertension
D. Lower extremity edema and cool skin
Answer: C
Conceptual Explanation: Autonomic Dysreflexia is a medical emergency in spinal cord
injury patients characterized by sudden, severe hypertension, bradycardia, and a pounding
headache.
, 4. A client is prescribed Digoxin 0.125 mg daily. Which clinical manifestation should the nurse
recognize as an early sign of Digoxin toxicity?
A. Increased appetite and thirst
B. Sudden increase in urinary output
C. Hyperactive bowel sounds
D. Anorexia, nausea, and vomiting
Answer: D
Conceptual Explanation: Early signs of digoxin toxicity are gastrointestinal related,
including anorexia, nausea, vomiting, and abdominal pain, followed by visual disturbances.
5. The nurse is assigned to four patients. Which patient should be assessed first?
A. A patient with COPD whose oxygen saturation is 89% on room air
B. A patient with a history of angina reporting stable chest pain after exertion
C. A patient who underwent a thyroidectomy 6 hours ago with new-onset stridor
D. A patient with diabetes whose blood glucose is 150 mg/dL
Answer: C
Conceptual Explanation: New-onset stridor after thyroidectomy suggests airway
obstruction due to edema or laryngeal nerve damage, representing an immediate threat to
the ABCs.
KIT - HIGH DIFFICULTY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient’s arterial blood gas results are: pH 7.30, PaCO2 52 mmHg, and HCO3 27 mEq/L.
How should the nurse interpret these findings?
A. Metabolic acidosis, fully compensated
B. Metabolic alkalosis, partially compensated
C. Respiratory alkalosis, uncompensated
D. Respiratory acidosis, partially compensated
Answer: D
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is high (indicating the kidneys are attempting to compensate), but the pH is
not yet in the normal range, indicating partial compensation.
,2. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which EKG change is most
characteristic of this condition?
A. U waves
B. Prominent ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Conceptual Explanation: Hyperkalemia (K+ > 5.0) typically causes tall peaked T waves,
widened QRS complexes, and potentially P-wave flattening.
3. Which assessment finding should the nurse prioritize in a patient diagnosed with
Autonomic Dysreflexia?
A. Tachycardia and hypotension
B. Flaccid paralysis below the level of injury
C. Pounding headache and severe hypertension
D. Lower extremity edema and cool skin
Answer: C
Conceptual Explanation: Autonomic Dysreflexia is a medical emergency in spinal cord
injury patients characterized by sudden, severe hypertension, bradycardia, and a pounding
headache.
, 4. A client is prescribed Digoxin 0.125 mg daily. Which clinical manifestation should the nurse
recognize as an early sign of Digoxin toxicity?
A. Increased appetite and thirst
B. Sudden increase in urinary output
C. Hyperactive bowel sounds
D. Anorexia, nausea, and vomiting
Answer: D
Conceptual Explanation: Early signs of digoxin toxicity are gastrointestinal related,
including anorexia, nausea, vomiting, and abdominal pain, followed by visual disturbances.
5. The nurse is assigned to four patients. Which patient should be assessed first?
A. A patient with COPD whose oxygen saturation is 89% on room air
B. A patient with a history of angina reporting stable chest pain after exertion
C. A patient who underwent a thyroidectomy 6 hours ago with new-onset stridor
D. A patient with diabetes whose blood glucose is 150 mg/dL
Answer: C
Conceptual Explanation: New-onset stridor after thyroidectomy suggests airway
obstruction due to edema or laryngeal nerve damage, representing an immediate threat to
the ABCs.
