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Practice Test 1 - NCLEX Rn

20 questions. Answer them in any order, then submit to see your score and every explanation.

  1. A 15-year-old client is brought in after being found vomiting at a party. The client admits drinking heavily and says, "I didn't want to look weak." The parent is tearful and asks the nurse to "tell me everything they said." Which finding requires IMMEDIATE intervention by the nurse during counseling and discharge planning?
  2. A 74-year-old client with type 2 diabetes is admitted for cellulitis. Current regimen: insulin glargine 26 units at bedtime and insulin lispro 7 units with meals. At 1600, the client is confused and diaphoretic; blood glucose is 54 mg/dL (normal fasting 70–100 mg/dL). Vital signs: T 99.1°F (37.3°C), HR 112/min, RR 18/min, BP 146/82 mm Hg. The client is awake and can swallow. Which action should the nurse take FIRST in response to the client's hypoglycemia?
  3. A 41-year-old client is evaluated in the emergency department after a panic attack at work. Psychosocial history includes recent termination notice and heavy alcohol use on weekends; medical history includes gastroesophageal reflux disease. The client is visibly anxious and states, "Sometimes I think everyone would be better off if I wasn't here." Which action should the nurse take FIRST to ensure client safety?
  4. A 67-year-old client has both confirmed influenza and a positive stool test for Clostridioides difficile. Vital signs: T 38.4°C (101.1°F), HR 106/min, RR 22/min, BP 112/68 mmHg, SpO2 95% on room air. Which infection control approach is necessary while providing routine bedside care?
  5. A 58-year-old client with gastrointestinal bleeding is receiving packed red blood cells through an IV pump with blood tubing. The pump is set to 150 mL/hr. Fifteen minutes after initiation, the client reports chills and back pain, and the pump continues to infuse. Which action should the nurse take FIRST?
  6. A 60-year-old client arrives at the emergency department after a recent spouse death and states, "I have pills at home and I'm going to take them all." The client is calm but has flat affect and avoids eye contact; the client's adult child is at bedside and repeatedly answers questions for the client. Which action should the nurse take FIRST to de-escalate the situation and ensure safety?
  7. In a hospital room, a 58-year-old client becomes angry during discharge teaching after a myocardial infarction. The client has a history of poor experiences with healthcare and says, "You're just trying to get me out of here—this is pointless." Which response should the nurse make FIRST?
  8. A 31-year-old client at 28 weeks of gestation was diagnosed with gestational diabetes after a 3-hour oral glucose tolerance test; her fasting glucose goal is 70–95 mg/dL. She asks what to watch for at home. Which symptom should the client report IMMEDIATELY to her healthcare provider?
  9. In a long-term care facility, an RN is stuck in the right thumb by a used insulin pen needle while disposing of sharps after administering insulin to a 79-year-old resident with known human immunodeficiency virus infection and hypertension; current medications include insulin glargine, amlodipine, and antiretroviral therapy. The puncture site is small with minimal bleeding; the nurse's vital signs are temperature 99.0°F (37.2°C), heart rate 88/min, respiratory rate 16/min, blood pressure 122/70 mm Hg. Which intervention is PRIORITY to prevent infection?
  10. A 39-year-old client has a newly diagnosed draining pressure injury with heavy exudate; the wound cannot be fully covered with a dressing. Vital signs: T 37.3°C (99.1°F), HR 88/min, RR 16/min, BP 122/76 mmHg, SpO2 98% on room air. The nurse should prioritize which infection control measure?
  11. A 59-year-old client with COPD is in an acute care emergency department with severe dyspnea and audible wheezing. Vital signs: heart rate 124/min, respiratory rate 36/min, blood pressure 164/92 mm Hg, oxygen saturation 78% on room air; arterial blood gas: pH 7.28, PaCO2 70 mm Hg, PaO2 44 mm Hg. Which oxygen delivery device is most appropriate as an immediate, short-term intervention while preparing for additional respiratory support?
  12. A 66-year-old client with COPD is receiving 4 L/min oxygen by nasal cannula for increased dyspnea; vital signs are heart rate 104/min, respiratory rate 10/min, blood pressure 142/78 mm Hg, oxygen saturation 91%, and the client is difficult to arouse. Arterial blood gas results are pH 7.22, PaCO2 70 mm Hg, HCO3 30 mEq/L, PaO2 68 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
  13. A 27-year-old client is in a prenatal clinic and has just learned the pregnancy is high-risk. The client has a history of pregnancy loss and says, "I can't go through this again." The client is tearful and clutches the exam table paper. What is the MOST appropriate response by the nurse?
  14. A 31-year-old client is admitted to an inpatient psychiatric unit after using methamphetamine for several days; the client reports no sleep for 3 nights. The client is pacing, yelling at staff, and appears paranoid; vital signs: temperature 37.2°C (99.0°F), heart rate 132/min, blood pressure 168/96 mm Hg, respiratory rate 24/min; mental status: alert, hypervigilant, and aggressive; labs: creatine kinase 420 U/L (normal 30–200 U/L). Which intervention should the nurse implement IMMEDIATELY for this client?
  15. In a clinic, the nurse performed wound care with a splashing risk while wearing gloves, a gown, a mask, and a face shield, and has just removed the gloves. Following the CDC sequence, in what order should the nurse remove the remaining PPE?
  16. A 72-year-old client with coronary artery disease and atrial fibrillation is 12 hours post colectomy and is receiving heparin prophylaxis. Current status: increasing abdominal distention and restlessness. Vital signs: heart rate 118/min, blood pressure 90/58 mm Hg, respiratory rate 26/min, oxygen saturation 94% on 2 L/min nasal cannula. Labs: hemoglobin decreased from 11.4 to 9.0 g/dL in 6 hours. Which assessment finding indicates the client is deteriorating?
  17. A 59-year-old client in a rehabilitation unit after a spinal cord injury says angrily, "Stop asking me to do things—I can't do anything anymore!" The client recently was the primary wage earner and avoids therapy sessions. Which response by the nurse demonstrates effective therapeutic communication?
  18. At a family practice clinic, a 68-year-old client with chronic obstructive pulmonary disease (COPD) reports receiving pneumococcal polysaccharide vaccine (PPSV23) once at age 66 and has never received a pneumococcal conjugate vaccine. The client has no history of severe vaccine reaction. Which immunization is due based on current CDC adult pneumococcal recommendations?
  19. A 40-year-old client is 24 hours post-operative after a total abdominal hysterectomy. The client reports nausea and has eaten less than 25% of meals; urine output is 25 mL/hr for the last 4 hours. Vital signs: HR 110/min, BP 94/60 mm Hg. What is the PRIORITY nursing intervention for this client's hydration status?
  20. A 66-year-old with a history of deep vein thrombosis is hospitalized after hip surgery. The client suddenly reports shortness of breath and "impending doom." Assessment: respiratory rate 30/min, oxygen saturation 85% on room air, heart rate 126/min, blood pressure 92/58 mm Hg; lungs clear to auscultation; labs: D-dimer 2.1 mg/L FEU (normal <0.5). Which intervention should the nurse perform FIRST?

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