NCLEX-RN & NGN Advanced Prep: Master
Clinical Judgment, Nursing Priorities &
NCLEX-RN Practice Questions with Detailed
Rationales
Subject: NCLEX-RN / Next Generation NCLEX (NGN) – Clinical Judgment,
Prioritization, and Pharmacology
Question 1: A nurse is caring for a client with a history of heart failure who is receiving an
infusion of milrinone. The client’s blood pressure drops from 110/70 mmHg to 88/58 mmHg,
and the heart rate increases from 82 bpm to 118 bpm. Which action should the nurse take first?
A) Increase the rate of the maintenance IV fluids.
B) Slow or stop the milrinone infusion and notify the provider.
C) Administer a bolus of 0.9% normal saline as per protocol.
D) Elevate the head of the bed to 45 degrees.
Correct Answer: B) Slow or stop the milrinone infusion and notify the provider.
Explanation: Milrinone is a phosphodiesterase inhibitor that causes both positive inotropy and
systemic vasodilation. The sudden drop in blood pressure and compensatory tachycardia suggest
the client is experiencing profound hypotension related to the drug's vasodilatory effects.
Stopping the infusion is the priority intervention to prevent cardiovascular collapse. While fluids
(C) might be indicated, stopping the causative agent takes precedence.
Question 2: A nurse is assessing a client who is 4 hours postoperative following a thyroidectomy.
The nurse notes laryngeal stridor and restlessness. What is the nurse's priority action?
A) Notify the surgeon immediately and prepare for emergency intubation.
B) Administer the prescribed IV calcium gluconate.
C) Position the client in a high-Fowler’s position.
D) Check the dressing for signs of hemorrhage.
Correct Answer: A) Notify the surgeon immediately and prepare for emergency intubation.
, Explanation: Laryngeal stridor is a high-pitched sound indicating airway obstruction, which is a
medical emergency following a thyroidectomy. It may result from edema or accidental nerve
damage. Immediate notification and preparation for airway management take precedence over
all other assessments or interventions (such as calcium, which addresses tetany).
Question 3: A client is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which laboratory finding should the nurse expect?
A) Serum sodium 125 mEq/L
B) Serum osmolality 310 mOsm/kg
C) Urine specific gravity 1.005
D) Serum potassium 3.0 mEq/L
Correct Answer: A) Serum sodium 125 mEq/L
Explanation: SIADH causes excessive release of ADH, leading to water retention and dilutional
hyponatremia. A serum sodium of 125 mEq/L reflects this dilution. The other options are
incorrect: Serum osmolality would be low (<275), urine specific gravity would be high (>1.030),
and potassium is not primarily affected in the same way.
Question 4: A nurse is caring for a client who is receiving vancomycin IV. The client develops
flushing of the face, neck, and upper torso. Which nursing intervention is most appropriate?
A) Discontinue the infusion immediately as the client is having an anaphylactic reaction.
B) Slow the rate of the vancomycin infusion.
C) Administer diphenhydramine and continue the infusion at the same rate.
D) Document the finding as an expected side effect of the medication.
Correct Answer: B) Slow the rate of the vancomycin infusion.
Explanation: The client is experiencing "Red Man Syndrome," which is a rate-dependent infusion
reaction caused by the rapid release of histamine, not a true allergic reaction. Slowing the
infusion rate usually resolves these symptoms. It does not require discontinuation unless severe,
nor is it a simple side effect that should be ignored.
Question 5: A nurse is triaging clients in the emergency department. Which client should the
nurse see first?
A) A client with a sprained ankle reporting pain of 8/10.
Clinical Judgment, Nursing Priorities &
NCLEX-RN Practice Questions with Detailed
Rationales
Subject: NCLEX-RN / Next Generation NCLEX (NGN) – Clinical Judgment,
Prioritization, and Pharmacology
Question 1: A nurse is caring for a client with a history of heart failure who is receiving an
infusion of milrinone. The client’s blood pressure drops from 110/70 mmHg to 88/58 mmHg,
and the heart rate increases from 82 bpm to 118 bpm. Which action should the nurse take first?
A) Increase the rate of the maintenance IV fluids.
B) Slow or stop the milrinone infusion and notify the provider.
C) Administer a bolus of 0.9% normal saline as per protocol.
D) Elevate the head of the bed to 45 degrees.
Correct Answer: B) Slow or stop the milrinone infusion and notify the provider.
Explanation: Milrinone is a phosphodiesterase inhibitor that causes both positive inotropy and
systemic vasodilation. The sudden drop in blood pressure and compensatory tachycardia suggest
the client is experiencing profound hypotension related to the drug's vasodilatory effects.
Stopping the infusion is the priority intervention to prevent cardiovascular collapse. While fluids
(C) might be indicated, stopping the causative agent takes precedence.
Question 2: A nurse is assessing a client who is 4 hours postoperative following a thyroidectomy.
The nurse notes laryngeal stridor and restlessness. What is the nurse's priority action?
A) Notify the surgeon immediately and prepare for emergency intubation.
B) Administer the prescribed IV calcium gluconate.
C) Position the client in a high-Fowler’s position.
D) Check the dressing for signs of hemorrhage.
Correct Answer: A) Notify the surgeon immediately and prepare for emergency intubation.
, Explanation: Laryngeal stridor is a high-pitched sound indicating airway obstruction, which is a
medical emergency following a thyroidectomy. It may result from edema or accidental nerve
damage. Immediate notification and preparation for airway management take precedence over
all other assessments or interventions (such as calcium, which addresses tetany).
Question 3: A client is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which laboratory finding should the nurse expect?
A) Serum sodium 125 mEq/L
B) Serum osmolality 310 mOsm/kg
C) Urine specific gravity 1.005
D) Serum potassium 3.0 mEq/L
Correct Answer: A) Serum sodium 125 mEq/L
Explanation: SIADH causes excessive release of ADH, leading to water retention and dilutional
hyponatremia. A serum sodium of 125 mEq/L reflects this dilution. The other options are
incorrect: Serum osmolality would be low (<275), urine specific gravity would be high (>1.030),
and potassium is not primarily affected in the same way.
Question 4: A nurse is caring for a client who is receiving vancomycin IV. The client develops
flushing of the face, neck, and upper torso. Which nursing intervention is most appropriate?
A) Discontinue the infusion immediately as the client is having an anaphylactic reaction.
B) Slow the rate of the vancomycin infusion.
C) Administer diphenhydramine and continue the infusion at the same rate.
D) Document the finding as an expected side effect of the medication.
Correct Answer: B) Slow the rate of the vancomycin infusion.
Explanation: The client is experiencing "Red Man Syndrome," which is a rate-dependent infusion
reaction caused by the rapid release of histamine, not a true allergic reaction. Slowing the
infusion rate usually resolves these symptoms. It does not require discontinuation unless severe,
nor is it a simple side effect that should be ignored.
Question 5: A nurse is triaging clients in the emergency department. Which client should the
nurse see first?
A) A client with a sprained ankle reporting pain of 8/10.
