NCLEX Comprehensive Nursing Review

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Sample questions from NCLEX Comprehensive Nursing Review

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.The nurse receives reports on four clients. Which client should be assessed first?

   • A.A. A client with chronic heart failure and unchanged bilateral ankle edema
   • B.B. A client 1 hour after thyroid surgery who has new stridor
   • C.C. A client with diabetes whose glucose is 182 mg/dL before lunch
   • D.D. A client awaiting discharge who requests medication teaching

   Rationale: B is correct because new stridor suggests an upper airway emergency after neck surgery. A requires ongoing fluid assessment but has no reported acute change. C requires management according to the treatment plan but is not immediately life-threatening. D is important for discharge safety but follows treatment of an airway threat.

2. 2.A client receiving intravenous morphine is difficult to arouse and has shallow respirations at 6/min. Which action is most appropriate?

   • A.A. Document that the client is resting comfortably
   • B.B. Wait 30 minutes and repeat the respiratory count
   • C.C. Activate emergency assistance, support ventilation, and administer naloxone according to protocol
   • D.D. Give the next opioid dose by the oral route

   Rationale: C is correct because severe sedation with inadequate ventilation requires immediate rescue measures and opioid reversal when indicated. A misinterprets dangerous sedation as comfort. B delays treatment of respiratory failure. D can worsen toxicity. Ventilation support and continued reassessment remain essential even when naloxone is available.

3. 3.A client with kidney injury has potassium of 6.7 mEq/L and widening QRS complexes. Prescribed intravenous calcium gluconate is administered. Which outcome best reflects its immediate purpose?

   • A.A. Increased potassium excretion in the urine
   • B.B. Removal of potassium through the gastrointestinal tract
   • C.C. Movement of potassium from cells into plasma
   • D.D. Stabilization of the cardiac cell membrane

   Rationale: D is correct because calcium reduces the immediate cardiac effects of hyperkalemia by stabilizing myocardial membranes. A and B describe potassium elimination strategies, not calcium's action. C would worsen extracellular hyperkalemia. Calcium does not lower the potassium concentration, so additional potassium-shifting or elimination treatment is still needed.

4. 4.A client suddenly develops facial droop and difficulty speaking. Which combination of actions should the nurse initiate? 1. Determine the last known well time. 2. Check bedside glucose. 3. Offer water to assess swallowing informally. 4. Activate the stroke response pathway.

   • A.A. 1, 2, and 4 only
   • B.B. 1 and 3 only
   • C.C. 2 and 3 only
   • D.D. 1, 2, 3, and 4

   Answer and rationale are in the full material.

5. 5.An alert client with diabetes is sweating and reports shakiness. Glucose is 58 mg/dL, and swallowing is intact. What should the nurse do first?

   • A.A. Administer the scheduled rapid-acting insulin
   • B.B. Provide 15 g of rapid-acting carbohydrate
   • C.C. Offer a high-fat meal and recheck glucose in 2 hours
   • D.D. Encourage the client to walk until symptoms improve

   Answer and rationale are in the full material.