3RD LECT EXAM SAMPLE QUESTIONS

1.

A client suddenly develops tracheal deviation, absent breath sounds on the left,
and severe dyspnea after chest trauma. What is the nurse’s priority action?

a. Notify the provider and prepare for emergent needle decompression

b. Place the client in high Fowler’s position with oxygen
c. Perform a rapid chest x-ray before further interventions
d. Administer IV morphine for pain relief

Answer: a. Notify the provider and prepare for emergent needle decompression
• Rationale: Classic tension pneumothorax signs → decompress immediately.
• b: Helpful but not definitive.
• c: Delays life-saving intervention.
• d: Pain is secondary.
Tip: Tracheal deviation = tension pneumo emergency.

2.

A nurse is caring for a client with severe dyspnea and SpO₂ 84% despite high-flow
oxygen. Which intervention should the nurse anticipate?

a. Endotracheal intubation with mechanical ventilation

b. Encouraging incentive spirometry
c. Increasing O₂ to 15 L/min via nasal cannula
d. Providing frequent oral suctioning

Answer: a. Endotracheal intubation with mechanical ventilation

• Rationale: Refractory hypoxemia requires intubation.
• b: Useful, but not in severe distress.
• c: High-flow NC isn’t enough.
• d: Supportive only.
Tip: Hypoxemia unresponsive to O₂ → mechanical ventilation.

3.

A client with ESRD reports muscle weakness and irregular heartbeat. Potassium is
6.8 mEq/L. Which order should the nurse carry out first?

a. Place client on cardiac monitor

b. Restrict oral potassium intake
c. Prepare the client for hemodialysis
d. Encourage increased oral fluids

Answer: a. Place client on cardiac monitor

• Rationale: Hyperkalemia can cause lethal arrhythmias; monitoring
ensures early recognition.
• b/c: Important, but not immediate.
• d: Not appropriate for ESRD.
Tip: Safety first → monitor before interventions.

4.
A client recovering from thoracentesis suddenly develops increased HR, SOB, and
SpO₂ drop. What should the nurse do immediately?

a. Assess for tracheal shift and breath sounds

b. Place the client in supine position
c. Encourage deep breathing and coughing
d. Document findings and reassess in 15 minutes

Answer: a. Assess for tracheal shift and breath sounds

• Rationale: Assess for pneumothorax complications.
• b: Supine worsens distress.
• c: Coughing isn’t safe if pneumo develops.
• d: Delays urgent assessment.
Tip: Always assess first when sudden deterioration occurs.

5.

A client with suspected sepsis has ABGs: pH 7.28, PaCO₂ 33, HCO₃⁻ 18. What is the
interpretation?

a. Metabolic acidosis with partial compensation

b. Respiratory acidosis uncompensated
c. Metabolic alkalosis compensated
d. Respiratory alkalosis partially compensated

Answer: a. Metabolic acidosis with partial compensation

• Rationale: Low pH, low HCO₃⁻ → metabolic acidosis; PaCO₂ is low (resp
compensation).
• b/c/d: Do not match the ABG.
Tip: Match pH direction with cause, then check if other value compensates.

6.

A client with emphysema is restless and confused. O₂ sat = 86%. What should the
nurse do first?

a. Raise HOB and apply low-flow oxygen

b. Notify the provider immediately
c. Administer PRN anxiolytic
d. Encourage client to cough forcefully

Answer: a. Raise HOB and apply low-flow oxygen

• Rationale: Positioning + O₂ = fastest way to improve oxygenation.
• b: Call after stabilizing.
• c: Sedatives depress breathing.
• d: Coughing not priority here.
Tip: Always think ABC: Airway, Breathing first.

7.

A client with UTI is prescribed ciprofloxacin. Which statement shows need for
teaching?
a. “I’ll avoid antacids while on this medication.”
b. “I need to complete the full course even if I feel better.”
c. “I should drink plenty of fluids daily.”
d. “It’s okay to stop if my symptoms improve quickly.”

Answer: d. “It’s okay to stop if my symptoms improve quickly.”

• Rationale: Must complete course.
• a/b/c are correct.
Tip: Antibiotics = always finish the full course.

8.

A trauma patient develops muffled heart sounds, hypotension, and distended neck
veins. What should the nurse do?

a. Prepare for pericardiocentesis

b. Administer IV furosemide
c. Place client on side-lying position
d. Apply external chest compression

Answer: a. Prepare for pericardiocentesis

• Rationale: Beck’s triad = cardiac tamponade.
• b/c/d: Ineffective.
Tip: Tamponade = drain the sac.

9.

A client with CKD reports persistent nausea, fatigue, and metallic taste. Which lab
is most concerning?

a. Potassium 6.5 mEq/L

b. Calcium 8.8 mg/dL
c. BUN 65 mg/dL
d. Hemoglobin 9 g/dL

Answer: a. Potassium 6.5 mEq/L

• Rationale: Life-threatening arrhythmia risk.
• b/c/d: Abnormal but less urgent.
Tip: In kidney disease, always prioritize K⁺.

10.

A nurse notices continuous bubbling in chest tube water seal chamber. Which action
is best?

a. Assess and locate the source of air leak

b. Increase suction until bubbling subsides
c. Clamp tube immediately
d. Continue to monitor without action

Answer: a. Assess and locate the source of air leak

• Rationale: Continuous bubbling = leak.
 • b: Doesn’t fix problem.
• c: Unsafe—risk of tension pneumo.
• d: Ignoring is unsafe.
Tip: Intermittent bubbling = okay; continuous = problem.

11.

A client with pyelonephritis has flank pain, chills, and fever. Which order is
priority?

a. Start IV broad-spectrum antibiotics

b. Encourage increased oral fluids
c. Provide warm compress to flank area
d. Administer acetaminophen for fever

Answer: a. Start IV broad-spectrum antibiotics

• Rationale: Sepsis prevention.
• b/c/d supportive but not first.
Tip: Suspected infection → antibiotics first.

12.

After chest trauma, a client’s chest tube accidentally disconnects. What is the
nurse’s priority action?

a. Place tube end in sterile water

b. Reconnect tube immediately to suction
c. Clamp the chest tube securely
d. Notify provider at once

Answer: a. Place tube end in sterile water

• Rationale: Maintains water seal, prevents air entry.
• b: Not sterile yet.
• c: Risk of tension pneumo.
• d: Notify after stabilizing.
Tip: In chest tube disconnection → submerge in sterile water.

13.

A client with ESRD is scheduled for hemodialysis. Which finding should the nurse
report before treatment?

a. Serum potassium 6.9 mEq/L

b. BP 88/54 mmHg
c. Weight gain of 2 kg in 2 days
d. BUN 85 mg/dL

Answer: b. BP 88/54 mmHg

• Rationale: Hypotension increases risk during dialysis.
• a/c/d: Indications for dialysis, but not a reason to delay.
Tip: Check hemodynamic stability before dialysis.

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14.

A client with urinary incontinence is placed on bladder training. Which finding

indicates success?

a. Voiding every 3–4 hours with minimal leakage

b. Reduced oral fluid intake to decrease episodes
c. Use of indwelling catheter without skin breakdown
d. Wearing absorbent pads most of the day

Answer: a. Voiding every 3–4 hours with minimal leakage

• Rationale: Goal = continence.
• b/c/d: Not evidence-based.
Tip: Bladder training focuses on scheduled voiding, not restriction.

15.

A child is admitted after being found unresponsive at home. SIDS is suspected. What
is the nurse’s priority?

a. Provide emotional support to parents

b. Collect detailed sleep environment history
c. Prepare for autopsy discussion
d. Notify child protective services immediately

Answer: a. Provide emotional support to parents

• Rationale: Family-centered care priority.
• b/c: Later steps.
• d: Only if abuse suspected.
Tip: In SIDS → support grieving parents first.

16.

A client with CKD reports severe itching. What should the nurse recommend?

a. Use cool baths and emollient lotions

b. Apply powder after bathing
c. Increase phosphorus in diet
d. Scrub skin vigorously to relieve itching

Answer: a. Use cool baths and emollient lotions

• Rationale: Helps pruritus relief in uremia.
• b: Powder may irritate skin.
• c: Restrict phosphorus, not increase.
• d: Worsens skin breakdown.
Tip: CKD pruritus = moisturize + cool comfort.

17.

A client with nephrolithiasis reports severe flank pain. What is the nurse’s first
action?
a. Administer prescribed IV morphine
b. Encourage ambulation
c. Offer oral fluids
d. Strain urine

Answer: a. Administer prescribed IV morphine

• Rationale: Pain relief first.
• b/c/d: Important but after pain control.
Tip: Pain = priority in renal colic.

18.

A client’s ABGs: pH 7.48, PaCO₂ 30, HCO₃⁻ 22. Which condition?

a. Respiratory alkalosis
b. Metabolic acidosis
c. Metabolic alkalosis
d. Respiratory acidosis

Answer: a. Respiratory alkalosis

• Rationale: High pH, low CO₂ → resp alkalosis.
• b/c/d: Don’t match values.
Tip: Low CO₂ = alkalosis; high CO₂ = acidosis.

19.

A client with COPD is receiving O₂ at 4 L/min by NC. He becomes increasingly

drowsy. What is the nurse’s best action?

a. Lower O₂ to 2 L/min and monitor response

b. Stop O₂ immediately
c. Place on non-rebreather mask at 15 L/min
d. Encourage client to cough and deep breathe

Answer: a. Lower O₂ to 2 L/min and monitor response

• Rationale: High O₂ may suppress drive in CO₂ retainers.
• b: Stopping O₂ causes hypoxemia.
• c: Worsens CO₂ retention.
• d: Supportive but not priority.
Tip: COPD = low-flow O₂.

20.

A client with ARDS is ventilated with high PEEP. Which complication is priority to
monitor?

a. Hypotension
b. Constipation
c. Hyperglycemia
d. Oral candidiasis

Answer: a. Hypotension
• Rationale: PEEP ↑ intrathoracic pressure → ↓ venous return.
 • b/c/d: Not related.
Tip: ARDS + PEEP → watch blood pressure.

21.

A client with polycystic kidney disease reports headache and blurred vision. Which
complication is suspected?

a. Hypertension crisis
b. Hypocalcemia
c. Pulmonary embolism
d. Urinary retention

Answer: a. Hypertension crisis

• Rationale: PKD → ↑ renin secretion → severe HTN.
• b/c/d: Not primary.
Tip: PKD progression strongly linked to hypertension.

22.

A nurse notes no bubbling or tidaling in chest tube water seal chamber. What is the
best initial action?

a. Assess tubing for kinks and check lung sounds

b. Clamp tube for 15 minutes
c. Increase suction level
d. Remove chest tube immediately

Answer: a. Assess tubing for kinks and check lung sounds

• Rationale: Always assess before intervention.
• b/c/d: Unsafe.
Tip: Device issues → trace system + assess client first.

23.

A client with UTI is prescribed phenazopyridine. Which teaching is correct?

a. “Your urine may turn orange or red.”

b. “This antibiotic should be taken with food.”
c. “Avoid caffeine as it decreases drug effect.”
d. “Expect your urine to become foamy.”

Answer: a. “Your urine may turn orange or red.”

• Rationale: Common harmless effect.
• b: Not antibiotic.
• c/d: Incorrect.
Tip: Phenazopyridine = orange urine.

24.

Which outcome best indicates improvement in a client with emphysema after pulmonary
rehab?

a. Performs ADLs with less dyspnea

b. Normal chest x-ray results
c. Breath sounds return to baseline
d. No sputum production

Answer: a. Performs ADLs with less dyspnea

• Rationale: Functional outcome is best measure.
• b/c/d: Not expected.
Tip: COPD outcomes = improved function, not cure.

25.

A client with pleural effusion undergoes thoracentesis. Which finding post-

procedure requires urgent attention?

a. Sudden chest pain and O₂ sat drop

b. Dullness to percussion at bases
c. Clear fluid drainage at site
d. Mild soreness at puncture site

Answer: a. Sudden chest pain and O₂ sat drop

• Rationale: Could indicate pneumothorax.
• b/c/d: Expected or mild.
Tip: After thoracentesis → monitor for pneumo.

26.

A client with acute kidney injury has ABGs: pH 7.30, PaCO₂ 38, HCO₃⁻ 18. Which
intervention is most urgent?

a. Administer sodium bicarbonate as prescribed

b. Encourage incentive spirometry hourly
c. Provide carbohydrate-rich snacks
d. Restrict oral potassium intake

Answer: a. Administer sodium bicarbonate as prescribed

• Rationale: Low pH, low HCO₃⁻ → metabolic acidosis; treat acidosis.
• b: Helps lungs, not acid-base here.
• c: Irrelevant.
• d: Important, but not immediate fix.
Tip: Severe metabolic acidosis → buffer replacement.

27.

A client with COPD is admitted for pneumonia. Which assessment finding requires
immediate action?

a. Clubbing of fingers
b. Increased sputum production
c. Confusion and new onset restlessness
d. Barrel chest appearance
Answer: c. Confusion and new onset restlessness
• Rationale: Early sign of hypoxemia/hypercapnia.
• a/b/d: Chronic expected findings.
Tip: New neuro changes = low oxygen to brain → act fast.

28.

During hemodialysis, the nurse notes the client has a headache, nausea,
restlessness, and HTN. What complication is suspected?

a. Dialysis disequilibrium syndrome

b. Hypovolemic shock
c. Peritonitis
d. Air embolism

Answer: a. Dialysis disequilibrium syndrome

• Rationale: Caused by rapid fluid/solute shifts.
• b: Not typical.
• c: Seen in peritoneal dialysis.
• d: Air embolism = chest pain, dyspnea.
Tip: Watch for neuro signs during hemodialysis.

29.

A client with a chest tube develops sudden severe SOB and no tidaling. What should
the nurse do?

a. Check for kinks and assess lung sounds

b. Clamp tube immediately
c. Apply more suction pressure
d. Remove tube and cover site

Answer: a. Check for kinks and assess lung sounds

• Rationale: Always troubleshoot tubing and assess patient.
• b/c/d: Unsafe.
Tip: In device malfunction → assess first, fix safely.

30.

A client with polycystic kidney disease reports headache and vision changes. Which
action is priority?

a. Measure blood pressure immediately

b. Give PRN analgesic
c. Restrict protein intake
d. Encourage fluid intake

Answer: a. Measure blood pressure immediately

• Rationale: PKD → HTN crisis possible.
• b/c/d: Not urgent first action.
Tip: PKD → always assess BP first.
⸻

31.

A nurse notes absent breath sounds over right lung base after thoracentesis. Which
action is priority?

a. Notify the provider immediately

b. Encourage coughing and deep breathing
c. Document finding as expected
d. Place client in left side-lying position

Answer: a. Notify the provider immediately

• Rationale: Could be pneumothorax.
• b: Delays recognition.
• c: Not expected.
• d: Positioning won’t help.
Tip: Post-thoracentesis → assess lungs, call provider if abnormal.

32.

A client with CKD reports generalized weakness. Labs: Ca 7.5, Phos 6.0. Which
prescription is priority?

a. Administer sevelamer with meals

b. Increase dietary dairy intake
c. Encourage weight-bearing exercise only
d. Administer potassium chloride supplement

Answer: a. Administer sevelamer with meals

• Rationale: Phosphate binder lowers phosphorus, prevents worsening
hypocalcemia.
• b: Dairy ↑ phosphorus.
• c: Helpful but not first.
• d: Unsafe; K is not low.
Tip: In CKD, treat high phos to improve calcium balance.

33.

Which finding best shows improvement in a client with pleural effusion after
thoracentesis?

a. Client reports decreased shortness of breath

b. Decreased chest wall soreness
c. Clear drainage from puncture site
d. Persistent diminished breath sounds

Answer: a. Client reports decreased shortness of breath

• Rationale: Outcome = symptom relief.
• b/c/d: Not primary indicators.
Tip: Always pick functional improvement as best outcome.

34.
A client with COPD is receiving discharge teaching. Which statement requires
correction?

a. “I will use pursed-lip breathing when I feel short of breath.”

b. “I should get the flu vaccine annually.”
c. “I can increase my oxygen flow rate when needed.”
d. “I will eat small frequent meals to reduce fatigue.”

Answer: c. “I can increase my oxygen flow rate when needed.”

• Rationale: O₂ flow must be prescribed; ↑ flow can worsen CO₂ retention.
• a/b/d: Correct.
Tip: COPD patients → never self-adjust O₂.

35.

Which assessment finding is priority in a client with suspected pyelonephritis?

a. Flank pain and fever

b. BP 86/50 mmHg
c. Dysuria and urgency
d. Positive costovertebral tenderness

Answer: b. BP 86/50 mmHg

• Rationale: Indicates sepsis/shock risk.
• a/c/d: Expected but not life-threatening.
Tip: In infection, hemodynamic instability = priority.

36.

During peritoneal dialysis, the nurse notes cloudy effluent. What is the priority
action?

a. Send sample for culture and sensitivity

b. Warm dialysate before next infusion
c. Increase protein intake
d. Continue monitoring without action

Answer: a. Send sample for culture and sensitivity

• Rationale: Cloudy effluent = peritonitis.
• b/c: Supportive, not urgent.
• d: Unsafe.
Tip: Cloudy outflow = infection until proven otherwise.

37.

Which client is at greatest risk for developing respiratory acidosis?

a. COPD patient with shallow respirations

b. Diabetic with persistent vomiting
c. Anxious client hyperventilating
d. Client with severe diarrhea
Answer: a. COPD patient with shallow respirations
• Rationale: CO₂ retention causes acidosis.
• b/d: Metabolic alkalosis/acidosis.
• c: Respiratory alkalosis.
Tip: Think: low ventilation = resp acidosis.

38.

A client with emphysema is receiving chest physiotherapy. Which position promotes

secretion drainage from the upper lobes?

a. Sitting upright leaning forward

b. Supine with legs elevated
c. Prone with head down
d. High Fowler’s with arms supported

Answer: a. Sitting upright leaning forward

• Rationale: Best for upper lobes.
• b/c: Drain lower lobes.
• d: Helps breathing, not drainage.
Tip: CPT positions = match gravity to lobe.

39.

Which instruction should the nurse provide to parents to reduce the risk of SIDS?

a. “Place your baby on the back to sleep.”

b. “Use soft pillows and stuffed animals in the crib.”
c. “Allow baby to sleep prone for naps only.”
d. “Keep room temperature very warm at night.”

Answer: a. “Place your baby on the back to sleep.”

• Rationale: Supine sleep = protective.
• b/c/d: Increase risk.
Tip: Back to sleep, bare crib, cool room.

40.

A client with empyema is scheduled for chest tube insertion. Which equipment is
most essential at the bedside?

a. Sterile water and occlusive dressing

b. Nebulizer setup
c. Incentive spirometer
d. Suction canister

Answer: a. Sterile water and occlusive dressing

• Rationale: Required if disconnection occurs.
• b/c: Helpful but not essential.
• d: Part of drainage system, but not emergency backup.
Tip: Always have water + dressing ready for chest tube patients.

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41.

A client with nephrolithiasis is advised to strain urine. Why is this important?

a. Determines stone composition for treatment

b. Prevents urinary tract infection
c. Reduces bladder irritation
d. Ensures adequate fluid intake

Answer: a. Determines stone composition for treatment

• Rationale: Guides therapy/prevention.
• b/c/d: Not the purpose.
Tip: Stone analysis = guides long-term management.

42.

A nurse is caring for a client with severe emphysema. Which finding requires urgent
attention?

a. Increased productive cough

b. Clubbing of fingers
c. SpO₂ 80% on 2 L/min oxygen
d. Diminished breath sounds

Answer: c. SpO₂ 80% on 2 L/min oxygen

• Rationale: Severe hypoxemia.
• a/b/d: Chronic expected findings.
Tip: Always prioritize acute low O₂ sat.

43.

A client’s ABGs: pH 7.50, PaCO₂ 48, HCO₃⁻ 30. Which disorder?

a. Metabolic alkalosis
b. Respiratory acidosis
c. Metabolic acidosis
d. Respiratory alkalosis

Answer: a. Metabolic alkalosis

• Rationale: High pH, high HCO₃⁻.
• b: Wrong; CO₂ is high but pH alkalotic.
• c/d: Do not fit.
Tip: High HCO₃⁻ = metabolic alkalosis.

44.

During dialysis, a client reports chest pain and dyspnea. What should the nurse
suspect first?

a. Air embolism
b. Fluid overload
c. Hypoglycemia
d. Electrolyte imbalance

Answer: a. Air embolism

• Rationale: Chest pain + dyspnea during dialysis → suspect embolism.
• b/c/d: Not classic presentation.
Tip: Air embolism = chest pain + SOB + anxiety.

45.

A client with urinary incontinence is started on pelvic floor (Kegel) exercises.

Which response indicates understanding?

a. “I will contract my pelvic muscles for 10 seconds, 10 times daily.”

b. “I’ll restrict fluids to reduce the need to void.”
c. “I should avoid exercises when I have urgency.”
d. “These exercises won’t help stress incontinence.”

Answer: a. “I will contract my pelvic muscles for 10 seconds, 10 times daily.”

• Rationale: Correct technique.
• b/c/d: Incorrect.
Tip: Kegels = best evidence-based care for stress incontinence.

46.

Which finding in a client with empyema indicates improvement?

a. Resolution of fever and decreased purulent drainage

b. Chest pain increases on deep inspiration
c. Breath sounds absent in affected lung
d. Persistent leukocytosis

Answer: a. Resolution of fever and decreased purulent drainage

• Rationale: Shows infection control.
• b/c/d: Indicate worsening.
Tip: Always look for resolution of infection signs.

47.

A client with COPD is discharged with home O₂. Which instruction is priority?

a. “Do not smoke or use open flames near oxygen.”

b. “Use petroleum jelly for nasal dryness.”
c. “Store cylinders under the bed.”
d. “Increase flow when breathless.”

Answer: a. “Do not smoke or use open flames near oxygen.”

• Rationale: Fire hazard is priority.
• b/c/d: Unsafe practices.
Tip: O₂ teaching = fire safety first.

48.
A client with CKD has K 6.9 and peaked T waves on ECG. Which medication should the
nurse expect first?

a. IV calcium gluconate
b. Oral sodium polystyrene sulfonate
c. Loop diuretic
d. ACE inhibitor

Answer: a. IV calcium gluconate

• Rationale: Stabilizes myocardium immediately.
• b/c: Slower acting.
• d: Contraindicated.
Tip: High K⁺ + ECG changes = IV calcium first.

49.

A client with pneumonia develops severe hypoxemia unresponsive to oxygen therapy.

What condition should the nurse suspect?

a. Acute respiratory distress syndrome

b. COPD exacerbation
c. Pulmonary embolism
d. Empyema

Answer: a. Acute respiratory distress syndrome

• Rationale: Refractory hypoxemia hallmark of ARDS.
• b/c/d: Do not explain oxygen resistance.
Tip: Think ARDS when oxygen doesn’t fix hypoxemia.

50.

Which finding indicates positive response to bladder training in a client with

incontinence?

a. Decreased leakage episodes and longer intervals between voiding

b. Reduction in fluid intake to prevent incontinence
c. Consistent use of indwelling catheter
d. Dependence on adult briefs daily

Answer: a. Decreased leakage episodes and longer intervals between voiding

• Rationale: Goal = continence improvement.
• b/c/d: Not desired outcomes.
Tip: Evidence-based outcome = fewer leaks, more control.

51.

A nurse enters the room of a client on chest tube drainage and notes the tube has
become disconnected. What should the nurse do first?

a. Submerge the tube in sterile water

b. Clamp the tube immediately
c. Reconnect the tubing to suction
d. Notify the provider

Answer: a. Submerge the tube in sterile water

• Rationale: Maintains water seal and prevents air entry.
• b: May cause tension pneumothorax.
• c: Must re-establish seal first.
• d: Notify after stabilizing.
Tip: Always think sterile water seal first in disconnections.

52.

A client with CKD has been prescribed epoetin alfa. Which lab best indicates the
medication is effective?

a. Hemoglobin increases to 11 g/dL

b. Serum potassium decreases to 4.0 mEq/L
c. BUN decreases to 20 mg/dL
d. Creatinine decreases to 1.2 mg/dL

Answer: a. Hemoglobin increases to 11 g/dL

• Rationale: Epoetin treats anemia.
• b/c/d: Not influenced by epoetin.
Tip: Always match the drug to its specific therapeutic goal.

53.

Which finding in a client with ARDS requires immediate action?

a. PaO₂ remains at 55 despite high FiO₂

b. Crackles heard in both lung bases
c. RR increases to 26/min
d. Thick secretions with cough

Answer: a. PaO₂ remains at 55 despite high FiO₂

• Rationale: Refractory hypoxemia hallmark.
• b/c/d: Common but not life-threatening.
Tip: ARDS red flag = hypoxemia unresponsive to O₂.

54.

A client with polycystic kidney disease reports dull flank pain and frequent
urination. Which teaching is priority?

a. Monitor blood pressure regularly

b. Avoid all physical activity
c. Limit water intake to 1 L/day
d. Take high-dose vitamin supplements

Answer: a. Monitor blood pressure regularly

• Rationale: HTN worsens PKD and leads to ESRD.
• b/c/d: Incorrect or harmful.
Tip: PKD management = control hypertension.
⸻

55.

A client with COPD is receiving O₂ at 4 L/min NC. The client becomes somnolent with
shallow respirations. What is the nurse’s priority action?

a. Lower O₂ to 2 L/min
b. Stop oxygen completely
c. Place on non-rebreather mask
d. Encourage vigorous coughing

Answer: a. Lower O₂ to 2 L/min

• Rationale: High O₂ suppresses drive in CO₂ retainers.
• b: Stopping O₂ causes hypoxemia.
• c: Too much O₂.
• d: Not priority.
Tip: COPD = low-flow O₂ always.

56.

A client with urinary tract infection is prescribed trimethoprim-sulfamethoxazole.

Which instruction is most important?

a. “Drink at least 2–3 liters of fluids daily.”

b. “Take this with antacids if stomach upset occurs.”
c. “Stop medication once burning subsides.”
d. “Expect urine to turn red-orange.”

Answer: a. “Drink at least 2–3 liters of fluids daily.”

• Rationale: Fluids prevent crystalluria.
• b: Antacids reduce absorption.
• c: Must complete antibiotics.
• d: Not a side effect of this drug.
Tip: Antibiotic + UTI = hydration is key.

57.

A client with pleural effusion undergoes thoracentesis. Which post-procedure

assessment requires immediate action?

a. Sudden chest pain with O₂ sat drop

b. Small amount of drainage on dressing
c. Dullness to percussion persists
d. Mild site soreness

Answer: a. Sudden chest pain with O₂ sat drop

• Rationale: May indicate pneumothorax.
• b/c/d: Expected or mild.
Tip: Watch for pneumothorax signs post-thoracentesis.

58.
A client on hemodialysis becomes restless, confused, and has a headache. Which
complication is suspected?

a. Dialysis disequilibrium syndrome

b. Hypoglycemia
c. Peritonitis
d. Hypokalemia

Answer: a. Dialysis disequilibrium syndrome

• Rationale: Rapid solute shifts → cerebral edema.
• b/c/d: Do not match presentation.
Tip: Neuro changes during dialysis = disequilibrium syndrome.

59.

Which intervention is priority for a client with nephrolithiasis and severe pain?

a. Administer IV opioids as prescribed

b. Encourage 3 liters oral fluids
c. Ambulate frequently
d. Strain urine for stones

Answer: a. Administer IV opioids as prescribed

• Rationale: Pain relief is priority.
• b/c/d: Important but secondary.
Tip: Pain control comes before supportive interventions.

60.

A client with emphysema is receiving discharge teaching. Which diet recommendation

is best?

a. High-calorie, high-protein small meals

b. Low-carbohydrate, large meals
c. High-fat, three large meals daily
d. Fluid-restricted low-sodium diet

Answer: a. High-calorie, high-protein small meals

• Rationale: Supports energy and reduces fatigue.
• b/c/d: Contraindicated.
Tip: COPD diet = small, frequent, nutrient-dense meals.

61.

A client receiving peritoneal dialysis develops abdominal pain and cloudy effluent.
What should the nurse do first?

a. Obtain a specimen for culture and sensitivity

b. Warm the dialysate
c. Slow the infusion rate
d. Reposition the client

Answer: a. Obtain a specimen for culture and sensitivity

 • Rationale: Suggests peritonitis.
• b/c/d: Comfort measures, not priority.
Tip: Cloudy effluent = infection until ruled out.

62.

Which finding indicates successful outcome of bladder training program?

a. Longer intervals between voiding with minimal leakage

b. Reduced fluid intake to prevent urgency
c. Reliance on absorbent products
d. Indwelling catheter without skin breakdown

Answer: a. Longer intervals between voiding with minimal leakage

• Rationale: Outcome goal = improved continence.
• b/c/d: Not evidence-based.
Tip: Best outcomes = function restored, not dependence.

63.

A client with empyema is receiving antibiotics and chest tube drainage. Which
finding best indicates improvement?

a. Afebrile with decreased purulent drainage

b. Absent breath sounds on affected side
c. Persistent leukocytosis
d. Increased chest pain on inspiration

Answer: a. Afebrile with decreased purulent drainage

• Rationale: Infection resolving.
• b/c/d: Worsening or not expected.
Tip: Track resolution of infection signs.

64.

A client with COPD suddenly becomes confused and drowsy. ABG: pH 7.28, PaCO₂ 72,
HCO₃⁻ 32. Which intervention is priority?

a. Start noninvasive positive-pressure ventilation (BiPAP)

b. Administer sedative for rest
c. Encourage incentive spirometry
d. Reduce fluid intake

Answer: a. Start noninvasive positive-pressure ventilation (BiPAP)

• Rationale: Acute hypercapnia → ventilation support.
• b: Unsafe.
• c: Supportive but not sufficient.
• d: Irrelevant.
Tip: CO₂ narcosis = ventilate, not sedate.

65.
A client with pneumonia is receiving antibiotics. Which finding best shows
treatment effectiveness?

a. SpO₂ improves from 88% to 95%

b. WBC remains elevated
c. Crackles persist at lung bases
d. Client still has productive cough

Answer: a. SpO₂ improves from 88% to 95%

• Rationale: O₂ improvement = best outcome.
• b/c/d: May persist.
Tip: Prioritize oxygenation status as indicator.

66.

A client with ESRD reports nausea and pruritus. Which lab value is most concerning?

a. Potassium 6.4 mEq/L

b. Hemoglobin 9 g/dL
c. Calcium 8.9 mg/dL
d. BUN 72 mg/dL

Answer: a. Potassium 6.4 mEq/L

• Rationale: Risk of arrhythmia.
• b/c/d: Chronic but not immediately fatal.
Tip: Always prioritize potassium.

67.

Which ABG result indicates respiratory acidosis?

a. pH 7.30, PaCO₂ 52, HCO₃⁻ 25

b. pH 7.49, PaCO₂ 28, HCO₃⁻ 24
c. pH 7.48, PaCO₂ 40, HCO₃⁻ 30
d. pH 7.32, PaCO₂ 36, HCO₃⁻ 19

Answer: a. pH 7.30, PaCO₂ 52, HCO₃⁻ 25

• Rationale: Low pH, high CO₂.
• b: Resp alkalosis.
• c: Metabolic alkalosis.
• d: Metabolic acidosis.
Tip: CO₂ high + pH low = resp acidosis.

68.

A client with nephrolithiasis asks why urine must be strained. The nurse responds:

a. “It helps determine the type of stone to guide treatment.”

b. “It prevents infection from occurring.”
c. “It reduces the risk of bladder spasms.”
d. “It ensures you are drinking enough fluids.”
Answer: a. “It helps determine the type of stone to guide treatment.”
• Rationale: Stone analysis directs therapy.
• b/c/d: Not correct.
Tip: Always link diagnostic action → treatment planning.

69.

Which intervention should the nurse include for a client at risk for SIDS?

a. Place infant supine on a firm mattress

b. Keep soft toys in crib
c. Place baby prone to reduce reflux
d. Allow infant to co-sleep with parents

Answer: a. Place infant supine on a firm mattress

• Rationale: Key prevention.
• b/c/d: Unsafe.
Tip: “Back to sleep, bare crib, cool room.”

70.

A client with empyema reports chest pain and fever. Which intervention is priority?

a. Administer IV antibiotics as prescribed

b. Apply warm compress to chest
c. Encourage deep breathing and coughing
d. Provide opioid analgesic only

Answer: a. Administer IV antibiotics as prescribed

• Rationale: Treat infection source.
• b/c/d: Supportive, not definitive.
Tip: Infection? Antibiotics first.

71.

A client undergoing dialysis develops chest pain, dyspnea, and anxiety. Which
complication should be suspected?

a. Air embolism
b. Hypocalcemia
c. Hypotension
d. Disequilibrium syndrome

Answer: a. Air embolism

• Rationale: Classic presentation.
• b/c/d: Do not match.
Tip: Dialysis + chest pain/dyspnea = air embolism.

72.

A client with COPD is receiving pulmonary rehab. Which finding indicates success?
a. Walks longer distances with less fatigue
b. Chest x-ray shows normal lung fields
c. Barrel chest appearance resolved
d. No longer produces sputum

Answer: a. Walks longer distances with less fatigue

• Rationale: Functional improvement.
• b/c/d: Not expected.
Tip: Focus on function, not cure.

73.

Which diet teaching is best for a client with CKD?

a. Limit potassium-rich foods like bananas and oranges

b. Increase protein intake daily
c. Add dairy for calcium replacement
d. Eat unlimited fresh fruits and vegetables

Answer: a. Limit potassium-rich foods like bananas and oranges

• Rationale: Hyperkalemia risk.
• b: Protein often restricted.
• c: Dairy ↑ phosphorus.
• d: Unlimited not safe.
Tip: CKD diet = low K, low phosphorus, moderate protein.

74.

A client with hemothorax has a chest tube in place. Which finding requires
immediate action?

a. Bright red drainage >200 mL/hr

b. Small intermittent bubbling in chamber
c. Tidaling present with respirations
d. Serosanguineous drainage 50 mL/hr

Answer: a. Bright red drainage >200 mL/hr

• Rationale: Suggests active bleeding.
• b/c/d: Expected.
Tip: >200 mL/hr blood = surgical emergency.

75.

A client with pyelonephritis is started on IV antibiotics. Which statement

indicates teaching success?

a. “I’ll finish all my antibiotics even if I feel better.”

b. “I can stop the medication once my fever resolves.”
c. “I should avoid drinking fluids until the pain subsides.”
d. “I can take leftover antibiotics if symptoms return later.”

Answer: a. “I’ll finish all my antibiotics even if I feel better.”

 • Rationale: Prevents recurrence/resistance.
• b/c/d: Incorrect.
Tip: Antibiotics must always be completed.

Alright ✅ here’s the final set (Items 76–100).

Still randomized, situational, prioritization/safety/outcome-based, with answers,
rationales, wrong-option clarifications, and quick test-taking tips.

🩺 NCLEX-Style Exam (Items 76–100)

76.

A client with ESRD is scheduled for dialysis today. Which finding is most
concerning to report before the procedure?

a. BP 88/52 mmHg
b. Serum potassium 6.0 mEq/L
c. Weight gain of 2 kg in 3 days
d. Hemoglobin 9 g/dL

Answer: a. BP 88/52 mmHg

• Rationale: Hypotension is unsafe for dialysis.
• b/c/d: Indications for dialysis, but not reasons to delay.
Tip: Check hemodynamic stability first.

77.

A client with emphysema develops acute SOB and uses pursed-lip breathing. What is
the nurse’s first action?

a. Encourage continuation of pursed-lip breathing

b. Place client in high Fowler’s position
c. Increase O₂ to 8 L/min NC
d. Notify the provider immediately

Answer: b. Place client in high Fowler’s position

• Rationale: Position improves expansion and O₂ exchange fastest.
• a: Helpful but not priority.
• c: Too much O₂ risks hypoventilation.
• d: Call after stabilization.
Tip: In SOB → position first.

78.

A nurse notes absent breath sounds and tracheal deviation after chest trauma. What
complication is suspected?

a. Tension pneumothorax
b. Empyema
c. Pleural effusion
d. Hemothorax
Answer: a. Tension pneumothorax
• Rationale: Classic finding.
• b/c/d: Don’t cause tracheal deviation like this.
Tip: Tracheal shift = tension pneumo until proven otherwise.

79.

A client with polycystic kidney disease reports severe flank pain. Which
intervention is priority?

a. Administer prescribed analgesics

b. Encourage oral hydration of 3 L/day
c. Apply heating pad to flank
d. Restrict dietary sodium

Answer: a. Administer prescribed analgesics

• Rationale: Pain relief is immediate need.
• b/c/d: Supportive, not priority.
Tip: Pain control comes before long-term teaching.

80.

Which ABG indicates metabolic acidosis?

a. pH 7.30, PaCO₂ 35, HCO₃⁻ 18

b. pH 7.50, PaCO₂ 28, HCO₃⁻ 24
c. pH 7.48, PaCO₂ 50, HCO₃⁻ 30
d. pH 7.31, PaCO₂ 52, HCO₃⁻ 26

Answer: a. pH 7.30, PaCO₂ 35, HCO₃⁻ 18

• Rationale: Low pH, low HCO₃⁻ = metabolic acidosis.
• b: Resp alkalosis.
• c: Metabolic alkalosis.
• d: Resp acidosis.
Tip: Low bicarb = metabolic acidosis.

81.

A client with COPD asks how to prevent future infections. Which instruction is
best?

a. Receive annual influenza and pneumococcal vaccines

b. Avoid physical activity to conserve energy
c. Restrict fluid intake to reduce mucus
d. Use antibiotics at first sign of cough

Answer: a. Receive annual influenza and pneumococcal vaccines

• Rationale: Vaccines reduce risk.
• b/c/d: Incorrect or unsafe.
Tip: Vaccination = prevention priority in COPD.

⸻
82.

During dialysis, the client becomes lightheaded, hypotensive, and diaphoretic. What
should the nurse do first?

a. Lower the head of bed and administer saline bolus

b. Stop dialysis immediately
c. Encourage deep breathing
d. Increase ultrafiltration rate

Answer: a. Lower the head of bed and administer saline bolus

• Rationale: Treat hypotension with fluids.
• b: Only if unresponsive.
• c: Not corrective.
• d: Worsens fluid removal.
Tip: Dialysis hypotension = fluid replacement first.

83.

Which outcome best shows improvement after antibiotic treatment for pyelonephritis?

a. Afebrile and reports decreased flank pain

b. WBC remains elevated
c. Positive costovertebral tenderness persists
d. Dysuria continues

Answer: a. Afebrile and reports decreased flank pain

• Rationale: Indicates resolution of infection.
• b/c/d: Indicate persistence.
Tip: Look for symptom resolution as best outcome.

84.

A client with ARDS is ventilated with high PEEP. Which complication must the nurse
monitor for?

a. Hypotension
b. Polyuria
c. Constipation
d. Hyperglycemia

Answer: a. Hypotension
• Rationale: High PEEP ↑ intrathoracic pressure, ↓ venous return.
• b/c/d: Not related.
Tip: ARDS + PEEP = check blood pressure.

85.

A client with COPD is prescribed pulmonary rehab. Which statement indicates

success?

a. “I can now walk longer distances with less shortness of breath.”

b. “My barrel chest has gone away.”
c. “I no longer produce sputum.”
d. “My chest x-ray looks normal again.”

Answer: a. “I can now walk longer distances with less shortness of breath.”
• Rationale: Focus is on function.
• b/c/d: COPD not reversible.
Tip: Rehab goals = functional capacity, not cure.

86.

A nurse observes continuous bubbling in the chest tube water seal. What should the
nurse do?

a. Check for air leaks in the system

b. Clamp the tube
c. Increase suction pressure
d. Continue monitoring

Answer: a. Check for air leaks in the system

• Rationale: Continuous bubbling = leak.
• b: Dangerous.
• c: Won’t help.
• d: Unsafe.
Tip: Continuous bubbling = fix leak.

87.

A client with nephrolithiasis is prescribed tamsulosin. What is the expected

outcome?

a. Relaxation of ureter to promote stone passage

b. Reduction of uric acid production
c. Dissolution of calcium oxalate stones
d. Elimination of infection risk

Answer: a. Relaxation of ureter to promote stone passage

• Rationale: Alpha-blocker helps stone passage.
• b/c/d: Not mechanism.
Tip: Tamsulosin = stone passage aid.

88.

Which assessment finding indicates peritonitis in a client receiving peritoneal

dialysis?

a. Abdominal rigidity and rebound tenderness

b. Clear effluent
c. Weight loss
d. Mild thirst

Answer: a. Abdominal rigidity and rebound tenderness

• Rationale: Classic peritonitis signs.
 • b/c/d: Not diagnostic.
Tip: Think rigid abdomen = infection.

89.

A client with CKD is prescribed calcium acetate. What is the purpose of this
medication?

a. To bind phosphorus and prevent hyperphosphatemia

b. To increase hemoglobin production
c. To lower potassium
d. To reduce sodium levels

Answer: a. To bind phosphorus and prevent hyperphosphatemia

• Rationale: Phosphate binder.
• b: Epoetin for Hgb.
• c: Kayexalate/insulin for K.
• d: Not sodium drug.
Tip: CKD meds → know which electrolyte each affects.

90.

Which outcome best indicates improvement in a client with pleural effusion after
thoracentesis?

a. Reports decreased dyspnea

b. Dullness persists on percussion
c. Mild soreness at puncture site
d. O₂ sat remains unchanged

Answer: a. Reports decreased dyspnea

• Rationale: Symptom relief.
• b/c/d: Not outcome.
Tip: Best outcomes = functional improvement.

91.

A client with empyema has chest tube drainage. Which finding should be reported?

a. Drainage suddenly becomes bright red and >200 mL/hr

b. Purulent drainage that decreases daily
c. Intermittent bubbling in water seal
d. Tidaling in chest tube with respirations

Answer: a. Drainage suddenly becomes bright red and >200 mL/hr

• Rationale: Suggests hemorrhage.
• b/c/d: Expected.
Tip: >200 mL/hr chest tube output = surgical emergency.

92.
Which intervention is priority for a client with hyperkalemia?

a. Place on continuous cardiac monitoring

b. Restrict oral potassium
c. Encourage ambulation
d. Increase fluid intake

Answer: a. Place on continuous cardiac monitoring

• Rationale: Life-threatening arrhythmias.
• b/c/d: Supportive, not immediate.
Tip: Hyperkalemia = ECG monitor first.

93.

Which finding is most concerning in a client with pneumonia?

a. Confusion and disorientation

b. Crackles in lung bases
c. Fever of 101°F (38.3°C)
d. Sputum production

Answer: a. Confusion and disorientation

• Rationale: Indicates hypoxemia.
• b/c/d: Expected.
Tip: New neuro changes = urgent O₂ issue.

94.

Which teaching is most important for a client with urinary incontinence?

a. Perform pelvic floor (Kegel) exercises regularly

b. Restrict all fluids after 6 pm
c. Use indwelling catheter for convenience
d. Wear absorbent pads at all times

Answer: a. Perform pelvic floor (Kegel) exercises regularly

• Rationale: Evidence-based practice.
• b/c/d: Not best.
Tip: First-line = Kegel training.

95.

A client with empyema is scheduled for thoracentesis. Which pre-procedure

assessment is most important?

a. Check INR and platelet count

b. Auscultate for crackles
c. Assess for costovertebral tenderness
d. Monitor urine output

Answer: a. Check INR and platelet count

• Rationale: Risk of bleeding.
• b/c/d: Not priority.
Tip: Before invasive procedures = check coagulation.

96.

A child with suspected SIDS is admitted. Which nursing priority is correct?

a. Provide emotional support to grieving parents

b. Collect detailed history immediately
c. Prepare for coroner’s report first
d. Notify social services before family support

Answer: a. Provide emotional support to grieving parents

• Rationale: Family-centered care priority.
• b/c/d: Come later.
Tip: SIDS = support parents first.

97.

A client with nephrolithiasis is given morphine. Which outcome indicates

effectiveness?

a. Reports pain relief

b. Produces clear urine
c. Voids 2 liters in 24 hours
d. Passes stone fragments

Answer: a. Reports pain relief

• Rationale: Pain management is immediate goal.
• b/c/d: May follow, but not first.
Tip: Effectiveness = symptom relief.

98.

Which ABG indicates respiratory alkalosis?

a. pH 7.48, PaCO₂ 30, HCO₃⁻ 24

b. pH 7.31, PaCO₂ 50, HCO₃⁻ 24
c. pH 7.30, PaCO₂ 38, HCO₃⁻ 18
d. pH 7.48, PaCO₂ 50, HCO₃⁻ 30

Answer: a. pH 7.48, PaCO₂ 30, HCO₃⁻ 24

• Rationale: High pH, low CO₂.
• b: Resp acidosis.
• c: Metabolic acidosis.
• d: Metabolic alkalosis.
Tip: Low CO₂ = resp alkalosis.

99.

Which intervention is priority after thoracentesis?

a. Monitor for sudden dyspnea and chest pain
b. Apply heat pack over puncture site
c. Encourage coughing and deep breathing immediately
d. Keep client supine for 12 hours

Answer: a. Monitor for sudden dyspnea and chest pain

• Rationale: Pneumothorax risk.
• b/c/d: Not priorities.
Tip: After thoracentesis → watch for pneumo.

100.

A client with ESRD is prescribed sevelamer. Which statement shows correct

understanding?

a. “This will help lower my phosphorus levels.”

b. “This will increase my urine output.”
c. “This will fix my potassium levels.”
d. “This will replace my lost calcium.”

Answer: a. “This will help lower my phosphorus levels.”

• Rationale: Phosphate binder.
• b/c/d: Incorrect purposes.
Tip: Sevelamer = phosphorus control.