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NCLEX-RN practice questions

200 free questions with answers and explanations.

Practice test
  1. 51.A client with chronic osteoarthritis pain asks the nurse how a transcutaneous electrical nerve stimulation (TENS) unit relieves pain. Which explanation by the nurse is accurate?Basic Care and Comfort
  2. 52.A nurse in the emergency department is completing an incident report after mistakenly administering a medication to the wrong client. The client was assessed, no harm occurred, and the provider was notified. Which statement best describes the purpose of the incident report?Management of Care
  3. 53.A nurse is caring for four clients. Which client should the nurse assess first?Management of Care
  4. 54.A client with metastatic breast cancer has a serum calcium level of 12.5 mg/dL. Which additional finding should the nurse expect during assessment?Physiological Adaptation
  5. 55.A 16-year-old presents to the emergency department requesting treatment for a sexually transmitted infection and asks that her parents not be notified. According to most state minor consent laws, how should the nurse proceed?Management of Care
  6. 56.A nurse is caring for a client with a traumatic brain injury and intracranial pressure monitoring. The nurse notes a blood pressure of 178/60 mm Hg, heart rate of 48/min, and irregular respirations. Which action should the nurse take first?Physiological Adaptation
  7. 57.A nurse is caring for a client receiving continuous enteral tube feeding through a nasogastric tube. To reduce the risk of aspiration, which action should the nurse implement?Basic Care and Comfort
  8. 58.A client taking digoxin and furosemide has a serum potassium level of 3.0 mEq/L. The nurse notes the client reports seeing yellow-green halos around lights and has a pulse of 52 beats/min. Which is the priority nursing action?Pharmacological and Parenteral Therapies
  9. 59.A client with terminal pancreatic cancer tells the nurse she wants to stop chemotherapy and focus on comfort care. The client's adult children insist that the nurse convince their mother to continue treatment. Which response by the nurse best reflects the principle of autonomy?Management of Care
  10. 60.A client with a history of untreated hypertension arrives in the emergency department with a blood pressure of 232/138 mm Hg, severe headache, blurred vision, and confusion. Which action should the nurse take first?Physiological Adaptation
  11. 61.A nurse administers the wrong dose of an anticoagulant to a client due to a transcription error, resulting in no adverse effect to the client. What is the nurse's most appropriate first action?Management of Care
  12. 62.A nurse accepts an assignment at the start of the shift, then midway through the shift leaves the unit without notifying the charge nurse or giving report to another nurse, due to a personal emergency. Which term best describes this nurse's action?Management of Care
  13. 63.A client with a substance use disorder insists on leaving the hospital before treatment is complete, against medical advice. The client is alert, oriented, and demonstrates understanding of the risks of leaving. What is the nurse's most appropriate action?Management of Care
  14. 64.An 82-year-old client who lives alone is being discharged after being newly started on insulin therapy. The client has poor vision and limited hand dexterity. Which action by the nurse best promotes continuity of care?Management of Care
  15. 65.An unlicensed assistive personnel (UAP) is assigned to a nurse's team. Which task is appropriate for the nurse to delegate to the UAP?Management of Care
  16. 66.A client in the ICU has been frequently awakened every 1-2 hours for vital signs and treatments over the past 4 nights. The client now appears confused, irritable, and reports vivid, unsettling dreams during brief periods of sleep. The nurse recognizes these findings are most consistent with which phenomenon?Basic Care and Comfort
  17. 67.A nurse is assigned to four clients at the start of the shift. Which client should the nurse assess first?Management of Care
  18. 68.A client presents with hypotension, jugular venous distention, and muffled heart sounds after a motor vehicle collision. Which diagnosis should the nurse suspect?Physiological Adaptation
  19. 69.A client is receiving general anesthesia with succinylcholine for surgery. The nurse in the operating room notes the client's end-tidal CO2 rising rapidly, muscle rigidity, and a temperature increasing from 37°C to 39.5°C (98.6°F to 103.1°F) within 15 minutes. Which medication should the nurse prepare to administer immediately?Physiological Adaptation
  20. 70.On postoperative day 1 following abdominal surgery, a client has a temperature of 100.8°F (38.2°C), bibasilar crackles, shallow respirations, and is splinting the incision due to pain. Which nursing intervention is the priority?Reduction of Risk Potential
  21. 71.A physician calls the unit and gives a verbal order for a new IV antibiotic dose. Which action by the nurse best ensures client safety?Management of Care
  22. 72.Six hours after a total thyroidectomy, a client reports a tight feeling in the throat and tingling around the mouth. The nurse notes a positive Chvostek sign. What is the nurse's priority action?Reduction of Risk Potential
  23. 73.A client with a history of chronic obstructive pulmonary disease (COPD) has the following arterial blood gas results: pH 7.34, PaCO2 58 mmHg, HCO3- 32 mEq/L. Which interpretation is correct?Physiological Adaptation
  24. 74.A surgeon obtains informed consent from a client for an elective knee replacement and asks the nurse to witness the client's signature on the consent form. Which statement best describes the nurse's responsibility in this situation?Management of Care
  25. 75.A client scheduled for a cardiac catheterization tells the nurse, 'I don't really understand why I need this test, but I signed the paper the doctor's assistant brought me.' What is the nurse's best action?Management of Care
  26. 76.A client is admitted to a psychiatric unit for treatment of major depressive disorder. The client's adult daughter calls the nursing station and asks the nurse to describe her mother's diagnosis and current treatment plan. The client has not signed any authorization for release of information. Which response should the nurse give?Management of Care
  27. 77.A nurse is establishing a bowel training program for a client with fecal incontinence related to a spinal cord injury. Which time should the nurse schedule the client for toileting to take advantage of a natural physiologic reflex?Basic Care and Comfort
  28. 78.A nurse receives an order to administer potassium chloride 20 mEq IV for a client with hypokalemia. Which action is essential for safe administration of this high-alert medication?Pharmacological and Parenteral Therapies
  29. 79.A client is postoperative day 2 following a total hip arthroplasty. The client suddenly reports shortness of breath and sharp chest pain, and the nurse notes a heart rate of 128 beats/min and SpO2 of 88% on room air. What is the nurse's priority action?Reduction of Risk Potential
  30. 80.A nurse notices a coworker accessing the electronic medical record of a client who is a local celebrity but is not assigned to that coworker's care. What is the nurse's priority action?Management of Care
  31. 81.A client returns to the unit after a bronchoscopy in which the throat was sprayed with topical anesthetic. Which action should the nurse take before offering the client oral fluids?Reduction of Risk Potential
  32. 82.A nurse fails to check a client's chart before administering medication and does not notice a documented allergy to penicillin. The nurse administers penicillin, and the client develops anaphylaxis requiring emergency intervention. Which statement identifies why this situation meets the legal criteria for malpractice?Management of Care
  33. 83.A client receiving furosemide for heart failure reports leg cramps and generalized weakness. The serum potassium level is 2.9 mEq/L (normal 3.5–5.0 mEq/L). Which action should the nurse take?Reduction of Risk Potential
  34. 84.A client is unconscious following a traumatic injury and unable to make healthcare decisions. A durable power of attorney for healthcare document on file names the client's sister as the designated decision-maker. The client's spouse, who lives with the client, arrives and insists on making all treatment decisions instead. Which action should the nurse take?Management of Care
  35. 85.Fifteen minutes into a packed red blood cell transfusion, a client reports low back pain and chills, with a temperature increase to 101.2°F (38.4°C), HR 118/min, and reddish-tinged urine. Which action should the nurse take first?Reduction of Risk Potential
  36. 86.Two hours after a cardiac catheterization performed via the right femoral artery, a client reports severe low back and flank pain. Vital signs have changed from BP 130/80 mmHg and HR 84/min to BP 92/58 mmHg and HR 124/min. The groin site is dry with no hematoma. The nurse suspects which complication?Reduction of Risk Potential
  37. 87.A nurse is preparing to apply a new skin barrier wafer for a client with a fresh colostomy. The stoma measures 3.2 cm in diameter. Using standard ostomy sizing guides, the nurse should cut the wafer opening to which size?Basic Care and Comfort
  38. 88.A nurse performs a bladder scan on a client who reports difficulty voiding after removal of an indwelling catheter. The scan shows a post-void residual (PVR) of 480 mL. What should the nurse do next?Basic Care and Comfort
  39. 89.A client who twisted an ankle 30 minutes ago has significant swelling and reports pain rated 7/10. Which non-pharmacologic intervention should the nurse implement first?Basic Care and Comfort
  40. 90.A nurse is teaching a client about preventing constipation through diet. Which instruction should the nurse include?Basic Care and Comfort
  41. 91.During a surgical procedure, the anesthesia provider reports the client's end-tidal CO2 is rapidly rising, heart rate is 140 beats/min, and the client's jaw and limb muscles are rigid. Temperature has risen to 39.8°C (103.6°F). Which medication should the nurse anticipate administering immediately?Reduction of Risk Potential
  42. 92.A charge nurse assigns a nurse eight acute medical-surgical clients, which exceeds the unit's established safe staffing ratio. The nurse believes the assignment is unsafe. What is the nurse's first action?Management of Care
  43. 93.A client receiving a continuous heparin infusion for a deep vein thrombosis has an activated partial thromboplastin time (aPTT) result of 100 seconds; the control range is 25-35 seconds and the therapeutic goal is 1.5-2.5 times control. What should the nurse do first?Pharmacological and Parenteral Therapies
  44. 94.A client is found unresponsive with a respiratory rate of 6/min and pinpoint pupils after a suspected opioid overdose. Arterial blood gas results show pH 7.22, PaCO2 68 mmHg, HCO3 24 mEq/L, and PaO2 58 mmHg. Which action should the nurse take first?Physiological Adaptation
  45. 95.A confused older adult client repeatedly attempts to pull out an IV line and climb out of bed unassisted despite frequent reorientation and bed alarm use. The physician orders bilateral wrist restraints. Which nursing action is most important to ensure the client's legal rights are protected?Management of Care
  46. 96.An 80 kg client sustains a 40% total body surface area burn at 0800. The client arrives in the emergency department at 1000. Using the Parkland formula (4 mL/kg/%TBSA), the nurse calculates the total 24-hour fluid requirement and administers half of that volume in the first 8 hours from the time of injury. At what rate, in mL/hr, should the IV pump be set for the remainder of the first 8-hour period?Physiological Adaptation
  47. 97.A client taking digoxin and furosemide reports nausea and seeing yellow-green halos around lights. The morning laboratory results show potassium 3.0 mEq/L, sodium 138 mEq/L, and magnesium 1.9 mEq/L. Which action should the nurse take first?Physiological Adaptation
  48. 98.A client receiving an IV infusion of penicillin suddenly develops hives, audible wheezing, throat tightness, and a blood pressure of 78/44 mmHg. Which action should the nurse take first?Physiological Adaptation
  49. 99.A client with type 1 diabetes is admitted with fruity breath, Kussmaul respirations, and blood glucose of 480 mg/dL. Arterial blood gas shows pH 7.22, HCO3- 10 mEq/L, PaCO2 28 mmHg. Which action is the nurse's priority?Physiological Adaptation
  50. 100.A provider orders 1,000 mL of 0.9% normal saline to infuse over 8 hours using tubing with a drop factor of 15 gtt/mL. The IV pump is unavailable, so the nurse must set the infusion by gravity. How many drops per minute should the nurse set?Pharmacological and Parenteral Therapies