EXAM REAL EXAM QUESTIONS AND CORRECT

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pg. 1 UWorld NCLEX-RN TEST 2 NEWEST 2025 ACTUAL

EXAM| REAL EXAM QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

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The nurse assesses the heart sounds of a 77-year-old client with chronic heart failure. Which heart sound should the nurse document? Listen to the audio clip. (Headphones are required for best audio quality.)

• Pericardial friction rub
• S1, S2, no adventitious sounds
• S3 extra heart sound
• Systolic murmur - Correct Answer - 3.

A nurse caring for a client following a right femoral angiogram is unable to palpate the right pedal pulse. What should the nurse do next?

• Apply a heating pad to increase circulation
• Call the health care provider
• Document "0" for right pedal pulse strength
• Obtain a Doppler ultrasound - Correct Answer - 4

What nursing intervention is most appropriate when caring for a client with impairment to cranial nerve II?

• Ensure that the client has a mechanical soft diet
• Raise the head of the bed to prevent aspiration
• Use pen and paper to write instructions 1 / 4

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• Verbally explain nursing interventions in detail - Correct Answer - 4.

The nurse is teaching a seminar about atypical presentation of myocardial infarction. The nurse teaches about which factor that increases a client's risk of experiencing atypical symptoms?

• Female gender
• History of smoking
• Hyperlipidemia
• Hypertension - Correct Answer - 1.

After assessing 4 clients in the pediatric emergency department, the nurse should alert the health care provider to see which client first?

• 4-month-old who is lethargic with fever and vomiting
• 2-year-old who is alert and calm with an occasional barking cough
• 8-year-old with cola-colored urine and generalized edema
• 15-year-old who is withdrawn and having painful urination - Correct

Answer - 1.

The nurse is caring for a client 1 hour after receiving the first electroconvulsive therapy treatment for severe major depressive disorder. The client reports a headache, is disoriented to place, and cannot recall the spouse's name. What is the appropriate nursing action?

• Call the spouse to ask about memory problems prior to admission
• Complete a full neurological examination and stroke assessment
• Document the findings in the client's medical record 2 / 4

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• Request a prescription for a CT scan of the head - Correct Answer - 3.

The monitor tech on the telemetry unit notifies the charge nurse that there are no more client telemetry boxes available for new admissions.Which client should the charge nurse consider for discontinuation of telemetry monitoring?

• Client awaiting pacemaker battery replacement with a heart rate of

72/min

• Client on observation to rule out myocardial infarction who has no ST

elevation

• Client with chronic atrial fibrillation prescribed warfarin with an INR

of 3.0

• Client with second-degree type 2 heart block with a blood pressure of

126/78 mm Hg - Correct Answer - 3

The nurse is reviewing health history information for a client who is being seen for a routine physical examination. Which of the following clinical findings indicate that the client is at risk for latex allergy?

• Had an etonogestrel implant inserted 9 months ago for birth control
• Is allergic to shellfish, which cause throat swelling and rash
• Reports a positive family history of spina bifida
• Sought care 1 year ago for vaginitis after using a condom - Correct

Answer - 4.

The new nurse, caring for a 3-month-old client who is sedated in the intensive care unit following surgery, needs to prevent skin breakdown. 3 / 4

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pg. 4 Which action performed by the new nurse would cause the charge nurse to intervene?

• Applying barrier cream when changing the diaper
• Changing the pulse oximetry site
• Elevating the head of the bed 30 degrees
• Placing a donut pillow under the head - Correct Answer - 4.

The nurse is caring for a client with non-Hodgkin lymphoma who is starting chemotherapy. What assessment findings alert the nurse that the client is developing the potential complication of tumor lysis syndrome?

• Facial and upper body edema
• Generalized edema and hyponatremia
• Hyperkalemia and hyperuricemia
• Hypotension and elevated lactic acid - Correct Answer - 3.

The nurse on a medical-surgical unit prepares scheduled daily medications for a client and places them in a pill cup. After receiving the pill cup, the client states, "I take a whole tablet of metoprolol at home.The nurse assesses a client who is intubated and mechanically ventilated after a cerebrovascular accident. Which assessment finding is most important for the nurse to report to the health care provider?

• Flaccid right hand and arm
• Impaired gag reflex when suctioning
• Presence of urinary incontinence
• Rigid flexion of arms at the elbows - Correct Answer - 4.
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