NCSBN
Leading Regulatory Excellence
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NCLEX RN NGN ACTUAL EXAM QUESTIONS AND ANSWERS
,1. The nurse is caring for four clients in the ICU. Which client should the nurse assess first?
· A. A client with a spinal cord injury at T3 who reports a sudden "bursting" headache and is sweating
profusely.
· B. A client with a pulmonary embolism receiving Heparin whose aPTT is 95 seconds.
· C. A client 12 hours post-thoracotomy with $150 \text{ mL}$ of serosanguinous drainage in the chest
tube collection chamber over the last hour.
· D. A client with acute pancreatitis who is complaining of severe, radiating epigastric pain and has a rigid,
26
board-like abdomen.
Answer: D Strategy: Prioritize "New/Sudden" vs. "Expected." While A is Autonomic Dysreflexia (urgent), D indicates
a perforated viscus or peritonitis (surgical emergency). C is a high volume for a thoracotomy, but a rigid abdomen in
20
pancreatitis often signals a life-threatening complication like perforation or hemorrhage.
2. A client is admitted with a diagnosis of Myasthenic Crisis. Which of the following clinical findings would the nurse
anticipate? (Select All That Apply)
·
·
·
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· A. Improved muscle strength after the administration of edrophonium.
B. Increased bronchial secretions and miosis.
C. Respiratory muscle weakness leading to decreased vital capacity.
D. Bowel and bladder incontinence.
· E. Ptosis and diplopia.
Ex
Answer: A, C, E Strategy:Differentiate between Myasthenic Crisis (not enough meds) and Cholinergic Crisis (too much
meds). In Myasthenic Crisis, edrophonium improves symptoms. "Wet"symptoms like secretions and miosis (B) are
signs of Cholinergic Crisis.
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3. A client with a history of heart failure and atrial fibrillation is prescribed Digoxin and Furosemide.
Which assessment finding requires the most immediate intervention?
· A. Serum potassium level of $3.4 \text{ mEq/L}$.
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· B. Heart rate of $58 \text{ bpm}$ with occasional premature ventricular contractions (PVCs).
· C. Client reports seeing blurry, green-tinted halos around the television.
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· D. A weight gain of $2 \text{ lbs}$ over the last 24 hours.
Answer: C Strategy: Identify the "killer" complication. While all options are concerning, visual halos are a
pathognomonic sign of Digoxin Toxicity. Low potassium (A) exacerbates this toxicity, but the visual change is an
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active toxic symptom.
4. The nurse is preparing to administer a nitroprusside infusion to a client in hypertensive crisis.Which actions
must the nurse take? (Select All That Apply)
· A. Protect the IV bag and tubing from light with an opaque cover.
· B.Monitor the client for signs of thiocyanate toxicity (confusion, agitation).
, · C. Maintain the infusion for no longer than 72 hours if possible.
· D. Titrate the dose to maintain a Mean Arterial Pressure (MAP) reduction of $40\%$ in the first hour.
· E. Ensure the solution is a dark blue color before hanging.
Answer: A, B, C Strategy: Pharmacology Safety. Nitroprusside is light-sensitive (A). It metabolizes into
cyanide/thiocyanate (B). RRapid reduction of BP (D) is dangerous; MAP should be lowered by no more than
$20\text{-}25\%$ initially. Blue color (E) indicates the drug has decomposed.
5. Case Study: A 24-year-old female presents with a BMI of 14, lanuigo on her back, and a potassium level of $2.8
26
\text{ mEq/L}$. She is admitted for Anorexia Nervosa. During the first 48 hours of refeeding, the nurse notes the
client has developed bilateral pedal edema and a heart rate of $110\text{ bpm}$. What is the nurse’s priority action?
20
· A. Encourage the client to verbalize her feelings about body image.
· B. Check the client's phosphorus, magnesium, and glucose levels.
· C. Increase the rate of the nutritional supplement.
· D. Weigh the client to assess the effectiveness of the refeeding.
am
Answer: B Strategy: Recognize "Refeeding Syndrome." When a starved client is fed, insulin spikes,causing
phosphorus, magnesium, and potassium to shift into cells, leading to cardiovascular collapse.Edema and tachycardia
are early red flags.
6. A client with Type 1 Diabetes is found unresponsive. The nurse notes a fruity odor to the breath and Kussmaul
Ex
respirations. The arterial blood gas (ABG) results are: pH 7.15, $PaCO_2$ $28 \text{mmHg}$, $HCO 3$ $12 \text{
mEq/L}$. Which interpretation is correct?
· A. Metabolic Acidosis with partial compensation.
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· B. Respiratory Acidosis with full compensation.
· C. Metabolic Acidosis with no compensation.
· D. Metabolic Alkalosis with partial compensation.
Answer: A Strategy: Use the "ROME" method or "Matching" method. pH (Acid) + $HCO3$(Acid) = Metabolic
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Acidosis. Since the $CO 2$ is moving in the opposite direction (Alkalotic) to try to fix the pH, but the pH is still
abnormal, it is "Partial Compensation."
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7. Which client should the charge nurse assign to a nurse who has been floated from the Post-Anesthesia
Care Unit (PACU) to the Medical-Surgical unit?
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· A. A client with chronic emphysema being discharged on home oxygen.
· B. A client with a new diagnosis of diabetes needing extensive insulin teaching.
· C. A client who is 24 hours post-op after a total hip replacement with a PCA pump.
· D. A client with a suspected bowel obstruction who has an NG tube to low intermittent suction.
, Answer: C Strategy: Match the float nurse's skill set to the client. PACU nurses are experts in post-op recovery,
airway management, and pain control (PCA pumps). They are less familiar with long-term discharge teaching (A/B)
or chronic medical management.
8. The nurse is caring for a client with a closed head injury. Which of the following nursing interventions
help to maintain a stable Intracranial Pressure (ICP)? (Select AAll That Apply)
· A. Hyperventilate the client to maintain a $PaCO_2$ of $30\text{-}35 \text{ mmHg}$.
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· B. Suction the client every 2 hours to maintain airway patency.
· C. Maintain the head of the bed at $30\text{-}45^\circ$.
· D. Group all nursing activities together to allow for long rest periods.
· E. Administer stool softeners to prevent straining.
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Answer: A, C, E Strategy: ICP Management. Low $CO_2$ causes cerebral vasoconstriction, which lowers ICP (A).
Elevating the HOB promotes venous drainage (C). Straining (E) increases ICP.Suctioning and grouping activities (B/D)
actually spike ICP.
am
9. A 4-year-old child with Tetralogy of Fallot is having a "tet spell" during an IV start. Which of the following is the
most appropriate sequence of interventions?
· A. Oxygen $\rightarrow$ Morphine $\rightarrow$ Knee-chest position.
· B. Knee-chest position $\rightarrow$ Oxygen $\rightarrow$ Morphine.
Ex
· C. Morphine $\rightarrow$ Knee-chest position $lrightarrow$ Fluid bolus.
· D. Call a code $\rightarrow$ Start CPR $\rightarrow$ Intubate.
Answer: B Strategy: Least invasive to most invasive. Knee-chest position is an immediate physical maneuver that
increases systemic resistance and reduces the right-to-left shunt. Oxygen and sedation (Morphine) follow.
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10. A client is receiving a dose of IV Vancomycin. The nurse notes the client's face, neck, and upper chest have
become bright red and itchy. The client's blood pressure is $118/72 \text{ mmHg}$. What is the nurse's first action?
si
· . Stop the infusion and notify the provider of an anaphylactic reaction.
· B.Slow the infusion rate and monitor the client.
ur
· C.Administer Epinephrine IM immediately.
· D. Stop the infusion and administer Diphenhydramine.
Answer: B Strategy: Distinguish "Red Man Syndrome" from Anaphylaxis. Red Man Syndrome is a rate-related
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reaction (not a true allergy) characterized by flushing. Since the BP is stable and there is no wheezing, slowing the
rate is the standard intervention.
11. A client with Acute Respiratory Distress Syndrome (ARDS) is being mechmanically ventilated in the prone
position. Which finding indicates the prone positioning is effective?
Leading Regulatory Excellence
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am
Ex
ng
si
ur
N
NCLEX RN NGN ACTUAL EXAM QUESTIONS AND ANSWERS
,1. The nurse is caring for four clients in the ICU. Which client should the nurse assess first?
· A. A client with a spinal cord injury at T3 who reports a sudden "bursting" headache and is sweating
profusely.
· B. A client with a pulmonary embolism receiving Heparin whose aPTT is 95 seconds.
· C. A client 12 hours post-thoracotomy with $150 \text{ mL}$ of serosanguinous drainage in the chest
tube collection chamber over the last hour.
· D. A client with acute pancreatitis who is complaining of severe, radiating epigastric pain and has a rigid,
26
board-like abdomen.
Answer: D Strategy: Prioritize "New/Sudden" vs. "Expected." While A is Autonomic Dysreflexia (urgent), D indicates
a perforated viscus or peritonitis (surgical emergency). C is a high volume for a thoracotomy, but a rigid abdomen in
20
pancreatitis often signals a life-threatening complication like perforation or hemorrhage.
2. A client is admitted with a diagnosis of Myasthenic Crisis. Which of the following clinical findings would the nurse
anticipate? (Select All That Apply)
·
·
·
am
· A. Improved muscle strength after the administration of edrophonium.
B. Increased bronchial secretions and miosis.
C. Respiratory muscle weakness leading to decreased vital capacity.
D. Bowel and bladder incontinence.
· E. Ptosis and diplopia.
Ex
Answer: A, C, E Strategy:Differentiate between Myasthenic Crisis (not enough meds) and Cholinergic Crisis (too much
meds). In Myasthenic Crisis, edrophonium improves symptoms. "Wet"symptoms like secretions and miosis (B) are
signs of Cholinergic Crisis.
ng
3. A client with a history of heart failure and atrial fibrillation is prescribed Digoxin and Furosemide.
Which assessment finding requires the most immediate intervention?
· A. Serum potassium level of $3.4 \text{ mEq/L}$.
si
· B. Heart rate of $58 \text{ bpm}$ with occasional premature ventricular contractions (PVCs).
· C. Client reports seeing blurry, green-tinted halos around the television.
ur
· D. A weight gain of $2 \text{ lbs}$ over the last 24 hours.
Answer: C Strategy: Identify the "killer" complication. While all options are concerning, visual halos are a
pathognomonic sign of Digoxin Toxicity. Low potassium (A) exacerbates this toxicity, but the visual change is an
N
active toxic symptom.
4. The nurse is preparing to administer a nitroprusside infusion to a client in hypertensive crisis.Which actions
must the nurse take? (Select All That Apply)
· A. Protect the IV bag and tubing from light with an opaque cover.
· B.Monitor the client for signs of thiocyanate toxicity (confusion, agitation).
, · C. Maintain the infusion for no longer than 72 hours if possible.
· D. Titrate the dose to maintain a Mean Arterial Pressure (MAP) reduction of $40\%$ in the first hour.
· E. Ensure the solution is a dark blue color before hanging.
Answer: A, B, C Strategy: Pharmacology Safety. Nitroprusside is light-sensitive (A). It metabolizes into
cyanide/thiocyanate (B). RRapid reduction of BP (D) is dangerous; MAP should be lowered by no more than
$20\text{-}25\%$ initially. Blue color (E) indicates the drug has decomposed.
5. Case Study: A 24-year-old female presents with a BMI of 14, lanuigo on her back, and a potassium level of $2.8
26
\text{ mEq/L}$. She is admitted for Anorexia Nervosa. During the first 48 hours of refeeding, the nurse notes the
client has developed bilateral pedal edema and a heart rate of $110\text{ bpm}$. What is the nurse’s priority action?
20
· A. Encourage the client to verbalize her feelings about body image.
· B. Check the client's phosphorus, magnesium, and glucose levels.
· C. Increase the rate of the nutritional supplement.
· D. Weigh the client to assess the effectiveness of the refeeding.
am
Answer: B Strategy: Recognize "Refeeding Syndrome." When a starved client is fed, insulin spikes,causing
phosphorus, magnesium, and potassium to shift into cells, leading to cardiovascular collapse.Edema and tachycardia
are early red flags.
6. A client with Type 1 Diabetes is found unresponsive. The nurse notes a fruity odor to the breath and Kussmaul
Ex
respirations. The arterial blood gas (ABG) results are: pH 7.15, $PaCO_2$ $28 \text{mmHg}$, $HCO 3$ $12 \text{
mEq/L}$. Which interpretation is correct?
· A. Metabolic Acidosis with partial compensation.
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· B. Respiratory Acidosis with full compensation.
· C. Metabolic Acidosis with no compensation.
· D. Metabolic Alkalosis with partial compensation.
Answer: A Strategy: Use the "ROME" method or "Matching" method. pH (Acid) + $HCO3$(Acid) = Metabolic
si
Acidosis. Since the $CO 2$ is moving in the opposite direction (Alkalotic) to try to fix the pH, but the pH is still
abnormal, it is "Partial Compensation."
ur
7. Which client should the charge nurse assign to a nurse who has been floated from the Post-Anesthesia
Care Unit (PACU) to the Medical-Surgical unit?
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· A. A client with chronic emphysema being discharged on home oxygen.
· B. A client with a new diagnosis of diabetes needing extensive insulin teaching.
· C. A client who is 24 hours post-op after a total hip replacement with a PCA pump.
· D. A client with a suspected bowel obstruction who has an NG tube to low intermittent suction.
, Answer: C Strategy: Match the float nurse's skill set to the client. PACU nurses are experts in post-op recovery,
airway management, and pain control (PCA pumps). They are less familiar with long-term discharge teaching (A/B)
or chronic medical management.
8. The nurse is caring for a client with a closed head injury. Which of the following nursing interventions
help to maintain a stable Intracranial Pressure (ICP)? (Select AAll That Apply)
· A. Hyperventilate the client to maintain a $PaCO_2$ of $30\text{-}35 \text{ mmHg}$.
26
· B. Suction the client every 2 hours to maintain airway patency.
· C. Maintain the head of the bed at $30\text{-}45^\circ$.
· D. Group all nursing activities together to allow for long rest periods.
· E. Administer stool softeners to prevent straining.
20
Answer: A, C, E Strategy: ICP Management. Low $CO_2$ causes cerebral vasoconstriction, which lowers ICP (A).
Elevating the HOB promotes venous drainage (C). Straining (E) increases ICP.Suctioning and grouping activities (B/D)
actually spike ICP.
am
9. A 4-year-old child with Tetralogy of Fallot is having a "tet spell" during an IV start. Which of the following is the
most appropriate sequence of interventions?
· A. Oxygen $\rightarrow$ Morphine $\rightarrow$ Knee-chest position.
· B. Knee-chest position $\rightarrow$ Oxygen $\rightarrow$ Morphine.
Ex
· C. Morphine $\rightarrow$ Knee-chest position $lrightarrow$ Fluid bolus.
· D. Call a code $\rightarrow$ Start CPR $\rightarrow$ Intubate.
Answer: B Strategy: Least invasive to most invasive. Knee-chest position is an immediate physical maneuver that
increases systemic resistance and reduces the right-to-left shunt. Oxygen and sedation (Morphine) follow.
ng
10. A client is receiving a dose of IV Vancomycin. The nurse notes the client's face, neck, and upper chest have
become bright red and itchy. The client's blood pressure is $118/72 \text{ mmHg}$. What is the nurse's first action?
si
· . Stop the infusion and notify the provider of an anaphylactic reaction.
· B.Slow the infusion rate and monitor the client.
ur
· C.Administer Epinephrine IM immediately.
· D. Stop the infusion and administer Diphenhydramine.
Answer: B Strategy: Distinguish "Red Man Syndrome" from Anaphylaxis. Red Man Syndrome is a rate-related
N
reaction (not a true allergy) characterized by flushing. Since the BP is stable and there is no wheezing, slowing the
rate is the standard intervention.
11. A client with Acute Respiratory Distress Syndrome (ARDS) is being mechmanically ventilated in the prone
position. Which finding indicates the prone positioning is effective?
