**THE ULTIMATE NURSING SYNTHESIS DRILL: 2026
LICENSURE EXAM PREP FORGE**
Question 1
A nurse is caring for a patient with a new diagnosis of Addison's disease. Which finding requires
immediate intervention?
A) Skin hyperpigmentation
B) Blood pressure 85/50 mmHg with heart rate 120 bpm
C) Serum sodium 134 mEq/L
D) Fasting blood glucose 100 mg/dL
---
💫RATIONALE✔️✔️: Hypotension with tachycardia indicates adrenal crisis (hypovolemic shock), requiring
immediate IV fluids and hydrocortisone.
💫ANSWER✔️✔️: B) Blood pressure 85/50 mmHg with heart rate 120 bpm
Question 2
A patient with a history of seizures is prescribed levetiracetam. Which side effect should the nurse teach
the patient to report?
A) Drowsiness and fatigue
B) Behavioral changes or suicidal thoughts
C) Weight gain
D) Blurred vision
---
💫RATIONALE✔️✔️: Levetiracetam carries a black box warning for serious behavioral changes (aggression,
psychosis) and suicidal ideation.
💫ANSWER✔️✔️: B) Behavioral changes or suicidal thoughts
Question 3
,A nurse is assessing a patient with a suspected small bowel obstruction. Which finding is most
characteristic?
A) Constipation and absent bowel sounds
B) Projectile vomiting and hyperactive bowel sounds
C) Diarrhea and fecal incontinence
D) Dullness to percussion over the abdomen
---
💫RATIONALE✔️✔️: Early small bowel obstruction presents with hyperactive, high-pitched bowel sounds
and profuse, projectile vomiting.
💫ANSWER✔️✔️: B) Projectile vomiting and hyperactive bowel sounds
Question 4
A client with a history of bipolar disorder is taking lithium. The nurse notes a tremor, nausea, and
confusion. What is the priority action?
A) Administer a PRN dose of benztropine
B) Hold the next lithium dose and check serum level
C) Increase the patient's fluid intake
D) Reassure the patient that these are normal side effects
---
💫RATIONALE✔️✔️: Nausea, coarse tremor, and confusion suggest lithium toxicity; the nurse must hold
the dose and obtain a stat serum level.
💫ANSWER✔️✔️: B) Hold the next lithium dose and check serum level
Question 5
A patient is receiving a continuous heparin infusion. The nurse notes petechiae on the patient's chest
and a platelet count of 50,000/mm³. What should the nurse do?
A) Continue the heparin and monitor for bleeding
B) Stop the heparin infusion immediately
C) Administer protamine sulfate
D) Increase the heparin rate to prevent clotting
, ---
💫RATIONALE✔️✔️: Sudden thrombocytopenia and petechiae suggest heparin-induced
thrombocytopenia (HIT); stop heparin immediately to prevent thrombosis.
💫ANSWER✔️✔️: B) Stop the heparin infusion immediately
Question 6
A nurse is teaching a patient with a new colostomy about diet. Which food is most likely to cause gas
and odor?
A) Applesauce
B) Eggs
C) Yogurt
D) White rice
---
💫RATIONALE✔️✔️: Eggs, onions, garlic, beans, and cabbage increase gas and odor in colostomy output.
💫ANSWER✔️✔️: B) Eggs
Question 7
A patient with chronic heart failure is prescribed carvedilol. The nurse should withhold the dose if which
finding is present?
A) Blood pressure 110/70 mmHg
B) Heart rate 52 bpm
C) Weight gain of 1 kg in 24 hours
D) Serum potassium 4.2 mEq/L
---
💫RATIONALE✔️✔️: Carvedilol (beta-blocker) is held if the heart rate is <55-60 bpm; bradycardia can
worsen heart failure and cause syncope.
💫ANSWER✔️✔️: B) Heart rate 52 bpm
Question 8
LICENSURE EXAM PREP FORGE**
Question 1
A nurse is caring for a patient with a new diagnosis of Addison's disease. Which finding requires
immediate intervention?
A) Skin hyperpigmentation
B) Blood pressure 85/50 mmHg with heart rate 120 bpm
C) Serum sodium 134 mEq/L
D) Fasting blood glucose 100 mg/dL
---
💫RATIONALE✔️✔️: Hypotension with tachycardia indicates adrenal crisis (hypovolemic shock), requiring
immediate IV fluids and hydrocortisone.
💫ANSWER✔️✔️: B) Blood pressure 85/50 mmHg with heart rate 120 bpm
Question 2
A patient with a history of seizures is prescribed levetiracetam. Which side effect should the nurse teach
the patient to report?
A) Drowsiness and fatigue
B) Behavioral changes or suicidal thoughts
C) Weight gain
D) Blurred vision
---
💫RATIONALE✔️✔️: Levetiracetam carries a black box warning for serious behavioral changes (aggression,
psychosis) and suicidal ideation.
💫ANSWER✔️✔️: B) Behavioral changes or suicidal thoughts
Question 3
,A nurse is assessing a patient with a suspected small bowel obstruction. Which finding is most
characteristic?
A) Constipation and absent bowel sounds
B) Projectile vomiting and hyperactive bowel sounds
C) Diarrhea and fecal incontinence
D) Dullness to percussion over the abdomen
---
💫RATIONALE✔️✔️: Early small bowel obstruction presents with hyperactive, high-pitched bowel sounds
and profuse, projectile vomiting.
💫ANSWER✔️✔️: B) Projectile vomiting and hyperactive bowel sounds
Question 4
A client with a history of bipolar disorder is taking lithium. The nurse notes a tremor, nausea, and
confusion. What is the priority action?
A) Administer a PRN dose of benztropine
B) Hold the next lithium dose and check serum level
C) Increase the patient's fluid intake
D) Reassure the patient that these are normal side effects
---
💫RATIONALE✔️✔️: Nausea, coarse tremor, and confusion suggest lithium toxicity; the nurse must hold
the dose and obtain a stat serum level.
💫ANSWER✔️✔️: B) Hold the next lithium dose and check serum level
Question 5
A patient is receiving a continuous heparin infusion. The nurse notes petechiae on the patient's chest
and a platelet count of 50,000/mm³. What should the nurse do?
A) Continue the heparin and monitor for bleeding
B) Stop the heparin infusion immediately
C) Administer protamine sulfate
D) Increase the heparin rate to prevent clotting
, ---
💫RATIONALE✔️✔️: Sudden thrombocytopenia and petechiae suggest heparin-induced
thrombocytopenia (HIT); stop heparin immediately to prevent thrombosis.
💫ANSWER✔️✔️: B) Stop the heparin infusion immediately
Question 6
A nurse is teaching a patient with a new colostomy about diet. Which food is most likely to cause gas
and odor?
A) Applesauce
B) Eggs
C) Yogurt
D) White rice
---
💫RATIONALE✔️✔️: Eggs, onions, garlic, beans, and cabbage increase gas and odor in colostomy output.
💫ANSWER✔️✔️: B) Eggs
Question 7
A patient with chronic heart failure is prescribed carvedilol. The nurse should withhold the dose if which
finding is present?
A) Blood pressure 110/70 mmHg
B) Heart rate 52 bpm
C) Weight gain of 1 kg in 24 hours
D) Serum potassium 4.2 mEq/L
---
💫RATIONALE✔️✔️: Carvedilol (beta-blocker) is held if the heart rate is <55-60 bpm; bradycardia can
worsen heart failure and cause syncope.
💫ANSWER✔️✔️: B) Heart rate 52 bpm
Question 8
