NCLEX-RN KAPLAN DIAGNOSTIC
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A nurse is caring for a client with a chest tube. The nurse notices continuous bubbling in
the water seal chamber. Which action should the nurse take first?
A. Increase the suction to the prescribed level.
B. Check for a leak in the system.
C. Document the finding as a normal occurrence.
D. Notify the healthcare provider immediately.
Answer: B
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak in the system. The nurse should check the connections and the insertion site to locate
the source of the leak.
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which
instruction is most important for the nurse to include in the discharge teaching?
A. Maintain a consistent intake of sodium and fluids.
,B. Restrict sodium intake to prevent toxicity.
C. Take the medication only when feeling manic.
D. Avoid foods high in tyramine, such as aged cheese.
Answer: A
Conceptual Explanation: Lithium is a salt; therefore, maintaining a consistent intake of
sodium and fluids (2-3 L/day) is vital to prevent toxicity. Decreasing sodium intake can
cause lithium levels to rise.
3. A nurse is preparing to administer digoxin to a client with heart failure. Which clinical
finding should cause the nurse to withhold the medication?
A. Blood pressure of 140/90 mmHg
B. Apical pulse rate of 52 beats per minute
C. Respiratory rate of 20 breaths per minute
D. Potassium level of 4.5 mEq/L
Answer: B
Conceptual Explanation: Digoxin should be withheld if the apical pulse is less than 60
beats per minute in an adult, as the drug slows heart rate. Bradycardia is a sign of digoxin
toxicity.
, 4. A client diagnosed with schizophrenia is experiencing auditory hallucinations. What is the
most appropriate initial response by the nurse?
A. ‘I know the voices are real to you, but I do not hear them.’
B. ‘What are the voices telling you to do?’
C. ‘Why do you think these voices are talking to you?’
D. ‘I don’t hear anything; you are just imagining it.’
Answer: A
Conceptual Explanation: The nurse should acknowledge the client’s experience without
validating the hallucination. Asking what the voices are saying (Option B) is important for
safety, but D is the foundational therapeutic response for reality orientation.
5. The nurse is caring for a client who underwent a thyroidectomy 12 hours ago. Which
finding requires immediate intervention?
A. Sore throat when swallowing
B. Blood-tinged dressing at the incision site
C. Tingling around the mouth and fingertips
D. Hoarseness while speaking
Answer: C
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A nurse is caring for a client with a chest tube. The nurse notices continuous bubbling in
the water seal chamber. Which action should the nurse take first?
A. Increase the suction to the prescribed level.
B. Check for a leak in the system.
C. Document the finding as a normal occurrence.
D. Notify the healthcare provider immediately.
Answer: B
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak in the system. The nurse should check the connections and the insertion site to locate
the source of the leak.
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which
instruction is most important for the nurse to include in the discharge teaching?
A. Maintain a consistent intake of sodium and fluids.
,B. Restrict sodium intake to prevent toxicity.
C. Take the medication only when feeling manic.
D. Avoid foods high in tyramine, such as aged cheese.
Answer: A
Conceptual Explanation: Lithium is a salt; therefore, maintaining a consistent intake of
sodium and fluids (2-3 L/day) is vital to prevent toxicity. Decreasing sodium intake can
cause lithium levels to rise.
3. A nurse is preparing to administer digoxin to a client with heart failure. Which clinical
finding should cause the nurse to withhold the medication?
A. Blood pressure of 140/90 mmHg
B. Apical pulse rate of 52 beats per minute
C. Respiratory rate of 20 breaths per minute
D. Potassium level of 4.5 mEq/L
Answer: B
Conceptual Explanation: Digoxin should be withheld if the apical pulse is less than 60
beats per minute in an adult, as the drug slows heart rate. Bradycardia is a sign of digoxin
toxicity.
, 4. A client diagnosed with schizophrenia is experiencing auditory hallucinations. What is the
most appropriate initial response by the nurse?
A. ‘I know the voices are real to you, but I do not hear them.’
B. ‘What are the voices telling you to do?’
C. ‘Why do you think these voices are talking to you?’
D. ‘I don’t hear anything; you are just imagining it.’
Answer: A
Conceptual Explanation: The nurse should acknowledge the client’s experience without
validating the hallucination. Asking what the voices are saying (Option B) is important for
safety, but D is the foundational therapeutic response for reality orientation.
5. The nurse is caring for a client who underwent a thyroidectomy 12 hours ago. Which
finding requires immediate intervention?
A. Sore throat when swallowing
B. Blood-tinged dressing at the incision site
C. Tingling around the mouth and fingertips
D. Hoarseness while speaking
Answer: C
