Mark Klimek NCLEX High-Yield Exam
Prep with Detailed Rationales
Course Code: NCLEX-RN / PN
Course Name: Next-Generation NCLEX Comprehensive Exam Review
Topic: Mark Klimek Blue Book & Yellow Book High-Yield Blueprints
Academic Year: 2026/2027
1. A nurse is caring for a patient who has an order for regular insulin and
NPH insulin to be administered subcutaneously at 0700. When mixing these
two insulins in a single syringe, which sequence of actions must the nurse
perform to guarantee safety?
A. Inject air into NPH, inject air into regular, withdraw regular, then
withdraw NPH.
B. Inject air into regular, withdraw regular, inject air into NPH, then
withdraw NPH.
C. Withdraw NPH, inject air into regular, withdraw regular, then inject air
into NPH.
D. Inject air into NPH, withdraw NPH, inject air into regular, then withdraw
regular.
CORRECT ANSWER: A. Inject air into NPH, inject air into regular,
withdraw regular, then withdraw NPH.
RATIONALE: According to the classic Mark Klimek "RN" memory trick
(Regular before NPH when drawing up, but air goes in reverse order), the
nurse must first inject air into the cloudy insulin (NPH), inject air into the
clear insulin (regular), withdraw the clear (regular), and finally withdraw
the cloudy (NPH). This prevents contaminating the short-acting regular
insulin vial with intermediate-acting NPH proteins.
• Distractor B is incorrect because it does not follow the proper sequence for
air injection, which must begin with the cloudy vial.
• Distractor C is incorrect because drawing up cloudy insulin first risks
contaminating the clear vial during the subsequent steps.
,• Distractor D is incorrect because it reverses the withdrawal sequence, which
must always proceed from clear to cloudy.
2. A patient with a history of severe chronic plaque psoriasis is prescribed
etanercept subcutaneously weekly. Which pre-administration screening or
diagnostic parameter is the most critical baseline priority for the nurse to
verify?
A. A negative tuberculin skin test or interferon-gamma release assay
B. A normal baseline serum amylase and lipase profile
C. An absence of deep vein thrombosis risk factors
D. A negative serum human chorionic gonadotropin test
CORRECT ANSWER: A. A negative tuberculin skin test or interferon-
gamma release assay
RATIONALE: Etanercept is a tumor necrosis factor (TNF) inhibitor that
suppresses the immune system. A critical Mark Klimek rule for biological
response modifiers is that they can reactivate latent infections, particularly
tuberculosis. Therefore, a negative tuberculin skin test or IGRA must be
verified before starting therapy.
• Distractor B is incorrect because etanercept is not typically associated with
acute pancreatitis or major elevations in pancreatic enzymes.
• Distractor C is incorrect because TNF inhibitors do not directly increase the
risk of deep vein thrombosis or hypercoagulability.
• Distractor D is incorrect because while pregnancy requires caution, verifying
a negative tuberculosis status is a more universal safety rule for this class of
drugs.
3. True or False: In a patient presenting with suspected cranial nerve VII
(facial) paralysis, the nurse expects the patient to demonstrate a complete
loss of general sensation across the anterior two-thirds of the tongue surface.
A. True
B. False
, CORRECT ANSWER: B. False
RATIONALE: Cranial nerve VII (facial) mediates taste sensation on the
anterior two-thirds of the tongue, not general somatic sensation (such as
touch, pain, or temperature). General sensation in that area is managed by
the trigeminal nerve (CN V).
• Distractor A is incorrect because it confuses specialized gustatory taste
fibers with general somatic sensory innervation pathways.
4. A multiparous client is in active labor at 39 weeks gestation. The nurse notes
that the fetal heart rate monitor displays variable decelerations that drop
sharply below the baseline for 30 seconds. Which underlying mechanism is
responsible for this pattern, and what is the priority nursing action?
A. Umbilical cord compression; reposition the client to a lateral side-lying
position
B. Uteroplacental insufficiency; initiate a high-flow oxygen mask
immediately
C. Fetal head compression; prepare for immediate forceps-assisted delivery
D. Maternal hypotension; administer an immediate intravenous push dose of
epinephrine
CORRECT ANSWER: A. Umbilical cord compression; reposition the
client to a lateral side-lying position
RATIONALE: Using the Mark Klimek "VEAL CHOP" memory aid
(Variable = Cord compression), variable decelerations indicate umbilical
cord compression. The first and most effective action is to reposition the
client to relieve mechanical pressure on the cord.
• Distractor B is incorrect because uteroplacental insufficiency causes late
decelerations, not variable decelerations.
• Distractor C is incorrect because fetal head compression causes early
decelerations, which are benign and do not require acute intervention.
• Distractor D is incorrect because maternal hypotension is managed with IV
fluids or ephedrine, never an immediate push dose of epinephrine in
standard labor.
, 5. The nurse is preparing to care for a patient with a confirmed diagnosis of
active pulmonary tuberculosis. Which personal protective equipment
(PPE) combination must the nurse don before entering the patient's negative-
pressure isolation room?
A. An N95 respirator mask, gown, and clean gloves
B. A standard fluid-resistant surgical mask, gown, and sterile gloves
C. A fitted surgical mask paired with protective eye goggles only
D. A full face shield, protective shoe covers, and an un-fitted cloth mask
CORRECT ANSWER: A. An N95 respirator mask, gown, and clean
gloves
RATIONALE: Active pulmonary tuberculosis requires strict airborne
precautions. The nurse must wear an N95 respirator mask to filter out tiny
airborne droplet nuclei, along with a gown and clean gloves to protect
against body fluid contact.
• Distractor B is incorrect because a standard surgical mask does not provide
adequate filtration against airborne pathogens.
• Distractor C is incorrect because eye goggles alone do not substitute for the
respiratory filtration provided by an N95 mask.
• Distractor D is incorrect because a cloth mask lacks the necessary filtration
efficiency to protect against airborne tuberculosis transmission.
6. A patient is admitted with severe diabetic ketoacidosis (DKA). The nurse
assesses the patient's respiratory pattern and notes deep, rapid, sighing
breaths. How should the nurse document this specific breathing pattern, and
what compensatory mechanism does it represent?
A. Kussmaul respirations; respiratory compensation for metabolic acidosis
B. Cheyne-Stokes respirations; central neurological failure from cerebral
edema
C. Biot's respirations; physiological response to acute hypercapnia
D. Hypoventilation; renal compensation for a severe metabolic alkalosis
Prep with Detailed Rationales
Course Code: NCLEX-RN / PN
Course Name: Next-Generation NCLEX Comprehensive Exam Review
Topic: Mark Klimek Blue Book & Yellow Book High-Yield Blueprints
Academic Year: 2026/2027
1. A nurse is caring for a patient who has an order for regular insulin and
NPH insulin to be administered subcutaneously at 0700. When mixing these
two insulins in a single syringe, which sequence of actions must the nurse
perform to guarantee safety?
A. Inject air into NPH, inject air into regular, withdraw regular, then
withdraw NPH.
B. Inject air into regular, withdraw regular, inject air into NPH, then
withdraw NPH.
C. Withdraw NPH, inject air into regular, withdraw regular, then inject air
into NPH.
D. Inject air into NPH, withdraw NPH, inject air into regular, then withdraw
regular.
CORRECT ANSWER: A. Inject air into NPH, inject air into regular,
withdraw regular, then withdraw NPH.
RATIONALE: According to the classic Mark Klimek "RN" memory trick
(Regular before NPH when drawing up, but air goes in reverse order), the
nurse must first inject air into the cloudy insulin (NPH), inject air into the
clear insulin (regular), withdraw the clear (regular), and finally withdraw
the cloudy (NPH). This prevents contaminating the short-acting regular
insulin vial with intermediate-acting NPH proteins.
• Distractor B is incorrect because it does not follow the proper sequence for
air injection, which must begin with the cloudy vial.
• Distractor C is incorrect because drawing up cloudy insulin first risks
contaminating the clear vial during the subsequent steps.
,• Distractor D is incorrect because it reverses the withdrawal sequence, which
must always proceed from clear to cloudy.
2. A patient with a history of severe chronic plaque psoriasis is prescribed
etanercept subcutaneously weekly. Which pre-administration screening or
diagnostic parameter is the most critical baseline priority for the nurse to
verify?
A. A negative tuberculin skin test or interferon-gamma release assay
B. A normal baseline serum amylase and lipase profile
C. An absence of deep vein thrombosis risk factors
D. A negative serum human chorionic gonadotropin test
CORRECT ANSWER: A. A negative tuberculin skin test or interferon-
gamma release assay
RATIONALE: Etanercept is a tumor necrosis factor (TNF) inhibitor that
suppresses the immune system. A critical Mark Klimek rule for biological
response modifiers is that they can reactivate latent infections, particularly
tuberculosis. Therefore, a negative tuberculin skin test or IGRA must be
verified before starting therapy.
• Distractor B is incorrect because etanercept is not typically associated with
acute pancreatitis or major elevations in pancreatic enzymes.
• Distractor C is incorrect because TNF inhibitors do not directly increase the
risk of deep vein thrombosis or hypercoagulability.
• Distractor D is incorrect because while pregnancy requires caution, verifying
a negative tuberculosis status is a more universal safety rule for this class of
drugs.
3. True or False: In a patient presenting with suspected cranial nerve VII
(facial) paralysis, the nurse expects the patient to demonstrate a complete
loss of general sensation across the anterior two-thirds of the tongue surface.
A. True
B. False
, CORRECT ANSWER: B. False
RATIONALE: Cranial nerve VII (facial) mediates taste sensation on the
anterior two-thirds of the tongue, not general somatic sensation (such as
touch, pain, or temperature). General sensation in that area is managed by
the trigeminal nerve (CN V).
• Distractor A is incorrect because it confuses specialized gustatory taste
fibers with general somatic sensory innervation pathways.
4. A multiparous client is in active labor at 39 weeks gestation. The nurse notes
that the fetal heart rate monitor displays variable decelerations that drop
sharply below the baseline for 30 seconds. Which underlying mechanism is
responsible for this pattern, and what is the priority nursing action?
A. Umbilical cord compression; reposition the client to a lateral side-lying
position
B. Uteroplacental insufficiency; initiate a high-flow oxygen mask
immediately
C. Fetal head compression; prepare for immediate forceps-assisted delivery
D. Maternal hypotension; administer an immediate intravenous push dose of
epinephrine
CORRECT ANSWER: A. Umbilical cord compression; reposition the
client to a lateral side-lying position
RATIONALE: Using the Mark Klimek "VEAL CHOP" memory aid
(Variable = Cord compression), variable decelerations indicate umbilical
cord compression. The first and most effective action is to reposition the
client to relieve mechanical pressure on the cord.
• Distractor B is incorrect because uteroplacental insufficiency causes late
decelerations, not variable decelerations.
• Distractor C is incorrect because fetal head compression causes early
decelerations, which are benign and do not require acute intervention.
• Distractor D is incorrect because maternal hypotension is managed with IV
fluids or ephedrine, never an immediate push dose of epinephrine in
standard labor.
, 5. The nurse is preparing to care for a patient with a confirmed diagnosis of
active pulmonary tuberculosis. Which personal protective equipment
(PPE) combination must the nurse don before entering the patient's negative-
pressure isolation room?
A. An N95 respirator mask, gown, and clean gloves
B. A standard fluid-resistant surgical mask, gown, and sterile gloves
C. A fitted surgical mask paired with protective eye goggles only
D. A full face shield, protective shoe covers, and an un-fitted cloth mask
CORRECT ANSWER: A. An N95 respirator mask, gown, and clean
gloves
RATIONALE: Active pulmonary tuberculosis requires strict airborne
precautions. The nurse must wear an N95 respirator mask to filter out tiny
airborne droplet nuclei, along with a gown and clean gloves to protect
against body fluid contact.
• Distractor B is incorrect because a standard surgical mask does not provide
adequate filtration against airborne pathogens.
• Distractor C is incorrect because eye goggles alone do not substitute for the
respiratory filtration provided by an N95 mask.
• Distractor D is incorrect because a cloth mask lacks the necessary filtration
efficiency to protect against airborne tuberculosis transmission.
6. A patient is admitted with severe diabetic ketoacidosis (DKA). The nurse
assesses the patient's respiratory pattern and notes deep, rapid, sighing
breaths. How should the nurse document this specific breathing pattern, and
what compensatory mechanism does it represent?
A. Kussmaul respirations; respiratory compensation for metabolic acidosis
B. Cheyne-Stokes respirations; central neurological failure from cerebral
edema
C. Biot's respirations; physiological response to acute hypercapnia
D. Hypoventilation; renal compensation for a severe metabolic alkalosis
