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Practice Test 8 - NCLEX Rn

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

  1. A 59-year-old client is 6 hours post-operative after a laparoscopic cholecystectomy. Assessment shows pain 4/10, lower extremity strength 5/5, mild nausea, and the client has not yet ambulated. Which action should the nurse take to improve client mobility?
  2. A nurse in the hospital kitchen sees smoke coming from a toaster oven, and a small fire is visible inside the appliance. Staff are present and the exit is clear. After rescuing anyone in immediate danger and activating the alarm, how should the nurse use the fire extinguisher following PASS?
  3. A 57-year-old client has a chest tube for hemothorax. VS: HR 112, RR 24, BP 98/58, SpO2 93% on 4 L/min nasal cannula; drainage is 220 mL/hr of bright red blood for 2 consecutive hours. What is the nurse's PRIORITY action?
  4. A 63-year-old client with hypertension is prescribed metoprolol 25 mg by mouth. The nurse notices that the medication administration record lists metoprolol 50 mg, but the provider's order is clearly 25 mg; the dose has not been given yet. Which action should the nurse take FIRST?
  5. A 77-year-old male with chronic constipation is admitted from home for dehydration. He reports no bowel movement for 8 days and severe rectal pressure. Assessment: T 37.1°C (98.8°F), HR 96/min, RR 18/min, BP 110/64 mm Hg; abdomen mildly distended; rectal exam shows a large amount of hard stool. Which intervention should the nurse implement FIRST?
  6. A 60-year-old client is in a rehabilitation facility after a stroke with new mobility limitations. Psychosocial history includes being a caregiver for a spouse and feeling like a burden; the client's mood is depressed and the client states, "I can't do this anymore." What is the nurse's PRIORITY assessment when evaluating suicide risk?
  7. A 6-year-old child is in an urgent care clinic with a new long-arm cast placed earlier today for a supracondylar humerus fracture. The caregiver reports the child has been crying nonstop and says the fingers feel "asleep"; assessment shows fingers cool and pale, capillary refill 5 seconds, increasing swelling at the hand, and the child cannot wiggle the fingers as well as before. Which finding requires IMMEDIATE intervention by the nurse?
  8. In the emergency department, a 59-year-old client with a history of coronary artery disease reports crushing chest pain and becomes pale and diaphoretic. Assessment: blood pressure 78/44 mm Hg, heart rate 132/min, respiratory rate 24/min, oxygen saturation 93% on room air; 12-lead electrocardiogram shows ST elevation in leads II, III, and aVF. What is the PRIORITY nursing action?
  9. A 64-year-old client with coronary artery disease is scheduled for coronary angiography using iodinated contrast (iodixanol) for evaluation of unstable angina. The client reports allergies to penicillin (rash), morphine (itching), and a prior severe iodinated contrast reaction (throat tightness requiring epinephrine); current medications include aspirin and metoprolol; vital signs: BP 118/70 mm Hg, HR 64/min. Which precaution should the nurse take PRIOR to contrast administration?
  10. A 49-year-old client with type 1 diabetes reports erratic blood glucose levels due to inconsistent meal patterns while working rotating shifts. The regimen is insulin glargine 20 units subcutaneously at bedtime and insulin lispro 1 unit per 10 g carbohydrate with meals. Recent readings show pre-meal values ranging from 65–220 mg/dL; the client describes episodes of sweating and shakiness when meals are delayed, with one reading of 59 mg/dL (expected fasting 70–99 mg/dL). History includes recent weight loss and increased caffeine intake. What teaching point is MOST important for the client regarding insulin administration?
  11. A 74-year-old client is being discharged after a transurethral resection of the prostate. The client is voiding with light pink urine, has stable vital signs, and will go home with a spouse. The client asks what symptoms require immediate follow-up. Which discharge instruction is MOST important for the client?
  12. A 54-year-old client with chronic kidney disease stage 3 is postoperative day 1 after total knee arthroplasty and is using an intravenous opioid PCA. Current assessment: pain 8/10, blood pressure 146/84 mm Hg, heart rate 104/min, respiratory rate 18/min, oxygen saturation 96% on room air; the client states, "I keep pressing the button and nothing is happening." What is the nurse's PRIORITY action with the PCA?
  13. A 29-year-old client is being discharged after an uncomplicated vaginal delivery. The client plans to breastfeed, reports mild perineal discomfort, and has stable vital signs. The client lives with a supportive partner but has a history of depression and reports feeling "overwhelmed." What is the nurse's PRIORITY when planning for this client's discharge?
  14. At a routine check-up, the nurse evaluates a healthy 4-year-old preschooler who attends daycare and has no chronic conditions. Which fine motor milestone is expected at this age?
  15. A 63-year-old client with heart failure is scheduled for CT angiography with iodinated contrast (iopamidol) to evaluate an abdominal aortic aneurysm. The client has no known drug allergies and is taking furosemide and lisinopril; vital signs are blood pressure 110/68 mm Hg, heart rate 92/min; creatinine 1.6 mg/dL. Which client condition REQUIRES immediate intervention before contrast administration?
  16. A nurse is reviewing a new medication administration record for four clients. The nurse should QUESTION which order? (1) 80-year-old with heart failure and potassium 5.8 mEq/L: spironolactone 25 mg PO daily; (2) 45-year-old with pneumonia: ceftriaxone IV; (3) 30-year-old with nausea: ondansetron IV PRN; (4) 67-year-old with osteoarthritis: acetaminophen PO PRN. Vital signs are stable for all clients.
  17. A 2-year-old child with bronchiolitis is admitted for increased work of breathing. Current status: poor feeding and fewer wet diapers. Vital signs: heart rate 170/min, respiratory rate 52/min, temperature 38.1°C (100.6°F), oxygen saturation 91% on room air. The nurse observes head bobbing and grunting. Which assessment finding indicates the child is deteriorating?
  18. An 88-year-old client in long-term care with severe dementia is placed in a lap belt "for safety," but the client has no recent falls and is calm, seated, and cooperative. Which approach reflects the use of the least restrictive measure?
  19. A 68-year-old man with hyperlipidemia and a 30 pack-year smoking history quit smoking 8 years ago. He is asymptomatic and says he avoids clinics due to mistrust from prior experiences; he will agree to one high-value screening today. Which screening should be prioritized for this client?
  20. After a bombing, the nurse is using START triage. What is the nurse's PRIORITY action when an adult victim has respirations 0/min and does not start breathing after the nurse opens the airway?

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