Download NCLEX-RN Practice Exam: Medical-Surgical Nursing Q&A and more Exams Nursing in PDF only on Docsity!
Comprehensive NCLEX-RN Practice Exam
Q&A 2025 (MODULE 2 )
1. Question
Category: Reduction of Risk Potential
After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. Nurse Katrina determines that mean arterial pressure (MAP) is which of the following?
A. 46 mm Hg
B. 80 mm Hg
C. 95 mm Hg
D. 90 mm Hg
The correct answer is:
C. 95 mm Hg
Rationale:
The mean arterial pressure is calculated as
MAP = (SBP+2×DBP)/3 = (126+2(80))/3 = (126+1600)/3= (286)/3 ≈ 95.3 mm Hg
2. Question
Category: Physiological Adaptation
A female client arrives at the emergency department with chest and stomach pain and a report of black tarry stool for several months. Which of the following orders should the nurse Oliver anticipate?
A. Cardiac monitor, oxygen, creatine kinase and lactate dehydrogenase levels
B. Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split product values
C. Electrocardiogram, complete blood count, testing for occult blood, comprehensive serum metabolic panel
D. Electroencephalogram, alkaline phosphatase, and aspartate aminotransferase levels, basic serum metabolic panel
The correct answer is:
C. Electrocardiogram, complete blood count, testing for occult blood, comprehensive serum metabolic panel
Rationale:
Electrocardiogram (ECG): Evaluates chest pain to rule out cardiac involvement
Complete blood count (CBC): Detects anemia due to chronic GI bleeding
Testing for occult blood: Confirms gastrointestinal bleeding
Comprehensive metabolic panel (CMP): Assesses electrolytes, renal and liver function, which may be affected by blood loss or systemic stress
3. Question
Olivia had coronary artery bypass graft (CABG) surgery 3 days ago. Which of the following conditions is suspected by the nurse when a decrease in platelet count from 230,000 ul to 5,000 ul is noted?
A. Pancytopenia
B. Idiopathic thrombocytopenic purpura (ITP)
C. Disseminated intravascular coagulation (DIC)
D. Heparin-associated thrombosis and thrombocytopenia (HATT)
The correct answer is:
D. Heparin-associated thrombosis and thrombocytopenia (HATT)
Rationale:
More commonly referred to as Heparin-Induced Thrombocytopenia (HIT) , HATT is a serious immune- mediated reaction to heparin. It typically occurs 4 – 10 days after heparin exposure , but can appear sooner (especially in patients with previous exposure).
Key clues:
Recent CABG : high likelihood of heparin use
Rapid, drastic platelet drop
Timing fits with early onset HIT/HATT
4. Question
Category: Pharmacological and Parenteral Therapies
A. Allogeneic – Transplant between two humans who are genetically different (e.g., kidney from a donor to a non-related recipient).
B. Autologous – Transplant using the person’s own tissues (e.g., skin graft from one part of the body to another).
C. Syngeneic – Transplant between genetically identical individuals , like identical twins.
D. Xenogeneic – Transplant between species (e.g., pig valve to human).
6. Question
Category: Physiological Adaptation
Marco falls off his bicycle and injures his ankle. Which of the following actions shows the initial response to the injury in the extrinsic pathway?
A. Release of Calcium
B. Release of tissue thromboplastin
C. Conversion of factors XII to factor XIIa
D. Conversion of factor VIII to factor VIIIa
The correct answer is:
B. Release of tissue thromboplastin
Rationale:
Tissue thromboplastin is released when damaged tissue comes in contact with clotting factors.
Option A: Calcium is released to assist the conversion of factors X to Xa.
Option C: Conversion of factors XII to XIIa are part of the intrinsic pathway.
Option D: Conversion factors VIII to VIIIa are part of the intrinsic pathway.
7. Question
Category: Physiological Adaptation
Instructions for a client with systemic lupus erythematosus (SLE) would include information about which of the following blood dyscrasias?
A. Dressler’s syndrome
B. Polycythemia
C. Essential thrombocytopenia
D. Von Willebrand’s disease
The correct answer is:
C. Essential thrombocytopenia
Rationale:
Essential thrombocytopenia is linked to immunologic disorders, such as SLE and the human immunodeficiency virus.
Option A: Dressler’s syndrome is pericarditis that occurs after myocardial infarction and isn’t linked to SLE.
Option B: Moderate to severe anemia is associated with SLE, not polycythemia. It is found in about 50% of patients, with anemia of chronic disease being the most common form.
Option D: Von Willebrand disease is a blood disorder in which the blood doesn’t clot properly. Blood contains many proteins that help the body stop bleeding. One of these proteins is called von Willebrand factor.
8. Question
Category: Reduction of Risk Potential
The nurse is aware that the following symptom is most commonly an early indication of stage 1 Hodgkin’s disease?
A. Pericarditis
B. Night sweat
C. Splenomegaly
D. Persistent hypothermia
The correct answer is:
B. Night sweat
Rationale:
In stage 1, symptoms include a single enlarged lymph node (usually), unexplained fever, night sweats, malaise, and generalized pruritus.
Option A: Pericarditis refers to the inflammation of the pericardium, two thin layers of a sac-like tissue that surround the heart, hold it in place, and help it work. Pericarditis isn’t associated with
D. Myocardial irritability
The correct answer is:
B. Muscle spasm
Rationale:
Back pain or paresthesia in the lower extremities may indicate impending spinal cord compression from a spinal tumor. This should be recognized and treated promptly as the progression of the tumor may result in paraplegia.
Option A: The reasons underlying the relative paucity of CNS invasion by multiple myeloma in comparison with other tumors, whether solid or hematological, remain unknown, but this phenomenon might be the result of underlying biological characteristics, or lack thereof, of malignant plasma cells.
Option C: In some cases, renal impairment is caused by the accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in renal obstruction.
Option D: Some of the treatments used in MM may also affect cardiovascular health, however, with careful risk assessment, monitoring, and prophylactic therapy, many of these cardiovascular complications can be managed or treated successfully.
11. Question
Category: Physiological Adaptation
Nurse Patricia is aware that the average length of time from human immunodeficiency virus (HIV) infection to the development of acquired immunodeficiency syndrome (AIDS)?
A. Less than 5 years
B. 5 to 7 years
C. 10 years
D. More than 10 years
The correct answer is:
C. 10 years
Rationale:
Epidemiologic studies show the average time from initial contact with HIV to the development of AIDS is 10 years. The interval from HIV infection to the diagnosis of AIDS ranges from about 9 months to 20 years or longer, with a median of 12 years. This timeline can vary depending on:
The individual's immune system
Presence of co-infections
Access to healthcare
Use of antiretroviral therapy (ART) (which can delay or prevent progression to AIDS)
In the absence of treatment, most people progress to AIDS within approximately 10 years of initial infection.
12. Question
Category: Reduction of Risk Potential
An 18-year-old male client admitted with heat stroke begins to show signs of disseminated intravascular coagulation (DIC). Which of the following laboratory findings is most consistent with DIC?
A. Low platelet count
B. Elevated fibrinogen levels
C. Low levels of fibrin degradation products
D. Reduced prothrombin time
The correct answer is:
A. Low platelet count
Rationale:
Disseminated intravascular coagulation (DIC) is a complex disorder characterized by widespread activation of clotting, which consumes platelets and clotting factors, leading to:
Low platelet count (thrombocytopenia)
Prolonged prothrombin time (PT) and partial thromboplastin time (PTT)
Low fibrinogen levels (because it is consumed in clot formation)
Elevated fibrin degradation products (FDPs) or D-dimers due to fibrinolysis
Option B: Severe, rapidly evolving DIC is diagnosed by demonstrating thrombocytopenia, an elevated partial thromboplastin time and prothrombin time, increased levels of plasma D-dimers, and a decreasing plasma fibrinogen level.
Option C: Fibrin degradation products increase as fibrinolysis takes place.
Option D: Both PT and aPTT seem prolonged in about 50% of DIC cases which is attributed to the consumption of coagulation factors but can also be prolonged in impaired synthesis of coagulation factors and in massive bleeding.
C. A Rh-negative
Rationale:
The client’s blood type is AB negative.
AB blood type means the person has both A and B antigens on red blood cells, so they can receive A, B, AB, or O blood types without an immune reaction to ABO antigens.
The Rh factor is negative , so they must receive Rh-negative blood to avoid Rh sensitization or reaction.
Breakdown of options:
A. AB Rh-positive: Has Rh antigen (positive), which may cause a reaction.
B. A Rh-positive: Rh-positive blood can cause sensitization/reaction.
C. A Rh-negative: Compatible ABO antigen and Rh-negative — safe.
D. O Rh-positive: Rh-positive is incompatible.
15. Question
Category: Health Promotion and Maintenance
Stacy was diagnosed with acute lymphoid leukemia (ALL). She was discharged from the hospital following her chemotherapy treatments. Which statement of Stacy’s mother indicated that she understands when she will contact the physician?
A. “I should contact the physician if Stacy has difficulty in sleeping”.
B. “I will call my doctor if Stacy has persistent vomiting and diarrhea”.
C. “My physician should be called if Stacy is irritable and unhappy”.
D. “Should Stacy have continued hair loss, I need to call the doctor”.
The correct answer is:
B. “I will call my doctor if Stacy has persistent vomiting and diarrhea”.
Rationale:
Persistent (more than 24 hours) vomiting, anorexia, and diarrhea are signs of toxicity and the patient should stop the medication and notify the healthcare provider.
Option A: Oftentimes, chemotherapy drugs cause patients to feel tired and sleepy throughout the day. Therefore, patients on chemotherapy can end up napping or sleeping during the day and that leads to difficulty sleeping at night or through the night.
Option C: Chemotherapy medications can directly impact the way people feel emotionally and physically.
Option D: Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in the body, including those in the hair roots.
16. Question
Category: Psychosocial Integrity
Molly Sue is diagnosed with acute lymphoid leukemia (ALL) and beginning chemotherapy. Her mother states to the nurse that it is hard to see Molly Sue with no hair. The best response for the nurse is:
A. “Molly Sue looks very nice wearing a hat”.
B. “You should not worry about her hair, just be glad that she is alive”.
C. “Yes, it is upsetting. But try to cover up your feelings when you are with her or else she may be upset”.
D. “This is only temporary; Molly Sue will re-grow new hair in 3-6 months but may be different in texture”.
The correct answer is:
D. “This is only temporary; Molly Sue will re-grow new hair in 3-6 months but may be different in texture”.
Rationale:
This is the appropriate response. The nurse should help the mother how to cope with her own feelings regarding the child’s disease so as not to affect the child negatively. When the hair grows back, it is still of the same color and texture.
Option A: It can be an option for the client to use a hat, but the nurse should be open about explanations regarding the side effects of chemotherapy.
Option B: Avoid reassuring the client. Statements of fact would be a good response.
Option C: The mother should be open and honest with the child, and providing an honest and true response would be a big help to both of them.
17. Question
Category: Basic Care and Comfort
Edema or swelling at the IV site is a sign that the needle has been dislodged and the IV solution is leaking into the tissues causing the edema. The patient feels pain as the nerves are irritated by pressure and the IV solution. The first action of the nurse would be to discontinue the infusion right away to prevent further edema and other complications.
Option A: After discontinuing the infusion, the nurse should notify the physician.
Option B: Flushing may aggravate the edema since the IV cannula might be dislodged.
Option D: Compresses may be given as indicated by the physician.
19. Question
Category: Physiological Adaptation
The term “blue bloater” refers to a male client which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
The correct answer is:
C. Chronic obstructive bronchitis
Rationale:
The term “blue bloater” is classically used to describe clients with chronic bronchitis , a form of chronic obstructive pulmonary disease (COPD).
These patients tend to be cyanotic ("blue") due to hypoxia and edematous ("bloated") due to right-sided heart failure from chronic hypoxia.
They often have chronic cough and sputum production.
Option A: Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen.
Option B: Clients with asthma don’t exhibit characteristics of chronic disease.
Option D: Clients with emphysema appear pink and cachectic.
20. Question
Category: Physiological Adaptation
The term “pink puffer” refers to the female client with which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
The correct answer is:
D. Emphysema
Rationale:
The term “pink puffer” describes clients with emphysema , a form of COPD.
These clients tend to be thin ("puffer") and pink due to adequate oxygenation but have difficulty breathing and often use pursed-lip breathing.
They primarily have alveolar destruction leading to air trapping.
Option A: Clients with ARDS are usually acutely short of breath.
Option B: Clients with asthma don’t have any particular characteristics.
Option C: Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
21. Question
Category: Reduction of Risk Potential
Jose is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. Nurse Oliver would expect the paco2 to be which of the following values?
A. 15 mm Hg
B. 30 mm Hg
C. 40 mm Hg
D. 80 mm Hg
The correct answer is:
D. 80 mm Hg
Rationale:
Narcotic analgesics (e.g., morphine, fentanyl) can depress the respiratory center in the brain, leading to hypoventilation.
Interpretation:
The low pH and elevated PaCO₂ point directly to uncompensated respiratory acidosis.
This is typical of respiratory depression (e.g., from narcotics, COPD exacerbation, airway obstruction).
Option A: If the HCO3- was below 22 mEq/L the client would have metabolic acidosis.
Option B: The result of the ABG is less than 7.35, which makes metabolic alkalosis incorrect.
Option D: The pH is less than 7.35, academic, which eliminates respiratory alkalosis as a possibility.
23. Question
Category: Physiological Adaptation
Norma has started a new drug for hypertension. Thirty minutes after she takes the drug, she develops chest tightness and becomes short of breath and tachypnea. She has a decreased level of consciousness. These signs indicate which of the following conditions?
A. Asthma attack
B. Pulmonary embolism
C. Respiratory failure
D. Rheumatoid arthritis
The correct answer is:
C. Respiratory failure
Rationale:
The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventually respiratory failure.
Option A: The symptoms may look like an asthma attack, but it may change because of the new drug ingested.
Option B: Although the signs are also related to a pulmonary embolism, consider the new drug first.
Option D: Rheumatoid arthritis is an autoimmune and inflammatory disease, which means that the immune system attacks healthy cells in the body by mistake, causing inflammation in the affected parts of the body.
24. Question
Category: Reduction of Risk Potential
Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver which laboratory test indicates liver cirrhosis?
A. Decreased red blood cell count
B. Decreased serum acid phosphatase level
C. Elevated white blood cell count
D. Elevated serum aminotransferase
The correct answer is:
D. Elevated serum aminotransferase
Rationale:
Hepatic cell death causes the release of liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) into the circulation. Liver cirrhosis is a chronic and irreversible disease of the liver characterized by generalized inflammation and fibrosis of the liver tissues.
Option A: Decreased red blood cell count may indicate anemia.
Option B: Serum acid phosphatase is an enzyme that acts to liberate phosphate under acidic conditions. Until now, low values cannot be determined with certainty.
Option C: A high white blood cell count usually indicates increased production of white blood cells to fight infection.
25. Question
Category: Reduction of Risk Potential
The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for excessive bleeding primarily because of:
A. Impaired clotting mechanism
B. Varix formation
C. Inadequate nutrition
D. Trauma of invasive procedure
The correct answer is:
vessels to grow, called collateral blood vessels. These vessels act as channels to divert the blood under high pressure.
27. Question
Category: Pharmacological and Parenteral Therapies
Patrick who is diagnosed with liver cirrhosis is experiencing symptoms of hepatic encephalopathy. The physician ordered 50 ml of Lactulose p.o. every 2 hours. Patrick suddenly develops diarrhea. The nurse best action would be:
A. “I’ll see if your physician is in the hospital”.
B. “Maybe you’re reacting to the drug; I will withhold the next dose”.
C. “I’ll lower the dosage as ordered so the drug causes only 2 to 4 stools a day”.
D. “Frequently, bowel movements are needed to reduce sodium level”.
The correct answer is:
C. “I’ll lower the dosage as ordered so the drug causes only 2 to 4 stools a day”.
Rationale:
Lactulose is used in hepatic encephalopathy to lower ammonia levels by promoting its excretion through frequent bowel movements.
However, the goal is typically to induce 2 to 4 soft stools per day — not diarrhea , which can lead to dehydration and electrolyte imbalances.
The appropriate nursing action is to adjust the dose (if ordered to titrate) or notify the physician for a dose adjustment.
Why not the others?
A. “I’ll see if your physician is in the hospital” : Delays action — not a direct or proactive intervention.
B. “Maybe you’re reacting to the drug; I will withhold the next dose” : Inappropriate — nurse should not stop a medication without a provider's order unless there's a critical issue.
D. “Frequently, bowel movements are needed to reduce sodium level” : Incorrect — Lactulose targets ammonia , not sodium.
28. Question
Category: Physiological Adaptation
Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
A. Lower back pain, increased blood pressure, decreased red blood cell (RBC) count, increased white blood (WBC) count.
B. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
C. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased RBC count, decreased WBC count.
D. Intermittent lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
The correct answer is:
B. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
Rationale:
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count has decreased – not increased. The WBC count increases as cells migrate to the site of injury.
Option A: The pain is severe due to the ruptured aneurysm; the blood pressure is decreased due to blood loss.
Option C: The increase in WBC count is due to the cells migrating to the site of the injury.
Option D: The pain in a ruptured aneurysm is constant and can only be alleviated if the aneurysm is repaired.
29. Question
Category: Reduction of Risk Potential
After undergoing a cardiac catheterization, Tracy has a large puddle of blood under his buttocks. Which of the following steps should the nurse take first?
A. Call for help.
B. Obtain vital signs.
C. Ask the client to “lift up”.
