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Practice Test 12 - NCLEX Rn

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

  1. On an acute care telemetry unit, the RN is coordinating care with an LPN and a UAP. Which client care task requires RN intervention for a 76-year-old client admitted with heart failure who now reports new shortness of breath and has oxygen saturation of 88% on room air?
  2. A 60-year-old client with type 2 diabetes is 4 hours postoperative from lumbar fusion and is using an intravenous opioid PCA. Current assessment: pain 5/10, blood pressure 132/78 mm Hg, heart rate 80/min, respiratory rate 6/min, oxygen saturation 88% on room air; the client is difficult to awaken. What is the nurse's PRIORITY action with the PCA?
  3. A 69-year-old woman with type 2 diabetes is confused and weak after 5 days of poor intake with a urinary tract infection. Vital signs: BP 84/48 mm Hg, HR 134/min, RR 22/min, T 38.3°C (100.9°F); glucose 950 mg/dL. Labs: serum osmolality 342 mOsm/kg (normal 275–295), pH 7.37 (normal 7.35–7.45), HCO3− 23 mEq/L (normal 22–26), serum ketones negative (normal negative). What is the nurse's PRIORITY intervention for this patient?
  4. A 34-year-old client with schizophrenia is in a partial hospitalization program, taking aripiprazole and attending social-skills training. The client states, "The staff here are poisoning my coffee." Which communication strategy should the nurse use FIRST?
  5. A school nurse evaluates a 7-year-old student who is frequently absent and arrives hungry; the child has untreated dental pain and says, "My mom says the dentist costs too much." The child lives with the mother and a mother's boyfriend. Which finding requires IMMEDIATE reporting for suspected neglect?
  6. A 66-year-old client with a long-term tracheostomy (uncuffed) for 3 years is admitted to an acute care unit. The nurse assesses increased work of breathing, diminished breath sounds with rhonchi, and SpO2 87% on 4 L/min via trach collar; RR 28/min, HR 118/min, BP 150/86 mm Hg, T 99.3°F. What is the nurse's PRIORITY action when performing tracheostomy care?
  7. A nurse discovers smoke coming from an electrical outlet in a client room. The client is bedbound and attached to a pulse oximeter and blood pressure cuff. Which action should the nurse take FIRST when discovering a fire threat?
  8. A 76-year-old client (female) is admitted with a urinary tract infection; the RN notices her caregiver frequently withholds her phone and the client whispers that money is missing. The RN suspects exploitation and knows suspected elder abuse must be reported per law and policy. Which action by the nurse is legally required?
  9. A 79-year-old client is brought in after a household cleaning accident with a strong alkali drain cleaner splashed on the left forearm and hand; the client removed a sweater but did not rinse the area. History includes type 2 diabetes and chronic kidney disease stage 3. Assessment shows whitening and blistering of the skin with severe pain; vital signs: T 36.9°C (98.4°F), HR 104/min, RR 20/min, BP 146/78 mm Hg, SpO2 97% on room air. Which intervention should the nurse prioritize for this burn client?
  10. On an acute care unit, an RN is delegating tasks to an LPN and a UAP. A 40-year-old client with asthma is stable and requests help using a peak flow meter that was taught earlier in the day. The RN should assign which task to the LPN?
  11. In an adult primary care clinic, a 58-year-old with diabetes mellitus has no record of pneumococcal vaccination. The client is not immunocompromised and has no cerebrospinal fluid leak or cochlear implant. Which pneumococcal vaccination plan is recommended per current CDC guidance?
  12. A 59-year-old client with alcohol use disorder is being discharged after treatment for acute pancreatitis; pain is controlled, diet is advanced to low fat, and labs are improving. The client reports previous relapses and lives with a friend who drinks heavily. Which referral is MOST appropriate for the client's discharge needs?
  13. A 76-year-old client is 3 hours post-alteplase for ischemic stroke. The nurse notes the client is suddenly lethargic and has new right pupil dilation. Assessment: BP 204/110 mmHg, HR 60/min, RR 10/min, SpO2 94% on room air. What is the nurse's PRIORITY action?
  14. A 26-year-old client on an inpatient psychiatric unit with paranoia is yelling at another client, "You're following me!" and raises a fist. The nurse observes the two clients are within arm's reach, and the hallway is crowded during shift change. What is the nurse's PRIORITY intervention?
  15. A 60-year-old client is 1 day post-thoracic surgery with a chest tube for pneumothorax. The provider writes several chest tube orders. The client is stable: VS HR 88, RR 18, BP 124/72, SpO2 96% on 2 L NC; drainage is serosanguineous 120 mL over 8 hr. The nurse should QUESTION which order related to chest tube management?
  16. A nurse is caring for a 59-year-old with a central venous catheter receiving total parenteral nutrition (TPN). Assessment: temperature 39.0°C (102.2°F), HR 122, BP 92/54, chills, and the insertion site is erythematous with drainage. What is the nurse's FIRST action?
  17. An 80-year-old client is being discharged after treatment for pneumonia; history includes atrial fibrillation on anticoagulation and visual impairment. Current findings include mild dyspnea with exertion, oxygen saturation 94% on room air, and the client misreads medication labels. Who should the nurse consult FIRST to address the client's immediate safety need related to discharge medications?
  18. A 69-year-old client with chronic kidney disease is scheduled for CT of the abdomen and pelvis with iodinated contrast (ioversol) to evaluate bowel obstruction. The client reports a prior mild contrast reaction (itching) and takes metformin and amlodipine; vital signs are blood pressure 146/90 mm Hg; creatinine 2.0 mg/dL. Which client condition REQUIRES immediate intervention before contrast administration?
  19. A 19-year-old client on an inpatient psychiatric unit with a history of trauma becomes loud and hostile when a staff member stands in the doorway. The client yells, "Don't trap me!" and begins kicking the bedframe; the room has clutter, and another staff member is hovering near the client's bedside. Which intervention is MOST IMPORTANT for client safety?
  20. An 82-year-old client with chronic kidney disease (estimated glomerular filtration rate 22 mL/min/1.73 m²) and atrial fibrillation is hospitalized for a pulmonary embolism. The provider prescribes an intravenous unfractionated heparin bolus followed by a continuous infusion; current medications include aspirin and metoprolol. Incorrect dosing may cause major bleeding or clot progression. What is the nurse's PRIORITY action before starting the heparin infusion?

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