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Practice Test 11 - NCLEX Rn

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

  1. A nurse sees a small fire in a hallway trash can near several client rooms. After rescuing clients and activating the alarm, which action should the nurse take to best protect clients from smoke inhalation while following RACE?
  2. A 56-year-old client with a history of multiple prior transfusions is receiving PRBCs on a medical-surgical unit. Twenty minutes after starting the transfusion, the client develops sudden severe dyspnea and anxiety; vital signs are T 37.1°C (98.8°F), BP 104/62 mm Hg, HR 118/min, RR 34/min, SpO2 82% on room air with new bilateral crackles. What is the nurse's FIRST action upon recognizing a transfusion reaction?
  3. A nurse receives report on four clients on a step-down unit. Which client should the nurse assess FIRST? (1) 57-year-old with diabetic ketoacidosis on insulin infusion, blood glucose 210 mg/dL and trending down, potassium 4.2 mEq/L; (2) 66-year-old with sepsis receiving IV antibiotics, lactate 1.8 mmol/L, BP 118/70; (3) 74-year-old with a new tracheostomy who has copious secretions, audible gurgling, RR 26, SpO2 90%; (4) 39-year-old with pancreatitis, NPO, pain controlled with PCA, RR 16.
  4. A 63-year-old client with a history of transient ischemic attacks, carotid artery stenosis, and hypertension arrives to the emergency department with facial droop and inability to speak. The spouse reports the client was last known well 3 hours ago. Assessment: follows simple commands, expressive aphasia, right-sided weakness, BP 172/88 mmHg, HR 84/min, RR 16/min, oxygen saturation 97% on room air; glucose 98 mg/dL (normal 70–110). Which intervention should the nurse implement FIRST in response to the client's symptoms?
  5. A 58-year-old client with endometrial cancer has a sealed brachytherapy implant scheduled for 36 hours. The client has chronic kidney disease and is anxious; vital signs are stable. Which client education point is MOST IMPORTANT for radiation safety while the implant is in place?
  6. A 79-year-old with dementia in a long-term care facility is found on the floor next to the bed. Assessment: grimacing with movement, right leg shortened and externally rotated, BP 168/94, HR 104, RR 22, SpO2 95%. What is the nurse's PRIORITY action?
  7. In a long-term care facility, an 83-year-old client with a history of stroke and dysphagia begins coughing during lunch and then becomes unable to speak. Assessment: inspiratory stridor, cyanosis around the lips, oxygen saturation 76% on room air, respiratory rate 10/min with poor air movement; the client is clutching the throat. What is the PRIORITY nursing action for this client?
  8. A 65-year-old client is admitted with pancreatitis and has a nasogastric tube placed for enteral nutrition. The provider writes orders. The nurse should QUESTION which order related to enteral feeding? Assessment: client is intermittently drowsy, has nausea, and has a history of aspiration with prior hospitalization.
  9. A 66-year-old client is admitted for acute coronary syndrome and has an order for intravenous nitroglycerin infusion titrated to chest pain and blood pressure; current medications include aspirin and metoprolol. Nitroglycerin infusions are high-alert because incorrect dosing can cause severe hypotension. The nurse should QUESTION which part of the medication administration process?
  10. A 52-year-old client with leukemia is hospitalized and has ANC 180/mm³. The nurse is planning daily care. What is the PRIORITY action to reduce infection risk during routine nursing care?
  11. A 38-year-old client (male) is admitted for alcohol withdrawal; in a public corridor, a staff member tells another, "He's detoxing again—he's a frequent flyer." The RN knows confidentiality includes limiting unnecessary disclosures and maintaining respectful communication. Which statement reflects appropriate confidentiality practices?
  12. In a dialysis unit, an RN experiences a splash of blood onto non-intact skin (a small, cracked area on the wrist) while disconnecting a 62-year-old client with end-stage kidney disease and hepatitis B infection; current medications include epoetin alfa and sevelamer. The nurse's wrist has a visible crack with mild redness; the nurse's vital signs are temperature 98.9°F (37.2°C), heart rate 86/min, respiratory rate 18/min, blood pressure 126/82 mm Hg. Which intervention is PRIORITY to prevent infection?
  13. A 79-year-old client (weight 55 kg) with renal impairment has a creatinine clearance of 20 mL/min. The provider prescribes cefepime 1 g IV every 24 hours (renal-adjusted). The vial label reads 1 g per 10 mL after reconstitution. How many mL should the nurse prepare for one dose?
  14. A 47-year-old client is post-operative after gastric surgery and reports dumping symptoms (cramping and dizziness) after meals. The client has lost 3 kg in 1 month. Which dietary modification should the nurse implement IMMEDIATELY?
  15. A 50-year-old client is admitted for pancreatitis. A friend arrives on the unit and states, "I'm listed as their emergency contact—tell me what's going on." The client is asleep and has not given permission to share information with this person. How should the nurse handle a breach of client confidentiality?
  16. A 22-year-old client with schizophrenia in an inpatient unit is newly started on an antipsychotic and attends psychoeducation groups. The client reports, "The voices are quieter today, but they still tell me not to trust you." What is the nurse's PRIORITY in communicating with the client?
  17. A 74-year-old client post-stroke is receiving bolus PEG tube feedings and is at high risk for aspiration due to dysphagia and decreased cough reflex. Current assessment: head of bed at 40°, gastric residual volume 110 mL, oxygen saturation 95% on room air, and lungs are clear. The nurse is preparing to administer the next bolus feeding. What is the nurse's PRIORITY action to prevent aspiration during enteral feeding?
  18. A 60-year-old client is in the emergency department with suspected septic shock. Findings: temperature 38.8°C, heart rate 128/min, blood pressure 82/46 mm Hg, respiratory rate 28/min, oxygen saturation 93% on room air; urine output is minimal. Which intervention should be implemented IMMEDIATELY?
  19. A 73-year-old client in a skilled nursing facility receives nocturnal PEG feedings. Over the past 24 hours the client has had low-grade fever and increased coughing during the night. Current assessment: lung sounds with crackles in the right lower lobe, oxygen saturation 91% on room air, gastric residual volume 220 mL, and head of bed at 25°. What is the nurse's PRIORITY action to prevent aspiration during enteral feeding?
  20. A 69-year-old client is 12 hours post abdominal surgery and now has tachycardia and low blood pressure. Findings: temperature 38.6°C, heart rate 132/min, blood pressure 88/52 mm Hg, respiratory rate 24/min, oxygen saturation 94% on room air; skin is warm and flushed; white blood cell count 17,600/mm³ (4,500–11,000). Which assessment finding should the nurse address FIRST?

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