Step2Study

NCLEX-RN practice questions

200 free questions with answers and explanations.

Practice test
  1. 1.A nurse is caring for a client immediately after a large-volume paracentesis (5 liters removed) for ascites. Fifteen minutes later, the client becomes dizzy, and vital signs show blood pressure 84/50 mmHg (baseline 128/76 mmHg) and heart rate 118 beats/min. What is the priority nursing action?Reduction of Risk Potential
  2. 2.A client recovering from severe diarrhea for the past 3 days reports generalized muscle weakness and leg cramps. The nurse notes hypoactive bowel sounds and an ECG showing flattened T waves with a prominent U wave. Which laboratory finding does the nurse expect?Physiological Adaptation
  3. 3.A nurse is caring for a client receiving mechanical ventilation for acute respiratory distress syndrome (ARDS). Which ventilator strategy is most consistent with current lung-protective guidelines?Physiological Adaptation
  4. 4.After a percutaneous liver biopsy, a client is positioned on the right side. Thirty minutes later, the client reports increasing abdominal pain radiating to the right shoulder. Blood pressure has decreased from 122/76 mmHg to 100/60 mmHg, and heart rate has increased from 84/min to 112/min. Which action should the nurse take first?Reduction of Risk Potential
  5. 5.An alert and oriented client with end-stage renal disease refuses a scheduled hemodialysis session, stating, 'I'm tired of this, I don't want treatment today.' The nurse has explained the risks of refusing. What is the nurse's next best action?Management of Care
  6. 6.A client with chronic low back pain asks the nurse for a non-pharmacologic method to help manage pain during physical therapy sessions. Which technique should the nurse suggest?Basic Care and Comfort
  7. 7.A client has had a nasogastric tube to continuous suction for 3 days. Arterial blood gas results are: pH 7.52, PaCO2 46 mmHg, HCO3 32 mEq/L, PaO2 90 mmHg. How should the nurse interpret these results?Reduction of Risk Potential
  8. 8.A client arrives in the emergency department after a stab wound to the right chest. The nurse notes absent breath sounds on the right, tracheal deviation to the left, jugular venous distention, and a blood pressure of 78/50 mm Hg. Which intervention should the nurse anticipate as the priority?Physiological Adaptation
  9. 9.A client receiving continuous enteral tube feeding at 60 mL/hr through a gastrostomy tube has a gastric residual volume (GRV) of 520 mL when checked per facility protocol. What should the nurse do first?Basic Care and Comfort
  10. 10.A nurse is caring for a client on the first postoperative day after abdominal surgery. Before assisting the client out of bed for the first time, which action is the priority?Basic Care and Comfort
  11. 11.A client with a history of Addison disease is admitted after abruptly stopping oral hydrocortisone 2 days ago. The client is lethargic, hypotensive, and reports severe abdominal pain. Which prescription should the nurse anticipate as the priority?Physiological Adaptation
  12. 12.A client with a T4 spinal cord injury reports a sudden severe pounding headache. Assessment reveals blood pressure 210/122 mmHg, heart rate 48/min, and flushing above the level of injury. Which action should the nurse take first?Physiological Adaptation
  13. 13.A client with a spinal cord injury at T6 reports a sudden severe pounding headache. Assessment reveals blood pressure 210/120 mmHg, heart rate 48 beats/min, and flushing above the level of injury. What should the nurse do first?Reduction of Risk Potential
  14. 14.A charge nurse is making assignments for the shift. Which client is most appropriate to assign to a licensed practical nurse (LPN) working under RN supervision?Management of Care
  15. 15.A client with pneumonia has a temperature of 38.6°C (101.5°F), respiratory rate of 24/min, white blood cell count of 14,000/mm3, productive cough, and new-onset confusion with a blood pressure of 88/50 mmHg. Which finding should prompt the nurse to notify the provider immediately as a priority indicator of possible septic shock?Physiological Adaptation
  16. 16.A nurse reviews morning laboratory results for four clients. Which result requires the nurse to notify the health care provider immediately?Reduction of Risk Potential
  17. 17.A nurse notices that a coworker has slurred speech, unsteady gait, and the smell of alcohol on their breath before starting a shift. What is the nurse's priority action?Management of Care
  18. 18.A client returns from spinal fusion surgery with an order to maintain strict spinal alignment. Which technique should the nurse use when repositioning this client in bed?Basic Care and Comfort
  19. 19.A nurse enters a client's room to insert a urinary catheter for a scheduled procedure. The client, who is alert and oriented, states, 'No one explained why I need this or what it involves.' The nurse proceeds to insert the catheter anyway because it was ordered by the physician. Which tort has the nurse most likely committed?Management of Care
  20. 20.A nurse is providing perineal care to a female client with an indwelling urinary catheter. Which technique is correct?Basic Care and Comfort
  21. 21.A nurse applies bilateral wrist restraints to an alert, fully oriented client who has been frequently requesting help to get out of bed. The nurse applies the restraints without a physician's order because the unit is short-staffed and the nurse is concerned about falls. Which legal concept best describes this situation?Management of Care
  22. 22.A school nurse examines a 6-year-old child and notices multiple bruises in various stages of healing on the child's back and buttocks, along with the child's reluctance to discuss how the injuries occurred. What is the nurse's priority legal obligation?Management of Care
  23. 23.A charge nurse is delegating blood glucose monitoring to a UAP for four clients. Which client's blood glucose check is inappropriate to delegate to the UAP?Management of Care
  24. 24.A nurse removes a client's central venous catheter from the subclavian site and applies an occlusive dressing. Immediately afterward, the client reports chest pain, becomes acutely anxious, and a churning sound is auscultated over the precordium. Oxygen saturation drops to 88%. Which action should the nurse take first?Reduction of Risk Potential
  25. 25.A client is admitted with a serum sodium of 118 mEq/L, confusion, and concentrated urine following surgery. The nurse suspects syndrome of inappropriate antidiuretic hormone (SIADH). Which finding does the nurse expect on further assessment?Physiological Adaptation
  26. 26.Two hours after a lumbar puncture, a client reports a severe headache that worsens when sitting up and improves when lying flat. Which nursing action is most appropriate?Reduction of Risk Potential
  27. 27.A client tells the nurse, "I have trouble falling asleep every night." Which teaching by the nurse best promotes healthy sleep hygiene?Basic Care and Comfort
  28. 28.A client is admitted following a motor vehicle collision with significant blood loss. Vital signs are blood pressure 112/74 mmHg, heart rate 118/min, respiratory rate 22/min, and capillary refill 3 seconds. The client appears anxious. Which finding represents the earliest indicator of compensatory shock?Physiological Adaptation
  29. 29.A client who speaks limited English is scheduled for a surgical procedure requiring informed consent. The client's adult son offers to translate the consent discussion. What is the nurse's best action?Management of Care
  30. 30.A client with a history of COPD has the following arterial blood gas results: pH 7.28, PaCO2 60 mmHg, HCO3 24 mEq/L. The nurse interprets this finding as which acid-base imbalance?Reduction of Risk Potential
  31. 31.A client sustains a fracture of the femur in a motor vehicle collision. Approximately 36 hours later, the client develops sudden dyspnea, confusion, and a petechial rash across the chest and neck. Oxygen saturation is 88% on room air. Which condition does the nurse suspect?Physiological Adaptation
  32. 32.A client using patient-controlled analgesia (PCA) with morphine has a respiratory rate of 8 breaths/min and is difficult to arouse. Which action should the nurse take first?Pharmacological and Parenteral Therapies
  33. 33.A client with type 1 diabetes reports feeling shaky, sweaty, and confused 45 minutes after receiving regular insulin. Fingerstick glucose is 58 mg/dL and the client is alert enough to swallow. Which action should the nurse take first?Pharmacological and Parenteral Therapies
  34. 34.A client taking digoxin for heart failure reports nausea and seeing yellow halos around lights. Before administering the next dose, the nurse should prioritize checking which laboratory value?Reduction of Risk Potential
  35. 35.A nurse is assessing a client 2 hours after a below-knee cast application. The client reports severe pain unrelieved by opioids, and the toes are pale, cool, and have delayed capillary refill. What is the nurse's priority action?Physiological Adaptation
  36. 36.A client with a documented advance directive stating 'no cardiopulmonary resuscitation' goes into cardiac arrest. The client's adult child, who just arrived, demands that the healthcare team 'do everything, including CPR.' What should the nurse do?Management of Care
  37. 37.A client is 6 hours postoperative following a transsphenoidal hypophysectomy. The nurse notes urine output of 350-400 mL/hr for the past 3 hours, urine specific gravity of 1.001, and serum sodium of 150 mEq/L. Which prescribed intervention should the nurse anticipate?Physiological Adaptation
  38. 38.A medical-surgical nurse is floated to the pediatric unit for the shift due to staffing shortages. Which client should the charge nurse assign to the floated nurse?Management of Care
  39. 39.A nurse is caring for a client 4 hours after total hip arthroplasty. On admission to the unit, vital signs were BP 128/78 mmHg and HR 82/min. Now the client's BP is 96/56 mmHg, HR 118/min, RR 22/min, and the skin is pale and diaphoretic. The surgical dressing is dry and intact. Which action should the nurse take first?Reduction of Risk Potential
  40. 40.On postoperative day 3 after abdominal surgery, a client coughs forcefully and reports, "Something just gave way." The nurse observes loops of bowel protruding through the open incision. Which action should the nurse take first?Reduction of Risk Potential
  41. 41.A nurse is teaching a client with diabetes mellitus about proper foot care to prevent complications. Which statement by the client indicates a need for further teaching?Basic Care and Comfort
  42. 42.A client with type 2 diabetes and chronic kidney disease is scheduled for a CT scan with IV contrast. The client currently takes metformin. What is the nurse's priority action?Reduction of Risk Potential
  43. 43.A client is brought to the emergency department after ingesting an unknown quantity of amitriptyline. The nurse notes a widened QRS complex on ECG. Which medication should the nurse anticipate administering first?Physiological Adaptation
  44. 44.A client with a history of frequent vomiting due to hyperemesis gravidarum has the following labs: pH 7.50, HCO3- 32 mEq/L, PaCO2 44 mmHg, potassium 3.0 mEq/L. Which acid-base disorder does the nurse identify?Physiological Adaptation
  45. 45.A client receiving IV vancomycin develops flushing of the face, neck, and upper trunk along with pruritus during the infusion. Vital signs remain stable. Which action should the nurse take first?Pharmacological and Parenteral Therapies
  46. 46.A nurse is caring for four clients at the start of the shift. Which client should the nurse assess first?Management of Care
  47. 47.A nurse is caring for a client newly diagnosed with dysphagia after a stroke. Which action should the nurse include in the plan of care?Basic Care and Comfort
  48. 48.A client receiving IV magnesium sulfate for preeclampsia has the following assessment findings: respiratory rate 10 breaths/min, absent deep tendon reflexes, and urine output of 20 mL over the past hour. Which action should the nurse take first?Pharmacological and Parenteral Therapies
  49. 49.An off-duty nurse stops at the scene of a car accident and provides basic first aid to an injured passenger until paramedics arrive. Which statement best describes the legal protection available to this nurse?Management of Care
  50. 50.A client taking warfarin for atrial fibrillation has an INR of 5.5 and reports no bleeding. The target INR range for this client is 2-3. Which action should the nurse anticipate?Pharmacological and Parenteral Therapies