RN Concept-Based Assessment Level 3 Online Practice B –
Comprehensive NCLEX-Style Nursing Exam Prep with
Rationales, Clinical Scenarios & Concept Mastery Review
1. A nurse in a mental health clinic is assessing a client who states, "I don't think my
gambling is as big of a problem as my friends think it is." Which of the following findings
should the nurse identify as meeting the diagnostic criteria of gambling disorder?
Answer: The client asks others for money to compensate for gambling losses.
Rationale: Seeking financial bailouts is a DSM-5 diagnostic criterion for gambling disorder.
2. A nurse is assessing a client who has schizophrenia. Which of the following
manifestations should the nurse identify as positive symptoms of schizophrenia? (Select all
that apply.)
Answer: Magical thinking; Clang association; Auditory hallucinations.
Rationale: Positive symptoms are excess or distorted functions such as hallucinations, delusions,
and disorganized speech.
3. A nurse is assessing a client who has end-stage COPD. Which of the following findings
should the nurse identify as a late manifestation of this terminal illness?
Answer: Clubbing of fingernails.
Rationale: Chronic hypoxemia leads to digital clubbing in advanced COPD.
4. A nurse in an emergency department is assessing a newly admitted client. Which finding
is a manifestation of acute cocaine toxicity?
Answer: Agitation.
Rationale: Cocaine is a CNS stimulant causing agitation, tachycardia, and hypertension.
5. A nurse is providing teaching to a client who has preeclampsia without severe features.
Which instruction should the nurse include?
Answer: Use a side-lying position when resting.
Rationale: Side-lying improves uteroplacental perfusion and decreases vena cava compression.
,6. A nurse is planning care for a client who has a gambling disorder. Which intervention
should the nurse include?
Answer: Recommend joining a self-help group.
Rationale: Peer support groups promote accountability and recovery.
7. A nurse is caring for a client who has Alzheimer's disease (AD). The client's daughter
asks if she will develop AD as well. Which response should the nurse make regarding
genetic predisposition?
Answer: “You can be tested for the presence of apolipoprotein, which indicates an increased
risk.”
Rationale: APOE increases risk but does not guarantee development of AD.
8. A nurse is reviewing the laboratory findings of a client who has acute pancreatitis.
Which finding should the nurse expect?
Answer: Amylase 300 units/L.
Rationale: Elevated amylase is a key indicator of pancreatic inflammation.
9. A nurse is caring for a client who has schizophrenia and states, "The government has
spies here monitoring me." Which response should the nurse give?
Answer: “I understand that you believe that, but I don’t see any evidence of it.”
Rationale: Acknowledges feelings without reinforcing the delusion.
10. A nurse is reviewing the medical history of a client. Which finding indicates risk for
stroke?
Answer: Takes a combination oral contraceptive.
Rationale: Estrogen increases thromboembolic risk.
11. A nurse is caring for a client 4 hr postpartum with excessive vaginal bleeding. What is
the priority action?
Answer: Massage the client’s fundus.
Rationale: Uterine atony is the leading cause of postpartum hemorrhage.
12. A nurse is reviewing a new prescription for memantine. Which medication can interact
adversely?
, Answer: Sodium bicarbonate.
Rationale: Alkalinizes urine, decreasing drug excretion and increasing toxicity risk.
13. A school nurse is planning education for parents about bullying. Which information
should be included?
Answer: Victims of bullying have an increased risk of suicidal ideation.
Rationale: Bullying strongly correlates with depression and suicide risk.
14. A nurse is teaching a client who has bipolar disorder and a new prescription for
lithium. Which statement should the nurse make?
Answer: “Drink at least 1.5 liters of fluid per day.”
Rationale: Prevents lithium toxicity caused by dehydration.
15. A nurse is teaching the family of a client with dementia and confusion. Which
information should be included?
Answer: Use pictures and gestures when giving instructions.
Rationale: Visual cues improve comprehension in dementia.
16. A nurse is teaching the guardian of a child with juvenile idiopathic arthritis about pain
management. Which statement should the nurse make?
Answer: “Discourage your child from taking naps during the daytime.”
Rationale: Encourages nighttime sleep and reduces stiffness.
17. A nurse is teaching a client about a penile implant. Which statement indicates
understanding?
Answer: “This implant can be deflated by pushing a button in my scrotum.”
Rationale: Inflatable implants use a scrotal pump mechanism.
18. A nurse is caring for an infant with patent ductus arteriosus and heart failure. Which
intervention should the nurse perform?
Answer: Offer small, frequent feedings.
Rationale: Prevents fatigue and conserves energy.
Comprehensive NCLEX-Style Nursing Exam Prep with
Rationales, Clinical Scenarios & Concept Mastery Review
1. A nurse in a mental health clinic is assessing a client who states, "I don't think my
gambling is as big of a problem as my friends think it is." Which of the following findings
should the nurse identify as meeting the diagnostic criteria of gambling disorder?
Answer: The client asks others for money to compensate for gambling losses.
Rationale: Seeking financial bailouts is a DSM-5 diagnostic criterion for gambling disorder.
2. A nurse is assessing a client who has schizophrenia. Which of the following
manifestations should the nurse identify as positive symptoms of schizophrenia? (Select all
that apply.)
Answer: Magical thinking; Clang association; Auditory hallucinations.
Rationale: Positive symptoms are excess or distorted functions such as hallucinations, delusions,
and disorganized speech.
3. A nurse is assessing a client who has end-stage COPD. Which of the following findings
should the nurse identify as a late manifestation of this terminal illness?
Answer: Clubbing of fingernails.
Rationale: Chronic hypoxemia leads to digital clubbing in advanced COPD.
4. A nurse in an emergency department is assessing a newly admitted client. Which finding
is a manifestation of acute cocaine toxicity?
Answer: Agitation.
Rationale: Cocaine is a CNS stimulant causing agitation, tachycardia, and hypertension.
5. A nurse is providing teaching to a client who has preeclampsia without severe features.
Which instruction should the nurse include?
Answer: Use a side-lying position when resting.
Rationale: Side-lying improves uteroplacental perfusion and decreases vena cava compression.
,6. A nurse is planning care for a client who has a gambling disorder. Which intervention
should the nurse include?
Answer: Recommend joining a self-help group.
Rationale: Peer support groups promote accountability and recovery.
7. A nurse is caring for a client who has Alzheimer's disease (AD). The client's daughter
asks if she will develop AD as well. Which response should the nurse make regarding
genetic predisposition?
Answer: “You can be tested for the presence of apolipoprotein, which indicates an increased
risk.”
Rationale: APOE increases risk but does not guarantee development of AD.
8. A nurse is reviewing the laboratory findings of a client who has acute pancreatitis.
Which finding should the nurse expect?
Answer: Amylase 300 units/L.
Rationale: Elevated amylase is a key indicator of pancreatic inflammation.
9. A nurse is caring for a client who has schizophrenia and states, "The government has
spies here monitoring me." Which response should the nurse give?
Answer: “I understand that you believe that, but I don’t see any evidence of it.”
Rationale: Acknowledges feelings without reinforcing the delusion.
10. A nurse is reviewing the medical history of a client. Which finding indicates risk for
stroke?
Answer: Takes a combination oral contraceptive.
Rationale: Estrogen increases thromboembolic risk.
11. A nurse is caring for a client 4 hr postpartum with excessive vaginal bleeding. What is
the priority action?
Answer: Massage the client’s fundus.
Rationale: Uterine atony is the leading cause of postpartum hemorrhage.
12. A nurse is reviewing a new prescription for memantine. Which medication can interact
adversely?
, Answer: Sodium bicarbonate.
Rationale: Alkalinizes urine, decreasing drug excretion and increasing toxicity risk.
13. A school nurse is planning education for parents about bullying. Which information
should be included?
Answer: Victims of bullying have an increased risk of suicidal ideation.
Rationale: Bullying strongly correlates with depression and suicide risk.
14. A nurse is teaching a client who has bipolar disorder and a new prescription for
lithium. Which statement should the nurse make?
Answer: “Drink at least 1.5 liters of fluid per day.”
Rationale: Prevents lithium toxicity caused by dehydration.
15. A nurse is teaching the family of a client with dementia and confusion. Which
information should be included?
Answer: Use pictures and gestures when giving instructions.
Rationale: Visual cues improve comprehension in dementia.
16. A nurse is teaching the guardian of a child with juvenile idiopathic arthritis about pain
management. Which statement should the nurse make?
Answer: “Discourage your child from taking naps during the daytime.”
Rationale: Encourages nighttime sleep and reduces stiffness.
17. A nurse is teaching a client about a penile implant. Which statement indicates
understanding?
Answer: “This implant can be deflated by pushing a button in my scrotum.”
Rationale: Inflatable implants use a scrotal pump mechanism.
18. A nurse is caring for an infant with patent ductus arteriosus and heart failure. Which
intervention should the nurse perform?
Answer: Offer small, frequent feedings.
Rationale: Prevents fatigue and conserves energy.
