NCLEX-RN NGN PRACTICE EXAM– QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES
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1. A nurse in an emergency department is assessing a client who sustained severe burn
injuries in a house fire 2 hours ago. Which of the following fluid and electrolyte shifts
should the nurse anticipate during the emergent phase of the burn injury?
A. Movement of potassium from the intracellular space to the intravascular space
B. Shift of sodium and water into the intravascular space
C. Movement of plasma proteins and fluid from the intravascular space to the interstitial space
D. Total body dehydration accompanied by intracellular fluid volume overload
ANSWER: C. Movement of plasma proteins and fluid from the intravascular space to the
interstitial space
During the emergent phase of a major burn, increased capillary permeability allows plasma
proteins, water, and electrolytes to leak rapidly from the intravascular space into the
interstitial tissues, resulting in widespread edema, hypovolemia, and burn shock. Option A is
incorrect because potassium shifts extracellularly due to massive cell destruction, but option C
describes the primary fluid volume shift driving hypovolemia. Option B is incorrect because
sodium and water shift out of the vascular space. Option D is incorrect because intracellular
fluid volume typically decreases or shifts as cells lyse and water follows osmotic gradients.
2. A nurse is assessing a client who has acute glomerulonephritis following a streptococcal
infection. Which of the following findings should the nurse expect?
A. Polyuria with pale, dilute urine output
B. Cola-colored urine with hematuria and proteinuria
C. Hypotension with bounding peripheral pulses
D. Elevated serum albumin and total protein levels
ANSWER: B. Cola-colored urine with hematuria and proteinuria
Glomerular inflammation leads to altered capillary permeability, allowing red blood cells and
protein to pass into the filtrate, causing classic hematuria (often presenting as smoky, brown,
or cola-colored urine) and proteinuria. Option A is incorrect because oliguria is typical due to
decreased glomerular filtration rate. Option C is incorrect because hypertension is common
due to fluid retention. Option D is incorrect because serum albumin is often normal or
decreased due to urinary protein loss.
3. A nurse is providing discharge teaching to a client who has a prescription for sublingual
nitroglycerin tablets. Which of the following instructions should the nurse include?
, A. "Swallow the tablet whole with a full glass of water immediately upon feeling chest
discomfort."
B. "Keep the tablets in a plastic pillbox in your pocket for convenient daily access."
C. "Take one tablet at the onset of chest pain and repeat every 5 minutes for up to three doses if
pain persists."
D. "If you experience a mild headache after taking the medication, discontinue use
permanently."
ANSWER: C. "Take one tablet at the onset of chest pain and repeat every 5 minutes for up
to three doses if pain persists."
Sublingual nitroglycerin should be taken at the first sign of ischemic chest pain. The client
may take one tablet every 5 minutes for up to three doses, seeking emergency medical care if
pain is unimproved or worsening after the first dose. Option A is incorrect because the
medication must dissolve sublingually, not be swallowed. Option B is incorrect because tablets
degrade when exposed to light, heat, and moisture and must be kept in their original dark
glass container. Option D is incorrect because headache is a common expected side effect
caused by vasodilation.
4. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) and notes
that the current bag is nearly empty, but the next bag has not yet arrived from the
pharmacy. Which of the following actions should the nurse take?
A. Infuse 5% Dextrose in Water at the prescribed TPN rate until the new bag arrives.
B. Infuse 10% Dextrose in Water at the prescribed TPN rate until the new bag arrives.
C. Discontinue the intravenous line and flush the site with heparin.
D. Reduce the IV infusion rate by half to conserve the remaining volume.
ANSWER: B. Infuse 10% Dextrose in Water at the prescribed TPN rate until the new bag
arrives.
Abrupt cessation of TPN puts the client at high risk for severe rebound hypoglycemia because
the pancreas continues to secrete high levels of insulin. Infusing 10% or 20% Dextrose in
Water at the exact same rate as the TPN prevents this drop until the new solution is available.
Option A is incorrect because 5% dextrose does not provide enough concentrated glucose to
match high-concentration TPN formulas and prevent hypoglycemia. Option C is incorrect
because stopping the line abruptly accelerates hypoglycemia risk. Option D is incorrect
because slowing the infusion rate does not prevent abrupt discontinuation effects when the
bag empties.
5. A nurse is assessing a client who has Parkinson's disease. Which of the following findings
should the nurse expect?
A. Spastic paralysis and hyperactive deep tendon reflexes
B. Resting tremor, bradykinesia, and muscular rigidity
C. Intention tremor and profound muscle wasting
,D. Flaccid muscle tone and absent reflexes
ANSWER: B. Resting tremor, bradykinesia, and muscular rigidity
Parkinson's disease is characterized by classic motor symptoms resulting from dopamine
depletion in the basal ganglia, including a resting pill-rolling tremor, muscle rigidity,
bradykinesia (slow movement), and postural instability. Option A is incorrect because upper
motor neuron lesions cause spastic paralysis, whereas Parkinson's affects extrapyramidal
pathways. Option C is incorrect because intention tremors are associated with cerebellar
disease, not Parkinson's. Option D is incorrect because muscle tone is rigid rather than
flaccid.
6. A nurse is planning care for a client who has a diagnosis of schizophrenia and exhibits
negative symptoms. Which of the following manifestations should the nurse expect?
A. Auditory hallucinations and paranoid delusions
B. Bizarre motor behavior and psychomotor agitation
C. Flat affect, apathy, and social withdrawal
D. Rapid speech and flight of ideas
ANSWER: C. Flat affect, apathy, and social withdrawal
Negative symptoms of schizophrenia reflect a deficit or loss of normal function, including flat
affect, avolition (apathy), alogia (poverty of speech), and asociality. Option A and option B
describe positive symptoms, which reflect an excess or distortion of normal functions such as
hallucinations and delusions. Option D describes manic speech patterns associated with
bipolar disorder.
7. A nurse is reviewing laboratory results for a client who is receiving warfarin therapy.
Which of the following International Normalized Ratio (INR) values indicates the
therapeutic target range for a client with a mechanical heart valve?
A. 1.0 to 1.5
B. 2.0 to 3.0
C. 2.5 to 3.5
D. 4.0 to 5.0
ANSWER: C. 2.5 to 3.5
While a standard therapeutic INR range for conditions like deep vein thrombosis or
pulmonary embolism is 2.0 to 3.0, clients with high-risk conditions such as mechanical heart
valves require a higher therapeutic target range of 2.5 to 3.5 to prevent thromboembolism.
Option A is incorrect because it represents normal unmedicated clotting times. Option B is
incorrect because it is the standard range for standard thrombotic prophylaxis. Option D is
incorrect because an INR of 4.0 to 5.0 places the client at an unacceptably high risk for
spontaneous hemorrhage.
, 8. A nurse is caring for a client who is experiencing a postpartum hemorrhage due to
uterine atony. Which of the following medications should the nurse expect the provider to
prescribe first?
A. Oxytocin
B. Methylergonovine
C. Carboprost
D. Terbutaline
ANSWER: A. Oxytocin
Oxytocin is the first-line uterotonic medication used to stimulate uterine contractions and
control postpartum hemorrhage caused by uterine atony. Option B and option C are second-
line uterotonic agents used if oxytocin is ineffective, but they carry more severe side effects
like hypertension or bronchospasm. Option D is incorrect because terbutaline is a tocolytic
that relaxes uterine smooth muscle and would worsen hemorrhage.
9. A nurse is assessing a client who has an indwelling urinary catheter and notes that no
urine has drained into the collection bag for the past 2 hours. Which of the following
actions should the nurse take first?
A. Irrigate the catheter with sterile normal saline.
B. Check the tubing for kinks, loops, or external compression.
C. Deflate the balloon and remove the catheter immediately.
D. Notify the provider to obtain a prescription for a diuretic.
ANSWER: B. Check the tubing for kinks, loops, or external compression.
Using the nursing process and problem-solving framework, the nurse should first assess the
physical equipment for mechanical obstructions, such as kinks or dependent loops, before
attempting invasive interventions or notifying the provider. Option A is incorrect because
mechanical obstructions should be ruled out before performing invasive irrigation. Option C
is incorrect because removing the catheter is unwarranted without assessing the system first.
Option D is incorrect because lack of drainage is typically mechanical rather than renal
failure requiring diuretics.
10. A nurse is caring for a client who has chronic kidney disease and a serum potassium
level of 6.8 mEq/L. Which of the following electrocardiogram (ECG) changes should the
nurse expect to observe?
A. Flattened T waves and prominent U waves
B. Tall, peaked T waves and widened QRS complexes
C. Prolonged PR intervals with normal QRS complexes
D. Inverted P waves with shortened QT intervals
ANSWER: B. Tall, peaked T waves and widened QRS complexes
| VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES
| GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A nurse in an emergency department is assessing a client who sustained severe burn
injuries in a house fire 2 hours ago. Which of the following fluid and electrolyte shifts
should the nurse anticipate during the emergent phase of the burn injury?
A. Movement of potassium from the intracellular space to the intravascular space
B. Shift of sodium and water into the intravascular space
C. Movement of plasma proteins and fluid from the intravascular space to the interstitial space
D. Total body dehydration accompanied by intracellular fluid volume overload
ANSWER: C. Movement of plasma proteins and fluid from the intravascular space to the
interstitial space
During the emergent phase of a major burn, increased capillary permeability allows plasma
proteins, water, and electrolytes to leak rapidly from the intravascular space into the
interstitial tissues, resulting in widespread edema, hypovolemia, and burn shock. Option A is
incorrect because potassium shifts extracellularly due to massive cell destruction, but option C
describes the primary fluid volume shift driving hypovolemia. Option B is incorrect because
sodium and water shift out of the vascular space. Option D is incorrect because intracellular
fluid volume typically decreases or shifts as cells lyse and water follows osmotic gradients.
2. A nurse is assessing a client who has acute glomerulonephritis following a streptococcal
infection. Which of the following findings should the nurse expect?
A. Polyuria with pale, dilute urine output
B. Cola-colored urine with hematuria and proteinuria
C. Hypotension with bounding peripheral pulses
D. Elevated serum albumin and total protein levels
ANSWER: B. Cola-colored urine with hematuria and proteinuria
Glomerular inflammation leads to altered capillary permeability, allowing red blood cells and
protein to pass into the filtrate, causing classic hematuria (often presenting as smoky, brown,
or cola-colored urine) and proteinuria. Option A is incorrect because oliguria is typical due to
decreased glomerular filtration rate. Option C is incorrect because hypertension is common
due to fluid retention. Option D is incorrect because serum albumin is often normal or
decreased due to urinary protein loss.
3. A nurse is providing discharge teaching to a client who has a prescription for sublingual
nitroglycerin tablets. Which of the following instructions should the nurse include?
, A. "Swallow the tablet whole with a full glass of water immediately upon feeling chest
discomfort."
B. "Keep the tablets in a plastic pillbox in your pocket for convenient daily access."
C. "Take one tablet at the onset of chest pain and repeat every 5 minutes for up to three doses if
pain persists."
D. "If you experience a mild headache after taking the medication, discontinue use
permanently."
ANSWER: C. "Take one tablet at the onset of chest pain and repeat every 5 minutes for up
to three doses if pain persists."
Sublingual nitroglycerin should be taken at the first sign of ischemic chest pain. The client
may take one tablet every 5 minutes for up to three doses, seeking emergency medical care if
pain is unimproved or worsening after the first dose. Option A is incorrect because the
medication must dissolve sublingually, not be swallowed. Option B is incorrect because tablets
degrade when exposed to light, heat, and moisture and must be kept in their original dark
glass container. Option D is incorrect because headache is a common expected side effect
caused by vasodilation.
4. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) and notes
that the current bag is nearly empty, but the next bag has not yet arrived from the
pharmacy. Which of the following actions should the nurse take?
A. Infuse 5% Dextrose in Water at the prescribed TPN rate until the new bag arrives.
B. Infuse 10% Dextrose in Water at the prescribed TPN rate until the new bag arrives.
C. Discontinue the intravenous line and flush the site with heparin.
D. Reduce the IV infusion rate by half to conserve the remaining volume.
ANSWER: B. Infuse 10% Dextrose in Water at the prescribed TPN rate until the new bag
arrives.
Abrupt cessation of TPN puts the client at high risk for severe rebound hypoglycemia because
the pancreas continues to secrete high levels of insulin. Infusing 10% or 20% Dextrose in
Water at the exact same rate as the TPN prevents this drop until the new solution is available.
Option A is incorrect because 5% dextrose does not provide enough concentrated glucose to
match high-concentration TPN formulas and prevent hypoglycemia. Option C is incorrect
because stopping the line abruptly accelerates hypoglycemia risk. Option D is incorrect
because slowing the infusion rate does not prevent abrupt discontinuation effects when the
bag empties.
5. A nurse is assessing a client who has Parkinson's disease. Which of the following findings
should the nurse expect?
A. Spastic paralysis and hyperactive deep tendon reflexes
B. Resting tremor, bradykinesia, and muscular rigidity
C. Intention tremor and profound muscle wasting
,D. Flaccid muscle tone and absent reflexes
ANSWER: B. Resting tremor, bradykinesia, and muscular rigidity
Parkinson's disease is characterized by classic motor symptoms resulting from dopamine
depletion in the basal ganglia, including a resting pill-rolling tremor, muscle rigidity,
bradykinesia (slow movement), and postural instability. Option A is incorrect because upper
motor neuron lesions cause spastic paralysis, whereas Parkinson's affects extrapyramidal
pathways. Option C is incorrect because intention tremors are associated with cerebellar
disease, not Parkinson's. Option D is incorrect because muscle tone is rigid rather than
flaccid.
6. A nurse is planning care for a client who has a diagnosis of schizophrenia and exhibits
negative symptoms. Which of the following manifestations should the nurse expect?
A. Auditory hallucinations and paranoid delusions
B. Bizarre motor behavior and psychomotor agitation
C. Flat affect, apathy, and social withdrawal
D. Rapid speech and flight of ideas
ANSWER: C. Flat affect, apathy, and social withdrawal
Negative symptoms of schizophrenia reflect a deficit or loss of normal function, including flat
affect, avolition (apathy), alogia (poverty of speech), and asociality. Option A and option B
describe positive symptoms, which reflect an excess or distortion of normal functions such as
hallucinations and delusions. Option D describes manic speech patterns associated with
bipolar disorder.
7. A nurse is reviewing laboratory results for a client who is receiving warfarin therapy.
Which of the following International Normalized Ratio (INR) values indicates the
therapeutic target range for a client with a mechanical heart valve?
A. 1.0 to 1.5
B. 2.0 to 3.0
C. 2.5 to 3.5
D. 4.0 to 5.0
ANSWER: C. 2.5 to 3.5
While a standard therapeutic INR range for conditions like deep vein thrombosis or
pulmonary embolism is 2.0 to 3.0, clients with high-risk conditions such as mechanical heart
valves require a higher therapeutic target range of 2.5 to 3.5 to prevent thromboembolism.
Option A is incorrect because it represents normal unmedicated clotting times. Option B is
incorrect because it is the standard range for standard thrombotic prophylaxis. Option D is
incorrect because an INR of 4.0 to 5.0 places the client at an unacceptably high risk for
spontaneous hemorrhage.
, 8. A nurse is caring for a client who is experiencing a postpartum hemorrhage due to
uterine atony. Which of the following medications should the nurse expect the provider to
prescribe first?
A. Oxytocin
B. Methylergonovine
C. Carboprost
D. Terbutaline
ANSWER: A. Oxytocin
Oxytocin is the first-line uterotonic medication used to stimulate uterine contractions and
control postpartum hemorrhage caused by uterine atony. Option B and option C are second-
line uterotonic agents used if oxytocin is ineffective, but they carry more severe side effects
like hypertension or bronchospasm. Option D is incorrect because terbutaline is a tocolytic
that relaxes uterine smooth muscle and would worsen hemorrhage.
9. A nurse is assessing a client who has an indwelling urinary catheter and notes that no
urine has drained into the collection bag for the past 2 hours. Which of the following
actions should the nurse take first?
A. Irrigate the catheter with sterile normal saline.
B. Check the tubing for kinks, loops, or external compression.
C. Deflate the balloon and remove the catheter immediately.
D. Notify the provider to obtain a prescription for a diuretic.
ANSWER: B. Check the tubing for kinks, loops, or external compression.
Using the nursing process and problem-solving framework, the nurse should first assess the
physical equipment for mechanical obstructions, such as kinks or dependent loops, before
attempting invasive interventions or notifying the provider. Option A is incorrect because
mechanical obstructions should be ruled out before performing invasive irrigation. Option C
is incorrect because removing the catheter is unwarranted without assessing the system first.
Option D is incorrect because lack of drainage is typically mechanical rather than renal
failure requiring diuretics.
10. A nurse is caring for a client who has chronic kidney disease and a serum potassium
level of 6.8 mEq/L. Which of the following electrocardiogram (ECG) changes should the
nurse expect to observe?
A. Flattened T waves and prominent U waves
B. Tall, peaked T waves and widened QRS complexes
C. Prolonged PR intervals with normal QRS complexes
D. Inverted P waves with shortened QT intervals
ANSWER: B. Tall, peaked T waves and widened QRS complexes
