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Practice Test 6 - NCLEX Rn

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

  1. A 55-year-old client is 2 days post-tracheostomy for airway protection after neck surgery; a cuffed tracheostomy tube has been in place for 48 hours. The client has thick secretions, rhonchi over the trachea, SpO2 90% on 30% FiO2 trach collar, RR 26/min, HR 104/min, BP 132/78 mm Hg, T 98.8°F. What is the nurse's PRIORITY action when performing tracheostomy care?
  2. A 71-year-old client has a chest tube for postoperative pneumothorax. VS: T 38.6°C, HR 106, RR 22, BP 118/66, SpO2 94% on 2 L/min nasal cannula; the insertion site has increasing redness and foul-smelling drainage. Which intervention should the nurse implement to prevent infection?
  3. On a telemetry unit, smoke is visible coming from a client room where a bedside monitor is plugged in. The nurse has moved the client into the hallway. Which action should the nurse take NEXT to best Confine the fire?
  4. A 30-year-old client with schizophrenia is inpatient and receiving risperidone and occupational therapy. The client says, "The voices say I'm evil and should die," and appears tearful. Which communication strategy should the nurse use FIRST?
  5. A 45-year-old client in the emergency department is intoxicated and becomes verbally aggressive, shouting profanity and pointing at staff. The client's speech is slurred, they are unsteady, and the hallway is congested with visitors; the client is within arm's reach of a supply cart. The nurse should implement which strategy IMMEDIATELY?
  6. A 23-year-old newly diagnosed client with type 1 diabetes is being taught about insulin. The prescribed regimen is NPH insulin 10 units subcutaneously at 0730 and 1730 and regular insulin 6 units subcutaneously 30 minutes before breakfast and dinner. This morning the client reports feeling anxious with palpitations and has a blood glucose of 60 mg/dL (normal fasting 70–100 mg/dL). Relevant history includes recent weight loss and no other chronic conditions. Which finding indicates that immediate intervention is needed?
  7. In the emergency department, the nurse prepares to provide care for a client with active bleeding and will wear gown, gloves, mask, and face shield. What is the correct sequence for donning PPE before client contact?
  8. A 75-year-old client with dementia in a long-term care facility receives bolus gastrostomy tube feedings. The nurse prepares to administer a feeding and notes: head of bed at 0°, client is restless and pulls at tubing, gastric residual volume 60 mL, and lung sounds are clear. What is the nurse's PRIORITY action to prevent aspiration during enteral feeding?
  9. A 70-year-old client with a history of heart failure is receiving PRBCs on a medical-surgical unit for symptomatic anemia. Halfway through the unit, the client becomes increasingly dyspneic with crackles at the lung bases; vital signs are BP 176/94 mm Hg, HR 110/min, RR 28/min, SpO2 88% on 2 L/min nasal cannula. Which finding requires IMMEDIATE intervention during a blood transfusion?
  10. A 28-year-old client with type 1 diabetes is seen in an outpatient clinic for insulin education. The regimen is insulin glargine 22 units subcutaneously at bedtime and insulin lispro with meals using carbohydrate counting. Recent self-monitoring shows pre-lunch blood glucose values of 58–65 mg/dL for the last 3 days (expected fasting 70–99 mg/dL), and the client reports mid-day shakiness and sweating. History includes recent increase in exercise during lunch breaks. What teaching point is MOST important for the client regarding insulin administration?
  11. A 34-year-old female is 8 hours post-op after abdominal hysterectomy under general anesthesia and has received IV opioids. She reports suprapubic pressure and inability to void since surgery; bladder scan shows 780 mL urine. Vital signs: T 36.8°C (98.2°F), HR 104/min, RR 18/min, BP 128/74 mm Hg. Which intervention should the nurse implement FIRST?
  12. A 14-year-old adolescent weighs 50 kg with acute otitis media. Assessment: temperature 38.0°C, ear pain rated 5/10, bulging tympanic membrane; the teen wants to manage their own medications. The provider orders amoxicillin 45 mg/kg/day45\ \text{mg/kg/day} by mouth divided into 2 equal doses. Based on the client's weight, how many mg should be administered per dose?
  13. In an acute care pediatric urgent care clinic, a 10-year-old child with asthma is anxious and wheezing after running outside in cold air. Vital signs: temperature 36.9°C (98.4°F), heart rate 118/min, respiratory rate 32/min, blood pressure 110/70 mm Hg, oxygen saturation 93% on room air; mild suprasternal retractions are present. What is the best initial action regarding oxygen therapy?
  14. A 79-year-old client with chronic heart failure is being discharged from acute care to home with a new prescription for oxygen during exertion. Oxygen saturation is 93% at rest on room air and drops to 87% during a 6-minute walk test. Which oxygen delivery system is most appropriate for this client at home?
  15. A 60-year-old client is postoperative day 2 after nephrectomy. History includes hypertension and tobacco use. Orders include early ambulation and antiembolism stockings. Assessment: heart rate 94/min, blood pressure 146/82 mm Hg, respiratory rate 18/min, oxygen saturation 96% on room air; client states, "I'll just stay in bed so I don't get a blood clot." Which nursing action is most appropriate to prevent DVT/PE?
  16. A 70-year-old client with hypertension and hyperlipidemia presents to the emergency department 3 hours after sudden left-sided weakness and slurred speech began. Assessment: BP 212/110 mmHg, HR 78/min, RR 18/min, SpO2 96% on room air, blood glucose 102 mg/dL (normal 70–110). The provider writes orders for suspected acute ischemic stroke. The nurse should QUESTION which order related to stroke management?
  17. A 40-year-old client with a chest tube for pneumothorax has the drainage system accidentally placed on the bed above chest level. VS: HR 98, RR 20, BP 128/80, SpO2 92% on 2 L/min nasal cannula; drainage is 15 mL serosanguineous in 1 hr. Which assessment finding indicates a complication with the chest tube?
  18. A 32-year-old client who is 30 weeks pregnant has chronic hypertension and is being seen for a prenatal visit. Today her blood pressure is 156/98 mm Hg, and she reports a new, severe headache that is not relieved by acetaminophen. Which symptom should the client report IMMEDIATELY to her healthcare provider?
  19. At a community clinic, an RN accidentally splashes blood-tinged fluid into the right eye while assisting with a laceration repair for a 34-year-old client with a history of intravenous drug use; current medications include buprenorphine-naloxone. The nurse is wearing gloves but no eye protection; the nurse's vital signs are temperature 98.4°F (36.9°C), heart rate 96/min, respiratory rate 18/min, blood pressure 130/78 mm Hg. What is the nurse's FIRST action following exposure?
  20. In an outpatient clinic, the nurse will irrigate a draining wound for a client with methicillin-resistant Staphylococcus aureus (MRSA) and expects splashing. The nurse will use gown, mask, face shield, and gloves. Which step should the nurse perform FIRST when donning PPE?

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