UWORLD NCLEX-RN HIGH-
DIFFICULTY PRACTICE TEST 2
QUESTIONS AND ANSWERS
1. A nurse is caring for a client with a suspected pheochromocytoma. Which clinical
manifestation should the nurse prioritize for immediate assessment?
A. Severe hypertension with a blood pressure of 210/110 mmHg
B. Persistent headache and palpitations
C. Profuse diaphoresis and pallor
D. Glycosuria and polyuria
Answer: A
Conceptual Explanation: Pheochromocytoma causes excessive catecholamine release.
Severe hypertension is the most life-threatening complication as it can lead to stroke, heart
failure, or aortic dissection.
2. Which client should the triage nurse in the emergency department assess first?
A. A 45-year-old with crushing chest pain and diaphoresis
B. A 22-year-old with a sudden onset of ‘worst headache of my life’
C. A 60-year-old with right-sided weakness and facial drooping for 1 hour
,D. A 10-year-old with a high fever and a non-blanching petechial rash
Answer: D
Conceptual Explanation: While all options are emergencies, a non-blanching petechial
rash in a febrile child suggests meningococcemia, which is rapidly fatal and requires
immediate isolation and antibiotics.
3. The nurse is monitoring a client receiving Magnesium Sulfate for preeclampsia. Which
finding requires the nurse to stop the infusion immediately?
A. Respirations of 10 breaths/minute
B. Absent deep tendon reflexes (DTRs)
C. Urine output of 25 mL/hour
D. Blood pressure of 150/90 mmHg
Answer: B
Conceptual Explanation: Loss of deep tendon reflexes is the earliest sign of magnesium
toxicity. Respiratory depression below 12 is also a sign, but absent DTRs usually occur first
as toxicity levels rise.
4. A client is diagnosed with Serotonin Syndrome. Which medication in the client’s history
likely contributed to this condition when combined with an SSRI?
A. Warfarin
B. Acetaminophen
, C. St. John’s Wort
D. Metformin
Answer: C
Conceptual Explanation: St. John’s Wort is an herbal supplement that increases serotonin
levels. Combining it with SSRIs increases the risk of Serotonin Syndrome.
5. An infant is admitted with Tetralogy of Fallot and begins to have a ‘tet spell’. What is the
nurse’s priority action?
A. Administer 100% oxygen via face mask
B. Administer morphine sulfate IM
C. Place the infant in the knee-chest position
D. Start an IV line for fluid bolus
Answer: C
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a cyanotic spell.
6. A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the
water seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally for a client with a pneumothorax
B. There is a leak in the drainage system or at the insertion site
C. The suction level is set too high
DIFFICULTY PRACTICE TEST 2
QUESTIONS AND ANSWERS
1. A nurse is caring for a client with a suspected pheochromocytoma. Which clinical
manifestation should the nurse prioritize for immediate assessment?
A. Severe hypertension with a blood pressure of 210/110 mmHg
B. Persistent headache and palpitations
C. Profuse diaphoresis and pallor
D. Glycosuria and polyuria
Answer: A
Conceptual Explanation: Pheochromocytoma causes excessive catecholamine release.
Severe hypertension is the most life-threatening complication as it can lead to stroke, heart
failure, or aortic dissection.
2. Which client should the triage nurse in the emergency department assess first?
A. A 45-year-old with crushing chest pain and diaphoresis
B. A 22-year-old with a sudden onset of ‘worst headache of my life’
C. A 60-year-old with right-sided weakness and facial drooping for 1 hour
,D. A 10-year-old with a high fever and a non-blanching petechial rash
Answer: D
Conceptual Explanation: While all options are emergencies, a non-blanching petechial
rash in a febrile child suggests meningococcemia, which is rapidly fatal and requires
immediate isolation and antibiotics.
3. The nurse is monitoring a client receiving Magnesium Sulfate for preeclampsia. Which
finding requires the nurse to stop the infusion immediately?
A. Respirations of 10 breaths/minute
B. Absent deep tendon reflexes (DTRs)
C. Urine output of 25 mL/hour
D. Blood pressure of 150/90 mmHg
Answer: B
Conceptual Explanation: Loss of deep tendon reflexes is the earliest sign of magnesium
toxicity. Respiratory depression below 12 is also a sign, but absent DTRs usually occur first
as toxicity levels rise.
4. A client is diagnosed with Serotonin Syndrome. Which medication in the client’s history
likely contributed to this condition when combined with an SSRI?
A. Warfarin
B. Acetaminophen
, C. St. John’s Wort
D. Metformin
Answer: C
Conceptual Explanation: St. John’s Wort is an herbal supplement that increases serotonin
levels. Combining it with SSRIs increases the risk of Serotonin Syndrome.
5. An infant is admitted with Tetralogy of Fallot and begins to have a ‘tet spell’. What is the
nurse’s priority action?
A. Administer 100% oxygen via face mask
B. Administer morphine sulfate IM
C. Place the infant in the knee-chest position
D. Start an IV line for fluid bolus
Answer: C
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a cyanotic spell.
6. A nurse is caring for a client with a chest tube. The nurse notes continuous bubbling in the
water seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally for a client with a pneumothorax
B. There is a leak in the drainage system or at the insertion site
C. The suction level is set too high
