1|Page
ADVANCED CLINICAL NURSING
EXAMINATION
Critical Care & Medical-Surgical Nursing
NCLEX-Style Practice Test | 25 Questions
---
> Instructions: Select the single best answer for each Question.
Read each clinical scenario carefully before answering. All
Questions are application or analysis level unless otherwise
noted.
1|Page
,2|Page
SECTION 1: RESPIRATORY & CARDIAC MANAGEMENT
Question 1
A 72-year-old client with a history of heart failure is admitted
with worsening shortness of breath. Assessment reveals: BP
158/94 mmHg, HR 112 bpm, RR 28 breaths/min, SpO2 88% on
room air, crackles bilaterally, and 3+ pitting edema to the knees.
The client is anxious and sitting upright. Which intervention
should the nurse implement FIRST?
A) Administer furosemide 40mg IV as ordered
B) Place client in high-Fowler's position and apply oxygen
C) Obtain a STAT 12-lead ECG
D) Insert a urinary catheter to monitor strict I&O
Correct answer: B
Explanation:
- Client shows signs of acute pulmonary edema — the immediate
threat is hypoxia (SpO2 88%)
- High-Fowler's position reduces preload, decreases work of
breathing, and improves lung expansion
- Oxygen addresses hypoxemia, the most life-threatening concern
at this moment
2|Page
,3|Page
- (A) Furosemide is appropriate but secondary — positioning and
oxygenation come first
- (C) ECG is important but not the immediate priority over
airway/oxygenation
- (D) Catheter insertion is a supportive measure, not a priority
intervention
- NCLEX Category: Physiological Integrity — Reduction of Risk
Potential
- Cognitive Level: Analysis
---
Question 2
A nurse is caring for a postoperative client (24 hours after
abdominal surgery) who suddenly reports chest pain rated 9/10
and difficulty breathing. VS: BP 100/60 mmHg, HR 128 bpm, RR
30 breaths/min, SpO2 89%. The client's left calf is warm and
swollen. Which condition does the nurse suspect, and what is the
PRIORITY action?
A) Myocardial infarction; administer aspirin 325mg PO
B) Pulmonary embolism; place client in semi-Fowler's and call
rapid response
C) Pneumothorax; prepare for chest tube insertion
D) Anxiety attack; administer lorazepam 1mg IV and reassure the
client
Correct answer: B
3|Page
, 4|Page
Explanation:
- Classic PE presentation: sudden pleuritic chest pain, dyspnea,
tachycardia, hypotension + risk factors (post-op immobility,
unilateral calf swelling suggesting DVT)
- Priority action: optimize oxygenation (semi-Fowler's) and
escalate care immediately via rapid response
- (A) Aspirin targets arterial clots (MI); PE involves venous
thromboembolism — not the priority drug or diagnosis
- (C) No evidence supports pneumothorax (absent breath sounds,
tracheal deviation would be expected)
- (D) Never assume anxiety with objective hemodynamic
instability — dangerous and delays care
- NCLEX Category: Physiological Integrity — Physiological
Adaptation
- Cognitive Level: Analysis
---
Question 3
A 55-year-old client is receiving mechanical ventilation after
respiratory failure. Current ventilator settings: FiO2 70%, PEEP 8
cmH2O. ABG results: pH 7.48, PaCO2 30 mmHg, HCO3- 23 mEq/L,
PaO2 98 mmHg. How does the nurse interpret these findings?
A) Metabolic alkalosis, compensated
B) Respiratory alkalosis, uncompensated
C) Respiratory acidosis with metabolic compensation
4|Page
ADVANCED CLINICAL NURSING
EXAMINATION
Critical Care & Medical-Surgical Nursing
NCLEX-Style Practice Test | 25 Questions
---
> Instructions: Select the single best answer for each Question.
Read each clinical scenario carefully before answering. All
Questions are application or analysis level unless otherwise
noted.
1|Page
,2|Page
SECTION 1: RESPIRATORY & CARDIAC MANAGEMENT
Question 1
A 72-year-old client with a history of heart failure is admitted
with worsening shortness of breath. Assessment reveals: BP
158/94 mmHg, HR 112 bpm, RR 28 breaths/min, SpO2 88% on
room air, crackles bilaterally, and 3+ pitting edema to the knees.
The client is anxious and sitting upright. Which intervention
should the nurse implement FIRST?
A) Administer furosemide 40mg IV as ordered
B) Place client in high-Fowler's position and apply oxygen
C) Obtain a STAT 12-lead ECG
D) Insert a urinary catheter to monitor strict I&O
Correct answer: B
Explanation:
- Client shows signs of acute pulmonary edema — the immediate
threat is hypoxia (SpO2 88%)
- High-Fowler's position reduces preload, decreases work of
breathing, and improves lung expansion
- Oxygen addresses hypoxemia, the most life-threatening concern
at this moment
2|Page
,3|Page
- (A) Furosemide is appropriate but secondary — positioning and
oxygenation come first
- (C) ECG is important but not the immediate priority over
airway/oxygenation
- (D) Catheter insertion is a supportive measure, not a priority
intervention
- NCLEX Category: Physiological Integrity — Reduction of Risk
Potential
- Cognitive Level: Analysis
---
Question 2
A nurse is caring for a postoperative client (24 hours after
abdominal surgery) who suddenly reports chest pain rated 9/10
and difficulty breathing. VS: BP 100/60 mmHg, HR 128 bpm, RR
30 breaths/min, SpO2 89%. The client's left calf is warm and
swollen. Which condition does the nurse suspect, and what is the
PRIORITY action?
A) Myocardial infarction; administer aspirin 325mg PO
B) Pulmonary embolism; place client in semi-Fowler's and call
rapid response
C) Pneumothorax; prepare for chest tube insertion
D) Anxiety attack; administer lorazepam 1mg IV and reassure the
client
Correct answer: B
3|Page
, 4|Page
Explanation:
- Classic PE presentation: sudden pleuritic chest pain, dyspnea,
tachycardia, hypotension + risk factors (post-op immobility,
unilateral calf swelling suggesting DVT)
- Priority action: optimize oxygenation (semi-Fowler's) and
escalate care immediately via rapid response
- (A) Aspirin targets arterial clots (MI); PE involves venous
thromboembolism — not the priority drug or diagnosis
- (C) No evidence supports pneumothorax (absent breath sounds,
tracheal deviation would be expected)
- (D) Never assume anxiety with objective hemodynamic
instability — dangerous and delays care
- NCLEX Category: Physiological Integrity — Physiological
Adaptation
- Cognitive Level: Analysis
---
Question 3
A 55-year-old client is receiving mechanical ventilation after
respiratory failure. Current ventilator settings: FiO2 70%, PEEP 8
cmH2O. ABG results: pH 7.48, PaCO2 30 mmHg, HCO3- 23 mEq/L,
PaO2 98 mmHg. How does the nurse interpret these findings?
A) Metabolic alkalosis, compensated
B) Respiratory alkalosis, uncompensated
C) Respiratory acidosis with metabolic compensation
4|Page
