Page 1 of 48
NCLEX HURST REVIEW ADULT HEALTH EXAM
WITH CORRECT ANSWERS,RATIONALES AND
WHY THE OTHERS ARE NOT CORRECT NEWEST
2026 EXAM VERIFIED 100 %
What is the priority nursing action for a client that was admitted with tingling
of the toes and feet after having the flu for several days when the client begins
to have numbness in the legs and hips?
1. Notify the primary healthcare provider
2. Monitor for paresthesia in the fingers and hands
3. Insert an indwelling urinary catheter
4. Assist the client with performing passive range of motion
1. Notify the primary healthcare provider
Why the Correct Option Is Right
• 1. Notify the primary healthcare provider
o The Pathophysiology: The client is presenting with the classic, rapid
progression of Guillain-Barré Syndrome (GBS). GBS is an
autoimmune disorder that frequently follows a recent viral infection (like
the flu) and causes an ascending symmetrical paralysis.
o The Critical Threat: The tingling and numbness are actively climbing
from the toes up into the legs and hip region. If this ascending paralysis
continues to advance up the torso, it will paralyze the intercostal
muscles and the diaphragm, leading to sudden acute respiratory
failure.
o The Priority: Because this rapid neurological deterioration requires
immediate medical interventions (such as preparing for elective
intubation, initiating plasmapheresis, or administering IVIG therapy),
the nurse must notify the primary healthcare provider immediately.
, Page 2 of 48
Why the Other Options Are Wrong
• ❌ 2. Monitor for paresthesia in the fingers and hands
o While the nurse must continue to monitor the patient's neurological
status, merely watching the numbness spread to the upper extremities
is a passive action. It delays life-saving medical intervention while the
patient's respiratory system is actively at risk.
• ❌ 3. Insert an indwelling urinary catheter
o Autonomic dysfunction from GBS can eventually cause urinary
retention, which might require a catheter. However, securing a urinary
catheter is a secondary task that does not address the immediate, life-
threatening risk of respiratory arrest.
• ❌ 4. Assist the client with performing passive range of motion
o Performing passive range of motion exercises is an excellent nursing
intervention to prevent muscle atrophy and contractures in a paralyzed
patient. However, this is part of long-term rehabilitative care and takes
a low priority during an acute, rapidly advancing neurological
emergency.
A client reports excruciating paroxysmal facial pain occurring after feeling a
cool breeze and drinking cold beverages. Based on this client's reports, what
disorder does the nurse suspect?
1. Bell's palsy
2. Submucous cleft palate
3. Trigeminal neuralgia
4. Temporomandibular joint disorder (TMD)
3. Trigeminal neuralgia
Why the Correct Option Is Right
• 3. Trigeminal neuralgia
o Pathophysiology: Trigeminal neuralgia (or tic douloureux) is a chronic
pain disorder that affects the fifth cranial nerve (CN V), which
supplies sensation to the face.
o The Mechanism: Blood vessel compression or nerve irritation causes
the nerve's protective myelin sheath to wear down. This leaves the
nerve hyper-sensitive and causes mild, non-painful sensory inputs to
be misread by the brain as extreme trauma.
o The Triggers: This condition is characterized by sudden, severe, and
excruciating paroxysmal (shock-like) facial pain. These agonizing
attacks are predictably triggered by simple, everyday actions that
stimulate the face, such as feeling a cool breeze, washing the face,
brushing teeth, eating, or drinking cold beverages.
, Page 3 of 48
Why the Other Options Are Wrong
• ❌ 1. Bell's palsy
o Bell's palsy is an acute inflammation of the seventh cranial nerve (CN
VII), also known as the facial nerve. CN VII primarily controls the
physical muscles of facial expression, not facial sensation. Therefore,
Bell's palsy causes a sudden, unilateral muscle drooping or
paralysis of the face, rather than excruciating paroxysmal pain.
• ❌ 2. Submucous cleft palate
o A submucous cleft palate is a congenital birth defect where the tissue
of the hard or soft palate fails to fuse completely under the mucous
membrane. It causes structural speech issues (a hypernasal voice) and
feeding difficulties in infants, not sudden facial pain triggered by
environmental factors in adults.
• ❌ 4. Temporomandibular joint disorder (TMD)
o TMD involves inflammation, misalignment, or dysfunction of the jaw
joint and its surrounding muscles. While it causes facial discomfort, the
pain is typically described as a dull, constant ache or clicking sensation
that is worsened by chewing or clenching the teeth. It does not present
as sharp, shock-like paroxysmal pain triggered simply by a passing
cool breeze
The nurse is reviewing sequential lab results on a newly admitted client with
multiple health issues. Critical changes in which body system require the
nurse to immediately notify the primary healthcare provider?
1. Renal
2. Endocrine
3. Pulmonary
4. Cardiovascular
1. Renal
Why the Correct Option Is Right
• 1. Renal
o Systemic Impact: The renal (kidney) system is responsible for
regulating the body's entire fluid, electrolyte, and acid-base balance, as
well as filtering out toxic metabolic waste products.
o The Safety Cascade: When sequential laboratory values indicate acute
kidney injury or worsening renal failure (evidenced by a rapid spike in
serum creatinine, blood urea nitrogen, and a plunging glomerular
filtration rate), it triggers a lethal domino effect across multiple body
systems.
o Critical Threats: Failing kidneys cause sudden, dangerous
hyperkalemia (which can prompt fatal cardiac arrest) and severe
metabolic acidosis (which impairs global cellular function). Because
, Page 4 of 48
these acute chemical shifts present an immediate, catastrophic threat
to the client's life, critical changes in the renal lab panel require the
most urgent provider notification.
Why the Other Options Are Less Immediate Priorities
• ❌ 2. Endocrine
o While severe, unmanaged shifts in endocrine values (such as
fluctuating blood sugars in a diabetic patient or extreme thyroid levels)
require careful tracking and eventual medication adjustments, they
rarely cause the immediate, multi-system chemical collapse seen in
acute renal failure.
• ❌ 3. Pulmonary
o Pulmonary status is primarily tracked and evaluated using clinical
nursing assessments (respiratory rate, accessory muscle use, lung
sounds) and immediate bedside monitoring (pulse oximetry) rather
than waiting on sequential laboratory results. While Arterial Blood
Gases (ABGs) are an exception, the physiological driver of chronic
metabolic acid-base emergencies in a medical unit is routinely the
renal system.
• ❌ 4. Cardiovascular
o Acute cardiovascular damage is detected via specific biomarkers like
troponin or CK-MB. While a heart attack is an emergency, a single
elevated troponin line is diagnostic for an ongoing localized cardiac
event. Worsening sequential renal labs, conversely, signal a systemic
failure that actively destabilizes the heart itself (via hyperkalemia)
alongside the neurological and hematological systems
A client with chronic arterial occlusive disease has a bypass graft of the left
femoral artery. Postoperatively, the client develops left leg pain and coolness
in the left foot. What is the priority action by the nurse?
1. Elevate the leg.
2. Check distal pulses.
3. Increase the IV rate.
4. Notify the primary healthcare provider.
4. Notify the primary healthcare provider.
Why the Correct Option Is Right
• 4. Notify the primary healthcare provider.
o The Critical Threat: Following an arterial bypass graft surgery, the
sudden development of severe pain and a cold foot in the surgical
extremity are classic, definitive signs of acute graft occlusion
(clotting) or arterial thrombosis.
o Pathophysiology: The newly grafted artery has become completely
blocked, cutting off all arterial blood and oxygen delivery to the lower
leg and foot. This creates an immediate, severe ischemic crisis.
o The Priority: If blood flow is not surgically restored within a very tight
timeframe, the tissue will experience permanent necrosis (tissue
NCLEX HURST REVIEW ADULT HEALTH EXAM
WITH CORRECT ANSWERS,RATIONALES AND
WHY THE OTHERS ARE NOT CORRECT NEWEST
2026 EXAM VERIFIED 100 %
What is the priority nursing action for a client that was admitted with tingling
of the toes and feet after having the flu for several days when the client begins
to have numbness in the legs and hips?
1. Notify the primary healthcare provider
2. Monitor for paresthesia in the fingers and hands
3. Insert an indwelling urinary catheter
4. Assist the client with performing passive range of motion
1. Notify the primary healthcare provider
Why the Correct Option Is Right
• 1. Notify the primary healthcare provider
o The Pathophysiology: The client is presenting with the classic, rapid
progression of Guillain-Barré Syndrome (GBS). GBS is an
autoimmune disorder that frequently follows a recent viral infection (like
the flu) and causes an ascending symmetrical paralysis.
o The Critical Threat: The tingling and numbness are actively climbing
from the toes up into the legs and hip region. If this ascending paralysis
continues to advance up the torso, it will paralyze the intercostal
muscles and the diaphragm, leading to sudden acute respiratory
failure.
o The Priority: Because this rapid neurological deterioration requires
immediate medical interventions (such as preparing for elective
intubation, initiating plasmapheresis, or administering IVIG therapy),
the nurse must notify the primary healthcare provider immediately.
, Page 2 of 48
Why the Other Options Are Wrong
• ❌ 2. Monitor for paresthesia in the fingers and hands
o While the nurse must continue to monitor the patient's neurological
status, merely watching the numbness spread to the upper extremities
is a passive action. It delays life-saving medical intervention while the
patient's respiratory system is actively at risk.
• ❌ 3. Insert an indwelling urinary catheter
o Autonomic dysfunction from GBS can eventually cause urinary
retention, which might require a catheter. However, securing a urinary
catheter is a secondary task that does not address the immediate, life-
threatening risk of respiratory arrest.
• ❌ 4. Assist the client with performing passive range of motion
o Performing passive range of motion exercises is an excellent nursing
intervention to prevent muscle atrophy and contractures in a paralyzed
patient. However, this is part of long-term rehabilitative care and takes
a low priority during an acute, rapidly advancing neurological
emergency.
A client reports excruciating paroxysmal facial pain occurring after feeling a
cool breeze and drinking cold beverages. Based on this client's reports, what
disorder does the nurse suspect?
1. Bell's palsy
2. Submucous cleft palate
3. Trigeminal neuralgia
4. Temporomandibular joint disorder (TMD)
3. Trigeminal neuralgia
Why the Correct Option Is Right
• 3. Trigeminal neuralgia
o Pathophysiology: Trigeminal neuralgia (or tic douloureux) is a chronic
pain disorder that affects the fifth cranial nerve (CN V), which
supplies sensation to the face.
o The Mechanism: Blood vessel compression or nerve irritation causes
the nerve's protective myelin sheath to wear down. This leaves the
nerve hyper-sensitive and causes mild, non-painful sensory inputs to
be misread by the brain as extreme trauma.
o The Triggers: This condition is characterized by sudden, severe, and
excruciating paroxysmal (shock-like) facial pain. These agonizing
attacks are predictably triggered by simple, everyday actions that
stimulate the face, such as feeling a cool breeze, washing the face,
brushing teeth, eating, or drinking cold beverages.
, Page 3 of 48
Why the Other Options Are Wrong
• ❌ 1. Bell's palsy
o Bell's palsy is an acute inflammation of the seventh cranial nerve (CN
VII), also known as the facial nerve. CN VII primarily controls the
physical muscles of facial expression, not facial sensation. Therefore,
Bell's palsy causes a sudden, unilateral muscle drooping or
paralysis of the face, rather than excruciating paroxysmal pain.
• ❌ 2. Submucous cleft palate
o A submucous cleft palate is a congenital birth defect where the tissue
of the hard or soft palate fails to fuse completely under the mucous
membrane. It causes structural speech issues (a hypernasal voice) and
feeding difficulties in infants, not sudden facial pain triggered by
environmental factors in adults.
• ❌ 4. Temporomandibular joint disorder (TMD)
o TMD involves inflammation, misalignment, or dysfunction of the jaw
joint and its surrounding muscles. While it causes facial discomfort, the
pain is typically described as a dull, constant ache or clicking sensation
that is worsened by chewing or clenching the teeth. It does not present
as sharp, shock-like paroxysmal pain triggered simply by a passing
cool breeze
The nurse is reviewing sequential lab results on a newly admitted client with
multiple health issues. Critical changes in which body system require the
nurse to immediately notify the primary healthcare provider?
1. Renal
2. Endocrine
3. Pulmonary
4. Cardiovascular
1. Renal
Why the Correct Option Is Right
• 1. Renal
o Systemic Impact: The renal (kidney) system is responsible for
regulating the body's entire fluid, electrolyte, and acid-base balance, as
well as filtering out toxic metabolic waste products.
o The Safety Cascade: When sequential laboratory values indicate acute
kidney injury or worsening renal failure (evidenced by a rapid spike in
serum creatinine, blood urea nitrogen, and a plunging glomerular
filtration rate), it triggers a lethal domino effect across multiple body
systems.
o Critical Threats: Failing kidneys cause sudden, dangerous
hyperkalemia (which can prompt fatal cardiac arrest) and severe
metabolic acidosis (which impairs global cellular function). Because
, Page 4 of 48
these acute chemical shifts present an immediate, catastrophic threat
to the client's life, critical changes in the renal lab panel require the
most urgent provider notification.
Why the Other Options Are Less Immediate Priorities
• ❌ 2. Endocrine
o While severe, unmanaged shifts in endocrine values (such as
fluctuating blood sugars in a diabetic patient or extreme thyroid levels)
require careful tracking and eventual medication adjustments, they
rarely cause the immediate, multi-system chemical collapse seen in
acute renal failure.
• ❌ 3. Pulmonary
o Pulmonary status is primarily tracked and evaluated using clinical
nursing assessments (respiratory rate, accessory muscle use, lung
sounds) and immediate bedside monitoring (pulse oximetry) rather
than waiting on sequential laboratory results. While Arterial Blood
Gases (ABGs) are an exception, the physiological driver of chronic
metabolic acid-base emergencies in a medical unit is routinely the
renal system.
• ❌ 4. Cardiovascular
o Acute cardiovascular damage is detected via specific biomarkers like
troponin or CK-MB. While a heart attack is an emergency, a single
elevated troponin line is diagnostic for an ongoing localized cardiac
event. Worsening sequential renal labs, conversely, signal a systemic
failure that actively destabilizes the heart itself (via hyperkalemia)
alongside the neurological and hematological systems
A client with chronic arterial occlusive disease has a bypass graft of the left
femoral artery. Postoperatively, the client develops left leg pain and coolness
in the left foot. What is the priority action by the nurse?
1. Elevate the leg.
2. Check distal pulses.
3. Increase the IV rate.
4. Notify the primary healthcare provider.
4. Notify the primary healthcare provider.
Why the Correct Option Is Right
• 4. Notify the primary healthcare provider.
o The Critical Threat: Following an arterial bypass graft surgery, the
sudden development of severe pain and a cold foot in the surgical
extremity are classic, definitive signs of acute graft occlusion
(clotting) or arterial thrombosis.
o Pathophysiology: The newly grafted artery has become completely
blocked, cutting off all arterial blood and oxygen delivery to the lower
leg and foot. This creates an immediate, severe ischemic crisis.
o The Priority: If blood flow is not surgically restored within a very tight
timeframe, the tissue will experience permanent necrosis (tissue
