NGN NCLEX /NCLEX NGN RN ACTUAL EXAM LATEST MAY 2023 TEST
BANK 300 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES |AGRADE
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is
experiencing severe hypoxemia. The nurse understands this is primarily due to:
A) Bronchospasm.
B) Increased alveolar ventilation.
C) Intrapulmonary shunting.
D) Decreased pulmonary artery pressure.
E) Metabolic alkalosis.
Correct Answer: C) Intrapulmonary shunting.
Rationale: In ARDS, widespread alveolar collapse and fluid filling lead to severe
intrapulmonary shunting, where blood passes through unventilated lung areas without picking
up oxygen, causing refractory hypoxemia.
Question 2
A client with chronic kidney disease (CKD) is experiencing hyperkalemia. Which of the
following is the most life-threatening complication of hyperkalemia?
A) Muscle weakness.
B) Gastrointestinal cramping.
C) Cardiac dysrhythmias.
D) Paresthesias.
E) Oliguria.
Correct Answer: C) Cardiac dysrhythmias.
Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction abnormalities
and dysrhythmias, including ventricular fibrillation and asystole.
Question 3
A client's arterial blood gas (ABG) results are: pH 7.25, PaCO2 55 mmHg, HCO3- 24 mEq/L.
This indicates which acid-base imbalance?
A) Metabolic acidosis, uncompensated.
B) Respiratory acidosis, uncompensated.
C) Metabolic alkalosis, uncompensated.
D) Respiratory alkalosis, uncompensated.
E) Respiratory acidosis, partially compensated.
Correct Answer: B) Respiratory acidosis, uncompensated.
,Rationale: The pH is acidic, the PaCO2 is high (indicating a primary respiratory problem), and
the HCO3- is within normal limits, signifying uncompensated respiratory acidosis.
Question 4
A nurse is preparing to administer insulin glargine to a client with type 2 diabetes mellitus. The
nurse understands that this insulin:
A) Has a rapid onset of 10-15 minutes.
B) Is typically administered intravenously.
C) Has no peak action and provides a steady effect.
D) Should be mixed with NPH insulin.
E) Is used for immediate glucose correction.
Correct Answer: C) Has no peak action and provides a steady effect.
Rationale: Insulin glargine is a long-acting insulin with a relatively flat absorption profile and no
pronounced peak, providing a continuous basal level of insulin over 24 hours.
Question 5
A client with a myocardial infarction (MI) is experiencing chest pain. The nurse understands that
the pain of an MI is primarily caused by:
A) Pericardial inflammation.
B) Smooth muscle spasm.
C) Myocardial ischemia.
D) Neuralgia.
E) Anxiety.
Correct Answer: C) Myocardial ischemia.
Rationale: The pain of a myocardial infarction is caused by prolonged ischemia (lack of blood
flow and oxygen) to the heart muscle, leading to cellular injury and necrosis.
Question 6
A nurse is assessing a client in cardiogenic shock. Which of the following assessment findings
should the nurse expect?
A) Warm, flushed skin.
B) Bounding peripheral pulses.
C) Hypotension and decreased cardiac output.
D) Increased urine output.
E) Bradycardia.
Correct Answer: C) Hypotension and decreased cardiac output.
,Rationale: Cardiogenic shock is characterized by the heart's inability to pump sufficient blood
to meet the body's demands, leading to decreased cardiac output, hypotension, and signs of
poor perfusion.
Question 7
A nurse is caring for a client receiving mechanical ventilation. To prevent ventilator-associated
pneumonia (VAP), which intervention is essential?
A) Maintaining the head of the bed flat.
B) Performing oral care with chlorhexidine.
C) Routine suctioning every hour.
D) Administering prophylactic antibiotics daily.
E) Providing frequent nebulizer treatments.
Correct Answer: B) Performing oral care with chlorhexidine.
Rationale: Performing regular and thorough oral care with an antiseptic solution like
chlorhexidine is a critical intervention to reduce bacterial colonization in the oropharynx and
prevent VAP.
Question 8
A nurse is preparing to administer packed red blood cells to a client. What is the most
important initial nursing action?
A) Administering a bolus of normal saline.
B) Verifying blood compatibility with another licensed nurse.
C) Warming the blood to body temperature.
D) Administering an antihistamine pre-transfusion.
E) Obtaining the client's consent for the transfusion.
Correct Answer: B) Verifying blood compatibility with another licensed nurse.
Rationale: Proper client identification and verification of the blood product with another
licensed nurse is the most critical step to prevent a fatal transfusion reaction.
Question 9
A pregnant client is 32 weeks gestation and experiencing painless vaginal bleeding. The nurse
should suspect which of the following conditions?
A) Abruptio placentae
B) Placenta previa
C) Vasa previa
D) Preterm labor
E) Cervical insufficiency
, Correct Answer: B) Placenta previa
Rationale: Painless vaginal bleeding during the second or third trimester is the hallmark
symptom of placenta previa, where the placenta covers the cervical os.
Question 10
A nurse is collecting data from an infant who has dehydration. Which of the following findings
should the nurse expect?
A) Increased urine output
B) Sunken fontanelles
C) Bounding peripheral pulses
D) Moist mucous membranes
E) Increased skin turgor
Correct Answer: B) Sunken fontanelles
Rationale: Sunken fontanelles are a classic physical sign of dehydration in infants, indicating
decreased fluid volume.
Question 11
A nurse is reinforcing teaching with a client who has gestational diabetes about managing blood
glucose levels. Which of the following statements by the client indicates a need for further
teaching?
A) "I will test my blood sugar every morning before I eat."
B) "I will eat three large meals and no snacks to control my sugar."
C) "I understand that exercise helps lower my blood sugar."
D) "I will report any symptoms of hyperglycemia or hypoglycemia."
E) "I know my diet is the most important part of managing my diabetes."
Correct Answer: B) "I will eat three large meals and no snacks to control my
sugar."
Rationale: For gestational diabetes, eating smaller, more frequent meals and snacks helps
stabilize blood glucose levels and prevents extreme fluctuations.
Question 12
A nurse is assisting with the care of a client who has a chest tube. The nurse observes
continuous bubbling in the water-seal chamber. Which of the following actions should the nurse
take?
A) Clamp the chest tube immediately.
B) Increase the suction setting on the wall regulator.
C) Document the finding as expected.
BANK 300 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES |AGRADE
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is
experiencing severe hypoxemia. The nurse understands this is primarily due to:
A) Bronchospasm.
B) Increased alveolar ventilation.
C) Intrapulmonary shunting.
D) Decreased pulmonary artery pressure.
E) Metabolic alkalosis.
Correct Answer: C) Intrapulmonary shunting.
Rationale: In ARDS, widespread alveolar collapse and fluid filling lead to severe
intrapulmonary shunting, where blood passes through unventilated lung areas without picking
up oxygen, causing refractory hypoxemia.
Question 2
A client with chronic kidney disease (CKD) is experiencing hyperkalemia. Which of the
following is the most life-threatening complication of hyperkalemia?
A) Muscle weakness.
B) Gastrointestinal cramping.
C) Cardiac dysrhythmias.
D) Paresthesias.
E) Oliguria.
Correct Answer: C) Cardiac dysrhythmias.
Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction abnormalities
and dysrhythmias, including ventricular fibrillation and asystole.
Question 3
A client's arterial blood gas (ABG) results are: pH 7.25, PaCO2 55 mmHg, HCO3- 24 mEq/L.
This indicates which acid-base imbalance?
A) Metabolic acidosis, uncompensated.
B) Respiratory acidosis, uncompensated.
C) Metabolic alkalosis, uncompensated.
D) Respiratory alkalosis, uncompensated.
E) Respiratory acidosis, partially compensated.
Correct Answer: B) Respiratory acidosis, uncompensated.
,Rationale: The pH is acidic, the PaCO2 is high (indicating a primary respiratory problem), and
the HCO3- is within normal limits, signifying uncompensated respiratory acidosis.
Question 4
A nurse is preparing to administer insulin glargine to a client with type 2 diabetes mellitus. The
nurse understands that this insulin:
A) Has a rapid onset of 10-15 minutes.
B) Is typically administered intravenously.
C) Has no peak action and provides a steady effect.
D) Should be mixed with NPH insulin.
E) Is used for immediate glucose correction.
Correct Answer: C) Has no peak action and provides a steady effect.
Rationale: Insulin glargine is a long-acting insulin with a relatively flat absorption profile and no
pronounced peak, providing a continuous basal level of insulin over 24 hours.
Question 5
A client with a myocardial infarction (MI) is experiencing chest pain. The nurse understands that
the pain of an MI is primarily caused by:
A) Pericardial inflammation.
B) Smooth muscle spasm.
C) Myocardial ischemia.
D) Neuralgia.
E) Anxiety.
Correct Answer: C) Myocardial ischemia.
Rationale: The pain of a myocardial infarction is caused by prolonged ischemia (lack of blood
flow and oxygen) to the heart muscle, leading to cellular injury and necrosis.
Question 6
A nurse is assessing a client in cardiogenic shock. Which of the following assessment findings
should the nurse expect?
A) Warm, flushed skin.
B) Bounding peripheral pulses.
C) Hypotension and decreased cardiac output.
D) Increased urine output.
E) Bradycardia.
Correct Answer: C) Hypotension and decreased cardiac output.
,Rationale: Cardiogenic shock is characterized by the heart's inability to pump sufficient blood
to meet the body's demands, leading to decreased cardiac output, hypotension, and signs of
poor perfusion.
Question 7
A nurse is caring for a client receiving mechanical ventilation. To prevent ventilator-associated
pneumonia (VAP), which intervention is essential?
A) Maintaining the head of the bed flat.
B) Performing oral care with chlorhexidine.
C) Routine suctioning every hour.
D) Administering prophylactic antibiotics daily.
E) Providing frequent nebulizer treatments.
Correct Answer: B) Performing oral care with chlorhexidine.
Rationale: Performing regular and thorough oral care with an antiseptic solution like
chlorhexidine is a critical intervention to reduce bacterial colonization in the oropharynx and
prevent VAP.
Question 8
A nurse is preparing to administer packed red blood cells to a client. What is the most
important initial nursing action?
A) Administering a bolus of normal saline.
B) Verifying blood compatibility with another licensed nurse.
C) Warming the blood to body temperature.
D) Administering an antihistamine pre-transfusion.
E) Obtaining the client's consent for the transfusion.
Correct Answer: B) Verifying blood compatibility with another licensed nurse.
Rationale: Proper client identification and verification of the blood product with another
licensed nurse is the most critical step to prevent a fatal transfusion reaction.
Question 9
A pregnant client is 32 weeks gestation and experiencing painless vaginal bleeding. The nurse
should suspect which of the following conditions?
A) Abruptio placentae
B) Placenta previa
C) Vasa previa
D) Preterm labor
E) Cervical insufficiency
, Correct Answer: B) Placenta previa
Rationale: Painless vaginal bleeding during the second or third trimester is the hallmark
symptom of placenta previa, where the placenta covers the cervical os.
Question 10
A nurse is collecting data from an infant who has dehydration. Which of the following findings
should the nurse expect?
A) Increased urine output
B) Sunken fontanelles
C) Bounding peripheral pulses
D) Moist mucous membranes
E) Increased skin turgor
Correct Answer: B) Sunken fontanelles
Rationale: Sunken fontanelles are a classic physical sign of dehydration in infants, indicating
decreased fluid volume.
Question 11
A nurse is reinforcing teaching with a client who has gestational diabetes about managing blood
glucose levels. Which of the following statements by the client indicates a need for further
teaching?
A) "I will test my blood sugar every morning before I eat."
B) "I will eat three large meals and no snacks to control my sugar."
C) "I understand that exercise helps lower my blood sugar."
D) "I will report any symptoms of hyperglycemia or hypoglycemia."
E) "I know my diet is the most important part of managing my diabetes."
Correct Answer: B) "I will eat three large meals and no snacks to control my
sugar."
Rationale: For gestational diabetes, eating smaller, more frequent meals and snacks helps
stabilize blood glucose levels and prevents extreme fluctuations.
Question 12
A nurse is assisting with the care of a client who has a chest tube. The nurse observes
continuous bubbling in the water-seal chamber. Which of the following actions should the nurse
take?
A) Clamp the chest tube immediately.
B) Increase the suction setting on the wall regulator.
C) Document the finding as expected.
