NUR 283 COMPREHENSIVE
PREDICTOR MOCK EXAM STUDY
GUIDE 200 NCLEX STYLE
QUESTIONS WITH DETAILED
RATIONALES
Nursing NUR 283: Comprehensive 2 Mock Exam
Question 1
A client with a history of chronic kidney disease (CKD) presents to the
emergency department with a serum potassium level of 6.8 mEq/L. The
electrocardiogram (ECG) reveals tall, peaked T waves and a widened
QRS complex. Which intravenous medication should the nurse
anticipate administering first to stabilize the myocardial cell membrane?
• A) Sodium polystyrene sulfonate
• B) 10% Calcium gluconate
• C) Regular insulin and 50% dextrose
• D) Sodium bicarbonate
Rationale: While insulin, dextrose, and sodium polystyrene sulfonate
work to lower serum potassium levels, 10% calcium gluconate is the
priority intervention because it immediately stabilizes the myocardial
cell membrane, reducing the risk of life-threatening ventricular
arrhythmias. It does not lower the potassium level itself but protects the
heart while other therapies shift or eliminate the potassium.
Question 2
The nurse is caring for a client in the intensive care unit who is receiving
mechanical ventilation. The ventilator's high-pressure alarm suddenly
sounds. Which physiological or mechanical event should the nurse
investigate as a potential cause of this alarm?
• A) A disconnection between the ventilator tubing and the
endotracheal tube.
, • B) A cuff leak within the patient's artificial airway.
• C) The client biting the endotracheal tube or excessive
pulmonary secretions.
• D) Total electrical power failure of the mechanical ventilator unit.
Rationale: High-pressure alarms are triggered by an increase in
resistance to airflow within the ventilator circuit, such as a client biting
the tube, a kink in the tubing, excessive secretions requiring suctioning,
or bronchospasms. Disconnections and cuff leaks drop the circuit
pressure, which triggers a low-pressure alarm.
Question 3
A client is admitted to the medical-surgical unit 2 hours post-operative
following a subtotal thyroidectomy. Which clinical finding should the
nurse prioritize as an early sign of latent tetany secondary to accidental
parathyroid gland removal?
• A) Severe hoarseness when speaking to the nurse.
• B) Profuse bleeding on the posterior neck dressing.
• C) Numbness and tingling around the mouth and in the
fingertips.
• D) Severe localized pain at the anterior surgical incision site.
Rationale: Accidental damage or removal of the parathyroid glands
during a thyroidectomy causes hypocalcemia. Early neuromuscular
signs of low calcium levels include circumoral paresthesia
(numbness/tingling around the mouth) and tingling fingertips, which
can progress to positive Chvostek's or Trousseau's signs and
laryngospasm.
Question 4
The nurse is reviewing the arterial blood gas (ABG) results of a client
with severe, prolonged vomiting due to a bowel obstruction. The results
reveal: pH 7.51, PaCO2 48 mmHg, and HCO3 36 mEq/L. How should
the nurse accurately interpret this acid-base imbalance?
• A) Uncompensated respiratory acidosis.
, • B) Fully compensated metabolic acidosis.
• C) Partially compensated metabolic alkalosis.
• D) Uncompensated respiratory alkalosis.
Rationale: The pH is elevated (7.51), indicating alkalosis. The HCO3 is
high (36 mEq/L), which matches the alkalosis profile (metabolic). The
PaCO2 is also elevated (48 mmHg), showing that the respiratory
system is attempting to retain acid to correct the imbalance. Because
the pH has not yet returned to the normal range, it is partially
compensated metabolic alkalosis.
Question 5
A client with a history of deep vein thrombosis (DVT) is receiving a
continuous intravenous heparin infusion. The client’s baseline activated
partial thromboplastin time (aPTT) was 30 seconds. Which current aPTT
value indicates that the client has reached a therapeutic anticoagulation
level?
• A) 32 seconds
• B) 42 seconds
• C) 70 seconds
• D) 115 seconds
Rationale: The therapeutic goal for a client receiving heparin is an
aPTT value that is approximately 1.5 to 2.5 times the baseline or normal
control value. With a baseline of 30 seconds, the therapeutic range falls
between 45 and 75 seconds. A value of 115 seconds is excessively
prolonged and increases the risk of hemorrhage.
Question 6
The nurse is assessing a client who was admitted with a diagnosis of
acute pancreatitis. Which physical assessment finding should the nurse
document as Cullen's sign?
• A) A sharp, localized pain elicited by palpating the right upper
abdominal quadrant.
, • B) Bluish discoloration around the periumbilical area
indicating intra-abdominal hemorrhage.
• C) Pain in the left shoulder aggravated by deep inspiration.
• D) Ecchymosis localized to the bilateral flanks and lower back
region.
Rationale: Cullen’s sign is defined as a bluish or purple discoloration
around the umbilicus, which indicates subcutaneous intraperitoneal
hemorrhage, a severe complication of acute pancreatitis. Flank
ecchymosis is known as Grey Turner’s sign.
Question 7
A client is brought to the emergency department via ambulance with a
suspected acute myocardial infarction. The nurse prepares to administer
a thrombolytic agent. Which finding in the client’s medical history
represents an absolute contraindication to thrombolytic therapy?
• A) Controlled primary hypertension managed with daily lisinopril.
• B) Ischemic stroke occurring 18 months ago without residual
deficits.
• C) History of an intracranial hemorrhage or an active
internal bleed.
• D) Uncomplicated lumbar spinal surgery performed 6 months ago.
Rationale: Thrombolytic therapy lyses clots systemically. A history of
intracranial hemorrhage, structural cerebrovascular lesions, known
intracranial malignant neoplasms, or active internal bleeding
represents an absolute contraindication due to the catastrophic risk of
fatal cerebral or systemic hemorrhage.
Question 8
The nurse is caring for a client with a history of cirrhosis who develops
severe esophageal varices. The client suddenly begins vomiting large
amounts of bright red blood. Which initial nursing intervention is the
highest priority?
PREDICTOR MOCK EXAM STUDY
GUIDE 200 NCLEX STYLE
QUESTIONS WITH DETAILED
RATIONALES
Nursing NUR 283: Comprehensive 2 Mock Exam
Question 1
A client with a history of chronic kidney disease (CKD) presents to the
emergency department with a serum potassium level of 6.8 mEq/L. The
electrocardiogram (ECG) reveals tall, peaked T waves and a widened
QRS complex. Which intravenous medication should the nurse
anticipate administering first to stabilize the myocardial cell membrane?
• A) Sodium polystyrene sulfonate
• B) 10% Calcium gluconate
• C) Regular insulin and 50% dextrose
• D) Sodium bicarbonate
Rationale: While insulin, dextrose, and sodium polystyrene sulfonate
work to lower serum potassium levels, 10% calcium gluconate is the
priority intervention because it immediately stabilizes the myocardial
cell membrane, reducing the risk of life-threatening ventricular
arrhythmias. It does not lower the potassium level itself but protects the
heart while other therapies shift or eliminate the potassium.
Question 2
The nurse is caring for a client in the intensive care unit who is receiving
mechanical ventilation. The ventilator's high-pressure alarm suddenly
sounds. Which physiological or mechanical event should the nurse
investigate as a potential cause of this alarm?
• A) A disconnection between the ventilator tubing and the
endotracheal tube.
, • B) A cuff leak within the patient's artificial airway.
• C) The client biting the endotracheal tube or excessive
pulmonary secretions.
• D) Total electrical power failure of the mechanical ventilator unit.
Rationale: High-pressure alarms are triggered by an increase in
resistance to airflow within the ventilator circuit, such as a client biting
the tube, a kink in the tubing, excessive secretions requiring suctioning,
or bronchospasms. Disconnections and cuff leaks drop the circuit
pressure, which triggers a low-pressure alarm.
Question 3
A client is admitted to the medical-surgical unit 2 hours post-operative
following a subtotal thyroidectomy. Which clinical finding should the
nurse prioritize as an early sign of latent tetany secondary to accidental
parathyroid gland removal?
• A) Severe hoarseness when speaking to the nurse.
• B) Profuse bleeding on the posterior neck dressing.
• C) Numbness and tingling around the mouth and in the
fingertips.
• D) Severe localized pain at the anterior surgical incision site.
Rationale: Accidental damage or removal of the parathyroid glands
during a thyroidectomy causes hypocalcemia. Early neuromuscular
signs of low calcium levels include circumoral paresthesia
(numbness/tingling around the mouth) and tingling fingertips, which
can progress to positive Chvostek's or Trousseau's signs and
laryngospasm.
Question 4
The nurse is reviewing the arterial blood gas (ABG) results of a client
with severe, prolonged vomiting due to a bowel obstruction. The results
reveal: pH 7.51, PaCO2 48 mmHg, and HCO3 36 mEq/L. How should
the nurse accurately interpret this acid-base imbalance?
• A) Uncompensated respiratory acidosis.
, • B) Fully compensated metabolic acidosis.
• C) Partially compensated metabolic alkalosis.
• D) Uncompensated respiratory alkalosis.
Rationale: The pH is elevated (7.51), indicating alkalosis. The HCO3 is
high (36 mEq/L), which matches the alkalosis profile (metabolic). The
PaCO2 is also elevated (48 mmHg), showing that the respiratory
system is attempting to retain acid to correct the imbalance. Because
the pH has not yet returned to the normal range, it is partially
compensated metabolic alkalosis.
Question 5
A client with a history of deep vein thrombosis (DVT) is receiving a
continuous intravenous heparin infusion. The client’s baseline activated
partial thromboplastin time (aPTT) was 30 seconds. Which current aPTT
value indicates that the client has reached a therapeutic anticoagulation
level?
• A) 32 seconds
• B) 42 seconds
• C) 70 seconds
• D) 115 seconds
Rationale: The therapeutic goal for a client receiving heparin is an
aPTT value that is approximately 1.5 to 2.5 times the baseline or normal
control value. With a baseline of 30 seconds, the therapeutic range falls
between 45 and 75 seconds. A value of 115 seconds is excessively
prolonged and increases the risk of hemorrhage.
Question 6
The nurse is assessing a client who was admitted with a diagnosis of
acute pancreatitis. Which physical assessment finding should the nurse
document as Cullen's sign?
• A) A sharp, localized pain elicited by palpating the right upper
abdominal quadrant.
, • B) Bluish discoloration around the periumbilical area
indicating intra-abdominal hemorrhage.
• C) Pain in the left shoulder aggravated by deep inspiration.
• D) Ecchymosis localized to the bilateral flanks and lower back
region.
Rationale: Cullen’s sign is defined as a bluish or purple discoloration
around the umbilicus, which indicates subcutaneous intraperitoneal
hemorrhage, a severe complication of acute pancreatitis. Flank
ecchymosis is known as Grey Turner’s sign.
Question 7
A client is brought to the emergency department via ambulance with a
suspected acute myocardial infarction. The nurse prepares to administer
a thrombolytic agent. Which finding in the client’s medical history
represents an absolute contraindication to thrombolytic therapy?
• A) Controlled primary hypertension managed with daily lisinopril.
• B) Ischemic stroke occurring 18 months ago without residual
deficits.
• C) History of an intracranial hemorrhage or an active
internal bleed.
• D) Uncomplicated lumbar spinal surgery performed 6 months ago.
Rationale: Thrombolytic therapy lyses clots systemically. A history of
intracranial hemorrhage, structural cerebrovascular lesions, known
intracranial malignant neoplasms, or active internal bleeding
represents an absolute contraindication due to the catastrophic risk of
fatal cerebral or systemic hemorrhage.
Question 8
The nurse is caring for a client with a history of cirrhosis who develops
severe esophageal varices. The client suddenly begins vomiting large
amounts of bright red blood. Which initial nursing intervention is the
highest priority?
