NCLEX RN PRACTICE
QUESTIONS
Question 1: A nurse is preparing to administer an intravenous infusion of potassium chloride to a client with severe hypokalemia. Which of the following actions is the priority?
Choices:
1) Verify that the infusion rate does not exceed 10 mEq/hour.2) Assess the client's deep tendon re�exes.3) Monitor the client's urine output to ensure it is at least 30 mL/hour.4) Obtain a baseline electrocardiogram (ECG).
Correct Answer: Verify that the infusion rate does not exceed 10 mEq/hour.
Explanation: Potassium chloride must never be administered rapidly due to the risk of cardiac arrest. The priority safety action is to ensure it is infused via an infusion pump at a rate not exceeding 10 mEq/hr (or up to 20 mEq/hr in central lines with continuous ECG monitoring).Monitoring urine output and ECG are important but ensuring the safe rate of administration directly prevents immediate lethal dysrhythmias.Question 2: A nurse is caring for a client who is 12 hours postoperative following a total thyroidectomy. The nurse notes that the client has developed muscle spasms, Page 1
tingling in the �ngertips, and a positive Chvostek's sign. Which medication should the nurse anticipate administering?
Choices:
1) Sodium bicarbonate 2) Calcium gluconate 3) Potassium chloride 4) Magnesium sulfate
Correct Answer: Calcium gluconate
Explanation: Damage or accidental removal of the parathyroid glands during a thyroidectomy can lead to acute hypocalcemia. Symptoms include tetany, tingling, and a positive Chvostek's sign (facial twitching). Intravenous calcium gluconate is the standard treatment to reverse acute hypocalcemia and prevent seizures or laryngospasm.Question 3: A nurse in the emergency department is assessing a client brought in with suspected diabetic ketoacidosis (DKA). Which clinical manifestation would support this diagnosis?
Choices:
1) Cheyne-Stokes respirations and blood glucose 250 mg/dL 2) Kussmaul respirations and fruity breath odor 3) Slow, shallow breathing and profound bradycardia 4) High blood pressure and moist, clammy skin
Correct Answer: Kussmaul respirations and fruity breath odor
Explanation: DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis. The respiratory system attempts to compensate for metabolic acidosis by blowing o� carbon dioxide via rapid, deep respirations known as Kussmaul respirations. Acetone production causes a characteristic fruity breath odor.Page 2
Question 4: A nurse is caring for a client on the medical-surgical unit who is receiving a blood transfusion. Within 15 minutes of the start of the infusion, the client develops chills, lower back pain, and a fever. Which action should the nurse take �rst?
Choices:
1) Notify the health care provider and the blood bank.2) Slow down the infusion rate and reassess vital signs.3) Stop the transfusion immediately and disconnect the tubing.4) Administer an antipyretic as prescribed.
Correct Answer: Stop the transfusion immediately and disconnect the tubing.
Explanation: The client is exhibiting signs of an acute hemolytic transfusion reaction (chills, low back pain, fever). The immediate priority action is to stop the transfusion to prevent further exposure to the incompatible blood, disconnect the blood administration set, and maintain intravenous access with normal saline using new tubing.Question 5: A charge nurse is making assignments for the upcoming shift. Which of the following clients should be assigned to an experienced Licensed Practical Nurse
(LPN/LVN)?
Choices:
1) A client who was admitted 2 hours ago with an unstable compound fracture of the femur.2) A client with chronic obstructive pulmonary disease (COPD) who requires scheduled scheduled bronchodilator inhalers.3) A client who is 1 day postoperative following a coronary artery bypass graft (CABG) with a chest tube.4) A client newly diagnosed with type 1 diabetes who requires comprehensive discharge education.Correct Answer: A client with chronic obstructive pulmonary disease (COPD) who requires scheduled scheduled bronchodilator inhalers.Page 3