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NCLEX-RN practice questions

200 free questions with answers and explanations.

Practice test
  1. 101.The nurse reviews telemetry on a client with a serum potassium level of 6.8 mEq/L. Which ECG change is the priority finding requiring immediate intervention?Physiological Adaptation
  2. 102.A client is admitted with diabetic ketoacidosis. Laboratory results show: glucose 468 mg/dL, pH 7.21, HCO3 9 mEq/L, PaCO2 29 mmHg, and serum potassium 3.1 mEq/L. An IV insulin infusion has been ordered. Which action should the nurse take first?Reduction of Risk Potential
  3. 103.Ten minutes after a blood transfusion is started, a client reports lower back pain and chills. The nurse notes a temperature increase from 37.0°C to 38.6°C and dark urine. Which action should the nurse take first?Pharmacological and Parenteral Therapies
  4. 104.Following a multi-vehicle collision, four clients arrive simultaneously in the emergency department during a mass casualty event with limited staff and resources. Using disaster triage principles, which client should be treated first?Management of Care
  5. 105.A nurse is transferring care of a client to the oncoming nurse at shift change. Using SBAR format, which information is most important to include in the 'Recommendation' component of the handoff?Management of Care
  6. 106.A client arrives in the emergency department after a fall from a ladder with visible chest wall movement that is asymmetric, moving inward during inspiration and outward during expiration. The client is tachypneic with oxygen saturation of 88%. Which condition does the nurse suspect?Physiological Adaptation
  7. 107.A client has a long-leg cast applied after a tibial fracture. Two hours later, the client reports severe pain unrelieved by IV morphine and pain with passive extension of the toes. Which action should the nurse take first?Reduction of Risk Potential
  8. 108.A nurse is caring for a client with type 1 diabetes who received regular insulin 45 minutes ago before lunch. The client's lunch tray has not yet arrived. The client becomes diaphoretic, tremulous, and reports feeling shaky. A fingerstick glucose reads 58 mg/dL. Which action should the nurse take first?Reduction of Risk Potential
  9. 109.A nurse is teaching a client who had a left total knee replacement how to use a single-point cane for ambulation. Which statement by the client indicates correct understanding of the teaching?Basic Care and Comfort
  10. 110.A nurse observes that the unit has been consistently understaffed for three consecutive shifts, resulting in delayed medication administration and missed assessments. The nurse manager dismisses concerns, stating budget constraints prevent additional staffing. What is the nurse's most appropriate next step?Management of Care
  11. 111.A client with septic shock develops oozing from IV insertion sites, petechiae, and blood in the urine. Laboratory results show a platelet count of 45,000/mm3, prolonged PT and aPTT, decreased fibrinogen, and elevated D-dimer. Which condition does the nurse suspect?Physiological Adaptation
  12. 112.A client 2 days postoperative from abdominal surgery suddenly develops sharp pleuritic chest pain, dyspnea, tachycardia, and an oxygen saturation of 88% on room air. Which action should the nurse take first?Physiological Adaptation
  13. 113.A client sustained a closed fracture of the femur 20 hours ago and is awaiting surgical repair. The nurse notes new-onset confusion, a respiratory rate of 32/min, oxygen saturation of 89% on room air, and a petechial rash across the chest and axillae. Which complication should the nurse suspect?Reduction of Risk Potential
  14. 114.A client who is declared brain dead is being evaluated as a potential organ donor. The client's driver's license indicates organ donor status, but the family is present and distressed, stating they do not want organ donation to proceed. What is the nurse's most appropriate action?Management of Care
  15. 115.A nursing assistant is helping a client with right-sided hemiparesis ambulate for the first time after a stroke. On which side of the client should the nursing assistant stand while using a gait belt?Basic Care and Comfort
  16. 116.A client with terminal cancer has a documented living will stating no artificial nutrition or hydration should be provided if she becomes unable to make decisions. The client is now unresponsive, and her adult children insist the nurse start tube feedings against the living will. What is the nurse's priority action as the client's advocate?Management of Care
  17. 117.A client is scheduled to receive a dose of vancomycin IV. The nurse notes the client's creatinine clearance (CrCl) is 25 mL/min. Which action should the nurse take?Pharmacological and Parenteral Therapies
  18. 118.A client receiving a continuous infusion of heparin has an activated partial thromboplastin time (aPTT) of 120 seconds. The therapeutic range for this client is 60-80 seconds. The heparin protocol states to decrease the infusion rate by 4 units/kg/hr for an aPTT > 90 seconds. The client weighs 150 lbs, and the current infusion is 1,200 units/hr. What is the new infusion rate in units/hr?Pharmacological and Parenteral Therapies
  19. 119.A client is prescribed intravenous immunoglobulin (IVIG) for Guillain-Barré Syndrome. During the infusion, the client develops a headache, chills, and muscle aches. The nurse notes the infusion rate is 100 mL/hr. Which action should the nurse take FIRST?Pharmacological and Parenteral Therapies
  20. 120.A client is prescribed intravenous vancomycin 1 gram every 12 hours. The nurse notes the client's current serum creatinine is 2.1 mg/dL and BUN is 35 mg/dL. The nurse should take which action?Pharmacological and Parenteral Therapies
  21. 121.A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The nurse notes that the TPN bag is empty and the new bag is not yet available from the pharmacy. What is the most appropriate immediate nursing action?Pharmacological and Parenteral Therapies
  22. 122.A client is receiving a continuous IV infusion of norepinephrine (Levophed) for septic shock. The nurse notes extravasation at the IV site, with blanching and coolness of the surrounding skin. Which medication should the nurse anticipate administering subcutaneously as an antidote?Pharmacological and Parenteral Therapies
  23. 123.A client is scheduled to receive a unit of platelets. The client's temperature is 100.8°F (38.2°C) orally. The provider has been notified of the fever and states to proceed with the transfusion. Which action should the nurse take before starting the platelet transfusion?Pharmacological and Parenteral Therapies
  24. 124.A client with a deep vein thrombosis is prescribed enoxaparin 1 mg/kg subcutaneously every 12 hours. The client weighs 176 lbs. The available concentration is enoxaparin 100 mg/mL. How many milliliters should the nurse administer per dose?Pharmacological and Parenteral Therapies
  25. 125.A client is receiving a blood transfusion of packed red blood cells. Fifteen minutes into the infusion, the client develops a sudden fever, chills, and flank pain. The nurse suspects an acute hemolytic reaction. After stopping the transfusion, what is the nurse's NEXT PRIORITY action?Pharmacological and Parenteral Therapies
  26. 126.A home health nurse visits an 82-year-old client who lives with an adult child caregiver. The nurse notes the client is underweight, has an unexplained stage 2 pressure injury, and appears fearful when the caregiver enters the room, becoming quiet and avoiding eye contact. What is the nurse's priority action?Psychosocial Integrity
  27. 127.The nurse is preparing to administer 500 mL of 0.9% Normal Saline to a client with a peripheral IV. Upon assessment, the nurse notes redness, swelling, and pain at the insertion site, and the IV is no longer infusing. Which action should the nurse take NEXT?Pharmacological and Parenteral Therapies
  28. 128.A client is prescribed intravenous potassium chloride (KCl) 40 mEq to be infused over 4 hours. The available solution is 100 mL of 0.9% Normal Saline with 40 mEq KCl. The IV pump should be set to deliver how many mL/hr?Pharmacological and Parenteral Therapies
  29. 129.A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The nurse notes the TPN bag is nearly empty, and the new bag is not yet available from the pharmacy. The client's blood glucose is 180 mg/dL. Which action should the nurse take?Pharmacological and Parenteral Therapies
  30. 130.A school nurse notices a 7-year-old child has multiple bruises in various stages of healing on the back and buttocks, areas not typically injured accidentally. The child says, "I fell down the stairs." What is the nurse's priority action?Psychosocial Integrity
  31. 131.A client is prescribed 10 units of regular insulin subcutaneously. The nurse draws up the insulin and prepares to administer it. Which site is most appropriate for rapid absorption of regular insulin?Pharmacological and Parenteral Therapies
  32. 132.A nurse is caring for a client who says, "I don't know what to do about my marriage." Which response by the nurse best demonstrates therapeutic communication?Psychosocial Integrity
  33. 133.A client with a history of heart failure is prescribed furosemide 40 mg PO daily. The nurse notes the client's serum potassium level is 3.2 mEq/L. Which action should the nurse take FIRST?Pharmacological and Parenteral Therapies
  34. 134.Emergency responders bring in an unresponsive client with pinpoint pupils, a respiratory rate of 6 breaths/min, and shallow breathing. A friend states the client "took some pills" a short time ago. What is the nurse's priority action?Psychosocial Integrity
  35. 135.A client is receiving a continuous infusion of a new antibiotic. Thirty minutes after the infusion began, the client reports feeling dizzy and lightheaded, and the nurse observes facial flushing and a blood pressure of 88/50 mmHg. What is the nurse's PRIORITY action?Pharmacological and Parenteral Therapies
  36. 136.A client is receiving a continuous infusion of dobutamine. The nurse notes the client's heart rate has increased from 88 bpm to 118 bpm and blood pressure from 102/68 mmHg to 138/84 mmHg. The nurse should anticipate an order to take which action?Pharmacological and Parenteral Therapies
  37. 137.A client is scheduled to receive a unit of packed red blood cells (PRBCs). The client's temperature is 100.8°F (38.2°C) orally. All other vital signs are within normal limits. What is the most appropriate nursing action?Pharmacological and Parenteral Therapies
  38. 138.A client is scheduled for surgery and has a prescription for cefazolin 1 gram IV to be administered 30 minutes prior to incision. The nurse notes the client reports a penicillin allergy with a rash. What is the nurse's PRIORITY action?Pharmacological and Parenteral Therapies
  39. 139.A client with a history of alcohol use disorder is admitted with acute pancreatitis. The provider prescribes thiamine 100 mg IV daily. The nurse understands this medication is prescribed primarily to prevent which complication?Pharmacological and Parenteral Therapies
  40. 140.A client who reports drinking a fifth of vodka daily for the past 10 years is admitted for an unrelated surgery. The nurse should monitor most closely for onset of alcohol withdrawal symptoms within which time frame after the last drink?Psychosocial Integrity
  41. 141.A client is prescribed phenobarbital 60 mg PO TID for seizure control. The pharmacy dispenses phenobarbital oral solution labeled 20 mg/5 mL. How many milliliters should the nurse administer per dose?Pharmacological and Parenteral Therapies
  42. 142.A client with terminal cancer says to the nurse, "I know I'm dying, but I keep praying that if I just eat healthier, I'll be cured." The nurse recognizes this statement as reflecting which stage of grief and responds most therapeutically by saying which of the following?Psychosocial Integrity
  43. 143.A client in the emergency department after a natural disaster is pacing, crying uncontrollably, and unable to answer simple questions about their name or location. Which nursing intervention is the priority?Psychosocial Integrity
  44. 144.A client is receiving a continuous intravenous infusion of 0.9% Normal Saline at 100 mL/hour. The nurse assesses the client's IV site and notes swelling, coolness, and pallor above the insertion site. The client reports discomfort. What is the most appropriate initial nursing action?Pharmacological and Parenteral Therapies
  45. 145.A client with deep vein thrombosis is prescribed enoxaparin 1 mg/kg subcutaneously every 12 hours. The client weighs 176 lbs. How many milligrams of enoxaparin should the nurse administer per dose?Pharmacological and Parenteral Therapies
  46. 146.A client with a diagnosis of borderline personality disorder tells the nurse, "You are the only staff member who really understands me. The other nurses are terrible and don't care about me at all." Which is the nurse's best response?Psychosocial Integrity
  47. 147.A nurse is assessing a client who states, "I have a gun at home and I'm planning to use it tonight." Which action should the nurse take first?Psychosocial Integrity
  48. 148.A client whose spouse died 2 weeks ago tells the nurse, "It's not fair, why did this happen to us? We had so many plans." According to Kübler-Ross, which stage of grief is this client demonstrating?Psychosocial Integrity
  49. 149.A nurse is providing education to a primigravida client at 10 weeks' gestation about common discomforts of pregnancy. The client reports experiencing frequent nausea and vomiting, especially in the mornings. Which of the following recommendations should the nurse prioritize?Health Promotion and Maintenance
  50. 150.A nurse is teaching a group of expectant parents about newborn care. A client asks, "How often should I expect my newborn to have wet diapers?" Which of the following responses by the nurse is most accurate for a healthy, full-term newborn after the first 24 hours of life?Health Promotion and Maintenance