ULTIMATE NCLEX and NURSING EXAM
PRACTICE QUESTION BANK 150 CORE
CLINICAL QUESTIONS RATIONALES AND
ANSWERS (Q51-150)
NSG 4800 Comprehensive Nursing Exam Practice
Questions
Question 1
A 68-year-old male patient with a history of chronic heart
failure and chronic kidney disease is admitted to the
progressive care unit presenting with worsening peripheral
edema, dyspnea at rest, and jugular venous distention. The
physician prescribes an aggressive intravenous push of a loop
diuretic to manage the fluid volume overload. Before
administering this high-alert medication, which specific safety
protocol must the registered nurse complete to prevent
systemic toxicities or medication errors?
A) Confirm the patient’s dietary intake of sodium over the past
48 hours to adjust the baseline milligram calculations.
B) Verify the patient’s current serum potassium level and
calculate the safe rate of IV push administration to prevent
acute ototoxicity.
C) Obtain a stat 12-lead electrocardiogram exclusively to
document baseline QRS axis deviations.
D) Request a pharmacy-validated blood glucose profile to
evaluate potential insulin dependencies.
Correct Answer: B
Rationale: Loop diuretics (like furosemide) are highly
ototoxic if administered too rapidly via intravenous push, and
they aggressively deplete potassium; verifying potassium
levels prevents life-threatening arrhythmias, while tracking
,the rate of delivery (typically not exceeding 4 mg/minute)
preserves acoustic nerve integrity.
Question 2
An acute care nurse is assuming the bedside management of a
patient who underwent a total abdominal hysterectomy twelve
hours ago and is receiving continuous Patient-Controlled
Analgesia (PCA) with morphine sulfate. During the hourly
assessment, the nurse notes that the patient is difficult to
arouse, exhibits a respiratory rate of 7 breaths per minute, and
has a pulse oximetry reading of 86% on room air. What is the
immediate priority order of nursing operations for this clinical
emergency?
A) Increase the supplementary oxygen flow rate to 15 liters per
minute via a non-rebreather mask and document the trends in
the electronic chart.
B) Discontinue the PCA pump immediately, attempt physical
arousal, administer prescribed intravenous naloxone, and call
for emergency respiratory support.
C) Log out of the medication dispensing cabinet, double-check
the original opioid prescription with another peer, and notify
the surgeon.
D) Elevate the head of the bed to a high-Fowler’s position and
perform a comprehensive neurological cranial nerve
assessment.
Correct Answer: B
Rationale: Opioid-induced respiratory depression is a life-
threatening emergency requiring rapid, decisive action; the
nurse must stop the opioid infusion immediately to prevent
further toxicity, stimulate the patient, and administer the
reversal agent (naloxone) while calling for help.
Question 3
A patient diagnosed with severe sepsis is being resuscitated in
the intensive care unit according to evidence-based clinical
bundles. The nurse is monitoring the central venous pressure
,(CVP) and arterial line waveforms to evaluate structural
responses to aggressive isotonic fluid resuscitation. If the
patient’s CVP transitions from 3 mmHg to 11 mmHg alongside
a stabilizing mean arterial pressure (MAP) of 72 mmHg, how
should the nurse interpret these hemodynamic metrics?
A) The patient is exhibiting absolute refractory septic shock and
requires immediate surgical intervention to insert a ventricular
assist device.
B) The fluid resuscitation is achieving the desired therapeutic
target, indicating improved venous return and adequate right
ventricular preload.
C) The patient has developed severe left-sided pulmonary
edema requiring the immediate discontinuation of all
crystalloid fluids.
D) The arterial transducer is uncalibrated and must be
repositioned at the level of the patient's left carotid artery.
Correct Answer: B
Rationale: A normal target CVP during septic fluid
resuscitation ranges between 8–12 mmHg; an increase from a
low baseline (3 mmHg) to a stable target (11 mmHg) alongside
a MAP above 65 mmHg confirms successful volume
replacement and adequate tissue perfusion.
Question 4
A 42-year-old female patient is admitted with a diagnosis of
acute pancreatitis secondary to cholelithiasis. The patient
reports excruciating, tearing epigastric pain that radiates
directly to her back, accompanied by persistent non-bilious
vomiting. Which laboratory profiling configuration should the
nurse anticipate as the most specific diagnostic confirmation of
acute pancreatic parenchymal inflammation?
A) Markedly elevated serum amylase and lipase levels, with
lipase remaining elevated for a longer duration.
B) Elevated serum creatinine kinase-MB levels accompanied by
a profound drop in total white blood cell counts.
, C) Severely depressed serum bilirubin levels alongside a spike
in international normalized ratio (INR) values.
D) Elevated alkaline phosphatase levels matching a severe
decline in serum potassium.
Correct Answer: A
Rationale: Serum amylase and lipase are core digestive
enzymes synthesized by the pancreas; during acute
pancreatitis, structural cellular injury causes these enzymes to
spill into circulation, with lipase offering higher diagnostic
specificity and a longer half-life.
Question 5
During a shift change on an oncology medical-surgical unit, a
nurse receives a report on a patient undergoing active
chemotherapy for advanced small cell lung cancer. The
outgoing nurse states that the patient has developed new-onset
facial edema, jugular venous distention, and prominent
superficial collateral vein patterns across the upper chest wall.
Based on these specific clinical indicators, which oncological
emergency should the nurse immediately suspect?
A) Tumor Lysis Syndrome (TLS)
B) Superior Vena Cava Syndrome (SVCS)
C) Spinal Cord Compression (SCC)
D) Neutropenic Enterocolitis
Correct Answer: B
Rationale: Superior Vena Cava Syndrome occurs when an
oncological mass mechanically compresses or invades the
superior vena cava, obstructing venous drainage from the
upper body and causing characteristic facial plethora, neck
vein distention, and upper chest collateral circulation.
Question 6
A charge nurse is reviewing the assignment layout for an acute
care unit that includes an experienced registered nurse, a newly
licensed nurse, and an unlicensed assistive personnel (UAP).
PRACTICE QUESTION BANK 150 CORE
CLINICAL QUESTIONS RATIONALES AND
ANSWERS (Q51-150)
NSG 4800 Comprehensive Nursing Exam Practice
Questions
Question 1
A 68-year-old male patient with a history of chronic heart
failure and chronic kidney disease is admitted to the
progressive care unit presenting with worsening peripheral
edema, dyspnea at rest, and jugular venous distention. The
physician prescribes an aggressive intravenous push of a loop
diuretic to manage the fluid volume overload. Before
administering this high-alert medication, which specific safety
protocol must the registered nurse complete to prevent
systemic toxicities or medication errors?
A) Confirm the patient’s dietary intake of sodium over the past
48 hours to adjust the baseline milligram calculations.
B) Verify the patient’s current serum potassium level and
calculate the safe rate of IV push administration to prevent
acute ototoxicity.
C) Obtain a stat 12-lead electrocardiogram exclusively to
document baseline QRS axis deviations.
D) Request a pharmacy-validated blood glucose profile to
evaluate potential insulin dependencies.
Correct Answer: B
Rationale: Loop diuretics (like furosemide) are highly
ototoxic if administered too rapidly via intravenous push, and
they aggressively deplete potassium; verifying potassium
levels prevents life-threatening arrhythmias, while tracking
,the rate of delivery (typically not exceeding 4 mg/minute)
preserves acoustic nerve integrity.
Question 2
An acute care nurse is assuming the bedside management of a
patient who underwent a total abdominal hysterectomy twelve
hours ago and is receiving continuous Patient-Controlled
Analgesia (PCA) with morphine sulfate. During the hourly
assessment, the nurse notes that the patient is difficult to
arouse, exhibits a respiratory rate of 7 breaths per minute, and
has a pulse oximetry reading of 86% on room air. What is the
immediate priority order of nursing operations for this clinical
emergency?
A) Increase the supplementary oxygen flow rate to 15 liters per
minute via a non-rebreather mask and document the trends in
the electronic chart.
B) Discontinue the PCA pump immediately, attempt physical
arousal, administer prescribed intravenous naloxone, and call
for emergency respiratory support.
C) Log out of the medication dispensing cabinet, double-check
the original opioid prescription with another peer, and notify
the surgeon.
D) Elevate the head of the bed to a high-Fowler’s position and
perform a comprehensive neurological cranial nerve
assessment.
Correct Answer: B
Rationale: Opioid-induced respiratory depression is a life-
threatening emergency requiring rapid, decisive action; the
nurse must stop the opioid infusion immediately to prevent
further toxicity, stimulate the patient, and administer the
reversal agent (naloxone) while calling for help.
Question 3
A patient diagnosed with severe sepsis is being resuscitated in
the intensive care unit according to evidence-based clinical
bundles. The nurse is monitoring the central venous pressure
,(CVP) and arterial line waveforms to evaluate structural
responses to aggressive isotonic fluid resuscitation. If the
patient’s CVP transitions from 3 mmHg to 11 mmHg alongside
a stabilizing mean arterial pressure (MAP) of 72 mmHg, how
should the nurse interpret these hemodynamic metrics?
A) The patient is exhibiting absolute refractory septic shock and
requires immediate surgical intervention to insert a ventricular
assist device.
B) The fluid resuscitation is achieving the desired therapeutic
target, indicating improved venous return and adequate right
ventricular preload.
C) The patient has developed severe left-sided pulmonary
edema requiring the immediate discontinuation of all
crystalloid fluids.
D) The arterial transducer is uncalibrated and must be
repositioned at the level of the patient's left carotid artery.
Correct Answer: B
Rationale: A normal target CVP during septic fluid
resuscitation ranges between 8–12 mmHg; an increase from a
low baseline (3 mmHg) to a stable target (11 mmHg) alongside
a MAP above 65 mmHg confirms successful volume
replacement and adequate tissue perfusion.
Question 4
A 42-year-old female patient is admitted with a diagnosis of
acute pancreatitis secondary to cholelithiasis. The patient
reports excruciating, tearing epigastric pain that radiates
directly to her back, accompanied by persistent non-bilious
vomiting. Which laboratory profiling configuration should the
nurse anticipate as the most specific diagnostic confirmation of
acute pancreatic parenchymal inflammation?
A) Markedly elevated serum amylase and lipase levels, with
lipase remaining elevated for a longer duration.
B) Elevated serum creatinine kinase-MB levels accompanied by
a profound drop in total white blood cell counts.
, C) Severely depressed serum bilirubin levels alongside a spike
in international normalized ratio (INR) values.
D) Elevated alkaline phosphatase levels matching a severe
decline in serum potassium.
Correct Answer: A
Rationale: Serum amylase and lipase are core digestive
enzymes synthesized by the pancreas; during acute
pancreatitis, structural cellular injury causes these enzymes to
spill into circulation, with lipase offering higher diagnostic
specificity and a longer half-life.
Question 5
During a shift change on an oncology medical-surgical unit, a
nurse receives a report on a patient undergoing active
chemotherapy for advanced small cell lung cancer. The
outgoing nurse states that the patient has developed new-onset
facial edema, jugular venous distention, and prominent
superficial collateral vein patterns across the upper chest wall.
Based on these specific clinical indicators, which oncological
emergency should the nurse immediately suspect?
A) Tumor Lysis Syndrome (TLS)
B) Superior Vena Cava Syndrome (SVCS)
C) Spinal Cord Compression (SCC)
D) Neutropenic Enterocolitis
Correct Answer: B
Rationale: Superior Vena Cava Syndrome occurs when an
oncological mass mechanically compresses or invades the
superior vena cava, obstructing venous drainage from the
upper body and causing characteristic facial plethora, neck
vein distention, and upper chest collateral circulation.
Question 6
A charge nurse is reviewing the assignment layout for an acute
care unit that includes an experienced registered nurse, a newly
licensed nurse, and an unlicensed assistive personnel (UAP).
