Free NCLEX-RN Practice Test

A nurse is caring for an adult client with heart failure who is receiving oral digoxin 0.25 mg daily and furosemide 40 mg daily. The client reports nausea, anorexia, and seeing yellowish-green halos around lights. Assessment reveals BP 118/72 mmHg, apical pulse 52 beats/min and irregular. Serum potassium is 3.1 mEq/L (reference: 3.5–5.0 mEq/L). Which nursing action should the nurse prioritize first?

A nurse is providing discharge instructions to a client with Type 1 diabetes mellitus who has been prescribed subcutaneous regular insulin before meals and insulin glargine at bedtime. At which time interval following subcutaneous administration of regular insulin is the client at greatest risk for experiencing acute hypoglycemic episodes?

A nurse assesses a client 4 hours following an exploratory laparotomy. The client's surgical abdominal dressing is dry and intact. Assessment reveals: BP dropped from baseline 124/78 mmHg to 88/54 mmHg, HR increased from 76 to 118 beats/min (weak, thready), RR is 24 breaths/min, and the skin is cool, pale, and diaphoretic. Which pathophysiological process and immediate nursing intervention should the nurse recognize?

A nurse is monitoring an adult client on postoperative day 1 following a total thyroidectomy. The client reports perioral tingling and numbness in the fingertips. When the nurse gently taps the client's facial nerve anterior to the ear, the ipsilateral facial muscles contract involuntarily (positive Chvostek's sign). Which clinical condition and emergency intervention should the nurse anticipate?

A nurse is admitting an adult client presenting to the emergency department with a 3-week history of productive cough with hemoptysis, night sweats, fatigue, and unintended weight loss. Pulmonary tuberculosis (TB) is suspected. Which infection control measures must the nurse implement immediately?

A registered nurse (RN) is organizing shift care on a medical-surgical unit. The care team consists of the RN, a licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). According to NCSBN delegation principles, which task is most appropriate for the RN to assign to the UAP?

A nurse is providing discharge education to the parents of a healthy 2-day-old newborn regarding infant sleep safety and Sudden Infant Death Syndrome (SIDS) risk reduction. Which parental statement demonstrates correct understanding of safe sleep guidelines?

A nurse is conducting an initial assessment with a client admitted with severe Major Depressive Disorder. The client sits with slumped posture, avoids eye contact, and quietly whispers, "Everything is hopeless now. My family would be so much better off without having to deal with me anymore." Which therapeutic response should the nurse provide first?

A registered nurse (RN) is organizing patient care assignments on an acute medical floor. Which task is most appropriate for the RN to delegate to unlicensed assistive personnel (UAP)?

A nurse receives report at the start of the morning shift on four hospitalized adult clients. Which client should the nurse assess first?

A nurse is preparing to enter the room of an immunocompromised client admitted with confirmed disseminated herpes zoster (shingles) with extensive active, fluid-filled vesicles across multiple dermatomes. Which personal protective equipment (PPE) and room placement are required for this client?

A nurse in the mother-baby postpartum unit is performing an initial physical assessment on a 2-hour-old term neonate born to a mother with poorly controlled gestational diabetes mellitus. Which clinical assessment finding should the nurse recognize as a classic manifestation of neonatal hypoglycemia requiring immediate blood glucose screening?

A nurse at a community well-child clinic is providing anticipatory safety guidance to the parents of a healthy 12-month-old infant who weighs 22 lb (10 kg). Which recommendation regarding motor vehicle safety seat positioning aligns with American Academy of Pediatrics (AAP) standards?

A client diagnosed with Bipolar I Disorder is admitted to the inpatient behavioral health unit during an acute manic episode. The client is pacing the corridors rapidly, speaking in loud, pressured bursts with flight of ideas, exhibiting grandiose statements, and has not eaten or slept for over 24 hours. Which nursing intervention should be prioritized in the immediate plan of care?

A client with a 15-year history of heavy ethanol consumption is admitted to a surgical telemetry unit following an emergency appendectomy. Forty-eight hours after admission, the client becomes markedly agitated, diaphoretic, tachycardic (heart rate 128 beats/min), hypertensive (blood pressure 174/102 mmHg), and reports seeing crawling insects on the bed linens. Which pharmacological class should the nurse anticipate as the standard first-line therapy for managing this acute condition?

A nurse is administering a continuous enteral feeding via a nasogastric (NG) tube to an older adult client recovering from an acute ischemic stroke with severe oropharyngeal dysphagia. Which nursing intervention is essential to prevent pulmonary aspiration during the continuous infusion?

A nurse is caring for an adult client with an acute femoral shaft fracture who is placed in skeletal traction with a Steinmann pin and suspension frame awaiting open reduction and internal fixation. Which nursing action is mandatory to maintain the therapeutic efficacy of the traction system?

An adult client hospitalized with an acute pulmonary embolism is receiving a continuous intravenous unfractionated heparin infusion according to a weight-based hospital protocol. The nurse reviews the client's latest laboratory results and notes an activated partial thromboplastin time (aPTT) of 138 seconds (laboratory baseline control: 32 seconds; therapeutic reference target: 60 to 85 seconds). Which action should the nurse take first?

A client diagnosed with bipolar affective disorder who has been maintained on oral lithium carbonate for 8 months presents to the clinic with persistent nausea, frequent watery diarrhea, uncoordinated gait (ataxia), slurred speech, and coarse hand tremors. Which nursing action is the priority?

A nurse is assessing a postoperative adult client who is receiving intravenous morphine via a patient-controlled analgesia (PCA) pump following major abdominal surgery. The nurse finds the client unresponsive to physical stimulation, with pinpoint pupils (miosis) and a respiratory rate of 6 breaths/min with shallow, irregular ventilations. Which intervention should the nurse perform immediately?

A nurse evaluates the arterial blood gas (ABG) results of an adult client admitted with an acute exacerbation of severe asthma who is exhibiting diaphoresis, intercostal retractions, and extreme fatigue: pH 7.28, PaCO₂ 52 mmHg, HCO₃⁻ 24 mEq/L, PaO₂ 64 mmHg. How should the nurse accurately interpret this acid-base profile?

A nurse is monitoring an adult client 45 minutes following a diagnostic percutaneous coronary intervention (PCI) via right femoral artery access. Upon inspection of the groin site, the nurse observes that the pressure dressing is saturated with expanding bright red blood, a firm 4-cm hematoma is palpable beneath the skin, and the right dorsalis pedis pulse has weakened from baseline. Which action should the nurse take immediately?

Fifteen minutes after initiating an intravenous transfusion of packed red blood cells (PRBCs), a client develops sudden rigors, severe bilateral flank pain, dyspnea, and a rise in body temperature from 36.8°C (98.2°F) to 38.6°C (101.5°F). Which sequence of actions represents the mandatory first nursing response?

A client with a complete spinal cord injury at the T4 level reports a sudden, excruciating, pounding frontal headache and visual blurring. The nurse observes profuse facial diaphoresis, blotchy skin erythema above the clavicles, a blood pressure of 214/112 mmHg, and a heart rate of 50 beats/min. Which initial action should the nurse take?

An adult client with Type 1 diabetes mellitus is admitted to the intensive care unit with Diabetic Ketoacidosis (DKA). Continuous regular insulin infusion and 0.9% normal saline resuscitation have been running for 4 hours. Current laboratory values reveal: blood glucose 235 mg/dL, serum potassium 3.7 mEq/L, and serum sodium 138 mEq/L. Which adjustment to the intravenous orders should the nurse anticipate at this time?