Page 1 of 69
NCLEX PRACTICE EXAM REVIEW ARCHER
EXAM 2026 QUESTIONS LATEST VERSION
QUESTIONS AND ANSWERS
Nclex practice exam Review archer
The nurse is assisting the risk manager in reviewing a serious medication
error. Which process should the nurse recommend be used to identify the
origin of the issue and potential solution?
A. Root cause analysis
B. Collective bargaining
C. Six Sigma
D. Team STEPPS program
Choice A is correct. Performance improvement teams often use the root cause
analysis process to find the most basic causes of process failures. Root cause
analysis is done in a blame-free environment to determine why a failed process is
not fail-proof. This approach may involve multiple specialists from different
departments.
Choice B is incorrect. Collective bargaining is a negotiating process between
employees and their employers. This is not a tool used to identify the causation of an
error.
Choice C is incorrect. Six sigma is a quality improvement change process that is
data-driven. This process does not look for a root cause (or error); rather, the focus
is on implementing change supported by evidence.
Choice D is incorrect. Team STEPPS is a teamwork system designed to improve
communication, efficiency, and team dynamics in an organization.
The nurse is caring for an infant with the below tracing on the
electrocardiogram (ECG).
, Page 2 of 69
The nurse should plan to take which initial action? See the image below.
A. Instruct the infant to bear down.
B. Prepare a bag filled with ice and water.
C. Assess the infant's axillary temperature.
D. Obtain the infant's carotid pulse.
Choice B is correct. This tracing reflects supraventricular tachycardia (SVT), which
is concerning because of the very high rate. The rate may be as high as 180 to 280
beats/min in infants. Characteristically, SVT does not have P-waves as they are
buried in the T-waves. Preparing a bag filled with ice and water is essential because
this may be applied to the face above the nose and mouth for 15 to 30 seconds. If
that is ineffective, another vagal maneuver would be pressing the infant's knees to
the chest for 15-30 seconds.
Choice A is incorrect. Instructing an infant to bear down would be futile because
the infant does not have the cognitive ability to follow this instruction. This is the
instruction that could be provided to a child or adult.
Choice C is incorrect. Assessing the infant's axillary temperature would not have
clinical significance because of the necessity to break the SVT. While SVT may be
caused by severe febrile illness, the infant's rhythm must be corrected.
Choice D is incorrect. An infant's pulse should be obtained via the brachial artery,
not the carotid artery.
Svt additional notes.
✓ During SVT, P waves may not be visible because the P waves are embedded in
the preceding T wave
✓ A client with SVT may be asymptomatic. If the client is symptomatic, they may
exhibit manifestations such as palpitations, dizziness, dyspnea, and nervousness
✓ Treatment includes vagal maneuvers. Vagal maneuvers include having
the beardown, blowing through a straw, having the primary healthcare provider
(PHCP) perform a carotid massage, and, if the client is an infant, applying a bag
filled with ice and water to the face above the nose and mouth for 15 to 30
seconds. If that is ineffective, another vagal maneuver would be pressing the infant's
knees to the chest for 15-30 seconds.
, Page 3 of 69
✓ If these measures are ineffective, the nurse should prepare to administer the
prescribed adenosine by rapid intravenous push (IVP) that is followed by a flush of
0.9% saline.
✓ When adenosine is administered, the emergency (code) cart should be nearby,
and the nurse should always have additional personnel in the room.
Which of the following findings would be consistent with a diagnosis of a
tracheoesophageal fistula?
A. hypersensitive gag reflex.
B. dry mouth.
C. cyanosis.
D. decreased level of consciousness.
Choice C is correct. Cyanosis is a notable symptom in a neonate with a
tracheoesophageal fistula. The cyanosis often results from a laryngospasm (a
protective mechanism that the body has to prevent aspiration into the trachea).
Choice A is incorrect. A hypersensitive gag reflex is not a symptom traditionally
related to a tracheoesophageal fistula. However, regurgitation can occur from
secretions that pool in a blind pouch of the fistula. These infants may need more
suctioning.
Choice B is incorrect. Individuals afflicted with tracheoesophageal fistulas typically
display excessive salivation and drooling, not a dry mouth.
Choice D is incorrect. A decreased level of consciousness is not a symptom
commonly associated with a tracheoesophageal fistula.
tracheoesophageal fistula
✓ A tracheoesophageal fistula is an abnormal passage or connection between the
esophagus (typically the lower) and the trachea.
✓ Cyanotic spells, also known as blue spells, dying spells, or apparent life-
threatening events, refer to a bluish tone visible in the mucosal membranes and skin
caused by an oxygen decrease in the peripheral circulation.
✓ Esophageal atresia and tracheoesophageal fistula often occur together. The two
conditions are also frequently seen in children with other birth defects of the spine,
heart, kidney, genitals, ears, and limbs and delayed mental development, physical
development, or both.
, Page 4 of 69
The nurse is providing the client with information regarding advanced
directives.
The nurse understands that giving this information supports the client's
A. right to privacy.
B. right to emergency care regardless of the ability to pay.
C. self-determination.
D. ability to receive appropriate treatment for their pain.
Choice C is correct. A client who completes advanced care planning documents is
asserting and using their fundamental right to self-determination. Self-determination
is defined as the intrinsic right of all people, including healthcare consumers, to make
autonomous decisions about accepting or rejecting care or treatments. Self-
determination is respecting the client and their ability to outline care for themselves if
they become incapacitated, such as formulating advanced directives.
Choice A is incorrect. The right to privacy is essential for all clients. Privacy fosters
an environment allowing the client to be honest. This is not an example of self-
determination.
Choice B is incorrect. The right to emergency care, regardless of the ability to pay,
is mandated in most countries. In the United States, this is referred to as the
emergency medical treatment and active labor act (EMTALA).
Choice D is incorrect. The client receiving appropriate treatment for their pain is
part of the client's bill of rights, not self-determination.
advanced directive
✓ Self-determination granted individuals the right to determine the medical care they
wanted if they became incapacitated.
✓ Documentation of self-determination is accomplished by completing an advance
directive (AD)
✓ Self-determination threads to a client's autonomy and requires the client to be
informed of advanced directive options
The nurse works with individuals both within and beyond the immediate care
team to achieve shared goals and make decisions in the best interest of the
client.
Which role is the nurse fulfilling in this situation?
A. Collaborator
NCLEX PRACTICE EXAM REVIEW ARCHER
EXAM 2026 QUESTIONS LATEST VERSION
QUESTIONS AND ANSWERS
Nclex practice exam Review archer
The nurse is assisting the risk manager in reviewing a serious medication
error. Which process should the nurse recommend be used to identify the
origin of the issue and potential solution?
A. Root cause analysis
B. Collective bargaining
C. Six Sigma
D. Team STEPPS program
Choice A is correct. Performance improvement teams often use the root cause
analysis process to find the most basic causes of process failures. Root cause
analysis is done in a blame-free environment to determine why a failed process is
not fail-proof. This approach may involve multiple specialists from different
departments.
Choice B is incorrect. Collective bargaining is a negotiating process between
employees and their employers. This is not a tool used to identify the causation of an
error.
Choice C is incorrect. Six sigma is a quality improvement change process that is
data-driven. This process does not look for a root cause (or error); rather, the focus
is on implementing change supported by evidence.
Choice D is incorrect. Team STEPPS is a teamwork system designed to improve
communication, efficiency, and team dynamics in an organization.
The nurse is caring for an infant with the below tracing on the
electrocardiogram (ECG).
, Page 2 of 69
The nurse should plan to take which initial action? See the image below.
A. Instruct the infant to bear down.
B. Prepare a bag filled with ice and water.
C. Assess the infant's axillary temperature.
D. Obtain the infant's carotid pulse.
Choice B is correct. This tracing reflects supraventricular tachycardia (SVT), which
is concerning because of the very high rate. The rate may be as high as 180 to 280
beats/min in infants. Characteristically, SVT does not have P-waves as they are
buried in the T-waves. Preparing a bag filled with ice and water is essential because
this may be applied to the face above the nose and mouth for 15 to 30 seconds. If
that is ineffective, another vagal maneuver would be pressing the infant's knees to
the chest for 15-30 seconds.
Choice A is incorrect. Instructing an infant to bear down would be futile because
the infant does not have the cognitive ability to follow this instruction. This is the
instruction that could be provided to a child or adult.
Choice C is incorrect. Assessing the infant's axillary temperature would not have
clinical significance because of the necessity to break the SVT. While SVT may be
caused by severe febrile illness, the infant's rhythm must be corrected.
Choice D is incorrect. An infant's pulse should be obtained via the brachial artery,
not the carotid artery.
Svt additional notes.
✓ During SVT, P waves may not be visible because the P waves are embedded in
the preceding T wave
✓ A client with SVT may be asymptomatic. If the client is symptomatic, they may
exhibit manifestations such as palpitations, dizziness, dyspnea, and nervousness
✓ Treatment includes vagal maneuvers. Vagal maneuvers include having
the beardown, blowing through a straw, having the primary healthcare provider
(PHCP) perform a carotid massage, and, if the client is an infant, applying a bag
filled with ice and water to the face above the nose and mouth for 15 to 30
seconds. If that is ineffective, another vagal maneuver would be pressing the infant's
knees to the chest for 15-30 seconds.
, Page 3 of 69
✓ If these measures are ineffective, the nurse should prepare to administer the
prescribed adenosine by rapid intravenous push (IVP) that is followed by a flush of
0.9% saline.
✓ When adenosine is administered, the emergency (code) cart should be nearby,
and the nurse should always have additional personnel in the room.
Which of the following findings would be consistent with a diagnosis of a
tracheoesophageal fistula?
A. hypersensitive gag reflex.
B. dry mouth.
C. cyanosis.
D. decreased level of consciousness.
Choice C is correct. Cyanosis is a notable symptom in a neonate with a
tracheoesophageal fistula. The cyanosis often results from a laryngospasm (a
protective mechanism that the body has to prevent aspiration into the trachea).
Choice A is incorrect. A hypersensitive gag reflex is not a symptom traditionally
related to a tracheoesophageal fistula. However, regurgitation can occur from
secretions that pool in a blind pouch of the fistula. These infants may need more
suctioning.
Choice B is incorrect. Individuals afflicted with tracheoesophageal fistulas typically
display excessive salivation and drooling, not a dry mouth.
Choice D is incorrect. A decreased level of consciousness is not a symptom
commonly associated with a tracheoesophageal fistula.
tracheoesophageal fistula
✓ A tracheoesophageal fistula is an abnormal passage or connection between the
esophagus (typically the lower) and the trachea.
✓ Cyanotic spells, also known as blue spells, dying spells, or apparent life-
threatening events, refer to a bluish tone visible in the mucosal membranes and skin
caused by an oxygen decrease in the peripheral circulation.
✓ Esophageal atresia and tracheoesophageal fistula often occur together. The two
conditions are also frequently seen in children with other birth defects of the spine,
heart, kidney, genitals, ears, and limbs and delayed mental development, physical
development, or both.
, Page 4 of 69
The nurse is providing the client with information regarding advanced
directives.
The nurse understands that giving this information supports the client's
A. right to privacy.
B. right to emergency care regardless of the ability to pay.
C. self-determination.
D. ability to receive appropriate treatment for their pain.
Choice C is correct. A client who completes advanced care planning documents is
asserting and using their fundamental right to self-determination. Self-determination
is defined as the intrinsic right of all people, including healthcare consumers, to make
autonomous decisions about accepting or rejecting care or treatments. Self-
determination is respecting the client and their ability to outline care for themselves if
they become incapacitated, such as formulating advanced directives.
Choice A is incorrect. The right to privacy is essential for all clients. Privacy fosters
an environment allowing the client to be honest. This is not an example of self-
determination.
Choice B is incorrect. The right to emergency care, regardless of the ability to pay,
is mandated in most countries. In the United States, this is referred to as the
emergency medical treatment and active labor act (EMTALA).
Choice D is incorrect. The client receiving appropriate treatment for their pain is
part of the client's bill of rights, not self-determination.
advanced directive
✓ Self-determination granted individuals the right to determine the medical care they
wanted if they became incapacitated.
✓ Documentation of self-determination is accomplished by completing an advance
directive (AD)
✓ Self-determination threads to a client's autonomy and requires the client to be
informed of advanced directive options
The nurse works with individuals both within and beyond the immediate care
team to achieve shared goals and make decisions in the best interest of the
client.
Which role is the nurse fulfilling in this situation?
A. Collaborator
