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Practice Test 7 - NCLEX Rn

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

  1. A 52-year-old client with cervical cancer and type 2 diabetes is receiving low-dose-rate brachytherapy with an internal implant expected to remain in place for 72 hours. She is stable with vital signs temperature 36.8°C (98.2°F), heart rate 88/min, respiratory rate 16/min, blood pressure 126/76 mm Hg, oxygen saturation 97% on room air. The nurse should PRIORITIZE which safety measure?
  2. A 24-year-old is brought to the emergency department after being pulled from a house fire. Assessment: soot around the nares, singed nasal hairs, hoarse voice; respiratory rate 26/min, oxygen saturation 95% on room air, heart rate 110/min, blood pressure 128/76 mm Hg; arterial blood gas: carboxyhemoglobin 18% (normal <2%). Which intervention should the nurse perform FIRST?
  3. A 28-year-old client with short bowel syndrome is preparing for discharge on home TPN after multiple bowel resections. The client will infuse TPN nightly via a tunneled central venous catheter: 2,000 mL over 12 hours (dextrose 20%, amino acids 5%, electrolytes, vitamins, trace elements) using an infusion pump; 20% lipid emulsion is infused 3 nights per week. Which assessment finding indicates a complication of TPN therapy during a home health visit?
  4. A 47-year-old client with alcohol use disorder is admitted for acute pancreatitis and is now medically stable for discharge. The client states motivation to stop drinking but has relapsed multiple times and reports unstable housing. Which interdisciplinary team member should the nurse consult FIRST?
  5. An 82-year-old long-term care resident with a history of chronic kidney disease and dementia is newly confused and lethargic. Current findings: temperature 38.3°C, heart rate 110/min, blood pressure 88/50 mm Hg, respiratory rate 22/min, oxygen saturation 95% on room air; urine output has been low for 8 hours; white blood cell count 15,900/mm³ (4,500–11,000), creatinine 2.4 mg/dL (0.6–1.3), lactate 3.2 mmol/L (0.5–2.0). Which assessment finding should the nurse address FIRST?
  6. A 15-year-old client reports vaping nicotine daily and occasionally using marijuana at parties; the client says, "Everyone does it," and denies any health concerns. The client lives with two caregivers who disagree about discipline and reports a strong connection to a peer group that vapes between classes. What is the most effective intervention to address the client's risk behavior?
  7. At a 9-month well-baby visit, the nurse reviews safety with the parent of a healthy infant who is increasingly mobile. Which advice should the nurse give the parent based on expected development at 9 months?
  8. A 60-year-old client with congestive heart failure is on a low-sodium diet. Dietary services delivers a tray labeled for the client that contains high-sodium foods; the nurse notices before the client eats. Which detail is MOST important to include in the near-miss report for quality improvement?
  9. A 65-year-old long-term care resident has a stage 2 pressure injury on the coccyx with a moist, pink wound bed. The nursing assistant reports applying a donut cushion when the resident sits in the wheelchair. The nurse should QUESTION which order related to skin care?
  10. A 46-year-old client is admitted to a medical unit with suspected pulmonary tuberculosis after 3 weeks of cough, night sweats, weight loss, and hemoptysis; a chest x-ray shows upper-lobe infiltrates. Vital signs: T 38.2°C (100.8°F), HR 96/min, RR 20/min, BP 124/78 mmHg, SpO2 94% on room air. What precaution should the nurse take FIRST when preparing to enter the room?
  11. A 29-year-old client with a history of schizophrenia was started on olanzapine 5 days ago on an inpatient psychiatric unit and attends daily psychoeducation. The client reports, "The voices are quieter, but they still tell me I'm worthless," and appears tearful. Which statement by the nurse best addresses the client's hallucination?
  12. In the emergency department, a 35-year-old client presents with a forearm fracture and facial bruising; the client's spouse states, "She fell down the stairs," but the client quietly says, "It was my fault—I made him angry." The client has two small children at home. What is the nurse's PRIORITY action related to safety and reporting?
  13. A 70-year-old client on a medical-surgical unit is receiving packed red blood cells for chronic anemia; the transfusion started 8 minutes ago. The client reports chest tightness and nausea and the nurse notes flushing and dark urine in the catheter bag; vital signs are temperature 38.6 0C (101.5 0F), heart rate 132/min, blood pressure 90/50 mm Hg, respiratory rate 22/min, and oxygen saturation 95% on room air. Which symptom indicates an IMMEDIATE need to stop the transfusion?
  14. A 52-year-old client is admitted with bacterial meningitis suspected due to fever, severe headache, nuchal rigidity, and photophobia; antibiotics are being prepared. Vital signs: T 39.4°C (102.9°F), HR 112/min, RR 20/min, BP 128/72 mmHg, SpO2 97% on room air. What precaution should the nurse take FIRST when initiating care?
  15. A 72-year-old client with type 2 diabetes is being discharged after treatment for a foot ulcer and cellulitis; the client will complete oral antibiotics and has a new order for daily wound care. The client's glucose is controlled with insulin, and the client has decreased vision and limited ability to bend. The client lives with an adult daughter who works days and can assist in the evenings. Which referral is MOST appropriate for the client's discharge needs?
  16. A 69-year-old client is 48 hours post-tracheostomy for head and neck cancer surgery; a cuffed tube is in place. The nurse notes copious secretions and frequent coughing, SpO2 91% on 35% FiO2, RR 24/min, HR 100/min, BP 136/78 mm Hg, T 99.2°F. Which assessment finding requires IMMEDIATE intervention in a client with a tracheostomy?
  17. A 51-year-old client with ulcerative colitis is receiving TPN via a central line after bowel surgery. The TPN is infusing at 80 mL/hr and contains dextrose 25%, amino acids 5%, electrolytes, vitamins, and trace elements; lipids are infused separately. The client's capillary blood glucose is 58 mg/dL (3.2 mmol/L), and the client is diaphoretic and confused. What is the nurse's PRIORITY action for a client receiving TPN?
  18. A 45-year-old client (history: type 2 diabetes) presents to the emergency department 1 hour after a kitchen explosion with 40% TBSA partial- and full-thickness burns to the torso and both legs. Current assessment: alert but restless; burns are circumferential on the right leg; urine output has not yet been measured; vital signs: T 36.8°C (98.2°F), HR 122/min, RR 24/min, BP 94/58 mm Hg, SpO2 97% on 2 L/min nasal cannula. Which intervention should the nurse prioritize for this burn client?
  19. A 26-year-old first-time mother at 22 weeks gestation is receiving prenatal teaching and asks which symptoms are normal versus warning signs. She reports mild heartburn after meals and occasional constipation but denies pain with urination. Which symptom should the client report IMMEDIATELY to her healthcare provider?
  20. In a hospital setting, the nurse is preparing to enter a contact-precautions room to assist with perineal care and expects significant contact with linens. The nurse will wear gown and gloves. What is the correct sequence for doffing PPE after providing care and exiting the room?

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