ESTUDY
NR 322 PASSPOINT NCLEX COMPREHENSIVE NURSING PRACTICE
QUESTIONS AND ANSWERS: CLINICAL SCENARIOS, RATIONALES, AND
KEY CONCEPTS
1. An adolescent is brought to the emergency department (ED) after accidentally taking an overdose
of heroin. The adolescent is semiconscious, unable to respond appropriately to questions, slurs words,
and has constricted pupils; the client's vital signs are blood pressure 60/50 mm Hg, pulse 50
beats/min, and respirations 8 breaths/min. Naloxone is administered to temporarily reverse the
effects of the heroin. Which finding would first indicate that the naloxone administration has been
effective?
A. The client's blood pressure increases to 90/60 mm Hg
B. The client's pulse rate increases to 70 beats/min
C. The client's respirations improve to 12/min
D. The client becomes fully conscious and alert
Rationale: The most dangerous effects of heroin overdose are respiratory depression and coma.
Naloxone reverses these effects, and an improvement in respiratory rate is the first sign of its
effectiveness. Changes in blood pressure, pulse, and consciousness may take longer to normalize.
2. The third stage of labor ends:
A. After complete cervical dilation
B. After the birth of the neonate
C. After the delivery of the placenta
D. After the first 4 hours postpartum
Rationale: The third stage of labor is defined as the period from the birth of the neonate to the delivery
of the placenta. The first stage ends with complete cervical dilation, the second stage ends with the
birth of the neonate, and the fourth stage includes the first 4 hours postpartum.
3. The client with a nasogastric (NG) tube has abdominal distention. What should the nurse do first?
A. Reposition the NG tube
B. Check the function of the suction equipment
C. Irrigate the NG tube
D. Notify the healthcare provider
,ESTUDY
Rationale: Abdominal distention in a client with an NG tube is often due to improper functioning of the
suction equipment. The nurse should first check the suction equipment to ensure it is working correctly
before taking other steps.
4. A public health nurse has been asked to teach the importance of hand washing to elderly clients.
Which statement by a client indicates that the teaching has been effective?
A. "Soap is the most important part of hand washing."
B. "Friction while washing hands decreases transmission of bacteria."
C. "Warm water alone is enough to clean my hands."
D. "I only need to wash my hands for 15 seconds."
Rationale: Friction is essential for removing microorganisms during hand washing. Soap helps reduce
surface tension, but friction is necessary for effective cleaning. Warm water alone or washing for only 15
seconds is insufficient.
5. A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's
physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how
neomycin decreases the serum ammonia concentration. How should the nurse respond?
A. "Neomycin traps ammonia in the GI tract."
B. "Neomycin decreases the amount of ammonia-producing bacteria in the GI tract."
C. "Neomycin binds with ammonia in the bloodstream."
D. "Neomycin increases the excretion of ammonia in the urine."
Rationale: Neomycin reduces the number of ammonia-producing bacteria in the gastrointestinal tract,
thereby lowering blood ammonia levels. It does not trap, bind, or excrete ammonia directly.
6. A hospital safety officer is evaluating nurses' responses to potential safety hazards. Which
employee actions are appropriate for the situation? Select all that apply.
A. Taking small steps with feet shoulder length apart when walking on wet surfaces
B. Removing clients from the area where a fire is reported
C. Using tongs to place a dislodged radioactive device in a lead container
D. Running to respond to an emergency call
E. Ignoring a spill to attend to a client
Rationale: Taking small steps on wet surfaces prevents slipping, removing clients from a fire ensures
their safety, and using tongs for radioactive materials minimizes exposure. Running and ignoring spills
are unsafe practices.
,ESTUDY
7. A client with chronic obstructive pulmonary disease presents with respiratory acidosis and
hypoxemia. The client tells the nurse that they don't want to be placed on a ventilator. What action
should the nurse take?
A. Document the client's wishes and notify the physician later
B. Notify the physician immediately to have the physician determine client competency
C. Discuss the implications of a DNR order with the client
D. Consult the palliative care team
Rationale: The client’s respiratory acidosis and hypoxemia may impair their decision-making capacity.
The physician must assess competency before honoring the client’s wishes. The nurse should not delay
notifying the physician.
8. A client in the emergency department reported vomiting and diarrhea for the previous 24 hours.
The client's blood pressure is 90/60 mm Hg, respiration is 20 breaths per minute, heart rate is 92 beats
per minute, and temperature is 37.5° C (99.5° F). Which intervention will the nurse perform first?
A. Administer antiemetic medication
B. Assess for dehydration
C. Raise the head of the bed
D. Administer IV fluids
Rationale: The priority is to assess the client’s condition. Dehydration is likely due to vomiting and
diarrhea, and assessment guides further interventions such as IV fluid administration.
9. A nurse is caring for a client who has returned to their room after a carotid endarterectomy. Which
action should the nurse take first?
A. Check the surgical incision for bleeding
B. Ask the client if they have trouble breathing
C. Assess the client’s neurological status
D. Administer prescribed pain medication
Rationale: A carotid endarterectomy can lead to an incisional hematoma, which may compress the
trachea and cause breathing difficulties. Assessing the client’s airway is the top priority.
10. A charge nurse is making client care assignments for the day. Which client would be most
appropriate to assign a licensed practical nurse (LPN)?
, ESTUDY
A. A 6-month-old infant with pneumonia requiring oxygen
B. A 6-year-old child 2-day post-op appendectomy with a surgical drain
C. A 3-year-old child with nephrotic syndrome and 4+ proteinuria
D. A 10-year-old child with a respiratory rate of 60 breaths/min
Rationale: The 6-year-old post-appendectomy child is the most stable and requires routine care, which
is within the LPN’s scope of practice. The other clients are more unstable and require advanced
assessments and interventions.
11. The parents of a child with occasional generalized seizures want to send the child to summer
camp. The nurse advises the family to avoid which activity?
A. Swimming
B. Hiking
C. Rock climbing
D. Tennis
Rationale: Rock climbing is a high-risk activity for a child with seizures due to the potential for injury
during a seizure. Swimming and hiking can be safe if supervised, and tennis is non-hazardous.
12. A client with a history of heart failure is prescribed furosemide (Lasix). Which finding indicates the
medication is effective?
A. Increased urine output
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased heart rate
Rationale: Furosemide is a diuretic that reduces fluid overload. A decrease in peripheral edema
indicates effective fluid removal and improved heart failure symptoms.
13. A nurse is caring for a client with a chest tube. Which action should the nurse take if the chest tube
becomes dislodged?
A. Clamp the tube immediately
B. Cover the insertion site with a sterile dressing
C. Reinsert the tube quickly
D. Notify the physician after 1 hour
NR 322 PASSPOINT NCLEX COMPREHENSIVE NURSING PRACTICE
QUESTIONS AND ANSWERS: CLINICAL SCENARIOS, RATIONALES, AND
KEY CONCEPTS
1. An adolescent is brought to the emergency department (ED) after accidentally taking an overdose
of heroin. The adolescent is semiconscious, unable to respond appropriately to questions, slurs words,
and has constricted pupils; the client's vital signs are blood pressure 60/50 mm Hg, pulse 50
beats/min, and respirations 8 breaths/min. Naloxone is administered to temporarily reverse the
effects of the heroin. Which finding would first indicate that the naloxone administration has been
effective?
A. The client's blood pressure increases to 90/60 mm Hg
B. The client's pulse rate increases to 70 beats/min
C. The client's respirations improve to 12/min
D. The client becomes fully conscious and alert
Rationale: The most dangerous effects of heroin overdose are respiratory depression and coma.
Naloxone reverses these effects, and an improvement in respiratory rate is the first sign of its
effectiveness. Changes in blood pressure, pulse, and consciousness may take longer to normalize.
2. The third stage of labor ends:
A. After complete cervical dilation
B. After the birth of the neonate
C. After the delivery of the placenta
D. After the first 4 hours postpartum
Rationale: The third stage of labor is defined as the period from the birth of the neonate to the delivery
of the placenta. The first stage ends with complete cervical dilation, the second stage ends with the
birth of the neonate, and the fourth stage includes the first 4 hours postpartum.
3. The client with a nasogastric (NG) tube has abdominal distention. What should the nurse do first?
A. Reposition the NG tube
B. Check the function of the suction equipment
C. Irrigate the NG tube
D. Notify the healthcare provider
,ESTUDY
Rationale: Abdominal distention in a client with an NG tube is often due to improper functioning of the
suction equipment. The nurse should first check the suction equipment to ensure it is working correctly
before taking other steps.
4. A public health nurse has been asked to teach the importance of hand washing to elderly clients.
Which statement by a client indicates that the teaching has been effective?
A. "Soap is the most important part of hand washing."
B. "Friction while washing hands decreases transmission of bacteria."
C. "Warm water alone is enough to clean my hands."
D. "I only need to wash my hands for 15 seconds."
Rationale: Friction is essential for removing microorganisms during hand washing. Soap helps reduce
surface tension, but friction is necessary for effective cleaning. Warm water alone or washing for only 15
seconds is insufficient.
5. A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's
physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how
neomycin decreases the serum ammonia concentration. How should the nurse respond?
A. "Neomycin traps ammonia in the GI tract."
B. "Neomycin decreases the amount of ammonia-producing bacteria in the GI tract."
C. "Neomycin binds with ammonia in the bloodstream."
D. "Neomycin increases the excretion of ammonia in the urine."
Rationale: Neomycin reduces the number of ammonia-producing bacteria in the gastrointestinal tract,
thereby lowering blood ammonia levels. It does not trap, bind, or excrete ammonia directly.
6. A hospital safety officer is evaluating nurses' responses to potential safety hazards. Which
employee actions are appropriate for the situation? Select all that apply.
A. Taking small steps with feet shoulder length apart when walking on wet surfaces
B. Removing clients from the area where a fire is reported
C. Using tongs to place a dislodged radioactive device in a lead container
D. Running to respond to an emergency call
E. Ignoring a spill to attend to a client
Rationale: Taking small steps on wet surfaces prevents slipping, removing clients from a fire ensures
their safety, and using tongs for radioactive materials minimizes exposure. Running and ignoring spills
are unsafe practices.
,ESTUDY
7. A client with chronic obstructive pulmonary disease presents with respiratory acidosis and
hypoxemia. The client tells the nurse that they don't want to be placed on a ventilator. What action
should the nurse take?
A. Document the client's wishes and notify the physician later
B. Notify the physician immediately to have the physician determine client competency
C. Discuss the implications of a DNR order with the client
D. Consult the palliative care team
Rationale: The client’s respiratory acidosis and hypoxemia may impair their decision-making capacity.
The physician must assess competency before honoring the client’s wishes. The nurse should not delay
notifying the physician.
8. A client in the emergency department reported vomiting and diarrhea for the previous 24 hours.
The client's blood pressure is 90/60 mm Hg, respiration is 20 breaths per minute, heart rate is 92 beats
per minute, and temperature is 37.5° C (99.5° F). Which intervention will the nurse perform first?
A. Administer antiemetic medication
B. Assess for dehydration
C. Raise the head of the bed
D. Administer IV fluids
Rationale: The priority is to assess the client’s condition. Dehydration is likely due to vomiting and
diarrhea, and assessment guides further interventions such as IV fluid administration.
9. A nurse is caring for a client who has returned to their room after a carotid endarterectomy. Which
action should the nurse take first?
A. Check the surgical incision for bleeding
B. Ask the client if they have trouble breathing
C. Assess the client’s neurological status
D. Administer prescribed pain medication
Rationale: A carotid endarterectomy can lead to an incisional hematoma, which may compress the
trachea and cause breathing difficulties. Assessing the client’s airway is the top priority.
10. A charge nurse is making client care assignments for the day. Which client would be most
appropriate to assign a licensed practical nurse (LPN)?
, ESTUDY
A. A 6-month-old infant with pneumonia requiring oxygen
B. A 6-year-old child 2-day post-op appendectomy with a surgical drain
C. A 3-year-old child with nephrotic syndrome and 4+ proteinuria
D. A 10-year-old child with a respiratory rate of 60 breaths/min
Rationale: The 6-year-old post-appendectomy child is the most stable and requires routine care, which
is within the LPN’s scope of practice. The other clients are more unstable and require advanced
assessments and interventions.
11. The parents of a child with occasional generalized seizures want to send the child to summer
camp. The nurse advises the family to avoid which activity?
A. Swimming
B. Hiking
C. Rock climbing
D. Tennis
Rationale: Rock climbing is a high-risk activity for a child with seizures due to the potential for injury
during a seizure. Swimming and hiking can be safe if supervised, and tennis is non-hazardous.
12. A client with a history of heart failure is prescribed furosemide (Lasix). Which finding indicates the
medication is effective?
A. Increased urine output
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased heart rate
Rationale: Furosemide is a diuretic that reduces fluid overload. A decrease in peripheral edema
indicates effective fluid removal and improved heart failure symptoms.
13. A nurse is caring for a client with a chest tube. Which action should the nurse take if the chest tube
becomes dislodged?
A. Clamp the tube immediately
B. Cover the insertion site with a sterile dressing
C. Reinsert the tube quickly
D. Notify the physician after 1 hour
