HURST REVIEW NCLEX-RN READINESS EXAM
QUESTIONS WITH VERIFIED SOLUTIONS WITH
RATIONALES NEW LATEST VERSION
The nurse is caring for a client in the emergency department with agitation, diarrhea, and
peripheral edema. Family reports client has a history of chronic renal damage and has been
taking a lot of antacids for indigestion. Which alterations in the arterial blood gases would the
nurse expect to find?
1. pH: 7.34, PaCO2: 48, HCO3: 29
2. pH: 7.50, PaCO2: 35, HCO3: 32
3. pH: 7.32, PaCO2: 36, HCO3: 20
4. pH: 7.42, PaCO2: 40, HCO3: 24 --CORRECT ANSWER--ANS: 2.
2. Correct: Metabolic alkalosis may not show any symptoms. People with this type of
alkalosis more often complain of the underlying conditions that are causing it. These can
include vomiting, diarrhea, swelling in the lower legs, and fatigue. Severe cases of metabolic
alkalosis can cause agitation, disorientation, seizures, and coma. So we are looking for ABGs
that indicate that this client is in metabolic alkalosis. A pH of 7.50 is higher than the normal
pH value of 7.45, which indicates alkalosis. The PaCO2 is 35, which is on the low end of
normal (34-45). The HCO3 is 32, which is higher than the normal HCO3 of 26, which
indicates alkalosis. So the Bicarb (Kidney chemical) matches the pH. Metabolic alkalosis.
1. Incorrect: This is partially compensated respiratory acidosis. pH: 7.34 (acid), PaCO2: 48
(acid), HCO3: 29 (alkaline)
3. Incorrect: This is metabolic acidosis. pH: 7.32 (acid), PaCO2: 36 (normal), HCO3: 20
(acid)
4. Incorrect: These are normal ABGs. pH: 7.42 (normal), PaCO2: 40 (normal), HCO3: 24
(normal)
Page 1 of 448
,Which signs and symptoms would concern the nurse if assessed in a client post radical neck
surgery?
1. Dysphagia
2. Facial numbness
3. Flushed and warm skin
4. Laryngeal stridor
5. Negative Chvostek's sign --CORRECT ANSWER--ANS: 1., 2., 4.
1., 2., & 4. Correct: Dyspnea, facial numbness and laryngeal stridor are signs indicating that
muscles are rigid and tight due to a low calcium level. Some of the parathyroids could have
been removed resulting in hypocalcemia.
3. Incorrect: Flushed and warm skin would be seen with hypermagnesemia due to
vasodilation.
5. Incorrect: A negative Chvostek's sign is a good thing. It would be positive if the calcium
level is low.
An intravenous infusion of 0.9% normal saline is prescribed at a rate of 1000 mL in 12 hours.
The tubing has a drop factor of 15. How many drops per minute (gtts/min) are delivered?
Round your answer to the nearest whole number.
Provide your answer using numbers and decimal points only. --CORRECT ANSWER--ANS:
21
The formula used to calculate drop rates is the total number of milliliters divided by the total
number of minutes multiplied by the drop factor. In this circumstance, the minutes portion
must be figured first, that is, 12 hours equals 720 minutes. Then, dividing 1000 by 720 equals
1.38888889. This is multiplied by the drop factor, which is 15. Multiplying 15 by 1.38888889
equals 20.83, which rounds to 21.
Page 2 of 448
,A nurse is caring for a client who is on bed rest following admission to the hospital two days
ago with a diagnosis of new onset heart failure. While evaluating the client's progress, what
assessment findings would indicate to the nurse that further treatment is required?
1. CVP 5 mmHg
2. Persistent cough
3. 4.4 kg weight loss in 24 hours
4. Ventricular gallop
5. Urinary output 160 mL/8 hrs
6. S2 heart sound --CORRECT ANSWER--ANS: 2., 4., 5.
2., 4., & 5. Correct: These are all signs of fluid volume excess seen with heart failure. So
further treatment is necessary.
1. Incorrect: This is a normal CVP value, which would indicate the client is improving.
3. Incorrect: A weight loss of 4.4 kg in 24 hours is a good thing. Excess fluid is being
removed from the body.
6. Incorrect: S1 and S2 are normal heart sounds.
A client arrives at the emergency department after being removed from a burning building.
The nurse suspects carbon monoxide poisoning when the client exhibits which signs and
symptoms?
1. Almond odor to breath
2. Blurred Vision
3. Dull headache
4. Excess salivation
5. Respirations 10 --CORRECT ANSWER--ANS: 2., 3., 5.
Page 3 of 448
, 2.,3. & 5. Correct: Not enough oxygen is getting to the vital organs, such as the brain and
heart, so blurred vision, a dull headache and respiratory depression can occur.
1. Incorrect: An almond odor to the breath is a manifestation of cyanide poisoning.
4. Incorrect: Excessive salivation can be seen with ingestion of acids or alkalis.
The client has pustules on the arm from intravenous drug abuse. The microbiology laboratory
informs the nurse that the client's cultures are growing methicillin-resistant Staphylococcus
aureus (MRSA). Which action would the nurse take?
1. Cover the pustules to prevent drainage.
2. Implement contact precautions immediately.
3. Instruct the client on the importance of hand hygiene.
4. Inform the client to wear a mask when ambulating in the hall.
5. Instruct visitors to wash hands before entering the client's room. --CORRECT ANSWER--
ANS: 1., 2., 3., 5.
1., 2., 3. & 5. Correct: The pustules should be covered with a dressing, because MRSA is
transmitted via contact! It is important that the nurse implement these interventions in order
to prevent the spread of infection. The number one way to prevent the spread of infection is
handwashing. That includes the client, staff, and visitors. If the client refuses to follow
instructions, then isolation precautions are warranted.
4. Incorrect: The client is placed on contact precautions not droplet precautions. The client
would not need to wear a mask since the infection is not transmitted via the respiratory
system.
The nurse is caring for a client 8 hours post colectomy who is receiving 40% humidified
oxygen. ABG results are: pH= 7.30, pO2= 91, pCO2= 50, HCO3= 24. Based on this
information, which nursing action should the nurse initiate?
1. Reposition the client every 2 hours.
2. Request respiratory therapy to perform postural drainage and percussion.
Page 4 of 448
QUESTIONS WITH VERIFIED SOLUTIONS WITH
RATIONALES NEW LATEST VERSION
The nurse is caring for a client in the emergency department with agitation, diarrhea, and
peripheral edema. Family reports client has a history of chronic renal damage and has been
taking a lot of antacids for indigestion. Which alterations in the arterial blood gases would the
nurse expect to find?
1. pH: 7.34, PaCO2: 48, HCO3: 29
2. pH: 7.50, PaCO2: 35, HCO3: 32
3. pH: 7.32, PaCO2: 36, HCO3: 20
4. pH: 7.42, PaCO2: 40, HCO3: 24 --CORRECT ANSWER--ANS: 2.
2. Correct: Metabolic alkalosis may not show any symptoms. People with this type of
alkalosis more often complain of the underlying conditions that are causing it. These can
include vomiting, diarrhea, swelling in the lower legs, and fatigue. Severe cases of metabolic
alkalosis can cause agitation, disorientation, seizures, and coma. So we are looking for ABGs
that indicate that this client is in metabolic alkalosis. A pH of 7.50 is higher than the normal
pH value of 7.45, which indicates alkalosis. The PaCO2 is 35, which is on the low end of
normal (34-45). The HCO3 is 32, which is higher than the normal HCO3 of 26, which
indicates alkalosis. So the Bicarb (Kidney chemical) matches the pH. Metabolic alkalosis.
1. Incorrect: This is partially compensated respiratory acidosis. pH: 7.34 (acid), PaCO2: 48
(acid), HCO3: 29 (alkaline)
3. Incorrect: This is metabolic acidosis. pH: 7.32 (acid), PaCO2: 36 (normal), HCO3: 20
(acid)
4. Incorrect: These are normal ABGs. pH: 7.42 (normal), PaCO2: 40 (normal), HCO3: 24
(normal)
Page 1 of 448
,Which signs and symptoms would concern the nurse if assessed in a client post radical neck
surgery?
1. Dysphagia
2. Facial numbness
3. Flushed and warm skin
4. Laryngeal stridor
5. Negative Chvostek's sign --CORRECT ANSWER--ANS: 1., 2., 4.
1., 2., & 4. Correct: Dyspnea, facial numbness and laryngeal stridor are signs indicating that
muscles are rigid and tight due to a low calcium level. Some of the parathyroids could have
been removed resulting in hypocalcemia.
3. Incorrect: Flushed and warm skin would be seen with hypermagnesemia due to
vasodilation.
5. Incorrect: A negative Chvostek's sign is a good thing. It would be positive if the calcium
level is low.
An intravenous infusion of 0.9% normal saline is prescribed at a rate of 1000 mL in 12 hours.
The tubing has a drop factor of 15. How many drops per minute (gtts/min) are delivered?
Round your answer to the nearest whole number.
Provide your answer using numbers and decimal points only. --CORRECT ANSWER--ANS:
21
The formula used to calculate drop rates is the total number of milliliters divided by the total
number of minutes multiplied by the drop factor. In this circumstance, the minutes portion
must be figured first, that is, 12 hours equals 720 minutes. Then, dividing 1000 by 720 equals
1.38888889. This is multiplied by the drop factor, which is 15. Multiplying 15 by 1.38888889
equals 20.83, which rounds to 21.
Page 2 of 448
,A nurse is caring for a client who is on bed rest following admission to the hospital two days
ago with a diagnosis of new onset heart failure. While evaluating the client's progress, what
assessment findings would indicate to the nurse that further treatment is required?
1. CVP 5 mmHg
2. Persistent cough
3. 4.4 kg weight loss in 24 hours
4. Ventricular gallop
5. Urinary output 160 mL/8 hrs
6. S2 heart sound --CORRECT ANSWER--ANS: 2., 4., 5.
2., 4., & 5. Correct: These are all signs of fluid volume excess seen with heart failure. So
further treatment is necessary.
1. Incorrect: This is a normal CVP value, which would indicate the client is improving.
3. Incorrect: A weight loss of 4.4 kg in 24 hours is a good thing. Excess fluid is being
removed from the body.
6. Incorrect: S1 and S2 are normal heart sounds.
A client arrives at the emergency department after being removed from a burning building.
The nurse suspects carbon monoxide poisoning when the client exhibits which signs and
symptoms?
1. Almond odor to breath
2. Blurred Vision
3. Dull headache
4. Excess salivation
5. Respirations 10 --CORRECT ANSWER--ANS: 2., 3., 5.
Page 3 of 448
, 2.,3. & 5. Correct: Not enough oxygen is getting to the vital organs, such as the brain and
heart, so blurred vision, a dull headache and respiratory depression can occur.
1. Incorrect: An almond odor to the breath is a manifestation of cyanide poisoning.
4. Incorrect: Excessive salivation can be seen with ingestion of acids or alkalis.
The client has pustules on the arm from intravenous drug abuse. The microbiology laboratory
informs the nurse that the client's cultures are growing methicillin-resistant Staphylococcus
aureus (MRSA). Which action would the nurse take?
1. Cover the pustules to prevent drainage.
2. Implement contact precautions immediately.
3. Instruct the client on the importance of hand hygiene.
4. Inform the client to wear a mask when ambulating in the hall.
5. Instruct visitors to wash hands before entering the client's room. --CORRECT ANSWER--
ANS: 1., 2., 3., 5.
1., 2., 3. & 5. Correct: The pustules should be covered with a dressing, because MRSA is
transmitted via contact! It is important that the nurse implement these interventions in order
to prevent the spread of infection. The number one way to prevent the spread of infection is
handwashing. That includes the client, staff, and visitors. If the client refuses to follow
instructions, then isolation precautions are warranted.
4. Incorrect: The client is placed on contact precautions not droplet precautions. The client
would not need to wear a mask since the infection is not transmitted via the respiratory
system.
The nurse is caring for a client 8 hours post colectomy who is receiving 40% humidified
oxygen. ABG results are: pH= 7.30, pO2= 91, pCO2= 50, HCO3= 24. Based on this
information, which nursing action should the nurse initiate?
1. Reposition the client every 2 hours.
2. Request respiratory therapy to perform postural drainage and percussion.
Page 4 of 448
