UWorld Self-Assessment Exam Questions
Comprehensive NCLEX-RN Practice Review & High-Yield Rationales
Subject: Nursing Practice & Clinical Judgement Total Questions: 14 Format: High-Yield Q&A with Explanations
Question 1 PEDIATRIC RESUSCITATION
The nurse witnesses the collapse of a child while outdoors. The child is not breathing and has a pulse of 50/
min. The nurse calls emergency services and initiates rescue breathing. After 2 minutes of rescue breaths,
the child is still not breathing and is pale with a pulse of 30/min. What is the nurse's next action?
1. Initiate chest compressions
2. Perform abdominal thrusts
3. Provide rescue breaths for an additional 2 minutes
4. Use a finger to check the child's mouth for blockage
CORRECT ANSWER
Option 1: Initiate chest compressions
EXPLANATION & RATIONALE
Rescue breathing is performed at a rate of 1 breath every 2–3 seconds. If the pulse remains ≤ 60/min and there are
signs of poor perfusion (e.g., skin pallor, mottling, cyanosis), the nurse should initiate chest compressions immediately
and reassess the pulse every 2 minutes.
NCLEX Practice Series | Comprehensive Exam Prep Page 1 of 8
, Question 2 CHEST TUBE MANAGEMENT
The nurse is assisting the client with repositioning in bed when the chest tube becomes dislodged from the
client's chest. Which action should the nurse perform first?
1. Administer supplemental oxygen
2. Call the rapid response team
3. Cover the insertion site with the palm of a gloved hand
4. Measure the client's SpO2 with pulse oximetry
CORRECT ANSWER
Option 3: Cover insertion site with the palm of a gloved hand
EXPLANATION & RATIONALE
If a chest tube is accidentally dislodged from the client's chest, the priority is to cover the insertion site immediately to
prevent atmospheric air from entering the pleural space. Ideally, a dry, sterile gauze dressing is placed over the site and
taped on three sides; this allows intrapleural air to escape and prevents development of a tension pneumothorax.
However, if sterile gauze is not immediately accessible, the priority is placing the palm of a clean, gloved hand firmly over
the site until a dressing can be obtained.
Question 3 RENAL & DIETARY MANAGEMENT
The nurse helps a client with end-stage renal disease and a serum potassium level of 5.2 mEq/L (5.2 mmol/L)
to plan menu choices. Which items would be best to include in the meal plan?
1. Black beans and rice, sliced tomatoes, half a cantaloupe
2. Grilled chicken sandwich on white bread, applesauce
3. Hamburger patty on whole wheat bun, carrot sticks, chocolate pudding
4. Poached salmon, green peas, baked potato, strawberries
CORRECT ANSWER
Option 2: Grilled chicken sandwich on white bread, applesauce
EXPLANATION & RATIONALE
Clients with end-stage renal disease (ESRD) and hyperkalemia (K+ > 5.0 mEq/L) require a low-potassium, low-
phosphorus, and low-sodium diet. Applesauce and white bread are low in potassium. Options 1, 3, and 4 contain high-
potassium foods such as cantaloupe, tomatoes, beans, chocolate, baked potatoes, and strawberries.
NCLEX Practice Series | Comprehensive Exam Prep Page 2 of 8
, Question 4 TRIAGE & PRIORITIZATION
A nurse receives change-of-shift report on four clients. Which client should the nurse assess first?
1. Client who experienced a transient ischemic attack 2 days ago and is due to receive aspirin
2. Client who had a subdural hemorrhage 36 hours ago and is requesting a breakfast tray
3. Client with a bowel resection receiving total parenteral nutrition who had 4800 mL of urine output over the
past 12 hours
4. Client with a stroke receiving t-PA whose Glasgow Coma Scale score changed from 9 to 13
CORRECT ANSWER
Option 3: Client with a bowel resection receiving TPN who had 4800 mL of urine output over past 12 hours
EXPLANATION & RATIONALE
Total parenteral nutrition (TPN) contains concentrated dextrose; therefore, the nurse must monitor for hyperglycemia and
hyperosmolar hyper-glycemic state (HHS). A massive urine output of 4800 mL over 12 hours (400 mL/hr) indicates
severe osmotic diuresis secondary to severe hyperglycemia. This client requires immediate assessment and intervention
to prevent severe dehydration, electrolyte collapse, seizures, coma, or death.
Question 5 MATERNAL - PREECLAMPSIA SATA
A client is at 28 weeks gestation with suspected preeclampsia. Which of the following signs/symptoms
indicate that the client has developed this syndrome? Select all that apply.
1. Anemia
✓ 2. Epigastric pain
3. Frequent urination
✓ 4. Headache and blurry vision
✓ 5. Proteinuria
CORRECT ANSWER
Options 2, 4, 5
EXPLANATION & RATIONALE
Preeclampsia is characterized by new-onset hypertension (SBP ≥ 140 or DBP ≥ 90 mm Hg) after 20 weeks gestation
accompanied by proteinuria or organ dysfunction. Epigastric or right upper quadrant (RUQ) pain indicates liver
involvement/hepatic swelling (HELLP syndrome risk). Headaches and visual changes reflect cerebral edema and CNS
irritability. Proteinuria demonstrates renal glomerular impairment.
NCLEX Practice Series | Comprehensive Exam Prep Page 3 of 8
, Question 6 PHARMACOLOGY & PHARMACOLOGY
INTERACTIONS
The nurse is performing a medication reconciliation during a clinic visit with a client recently prescribed
lithium. Which of the client's home medications is the priority to clarify with the health care provider?
1. Acetaminophen
2. Hydrochlorothiazide
3. Metformin
4. Sulfadiazine
CORRECT ANSWER
Option 2: Hydrochlorothiazide
EXPLANATION & RATIONALE
Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Thiazide diuretics (e.g., hydrochlorothiazide) decrease renal
clearance of sodium and lithium, leading to decreased lithium excretion and dramatically increased risk of severe lithium
toxicity. NSAIDs and ACE inhibitors also increase lithium toxicity risk.
Question 7 GASTROINTESTINAL / OSTOMY CARE
The nurse cares for a client with an established ascending colostomy. Which statement made by the client
indicates that further teaching is required?
1. "I always try to drink 3 liters of water each day."
2. "I avoid eating beans, onions, broccoli, and cauliflower."
3. "I change the appliance and bag every other day."
4. "I empty the bag when it is about one-third full."
CORRECT ANSWER
Option 3: "I change the appliance and bag every other day."
EXPLANATION & RATIONALE
An ostomy skin barrier/appliance system should typically be changed every 5–10 days unless leaking occurs. Removing
and changing the appliance too frequently causes skin stripping and severe peristomal skin irritation. Adequate hydration
(3 L/day), avoiding gas-forming foods, and emptying the pouch when 1/3 full are appropriate practices.
NCLEX Practice Series | Comprehensive Exam Prep Page 4 of 8
Comprehensive NCLEX-RN Practice Review & High-Yield Rationales
Subject: Nursing Practice & Clinical Judgement Total Questions: 14 Format: High-Yield Q&A with Explanations
Question 1 PEDIATRIC RESUSCITATION
The nurse witnesses the collapse of a child while outdoors. The child is not breathing and has a pulse of 50/
min. The nurse calls emergency services and initiates rescue breathing. After 2 minutes of rescue breaths,
the child is still not breathing and is pale with a pulse of 30/min. What is the nurse's next action?
1. Initiate chest compressions
2. Perform abdominal thrusts
3. Provide rescue breaths for an additional 2 minutes
4. Use a finger to check the child's mouth for blockage
CORRECT ANSWER
Option 1: Initiate chest compressions
EXPLANATION & RATIONALE
Rescue breathing is performed at a rate of 1 breath every 2–3 seconds. If the pulse remains ≤ 60/min and there are
signs of poor perfusion (e.g., skin pallor, mottling, cyanosis), the nurse should initiate chest compressions immediately
and reassess the pulse every 2 minutes.
NCLEX Practice Series | Comprehensive Exam Prep Page 1 of 8
, Question 2 CHEST TUBE MANAGEMENT
The nurse is assisting the client with repositioning in bed when the chest tube becomes dislodged from the
client's chest. Which action should the nurse perform first?
1. Administer supplemental oxygen
2. Call the rapid response team
3. Cover the insertion site with the palm of a gloved hand
4. Measure the client's SpO2 with pulse oximetry
CORRECT ANSWER
Option 3: Cover insertion site with the palm of a gloved hand
EXPLANATION & RATIONALE
If a chest tube is accidentally dislodged from the client's chest, the priority is to cover the insertion site immediately to
prevent atmospheric air from entering the pleural space. Ideally, a dry, sterile gauze dressing is placed over the site and
taped on three sides; this allows intrapleural air to escape and prevents development of a tension pneumothorax.
However, if sterile gauze is not immediately accessible, the priority is placing the palm of a clean, gloved hand firmly over
the site until a dressing can be obtained.
Question 3 RENAL & DIETARY MANAGEMENT
The nurse helps a client with end-stage renal disease and a serum potassium level of 5.2 mEq/L (5.2 mmol/L)
to plan menu choices. Which items would be best to include in the meal plan?
1. Black beans and rice, sliced tomatoes, half a cantaloupe
2. Grilled chicken sandwich on white bread, applesauce
3. Hamburger patty on whole wheat bun, carrot sticks, chocolate pudding
4. Poached salmon, green peas, baked potato, strawberries
CORRECT ANSWER
Option 2: Grilled chicken sandwich on white bread, applesauce
EXPLANATION & RATIONALE
Clients with end-stage renal disease (ESRD) and hyperkalemia (K+ > 5.0 mEq/L) require a low-potassium, low-
phosphorus, and low-sodium diet. Applesauce and white bread are low in potassium. Options 1, 3, and 4 contain high-
potassium foods such as cantaloupe, tomatoes, beans, chocolate, baked potatoes, and strawberries.
NCLEX Practice Series | Comprehensive Exam Prep Page 2 of 8
, Question 4 TRIAGE & PRIORITIZATION
A nurse receives change-of-shift report on four clients. Which client should the nurse assess first?
1. Client who experienced a transient ischemic attack 2 days ago and is due to receive aspirin
2. Client who had a subdural hemorrhage 36 hours ago and is requesting a breakfast tray
3. Client with a bowel resection receiving total parenteral nutrition who had 4800 mL of urine output over the
past 12 hours
4. Client with a stroke receiving t-PA whose Glasgow Coma Scale score changed from 9 to 13
CORRECT ANSWER
Option 3: Client with a bowel resection receiving TPN who had 4800 mL of urine output over past 12 hours
EXPLANATION & RATIONALE
Total parenteral nutrition (TPN) contains concentrated dextrose; therefore, the nurse must monitor for hyperglycemia and
hyperosmolar hyper-glycemic state (HHS). A massive urine output of 4800 mL over 12 hours (400 mL/hr) indicates
severe osmotic diuresis secondary to severe hyperglycemia. This client requires immediate assessment and intervention
to prevent severe dehydration, electrolyte collapse, seizures, coma, or death.
Question 5 MATERNAL - PREECLAMPSIA SATA
A client is at 28 weeks gestation with suspected preeclampsia. Which of the following signs/symptoms
indicate that the client has developed this syndrome? Select all that apply.
1. Anemia
✓ 2. Epigastric pain
3. Frequent urination
✓ 4. Headache and blurry vision
✓ 5. Proteinuria
CORRECT ANSWER
Options 2, 4, 5
EXPLANATION & RATIONALE
Preeclampsia is characterized by new-onset hypertension (SBP ≥ 140 or DBP ≥ 90 mm Hg) after 20 weeks gestation
accompanied by proteinuria or organ dysfunction. Epigastric or right upper quadrant (RUQ) pain indicates liver
involvement/hepatic swelling (HELLP syndrome risk). Headaches and visual changes reflect cerebral edema and CNS
irritability. Proteinuria demonstrates renal glomerular impairment.
NCLEX Practice Series | Comprehensive Exam Prep Page 3 of 8
, Question 6 PHARMACOLOGY & PHARMACOLOGY
INTERACTIONS
The nurse is performing a medication reconciliation during a clinic visit with a client recently prescribed
lithium. Which of the client's home medications is the priority to clarify with the health care provider?
1. Acetaminophen
2. Hydrochlorothiazide
3. Metformin
4. Sulfadiazine
CORRECT ANSWER
Option 2: Hydrochlorothiazide
EXPLANATION & RATIONALE
Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Thiazide diuretics (e.g., hydrochlorothiazide) decrease renal
clearance of sodium and lithium, leading to decreased lithium excretion and dramatically increased risk of severe lithium
toxicity. NSAIDs and ACE inhibitors also increase lithium toxicity risk.
Question 7 GASTROINTESTINAL / OSTOMY CARE
The nurse cares for a client with an established ascending colostomy. Which statement made by the client
indicates that further teaching is required?
1. "I always try to drink 3 liters of water each day."
2. "I avoid eating beans, onions, broccoli, and cauliflower."
3. "I change the appliance and bag every other day."
4. "I empty the bag when it is about one-third full."
CORRECT ANSWER
Option 3: "I change the appliance and bag every other day."
EXPLANATION & RATIONALE
An ostomy skin barrier/appliance system should typically be changed every 5–10 days unless leaking occurs. Removing
and changing the appliance too frequently causes skin stripping and severe peristomal skin irritation. Adequate hydration
(3 L/day), avoiding gas-forming foods, and emptying the pouch when 1/3 full are appropriate practices.
NCLEX Practice Series | Comprehensive Exam Prep Page 4 of 8
