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NCLEX Clinical Mastery 2025 | 200 Exam-Level
Questions on Med-Surg, Safety, Cardiac, Respiratory &
Endocrine
1. A nurse is caring for a patient with heart failure who reports sudden
shortness of breath and pink frothy sputum. Which action should the nurse
take first?
A. Administer morphine IV
B. Apply oxygen via non-rebreather mask
C. Notify the healthcare provider
D. Place the patient in high Fowler’s position
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Answer: D. Place the patient in high Fowler’s position
Rationale: Acute pulmonary edema is a life-threatening complication of heart
failure, characterized by pink frothy sputum and severe dyspnea. The immediate
priority is to improve oxygenation by maximizing lung expansion, which is
achieved by placing the patient in a high Fowler’s position. This intervention
promotes better ventilation and decreases venous return to the heart. Oxygen
administration will follow, but positioning comes first in emergencies based on the
ABC (Airway, Breathing, Circulation) prioritization.
2. A patient with COPD is receiving oxygen therapy at 4 L/min via nasal
cannula. Which finding requires immediate intervention?
A. O2 saturation 90%
B. Respiratory rate 8/min
C. Productive cough with yellow sputum
D. Barrel-shaped chest
Answer: B. Respiratory rate 8/min
Rationale: COPD patients rely partly on hypoxic drive for respiration. High-flow
oxygen can suppress their drive to breathe, leading to hypoventilation and
respiratory depression. A respiratory rate of 8/min indicates hypoventilation and
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impending respiratory failure, which is a medical emergency. While a barrel chest
and productive cough are chronic findings, bradypnea requires immediate
intervention to prevent respiratory arrest.
3. A nurse receives report on four patients. Which patient should be assessed
first?
A. Post-op cholecystectomy patient reporting shoulder pain
B. Pneumonia patient with O2 sat of 84% on 2L O2
C. Diabetic patient with blood sugar of 250 mg/dL
D. Patient with cellulitis complaining of 5/10 pain
Answer: B. Pneumonia patient with O2 sat of 84%
Rationale: Low oxygen saturation indicates hypoxemia, which can quickly lead to
respiratory failure if untreated. This patient is at highest risk of deterioration,
making them the priority according to the ABCs and clinical judgment. Post-op
shoulder pain and hyperglycemia are not immediately life-threatening, and
cellulitis pain can be addressed after ensuring oxygenation.
4. The nurse is caring for a patient with diabetic ketoacidosis (DKA). Which
IV fluid should be administered first?
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A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. D10W
Answer: A. 0.9% Normal Saline
Rationale: Patients with DKA present with severe dehydration due to osmotic
diuresis. The initial priority is rapid fluid resuscitation with isotonic saline (0.9%
NS) to restore intravascular volume and perfusion. Hypotonic solutions and
dextrose-containing fluids are used later once blood glucose drops and dehydration
is partially corrected.
5. A nurse is caring for a patient with chest pain and suspected myocardial
infarction. Which lab value is most specific for confirming the diagnosis?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B. Troponin I
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial
NCLEX Clinical Mastery 2025 | 200 Exam-Level
Questions on Med-Surg, Safety, Cardiac, Respiratory &
Endocrine
1. A nurse is caring for a patient with heart failure who reports sudden
shortness of breath and pink frothy sputum. Which action should the nurse
take first?
A. Administer morphine IV
B. Apply oxygen via non-rebreather mask
C. Notify the healthcare provider
D. Place the patient in high Fowler’s position
, 2
Answer: D. Place the patient in high Fowler’s position
Rationale: Acute pulmonary edema is a life-threatening complication of heart
failure, characterized by pink frothy sputum and severe dyspnea. The immediate
priority is to improve oxygenation by maximizing lung expansion, which is
achieved by placing the patient in a high Fowler’s position. This intervention
promotes better ventilation and decreases venous return to the heart. Oxygen
administration will follow, but positioning comes first in emergencies based on the
ABC (Airway, Breathing, Circulation) prioritization.
2. A patient with COPD is receiving oxygen therapy at 4 L/min via nasal
cannula. Which finding requires immediate intervention?
A. O2 saturation 90%
B. Respiratory rate 8/min
C. Productive cough with yellow sputum
D. Barrel-shaped chest
Answer: B. Respiratory rate 8/min
Rationale: COPD patients rely partly on hypoxic drive for respiration. High-flow
oxygen can suppress their drive to breathe, leading to hypoventilation and
respiratory depression. A respiratory rate of 8/min indicates hypoventilation and
, 3
impending respiratory failure, which is a medical emergency. While a barrel chest
and productive cough are chronic findings, bradypnea requires immediate
intervention to prevent respiratory arrest.
3. A nurse receives report on four patients. Which patient should be assessed
first?
A. Post-op cholecystectomy patient reporting shoulder pain
B. Pneumonia patient with O2 sat of 84% on 2L O2
C. Diabetic patient with blood sugar of 250 mg/dL
D. Patient with cellulitis complaining of 5/10 pain
Answer: B. Pneumonia patient with O2 sat of 84%
Rationale: Low oxygen saturation indicates hypoxemia, which can quickly lead to
respiratory failure if untreated. This patient is at highest risk of deterioration,
making them the priority according to the ABCs and clinical judgment. Post-op
shoulder pain and hyperglycemia are not immediately life-threatening, and
cellulitis pain can be addressed after ensuring oxygenation.
4. The nurse is caring for a patient with diabetic ketoacidosis (DKA). Which
IV fluid should be administered first?
, 4
A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. D10W
Answer: A. 0.9% Normal Saline
Rationale: Patients with DKA present with severe dehydration due to osmotic
diuresis. The initial priority is rapid fluid resuscitation with isotonic saline (0.9%
NS) to restore intravascular volume and perfusion. Hypotonic solutions and
dextrose-containing fluids are used later once blood glucose drops and dehydration
is partially corrected.
5. A nurse is caring for a patient with chest pain and suspected myocardial
infarction. Which lab value is most specific for confirming the diagnosis?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
Answer: B. Troponin I
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial
