WorksheetsNCLEX-Style: Advanced Application Set 1–33
Total questions: 100
Worksheet time: 55mins
The nurse reviews a patient's chart: - Serum Na+ 116 mEq/L - Urine specific gravity 1.032 - Complains of headache and confusion. Which order should the nurse question?
Restrict fluids to 800 mL/day
Administer 3% saline 50 mL/hr
Give desmopressin 0.3 mcg IV q12h
Elevate head of bed <10°
A patient receiving IV vasopressin for DI reports chest pain. Which action is priority?
Obtain a 12-lead ECG
Decrease infusion rate
Notify pharmacy
Check urine output
The nurse provides discharge teaching for Addison’s disease. Which statement indicates the need for more teaching?
I’ll carry hydrocortisone with me for emergencies.
If I get sick, I’ll double my steroid dose.
If I feel weak and dizzy, I’ll skip my steroid until I’m better.
I’ll wear my medical alert bracelet.
The nurse assesses a post-thyroidectomy client who becomes suddenly restless with stridor and drooling. What's the priority action?
Call rapid response
Assess surgical site
Suction secretions
Administer oxygen by NC
A type 1 diabetic who took insulin this morning is now diaphoretic and trembling. The nurse finds BG 52 mg/dL. The correct response is to:
Give ½ cup juice and recheck in 15 min
Administer 1 mg glucagon IM immediately
Start IV D5W at 125 mL/hr
Notify HCP before acting
Which new insulin order should the nurse clarify?
Lispro 10 U subQ before meals
NPH 30 U subQ Q0900
Glargine 10 U subQ at HS
Mix glargine with lispro in one syringe
The nurse evaluates a patient on metformin. Which finding requires immediate action?
Mild diarrhea
GFR 28 mL/min
BMI 36 kg/m²
A1C 8.0 %
A patient with DKA receives insulin IV infusion. Which lab warrants the nurse to hold the infusion?
K+ 3.0 mEq/L
pH 7.25
HCO3- 18 mEq/L
Glucose 240 mg/dL
A client taking levothyroxine reports palpitations and insomnia. Which action should the nurse take?
The nurse cares for a patient with cirrhosis and ascites. Which new order requires clarification?
Spironolactone 25 mg PO daily
Ibuprofen 600 mg q6h PRN pain
2 g sodium diet
Daily weight
Which statement about Lactulose indicates understanding?
"It will help me have soft stools to get rid of ammonia."
"It will raise my potassium levels."
"It will strengthen my liver enzymes."
"I can skip doses when I feel bloated."
The nurse reviews labs: - ALT 92 U/L - AST 110 U/L - Total bilirubin 4.3 mg/dL Which assessment finding supports hepatic dysfunction?
Jaundiced sclera
Pink urine
Dry mucous membranes
Bradycardia
The nurse teaches a patient with hypothyroidism about levothyroxine. Which statement requires further teaching?
I'll take it every morning before breakfast.
I'll stop taking it if my heart races.
This medication may take weeks to improve my energy.
I'll have my TSH checked regularly.
The nurse monitors a patient with SIADH on fluid restriction. Which assessment finding shows improvement?
Serum Na+ rising toward 135 mEq/L
Urine specific gravity increasing
Weight gain of 2 lb
Persistent confusion
A client with hyperthyroidism suddenly develops fever 104 °F, HR 140 bpm, agitation. The nurse suspects:
Thyroid storm
Myxedema coma
SIADH
Addisonian crisis
For the above thyroid storm, priority action?
Maintain airway and cooling
Encourage fluids 3 L/day
Restrict iodine intake
Administer glucagon
The nurse reviews a patient's labs: • Ca²⁺ 6.9 mg/dL • Positive Chvostek sign Which history finding is relevant?
Recent thyroidectomy
Type 2 DM
Addison’s disease
DKA
A client receiving chemo has ANC 420. Which action takes priority?
Hold fresh flowers and plants
Administer epoetin alfa
Which of the following should the nurse delegate to an experienced UAP caring for a patient with thrombocytopenia?
Measuring vital signs every 4 h
Checking for petechiae
Inserting a Foley catheter
Shaving the patient
A patient with leukemia is started on filgrastim. Which lab finding shows effectiveness?
Increased neutrophil count
Increased platelets
Decreased bilirubin
Lowered uric acid
A chemotherapy patient reports mouth pain and white patches. Priority nursing intervention?
Perform oral care with saline rinse after meals
Use alcohol-based mouthwash
Provide lemon-glycerin swabs
Encourage spicy foods for taste
A client with sickle-cell crisis reports 10/10 pain and O₂ sat 88%. Which action is priority?
Apply oxygen
Give PRN morphine
Encourage ambulation
Increase oral fluids
The nurse teaches a patient with iron-deficiency anemia. Which statement needs correction?
I’ll take my iron pill with orange juice.
It may turn my stools dark.
I should lie down after taking it.
I’ll avoid taking it with milk.
The nurse reviews the CBC: - Hgb 6.8 g/dL - Hct 20% - SOB, HR 118 bpm Which intervention is expected?
Prepare to transfuse PRBCs
Administer erythropoietin
Start iron supplementation
Restrict fluids
A patient with pernicious anemia after gastric bypass asks why B12 injections are needed. The best response:
Your stomach no longer makes intrinsic factor.
B12 pills don’t work for vegetarians.
The surgery removed all vitamin stores.
You can switch to oral supplements later.
The nurse notes bruising and platelet count 38 K/μL. Which action has highest priority?
Assess for headache/confusion
Encourage ambulation
Administer IM pain meds
Provide compression stockings
The nurse monitors a patient with Addison’s crisis. Which parameter requires immediate attention?
BP 82/50 mm Hg
Glucose 95 mg/dL
Sodium 138 mEq/L
Potassium 4.2 mEq/L
During chemo, the patient’s uric acid sharply increases and K+ 6.2 mEq/L. The nurse suspects:
Tumor lysis syndrome
Hypercalcemia of malignancy
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
Septic shock
A. Tumor lysis syndrome (Correct) B. SIADH C. DKA D. Hypercalcemia of malignancy
Tumor lysis syndrome
SIADH
DKA
Hypercalcemia of malignancy
For tumor lysis syndrome, the nurse anticipates administering:
Allopurinol
Calcium gluconate
Spironolactone
Desmopressin
A patient with Cushing’s syndrome asks why their face looks “round.” The best explanation:
“Steroid excess causes fat redistribution to the face and trunk.”
“You’ve likely gained muscle mass.”
“Fluid intake is too high.”
“It’s from thyroid hormone deficiency.”
A patient with hypoglycemia unawareness is being discharged. Which teaching is most important?
Always carry a fast-acting glucose source.
Avoid any insulin on sick days.
Limit protein intake.
Only test glucose when symptomatic.
The nurse evaluates teaching for SGLT2 inhibitor (empagliflozin). Which statement is correct?
I’ll drink plenty of water to reduce UTI risk.
I’ll expect constipation as a side effect.
This drug raises my blood sugar.
It may cause weight gain.
Which assessment finding in hypercalcemia of malignancy requires priority intervention?
Cardiac rhythm irregularities
Fatigue
A patient with SIADH develops muscle cramps and confusion. Which action should the nurse take first?
Check serum sodium level
Restrict fluids to 1 L/day
Give salt tablets
Notify provider for 3% saline order
The nurse evaluates a patient’s understanding of fluid restriction for SIADH. Which statement shows correct understanding?
I’ll record everything I drink, including soup and gelatin.
If I feel thirsty, I can have ice chips freely.
I should drink extra water with my medications.
Coffee and tea don’t count as fluids.
A DI patient on desmopressin reports a weight gain of 4 lb in two days. Which is the nurse’s priority?
Assess for water intoxication and hyponatremia
Encourage oral fluids
Re-educate about missed doses
Continue same dosage
The nurse cares for four clients. Which requires immediate assessment?
Cushing’s pt with glucose 190 mg/dL
Addison’s pt with BP 84/50 mm Hg
SIADH pt with urine SG 1.015
Type 2 DM pt with A1c 8.4 %
A newly diagnosed Cushing’s patient is distressed about facial changes. Which nursing response is therapeutic?
These changes are reversible once cortisol is controlled.
You’ll just need to accept the new look.
Avoid looking in mirrors until treatment is complete.
You can try heavy makeup to hide swelling.
Which finding in Addison’s crisis confirms therapeutic response to hydrocortisone?
Blood pressure increasing toward baseline
Sodium decreasing
Potassium increasing
Glucose trending lower
During thyroid storm, which medication blocks hormone synthesis?
Propylthiouracil (PTU)
Levothyroxine
Iodine solution
Beta-blocker
After radioactive iodine, which teaching is essential?
Sleep alone for several days
Avoid close contact with pregnant women/children
Use a private toilet and flush twice
Continue breastfeeding
Launder clothes separately
The nurse monitors a type 1 DM on IV insulin for DKA. Which lab finding shows improvement?
pH 7.35 and anion gap closed
K+ 3.0 mEq/L
A type 2 DM on metformin develops severe infection and dehydration. What's the priority?
Hold metformin to prevent lactic acidosis
Increase dose for hyperglycemia
Give additional fluids by mouth
Continue medication as ordered
Which order should the nurse question for a DKA patient?
Regular insulin IV infusion
0.9 % NaCl bolus
Potassium chloride 40 mEq IVPB when K = 6.0 mEq/L
Continuous cardiac monitoring
The nurse evaluates a patient's understanding of foot care with diabetes. Which statement shows correct learning?
I’ll inspect my feet daily using a mirror.
I can soak my feet daily in warm water.
I’ll cut corns myself to save money.
Tight socks help circulation.
The nurse cares for a cirrhosis patient with ascites. Which finding requires urgent action?
New confusion and tremors
Weight gain 2 lb/day
Spider angiomas on chest
Mild ankle edema
Which dietary selection is best for hepatic encephalopathy?
Moderate-protein, high-carbohydrate diet
High-protein, high-fat diet
Low-carb, high-protein
High-fiber vegan
The nurse monitors for bleeding risk in cirrhosis. Which lab value is most concerning?
INR 3.5
Albumin 3.2 g/dL
Bilirubin 2.8 mg/dL
AST 65 U/L
Which nursing diagnosis has the highest priority for a patient with DKA?
Deficient fluid volume
Knowledge deficit
Disturbed body image
Impaired physical mobility
A neutropenic patient develops a temperature of 100.8 °F. First action?
Notify provider immediately
Recheck in 1 hour
Give acetaminophen
Encourage ambulation
Which action by the UAP caring for a neutropenic client requires intervention?
Wearing gloves for oral care
Using alcohol-based hand gel before entering room
Bringing in fresh fruit for snack
Wearing mask if symptomatic
A patient with thrombocytopenia reports new headache and blurred vision. Nursing action?
Call provider—possible intracranial bleed
Give acetaminophen
Document and monitor
Encourage fluids
A client with sickle-cell crisis has O₂ sat 91 %, severe pain, and dehydration. In which order should the nurse act?
Apply O₂
Begin IV fluids
Give opioid analgesic
Keep extremities warm
A folic-acid–deficient patient asks about sources of folate. The best teaching includes:
Green leafy vegetables and citrus fruits
Red meat and milk
White rice and potatoes
Nuts and seeds only
A client receiving epoetin alfa should be monitored for which adverse effect?
Hypertension
Hypotension
Hypokalemia
Hypoglycemia
A patient with iron-deficiency anemia receives IV iron. The nurse should:
Use a separate line and test dose for allergy
Flush with dextrose solution
Give IM in deltoid
Administer rapidly over 1 min
The nurse prepares to administer blood transfusion to a patient with Hgb 6.5 g/dL. Which action requires correction?
Using 0.9 % NS IV line
Verifying ID with another RN
Warming unit in microwave
Obtaining baseline vital signs
After 15 min of transfusion, a patient develops chills and flank pain. Priority action?
Stop transfusion immediately
Slow the rate
Notify provider after completion
Reassure it's expected
A client with non-Hodgkin lymphoma receiving chemo develops uric acid 9.8 mg/dL. Which medication is expected?
(a)
During tumor lysis syndrome, the nurse monitors for which complication?
Hyperkalemia-induced dysrhythmias
Hypophosphatemia
Hypocalcemia tetany
Hyponatremia
A Cushing’s patient reports sudden weakness and vomiting after abruptly stopping steroids. The nurse suspects:
Addisonian crisis
Thyroid storm
Adrenal hyperplasia
Myxedema coma
The nurse gives discharge instructions for Addison’s disease. Which statement shows correct understanding?
I’ll carry an emergency injectable steroid.
I’ll skip my dose when stressed.
I don’t need salt in my diet.
I’ll double my dose when feeling dizzy.
The nurse notes a thyroidectomy patient with tingling around the mouth. Which lab should be checked?
Calcium
Sodium
Potassium
Phosphate
The nurse assesses a hyperparathyroidism patient. Which finding is consistent?
Bone pain and kidney stones
Tetany and twitching
Weight gain and cold intolerance
Hypotension
A type 2 diabetic on pioglitazone reports new shortness of breath and ankle swelling. Priority action?
Assess for heart failure
Encourage fluids
Increase dose
Reassure it's temporary
A patient receiving GLP-1 agonist (semaglutide) reports severe abdominal pain radiating to the back. Best action?
Hold the medication—possible pancreatitis
Administer antacid
Continue and monitor
Increase fiber intake
The nurse teaches a patient about levothyroxine. Which statement shows correct understanding?
I’ll take it every morning on an empty stomach.
I’ll take it with my calcium supplement.
I’ll expect it to make me drowsy.
If I miss a dose, I’ll double the next one.
A patient with Graves’ disease is prescribed propranolol. The primary reason for this drug is to:
The nurse reviews a patient's TSH 0.05 μIU/mL, T₄ high. Which nursing diagnosis is most appropriate?
Risk for decreased cardiac output r/t tachycardia
Risk for infection
Impaired gas exchange r/t airway edema
Activity intolerance r/t fatigue
A patient with hypothyroidism reports taking levothyroxine with coffee each morning. What should the nurse advise?
Take it with water only 30–60 min before breakfast
Coffee increases absorption
Time of administration doesn’t matter
Combine with calcium for best results
Which patient requires immediate nursing intervention?
Addison’s with Na⁺ 120 mEq/L
Cushing’s with glucose 170 mg/dL
SIADH with urine SG 1.015
Type 2 DM with fasting BG 130 mg/dL
A patient with Cushing’s syndrome expresses depression and poor self-image. Priority nursing action?
Provide emotional support and active listening
Focus on medication teaching
Encourage group therapy later
Emphasize dietary changes first
During Addisonian crisis, which IV fluid should the nurse anticipate?
0.9 % NaCl with 5 % dextrose
D5W only
Lactated Ringer’s with KCl
0.45 % NaCl
A patient on prednisone long term requires which discharge teaching?
Do not stop medication abruptly
Take on empty stomach
Double dose if missed
Avoid all protein foods
The nurse suspects SIADH in a patient receiving carbamazepine. Which lab supports this?
Low serum Na+, concentrated urine
High serum Na+, dilute urine
High calcium, high phosphate
High glucose, low urine osmolality
The nurse reviews four clients’ reports. Which finding needs priority action?
DI with urine output 4 L/24h
SIADH with Na+ 114 mEq/L
Type 1 DM with glucose 250 mg/dL
Addison’s with fatigue
A client with central DI on desmopressin reports a pounding headache. The nurse should:
Hold the next dose and check sodium level
Give an extra dose
Reassure and document
Restrict fluids further
A patient with cirrhosis is prescribed lactulose. Which outcome shows effectiveness?
Improved mental status
Reduced ascites
Decreased jaundice
Increased appetite
Which statement shows correct teaching for portal hypertension with varices?
I’ll avoid straining and coughing.
I can take ibuprofen for headaches.
A nurse prepares to administer propranolol to a patient with esophageal varices. Purpose of this drug?
Reduce portal venous pressure
Lower ammonia levels
Stimulate clotting factors
Increase bile secretion
A patient with thrombocytopenia requires teaching. Which statement indicates correct understanding?
I’ll use an electric razor and soft toothbrush.
I can take aspirin if I get a headache.
I’ll floss daily.
I’ll do contact sports cautiously.
A patient receiving chemotherapy asks why they need filgrastim injections. The nurse’s response:
It helps your bone marrow make more white blood cells.
It prevents anemia.
It boosts platelets.
It fights cancer directly.
The nurse provides teaching for epoetin alfa. Which lab must be monitored closely?
Hemoglobin
Calcium
Glucose
Sodium
A leukemia patient undergoing chemo reports painful mouth ulcers. Best intervention?
Rinse with saline or baking soda solution
Use lemon swabs
Apply viscous lidocaine after meals
Eat spicy foods for taste
A patient with acute leukemia reports fatigue and fever. The nurse’s first action is to:
Assess temperature and report >100.4 °F
Obtain hemoglobin level
Encourage ambulation
Administer acetaminophen
Which dietary teaching is appropriate for iron-deficiency anemia?
Eat red meats, leafy greens, and fortified cereals.
Avoid vitamin C while taking iron.
Take iron with milk.
Iron should be taken with antacids.
A patient with aplastic anemia requires which infection prevention teaching?
Avoid crowds and sick people
Get all live vaccines
Use herbal immune boosters
Report bruising only
A nurse reviews a patient's labs: • WBC 1.1 ×10⁹/μL • Platelets 90 K/μL • Hgb 7.5 g/dL Which diagnosis fits best?
Aplastic anemia
Sickle cell crisis
Polycythemia vera
Pernicious anemia
A client with tumor lysis syndrome after chemo presents with muscle cramps and tingling. The nurse suspects:
Hypocalcemia
Hypernatremia
Which medication is given to prevent uric acid nephropathy in tumor lysis syndrome?
Allopurinol
Epoetin alfa
Ondansetron
Methotrexate
Which finding in hypercalcemia of malignancy requires urgent attention?
ECG changes
Constipation
Fatigue
Nausea
The nurse prepares calcitonin for a patient with hypercalcemia. The expected effect is:
Drives calcium into bone and lowers serum Ca²⁺
Releases calcium from bone
Raises phosphate level
Stimulates PTH secretion
Which patient should the nurse assess first?
Chemo pt with temp 100.6 °F
Liver pt with mild jaundice
SIADH pt with Na⁺ 132 mEq/L
Hypothyroid pt with fatigue
During blood transfusion, which sign indicates possible hemolytic reaction?
Back pain and chills
Fever and urticaria
Cough and dyspnea
Headache
The nurse provides discharge education for a diabetic on glargine and lispro. Which teaching is correct?
Glargine provides 24-hour coverage and is not mixed with other insulin.
Lispro is taken 2 hours before meals.
Store opened insulin in the freezer.
Rotate injection sites weekly only.
The nurse identifies a Type 1 diabetic who skips insulin and develops Kussmaul respirations. Priority nursing diagnosis?
Deficient fluid volume
Ineffective airway clearance
Activity intolerance
Anxiety
Which statement about long-term corticosteroid therapy requires intervention?
I’ll monitor my blood glucose regularly.
I’ll stop it as soon as I feel better.
I’ll avoid people with infections.
I’ll report swelling or vision changes.
The nurse monitors a patient with cirrhosis. Which lab value shows worsening liver function?
Elevated ammonia level
Low potassium
Elevated hematocrit
Low bilirubin
A patient with hypoglycemia is unresponsive. Next nursing action?
Administer 1 mg glucagon IM
Give 15 g oral carbs
Encourage orange juice
Wait 15 minutes and recheck
