**Title:** **The Next Generation NCLEX-RN Clinical
Judgment Bootcamp: High-Acuity Scenarios**
---
### Question 1 of 112
A nurse is caring for a client with new DVT on heparin. aPTT is 110 sec, control 30 sec. Action?
A) Continue infusion
B) Decrease rate
C) Stop infusion, notify provider
D) Give vitamin K
💫RATIONALE✔️✔️: aPTT 110 is >3.6x control, supratherapeutic. Stop heparin, notify provider. Vitamin K
reverses warfarin.
💫ANSWER✔️✔️: C) Stop infusion, notify provider
---
### Question 2 of 112
A client with chest tube has continuous bubbling in water-seal chamber. First action?
A) Clamp tube
B) Tighten connections
C) Notify provider
,D) Document
💫RATIONALE✔️✔️: Continuous bubbling = air leak. First tighten connections (B). Clamping dangerous.
💫ANSWER✔️✔️: B) Tighten connections
---
### Question 3 of 112
**Select-All-That-Apply (SATA):** A nurse assesses a client with COPD exacerbation. Which findings
indicate severe exacerbation? (Select all that apply.)
A) Silent chest
B) SpO2 88% on RA
C) Pulsus paradoxus 15 mmHg
D) Speaking full sentences
E) PEF 50% personal best
💫RATIONALE✔️✔️: Silent chest (A), SpO2 <90% (B), pulsus paradoxus >12 (C) = severe. Full sentences =
mild. PEF 50% = moderate.
💫ANSWER✔️✔️: A, B, C
---
### Question 4 of 112
A client with HF has new lisinopril. Which finding requires immediate reporting?
A) Dry cough
,B) Serum K+ 4.8
C) BP 110/70
D) Angioedema
💫RATIONALE✔️✔️: Angioedema (D) is life-threatening allergic reaction to ACE inhibitors. Dry cough
common but not emergent.
💫ANSWER✔️✔️: D) Angioedema
---
### Question 5 of 112
A nurse is providing discharge teaching to a client on warfarin. Which statement indicates
understanding?
A) "I'll take ibuprofen for headaches."
B) "I'll have my INR checked regularly."
C) "I'll eat large amounts of spinach."
D) "If I miss a dose, I'll double the next."
💫RATIONALE✔️✔️: Regular INR monitoring (B) essential. Avoid NSAIDs, consistent vitamin K, no double-
dosing.
💫ANSWER✔️✔️: B) "I'll have my INR checked regularly."
---
### Question 6 of 112
A client receiving blood transfusion reports low back pain and chills. First action?
, A) Slow infusion
B) Stop transfusion
C) Give acetaminophen
D) Notify provider
💫RATIONALE✔️✔️: Low back pain/chills = hemolytic reaction. First stop transfusion (B), then notify
provider.
💫ANSWER✔️✔️: B) Stop transfusion
---
### Question 7 of 112
**Select-All-That-Apply (SATA):** A nurse assesses hyperthyroidism. Which findings are expected?
(Select all that apply.)
A) Weight loss
B) Bradycardia
C) Heat intolerance
D) Exophthalmos
E) Constipation
💫RATIONALE✔️✔️: Hyperthyroidism: weight loss (A), heat intolerance (C), exophthalmos (D).
Bradycardia/constipation are hypothyroidism.
💫ANSWER✔️✔️: A, C, D
---
### Question 8 of 112
Judgment Bootcamp: High-Acuity Scenarios**
---
### Question 1 of 112
A nurse is caring for a client with new DVT on heparin. aPTT is 110 sec, control 30 sec. Action?
A) Continue infusion
B) Decrease rate
C) Stop infusion, notify provider
D) Give vitamin K
💫RATIONALE✔️✔️: aPTT 110 is >3.6x control, supratherapeutic. Stop heparin, notify provider. Vitamin K
reverses warfarin.
💫ANSWER✔️✔️: C) Stop infusion, notify provider
---
### Question 2 of 112
A client with chest tube has continuous bubbling in water-seal chamber. First action?
A) Clamp tube
B) Tighten connections
C) Notify provider
,D) Document
💫RATIONALE✔️✔️: Continuous bubbling = air leak. First tighten connections (B). Clamping dangerous.
💫ANSWER✔️✔️: B) Tighten connections
---
### Question 3 of 112
**Select-All-That-Apply (SATA):** A nurse assesses a client with COPD exacerbation. Which findings
indicate severe exacerbation? (Select all that apply.)
A) Silent chest
B) SpO2 88% on RA
C) Pulsus paradoxus 15 mmHg
D) Speaking full sentences
E) PEF 50% personal best
💫RATIONALE✔️✔️: Silent chest (A), SpO2 <90% (B), pulsus paradoxus >12 (C) = severe. Full sentences =
mild. PEF 50% = moderate.
💫ANSWER✔️✔️: A, B, C
---
### Question 4 of 112
A client with HF has new lisinopril. Which finding requires immediate reporting?
A) Dry cough
,B) Serum K+ 4.8
C) BP 110/70
D) Angioedema
💫RATIONALE✔️✔️: Angioedema (D) is life-threatening allergic reaction to ACE inhibitors. Dry cough
common but not emergent.
💫ANSWER✔️✔️: D) Angioedema
---
### Question 5 of 112
A nurse is providing discharge teaching to a client on warfarin. Which statement indicates
understanding?
A) "I'll take ibuprofen for headaches."
B) "I'll have my INR checked regularly."
C) "I'll eat large amounts of spinach."
D) "If I miss a dose, I'll double the next."
💫RATIONALE✔️✔️: Regular INR monitoring (B) essential. Avoid NSAIDs, consistent vitamin K, no double-
dosing.
💫ANSWER✔️✔️: B) "I'll have my INR checked regularly."
---
### Question 6 of 112
A client receiving blood transfusion reports low back pain and chills. First action?
, A) Slow infusion
B) Stop transfusion
C) Give acetaminophen
D) Notify provider
💫RATIONALE✔️✔️: Low back pain/chills = hemolytic reaction. First stop transfusion (B), then notify
provider.
💫ANSWER✔️✔️: B) Stop transfusion
---
### Question 7 of 112
**Select-All-That-Apply (SATA):** A nurse assesses hyperthyroidism. Which findings are expected?
(Select all that apply.)
A) Weight loss
B) Bradycardia
C) Heat intolerance
D) Exophthalmos
E) Constipation
💫RATIONALE✔️✔️: Hyperthyroidism: weight loss (A), heat intolerance (C), exophthalmos (D).
Bradycardia/constipation are hypothyroidism.
💫ANSWER✔️✔️: A, C, D
---
### Question 8 of 112
