NGN/NCLEX PREP
QUESTIONS/RATIONALES WITH
COMPLETE SOLUTIONS
ThesnursesnotessthespresencesofsasPswave,sQRSscomplex,sflattenedsTswaves,sandsoccasio
nalsUswavessonsasclient'sscardiacsmonitorsscreen.sFillsinsthescorrectsmissingsinformationsbys
choosingsfromstheslistssofsoptionssinsthesdrop-downsmenus.s-
sans✔✔Thesnursesshouldssuspect
YoursAnswer:shypokalemiaCorrectsAnswer:shypokalemia
becausesofsthe
YoursAnswer:sflattenedsTswavessandsoccasionalsUswavesCorrectsAnswer:sflattenedsTswav
essandsoccasionalsUswaves
Rationale:Cardiacschangessinshypokalemiasincludesimpairedsrepolarization,sresultingsinsasf
latteningsofsthesTswavesandseventuallysthesemergencesofsasUswave.sTherefore,sthesnursess
houldssuspectshypokalemia.sThesincidencesofspotentiallyslethalsventricularsdysrhythmiassiss
increasedsinshypokalemia.sThesnursesshouldsimmediatelysassesssthesclient'ssvitalssignssan
dscardiacsstatussforssignssofshypokalemia.sThesnursesshouldsalsoschecksthesclient'ssmostsre
centsserumspotassiumslevelsandsthenscontactsthesprimaryshealthscaresproviderstosreportsthe
sfindingssandsobtainsprescriptionsstostreatstheshypokalemicsstate.
Thesnursesisspreparingsasclientsforsaschestsx-
raysandsnotessthatsthesclientsisswearingsasreligioussmedalsonsaschainsaroundsthesneck.sWhat
sshouldsthesnursesdoswithsregardstosthisspersonalsitem?
sClickstoshighlightsthescorrectsanswersfromsthesoptionssprovided.s-
sans✔✔Thesnursesshould:s(Selects1soption)
✓Asksthesclientsifstheschainsandsmedalscansbesremovedsduringsthesprocedure.
Because:s(Selects1soption)
✓Theschainsandsmedalsmayshavesculturalssignificance.
Rationale:Beforescertainsdiagnosticsprocedures,sitsisstypicalstoshavesasclientsremovesperso
nalsobjectssthatsareswornsonsthesbodysbecausesofsclientssafetysandsthespossibilitysofscompro
misingstestsresults.sTherefore,sthesnursesshouldsasksthesclientsaboutsthessignificancesofssuc
hsansitemsandsitssremovalsbecausesitsmayshavesculturalsorsspiritualssignificance.sIfsso,sthesn
ursesshouldsasksthesclientsifsthesitemscansbeseithersremovedstemporarilysorsplacedsonsanoth
erspartsofsthesbodysduringsthesproceduresifsappropriate.
Whilespreparingsasclientsforssurgerysscheduledsins1shour,sthesclientsstatesstosthesnurse:s"Isha
veschangedsmysmind.sIsdon'tswantsthisssurgery."sClickstoshighlightsthescorrectsanswersfromst
hesoptionssprovided.s-sans✔✔Thesnursesshould:s(Selects1soption)
,Cancelsthessurgery.
Contactsthessurgeon.
✓Discusssthesclient'ssconcerns.
Callsthesidentifiedssupportsperson.
Because:s(Selects1soption)
Clientsconsentsissrequiredspriorstosanysprocedure.
✓Furthersquestionssorsconcernssshouldsbesdeterminedsandsaddressed.s
Ethicalsconsiderationssaresimportantsforsasclientsundergoingssurgery.s
Thesnursingsscopesofspracticesplacesslimitationssonshowsthesnursescansrespond.
Rationale:Ifsthesclientsindicatessthatshesorsshesdoessnotswantsasprescribedstherapy,streatme
nt,sorsproceduressuchsasssurgery,sthesnursesshouldsfurthersinvestigatesthesclient'ssrequest.s
Ifsthesclientsindicatessthatshesorssheshasschangedshissorshersmindsaboutssurgery,sthesnurses
shouldsassesssthesclientsandsexploreswithsthesclientshissorshersconcernssaboutsnotswantingst
hessurgery.sThesnurseswouldsthenswithholdsfurtherssurgicalspreparationsandscontactsthessur
geonstosreportsthesclient'ssrequestssosthatsthessurgeonscansdiscusssthesconsequencessofsn
otshavingsthessurgeryswithsthesclient.sFurthersassessmentsandsfollow-
upsrelatedstosthesclient'ssrequestsneedstosbesdone.sItsissthesclient'ssrightstosrefusestreatment;s
however,sfurthersinvestigationsissneededssosthesinterventionsscansbestailoredstosspecificsne
eds.
Thesnursesnotessthatsthereshassbeensansincreasesinsthesnumbersofsintravenouss(IV)ssitesinf
ectionssthatsdevelopedsinsthesclientssbeingscaredsforsonsthesnursingsunit.sHowsshouldsthesn
ursesproceedstosimplementsasqualitysimprovementsprogram?
Forseachsaction,sclickstosspecifyswhethersthesactionswouldsbe:
Indicated:sansactionsthatsthesnursesshouldstakestosresolvesthesproblem
Non-
essential:sansactionsthatsthesnursescouldstakeswithoutsharmingsthesclient,sbutsthesactionswo
uldsnotsbeslikelystosaddresssthesproblem
Contraindicated:sansactionsthatscouldsharmsthesclientsandsshouldsnotsbestakens-
sans✔✔Collectsidentifyingspatientsinformation
Contraindicated
Notesthesmentalsstatussofsthesclient
Non-essential
Notesprimarysandssecondarysdiagnosessofsclientssaffected
Indicated
NotesthestypesofsIVscathetersused
Indicated
NotesthestypesofsIVssitesdressingssbeingsused
Indicated
Notesthesmedicationstypessbeingsinfused
Non-essential
NotesfrequencysofsassessmentssofsIVssites
Indicated
NotesthesexpectedsdurationsofsthesIVssite
Non-essential
, NotescaresproceduresstosthesIVssite
Indicated
NotesfrequencysofschangingsIVssites
Indicated
Rationale:Qualitysimprovement,salsosknownsassperformancesimprovement,sfocusessonspr
ocessessorssystemssthatssignificantlyscontributestosclientssafetysandseffectivesclientscaresou
tcomes;scriteriasaresusedstosmonitorsoutcomessofscaresandstosdeterminesthesneedsforschang
estosimprovesthesqualitysofscare.sIfsthesnursesnotessasparticularsproblem,ssuchsassansincreas
esinsthesnumbersofsintravenouss(IV)ssitesinfections,sthesnursesshouldscollectsdatasaboutsthes
problem.sThissshouldsincludesinformationssuchsassthesprimarysandssecondarysdiagnosessof
sthesclientssdevelopingsthesinfection,sthestypesofsIVscatheterssbeingsused,sthessitesofsthescat
heter,sIVssitesdressingssbeingsused,sfrequencysofsassessmentsandsmethodssofscarestosthesI
Vssite,sandslengthsofstimesthatsthesIVscatheterswassinserted.sOncesthesesdatasarescollecteds
andsanalyzed,sthesnursesshouldsexaminesevidence-
basedspracticesprotocolsstosidentifysthesbestspracticessforscarestosIVssitesstospreventsinfectio
n.sThesespracticesscansthensbesimplementedsandsfollowedsbysevaluationsofsresultssbasedso
nsthesevidence-
basedspracticesprotocolssused.sCollectingsidentifyingsclientsinformationsisscontraindicateds
becausesofsconfidentialitysandsissunnecessarysinsthissqualitysimprovementseffort.sNotingsth
esmentalsstatussofsthesclientsscansbesdonesbutsissnotslikelystosaddresssthe
ThesnursesperformssansAllen'sstestsonsasclientsscheduledsforsansarterialsbloodsgassdrawsfro
msthesradialsartery.sOnsreleasesofspressuresfromsthesulnarsartery,scolorsinstheshandsreturnss
afters20sseconds.sHowsshouldsthesnursesinterpretsthesfinding?
sFillsinsthescorrectsmissingsinformationsbyschoosingsfromstheslistssofsoptionssinsthesdrop-
downsmenus.s-sans✔✔Thestestsresultsis
YoursAnswer:sAbnormalsCorrectsAnswer:sAbnormal
because
YoursAnswer:sThestimesforscolorstosreturnsissprolongesCorrectsAnswer:sThestimesforscolorstos
returnsissprolonged
Rationale:Failurestosdeterminesthespresencesofsadequatescollateralscirculationsbeforesdraw
ingsansarterialsbloodsgassspecimenscouldsresultsinsseveresischemicsinjurystostheshandsifsdam
agestosthesradialsarterysoccursswithsarterialspuncture.sUponsreleasesofspressuresonsthesulna
rsartery,sifspinknesssfailsstosreturnswithins6stos7sseconds,sthesulnarsarterysissinsufficient,sindic
atingsthatsthesradialsarterysshouldsnotsbesusedsforsobtainingsasbloodsspecimen.sAnotherssite
sneedsstosbesselectedsforsthesarterialspuncture,sandsthesprimaryshealthscaresprovidersneedss
tosbesnotifiedsofsthesfinding.
Thesnurseshassjustsreceivedsasclientsfromsthespostanesthesiascaresunits(PACU)sandsissmoni
toringsthesclient'ssvitalssigns.sClickstoshighlightsthescurrentsfinding(s)sthatswouldsbesessential
stosfollowsupson.sHighlightsonlysfinding(s)sthatsrequiresfollow-
up.sTosdeselectsasfinding,sclicksthesfindingsagain.s-sans✔✔30sminsago:
BP=s142/78
HR=s98
QUESTIONS/RATIONALES WITH
COMPLETE SOLUTIONS
ThesnursesnotessthespresencesofsasPswave,sQRSscomplex,sflattenedsTswaves,sandsoccasio
nalsUswavessonsasclient'sscardiacsmonitorsscreen.sFillsinsthescorrectsmissingsinformationsbys
choosingsfromstheslistssofsoptionssinsthesdrop-downsmenus.s-
sans✔✔Thesnursesshouldssuspect
YoursAnswer:shypokalemiaCorrectsAnswer:shypokalemia
becausesofsthe
YoursAnswer:sflattenedsTswavessandsoccasionalsUswavesCorrectsAnswer:sflattenedsTswav
essandsoccasionalsUswaves
Rationale:Cardiacschangessinshypokalemiasincludesimpairedsrepolarization,sresultingsinsasf
latteningsofsthesTswavesandseventuallysthesemergencesofsasUswave.sTherefore,sthesnursess
houldssuspectshypokalemia.sThesincidencesofspotentiallyslethalsventricularsdysrhythmiassiss
increasedsinshypokalemia.sThesnursesshouldsimmediatelysassesssthesclient'ssvitalssignssan
dscardiacsstatussforssignssofshypokalemia.sThesnursesshouldsalsoschecksthesclient'ssmostsre
centsserumspotassiumslevelsandsthenscontactsthesprimaryshealthscaresproviderstosreportsthe
sfindingssandsobtainsprescriptionsstostreatstheshypokalemicsstate.
Thesnursesisspreparingsasclientsforsaschestsx-
raysandsnotessthatsthesclientsisswearingsasreligioussmedalsonsaschainsaroundsthesneck.sWhat
sshouldsthesnursesdoswithsregardstosthisspersonalsitem?
sClickstoshighlightsthescorrectsanswersfromsthesoptionssprovided.s-
sans✔✔Thesnursesshould:s(Selects1soption)
✓Asksthesclientsifstheschainsandsmedalscansbesremovedsduringsthesprocedure.
Because:s(Selects1soption)
✓Theschainsandsmedalsmayshavesculturalssignificance.
Rationale:Beforescertainsdiagnosticsprocedures,sitsisstypicalstoshavesasclientsremovesperso
nalsobjectssthatsareswornsonsthesbodysbecausesofsclientssafetysandsthespossibilitysofscompro
misingstestsresults.sTherefore,sthesnursesshouldsasksthesclientsaboutsthessignificancesofssuc
hsansitemsandsitssremovalsbecausesitsmayshavesculturalsorsspiritualssignificance.sIfsso,sthesn
ursesshouldsasksthesclientsifsthesitemscansbeseithersremovedstemporarilysorsplacedsonsanoth
erspartsofsthesbodysduringsthesproceduresifsappropriate.
Whilespreparingsasclientsforssurgerysscheduledsins1shour,sthesclientsstatesstosthesnurse:s"Isha
veschangedsmysmind.sIsdon'tswantsthisssurgery."sClickstoshighlightsthescorrectsanswersfromst
hesoptionssprovided.s-sans✔✔Thesnursesshould:s(Selects1soption)
,Cancelsthessurgery.
Contactsthessurgeon.
✓Discusssthesclient'ssconcerns.
Callsthesidentifiedssupportsperson.
Because:s(Selects1soption)
Clientsconsentsissrequiredspriorstosanysprocedure.
✓Furthersquestionssorsconcernssshouldsbesdeterminedsandsaddressed.s
Ethicalsconsiderationssaresimportantsforsasclientsundergoingssurgery.s
Thesnursingsscopesofspracticesplacesslimitationssonshowsthesnursescansrespond.
Rationale:Ifsthesclientsindicatessthatshesorsshesdoessnotswantsasprescribedstherapy,streatme
nt,sorsproceduressuchsasssurgery,sthesnursesshouldsfurthersinvestigatesthesclient'ssrequest.s
Ifsthesclientsindicatessthatshesorssheshasschangedshissorshersmindsaboutssurgery,sthesnurses
shouldsassesssthesclientsandsexploreswithsthesclientshissorshersconcernssaboutsnotswantingst
hessurgery.sThesnurseswouldsthenswithholdsfurtherssurgicalspreparationsandscontactsthessur
geonstosreportsthesclient'ssrequestssosthatsthessurgeonscansdiscusssthesconsequencessofsn
otshavingsthessurgeryswithsthesclient.sFurthersassessmentsandsfollow-
upsrelatedstosthesclient'ssrequestsneedstosbesdone.sItsissthesclient'ssrightstosrefusestreatment;s
however,sfurthersinvestigationsissneededssosthesinterventionsscansbestailoredstosspecificsne
eds.
Thesnursesnotessthatsthereshassbeensansincreasesinsthesnumbersofsintravenouss(IV)ssitesinf
ectionssthatsdevelopedsinsthesclientssbeingscaredsforsonsthesnursingsunit.sHowsshouldsthesn
ursesproceedstosimplementsasqualitysimprovementsprogram?
Forseachsaction,sclickstosspecifyswhethersthesactionswouldsbe:
Indicated:sansactionsthatsthesnursesshouldstakestosresolvesthesproblem
Non-
essential:sansactionsthatsthesnursescouldstakeswithoutsharmingsthesclient,sbutsthesactionswo
uldsnotsbeslikelystosaddresssthesproblem
Contraindicated:sansactionsthatscouldsharmsthesclientsandsshouldsnotsbestakens-
sans✔✔Collectsidentifyingspatientsinformation
Contraindicated
Notesthesmentalsstatussofsthesclient
Non-essential
Notesprimarysandssecondarysdiagnosessofsclientssaffected
Indicated
NotesthestypesofsIVscathetersused
Indicated
NotesthestypesofsIVssitesdressingssbeingsused
Indicated
Notesthesmedicationstypessbeingsinfused
Non-essential
NotesfrequencysofsassessmentssofsIVssites
Indicated
NotesthesexpectedsdurationsofsthesIVssite
Non-essential
, NotescaresproceduresstosthesIVssite
Indicated
NotesfrequencysofschangingsIVssites
Indicated
Rationale:Qualitysimprovement,salsosknownsassperformancesimprovement,sfocusessonspr
ocessessorssystemssthatssignificantlyscontributestosclientssafetysandseffectivesclientscaresou
tcomes;scriteriasaresusedstosmonitorsoutcomessofscaresandstosdeterminesthesneedsforschang
estosimprovesthesqualitysofscare.sIfsthesnursesnotessasparticularsproblem,ssuchsassansincreas
esinsthesnumbersofsintravenouss(IV)ssitesinfections,sthesnursesshouldscollectsdatasaboutsthes
problem.sThissshouldsincludesinformationssuchsassthesprimarysandssecondarysdiagnosessof
sthesclientssdevelopingsthesinfection,sthestypesofsIVscatheterssbeingsused,sthessitesofsthescat
heter,sIVssitesdressingssbeingsused,sfrequencysofsassessmentsandsmethodssofscarestosthesI
Vssite,sandslengthsofstimesthatsthesIVscatheterswassinserted.sOncesthesesdatasarescollecteds
andsanalyzed,sthesnursesshouldsexaminesevidence-
basedspracticesprotocolsstosidentifysthesbestspracticessforscarestosIVssitesstospreventsinfectio
n.sThesespracticesscansthensbesimplementedsandsfollowedsbysevaluationsofsresultssbasedso
nsthesevidence-
basedspracticesprotocolssused.sCollectingsidentifyingsclientsinformationsisscontraindicateds
becausesofsconfidentialitysandsissunnecessarysinsthissqualitysimprovementseffort.sNotingsth
esmentalsstatussofsthesclientsscansbesdonesbutsissnotslikelystosaddresssthe
ThesnursesperformssansAllen'sstestsonsasclientsscheduledsforsansarterialsbloodsgassdrawsfro
msthesradialsartery.sOnsreleasesofspressuresfromsthesulnarsartery,scolorsinstheshandsreturnss
afters20sseconds.sHowsshouldsthesnursesinterpretsthesfinding?
sFillsinsthescorrectsmissingsinformationsbyschoosingsfromstheslistssofsoptionssinsthesdrop-
downsmenus.s-sans✔✔Thestestsresultsis
YoursAnswer:sAbnormalsCorrectsAnswer:sAbnormal
because
YoursAnswer:sThestimesforscolorstosreturnsissprolongesCorrectsAnswer:sThestimesforscolorstos
returnsissprolonged
Rationale:Failurestosdeterminesthespresencesofsadequatescollateralscirculationsbeforesdraw
ingsansarterialsbloodsgassspecimenscouldsresultsinsseveresischemicsinjurystostheshandsifsdam
agestosthesradialsarterysoccursswithsarterialspuncture.sUponsreleasesofspressuresonsthesulna
rsartery,sifspinknesssfailsstosreturnswithins6stos7sseconds,sthesulnarsarterysissinsufficient,sindic
atingsthatsthesradialsarterysshouldsnotsbesusedsforsobtainingsasbloodsspecimen.sAnotherssite
sneedsstosbesselectedsforsthesarterialspuncture,sandsthesprimaryshealthscaresprovidersneedss
tosbesnotifiedsofsthesfinding.
Thesnurseshassjustsreceivedsasclientsfromsthespostanesthesiascaresunits(PACU)sandsissmoni
toringsthesclient'ssvitalssigns.sClickstoshighlightsthescurrentsfinding(s)sthatswouldsbesessential
stosfollowsupson.sHighlightsonlysfinding(s)sthatsrequiresfollow-
up.sTosdeselectsasfinding,sclicksthesfindingsagain.s-sans✔✔30sminsago:
BP=s142/78
HR=s98
