UWORLD NGN NCLEX STUDY GUIDE
Comprehensive Questions, Answers & Detailed Rationales
Q1 Pediatric Resuscitation & Rescue Breathing
The nurse witnesses the collapse of a child while at a sporting event. The child is not breathing and has a pulse of
50/min. The nurse calls emergency services and initiates rescue breathing. After 2 minutes of rescue breaths, the
child is still not breathing and is pale with a pulse of 30/min. Which of the following actions should the nurse take
next?
1. Initiate chest compressions.
2. Provide rescue breaths for an additional 2 minutes.
3. Perform abdominal thrusts.
4. Use a finger to check the mouth for a blockage.
Correct Answer: 1
Rationale: If a collapsed child is apneic with a pulse < 60/min, the nurse should begin rescue breathing. If the pulse remains < 60/min
after initiation of rescue breaths and the child has signs of poor perfusion (e.g., pallor), the nurse should initiate compressions.
Q2 Infection Control & Room Assignments
The nurse is making room assignments for multiple clients. Which of the following semi-private room assignments
would be appropriate?
1. A client with gastroenteritis and a client with chemotherapy-induced nausea and vomiting.
2. A client who had a bowel resection 1 day ago and a client with asthma exacerbation.
3. A client who had a total hip arthroplasty 2 days ago and a client with influenza.
4. A client with iron-deficiency anemia and a client with intractable diarrhea.
Correct Answer: 2
Rationale: When preparing room assignments, the nurse should not place a client who has a fresh surgical wound or is
immunocompromised in a room with a client who has an active or suspected infection. A client having an asthma exacerbation does
not have an infection and is not at risk for spreading infection to a client who had a recent surgery (option 2).
Q3 Post-MI Management & Dysrhythmia Prevention
The nurse is caring for a client who had a myocardial infarction 2 days ago. Which of the following actions would
be a priority for the nurse to take?
LABORATORY RESULTS:
Sodium: 136–145 mEq/L | Potassium: 3.5–5 mEq/L | Magnesium: 1.3–2.1 mEq/L | Creatinine: Male 0.6–1.3 mg/dL; Female 0.5–1.2 mg/
dL
1. Administer potassium
2. Administer amiodarone
3. Notify the health care provider
4. Apply cardiac defibrillator pads
Correct Answer: 1
Rationale: Myocardial injury predisposes the client to ectopy (e.g., PVCs), which increases the client's risk for lethal dysrhythmias.
PVCs are caused and/or exacerbated by hypoxia, electrolyte imbalances, emotional stimulants, fever, and exercise. This client's
morning lab results show hypokalemia; therefore, the priority is treatment of the underlying cause of the ectopy by administering the
prescribed potassium replacement (option 1).
,Q4 Ethics & Advance Directives
The nurse is caring for a client who has a DNR directive. The client experiences cardiac arrest, and the client's
adult child states, "Please, do whatever you can to save my parent!" Which of the following actions should the
nurse take?
1. Contact the health care provider to confirm the DNR directive.
2. Activate the emergency response team and initiate CPR.
3. Request the presence of the client's health care proxy.
4. Explain the DNR directive to the client's child.
Correct Answer: 4
Rationale: Advance directives outline the client's choices for medical care at the end of life, including resuscitation directives. Client's
wishes for medical care are honored over the wishes of family members.
Q5 Client Assessment & Triage Prioritization
The nurse is caring for assigned clients. The nurse should first assess the client who:
1. has infective endocarditis and a temperature of 101.5°F
2. had a heart transplant 2 months ago and has sustained sinus tachycardia of 110/min at rest
3. had coronary stent placement via the femoral artery 3 hours ago and is reporting severe back pain
4. had coronary artery bypass graft surgery 3 days ago and is reporting swelling of the extremity used for the donor graft
Correct Answer: 3
Rationale: Hypotension, back pain, flank ecchymosis, hematoma formation, and diminished distal pulses can be early signs of
bleeding into the retroperitoneal space and requires immediate intervention (option 3).
Q6 Factors Affecting Bone Healing
The nurse is caring for a client who sustained a fracture of the right tibia and fibula. Which of the following factors
would increase the client's risk for delayed bone healing?
1. BMI of 29.5 kg/m²
2. family history of osteoporosis
3. history of peripheral artery disease
4. consumes one glass of wine per day
Correct Answer: 3
Rationale: Bone healing depends on multiple factors, including nutrition, circulation, and age. A client with PAD has decreased
perfusion to the extremities due to atherosclerotic changes in the arteries. Without adequate perfusion, the bone is not supplied with the
oxygen and nutrients required for healing (option 3).
Q7 Pressure Injury Staging
The nurse is assessing a client who has a pressure injury. The nurse notes a clean, shallow, dark pink wound bed.
The nurse documents the pressure injury as:
1. Stage 1
2. Stage 2
3. Stage 3
4. Stage 4
Correct Answer: 2
Rationale:
• Stage 1: intact skin; nonblanchable with localized redness
• Stage 2: shallow, open ulcer; red-pink wound with no sloughing; possible intact or ruptured blister
• Stage 3: full-thickness skin loss with possible visible subcutaneous fat; no exposed bone, tendon, or muscles
• Stage 4: full-thickness skin loss; exposed bone, tendon, or muscle
• Unstageable: full-thickness skin loss; ulcer base covered by slough and/or eschar that needs removal to stage.
, Q8 Insulin Administration Technique
The nurse is preparing to administer NPH insulin to a client who has received the breakfast tray. Which of the
following actions should the nurse take?
1. Administer NPH insulin and regular insulin in 2 separate injections.
2. Administer NPH insulin now and regular insulin after the client has eaten.
3. Administer NPH insulin and regular insulin in the same syringe, drawing up the NPH insulin first.
4. Administer NPH insulin and regular insulin in the same syringe, drawing up the regular insulin first.
Correct Answer: 4
Rationale: NPH insulin and regular insulin may be safely mixed and administered as a single injection. Regular insulin should be drawn
into the syringe before intermediate-acting (NPH) insulin to avoid cross-contaminating multi-dose vials.
Q9 Blood Transfusion & Medication Timing
The nurse is caring for a client who is receiving a transfusion of packed RBCs through a peripherally inserted
central catheter (PICC). During the transfusion, the client receives a new prescription for IV amphotericin B. It
would be most appropriate for the nurse to:
1. administer amphotericin B through an open lumen of the PICC
2. insert a peripheral venous access device and administer the amphotericin B
3. interrupt the transfusion and administer the amphotericin B
4. wait 1 hour after the transfusion is complete before administering amphotericin B
Correct Answer: 4
Rationale: At least one hour should be allowed between completion of a blood transfusion and administration of amphotericin B. The
adverse effects of a transfusion-related reaction and an adverse reaction from amphotericin B are similar, and the observation time
enables the nurse to distinguish the triggering event if symptoms develop.
Q10 Hemothorax vs. Tension Pneumothorax
Specify which findings are consistent with the disease process of hemothorax or tension pneumothorax. Each
finding may support more than one disease process.
Clinical Finding Hemothorax Tension Pneumothorax
1. Tachycardia ✓ ✓
2. Hypotension ✓ ✓
3. Subcutaneous Emphysema ✓
4. Unilateral Diminished Breath Sounds ✓ ✓
Correct Answer: Hemothorax (1, 2, 4); Tension pneumothorax (1, 2, 3, 4)
Q11 Emergency Chest Tube Dislodgement
The nurse is assisting the client with repositioning in bed when the chest tube becomes dislodged from the client's
chest. Which of the following actions should the nurse take first?
1. Measure the client's SpO2 with pulse oximetry.
2. Call the rapid response team.
3. Cover the insertion site with the palm of a gloved hand.
4. Administer supplemental oxygen.
Correct Answer: 3
Rationale: Removal of a chest tube places clients at risk for pneumothorax. If a chest tube is accidentally dislodged from a client's
chest, the priority is to cover the insertion site. If a dry, sterile gauze dressing is unavailable, the nurse should use a clean, gloved hand
to firmly cover the site.
Comprehensive Questions, Answers & Detailed Rationales
Q1 Pediatric Resuscitation & Rescue Breathing
The nurse witnesses the collapse of a child while at a sporting event. The child is not breathing and has a pulse of
50/min. The nurse calls emergency services and initiates rescue breathing. After 2 minutes of rescue breaths, the
child is still not breathing and is pale with a pulse of 30/min. Which of the following actions should the nurse take
next?
1. Initiate chest compressions.
2. Provide rescue breaths for an additional 2 minutes.
3. Perform abdominal thrusts.
4. Use a finger to check the mouth for a blockage.
Correct Answer: 1
Rationale: If a collapsed child is apneic with a pulse < 60/min, the nurse should begin rescue breathing. If the pulse remains < 60/min
after initiation of rescue breaths and the child has signs of poor perfusion (e.g., pallor), the nurse should initiate compressions.
Q2 Infection Control & Room Assignments
The nurse is making room assignments for multiple clients. Which of the following semi-private room assignments
would be appropriate?
1. A client with gastroenteritis and a client with chemotherapy-induced nausea and vomiting.
2. A client who had a bowel resection 1 day ago and a client with asthma exacerbation.
3. A client who had a total hip arthroplasty 2 days ago and a client with influenza.
4. A client with iron-deficiency anemia and a client with intractable diarrhea.
Correct Answer: 2
Rationale: When preparing room assignments, the nurse should not place a client who has a fresh surgical wound or is
immunocompromised in a room with a client who has an active or suspected infection. A client having an asthma exacerbation does
not have an infection and is not at risk for spreading infection to a client who had a recent surgery (option 2).
Q3 Post-MI Management & Dysrhythmia Prevention
The nurse is caring for a client who had a myocardial infarction 2 days ago. Which of the following actions would
be a priority for the nurse to take?
LABORATORY RESULTS:
Sodium: 136–145 mEq/L | Potassium: 3.5–5 mEq/L | Magnesium: 1.3–2.1 mEq/L | Creatinine: Male 0.6–1.3 mg/dL; Female 0.5–1.2 mg/
dL
1. Administer potassium
2. Administer amiodarone
3. Notify the health care provider
4. Apply cardiac defibrillator pads
Correct Answer: 1
Rationale: Myocardial injury predisposes the client to ectopy (e.g., PVCs), which increases the client's risk for lethal dysrhythmias.
PVCs are caused and/or exacerbated by hypoxia, electrolyte imbalances, emotional stimulants, fever, and exercise. This client's
morning lab results show hypokalemia; therefore, the priority is treatment of the underlying cause of the ectopy by administering the
prescribed potassium replacement (option 1).
,Q4 Ethics & Advance Directives
The nurse is caring for a client who has a DNR directive. The client experiences cardiac arrest, and the client's
adult child states, "Please, do whatever you can to save my parent!" Which of the following actions should the
nurse take?
1. Contact the health care provider to confirm the DNR directive.
2. Activate the emergency response team and initiate CPR.
3. Request the presence of the client's health care proxy.
4. Explain the DNR directive to the client's child.
Correct Answer: 4
Rationale: Advance directives outline the client's choices for medical care at the end of life, including resuscitation directives. Client's
wishes for medical care are honored over the wishes of family members.
Q5 Client Assessment & Triage Prioritization
The nurse is caring for assigned clients. The nurse should first assess the client who:
1. has infective endocarditis and a temperature of 101.5°F
2. had a heart transplant 2 months ago and has sustained sinus tachycardia of 110/min at rest
3. had coronary stent placement via the femoral artery 3 hours ago and is reporting severe back pain
4. had coronary artery bypass graft surgery 3 days ago and is reporting swelling of the extremity used for the donor graft
Correct Answer: 3
Rationale: Hypotension, back pain, flank ecchymosis, hematoma formation, and diminished distal pulses can be early signs of
bleeding into the retroperitoneal space and requires immediate intervention (option 3).
Q6 Factors Affecting Bone Healing
The nurse is caring for a client who sustained a fracture of the right tibia and fibula. Which of the following factors
would increase the client's risk for delayed bone healing?
1. BMI of 29.5 kg/m²
2. family history of osteoporosis
3. history of peripheral artery disease
4. consumes one glass of wine per day
Correct Answer: 3
Rationale: Bone healing depends on multiple factors, including nutrition, circulation, and age. A client with PAD has decreased
perfusion to the extremities due to atherosclerotic changes in the arteries. Without adequate perfusion, the bone is not supplied with the
oxygen and nutrients required for healing (option 3).
Q7 Pressure Injury Staging
The nurse is assessing a client who has a pressure injury. The nurse notes a clean, shallow, dark pink wound bed.
The nurse documents the pressure injury as:
1. Stage 1
2. Stage 2
3. Stage 3
4. Stage 4
Correct Answer: 2
Rationale:
• Stage 1: intact skin; nonblanchable with localized redness
• Stage 2: shallow, open ulcer; red-pink wound with no sloughing; possible intact or ruptured blister
• Stage 3: full-thickness skin loss with possible visible subcutaneous fat; no exposed bone, tendon, or muscles
• Stage 4: full-thickness skin loss; exposed bone, tendon, or muscle
• Unstageable: full-thickness skin loss; ulcer base covered by slough and/or eschar that needs removal to stage.
, Q8 Insulin Administration Technique
The nurse is preparing to administer NPH insulin to a client who has received the breakfast tray. Which of the
following actions should the nurse take?
1. Administer NPH insulin and regular insulin in 2 separate injections.
2. Administer NPH insulin now and regular insulin after the client has eaten.
3. Administer NPH insulin and regular insulin in the same syringe, drawing up the NPH insulin first.
4. Administer NPH insulin and regular insulin in the same syringe, drawing up the regular insulin first.
Correct Answer: 4
Rationale: NPH insulin and regular insulin may be safely mixed and administered as a single injection. Regular insulin should be drawn
into the syringe before intermediate-acting (NPH) insulin to avoid cross-contaminating multi-dose vials.
Q9 Blood Transfusion & Medication Timing
The nurse is caring for a client who is receiving a transfusion of packed RBCs through a peripherally inserted
central catheter (PICC). During the transfusion, the client receives a new prescription for IV amphotericin B. It
would be most appropriate for the nurse to:
1. administer amphotericin B through an open lumen of the PICC
2. insert a peripheral venous access device and administer the amphotericin B
3. interrupt the transfusion and administer the amphotericin B
4. wait 1 hour after the transfusion is complete before administering amphotericin B
Correct Answer: 4
Rationale: At least one hour should be allowed between completion of a blood transfusion and administration of amphotericin B. The
adverse effects of a transfusion-related reaction and an adverse reaction from amphotericin B are similar, and the observation time
enables the nurse to distinguish the triggering event if symptoms develop.
Q10 Hemothorax vs. Tension Pneumothorax
Specify which findings are consistent with the disease process of hemothorax or tension pneumothorax. Each
finding may support more than one disease process.
Clinical Finding Hemothorax Tension Pneumothorax
1. Tachycardia ✓ ✓
2. Hypotension ✓ ✓
3. Subcutaneous Emphysema ✓
4. Unilateral Diminished Breath Sounds ✓ ✓
Correct Answer: Hemothorax (1, 2, 4); Tension pneumothorax (1, 2, 3, 4)
Q11 Emergency Chest Tube Dislodgement
The nurse is assisting the client with repositioning in bed when the chest tube becomes dislodged from the client's
chest. Which of the following actions should the nurse take first?
1. Measure the client's SpO2 with pulse oximetry.
2. Call the rapid response team.
3. Cover the insertion site with the palm of a gloved hand.
4. Administer supplemental oxygen.
Correct Answer: 3
Rationale: Removal of a chest tube places clients at risk for pneumothorax. If a chest tube is accidentally dislodged from a client's
chest, the priority is to cover the insertion site. If a dry, sterile gauze dressing is unavailable, the nurse should use a clean, gloved hand
to firmly cover the site.
