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Practice Test 3 - NCLEX Rn

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

  1. A 30-year-old female is 1 day postpartum after a prolonged labor with epidural anesthesia. She reports difficulty initiating urination and feels bladder fullness. Assessment: T 36.8°C (98.2°F), HR 90/min, RR 16/min, BP 116/70 mm Hg; fundus deviated to the right; lochia is moderate. Which intervention should the nurse implement FIRST?
  2. A 49-year-old client with cervical cancer is receiving sealed brachytherapy for 48 hours. The client's partner arrives with their 6-year-old child and asks to visit; the client's vital signs are temperature 98.4°F (36.9°C), heart rate 78/min, blood pressure 124/76 mm Hg. The nurse should PRIORITIZE which safety measure?
  3. A 64-year-old client is being discharged after coronary stent placement for stable angina. The client is stable, radial access site is without bleeding, and the client will go home with an adult son. New prescriptions include aspirin and clopidogrel. Which discharge instruction is MOST important for the client?
  4. During shift change, the outgoing nurse reports on a 26-year-old client with no significant medical history who is 4 hours after an appendectomy; current assessment shows temperature 37.9°C (100.2°F), heart rate 102/min, blood pressure 124/78 mm Hg, pain 7/10, and the client has not voided since surgery with a bladder scan of 620 mL. What is the MOST important recommendation for the nurse to communicate using SBAR to the incoming nurse?
  5. A nurse provides discharge teaching during a home visit for a 69-year-old client 3 days after cataract surgery who reports blurred vision in low light. The nurse notes the client's hallway has a burned-out bulb and the client keeps shoes and bags on the floor near the entry. Which finding indicates a need for INTERVENTION?
  6. A 66-year-old client is postoperative day 2 after a thoracotomy and is using a morphine PCA. History includes chronic obstructive pulmonary disease (COPD). Current assessment: pain 7/10 with coughing, blood pressure 140/82 mm Hg, heart rate 98/min, respiratory rate 20/min, oxygen saturation 95% on 2 L/min nasal cannula; the client is alert and using incentive spirometry. What is the nurse's PRIORITY action with the PCA?
  7. A 56-year-old client with a history of stroke and dysphagia has a nasogastric (NG) tube for enteral feeding. During a continuous feeding, the client begins coughing and gagging and reports throat discomfort; the nurse notes the NG tube marking at the nare has changed from 60 cm to 48 cm, SpO2 is 89% on room air, RR 28/min, and breath sounds are coarse. What is the nurse's PRIORITY intervention for this client?
  8. An 82-year-old client (male) with end-stage chronic obstructive pulmonary disease is hospitalized with worsening respiratory failure. His chart includes a valid do-not-resuscitate (DNR) order and an advance directive naming his spouse as healthcare proxy; at the bedside, the adult son insists, "Do everything, start CPR if he stops breathing," while the spouse states the client previously refused resuscitation. What is the nurse's ethical obligation in this scenario?
  9. At a community fall-prevention class, a 74-year-old adult reports using over-the-counter antihistamines for sleep and waking to use the bathroom. The client states the bathroom is down a dark hallway and there is a small pet that sleeps on the floor near the bed. Which modification should the nurse recommend to reduce fall risk?
  10. A 79-year-old client with mild dementia is admitted from an assisted living facility with confusion and weakness. The client has dry mucous membranes, poor skin turgor, and has had 300 mL of dark amber urine over the last 8 hours; vital signs: T 36.8°C (98.2°F), HR 108/min, BP 92/58 mm Hg, RR 18/min. Labs: Na 150 mEq/L, BUN 34 mg/dL, creatinine 1.2 mg/dL. What is the PRIORITY nursing intervention for this client's hydration status?
  11. A 49-year-old client receiving a heparin infusion has an aPTT of 118 seconds (therapeutic range typically 60–80 seconds). The nurse notes bleeding at the gumline and the client reports lightheadedness. What is the PRIORITY nursing action for this client?
  12. A 67-year-old client with cirrhosis and esophageal varices is admitted for gastrointestinal bleeding. Current status: black, tarry stools and increasing lightheadedness. Vital signs: heart rate 124/min, blood pressure 88/50 mm Hg, respiratory rate 24/min, oxygen saturation 96% on room air. Labs: hemoglobin 7.4 g/dL (low), platelets 68,000/mm³ (low). Which assessment finding indicates the client is deteriorating?
  13. A 40-year-old client with sickle cell disease is scheduled for placement of a peripherally inserted central catheter (PICC) for long-term antibiotics. The client is alert, English-speaking, and can correctly describe the procedure, risks (infection, bleeding), and alternatives. The client asks the nurse, "Can I change my mind after I sign?" Which element is ESSENTIAL for informed consent to be valid?
  14. A 64-year-old hospitalized client with a spinal cord injury is unable to feel the lower extremities and is on a low-air-loss mattress. On assessment, the nurse notes a new area of purple-maroon discoloration over the right buttock; skin is intact and cooler than surrounding tissue. What is the PRIORITY action for maintaining skin integrity?
  15. A 55-year-old client with cervical cancer is receiving low-dose-rate brachytherapy with a sealed internal implant planned for 72 hours. The nurse finds the client's partner sitting in a chair next to the bed and holding the client's hand. Which action should the nurse take FIRST to ensure radiation safety?
  16. A 17-year-old client seeks counseling and reports having multiple sexual partners over the past 3 months and inconsistent condom use; the client says, "I don't want my parents to find out," and is unsure how to negotiate condom use. The client reports a supportive best friend but a strained relationship with caregivers due to frequent arguments. Which aspect of the client's care should the nurse prioritize?
  17. A 76-year-old client with type 2 diabetes mellitus and stage 4 chronic kidney disease is prescribed a new dose of insulin glargine 28 units subcutaneously at bedtime. Current medications include carvedilol and gabapentin; the client reports poor appetite, increasing the risk for hypoglycemia if overdosed. Which step is essential before administering this high-alert medication?
  18. A 68-year-old client is postoperative day 1 after open ventral hernia repair. History includes chronic venous insufficiency and obesity. Assessment: heart rate 88/min, blood pressure 134/74 mm Hg, respiratory rate 16/min, oxygen saturation 98% on room air; client is on opioid analgesia and has not ambulated yet. Which intervention should the nurse implement to prevent DVT in this client?
  19. A 66-year-old client with hypertension is enrolled in remote monitoring. The nurse notices blood pressure readings are uploaded every hour overnight, which is not the prescribed schedule, raising concern that someone else may be using the device. What is the BEST way for the nurse to handle this discrepancy while protecting privacy?
  20. A 63-year-old client with acute lymphoblastic leukemia is hospitalized with ANC 240/mm³. The client has a central venous catheter and reports tenderness at the insertion site; temperature is 38.2°C (100.8°F). What is the PRIORITY action to reduce infection risk?

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