HURST REVIEW 2 QUESTIONS AND ANSWERS | COMPLETE HURST REVIEW 2
NCLEX STUDY GUIDE 2026/2027
The RN is caring for a client diagnosed with an abdominal aortic aneurysm. Which prescription can the
RN delegate to the LPN?
1. Obtain vital signs every 15 minutes.
2. Insert a urinary catheter for hourly urinary outputs.
3. Place a PICC line for fluid management.
4. Provide morphine 1 mg per PCA pump at a 10 minute lockout. - ANS ✔✔2 - insert a urinary catheter
for hourly urine outputs
A nurse, assigned to take care of a client who is HIV positive, refuses the assignment, stating fear of
personal injury. What action should the charge nurse take first?
1. Re-assign the client to a nurse who does not mind caring for HIV positive clients.
2. Inform the nurse that refusing client care is not acceptable nursing practice.
3. Have the nurse document rationale and support for refusing the client assignment.
4. Transfer the nurse to a unit where there are no HIV positive clients. - ANS ✔✔2 - not acceptable
nursing practice
This action by the charge nurse demonstrates an understanding of the code of ethics for nurses. Any
nurse who feels compelled to refuse to provide care for a particular type of client faces an ethical
dilemma. The reasons given for refusal range from a conflict of personal values to fear of personal risk of
injury. Such instances have increased since the advent of acquired immunodeficiency syndrome (AIDS) as
a major health problem. The ethical obligation to care for all clients is clearly identified in the first
statement of the Code of Ethics for Nurses. To avoid facing these moral and ethical situations, a nurse
can follow certain strategies. For example, when applying for a job, one should ask questions regarding
the client population. If one is uncomfortable with a particular situation, then not accepting the position
would be an option. Denial of care, or providing substandard nursing care to some members of our
society, is not acceptable nursing practice. As a professional, the nurse should provide the same level of
care to every client, regardless of diagnosis, skin color, ethnicity or economic status.
Which client should the nurse place in the room with a 6 year old with glomerulonephritis?
1. Twenty-two month old diagnosed with respiratory syncytial virus (RSV).
2. Four year old with nephrotic syndrome.
3. Three year old admitted with febrile seizures.
4. Two year old who has a fractured tibia. - ANS ✔✔2 - four year old with nephrotic syndrome
This child is not infectious and could be placed in the room with the child who has glomerulonephritis.
Since the children are close in age, they will adapt well together.
The nurse is caring for a client admitted to the psychiatric unit with a diagnosis of major depression.
What behaviors could the nurse expect upon assessment of this client?
1. Withdrawn behavior
2. Sitting in room, lights out, drapes closed
3. Unkempt appearance
4. Overeating
,5. Severe insomnia - ANS ✔✔1 - withdrawn
2 - sitting in dark room
3 - unkempt
5 - severe insomnia
he client with severe depression has extremely low self-esteem and low energy levels and may just sit for
hours. Depressed clients prefer to be alone and avoid social interactions. The room environment mimics
the mood of the client (dark and gloomy). The client may not have the energy to bathe, change clothes,
or even comb hair. The severely depressed person may have severe insomnia. However, sleeping too
much is also a symptom of mild depression.
The parents of a 4 year old child are concerned about whether the child will adapt to the newborn baby
they are expecting in two weeks. What suggestions should the nurse make to assist with sibling
adaptation?
1. Allow child to be one of the first to see the newborn.
2. Have child stay with parents during labor and delivery.
3. Arrange for one parent to spend time with the child while the other parent cares for the newborn.
4. Provide a gift from the newborn to give to the child.
5. Have child care for a doll. - ANS ✔✔1 - allow the child to see the newborn first
3 - have the parent spend time with the child while the other parent cares for the newborn
4 - provide a gift from the newborn
5 - have the child care for a doll
These are good recommendations for the nurse to make to the parents in an effort to promote sibling
adaptation. Make the 4 year old part of the process as much as possible. Demonstrate the importance of
the child by allowing the child to see the baby first. Provide personal time with the 4 year old. This shows
that the 4 year old is important to the family. The baby is providing a gift to the child which promotes a
bond between the two and demonstrates to the child that he or she is important. Having a 4 year old
care for a doll gets the child involved in caring for another. The child can learn what a newborn needs
both physically and emotionally by imitating the parents.
A client experiencing chest pain is prescribed an intravenous infusion of nitroglycerin. After the infusion
is initiated, the occurrence of which symptom would prompt the nurse to discontinue the nitroglycerin?
1. Frontal headache
2. Orthostatic hypotension
3. Decrease in intensity of chest pain
4. Cool, clammy skin - ANS ✔✔4 - cool clammy skin
This assessment finding of cool, clammy skin is an indication of decreased cardiac output that could be
the result of too much vasodilatation. Cardiac output could continue to decrease if the nitroglycerin is
not discontinued.
The nurse is teaching a client about foods containing tyramine which should be avoided while taking a
monoamine oxidase inhibitor (MAOI). Which meal selection, if chosen by the client, indicates successful
teaching?
1. Smoked turkey and dressing, sweet peas and carrots and milk.
2. Baked chicken over pasta with parmesan sauce, baked potato and tea.
3. Fried catfish, French fries, coleslaw and apple juice.
, 4. Liver smothered in gravy and onions, rice, squash and water. - ANS ✔✔3 - fried catfish, french fries,
coleslaw, apple juice
Tyramine is an amino acid that helps in the regulation of blood pressure. MAOIs block the enzyme
monoamine oxidase which is responsible for breaking down excess tyramine in the body. Eating foods
high in tyramine while on MAOIs can result in dangerously high levels of tyramine in the body. This can
lead to a serious rise in blood pressure, creating an emergency situation. Tyramine is found in protein-
containing foods and the levels increase as these foods age. Food such as strong or aged cheese, cured
meats, smoked or process meats, liver (especially aged liver), pickled or fermented foods, sauces,
soybeans, dried or overripe fruits, meat tenderizers, brewer's yeast, alcoholic beverages and caffeine-
such as in tea, cokes and coffee are considered to be high in tyramine and should be avoided in clients
taking MAOIs.
While examining a client's health history, which data indicates to the nurse that the client is at increased
risk for developing cancer?
1. Family history
2. Alcohol consumption
3. Spicy diet
4. Human papillomavirus
5. Tobacco use - ANS ✔✔1 - fam hx
2 - alcohol consumption
4 - hpv
5 - tobacco use
A client with cancer of the larynx undergoes radiation therapy for 5 weeks prior to a neck dissection and
tumor excision. The client asks the nurse how long the post surgical recovery time will be. How should
the nurse reply?
1. "I really don't know. It is different for everyone, but speak to your surgeon."
2. "Your medical insurance will cover the whole length of your stay, so don't worry."
3. "You shouldn't worry about how long you are going to stay. You should focus on getting better."
4. "It may be a little longer than average. The radiation you received sometimes delays tissue healing." -
ANS ✔✔4 - may take a little longer to heal because radiation delays tissue healing
Radiation can cause tissue trauma and changes that can delay wound healing.
A client's last two central venous pressure (CVP) readings were 13 cm of water. The nurse would expect
the client to manifest which associated signs and symptoms
1. Dry oral mucus membranes
2. Tachypnea
3. Orthostatic hypotension
4. Rales in the posterior chest
5. Jugular vein distention
6. Weight gain - ANS ✔✔2 - tachypnea
4 - rales in the posterior chest
5 - jugular vein distention
6 - weight gain
The normal range for CVP is 2-8 cmH2O or 2-6 mmHg.
, Therefore, the readings of 13 cmH2O are high and may be the result of fluid volume excess. The signs
and symptoms of FVE include: tachynea, rales, and jugular vein distention from the increased volume
and preload. Acute weight gain is one of the best indicators of FVE due to circulatory overload.
What should a nurse teach family members prior to them entering the room of a client who has
agranulocytosis?
1. Meticulous hand washing is needed.
2. Do not visit if you have any infection.
3. The client must wear a mask.
4. Children under 12 may not visit.
5. Flowers are not allowed in the room. - ANS ✔✔1 - hand washing needed
2 - do not visit if you have any infection
4 - children under 12 may not visit
5 - flowers are not allowed in the room
Protective isolation is needed for this client because of the presence of a low white blood cell count. We
are protecting the client from acquiring an infection. So any visitors will need to have meticulous hand
washing prior to entering. The visitor should not enter if he or she has any type of infection. To decrease
the risk of infection, small children should not visit. Even the mildest symptom of infection could be
detrimental to the client. Flowers have bacteria and should not be brought into the room.
A client diagnosed with major depression is admitted to the psychiatric unit for electroconvulsive
therapy (ECT). The client asks the nurse, "How many of these treatments do you think I will need?" What
is the nurse's best response?
1. That is a question you need to discuss with your primary healthcare provider.
2. Everyone responds differently, but on average clients need 6-12 treatments.
3. You will need to take a treatment every month for at least a year.
4. Let's just take one treatment at a time, shall we? - ANS ✔✔2 - everyone responds differently, but
usually between 6-12 sessions
Most clients require an average of 6 to 12 treatments, but some may require up to 20 treatments. These
treatments are generally given two to three times per week for three to four weeks. The number of
treatments required depends on the severity of the symptoms and how quickly the client improves.
A female client taking captopril for hypertension tells the clinic nurse that she is planning to get
pregnant. What recommendation should the nurse make?
1. "Captopril can be taken safely during pregnancy, but we will need to decrease your dose so you do
not become hypotensive."
2. "We will need to increase your dose of captopril once you become pregnant."
3. "In order to prevent neural tube defects, start taking folic acid."
4. "Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking
this medication. " - ANS ✔✔4 - can cause serious harm to an unborn baby, must prevent pregnancy
while on captopril
Which statement made by a client post-thyroidectomy would require further investigation by the nurse?
1. "I have a tingling feeling of my fingers."
2. "It hurts when I move my head."
NCLEX STUDY GUIDE 2026/2027
The RN is caring for a client diagnosed with an abdominal aortic aneurysm. Which prescription can the
RN delegate to the LPN?
1. Obtain vital signs every 15 minutes.
2. Insert a urinary catheter for hourly urinary outputs.
3. Place a PICC line for fluid management.
4. Provide morphine 1 mg per PCA pump at a 10 minute lockout. - ANS ✔✔2 - insert a urinary catheter
for hourly urine outputs
A nurse, assigned to take care of a client who is HIV positive, refuses the assignment, stating fear of
personal injury. What action should the charge nurse take first?
1. Re-assign the client to a nurse who does not mind caring for HIV positive clients.
2. Inform the nurse that refusing client care is not acceptable nursing practice.
3. Have the nurse document rationale and support for refusing the client assignment.
4. Transfer the nurse to a unit where there are no HIV positive clients. - ANS ✔✔2 - not acceptable
nursing practice
This action by the charge nurse demonstrates an understanding of the code of ethics for nurses. Any
nurse who feels compelled to refuse to provide care for a particular type of client faces an ethical
dilemma. The reasons given for refusal range from a conflict of personal values to fear of personal risk of
injury. Such instances have increased since the advent of acquired immunodeficiency syndrome (AIDS) as
a major health problem. The ethical obligation to care for all clients is clearly identified in the first
statement of the Code of Ethics for Nurses. To avoid facing these moral and ethical situations, a nurse
can follow certain strategies. For example, when applying for a job, one should ask questions regarding
the client population. If one is uncomfortable with a particular situation, then not accepting the position
would be an option. Denial of care, or providing substandard nursing care to some members of our
society, is not acceptable nursing practice. As a professional, the nurse should provide the same level of
care to every client, regardless of diagnosis, skin color, ethnicity or economic status.
Which client should the nurse place in the room with a 6 year old with glomerulonephritis?
1. Twenty-two month old diagnosed with respiratory syncytial virus (RSV).
2. Four year old with nephrotic syndrome.
3. Three year old admitted with febrile seizures.
4. Two year old who has a fractured tibia. - ANS ✔✔2 - four year old with nephrotic syndrome
This child is not infectious and could be placed in the room with the child who has glomerulonephritis.
Since the children are close in age, they will adapt well together.
The nurse is caring for a client admitted to the psychiatric unit with a diagnosis of major depression.
What behaviors could the nurse expect upon assessment of this client?
1. Withdrawn behavior
2. Sitting in room, lights out, drapes closed
3. Unkempt appearance
4. Overeating
,5. Severe insomnia - ANS ✔✔1 - withdrawn
2 - sitting in dark room
3 - unkempt
5 - severe insomnia
he client with severe depression has extremely low self-esteem and low energy levels and may just sit for
hours. Depressed clients prefer to be alone and avoid social interactions. The room environment mimics
the mood of the client (dark and gloomy). The client may not have the energy to bathe, change clothes,
or even comb hair. The severely depressed person may have severe insomnia. However, sleeping too
much is also a symptom of mild depression.
The parents of a 4 year old child are concerned about whether the child will adapt to the newborn baby
they are expecting in two weeks. What suggestions should the nurse make to assist with sibling
adaptation?
1. Allow child to be one of the first to see the newborn.
2. Have child stay with parents during labor and delivery.
3. Arrange for one parent to spend time with the child while the other parent cares for the newborn.
4. Provide a gift from the newborn to give to the child.
5. Have child care for a doll. - ANS ✔✔1 - allow the child to see the newborn first
3 - have the parent spend time with the child while the other parent cares for the newborn
4 - provide a gift from the newborn
5 - have the child care for a doll
These are good recommendations for the nurse to make to the parents in an effort to promote sibling
adaptation. Make the 4 year old part of the process as much as possible. Demonstrate the importance of
the child by allowing the child to see the baby first. Provide personal time with the 4 year old. This shows
that the 4 year old is important to the family. The baby is providing a gift to the child which promotes a
bond between the two and demonstrates to the child that he or she is important. Having a 4 year old
care for a doll gets the child involved in caring for another. The child can learn what a newborn needs
both physically and emotionally by imitating the parents.
A client experiencing chest pain is prescribed an intravenous infusion of nitroglycerin. After the infusion
is initiated, the occurrence of which symptom would prompt the nurse to discontinue the nitroglycerin?
1. Frontal headache
2. Orthostatic hypotension
3. Decrease in intensity of chest pain
4. Cool, clammy skin - ANS ✔✔4 - cool clammy skin
This assessment finding of cool, clammy skin is an indication of decreased cardiac output that could be
the result of too much vasodilatation. Cardiac output could continue to decrease if the nitroglycerin is
not discontinued.
The nurse is teaching a client about foods containing tyramine which should be avoided while taking a
monoamine oxidase inhibitor (MAOI). Which meal selection, if chosen by the client, indicates successful
teaching?
1. Smoked turkey and dressing, sweet peas and carrots and milk.
2. Baked chicken over pasta with parmesan sauce, baked potato and tea.
3. Fried catfish, French fries, coleslaw and apple juice.
, 4. Liver smothered in gravy and onions, rice, squash and water. - ANS ✔✔3 - fried catfish, french fries,
coleslaw, apple juice
Tyramine is an amino acid that helps in the regulation of blood pressure. MAOIs block the enzyme
monoamine oxidase which is responsible for breaking down excess tyramine in the body. Eating foods
high in tyramine while on MAOIs can result in dangerously high levels of tyramine in the body. This can
lead to a serious rise in blood pressure, creating an emergency situation. Tyramine is found in protein-
containing foods and the levels increase as these foods age. Food such as strong or aged cheese, cured
meats, smoked or process meats, liver (especially aged liver), pickled or fermented foods, sauces,
soybeans, dried or overripe fruits, meat tenderizers, brewer's yeast, alcoholic beverages and caffeine-
such as in tea, cokes and coffee are considered to be high in tyramine and should be avoided in clients
taking MAOIs.
While examining a client's health history, which data indicates to the nurse that the client is at increased
risk for developing cancer?
1. Family history
2. Alcohol consumption
3. Spicy diet
4. Human papillomavirus
5. Tobacco use - ANS ✔✔1 - fam hx
2 - alcohol consumption
4 - hpv
5 - tobacco use
A client with cancer of the larynx undergoes radiation therapy for 5 weeks prior to a neck dissection and
tumor excision. The client asks the nurse how long the post surgical recovery time will be. How should
the nurse reply?
1. "I really don't know. It is different for everyone, but speak to your surgeon."
2. "Your medical insurance will cover the whole length of your stay, so don't worry."
3. "You shouldn't worry about how long you are going to stay. You should focus on getting better."
4. "It may be a little longer than average. The radiation you received sometimes delays tissue healing." -
ANS ✔✔4 - may take a little longer to heal because radiation delays tissue healing
Radiation can cause tissue trauma and changes that can delay wound healing.
A client's last two central venous pressure (CVP) readings were 13 cm of water. The nurse would expect
the client to manifest which associated signs and symptoms
1. Dry oral mucus membranes
2. Tachypnea
3. Orthostatic hypotension
4. Rales in the posterior chest
5. Jugular vein distention
6. Weight gain - ANS ✔✔2 - tachypnea
4 - rales in the posterior chest
5 - jugular vein distention
6 - weight gain
The normal range for CVP is 2-8 cmH2O or 2-6 mmHg.
, Therefore, the readings of 13 cmH2O are high and may be the result of fluid volume excess. The signs
and symptoms of FVE include: tachynea, rales, and jugular vein distention from the increased volume
and preload. Acute weight gain is one of the best indicators of FVE due to circulatory overload.
What should a nurse teach family members prior to them entering the room of a client who has
agranulocytosis?
1. Meticulous hand washing is needed.
2. Do not visit if you have any infection.
3. The client must wear a mask.
4. Children under 12 may not visit.
5. Flowers are not allowed in the room. - ANS ✔✔1 - hand washing needed
2 - do not visit if you have any infection
4 - children under 12 may not visit
5 - flowers are not allowed in the room
Protective isolation is needed for this client because of the presence of a low white blood cell count. We
are protecting the client from acquiring an infection. So any visitors will need to have meticulous hand
washing prior to entering. The visitor should not enter if he or she has any type of infection. To decrease
the risk of infection, small children should not visit. Even the mildest symptom of infection could be
detrimental to the client. Flowers have bacteria and should not be brought into the room.
A client diagnosed with major depression is admitted to the psychiatric unit for electroconvulsive
therapy (ECT). The client asks the nurse, "How many of these treatments do you think I will need?" What
is the nurse's best response?
1. That is a question you need to discuss with your primary healthcare provider.
2. Everyone responds differently, but on average clients need 6-12 treatments.
3. You will need to take a treatment every month for at least a year.
4. Let's just take one treatment at a time, shall we? - ANS ✔✔2 - everyone responds differently, but
usually between 6-12 sessions
Most clients require an average of 6 to 12 treatments, but some may require up to 20 treatments. These
treatments are generally given two to three times per week for three to four weeks. The number of
treatments required depends on the severity of the symptoms and how quickly the client improves.
A female client taking captopril for hypertension tells the clinic nurse that she is planning to get
pregnant. What recommendation should the nurse make?
1. "Captopril can be taken safely during pregnancy, but we will need to decrease your dose so you do
not become hypotensive."
2. "We will need to increase your dose of captopril once you become pregnant."
3. "In order to prevent neural tube defects, start taking folic acid."
4. "Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking
this medication. " - ANS ✔✔4 - can cause serious harm to an unborn baby, must prevent pregnancy
while on captopril
Which statement made by a client post-thyroidectomy would require further investigation by the nurse?
1. "I have a tingling feeling of my fingers."
2. "It hurts when I move my head."
