NCLEX NURSING SCHOOL SURVIVAL
KIT – HIGH DIFFICULTY CHALLENGE
EXAM QUESTIONS AND ANSWERS
1. A nurse is caring for a patient in the ICU with a pH of 7.25, PaCO2 of 50 mmHg, and HCO3 of
26 mEq/L. Which interpretation and intervention are most appropriate?
A. Metabolic Acidosis; administer sodium bicarbonate
B. Respiratory Alkalosis; provide a rebreather mask
C. Respiratory Acidosis; encourage deep breathing and coughing
D. Metabolic Alkalosis; administer ammonium chloride
Answer: C
Conceptual Explanation: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3
is normal, indicating uncompensated respiratory acidosis. Interventions should focus on
improving ventilation.
2. When delegating tasks to an Unlicensed Assistive Personnel (UAP), which task is most
appropriate for the RN to assign?
A. Evaluating the effectiveness of pain medication
,B. Feeding a patient with a high risk for aspiration
C. Collecting a routine urine specimen from a stable patient
D. Teaching a patient how to use an incentive spirometer
Answer: C
Conceptual Explanation: UAPs can perform routine tasks on stable patients such as
specimen collection. Evaluation, assessment, and teaching are nursing responsibilities
(TEACH/EVAL/ASSESS).
3. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize as a sign of early toxicity?
A. Anorexia, nausea, and vomiting
B. Visual disturbances such as yellow halos
C. Occasional premature ventricular contractions
D. Increased urine output
Answer: A
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are usually the earliest signs of digoxin toxicity, followed by visual changes and
arrhythmias.
, 4. A patient is admitted with suspected Addisonian Crisis. Which laboratory finding should
the nurse expect to see?
A. Hyperglycemia and Hypokalemia
B. Hyponatremia and Hyperkalemia
C. Hypernatremia and Hypocalcemia
D. Hypomagnesemia and Hyperchloremia
Answer: B
Conceptual Explanation: Addison’s disease involves a lack of aldosterone and cortisol,
leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia).
5. A client is receiving a continuous Heparin infusion. The aPTT is 105 seconds (control 25-35).
What is the nurse’s priority action?
A. Increase the infusion rate per protocol
B. Continue the infusion and recheck in 4 hours
C. Stop the infusion and notify the provider
D. Prepare to administer Vitamin K
Answer: C
Conceptual Explanation: The aPTT is significantly above the therapeutic range (usually
1.5 to 2.5 times the control). The infusion must be stopped to prevent bleeding. Protamine
sulfate is the antidote, not Vitamin K.
KIT – HIGH DIFFICULTY CHALLENGE
EXAM QUESTIONS AND ANSWERS
1. A nurse is caring for a patient in the ICU with a pH of 7.25, PaCO2 of 50 mmHg, and HCO3 of
26 mEq/L. Which interpretation and intervention are most appropriate?
A. Metabolic Acidosis; administer sodium bicarbonate
B. Respiratory Alkalosis; provide a rebreather mask
C. Respiratory Acidosis; encourage deep breathing and coughing
D. Metabolic Alkalosis; administer ammonium chloride
Answer: C
Conceptual Explanation: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3
is normal, indicating uncompensated respiratory acidosis. Interventions should focus on
improving ventilation.
2. When delegating tasks to an Unlicensed Assistive Personnel (UAP), which task is most
appropriate for the RN to assign?
A. Evaluating the effectiveness of pain medication
,B. Feeding a patient with a high risk for aspiration
C. Collecting a routine urine specimen from a stable patient
D. Teaching a patient how to use an incentive spirometer
Answer: C
Conceptual Explanation: UAPs can perform routine tasks on stable patients such as
specimen collection. Evaluation, assessment, and teaching are nursing responsibilities
(TEACH/EVAL/ASSESS).
3. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize as a sign of early toxicity?
A. Anorexia, nausea, and vomiting
B. Visual disturbances such as yellow halos
C. Occasional premature ventricular contractions
D. Increased urine output
Answer: A
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are usually the earliest signs of digoxin toxicity, followed by visual changes and
arrhythmias.
, 4. A patient is admitted with suspected Addisonian Crisis. Which laboratory finding should
the nurse expect to see?
A. Hyperglycemia and Hypokalemia
B. Hyponatremia and Hyperkalemia
C. Hypernatremia and Hypocalcemia
D. Hypomagnesemia and Hyperchloremia
Answer: B
Conceptual Explanation: Addison’s disease involves a lack of aldosterone and cortisol,
leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia).
5. A client is receiving a continuous Heparin infusion. The aPTT is 105 seconds (control 25-35).
What is the nurse’s priority action?
A. Increase the infusion rate per protocol
B. Continue the infusion and recheck in 4 hours
C. Stop the infusion and notify the provider
D. Prepare to administer Vitamin K
Answer: C
Conceptual Explanation: The aPTT is significantly above the therapeutic range (usually
1.5 to 2.5 times the control). The infusion must be stopped to prevent bleeding. Protamine
sulfate is the antidote, not Vitamin K.
