**UWorld NCLEX-RN Readiness Surge: 2024
Assessment Exam** (Theme: UWorld NCLEX-
RN Readiness Assessment 2024)
---
1. Pt with acute exacerbation of COPD, RR 32, using accessory muscles, SpO2 88% on 2L NC. ABG: pH
7.31, PaCO2 65, PaO2 55. Next action?
💫RATIONALE✔️✔️: Hypercapnic respiratory failure with acidosis; BiPAP noninvasive ventilation first
line.
💫ANSWER✔️✔️: C. BiPAP.
---
2. Pt with heart failure, EF 25%, on carvedilol, lisinopril, furosemide. Reports 5 lb weight gain in 3 days,
increased dyspnea. Next intervention?
💫RATIONALE✔️✔️: Acute decompensation; increase furosemide dose or add metolazone.
💫ANSWER✔️✔️: B. Increase furosemide.
---
3. Pt with heparin drip for PE, aPTT 110 seconds, bloody gums. Next action?
💫RATIONALE✔️✔️: Supratherapeutic aPTT with bleeding; stop heparin, consider protamine.
💫ANSWER✔️✔️: A. Stop heparin drip.
---
4. Pt with acute pancreatitis, lipase 1200, pain 9/10, NPO. Which pain medication is preferred?
💫RATIONALE✔️✔️: IV hydromorphone or fentanyl; avoid meperidine (seizure risk).
💫ANSWER✔️✔️: D. Hydromorphone IV.
---
5. Pt with cirrhosis, ascites, on spironolactone and furosemide. Weight stable, but Na 125 mEq/L. Next
action?
, 💫RATIONALE✔️✔️: Hold diuretics for severe hyponatremia (Na <125); fluid restriction.
💫ANSWER✔️✔️: B. Hold spironolactone and furosemide.
---
6. Pt with new ileostomy, output 2000 mL/day, Na 130, K+ 3.0. Which instruction prevents dehydration?
💫RATIONALE✔️✔️: Increase oral rehydration solutions (broth, sports drinks); avoid plain water.
💫ANSWER✔️✔️: A. "Drink broth and sports drinks daily."
---
7. Pt with bipolar I disorder, acute mania, aggressive, psychotic. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Lithium or valproate plus second-generation antipsychotic (olanzapine,
risperidone).
💫ANSWER✔️✔️: C. Olanzapine + valproate.
---
8. Pt with major depression, failed sertraline and venlafaxine. Next evidence-based step?
💫RATIONALE✔️✔️: Augmentation with aripiprazole 2-5 mg or switch to vortioxetine.
💫ANSWER✔️✔️: B. Add aripiprazole.
---
9. Pt with panic disorder, on paroxetine 40 mg daily for 8 weeks, partial response. Next?
💫RATIONALE✔️✔️: Increase to 50-60 mg or add CBT; clonazepam for acute symptoms.
💫ANSWER✔️✔️: D. Increase paroxetine to 50 mg.
---
10. Pt with schizophrenia on clozapine, fever 38.5°C, sore throat, malaise. Priority lab?
💫RATIONALE✔️✔️: Absolute neutrophil count (ANC) for agranulocytosis; hold clozapine if ANC <1000.
💫ANSWER✔️✔️: A. ANC.
---
11. Pt with neuroleptic malignant syndrome (NMS) from haloperidol, temperature 39.5°C, rigidity, CPK
10,000. First drug?
💫RATIONALE✔️✔️: Dantrolene (for rigidity) and bromocriptine; stop antipsychotic.
💫ANSWER✔️✔️: A. Dantrolene.
Assessment Exam** (Theme: UWorld NCLEX-
RN Readiness Assessment 2024)
---
1. Pt with acute exacerbation of COPD, RR 32, using accessory muscles, SpO2 88% on 2L NC. ABG: pH
7.31, PaCO2 65, PaO2 55. Next action?
💫RATIONALE✔️✔️: Hypercapnic respiratory failure with acidosis; BiPAP noninvasive ventilation first
line.
💫ANSWER✔️✔️: C. BiPAP.
---
2. Pt with heart failure, EF 25%, on carvedilol, lisinopril, furosemide. Reports 5 lb weight gain in 3 days,
increased dyspnea. Next intervention?
💫RATIONALE✔️✔️: Acute decompensation; increase furosemide dose or add metolazone.
💫ANSWER✔️✔️: B. Increase furosemide.
---
3. Pt with heparin drip for PE, aPTT 110 seconds, bloody gums. Next action?
💫RATIONALE✔️✔️: Supratherapeutic aPTT with bleeding; stop heparin, consider protamine.
💫ANSWER✔️✔️: A. Stop heparin drip.
---
4. Pt with acute pancreatitis, lipase 1200, pain 9/10, NPO. Which pain medication is preferred?
💫RATIONALE✔️✔️: IV hydromorphone or fentanyl; avoid meperidine (seizure risk).
💫ANSWER✔️✔️: D. Hydromorphone IV.
---
5. Pt with cirrhosis, ascites, on spironolactone and furosemide. Weight stable, but Na 125 mEq/L. Next
action?
, 💫RATIONALE✔️✔️: Hold diuretics for severe hyponatremia (Na <125); fluid restriction.
💫ANSWER✔️✔️: B. Hold spironolactone and furosemide.
---
6. Pt with new ileostomy, output 2000 mL/day, Na 130, K+ 3.0. Which instruction prevents dehydration?
💫RATIONALE✔️✔️: Increase oral rehydration solutions (broth, sports drinks); avoid plain water.
💫ANSWER✔️✔️: A. "Drink broth and sports drinks daily."
---
7. Pt with bipolar I disorder, acute mania, aggressive, psychotic. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Lithium or valproate plus second-generation antipsychotic (olanzapine,
risperidone).
💫ANSWER✔️✔️: C. Olanzapine + valproate.
---
8. Pt with major depression, failed sertraline and venlafaxine. Next evidence-based step?
💫RATIONALE✔️✔️: Augmentation with aripiprazole 2-5 mg or switch to vortioxetine.
💫ANSWER✔️✔️: B. Add aripiprazole.
---
9. Pt with panic disorder, on paroxetine 40 mg daily for 8 weeks, partial response. Next?
💫RATIONALE✔️✔️: Increase to 50-60 mg or add CBT; clonazepam for acute symptoms.
💫ANSWER✔️✔️: D. Increase paroxetine to 50 mg.
---
10. Pt with schizophrenia on clozapine, fever 38.5°C, sore throat, malaise. Priority lab?
💫RATIONALE✔️✔️: Absolute neutrophil count (ANC) for agranulocytosis; hold clozapine if ANC <1000.
💫ANSWER✔️✔️: A. ANC.
---
11. Pt with neuroleptic malignant syndrome (NMS) from haloperidol, temperature 39.5°C, rigidity, CPK
10,000. First drug?
💫RATIONALE✔️✔️: Dantrolene (for rigidity) and bromocriptine; stop antipsychotic.
💫ANSWER✔️✔️: A. Dantrolene.
