2025 NCLEX RN UWORLD
COMPREHENSIVE STUDY
GUIDE
1. Prioritization & Delegation
Q: A nurse is working in a hospital unit and receives report on four patients. Which
patient should be assessed first?
A: The patient with an airway or breathing concern should be assessed first. A
patient with stridor, respiratory distress, or an unstable vital sign (e.g., hypotension,
tachycardia, or declining oxygen saturation) takes priority over stable patients.
2. Pharmacology
,Q: A patient receiving digoxin reports nausea, vomiting, and blurred vision. What
should the nurse do?
A: The nurse should suspect digoxin toxicity and assess the patient's heart rate and
potassium levels. Digoxin toxicity can cause bradycardia and is worsened by
hypokalemia. The provider should be notified immediately.
3. Safety & Infection Control
Q: A nurse is caring for a patient with Clostridium difficile infection. What
precautions should be taken?
A: The nurse should implement contact precautions, which include wearing gloves
and a gown when entering the room. The patient should be in a private room, and
hand hygiene should be performed using soap and water, as alcohol-based sanitizers
do not kill C. difficile spores.
4. Maternal & Newborn Care
Q: A postpartum patient has a boggy uterus and heavy bleeding. What should the
nurse do?
A: The nurse should immediately massage the fundus to stimulate uterine
contraction and prevent further hemorrhage. If the bleeding persists, notify the
provider and prepare for potential administration of oxytocin or other uterotonic
medications.
5. Cardiovascular System
Q: A patient with heart failure reports sudden weight gain and worsening shortness
of breath. What is the likely cause?
A: The patient is likely experiencing fluid overload, which may indicate worsening
heart failure. The nurse should assess lung sounds for crackles, check for peripheral
edema, and notify the provider. Diuretic therapy may be required.
6. Endocrine System
Q: A patient with diabetes mellitus is found unconscious with cool, clammy skin.
What is the immediate nursing intervention?
, A: The nurse should suspect hypoglycemia and administer a rapid-acting
carbohydrate, such as IV dextrose or glucagon if IV access is not available. Blood
glucose levels should be checked immediately.
7. Neurological System
Q: A patient with a history of stroke is experiencing difficulty swallowing. What is the
nurse’s priority intervention?
A: The nurse should keep the patient NPO until a swallow evaluation is completed to
prevent aspiration. Elevating the head of the bed and consulting a speech therapist
may be necessary.
8. Pediatric Care
Q: A child with asthma is experiencing increased wheezing and difficulty breathing.
What should the nurse do first?
A: The nurse should administer a short-acting beta-agonist (e.g., albuterol) via a
nebulizer or metered-dose inhaler as prescribed. The child's respiratory status
should be closely monitored for improvement or signs of respiratory failure.
9. Mental Health
Q: A patient with schizophrenia reports hearing voices commanding them to harm
themselves. What is the nurse’s priority action?
A: The nurse should assess the severity of the command hallucinations and the
patient’s intent to act on them. Ensuring patient safety by implementing suicide
precautions, involving the mental health team, and administering prescribed
antipsychotic medications are key interventions.
10. Renal System
Q: A patient with chronic kidney disease has a serum potassium level of 6.5 mEq/L.
What should the nurse anticipate?
A: The nurse should anticipate interventions to lower potassium, such as
administering sodium polystyrene sulfonate (Kayexalate), IV insulin with dextrose, or
COMPREHENSIVE STUDY
GUIDE
1. Prioritization & Delegation
Q: A nurse is working in a hospital unit and receives report on four patients. Which
patient should be assessed first?
A: The patient with an airway or breathing concern should be assessed first. A
patient with stridor, respiratory distress, or an unstable vital sign (e.g., hypotension,
tachycardia, or declining oxygen saturation) takes priority over stable patients.
2. Pharmacology
,Q: A patient receiving digoxin reports nausea, vomiting, and blurred vision. What
should the nurse do?
A: The nurse should suspect digoxin toxicity and assess the patient's heart rate and
potassium levels. Digoxin toxicity can cause bradycardia and is worsened by
hypokalemia. The provider should be notified immediately.
3. Safety & Infection Control
Q: A nurse is caring for a patient with Clostridium difficile infection. What
precautions should be taken?
A: The nurse should implement contact precautions, which include wearing gloves
and a gown when entering the room. The patient should be in a private room, and
hand hygiene should be performed using soap and water, as alcohol-based sanitizers
do not kill C. difficile spores.
4. Maternal & Newborn Care
Q: A postpartum patient has a boggy uterus and heavy bleeding. What should the
nurse do?
A: The nurse should immediately massage the fundus to stimulate uterine
contraction and prevent further hemorrhage. If the bleeding persists, notify the
provider and prepare for potential administration of oxytocin or other uterotonic
medications.
5. Cardiovascular System
Q: A patient with heart failure reports sudden weight gain and worsening shortness
of breath. What is the likely cause?
A: The patient is likely experiencing fluid overload, which may indicate worsening
heart failure. The nurse should assess lung sounds for crackles, check for peripheral
edema, and notify the provider. Diuretic therapy may be required.
6. Endocrine System
Q: A patient with diabetes mellitus is found unconscious with cool, clammy skin.
What is the immediate nursing intervention?
, A: The nurse should suspect hypoglycemia and administer a rapid-acting
carbohydrate, such as IV dextrose or glucagon if IV access is not available. Blood
glucose levels should be checked immediately.
7. Neurological System
Q: A patient with a history of stroke is experiencing difficulty swallowing. What is the
nurse’s priority intervention?
A: The nurse should keep the patient NPO until a swallow evaluation is completed to
prevent aspiration. Elevating the head of the bed and consulting a speech therapist
may be necessary.
8. Pediatric Care
Q: A child with asthma is experiencing increased wheezing and difficulty breathing.
What should the nurse do first?
A: The nurse should administer a short-acting beta-agonist (e.g., albuterol) via a
nebulizer or metered-dose inhaler as prescribed. The child's respiratory status
should be closely monitored for improvement or signs of respiratory failure.
9. Mental Health
Q: A patient with schizophrenia reports hearing voices commanding them to harm
themselves. What is the nurse’s priority action?
A: The nurse should assess the severity of the command hallucinations and the
patient’s intent to act on them. Ensuring patient safety by implementing suicide
precautions, involving the mental health team, and administering prescribed
antipsychotic medications are key interventions.
10. Renal System
Q: A patient with chronic kidney disease has a serum potassium level of 6.5 mEq/L.
What should the nurse anticipate?
A: The nurse should anticipate interventions to lower potassium, such as
administering sodium polystyrene sulfonate (Kayexalate), IV insulin with dextrose, or
