KAPLAN NCLEX-RN HIGH-DIFFICULTY
DIAGNOSTIC EXAM QUESTIONS AND
ANSWERS
1. A client with a history of heart failure is prescribed digoxin and furosemide. The nurse
notes the client reports seeing yellow-green halos around lights. Which action should the
nurse take first?
A. Administer the next dose of furosemide as scheduled.
B. Document the finding as a common side effect of diuretics.
C. Check the client’s most recent serum potassium level.
D. Assess the client’s apical pulse for one full minute.
Answer: D
Conceptual Explanation: The client is exhibiting signs of digoxin toxicity (visual
disturbances). The priority nursing action is to assess the client’s heart rate and rhythm via
apical pulse before notifying the provider and checking labs like potassium, which can
potentiate toxicity.
,2. A nurse delegates the task of repositioning an immobile client to an unlicensed assistive
personnel (UAP). Which observation by the nurse requires immediate intervention?
A. The UAP lowers the bed to the lowest position after turning the client.
B. The UAP places a pillow between the client’s knees while in a side-lying position.
C. The UAP uses a draw sheet to slide the client up in bed.
D. The UAP elevates the head of the bed to 45 degrees immediately after the client has
eaten.
Answer: C
Conceptual Explanation: Sliding a client creates shearing forces that damage skin. The
UAP should lift the client using a friction-reducing device or enough staff to prevent skin
breakdown. The other actions are appropriate care.
3. A client is admitted with a diagnosis of pheochromocytoma. Which assessment finding
should the nurse expect to observe?
A. Bradycardia and hypotension.
B. Profuse sweating and severe headache.
C. Weight gain and moon face.
D. Hypoglycemia and lethargy.
Answer: B
, Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the
adrenal medulla. Excess epinephrine and norepinephrine cause the classic triad of
diaphoresis, severe headache, and palpitations/hypertension.
4. The nurse provides discharge instructions to a client who had a total hip arthroplasty.
Which statement by the client indicates a need for further teaching?
A. ‘I will sit in my favorite recliner when I get home.’
B. ‘I will keep a pillow between my legs when I sleep.’
C. ‘I will use a raised toilet seat at home.’
D. ‘I will avoid crossing my legs at the ankles or knees.’
Answer: A
Conceptual Explanation: After a total hip arthroplasty, the client must avoid hip flexion
greater than 90 degrees. Low, soft chairs like recliners cause excessive flexion and increase
the risk of dislocation. The other statements are correct post-op precautions.
5. An adolescent client with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis
(DKA). Which arterial blood gas (ABG) result is most consistent with this diagnosis?
A. pH 7.30, PaCO2 30, HCO3 16
B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 48, HCO3 28
D. pH 7.50, PaCO2 40, HCO3 30
DIAGNOSTIC EXAM QUESTIONS AND
ANSWERS
1. A client with a history of heart failure is prescribed digoxin and furosemide. The nurse
notes the client reports seeing yellow-green halos around lights. Which action should the
nurse take first?
A. Administer the next dose of furosemide as scheduled.
B. Document the finding as a common side effect of diuretics.
C. Check the client’s most recent serum potassium level.
D. Assess the client’s apical pulse for one full minute.
Answer: D
Conceptual Explanation: The client is exhibiting signs of digoxin toxicity (visual
disturbances). The priority nursing action is to assess the client’s heart rate and rhythm via
apical pulse before notifying the provider and checking labs like potassium, which can
potentiate toxicity.
,2. A nurse delegates the task of repositioning an immobile client to an unlicensed assistive
personnel (UAP). Which observation by the nurse requires immediate intervention?
A. The UAP lowers the bed to the lowest position after turning the client.
B. The UAP places a pillow between the client’s knees while in a side-lying position.
C. The UAP uses a draw sheet to slide the client up in bed.
D. The UAP elevates the head of the bed to 45 degrees immediately after the client has
eaten.
Answer: C
Conceptual Explanation: Sliding a client creates shearing forces that damage skin. The
UAP should lift the client using a friction-reducing device or enough staff to prevent skin
breakdown. The other actions are appropriate care.
3. A client is admitted with a diagnosis of pheochromocytoma. Which assessment finding
should the nurse expect to observe?
A. Bradycardia and hypotension.
B. Profuse sweating and severe headache.
C. Weight gain and moon face.
D. Hypoglycemia and lethargy.
Answer: B
, Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the
adrenal medulla. Excess epinephrine and norepinephrine cause the classic triad of
diaphoresis, severe headache, and palpitations/hypertension.
4. The nurse provides discharge instructions to a client who had a total hip arthroplasty.
Which statement by the client indicates a need for further teaching?
A. ‘I will sit in my favorite recliner when I get home.’
B. ‘I will keep a pillow between my legs when I sleep.’
C. ‘I will use a raised toilet seat at home.’
D. ‘I will avoid crossing my legs at the ankles or knees.’
Answer: A
Conceptual Explanation: After a total hip arthroplasty, the client must avoid hip flexion
greater than 90 degrees. Low, soft chairs like recliners cause excessive flexion and increase
the risk of dislocation. The other statements are correct post-op precautions.
5. An adolescent client with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis
(DKA). Which arterial blood gas (ABG) result is most consistent with this diagnosis?
A. pH 7.30, PaCO2 30, HCO3 16
B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 48, HCO3 28
D. pH 7.50, PaCO2 40, HCO3 30
