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Practice Test 5 - NCLEX Rn

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

  1. A 73-year-old client with heart failure has a peripherally inserted central catheter placed and now requires a sterile dressing change due to lifting edges. The RN prepares the sterile field and removes the old dressing with clean gloves. Which action by the nurse maintains sterility when transitioning to the sterile portion of the procedure?
  2. A 70-year-old client with chronic kidney disease (estimated glomerular filtration rate 25 mL/min/1.73 m²) is admitted for cellulitis and has an order for intravenous gentamicin; current medications include amlodipine and warfarin. Aminoglycosides are high-alert due to nephrotoxicity and ototoxicity if dosed incorrectly. Which action should the nurse take FIRST to ensure medication safety?
  3. An 8-year-old child is discharged home with a long-arm cast after a fracture. The caregiver calls the unit reporting the child's fingers are swollen and the child says the hand is numb; the caregiver also notes the fingers look pale and feel cool. Which instruction is the nurse's PRIORITY response?
  4. In an acute care medical-surgical unit, the nurse receives shift report on four clients. Which client should the nurse assess FIRST? A. A 58-year-old with type 2 diabetes who is diaphoretic and confused; bedside glucose is 42 mg/dL (reference 70–110), vital signs: T 36.8°C (98.2°F), HR 104/min, RR 18/min, BP 148/86 mm Hg. B. A 76-year-old with heart failure reporting mild dyspnea on exertion; SpO2 93% on 2 L nasal cannula, lungs with bibasilar crackles, HR 88/min, RR 20/min, BP 154/78 mm Hg. C. A 44-year-old postoperative day 1 after appendectomy with pain 7/10; incision dry, HR 92/min, RR 16/min, BP 132/74 mm Hg, T 37.2°C (99.0°F). D. A 67-year-old with a urinary tract infection receiving IV antibiotics; temperature 38.1°C (100.6°F), HR 96/min, RR 18/min, BP 126/70 mm Hg, reports burning with urination.
  5. A 74-year-old client in a hospital room has advanced heart failure and is transitioning to comfort-focused care. The client's adult daughter says, "If we stop treatments, it means we're giving up on my dad," and begins to cry; she reports feeling responsible for making the "right" decision. The daughter's emotional need is support and clear, compassionate information. What is the MOST appropriate response by the nurse?
  6. During a home health visit, a 50-year-old client with hepatitis C infection (medications: sofosbuvir-velpatasvir) has a finger-stick glucose test performed by a family member. The nurse attempts to dispose of the used lancet and is punctured on the thumb; the site bleeds. Vital signs: temperature 36.9°C (98.4°F), heart rate 82/min, respiratory rate 16/min, blood pressure 130/78 mm Hg, oxygen saturation 98% on room air. This exposure poses risk for bloodborne pathogen transmission. What should the nurse DOCUMENT immediately post-exposure?
  7. A 48-year-old client on contact precautions for MRSA has a blood pressure cuff and stethoscope in the room labeled for single-client use. Another client on the unit needs vital signs taken urgently, and no other cuff is immediately available. What precaution should the nurse take FIRST?
  8. In home care, a 76-year-old client with chronic heart failure reports increasing fatigue and shortness of breath when walking from the bedroom to the bathroom. Vital signs: heart rate 92/min, respiratory rate 22/min, blood pressure 148/86 mm Hg, oxygen saturation 90% at rest on room air and 84% with ambulation; chest x-ray from last week shows mild pulmonary congestion; basic metabolic panel is within expected range. Which oxygen delivery device is most appropriate for this client to use during activity in the home setting?
  9. A 46-year-old client is scheduled for a CT pulmonary angiogram with iodinated contrast (iopamidol) to evaluate possible pulmonary embolism. History includes asthma and a shellfish allergy (urticaria after shrimp); current medications include albuterol inhaler and montelukast; vital signs: BP 128/76 mm Hg, HR 92/min, RR 18/min, SpO2 96% on room air. The nurse should VERIFY which information with the client before the procedure?
  10. A 30-year-old client at 19 weeks of gestation asks about swelling and weight gain. She reports her rings feel tighter over the last 2 days and she has a mild headache today. The nurse should provide which education regarding warning signs during pregnancy?
  11. A nurse visits a 67-year-old client discharged after laparoscopic surgery who reports taking opioid pain medication and feeling sleepy. The client states, "I get up quickly and rush to answer the phone when it rings." The nurse should QUESTION which client behavior?
  12. A 76-year-old post-operative abdominal surgery client becomes confused at night and attempts to remove the oxygen cannula and intravenous line; the client is weak and requires assistance to ambulate. Which action should the nurse take FIRST to ensure client safety?
  13. A 45-year-old client presents to the emergency department with fever, myalgias, cough, and sore throat for 24 hours; rapid influenza test is positive. VS: T 38.6°C (101.5°F), HR 104/min, RR 22/min, BP 122/70 mm Hg, SpO2 95% RA. What personal protective equipment (PPE) is required for the nurse to enter the room to perform an assessment?
  14. A home health nurse visits a 69-year-old client 1 week after hip surgery who uses a walker. The client's bathroom has a towel bar near the toilet, and the client states, "I pull on the towel bar to stand up." What is the PRIORITY action to ensure home safety?
  15. A 60-year-old post-surgical client is unable to reposition independently and has a Braden Scale score of 9. The nurse notes the client is lying on wrinkled linens and has crumbs in the bed; skin is intact. What is the PRIORITY action for maintaining skin integrity?
  16. A 58-year-old client with sleep apnea is in an acute care post-anesthesia care unit and is receiving oxygen via nasal cannula at 2 L/min. The client becomes increasingly somnolent with shallow breathing. Vital signs: heart rate 90/min, respiratory rate 9/min, blood pressure 118/66 mm Hg, oxygen saturation 90% on 2 L/min. Which finding indicates that supplemental oxygen alone is not adequate for this client?
  17. In a long-term care facility, the nurse sustains a needle-stick while disposing of a used subcutaneous heparin needle after administering it to an 82-year-old resident with known human immunodeficiency virus infection (medications: antiretroviral therapy; history: hypertension). The puncture is on the left index finger with mild bleeding; vital signs: temperature 36.9°C (98.4°F), heart rate 80/min, respiratory rate 16/min, blood pressure 130/70 mm Hg, oxygen saturation 98% on room air. The exposure has potential for human immunodeficiency virus transmission if not managed promptly. What is the nurse's FIRST action following exposure?
  18. A 15-year-old client reports being bullied online and at school and has begun drinking alcohol "a few times a week" to cope; the client's grades are dropping and the client avoids former friends. The client lives with a caregiver who minimizes mental health concerns and says, "Just ignore them," creating a barrier to seeking help. What is the most effective intervention to address the client's risk behavior?
  19. A 4-year-old child with a history of asthma is in the emergency department for respiratory distress after a viral illness. Current status: anxious, speaking in 1–2 word phrases; vital signs: heart rate 156/min, respiratory rate 44/min, temperature 38.1°C (100.6°F), oxygen saturation 89% on room air; breath sounds: diffuse wheezing that becomes markedly diminished in the bases; retractions are present. Which assessment finding indicates the child is deteriorating?
  20. Which of the following procedural steps is essential for the nurse to perform next?

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