Page 1 of 578
NCLEX HURST REVIEW READINESS EXAM WITH
CORRECT ANSWERS,RATIONALES AND WHY
THE OTHERS ARE NOT CORRECT NEWEST 2026
EXAM VERIFIED 100 %
The charge nurse is evaluating knowledge of tracheostomy suctioning of a
new nurse prior to that procedure being performed. Which statement by the
new nurse would indicate to the charge nurse that additional education is
needed?
1. "Prior to suctioning, I will hyper-oxygenate the client."
2. "I will instill normal saline bullets to liquefy secretions."
3. "I will allow at least 20 seconds between suctioning passes."
4. "Suctioning will be limited to a maximum of three catheter passes."
2
Why the Correct Option Is Right
• 2. "I will instill normal saline bullets to liquefy secretions."
o The Key Phrase: The question asks which statement shows that
additional education is needed (a negative-stem question).
o Clinical Danger: Routinely instilling normal saline drops or "bullets"
directly into a tracheostomy or endotracheal tube prior to suctioning is
no longer an approved clinical practice.
o The Consequences: Research shows that instilling saline does not
effectively liquefy deep secretions. Instead, it breaks up bacterial
biofilms and forces pathogens deeper into the lower respiratory tract,
significantly increasing the client's risk for Ventilator-Associated
Pneumonia (VAP) or tracheostomy infections. It also strips away
protective bronchial surfactant and causes a sudden, temporary drop in
the client's oxygen saturation levels. [1, 2]
Why the Other Options Are Correct Practices (Do Not Need
Correction)
, Page 2 of 578
• ❌ 1. "Prior to suctioning, I will hyper-oxygenate the client."
o This is excellent, standard nursing practice. Tracheal suctioning
removes both secretions and vital air from the lungs, which drops
oxygen levels. Providing 100% oxygen before starting protects the
patient from sudden hypoxemia and cardiac arrhythmias. [1, 2]
• ❌ 3. "I will allow at least 20 seconds between suctioning passes."
o This is a correct practice. Pausing for at least 20 to 30 seconds
between each catheter pass gives the client time to breathe, re-
oxygenate their blood, and recover from the stress of the procedure. [1,
2]
• ❌ 4. "Suctioning will be limited to a maximum of three catheter
passes."
o This is a correct practice. Limiting the entire suctioning session to a
maximum of 3 passes minimizes trauma to the sensitive tracheal
mucosa and prevents severe oxygen depletion
The nurse observes a client at a follow-up appointment using correct cane
walking technique but losing balance each time the quad cane is lifted off of
the floor. The client reports a history of recent falls. What is the best action for
the nurse to take?
1. Inform the primary healthcare provider of the observations made regarding
quad cane use, and imbalance assessment.
2. Inform client that there are only a few assistive devices available to help
with ambulation.
3. Instruct the client on proper quad cane use.
4. Notify the primary healthcare provider after consulting with the neighbor.
1
Why the Correct Option Is Right
• 1. Inform the primary healthcare provider of the observations made
regarding quad cane use, and imbalance assessment.
o Clinical Real-World Assessment: The nurse assesses that the client is
already using the correct cane technique, yet they are still losing their
balance and have a dangerous history of recent falls. This indicates
that a quad cane is no longer providing enough physical stability to
keep the client safe.
o Advocacy and Safety: The nurse's immediate priority is to
communicate these specific clinical findings to the primary healthcare
provider (HCP). This reporting prompts a necessary medical referral for
a physical therapy evaluation or an upgraded mobility device (such as
a rolling walker) to prevent a catastrophic fall injury.
Why the Other Options Are Wrong
, Page 3 of 578
• ❌ 2. Inform client that there are only a few assistive devices available
to help with ambulation.
o This statement is factually inaccurate and unhelpful. There is a wide
array of mobility and assistive equipment available—ranging from
single-point canes and hemi-walkers to standard walkers, rolling
walkers, and specialized wheelchairs—tailored to meet a client's
evolving physical needs.
• ❌ 3. Instruct the client on proper quad cane use.
o The question explicitly states that the nurse observed the client using
the correct cane walking technique. Re-teaching a skill that the client
has already mastered will not fix their underlying balance deficit or
solve the immediate safety hazard.
• ❌ 4. Notify the primary healthcare provider after consulting with the
neighbor.
o Consulting a neighbor regarding a client’s medical care or mobility
status is a severe violation of patient privacy laws (HIPAA). A nurse
must never share clinical information with unauthorized individuals
before contacting the healthcare provider.
The nurse is caring for a newly diagnosed diabetic in diabetic hyperosmolar
hyperglycemic nonketotic (HHNK) state. What does the nurse anticipate the
immediate treatment plan for this client will include?
1. NPH insulin.
2. Potassium 40 mEq (40 mmol/L) slow intravenous push.
3. Intravenous administration of isotonic saline.
4. Intravenous sodium bicarbonate.
3
Why the Correct Option Is Right
• 3. Intravenous administration of isotonic saline.
o Pathophysiology: Hyperosmolar Hyperglycemic State (HHS/HHNK) is a
life-threatening endocrine emergency characterized by extreme
hyperglycemia (often over \(600\text{ mg/dL}\)), profound dehydration,
and high serum osmolality.
o The Immediate Priority: Because there is no significant ketoacidosis,
the most immediate threat to the client's life is severe, hypovolemic
shock due to profound osmotic diuresis (patients can lose up to 8 to 12
liters of fluid).
o First-Line Intervention: The absolute highest priority in the initial
management of HHNK is aggressive fluid resuscitation using
intravenous isotonic saline (\(0.9\%\) Normal Saline) to restore blood
volume, stabilize blood pressure, and maintain organ perfusion. Fluid
resuscitation alone will also help lower blood glucose levels by diluting
the blood and improving kidney filtration.
, Page 4 of 578
Why the Other Options Are Wrong
• ❌ 1. NPH insulin.
o NPH is an intermediate-acting insulin that is never used in the
emergency management of acute hyperglycemic crises. The medical
standard requires an intravenous infusion of Regular insulin (a short-
acting insulin), which allows for immediate action and precise, hourly
rate adjustments based on fingerstick tracking. Furthermore, insulin is
usually delayed slightly until fluid resuscitation is safely underway to
prevent a rapid drop in blood pressure.
• ❌ 2. Potassium 40 mEq (40 mmol/L) slow intravenous push.
o As established in previous clinical safety rules, potassium chloride
must never be administered via an IV push of any speed, as doing so
will cause immediate, fatal cardiac arrest. While potassium
replacement is crucial during insulin therapy (because insulin drives
potassium into the cells), it must always be safely diluted and infused
over several hours.
• ❌ 4. Intravenous sodium bicarbonate.
o Sodium bicarbonate is used to correct severe metabolic acidosis.
Because clients in an HHNK state produce enough baseline insulin to
prevent the breakdown of fats into ketones, they do not experience
severe ketoacidosis. Their pH is typically normal or only mildly low,
making bicarbonate completely unnecessary
What is most important for the nurse to do prior to initiating peritoneal
dialysis?
1. Aspirate for placement.
2. Have the client void.
3. Irrigate the catheter for patency.
4. Warm the dialysate fluid.
4
Why the Correct Option Is Right
• 4. Warm the dialysate fluid.
o Clinical Comfort and Safety: Instilling cold or room-temperature fluid
directly into the peritoneal cavity can cause severe abdominal
cramping, extreme discomfort, and vasoconstriction of the peritoneal
blood vessels.
o Enhanced Cleansing: Warming the dialysate fluid to body
temperature (\(37^{\circ }\text{C}\) or \(98.6^{\circ }\text{F}\)) promotes
local vasodilation. This increased blood flow significantly improves the
clearance of urea, creatinine, and other metabolic toxins across the
peritoneal membrane.
NCLEX HURST REVIEW READINESS EXAM WITH
CORRECT ANSWERS,RATIONALES AND WHY
THE OTHERS ARE NOT CORRECT NEWEST 2026
EXAM VERIFIED 100 %
The charge nurse is evaluating knowledge of tracheostomy suctioning of a
new nurse prior to that procedure being performed. Which statement by the
new nurse would indicate to the charge nurse that additional education is
needed?
1. "Prior to suctioning, I will hyper-oxygenate the client."
2. "I will instill normal saline bullets to liquefy secretions."
3. "I will allow at least 20 seconds between suctioning passes."
4. "Suctioning will be limited to a maximum of three catheter passes."
2
Why the Correct Option Is Right
• 2. "I will instill normal saline bullets to liquefy secretions."
o The Key Phrase: The question asks which statement shows that
additional education is needed (a negative-stem question).
o Clinical Danger: Routinely instilling normal saline drops or "bullets"
directly into a tracheostomy or endotracheal tube prior to suctioning is
no longer an approved clinical practice.
o The Consequences: Research shows that instilling saline does not
effectively liquefy deep secretions. Instead, it breaks up bacterial
biofilms and forces pathogens deeper into the lower respiratory tract,
significantly increasing the client's risk for Ventilator-Associated
Pneumonia (VAP) or tracheostomy infections. It also strips away
protective bronchial surfactant and causes a sudden, temporary drop in
the client's oxygen saturation levels. [1, 2]
Why the Other Options Are Correct Practices (Do Not Need
Correction)
, Page 2 of 578
• ❌ 1. "Prior to suctioning, I will hyper-oxygenate the client."
o This is excellent, standard nursing practice. Tracheal suctioning
removes both secretions and vital air from the lungs, which drops
oxygen levels. Providing 100% oxygen before starting protects the
patient from sudden hypoxemia and cardiac arrhythmias. [1, 2]
• ❌ 3. "I will allow at least 20 seconds between suctioning passes."
o This is a correct practice. Pausing for at least 20 to 30 seconds
between each catheter pass gives the client time to breathe, re-
oxygenate their blood, and recover from the stress of the procedure. [1,
2]
• ❌ 4. "Suctioning will be limited to a maximum of three catheter
passes."
o This is a correct practice. Limiting the entire suctioning session to a
maximum of 3 passes minimizes trauma to the sensitive tracheal
mucosa and prevents severe oxygen depletion
The nurse observes a client at a follow-up appointment using correct cane
walking technique but losing balance each time the quad cane is lifted off of
the floor. The client reports a history of recent falls. What is the best action for
the nurse to take?
1. Inform the primary healthcare provider of the observations made regarding
quad cane use, and imbalance assessment.
2. Inform client that there are only a few assistive devices available to help
with ambulation.
3. Instruct the client on proper quad cane use.
4. Notify the primary healthcare provider after consulting with the neighbor.
1
Why the Correct Option Is Right
• 1. Inform the primary healthcare provider of the observations made
regarding quad cane use, and imbalance assessment.
o Clinical Real-World Assessment: The nurse assesses that the client is
already using the correct cane technique, yet they are still losing their
balance and have a dangerous history of recent falls. This indicates
that a quad cane is no longer providing enough physical stability to
keep the client safe.
o Advocacy and Safety: The nurse's immediate priority is to
communicate these specific clinical findings to the primary healthcare
provider (HCP). This reporting prompts a necessary medical referral for
a physical therapy evaluation or an upgraded mobility device (such as
a rolling walker) to prevent a catastrophic fall injury.
Why the Other Options Are Wrong
, Page 3 of 578
• ❌ 2. Inform client that there are only a few assistive devices available
to help with ambulation.
o This statement is factually inaccurate and unhelpful. There is a wide
array of mobility and assistive equipment available—ranging from
single-point canes and hemi-walkers to standard walkers, rolling
walkers, and specialized wheelchairs—tailored to meet a client's
evolving physical needs.
• ❌ 3. Instruct the client on proper quad cane use.
o The question explicitly states that the nurse observed the client using
the correct cane walking technique. Re-teaching a skill that the client
has already mastered will not fix their underlying balance deficit or
solve the immediate safety hazard.
• ❌ 4. Notify the primary healthcare provider after consulting with the
neighbor.
o Consulting a neighbor regarding a client’s medical care or mobility
status is a severe violation of patient privacy laws (HIPAA). A nurse
must never share clinical information with unauthorized individuals
before contacting the healthcare provider.
The nurse is caring for a newly diagnosed diabetic in diabetic hyperosmolar
hyperglycemic nonketotic (HHNK) state. What does the nurse anticipate the
immediate treatment plan for this client will include?
1. NPH insulin.
2. Potassium 40 mEq (40 mmol/L) slow intravenous push.
3. Intravenous administration of isotonic saline.
4. Intravenous sodium bicarbonate.
3
Why the Correct Option Is Right
• 3. Intravenous administration of isotonic saline.
o Pathophysiology: Hyperosmolar Hyperglycemic State (HHS/HHNK) is a
life-threatening endocrine emergency characterized by extreme
hyperglycemia (often over \(600\text{ mg/dL}\)), profound dehydration,
and high serum osmolality.
o The Immediate Priority: Because there is no significant ketoacidosis,
the most immediate threat to the client's life is severe, hypovolemic
shock due to profound osmotic diuresis (patients can lose up to 8 to 12
liters of fluid).
o First-Line Intervention: The absolute highest priority in the initial
management of HHNK is aggressive fluid resuscitation using
intravenous isotonic saline (\(0.9\%\) Normal Saline) to restore blood
volume, stabilize blood pressure, and maintain organ perfusion. Fluid
resuscitation alone will also help lower blood glucose levels by diluting
the blood and improving kidney filtration.
, Page 4 of 578
Why the Other Options Are Wrong
• ❌ 1. NPH insulin.
o NPH is an intermediate-acting insulin that is never used in the
emergency management of acute hyperglycemic crises. The medical
standard requires an intravenous infusion of Regular insulin (a short-
acting insulin), which allows for immediate action and precise, hourly
rate adjustments based on fingerstick tracking. Furthermore, insulin is
usually delayed slightly until fluid resuscitation is safely underway to
prevent a rapid drop in blood pressure.
• ❌ 2. Potassium 40 mEq (40 mmol/L) slow intravenous push.
o As established in previous clinical safety rules, potassium chloride
must never be administered via an IV push of any speed, as doing so
will cause immediate, fatal cardiac arrest. While potassium
replacement is crucial during insulin therapy (because insulin drives
potassium into the cells), it must always be safely diluted and infused
over several hours.
• ❌ 4. Intravenous sodium bicarbonate.
o Sodium bicarbonate is used to correct severe metabolic acidosis.
Because clients in an HHNK state produce enough baseline insulin to
prevent the breakdown of fats into ketones, they do not experience
severe ketoacidosis. Their pH is typically normal or only mildly low,
making bicarbonate completely unnecessary
What is most important for the nurse to do prior to initiating peritoneal
dialysis?
1. Aspirate for placement.
2. Have the client void.
3. Irrigate the catheter for patency.
4. Warm the dialysate fluid.
4
Why the Correct Option Is Right
• 4. Warm the dialysate fluid.
o Clinical Comfort and Safety: Instilling cold or room-temperature fluid
directly into the peritoneal cavity can cause severe abdominal
cramping, extreme discomfort, and vasoconstriction of the peritoneal
blood vessels.
o Enhanced Cleansing: Warming the dialysate fluid to body
temperature (\(37^{\circ }\text{C}\) or \(98.6^{\circ }\text{F}\)) promotes
local vasodilation. This increased blood flow significantly improves the
clearance of urea, creatinine, and other metabolic toxins across the
peritoneal membrane.
