NUR 224 NCLEX PREPARATION EXAM 2026 Q&A
1. A client with chronic kidney disease (CKD) stage 4 has a serum potassium level of 6.2
mEq/L. Which intervention should the nurse prioritize first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer regular insulin 10 units IV with dextrose 50%
C. Place the client on cardiac monitoring
D. Notify the healthcare provider immediately
Correct Answer: C
Explanation: Cardiac monitoring is the priority because hyperkalemia can cause life-
threatening dysrhythmias. While insulin/dextrose and Kayexalate treat hyperkalemia,
and the provider needs to be notified, ensuring cardiac safety through monitoring comes
first. Options A and B are appropriate treatments but require orders and take time to
work.
2. A client is admitted with suspected pulmonary embolism. Which assessment finding
requires immediate nursing intervention?
A. Oxygen saturation of 91% on room air
B. Sudden onset of dyspnea with chest pain
C. Heart rate of 118 beats/minute
D. Arterial blood gas showing pH 7.49, PaCO2 30 mmHg, PaO2 58 mmHg
Correct Answer: D
Explanation: The ABG indicates severe hypoxemia (PaO2 <60 mmHg) with respiratory
alkalosis, suggesting significant gas exchange impairment requiring immediate oxygen
therapy and intervention. While all findings are concerning, the critically low PaO2 poses
the greatest immediate threat to oxygenation.
3. The nurse is caring for a client receiving total parenteral nutrition (TPN). Which finding
indicates a potential complication requiring immediate action?
A. Blood glucose of 180 mg/dL
B. Temperature of 38.9°C (102°F)
C. Weight gain of 1 kg in 24 hours
D. Urine output of 2500 mL in 24 hours
Correct Answer: B
Explanation: Fever in a client on TPN is a red flag for catheter-related bloodstream
infection, a serious complication requiring immediate intervention including blood
, cultures and possibly antibiotic therapy. Mild hyperglycemia is common with TPN, and
slight weight gain may be fluid.
4. A client with heart failure is prescribed furosemide 40 mg daily. Which laboratory value
requires the most careful monitoring?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes significant potassium loss, leading
to hypokalemia which can cause dangerous cardiac dysrhythmias. While sodium,
calcium, and magnesium may also be affected, potassium monitoring is most critical for
cardiac safety.
5. A client returns to the unit after thyroidectomy. Which assessment finding requires
immediate notification of the healthcare provider?
A. Slight hoarseness of voice
B. Serum calcium of 7.8 mg/dL
C. Tingling around the mouth and fingertips
D. Pain at the surgical site rated 4/10
Correct Answer: C
Explanation: Perioral and fingertip tingling indicates hypocalcemia from possible
parathyroid gland damage, which can progress to tetany and laryngospasm. This is a
medical emergency requiring immediate calcium replacement. Mild hoarseness is
common post-thyroidectomy.
6. A client with diabetes mellitus presents with blood glucose of 48 mg/dL. The client is
alert and oriented. Which intervention is most appropriate?
A. Administer glucagon 1 mg IM
B. Give 4 oz orange juice and 2 crackers
C. Administer 50% dextrose 50 mL IV push
D. Call the rapid response team
Correct Answer: B
Explanation: For an alert client with hypoglycemia, the 15-15 rule applies: 15g fast-
, acting carbohydrates (orange juice) followed by protein/carbohydrate snack (crackers).
IV dextrose and glucagon are for unconscious clients. Rapid response is unnecessary for
an alert client.
7. A client with COPD has an arterial blood gas showing pH 7.32, PaCO2 58 mmHg, HCO3
29 mEq/L. How should the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
Correct Answer: B
Explanation: The acidic pH (<7.35) with elevated PaCO2 (>45) indicates respiratory
acidosis. The elevated HCO3 (>26) shows renal compensation has begun but hasn't fully
normalized the pH, indicating partial compensation characteristic of chronic COPD.
8. Which action by the nurse demonstrates proper delegation to unlicensed assistive
personnel (UAP)?
A. Asking UAP to assess a client's pain level after medication
B. Assigning UAP to feed a client with mild dysphagia
C. Instructing UAP to collect vital signs on stable clients
D. Requesting UAP to reinforce teaching about wound care
Correct Answer: C
Explanation: Vital signs on stable clients is within the UAP's scope. Assessment (A),
feeding clients with dysphagia (B), and reinforcing teaching (D) require nursing
knowledge and are outside UAP scope. Proper delegation considers client stability and
task complexity.
9. A client is starting warfarin therapy for atrial fibrillation. Which statement by the client
indicates understanding of discharge teaching?
A. "I'll take aspirin for headaches instead of ibuprofen"
B. "I'll eat more leafy green vegetables for better health"
C. "I'll use a soft toothbrush and electric razor"
D. "I'll stop the medication if I notice bruising"
Correct Answer: C
Explanation: Using a soft toothbrush and electric razor prevents bleeding, a major
, warfarin side effect. Leafy greens (B) contain vitamin K which interferes with warfarin.
Aspirin (A) increases bleeding risk. Medication should never be stopped without provider
approval (D).
10. A client with acute pancreatitis is admitted. Which laboratory value is most important for
the nurse to monitor?
A. Amylase and lipase
B. Complete blood count
C. Liver function tests
D. Serum calcium
Correct Answer: D
Explanation: Hypocalcemia is a serious complication of acute pancreatitis (due to fat
saponification) and can cause tetany and cardiac dysrhythmias. While amylase/lipase
confirm diagnosis, calcium monitoring predicts severity and complications.
11. The nurse is caring for a client with a chest tube. Which finding requires immediate
intervention?
A. Tidal movement in the water seal chamber
B. Continuous bubbling in the water seal chamber
C. Drainage of 50 mL serosanguineous fluid in 1 hour
D. Fluctuation in the suction control chamber
Correct Answer: B
Explanation: Continuous bubbling in the water seal chamber indicates an air leak, which
requires immediate investigation. Intermittent bubbling with respiration (tidal
movement) is normal. Serosanguineous drainage is expected initially.
12. A client with sepsis has a lactate level of 4.5 mmol/L. What does this indicate?
A. Adequate tissue perfusion
B. Mild tissue hypoxia
C. Significant tissue hypoperfusion
D. Resolving sepsis
Correct Answer: C
Explanation: Lactate >4 mmol/L indicates significant tissue hypoperfusion and anaerobic
metabolism, a marker of severe sepsis requiring aggressive fluid resuscitation and source
control. Normal lactate is <2 mmol/L.
1. A client with chronic kidney disease (CKD) stage 4 has a serum potassium level of 6.2
mEq/L. Which intervention should the nurse prioritize first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer regular insulin 10 units IV with dextrose 50%
C. Place the client on cardiac monitoring
D. Notify the healthcare provider immediately
Correct Answer: C
Explanation: Cardiac monitoring is the priority because hyperkalemia can cause life-
threatening dysrhythmias. While insulin/dextrose and Kayexalate treat hyperkalemia,
and the provider needs to be notified, ensuring cardiac safety through monitoring comes
first. Options A and B are appropriate treatments but require orders and take time to
work.
2. A client is admitted with suspected pulmonary embolism. Which assessment finding
requires immediate nursing intervention?
A. Oxygen saturation of 91% on room air
B. Sudden onset of dyspnea with chest pain
C. Heart rate of 118 beats/minute
D. Arterial blood gas showing pH 7.49, PaCO2 30 mmHg, PaO2 58 mmHg
Correct Answer: D
Explanation: The ABG indicates severe hypoxemia (PaO2 <60 mmHg) with respiratory
alkalosis, suggesting significant gas exchange impairment requiring immediate oxygen
therapy and intervention. While all findings are concerning, the critically low PaO2 poses
the greatest immediate threat to oxygenation.
3. The nurse is caring for a client receiving total parenteral nutrition (TPN). Which finding
indicates a potential complication requiring immediate action?
A. Blood glucose of 180 mg/dL
B. Temperature of 38.9°C (102°F)
C. Weight gain of 1 kg in 24 hours
D. Urine output of 2500 mL in 24 hours
Correct Answer: B
Explanation: Fever in a client on TPN is a red flag for catheter-related bloodstream
infection, a serious complication requiring immediate intervention including blood
, cultures and possibly antibiotic therapy. Mild hyperglycemia is common with TPN, and
slight weight gain may be fluid.
4. A client with heart failure is prescribed furosemide 40 mg daily. Which laboratory value
requires the most careful monitoring?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes significant potassium loss, leading
to hypokalemia which can cause dangerous cardiac dysrhythmias. While sodium,
calcium, and magnesium may also be affected, potassium monitoring is most critical for
cardiac safety.
5. A client returns to the unit after thyroidectomy. Which assessment finding requires
immediate notification of the healthcare provider?
A. Slight hoarseness of voice
B. Serum calcium of 7.8 mg/dL
C. Tingling around the mouth and fingertips
D. Pain at the surgical site rated 4/10
Correct Answer: C
Explanation: Perioral and fingertip tingling indicates hypocalcemia from possible
parathyroid gland damage, which can progress to tetany and laryngospasm. This is a
medical emergency requiring immediate calcium replacement. Mild hoarseness is
common post-thyroidectomy.
6. A client with diabetes mellitus presents with blood glucose of 48 mg/dL. The client is
alert and oriented. Which intervention is most appropriate?
A. Administer glucagon 1 mg IM
B. Give 4 oz orange juice and 2 crackers
C. Administer 50% dextrose 50 mL IV push
D. Call the rapid response team
Correct Answer: B
Explanation: For an alert client with hypoglycemia, the 15-15 rule applies: 15g fast-
, acting carbohydrates (orange juice) followed by protein/carbohydrate snack (crackers).
IV dextrose and glucagon are for unconscious clients. Rapid response is unnecessary for
an alert client.
7. A client with COPD has an arterial blood gas showing pH 7.32, PaCO2 58 mmHg, HCO3
29 mEq/L. How should the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
Correct Answer: B
Explanation: The acidic pH (<7.35) with elevated PaCO2 (>45) indicates respiratory
acidosis. The elevated HCO3 (>26) shows renal compensation has begun but hasn't fully
normalized the pH, indicating partial compensation characteristic of chronic COPD.
8. Which action by the nurse demonstrates proper delegation to unlicensed assistive
personnel (UAP)?
A. Asking UAP to assess a client's pain level after medication
B. Assigning UAP to feed a client with mild dysphagia
C. Instructing UAP to collect vital signs on stable clients
D. Requesting UAP to reinforce teaching about wound care
Correct Answer: C
Explanation: Vital signs on stable clients is within the UAP's scope. Assessment (A),
feeding clients with dysphagia (B), and reinforcing teaching (D) require nursing
knowledge and are outside UAP scope. Proper delegation considers client stability and
task complexity.
9. A client is starting warfarin therapy for atrial fibrillation. Which statement by the client
indicates understanding of discharge teaching?
A. "I'll take aspirin for headaches instead of ibuprofen"
B. "I'll eat more leafy green vegetables for better health"
C. "I'll use a soft toothbrush and electric razor"
D. "I'll stop the medication if I notice bruising"
Correct Answer: C
Explanation: Using a soft toothbrush and electric razor prevents bleeding, a major
, warfarin side effect. Leafy greens (B) contain vitamin K which interferes with warfarin.
Aspirin (A) increases bleeding risk. Medication should never be stopped without provider
approval (D).
10. A client with acute pancreatitis is admitted. Which laboratory value is most important for
the nurse to monitor?
A. Amylase and lipase
B. Complete blood count
C. Liver function tests
D. Serum calcium
Correct Answer: D
Explanation: Hypocalcemia is a serious complication of acute pancreatitis (due to fat
saponification) and can cause tetany and cardiac dysrhythmias. While amylase/lipase
confirm diagnosis, calcium monitoring predicts severity and complications.
11. The nurse is caring for a client with a chest tube. Which finding requires immediate
intervention?
A. Tidal movement in the water seal chamber
B. Continuous bubbling in the water seal chamber
C. Drainage of 50 mL serosanguineous fluid in 1 hour
D. Fluctuation in the suction control chamber
Correct Answer: B
Explanation: Continuous bubbling in the water seal chamber indicates an air leak, which
requires immediate investigation. Intermittent bubbling with respiration (tidal
movement) is normal. Serosanguineous drainage is expected initially.
12. A client with sepsis has a lactate level of 4.5 mmol/L. What does this indicate?
A. Adequate tissue perfusion
B. Mild tissue hypoxia
C. Significant tissue hypoperfusion
D. Resolving sepsis
Correct Answer: C
Explanation: Lactate >4 mmol/L indicates significant tissue hypoperfusion and anaerobic
metabolism, a marker of severe sepsis requiring aggressive fluid resuscitation and source
control. Normal lactate is <2 mmol/L.
