Nursing Clinical Judgment and NCLEX
Readiness Practice Exam questions and
correct answers– Updated 2026 (Graded A+)
instant download pdf
Subject: Nursing Clinical Judgment and NCLEX Readiness
Subtopic: Management of Care and Ethical Practice
Question 1: A nurse is caring for a client who is a devout Jehovah's Witness and requires a major
surgical procedure. The client explicitly states they will refuse any blood products, even if the
procedure results in significant blood loss. What is the most appropriate action by the nurse?
A) Document the refusal in the medical record and ensure a signed informed refusal form is
obtained.
B) Explain to the client that in life-threatening situations, the hospital has the legal right to
override religious objections.
C) Contact the hospital’s chaplain to attempt to persuade the client to change their mind before
surgery.
D) Prepare to administer blood products if the client loses consciousness and cannot provide
consent.
Correct Answer: A - Document the refusal in the medical record and ensure a signed
informed refusal form is obtained.
Rationale: The nurse must respect the client's autonomy and their right to refuse treatment based
on religious beliefs. Documentation and informed refusal are critical legal requirements to
protect both the patient's rights and the facility. Option B is incorrect because hospitals
generally cannot override a competent adult's refusal of treatment. Option C is inappropriate as
the nurse should not attempt to coerce or persuade the patient against their religious values.
Option D is illegal and violates the principle of informed consent; if the patient has made their
wishes known while competent, those wishes must be honored regardless of their level of
consciousness.
Subtopic: Medical-Surgical Nursing: Endocrine System
Question 2: A nurse is monitoring a client 6 hours following a subtotal thyroidectomy. The client
reports tingling in the fingers and circumoral numbness. Which of the following actions should
the nurse take first?
, A) Elevate the head of the bed to 45 degrees.
B) Check the client’s serum potassium levels.
C) Prepare to administer intravenous calcium gluconate.
D) Encourage the client to breathe into a paper bag to prevent hyperventilation.
Correct Answer: C - Prepare to administer intravenous calcium gluconate.
Rationale: Tingling in the fingers and circumoral numbness are classic signs of hypocalcemia,
which is a common complication following a thyroidectomy due to inadvertent damage or
removal of the parathyroid glands. Calcium gluconate is the standard treatment to reverse this
electrolyte imbalance. Option A helps with swelling but does not address the underlying
electrolyte deficit. Option B is incorrect because hypocalcemia, not hyperkalemia, is the
concern. Option D is incorrect because these symptoms are indicative of physiological
hypocalcemia, not respiratory alkalosis from hyperventilation.
Subtopic: Medical-Surgical Nursing: Hematology
Question 3: A nurse is assessing a pediatric client with sickle-cell anemia who presents with
signs of acute chest syndrome. Which of the following assessment findings should the nurse
prioritize?
A) Temperature of 37.9°C (100.2°F).
B) Substernal retractions and decreased oxygen saturation.
C) Reports of mild abdominal discomfort.
D) A heart rate of 95 beats per minute.
Correct Answer: B - Substernal retractions and decreased oxygen saturation.
Rationale: Acute chest syndrome is a life-threatening complication of sickle-cell anemia,
characterized by vaso-occlusion in the pulmonary vasculature. Clinical indicators include
respiratory distress (substernal retractions), hypoxia, and lung infiltrates. These findings require
immediate intervention to prevent respiratory failure. Option A, while potentially indicating
infection, is less immediate than signs of respiratory failure. Option C and D are common in
these patients but do not constitute the immediate life-threatening emergency of acute chest
syndrome.
Subtopic: Pharmacology and Medication Administration
Readiness Practice Exam questions and
correct answers– Updated 2026 (Graded A+)
instant download pdf
Subject: Nursing Clinical Judgment and NCLEX Readiness
Subtopic: Management of Care and Ethical Practice
Question 1: A nurse is caring for a client who is a devout Jehovah's Witness and requires a major
surgical procedure. The client explicitly states they will refuse any blood products, even if the
procedure results in significant blood loss. What is the most appropriate action by the nurse?
A) Document the refusal in the medical record and ensure a signed informed refusal form is
obtained.
B) Explain to the client that in life-threatening situations, the hospital has the legal right to
override religious objections.
C) Contact the hospital’s chaplain to attempt to persuade the client to change their mind before
surgery.
D) Prepare to administer blood products if the client loses consciousness and cannot provide
consent.
Correct Answer: A - Document the refusal in the medical record and ensure a signed
informed refusal form is obtained.
Rationale: The nurse must respect the client's autonomy and their right to refuse treatment based
on religious beliefs. Documentation and informed refusal are critical legal requirements to
protect both the patient's rights and the facility. Option B is incorrect because hospitals
generally cannot override a competent adult's refusal of treatment. Option C is inappropriate as
the nurse should not attempt to coerce or persuade the patient against their religious values.
Option D is illegal and violates the principle of informed consent; if the patient has made their
wishes known while competent, those wishes must be honored regardless of their level of
consciousness.
Subtopic: Medical-Surgical Nursing: Endocrine System
Question 2: A nurse is monitoring a client 6 hours following a subtotal thyroidectomy. The client
reports tingling in the fingers and circumoral numbness. Which of the following actions should
the nurse take first?
, A) Elevate the head of the bed to 45 degrees.
B) Check the client’s serum potassium levels.
C) Prepare to administer intravenous calcium gluconate.
D) Encourage the client to breathe into a paper bag to prevent hyperventilation.
Correct Answer: C - Prepare to administer intravenous calcium gluconate.
Rationale: Tingling in the fingers and circumoral numbness are classic signs of hypocalcemia,
which is a common complication following a thyroidectomy due to inadvertent damage or
removal of the parathyroid glands. Calcium gluconate is the standard treatment to reverse this
electrolyte imbalance. Option A helps with swelling but does not address the underlying
electrolyte deficit. Option B is incorrect because hypocalcemia, not hyperkalemia, is the
concern. Option D is incorrect because these symptoms are indicative of physiological
hypocalcemia, not respiratory alkalosis from hyperventilation.
Subtopic: Medical-Surgical Nursing: Hematology
Question 3: A nurse is assessing a pediatric client with sickle-cell anemia who presents with
signs of acute chest syndrome. Which of the following assessment findings should the nurse
prioritize?
A) Temperature of 37.9°C (100.2°F).
B) Substernal retractions and decreased oxygen saturation.
C) Reports of mild abdominal discomfort.
D) A heart rate of 95 beats per minute.
Correct Answer: B - Substernal retractions and decreased oxygen saturation.
Rationale: Acute chest syndrome is a life-threatening complication of sickle-cell anemia,
characterized by vaso-occlusion in the pulmonary vasculature. Clinical indicators include
respiratory distress (substernal retractions), hypoxia, and lung infiltrates. These findings require
immediate intervention to prevent respiratory failure. Option A, while potentially indicating
infection, is less immediate than signs of respiratory failure. Option C and D are common in
these patients but do not constitute the immediate life-threatening emergency of acute chest
syndrome.
Subtopic: Pharmacology and Medication Administration
