NCLEX-RN practice questions that teach the reasoning.

10 free practice questions

Independent practice, not affiliated with NCSBN.

1. 1.What does a low arterial blood pH indicate?

   1. A low hydrogen ion concentration

   2. An increased hydrogen ion concentration

   3. An increased bicarbonate concentration

   4. A reduced carbon dioxide concentration

   Answer: B

   Explanation

   A low pH reflects a higher hydrogen ion concentration and is associated with acidosis. Hydrogen ions are produced as by-products of metabolism.

   Practice set: Acid-Base Balance Practice Questions: ABG Concepts

2. 2.A lab report gives a potassium value of 5.4 mEq/L. Which interpretation is most appropriate using the typical range?

   1. It is below the typical range

   2. It is above the typical range and warrants attention to hyperkalemia

   3. It cannot be interpreted because potassium is measured in mg/dL

   4. It is within the typical range

   Answer: B

   Explanation

   The typical potassium range is 3.5-5.1 mEq/L, so 5.4 mEq/L is above that range. The laboratory's own reference interval should be used in practice.

   Practice set: Electrolyte Imbalance Quiz: Sodium and Potassium

3. 3.What is the primary acid-base problem in diabetic ketoacidosis?

   1. Retention of bicarbonate causing metabolic alkalosis

   2. Accumulation of ketone acids causing metabolic acidosis

   3. Excessive carbon dioxide removal causing respiratory alkalosis

   4. Loss of gastric hydrogen ions causing metabolic alkalosis

   Answer: B

   Explanation

   In diabetic ketoacidosis, ketones accumulate in the blood and contribute to metabolic acidosis. The primary change is metabolic rather than respiratory.

   Practice set: Acid-Base Balance Practice Questions: ABG Concepts

4. 4.Why may potassium supplementation be needed during therapy with loop or thiazide diuretics?

   1. Potassium is converted into sodium during diuretic therapy

   2. These drugs prevent all potassium absorption from the intestine

   3. Potassium is excreted by the kidneys along with water

   4. These drugs move potassium permanently into bone

   Answer: C

   Explanation

   Potassium is poorly conserved and can be lost in urine with water during loop and thiazide diuretic therapy.

   Practice set: Electrolyte Imbalance Quiz: Sodium and Potassium

5. 5.How does sodium polystyrene sulfonate help manage severe hyperkalemia?

   1. It moves potassium into cells through an insulin-like action

   2. It prevents sodium from being reabsorbed in the distal tubule

   3. It protects cardiac muscle without changing potassium handling

   4. It binds excess potassium so it can be excreted through the GI tract

   Answer: D

   Explanation

   Sodium polystyrene sulfonate binds excess potassium in the gastrointestinal tract, allowing potassium to be excreted through that route.

   Practice set: Electrolyte Imbalance Quiz: Sodium and Potassium

6. 6.A UAP receives additional training and validated competence to perform a nursing procedure that is not part of the UAP's routine role. How should this situation be classified?

   1. Formal delegation

   2. A routine assignment

   3. Independent nursing judgment

   4. Informal role substitution

   Answer: A

   Explanation

   Formal delegation allows a competent and accepting delegatee to perform a specific activity outside the person's traditional role. Additional training and competency validation are central to this process.

   Practice set: Nursing Delegation Practice Questions

7. 7.Using the ROME framework, which primary acid-base pattern is represented by pH 7.30, PaCO2 52 mmHg, and HCO3 24 mEq/L?

   1. Uncompensated metabolic acidosis

   2. Partially compensated respiratory acidosis

   3. Partially compensated metabolic alkalosis

   4. Uncompensated respiratory acidosis

   Answer: D

   Explanation

   The pH indicates acidosis, and the elevated PaCO2 moves opposite to the pH, identifying a respiratory cause under the ROME mnemonic. Because HCO3 remains within its reference range, compensation is not yet evident in this profile.

   Practice set: Acid-Base Balance Practice Questions: ABG Concepts

8. 8.Which comparison between hypernatremia and hyponatremia is correct?

   1. Both are treated by increasing free-water intake

   2. Both cause water to move out of brain cells

   3. Hypernatremia causes only gastrointestinal symptoms, whereas hyponatremia causes only renal symptoms

   4. Hypernatremia causes brain-cell shrinkage, whereas hyponatremia can cause brain-cell swelling

   Answer: D

   Explanation

   Hypernatremia draws water out of cells, including brain cells, while hyponatremia can drive water into cells. These opposite fluid shifts help explain their differing neurological manifestations.

   Practice set: Electrolyte Imbalance Quiz: Sodium and Potassium

9. 9.Which description best identifies a fully compensated arterial blood gas profile?

   1. The pH is abnormal, and only the causative component is outside its reference range

   2. The pH is within its reference range, and both PaCO2 and HCO3 are outside their reference ranges

   3. The pH and both regulatory components are within their reference ranges

   4. The pH is abnormal, and both PaCO2 and HCO3 are outside their reference ranges

   Answer: B

   Explanation

   Full compensation means the compensatory response has returned pH to the normal range while both PaCO2 and HCO3 remain abnormal. An abnormal pH with both components abnormal indicates partial compensation, whereas an abnormal pH with only one abnormal component indicates no compensation yet.

   Practice set: Acid-Base Balance Practice Questions: ABG Concepts

10. 10.Which escalation priority best reflects the potential danger of electrolyte abnormalities?

    1. Assess neurological status for sodium disturbances and cardiac status for potassium disturbances

    2. Assess only dietary intake because symptoms are rarely physiologic

    3. Treat sodium and potassium abnormalities identically

    4. Focus on skin findings and defer rhythm assessment

    Answer: A

    Explanation

    Sodium disturbances are especially associated with neurological changes from cellular water shifts, while potassium disturbances can cause serious cardiac rhythm and contractility abnormalities.

    Practice set: Electrolyte Imbalance Quiz: Sodium and Potassium