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Kaplan RN Readiness Exit Exam | 180 NCLEX
Predictor Questions and Rationales
Kaplan RN Readiness Exit Exam — 180 Questions and Rationales
1. A client is admitted with a diagnosis of acute myocardial infarction. Which
serum laboratory value is the most specific indicator of myocardial cell death?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. Troponin I
D. Lactate dehydrogenase (LDH)
: Correct Answer : C
*Rationale: Troponin I and T are highly specific for myocardial necrosis and rise
within 3–6 hours of injury, remaining elevated for up to 10–14 days. CK-MB is also
specific but less sensitive; myoglobin is early but non-specific. LDH is late and non-
specific.*
2. A client is receiving a continuous heparin infusion. The aPTT is 90 seconds
(therapeutic range 60–80 seconds). What is the priority nursing action?
A. Increase the heparin infusion rate.
B. Continue the current rate.
C. Decrease the heparin infusion rate per protocol.
D. Administer protamine sulfate.
: Correct Answer : C
Rationale: An aPTT above the therapeutic range increases the risk of bleeding. The
rate should be decreased as per the facility’s heparin nomogram. Protamine is
reserved for severe bleeding or overdose. Increasing the rate would be dangerous.
3. The nurse is caring for a client with a chest tube to water-seal drainage.
Continuous bubbling is observed in the water-seal chamber. What should the
nurse do first?
A. Clamp the chest tube immediately.
B. Check the system for an air leak from the client to the drainage unit.
pg. 1
,2
C. Empty the collection chamber.
D. Document the finding as normal.
: Correct Answer : B
Rationale: Continuous bubbling indicates an air leak. The nurse should assess the
entire system—connections, tubing, and insertion site—to locate the leak.
Clamping the tube can cause a tension pneumothorax. Intermittent bubbling
during exhalation is normal; continuous is not.
4. A client with major depressive disorder has been taking fluoxetine for 10
days. The client reports no improvement and wants to stop the medication.
What is the best nursing response?
A. "You should stop the medication if it’s not working."
B. "I’ll ask the doctor to increase your dose immediately."
C. "It may take 4 to 6 weeks for the full therapeutic effect. It’s important to
continue taking it."
D. "You need a different medication."
: Correct Answer : C
Rationale: SSRIs like fluoxetine take 2–6 weeks to achieve full therapeutic effect.
Education about the expected timeline improves adherence. Dosage adjustments
or changes are made after an adequate trial. Stopping abruptly can cause
discontinuation syndrome.
5. A client is receiving total parenteral nutrition (TPN) via a central line. The TPN
solution runs out, and the new bag is not available. What should the nurse hang
immediately?
A. 0.9% sodium chloride
B. Lactated Ringer’s
C. 10% dextrose in water
D. Sterile water
: Correct Answer : C
Rationale: TPN contains a high concentration of glucose. If abruptly stopped, the
client can develop rebound hypoglycemia. Infusing 10% dextrose prevents this
until the new TPN is ready. Normal saline and lactated Ringer’s do not provide
sufficient glucose. Sterile water is hypotonic and unsafe.
pg. 2
,3
6. The nurse is caring for a client 24 hours after a total hip replacement. Which
finding requires the most immediate intervention?
A. Pain level of 5 on a 0–10 scale.
B. Temperature of 100.2°F (37.9°C).
C. Sudden onset of confusion and tachypnea.
D. Serosanguineous drainage on the dressing.
: Correct Answer : C
Rationale: Sudden confusion and tachypnea in a client with a long-bone fracture
or hip replacement suggest fat embolism syndrome, a life-threatening emergency.
Pain, mild fever, and drainage are expected findings. The nurse must assess
oxygenation and notify the provider immediately.
7. Which client should the charge nurse assign to the new graduate nurse who is
on orientation?
A. A client with a newly inserted chest tube.
B. A client with stable chronic obstructive pulmonary disease receiving scheduled
treatments.
C. A client with a new diagnosis of type 1 diabetes requiring education.
D. A client who returned from a cardiac catheterization 1 hour ago.
: Correct Answer : B
Rationale: A stable client with a chronic condition is appropriate for a new nurse.
Clients with chest tubes, new diagnoses requiring education, and post-cardiac
catheterization require more experienced nursing assessment and intervention.
The assignment must match the nurse’s skill level.
8. A client with cirrhosis develops esophageal varices and begins vomiting large
amounts of bright red blood. What is the priority nursing action?
A. Obtain vital signs.
B. Administer vitamin K.
C. Suction the oropharynx and maintain airway.
D. Insert a nasogastric tube.
: Correct Answer : C
Rationale: Airway protection is the highest priority in massive hematemesis due to
the risk of aspiration. After ensuring a patent airway, the nurse can obtain vital
pg. 3
, 4
signs and assist with further interventions. Nasogastric tube insertion may cause
trauma to varices and is generally avoided. Vitamin K is not the first action.
9. A client with type 1 diabetes has a blood glucose of 480 mg/dL, pH 7.10, and
positive urine ketones. What is the initial fluid of choice for resuscitation?
A. 0.45% NaCl
B. 0.9% NaCl
C. Lactated Ringer’s
D. D5 ½ NS with 20 mEq KCl
: Correct Answer : B
Rationale: In diabetic ketoacidosis (DKA), the initial fluid is isotonic 0.9% sodium
chloride to restore intravascular volume. After initial resuscitation, fluids may be
changed based on serum sodium. Insulin is started after fluids, and potassium is
added when urine output is established and K <5.2. Hypotonic fluids and lactated
Ringer’s are not initial choices.
10. A client with a history of asthma is receiving albuterol via nebulizer. The
nurse notes the heart rate has increased from 80 to 130 bpm. What should the
nurse do first?
A. Continue the treatment; tachycardia is expected.
B. Stop the treatment and notify the provider.
C. Administer a beta-blocker.
D. Reduce the dose of albuterol.
: Correct Answer : B
*Rationale: Although tachycardia is a known side effect, a significant increase (to
130 bpm) may indicate intolerance or toxicity. The treatment should be stopped
and the provider notified. Continuing could lead to serious arrhythmias. The nurse
cannot independently change the dose or administer a beta-blocker without an
order.*
11. A client with a new ileostomy asks about diet. Which statement indicates a
correct understanding?
A. "I will avoid all fiber in my diet permanently."
B. "I should chew my food well and avoid foods that can cause obstruction, like
nuts and popcorn."
pg. 4
Kaplan RN Readiness Exit Exam | 180 NCLEX
Predictor Questions and Rationales
Kaplan RN Readiness Exit Exam — 180 Questions and Rationales
1. A client is admitted with a diagnosis of acute myocardial infarction. Which
serum laboratory value is the most specific indicator of myocardial cell death?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. Troponin I
D. Lactate dehydrogenase (LDH)
: Correct Answer : C
*Rationale: Troponin I and T are highly specific for myocardial necrosis and rise
within 3–6 hours of injury, remaining elevated for up to 10–14 days. CK-MB is also
specific but less sensitive; myoglobin is early but non-specific. LDH is late and non-
specific.*
2. A client is receiving a continuous heparin infusion. The aPTT is 90 seconds
(therapeutic range 60–80 seconds). What is the priority nursing action?
A. Increase the heparin infusion rate.
B. Continue the current rate.
C. Decrease the heparin infusion rate per protocol.
D. Administer protamine sulfate.
: Correct Answer : C
Rationale: An aPTT above the therapeutic range increases the risk of bleeding. The
rate should be decreased as per the facility’s heparin nomogram. Protamine is
reserved for severe bleeding or overdose. Increasing the rate would be dangerous.
3. The nurse is caring for a client with a chest tube to water-seal drainage.
Continuous bubbling is observed in the water-seal chamber. What should the
nurse do first?
A. Clamp the chest tube immediately.
B. Check the system for an air leak from the client to the drainage unit.
pg. 1
,2
C. Empty the collection chamber.
D. Document the finding as normal.
: Correct Answer : B
Rationale: Continuous bubbling indicates an air leak. The nurse should assess the
entire system—connections, tubing, and insertion site—to locate the leak.
Clamping the tube can cause a tension pneumothorax. Intermittent bubbling
during exhalation is normal; continuous is not.
4. A client with major depressive disorder has been taking fluoxetine for 10
days. The client reports no improvement and wants to stop the medication.
What is the best nursing response?
A. "You should stop the medication if it’s not working."
B. "I’ll ask the doctor to increase your dose immediately."
C. "It may take 4 to 6 weeks for the full therapeutic effect. It’s important to
continue taking it."
D. "You need a different medication."
: Correct Answer : C
Rationale: SSRIs like fluoxetine take 2–6 weeks to achieve full therapeutic effect.
Education about the expected timeline improves adherence. Dosage adjustments
or changes are made after an adequate trial. Stopping abruptly can cause
discontinuation syndrome.
5. A client is receiving total parenteral nutrition (TPN) via a central line. The TPN
solution runs out, and the new bag is not available. What should the nurse hang
immediately?
A. 0.9% sodium chloride
B. Lactated Ringer’s
C. 10% dextrose in water
D. Sterile water
: Correct Answer : C
Rationale: TPN contains a high concentration of glucose. If abruptly stopped, the
client can develop rebound hypoglycemia. Infusing 10% dextrose prevents this
until the new TPN is ready. Normal saline and lactated Ringer’s do not provide
sufficient glucose. Sterile water is hypotonic and unsafe.
pg. 2
,3
6. The nurse is caring for a client 24 hours after a total hip replacement. Which
finding requires the most immediate intervention?
A. Pain level of 5 on a 0–10 scale.
B. Temperature of 100.2°F (37.9°C).
C. Sudden onset of confusion and tachypnea.
D. Serosanguineous drainage on the dressing.
: Correct Answer : C
Rationale: Sudden confusion and tachypnea in a client with a long-bone fracture
or hip replacement suggest fat embolism syndrome, a life-threatening emergency.
Pain, mild fever, and drainage are expected findings. The nurse must assess
oxygenation and notify the provider immediately.
7. Which client should the charge nurse assign to the new graduate nurse who is
on orientation?
A. A client with a newly inserted chest tube.
B. A client with stable chronic obstructive pulmonary disease receiving scheduled
treatments.
C. A client with a new diagnosis of type 1 diabetes requiring education.
D. A client who returned from a cardiac catheterization 1 hour ago.
: Correct Answer : B
Rationale: A stable client with a chronic condition is appropriate for a new nurse.
Clients with chest tubes, new diagnoses requiring education, and post-cardiac
catheterization require more experienced nursing assessment and intervention.
The assignment must match the nurse’s skill level.
8. A client with cirrhosis develops esophageal varices and begins vomiting large
amounts of bright red blood. What is the priority nursing action?
A. Obtain vital signs.
B. Administer vitamin K.
C. Suction the oropharynx and maintain airway.
D. Insert a nasogastric tube.
: Correct Answer : C
Rationale: Airway protection is the highest priority in massive hematemesis due to
the risk of aspiration. After ensuring a patent airway, the nurse can obtain vital
pg. 3
, 4
signs and assist with further interventions. Nasogastric tube insertion may cause
trauma to varices and is generally avoided. Vitamin K is not the first action.
9. A client with type 1 diabetes has a blood glucose of 480 mg/dL, pH 7.10, and
positive urine ketones. What is the initial fluid of choice for resuscitation?
A. 0.45% NaCl
B. 0.9% NaCl
C. Lactated Ringer’s
D. D5 ½ NS with 20 mEq KCl
: Correct Answer : B
Rationale: In diabetic ketoacidosis (DKA), the initial fluid is isotonic 0.9% sodium
chloride to restore intravascular volume. After initial resuscitation, fluids may be
changed based on serum sodium. Insulin is started after fluids, and potassium is
added when urine output is established and K <5.2. Hypotonic fluids and lactated
Ringer’s are not initial choices.
10. A client with a history of asthma is receiving albuterol via nebulizer. The
nurse notes the heart rate has increased from 80 to 130 bpm. What should the
nurse do first?
A. Continue the treatment; tachycardia is expected.
B. Stop the treatment and notify the provider.
C. Administer a beta-blocker.
D. Reduce the dose of albuterol.
: Correct Answer : B
*Rationale: Although tachycardia is a known side effect, a significant increase (to
130 bpm) may indicate intolerance or toxicity. The treatment should be stopped
and the provider notified. Continuing could lead to serious arrhythmias. The nurse
cannot independently change the dose or administer a beta-blocker without an
order.*
11. A client with a new ileostomy asks about diet. Which statement indicates a
correct understanding?
A. "I will avoid all fiber in my diet permanently."
B. "I should chew my food well and avoid foods that can cause obstruction, like
nuts and popcorn."
pg. 4
