Next Gen NCLEX
NCLEX-RN Matrix / Grid Practice Questions
Matrix (grid) items ask you to make a judgment about each item in a list – is each finding expected or unexpected, each action indicated or contraindicated, each intervention effective or not. There is no partial credit, so every row counts. Below are 12 free matrix questions with rationales.
Matrix 1 of 12
A 52-year-old male is admitted with a new diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) following a small cell lung cancer diagnosis. His serum sodium is 118 mEq/L and he is lethargic and confused. The physician orders fluid restriction to 800 mL per day and hypertonic saline 3% IV at 25 mL/hr. The nurse is monitoring for response to treatment.
For each nursing assessment finding or intervention, indicate whether it is Expected or Unexpected in a patient with SIADH being treated with fluid restriction and hypertonic saline.
| Finding | Expected | Unexpected |
|---|---|---|
| Serum sodium rises to 122 mEq/L after 8 hours of treatment | ||
| Urine output increases to 200 mL/hr | ||
| Patient reports worsening headache and becomes increasingly confused | ||
| Urine osmolality remains greater than serum osmolality | ||
| Nurse corrects serum sodium by more than 12 mEq/L within 24 hours | ||
| Patient's neurological status gradually improves as sodium rises slowly |
Matrix 2 of 12
A 34-year-old female at 36 weeks gestation presents to the labor and delivery unit with a blood pressure of 158/104 mmHg, 3+ proteinuria, severe headache, and visual disturbances. She is diagnosed with severe preeclampsia and started on magnesium sulfate 4 g IV loading dose followed by 2 g/hr maintenance infusion. The nurse is preparing to care for this patient.
For each nursing action or clinical finding, indicate whether it is Indicated, Contraindicated, or Unrelated for the management of this patient with severe preeclampsia on magnesium sulfate.
| Finding | Indicated | Contraindicated | Unrelated |
|---|---|---|---|
| Monitor deep tendon reflexes every hour | |||
| Administer calcium gluconate 1 g IV at bedside as antidote | |||
| Encourage the patient to ambulate in the hallway for exercise | |||
| Continue magnesium infusion if respiratory rate falls to 10 breaths per minute | |||
| Schedule routine dental cleaning for the following week | |||
| Maintain urinary output monitoring at least 25 to 30 mL per hour |
Matrix 3 of 12
A 7-year-old male with a known peanut allergy is brought to the emergency department by his parents after accidentally ingesting a food containing peanuts at school. He presents with urticaria, stridor, and hypotension with a blood pressure of 72/40 mmHg. He is diagnosed with anaphylaxis. Epinephrine 0.01 mg/kg IM is administered to the lateral thigh.
For each clinical finding or intervention, indicate whether it is Expected or Unexpected after epinephrine administration for anaphylaxis in this pediatric patient.
| Finding | Expected | Unexpected |
|---|---|---|
| Heart rate increases to 130 beats per minute following epinephrine | ||
| Blood pressure improves to 96/60 mmHg within 5 to 10 minutes | ||
| Stridor completely resolves and does not return after a single dose | ||
| Skin pallor and diaphoresis appear immediately after injection | ||
| Child develops bradycardia and heart rate drops to 48 beats per minute | ||
| Symptoms recur 4 to 6 hours later requiring additional treatment |
Matrix 4 of 12
A 68-year-old female with a 20-year history of type 2 diabetes mellitus presents with a 3-day history of nausea, vomiting, polyuria, and progressive weakness. Laboratory results show blood glucose 620 mg/dL, serum osmolality 342 mOsm/kg, BUN 38 mg/dL, and creatinine 2.1 mg/dL with no ketonuria. She is diagnosed with hyperosmolar hyperglycemic state (HHS). IV insulin infusion and aggressive fluid resuscitation are initiated.
For each nursing action or assessment finding, indicate whether it is Indicated, Contraindicated, or Unrelated in the management of this patient with HHS.
| Finding | Indicated | Contraindicated | Unrelated |
|---|---|---|---|
| Administer 0.9% normal saline 1 L IV bolus in the first hour | |||
| Give IV potassium replacement before initiating insulin if potassium is less than 3.5 mEq/L | |||
| Begin insulin bolus of 0.1 units/kg IV without checking potassium level first | |||
| Assess neurological status every 1 to 2 hours during treatment | |||
| Restrict all oral and IV fluids to prevent fluid overload | |||
| Prepare discharge teaching materials about a low-cholesterol diet |
Matrix 5 of 12
A 45-year-old male with a history of alcohol use disorder is admitted with acute pancreatitis. He reports severe epigastric pain radiating to the back, rated 9 out of 10. Laboratory findings include lipase 1,840 units/L, calcium 7.2 mg/dL, WBC 18,000 cells/mcL, and blood glucose 210 mg/dL. He is placed on NPO status and IV fluid resuscitation is initiated.
For each nursing intervention or clinical finding, indicate whether it is Effective, Ineffective, or Unrelated in the management of acute pancreatitis.
| Finding | Effective | Ineffective | Unrelated |
|---|---|---|---|
| Administering IV lactated Ringer solution for fluid resuscitation | |||
| Maintaining NPO status to allow pancreatic rest | |||
| Administering oral pancreatic enzyme supplements to aid digestion during acute phase | |||
| Positioning the patient in a side-lying knee-chest position to reduce pain | |||
| Monitoring serum calcium levels and reporting hypocalcemia | |||
| Initiating a high-fat enteral tube feeding formula during the acute phase |
Matrix 6 of 12
A 72-year-old male with end-stage renal disease on hemodialysis three times weekly is admitted after missing two consecutive dialysis sessions. He presents with severe dyspnea, jugular venous distension, bilateral crackles, and a potassium level of 6.8 mEq/L with peaked T waves on ECG. He is awaiting emergent dialysis.
For each intervention, indicate whether it is Indicated, Contraindicated, or Unrelated while awaiting emergent dialysis for this patient with missed hemodialysis and hyperkalemia.
| Finding | Indicated | Contraindicated |
|---|---|---|
| Administer IV calcium gluconate to stabilize the cardiac membrane | ||
| Give IV regular insulin 10 units with 50% dextrose to shift potassium into cells | ||
| Administer a potassium-containing IV fluid such as lactated Ringer solution | ||
| Place the patient on continuous cardiac monitoring | ||
| Administer sodium polystyrene sulfonate enema as sole treatment for immediate potassium reduction | ||
| Encourage oral intake of potassium-rich foods such as bananas and oranges |
Matrix 7 of 12
A 68-year-old male with a history of heart failure is admitted with worsening dyspnea and bilateral lower-extremity edema. His current vital signs are: blood pressure 148/92 mmHg, heart rate 102 beats per minute, respiratory rate 22 breaths per minute, oxygen saturation 91% on room air, and temperature 37.1 degrees Celsius. He reports gaining 4 kg over the past week and states he has been sleeping on three pillows at night.
For each assessment finding, indicate whether it is expected or unexpected for a client with acutely decompensated heart failure.
| Finding | Expected | Unexpected |
|---|---|---|
| Bilateral crackles heard in the lung bases on auscultation | ||
| Jugular venous distension visible at 45-degree head elevation | ||
| Urine output of 80 mL over the past 4 hours | ||
| S3 heart sound on cardiac auscultation | ||
| Serum potassium of 2.9 mEq/L prior to diuretic therapy | ||
| Orthopnea requiring multiple pillows to breathe comfortably |
Matrix 8 of 12
A 54-year-old female with type 2 diabetes mellitus is admitted for a blood glucose of 620 mg/dL, severe dehydration, and altered mental status. Arterial blood gas results show pH 7.38, PaCO2 40 mmHg, and bicarbonate 24 mEq/L. Serum osmolality is 338 mOsm/kg. She has no ketonuria and her potassium is 4.1 mEq/L.
For each finding, indicate whether it is expected or unexpected for hyperosmolar hyperglycemic state (HHS).
| Finding | Expected | Unexpected |
|---|---|---|
| Absence of significant ketonuria | ||
| Serum osmolality greater than 320 mOsm/kg | ||
| Normal arterial blood gas pH of 7.38 | ||
| Blood glucose of 620 mg/dL | ||
| Kussmaul respirations noted on assessment |
Matrix 9 of 12
A nurse is caring for a 72-year-old female who is 2 days post-operative following a right total hip arthroplasty. She has a history of hypertension and osteoporosis. The care team has implemented a standard postoperative hip precaution and DVT prevention protocol. Vital signs are stable and she is tolerating a regular diet.
For each nursing intervention, indicate whether it is indicated or contraindicated for this client.
| Finding | Indicated | Contraindicated |
|---|---|---|
| Applying sequential compression devices to bilateral lower extremities while in bed | ||
| Instructing the client to flex the operative hip beyond 90 degrees when rising from a chair | ||
| Placing a pillow between the client's legs when turning her to the side | ||
| Administering prescribed low-molecular-weight heparin subcutaneously once daily | ||
| Encouraging the client to cross her operative leg over the midline while seated | ||
| Assisting the client to ambulate with a walker to the hallway on postoperative day 2 |
Matrix 10 of 12
A 45-year-old male with community-acquired pneumonia is being treated with IV ceftriaxone and azithromycin. After 48 hours of treatment, the nurse reassesses the client. Vital signs prior to treatment: temperature 39.4 degrees Celsius, heart rate 112, blood pressure 100/60 mmHg, respiratory rate 26. Current vital signs: temperature 37.6 degrees Celsius, heart rate 88, blood pressure 118/74 mmHg, respiratory rate 18. SpO2 is now 96% on 2 L nasal cannula.
For each client response, indicate whether it demonstrates that the treatment plan is effective, ineffective, or unrelated to the current treatment.
| Finding | Effective | Ineffective | Unrelated |
|---|---|---|---|
| Temperature decreased from 39.4 to 37.6 degrees Celsius | |||
| Heart rate decreased from 112 to 88 beats per minute | |||
| Client reports new onset of mild diarrhea | |||
| Repeat chest X-ray at 48 hours shows worsening lobar consolidation | |||
| Respiratory rate decreased from 26 to 18 breaths per minute | |||
| Blood glucose reading of 198 mg/dL in a client with no history of diabetes |
Matrix 11 of 12
A 28-year-old female at 34 weeks gestation is admitted with sudden-onset severe headache, visual disturbances, and epigastric pain. Vital signs: blood pressure 162/110 mmHg, heart rate 96, respiratory rate 18, oxygen saturation 98% on room air. Laboratory findings include platelets 88,000/mm3, ALT 210 units/L, AST 198 units/L, and LDH 720 units/L. A urine dipstick shows 3-plus proteinuria.
For each nursing action, indicate whether it is indicated or contraindicated for this client.
| Finding | Indicated | Contraindicated |
|---|---|---|
| Administering IV magnesium sulfate per protocol for seizure prophylaxis | ||
| Placing the client in a brightly lit room with continuous external stimulation | ||
| Monitoring deep tendon reflexes and respiratory rate every hour | ||
| Administering an antihypertensive agent for blood pressure persistently above 160/110 mmHg | ||
| Encouraging oral fluid intake of 3 liters per day to promote renal perfusion | ||
| Preparing for potential emergency delivery and notifying the obstetric team |
Matrix 12 of 12
A nurse is evaluating the response of a 60-year-old male with chronic obstructive pulmonary disease who was admitted for an acute exacerbation. He was started on controlled low-flow oxygen at 1 to 2 L via nasal cannula, systemic corticosteroids, and a short-acting bronchodilator. He is now 6 hours into treatment. Initial SpO2 was 82% with pH 7.30 and PaCO2 58 mmHg. Current SpO2 is 90%, pH 7.36, and PaCO2 50 mmHg.
For each client finding at 6 hours, indicate whether it demonstrates that the treatment plan is effective, ineffective, or unrelated to the current treatment.
| Finding | Effective | Ineffective | Unrelated |
|---|---|---|---|
| SpO2 improved from 82% to 90% on low-flow oxygen | |||
| pH improved from 7.30 to 7.36, moving toward normal range | |||
| Client reports improvement in wheezing after each bronchodilator treatment | |||
| PaCO2 remains elevated at 50 mmHg with minimal change from 58 mmHg | |||
| Fasting blood glucose is 218 mg/dL on corticosteroid therapy | |||
| Client requests a different flavor of diet gelatin from the dietary menu |
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