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Practice Test 2 - NCLEX Rn

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

  1. A 38-year-old client in an inpatient psychiatric unit with schizophrenia is responding to auditory hallucinations and begins shouting, "They told me to hurt you!" The client is staring at the nurse, pacing, and flexing hands; other clients are nearby and appear alarmed. What is the nurse's PRIORITY intervention?
  2. A 74-year-old resident in a long-term care facility is brought to the nurse by a nursing assistant after being found in a wet brief with strong urine odor. The resident has a new stage 2 pressure injury and says, "They leave me in bed all day," and appears fearful when staff approach. Which documentation should the nurse include in the report of suspected institutional neglect?
  3. In a postpartum unit, the nurse is caring for four clients. Which client should the nurse assess FIRST?
  4. A 72-year-old client with small cell lung cancer is hospitalized for neutropenic fever. Labs: ANC 290/mm³. The client has a temperature of 38.5°C (101.3°F), heart rate 112/min, and reports shortness of breath. Which precaution should the nurse implement FIRST?
  5. During a home health visit, a 71-year-old client with a chronic venous leg ulcer (history: peripheral vascular disease; medications: clopidogrel) has a dressing change, and a sealed sharps container tips over, spilling used lancets and blood-soiled gauze onto the floor. While picking up items, the nurse sustains a puncture through a glove on the right ring finger; the site is bleeding. Vital signs: temperature 36.8°C (98.2°F), heart rate 88/min, respiratory rate 18/min, blood pressure 138/82 mm Hg, oxygen saturation 97% on room air. The exposure increases risk for bloodborne pathogen transmission. Which intervention is PRIORITY to prevent infection?
  6. A 52-year-old client is 3 days postoperative after mastectomy with a closed-suction drain in place. The nurse notes the drain bulb is not compressed, the dressing is saturated, and the client reports a sudden increase in swelling near the insertion site; vital signs are T 36.9°C (98.4°F), HR 108/min, BP 118/70 mm Hg. What is the nurse's PRIORITY intervention for this client?
  7. An 83-year-old client in a long-term care facility has a history of dementia and chronic urinary incontinence. Today the client is more confused than baseline and is refusing fluids; assessment shows dry mucous membranes and new suprapubic tenderness. Current findings: temperature 38.3°C (100.9°F), heart rate 110/min, respiratory rate 22/min, blood pressure 90/52 mm Hg, oxygen saturation 95% on room air; white blood cell count 16,000/mm³ (reference 4,500–11,000). Which assessment finding should the nurse address FIRST?
  8. A 64-year-old client is postoperative day 2 after a laparoscopic colectomy; history includes chronic kidney disease stage 3 and prior gastrointestinal bleeding. Current assessment: heart rate 88/min, blood pressure 132/70 mm Hg, respiratory rate 16/min, oxygen saturation 97% on room air; the client is ambulating short distances with assistance. The provider writes new orders for DVT prophylaxis. The nurse should QUESTION which order related to DVT prophylaxis?
  9. A 48-year-old client with schizophrenia is inpatient and states, "The doctor is replacing my organs at night." The client takes an antipsychotic and attends individual therapy. How should the nurse respond to the client's statement?
  10. A 64-year-old client with pancreatic cancer is alert and completing paperwork to appoint a surrogate decision-maker. The client's adult daughter says, "I'll decide based on what I want for Mom." Current assessment: blood pressure 110/66 mm Hg, heart rate 98/min, reports fatigue and poor appetite. Which nursing response is MOST appropriate regarding the surrogate decision-maker's role?
  11. A 58-year-old client with hypertension and chronic kidney disease is admitted for dizziness and bradycardia. Vital signs: blood pressure 176/92 mm Hg, heart rate 48 beats/min; assessment shows generalized weakness. Current medications include lisinopril; the provider writes new orders. Labs: BUN 44 mg/dL (7–20), creatinine 2.3 mg/dL (0.6–1.3), potassium 6.0 mEq/L (3.5–5.0). The nurse should question which lab-related order?
  12. A 30-year-old postpartum client is hospitalized and has frequent visits from her partner, who controls her phone and answers questions. The nurse notes the client flinches when the partner raises his voice and the client states, "If I talk, he'll take the baby." What is the nurse's FIRST action to support safety and legal obligations?
  13. A 16-year-old client reports alcohol use and says they sometimes ride with an intoxicated driver because "it's the only way home." The client lives in a rural area with limited public transportation and does not want to call caregivers due to fear of punishment. Which counseling strategy should the nurse prioritize for this adolescent?
  14. A 55-year-old client with peripheral arterial disease is scheduled for lower-extremity angiography with iodinated contrast (iohexol). The client has a documented prior immediate contrast reaction (generalized hives) and takes prednisone 10 mg daily for rheumatoid arthritis; labs: serum creatinine 1.1 mg/dL; vital signs stable. Which medication order should the nurse QUESTION for a client with contrast allergy?
  15. A 46-year-old client with type 2 diabetes is receiving 0.9% NS at 125 mL/hr through a 20-gauge peripheral IV in the left forearm inserted 10 hours ago on a medical-surgical unit. The nurse notes localized swelling around the insertion site, skin cool to touch, and the client reports tightness rated 3/10; there is minimal redness and the IV is infusing sluggishly. Which sign indicates infiltration at the IV site?
  16. A 50-year-old client with newly diagnosed atrial fibrillation is being discharged on warfarin. The client reports inconsistent access to transportation and difficulty attending frequent lab appointments. Which action should the nurse take to ensure effective care coordination?
  17. A 41-year-old client is in a hospital room after surgery and is newly diagnosed with colorectal cancer. The client has two teenage children and says, "I can't tell them—I don't want them to see me weak." The client's voice is quiet and they stare at the floor. How should the nurse address the client's statement?
  18. A 76-year-old long-term care resident with a chronic indwelling urinary catheter is newly agitated and pulling at lines. Findings: temperature 38.6°C, heart rate 118/min, blood pressure 86/52 mm Hg, respiratory rate 22/min, oxygen saturation 97% on room air; urine is cloudy; white blood cell count 14,800/mm³ (4,500–11,000). What is the PRIORITY nursing action?
  19. A 61-year-old client (male) who speaks limited English is scheduled for a cardiac catheterization; he nods but cannot explain the procedure back, and his adult daughter offers to translate. The facility policy requires a qualified medical interpreter for informed consent discussions. What should the nurse do to ensure informed consent?
  20. A 42-year-old woman presents for a wellness exam. She has a 20 pack-year smoking history and currently smokes 1 pack/day. She asks about lung cancer screening because her uncle had lung cancer. Which screening should be prioritized for this client?

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