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20/07/2026

✅ Correct Answer: A. Dawn phenomenon

Rationale

The dawn phenomenon is early-morning hyperglycemia that occurs due to the nighttime release of hormones such as growth hormone and cortisol. These hormones increase glucose production by the liver and can cause blood glucose to rise between about 5:00 AM and 6:00 AM.

This is not caused by nighttime hypoglycemia. It is caused by normal overnight hormone release.

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Option Analysis

✅ A. Dawn phenomenon
Correct. Early-morning hyperglycemia caused by nighttime hormone release is consistent with the dawn phenomenon.

❌ B. Somogyi effect
Incorrect. Somogyi effect is rebound morning hyperglycemia caused by nighttime hypoglycemia followed by counterregulatory hormone release.

❌ C. Hyperosmolar hyperglycemic syndrome HHS
Incorrect. HHS is a serious complication usually seen in type 2 diabetes with extreme hyperglycemia and dehydration.

❌ D. Diabetic ketoacidosis DKA
Incorrect. DKA is an acute emergency with hyperglycemia, ketones, metabolic acidosis, dehydration, and often Kussmaul respirations.

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NCLEX Pearls

✅ Dawn phenomenon = early morning hyperglycemia.
✅ Caused by nighttime hormone release, especially growth hormone and cortisol.
✅ Somogyi effect = rebound hyperglycemia after nighttime hypoglycemia.
✅ Check overnight glucose trends to tell the difference.
✅ Dawn phenomenon usually does not include 2–3 AM hypoglycemia.

Memory Trick

“Dawn = hormones rise as the sun rises.”

Final Answer: ✅ A. Dawn phenomenon

NursingSchool RNCodeBlue

20/07/2026

✅ Correct Answer: A. pH 7.29, PCO₂ 56, PaO₂ 83, HCO₃ 22

Rationale

In acute respiratory failure, the client has impaired gas exchange. This commonly leads to CO₂ retention and respiratory acidosis.

Expected ABG findings include:

Low pH → acidosis

High PaCO₂ → respiratory cause

Low or decreased PaO₂ → impaired oxygenation

Normal or slightly changed HCO₃⁻ → little compensation in acute cases

Option A shows respiratory acidosis with elevated CO₂ and low pH, which is consistent with acute respiratory failure.

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Option Analysis

✅ A. pH 7.29, PCO₂ 56, PaO₂ 83, HCO₃ 22
Correct. Low pH and elevated PCO₂ indicate respiratory acidosis, commonly seen in acute respiratory failure.

❌ B. pH 7.38, PCO₂ 40, PaO₂ 92, HCO₃ 25
Incorrect. These values are within normal range and do not indicate respiratory failure.

❌ C. pH 7.49, PCO₂ 30, PaO₂ 96, HCO₃ 28
Incorrect. This indicates alkalosis, not acute respiratory failure with CO₂ retention.

❌ D. pH 7.50, PCO₂ 44, PaO₂ 93, HCO₃ 34
Incorrect. This is more consistent with metabolic alkalosis.

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NCLEX Pearls

✅ Acute respiratory failure can cause hypoxemia and hypercapnia.
✅ CO₂ retention causes respiratory acidosis.
✅ Respiratory acidosis = low pH + high PaCO₂.
✅ HCO₃⁻ may remain normal in acute respiratory acidosis.
✅ Monitor oxygenation, ventilation, respiratory effort, and mental status.

Memory Trick

“Respiratory failure traps CO₂.”

Final Answer: ✅ A. pH 7.29, PCO₂ 56, PaO₂ 83, HCO₃ 22

NursingSchool RNCodeBlue

20/07/2026

✅ Correct Answer: A. “The rotavirus vaccine is a live attenuated vaccine type.”

Rationale

The rotavirus vaccine is a live attenuated vaccine given orally to infants. Live attenuated vaccines contain a weakened form of the virus that helps the body develop immunity.

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Option Analysis

✅ A. “The rotavirus vaccine is a live attenuated vaccine type.”
Correct. Rotavirus vaccine is a live attenuated vaccine.

❌ B. “The hepatitis B vaccine is an example of a toxoid vaccine type.”
Incorrect. Hepatitis B vaccine is a recombinant vaccine, not a toxoid vaccine.

❌ C. “Polio vaccination is recommended during pregnancy.”
Incorrect. Polio vaccine is not routinely recommended during pregnancy unless the pregnant client is at increased risk for exposure.

❌ D. “The Human papillomavirus vaccine HPV reduces the risk for ovarian cancer.”
Incorrect. HPV vaccine helps reduce the risk of cervical cancer and other HPV-related cancers, not ovarian cancer.

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NCLEX Pearls

✅ Rotavirus = live attenuated vaccine.
✅ Hepatitis B = recombinant vaccine.
✅ Toxoid vaccines include tetanus and diphtheria.
✅ HPV vaccine helps prevent cervical and other HPV-related cancers.
✅ Always match the vaccine with its type and indication.

Memory Trick

“Rota is live.”

Final Answer: ✅ A. Rotavirus vaccine is live attenuated

NursingSchool RNCodeBlue

20/07/2026

✅ Correct Answer: D. 37 weeks gestation experiencing variable decelerations
Rationale
The nurse should initially assess the client with the finding that poses the greatest immediate risk to the fetus. Variable decelerations are associated with umbilical cord compression, which can decrease fetal oxygenation and requires prompt assessment and intervention.
Option Analysis
❌ A. 15 weeks gestation who reports not feeling any fetal movement
Incorrect. Fetal movement is usually felt around 16–20 weeks, so not feeling movement at 15 weeks can be expected.
❌ B. 28 weeks gestation who reports swollen feet and ankles
Incorrect. Mild dependent edema can be common in the second and third trimester.
❌ C. 36 weeks gestation who reports contractions that are irregular
Incorrect. Irregular contractions may be Braxton Hicks contractions and are not the priority unless they become regular, painful, or associated with other warning signs.
✅ D. 37 weeks gestation experiencing variable decelerations
Correct. Variable decelerations may indicate umbilical cord compression and require immediate assessment.
NCLEX Pearls
✅ Variable decelerations = think cord compression.
✅ Prioritize fetal heart rate changes that suggest impaired oxygenation.
✅ Mild swelling can be normal in pregnancy.
✅ Irregular contractions near term may be Braxton Hicks.
✅ Use ABCs for both mother and fetus.
Memory Trick
“Variable = cord variable squeezed.”
Final Answer: ✅ D. 37 weeks gestation experiencing variable decelerations
NursingSchool RNCodeBlue

20/07/2026

✅ Correct Answer: B. “Microcephaly is always caused by genetic factors.”

Rationale

Microcephaly means the baby’s head is smaller than expected for age and s*x, often related to impaired brain growth. It can be caused by genetic factors, but it is not always genetic.

Other causes may include prenatal infections, exposure to alcohol or toxins, poor oxygen supply to the fetus, severe malnutrition, or other pregnancy-related complications.

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Option Analysis

❌ A. “I understand that microcephaly may cause an abnormally small head size.”
Correct understanding. Microcephaly is associated with a smaller-than-expected head size.

✅ B. “Microcephaly is always caused by genetic factors.”
Needs further teaching. This is incorrect because microcephaly can have genetic and non-genetic causes.

❌ C. “I will ensure our baby receives regular developmental assessments.”
Correct understanding. Ongoing developmental follow-up is important.

❌ D. “Infections during my pregnancy may have caused microcephaly.”
Correct understanding. Certain prenatal infections can contribute to microcephaly.

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NCLEX Pearls

✅ Microcephaly = smaller-than-expected head size.
✅ Causes may include genetics, prenatal infections, toxins, alcohol exposure, or other fetal growth problems.
✅ Regular developmental assessment is important.
✅ Early intervention services may support growth and development.
✅ Avoid absolute words like always or never in NCLEX questions.

Memory Trick

“Microcephaly has many causes, not one cause.”

Final Answer: ✅ B. “Microcephaly is always caused by genetic factors.”

NursingSchool RNCodeBlue

20/07/2026

✅ Correct Answer: B. “I understand you are upset. This is certainly serious, but there is a treatment that can repair the omphalocele, and we will take excellent care of your baby.”

Rationale

The parent is extremely distressed and fearful. The nurse should use therapeutic communication by acknowledging the parent’s feelings, giving honest information, and providing realistic reassurance.

Omphalocele is serious, but treatment is available. The best response supports the parent emotionally while giving accurate and hopeful information.

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Option Analysis

❌ A. “Don’t worry, these things happen all the time; your baby will be fine without any intervention.”
Incorrect. This gives false reassurance and minimizes the parent’s fear. Omphalocele usually requires medical or surgical management.

✅ B. “I understand you are upset. This is certainly serious, but there is a treatment that can repair the omphalocele, and we will take excellent care of your baby.”
Correct. This response acknowledges the parent’s distress, gives honest information, and provides realistic reassurance.

❌ C. “I know this looks bad, but let’s not jump to conclusions. We’ll see how it goes.”
Incorrect. This is vague and does not provide clear support or information.

❌ D. “I understand you must be upset. Would you like to hold your baby while he is still here?”
Incorrect. This statement may increase fear by implying the infant may die soon. It is not therapeutic.

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NCLEX Pearls

✅ Acknowledge feelings first.
✅ Avoid false reassurance.
✅ Give honest, clear, compassionate information.
✅ Support parents during newborn complications.
✅ Therapeutic communication should reduce fear, not increase it.

Memory Trick

“Feelings first, facts second, reassurance last.”

Final Answer: ✅ B. Therapeutic, honest reassurance

NursingSchool RNCodeBlue

19/07/2026

✅ Correct Answer: C. Neurological status

Rationale

Severe hypernatremia causes water to shift out of brain cells, leading to cellular dehydration and neurologic dysfunction. Because neurologic changes can progress to confusion, lethargy, seizures, coma, or permanent injury, the nurse should prioritize assessing the client’s neurological status.

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Option Analysis

❌ A. Cardiovascular status
Incorrect. Cardiovascular assessment is important, especially with fluid imbalance, but the most urgent concern in severe hypernatremia is neurologic impairment.

❌ B. Genitourinary status
Incorrect. Urine output and hydration status should be monitored, but this is not the priority over neurologic changes.

✅ C. Neurological status
Correct. Severe hypernatremia can cause mental status changes, irritability, muscle twitching, seizures, and coma.

❌ D. Gastrointestinal status
Incorrect. GI symptoms may occur, but they are not the priority assessment in severe hypernatremia.

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NCLEX Pearls

✅ Hypernatremia = high sodium.
✅ Severe hypernatremia causes brain cell dehydration.
✅ Monitor level of consciousness, orientation, seizures, and neuromuscular changes.
✅ Correct sodium slowly to prevent cerebral edema.
✅ Assess neurologic status first in severe sodium imbalance.

Memory Trick

“High sodium dries the brain.”

Final Answer: ✅ C. Neurological status

NursingSchool RNCodeBlue

19/07/2026

✅ Correct Answers: A, C, E, and F

Rationale

When irrigating a nasogastric tube connected to suction, the nurse should use the prescribed amount of warm water, instill it gently through the correct tube opening, and then observe for return drainage. Irrigation helps maintain tube patency and confirms that the tube is functioning properly.

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Option Analysis

✅ A. Draw up 30 mL of warm water into the syringe.
Correct. Warm water is commonly used for NGT irrigation because it helps maintain patency and promotes client comfort.

❌ B. Unclamp the suction tubing near the connection site to instill water.
Incorrect. The suction tubing should be clamped or disconnected from suction before irrigation to prevent backflow and allow safe instillation.

✅ C. Place the tip of the syringe in the tube to gently instill warm water.
Correct. The nurse should gently instill the irrigating solution into the NG tube.

❌ D. Place the syringe in the blue air vent of a Salem sump or double-lumen tube.
Incorrect. The blue air vent is not used for irrigation. Irrigating the air vent can damage the tube system or increase aspiration risk.

✅ E. After instilling the water, hold the end of the NG tube over an irrigation tray.
Correct. This allows drainage to return by gravity and helps assess tube patency.

✅ F. Observe for return of NG drainage into an available container.
Correct. Return drainage confirms that the tube is patent and functioning.

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NCLEX Pearls

✅ Use warm water for NGT irrigation unless otherwise prescribed.
✅ Clamp or disconnect suction before instilling fluid.
✅ Never irrigate through the blue air vent of a Salem sump tube.
✅ Instill fluid gently; do not force irrigation.
✅ Observe for return drainage after irrigation.

Memory Trick

“Irrigate the tube, not the blue.”

Final Answer: ✅ A, C, E, and F

NursingSchool RNCodeBlue

19/07/2026

✅ Correct Answer: C. Perform a visual acuity exam

Rationale

For a child with a suspected foreign body in the eye, the nurse should first assess visual acuity before further treatment if the situation is not a chemical injury. This provides baseline data and helps determine the severity of the eye injury.

The child should be instructed not to rub the eye, because rubbing can scratch the cornea or push the object deeper.

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Option Analysis

❌ A. Rub the eye until the object dislodges
Incorrect. Rubbing the eye can worsen injury and cause corneal abrasion.

❌ B. Irrigate the affected eye with hydrogen peroxide
Incorrect. Hydrogen peroxide should never be used in the eye because it can damage eye tissue.

✅ C. Perform a visual acuity exam
Correct. Visual acuity should be assessed to establish baseline eye function before further intervention.

❌ D. Place a cold compress on the affected eye
Incorrect. A cold compress may reduce discomfort but does not address the priority assessment.

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NCLEX Pearls

✅ Do not rub an injured eye.
✅ Assess visual acuity with eye injuries when possible.
✅ Use sterile normal saline for irrigation if ordered or appropriate.
✅ Do not remove an embedded object.
✅ Cover the eye and notify the provider if the object remains or injury is severe.

Memory Trick

“Eye injury? Check vision before intervention.”

Final Answer: ✅ C. Perform a visual acuity exam

NursingSchool RNCodeBlue

19/07/2026

✅ Correct Answers: B, C, and E

Rationale

Adult basic life support focuses on rapid recognition of cardiac arrest, high-quality CPR, and early defibrillation when indicated. Effective chest compressions and early shock delivery for shockable rhythms, such as ventricular fibrillation, improve survival.

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Option Analysis

❌ A. Carotid pulse check should not take more than 20 seconds.
Incorrect. Pulse check should take no more than 10 seconds to avoid delaying CPR.

✅ B. The rate of chest compressions should be 100–120 per minute.
Correct. Adult chest compressions should be performed at a rate of 100–120/minute.

✅ C. Chest compression depth should be 2 inches on the center breastbone.
Correct. Adult compressions should be about 2 inches deep on the lower half/center of the sternum.

❌ D. Chest tube insertion should be prepared after five minutes of CPR.
Incorrect. Chest tube insertion is not part of adult BLS.

✅ E. Early defibrillation is essential in the survival of ventricular fibrillation.
Correct. Ventricular fibrillation is a shockable rhythm, and early defibrillation is critical for survival.

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NCLEX Pearls

✅ Check pulse for no more than 10 seconds.
✅ Compress at 100–120/minute.
✅ Compress about 2 inches deep in adults.
✅ Minimize interruptions in chest compressions.
✅ Defibrillate early for ventricular fibrillation or pulseless ventricular tachycardia.

Memory Trick

“Push fast, push deep, shock early.”

Final Answer: ✅ B, C, and E

NursingSchool RNCodeBlue

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