NGN-NCLEX Prep Questions with
Rationales.
The nurse notes the presence of a P wave, QRS complex, flattened T waves, and occasional U waves on a
client's cardiac monitor screen. Fill in the correct missing information by choosing from the lists of options in
the drop-down menus. The nurse should suspect
Your Answer: hypokalemiaCorrect Answer: hypokalemia
because of the
Your Answer: flattened T waves and occasional U wavesCorrect Answer: flattened T waves and occasional U
waves
Rationale:Cardiac changes in hypokalemia include impaired repolarization, resulting in a flattening of the T
wave and eventually the emergence of a U wave. Therefore, the nurse should suspect hypokalemia. The
incidence of potentially lethal ventricular dysrhythmias is increased in hypokalemia. The nurse should
immediately assess the client's vital signs and cardiac status for signs of hypokalemia. The nurse should also
check the client's most recent serum potassium level and then contact the primary health care provider to
report the findings and obtain prescriptions to treat the hypokalemic state.
The nurse is preparing a client for a chest x-ray and notes that the client is wearing a religious medal on a chain
around the neck. What should the nurse do with regard to this personal item? Click to highlight the correct
answer from the options provided. The nurse should: (Select 1 option)
✓Ask the client if the chain and medal can be removed during the procedure.
Because: (Select 1 option)
✓The chain and medal may have cultural significance.
Rationale:Before certain diagnostic procedures, it is typical to have a client remove personal objects that are
worn on the body because of client safety and the possibility of compromising test results. Therefore, the nurse
should ask the client about the significance of such an item and its removal because it may have cultural or
spiritual significance. If so, the nurse should ask the client if the item can be either removed temporarily or
placed on another part of the body during the procedure if appropriate.
,While preparing a client for surgery scheduled in 1 hour, the client states to the nurse: "I have changed my
mind. I don't want this surgery." Click to highlight the correct answer from the options provided. The nurse
should: (Select 1 option)
Cancel the surgery.
Contact the surgeon.
✓Discuss the client's concerns.
Call the identified support person.
Because: (Select 1 option)
Client consent is required prior to any procedure.
✓Further questions or concerns should be determined and addressed.
Ethical considerations are important for a client undergoing surgery.
The nursing scope of practice places limitations on how the nurse can respond.
Rationale:If the client indicates that he or she does not want a prescribed therapy, treatment, or procedure
such as surgery, the nurse should further investigate the client's request. If the client indicates that he or she
has changed his or her mind about surgery, the nurse should assess the client and explore with the client his or
her concerns about not wanting the surgery. The nurse would then withhold further surgical preparation and
contact the surgeon to report the client's request so that the surgeon can discuss the consequences of not
having the surgery with the client. Further assessment and follow-up related to the client's request need to be
done. It is the client's right to refuse treatment; however, further investigation is needed so the interventions
can be tailored to specific needs.
The nurse notes that there has been an increase in the number of intravenous (IV) site infections that
developed in the clients being cared for on the nursing unit. How should the nurse proceed to implement a
quality improvement program?For each action, click to specify whether the action would be:
Indicated: an action that the nurse should take to resolve the problem
Non-essential: an action that the nurse could take without harming the client, but the action would not be
likely to address the problem
Contraindicated: an action that could harm the client and should not be taken Collect identifying
patient information
Contraindicated
, Note the mental status of the client
Non-essential
Note primary and secondary diagnoses of clients affected
Indicated
Note the type of IV catheter used
Indicated
Note the type of IV site dressings being used
Indicated
Note the medication types being infused
Non-essential
Note frequency of assessments of IV sites
Indicated
Note the expected duration of the IV site
Non-essential
Note care procedures to the IV site
Indicated
Note frequency of changing IV sites
Indicated
Rationale:Quality improvement, also known as performance improvement, focuses on processes or systems
that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor
outcomes of care and to determine the need for change to improve the quality of care. If the nurse notes a
particular problem, such as an increase in the number of intravenous (IV) site infections, the nurse should
collect data about the problem. This should include information such as the primary and secondary diagnoses
of the clients developing the infection, the type of IV catheters being used, the site of the catheter, IV site
dressings being used, frequency of assessment and methods of care to the IV site, and length of time that the
IV catheter was inserted. Once these data are collected and analyzed, the nurse should examine evidence-
based practice protocols to identify the best practices for care to IV sites to prevent infection. These practices
can then be implemented and followed by evaluation of results based on the evidence-based practice
protocols used. Collecting identifying client information is contraindicated because of confidentiality and is
unnecessary in this quality improvement effort. Noting the mental status of the clients can be done but is not
Rationales.
The nurse notes the presence of a P wave, QRS complex, flattened T waves, and occasional U waves on a
client's cardiac monitor screen. Fill in the correct missing information by choosing from the lists of options in
the drop-down menus. The nurse should suspect
Your Answer: hypokalemiaCorrect Answer: hypokalemia
because of the
Your Answer: flattened T waves and occasional U wavesCorrect Answer: flattened T waves and occasional U
waves
Rationale:Cardiac changes in hypokalemia include impaired repolarization, resulting in a flattening of the T
wave and eventually the emergence of a U wave. Therefore, the nurse should suspect hypokalemia. The
incidence of potentially lethal ventricular dysrhythmias is increased in hypokalemia. The nurse should
immediately assess the client's vital signs and cardiac status for signs of hypokalemia. The nurse should also
check the client's most recent serum potassium level and then contact the primary health care provider to
report the findings and obtain prescriptions to treat the hypokalemic state.
The nurse is preparing a client for a chest x-ray and notes that the client is wearing a religious medal on a chain
around the neck. What should the nurse do with regard to this personal item? Click to highlight the correct
answer from the options provided. The nurse should: (Select 1 option)
✓Ask the client if the chain and medal can be removed during the procedure.
Because: (Select 1 option)
✓The chain and medal may have cultural significance.
Rationale:Before certain diagnostic procedures, it is typical to have a client remove personal objects that are
worn on the body because of client safety and the possibility of compromising test results. Therefore, the nurse
should ask the client about the significance of such an item and its removal because it may have cultural or
spiritual significance. If so, the nurse should ask the client if the item can be either removed temporarily or
placed on another part of the body during the procedure if appropriate.
,While preparing a client for surgery scheduled in 1 hour, the client states to the nurse: "I have changed my
mind. I don't want this surgery." Click to highlight the correct answer from the options provided. The nurse
should: (Select 1 option)
Cancel the surgery.
Contact the surgeon.
✓Discuss the client's concerns.
Call the identified support person.
Because: (Select 1 option)
Client consent is required prior to any procedure.
✓Further questions or concerns should be determined and addressed.
Ethical considerations are important for a client undergoing surgery.
The nursing scope of practice places limitations on how the nurse can respond.
Rationale:If the client indicates that he or she does not want a prescribed therapy, treatment, or procedure
such as surgery, the nurse should further investigate the client's request. If the client indicates that he or she
has changed his or her mind about surgery, the nurse should assess the client and explore with the client his or
her concerns about not wanting the surgery. The nurse would then withhold further surgical preparation and
contact the surgeon to report the client's request so that the surgeon can discuss the consequences of not
having the surgery with the client. Further assessment and follow-up related to the client's request need to be
done. It is the client's right to refuse treatment; however, further investigation is needed so the interventions
can be tailored to specific needs.
The nurse notes that there has been an increase in the number of intravenous (IV) site infections that
developed in the clients being cared for on the nursing unit. How should the nurse proceed to implement a
quality improvement program?For each action, click to specify whether the action would be:
Indicated: an action that the nurse should take to resolve the problem
Non-essential: an action that the nurse could take without harming the client, but the action would not be
likely to address the problem
Contraindicated: an action that could harm the client and should not be taken Collect identifying
patient information
Contraindicated
, Note the mental status of the client
Non-essential
Note primary and secondary diagnoses of clients affected
Indicated
Note the type of IV catheter used
Indicated
Note the type of IV site dressings being used
Indicated
Note the medication types being infused
Non-essential
Note frequency of assessments of IV sites
Indicated
Note the expected duration of the IV site
Non-essential
Note care procedures to the IV site
Indicated
Note frequency of changing IV sites
Indicated
Rationale:Quality improvement, also known as performance improvement, focuses on processes or systems
that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor
outcomes of care and to determine the need for change to improve the quality of care. If the nurse notes a
particular problem, such as an increase in the number of intravenous (IV) site infections, the nurse should
collect data about the problem. This should include information such as the primary and secondary diagnoses
of the clients developing the infection, the type of IV catheters being used, the site of the catheter, IV site
dressings being used, frequency of assessment and methods of care to the IV site, and length of time that the
IV catheter was inserted. Once these data are collected and analyzed, the nurse should examine evidence-
based practice protocols to identify the best practices for care to IV sites to prevent infection. These practices
can then be implemented and followed by evaluation of results based on the evidence-based practice
protocols used. Collecting identifying client information is contraindicated because of confidentiality and is
unnecessary in this quality improvement effort. Noting the mental status of the clients can be done but is not
