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Practice Test 9 - 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 poorly controlled hypertension is discharged from the emergency department after evaluation for headache; CT is negative and BP is improved. The client reports no transportation, limited literacy, and no primary care follow-up. Which action should the nurse take to ensure effective care coordination?
  2. In a long-term care facility, a nurse notes an urgent change in a 79-year-old client with dementia and a history of stroke; the client has a new fever 38.9°C (102.0°F), heart rate 112/min, blood pressure 88/54 mm Hg, respiratory rate 24/min, oxygen saturation 90% on room air, and is more lethargic than baseline with cloudy urine. What information should the nurse include in the SBAR report when calling the healthcare provider?
  3. An RN receives an EHR pop-up indicating the nurse is logged in at two workstations at the same time. The nurse realizes they forgot to log out of a computer in a public hallway after charting on a 33-year-old client admitted for appendicitis. What should the nurse do FIRST to reduce privacy risk?
  4. A 76-year-old client with mild cognitive impairment is postoperative day 0 after repair of a hip fracture and is using an intravenous opioid PCA. Current assessment: pain 5/10, blood pressure 136/78 mm Hg, heart rate 84/min, respiratory rate 14/min, oxygen saturation 95% on room air; the client is confused and repeatedly asks the nurse to "push the button for me." The nurse should QUESTION which aspect of PCA use?
  5. A 79-year-old client with a history of stroke (mild left-sided weakness, 4/5) is discharged with a quad cane. Assessment: mild left foot drop, slow gait, and fair balance. Which client statement indicates a need for further teaching about their cane?
  6. A 79-year-old client in a long-term care facility has chronic heart failure and has had gradually worsening fatigue and swelling over 2 weeks. Today the client is more short of breath at rest. Assessment: respiratory rate 30/min, oxygen saturation 89% on room air, heart rate 104/min, blood pressure 146/84 mm Hg, bilateral crackles halfway up the lungs, 3+ pitting edema, and weight gain of 3.2 kg (7 lb) in 10 days. Which intervention should the nurse implement IMMEDIATELY?
  7. A 72-year-old client has a chest tube for a postoperative pneumothorax. VS: T 38.4°C, HR 104, RR 20, BP 128/72, SpO2 94% on 2 L/min nasal cannula; the insertion site is erythematous with purulent drainage and tenderness. Which intervention should the nurse implement to prevent infection?
  8. A 64-year-old client arrives to the emergency department 4 hours after sudden onset of aphasia and right-sided weakness. History includes hypertension, type 2 diabetes, and smoking. Assessment: awake, follows commands, expressive aphasia, right arm drift; BP 176/90 mmHg, HR 88/min, RR 16/min, oxygen saturation 98% on room air; glucose 132 mg/dL (normal 70–110). Which assessment finding requires IMMEDIATE action?
  9. A 73-year-old client with chronic kidney disease (estimated glomerular filtration rate 24 mL/min/1.73 m²) is admitted for pain crisis due to vertebral fracture and has an order for intravenous morphine 4 mg every 2 hours as needed; current medications include gabapentin. Opioids are high-alert and may accumulate in renal impairment, increasing risk of oversedation and respiratory depression. What is the nurse's PRIORITY action before medication administration?
  10. In an urgent care clinic, a 28-year-old client with a history of depression and recent initiation of a selective serotonin reuptake inhibitor 10 days ago presents with agitation and insomnia. The client is pacing, has rapid speech, and reports a recent eviction notice and increased alcohol use; they state, "I keep thinking about crashing my car into a bridge." Which finding requires IMMEDIATE intervention by the nurse?
  11. A 52-year-old client is receiving an intravenous heparin infusion for deep vein thrombosis. The provider writes an order to give intramuscular (IM) ketorolac for pain; the client's aPTT is 74 seconds (therapeutic range typically 60–80 seconds). The nurse notes scattered ecchymoses on the arms. The nurse should QUESTION which provider order?
  12. A 32-year-old client in an urgent care clinic presents with a fractured rib and states she "ran into a door." Her spouse insists on staying in the room and answers questions for her; the client appears anxious and has old bruises on the torso. What is the nurse's FIRST action?
  13. A 57-year-old client receiving heparin for pulmonary embolism has an aPTT of 79 seconds (therapeutic range typically 60–80 seconds). The client suddenly develops slurred speech and right-sided weakness. What is the PRIORITY nursing action for this client?
  14. A 40-year-old client is in an orthopedic unit with a circumferential cast for a left radius fracture placed yesterday. The client reports increasing pain and numbness; assessment reveals fingers pale, capillary refill 5 seconds, decreased sensation, and pain with passive finger stretch. What is the PRIORITY nursing intervention?
  15. A 59-year-old client has had a cuffed tracheostomy for 2 weeks and is on a medical unit. During routine suctioning, the nurse plans multiple passes. The client's SpO2 is 92% on 28% FiO2, RR 24/min, HR 98/min, BP 130/76 mm Hg, T 98.6°F. Which action should the nurse take FIRST when suctioning a tracheostomy?
  16. A 38-year-old client is discharged from inpatient psychiatry after a suicide attempt by overdose 1 week ago and is now seen by a home health nurse. History includes depression and chronic insomnia; current mental status shows guarded behavior and minimal speech, and the client reports ongoing financial stress and access to leftover medications. Which action should the nurse take FIRST to ensure client safety during the home visit?
  17. A 22-year-old client with first-episode psychosis is in an inpatient psychiatric unit and has started aripiprazole; the plan includes daily reality-orientation and coping-skills coaching. The client looks toward the corner and says, "A man in the ceiling is telling me to run." How should the nurse respond to the client's statement?
  18. A 40-year-old client with tension-type headache reports pain rated 6/10, described as a tight band around the forehead and temples; the client has been working double shifts and states caffeine and screen time worsen symptoms. Which intervention is MOST appropriate given the client's pain type?
  19. A 77-year-old client with a chronic gastrostomy tube is receiving bolus feedings in a long-term care facility. The nurse notes the client has a weak cough and is positioned supine; gastric residual volume is 40 mL; lung sounds are clear. Which intervention should be implemented IMMEDIATELY to prevent aspiration?
  20. A 60-year-old client is on a telehealth follow-up after a stroke using a tablet. The client asks the nurse to record the session so the caregiver can watch later. Which action should the nurse take FIRST to ensure client privacy during the telehealth session?

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