12,241 verified 4-option questions Double-checked by independent solution

NCLEX-RN practice questions with explanations

12 questions · answers open · no sign-up

These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

Practice by category

Management of Care 486 in the bank Pharmacological and Parenteral Therapies 421 in the bank Safety and Infection Control 350 in the bank Physiological Adaptation 328 in the bank Reduction of Risk Potential 311 in the bank Basic Care and Comfort 279 in the bank Health Promotion and Maintenance 251 in the bank Psychosocial Integrity 240 in the bank

Mixed sample questions

Question 1

A 72-year-old client is admitted to the telemetry unit with a diagnosis of dehydration. The nurse obtains vital signs: blood pressure 100/58 mm Hg, heart rate 108 beats/min, respiratory rate 22 breaths/min, temperature 37.1°C (98.8°F), and oxygen saturation 96% on room air. Which vital sign finding is most concerning and requires immediate intervention?

  1. A Heart rate 108 beats/min
  2. B Respiratory rate 22 breaths/min
  3. C Blood pressure 100/58 mm Hg
  4. D Oxygen saturation 96% on room air
Show the answer and explanation

Correct answer: A

A heart rate of 108 is the most abnormal value and reflects compensation for reduced circulating volume. It signals the need for prompt fluid replacement before the blood pressure falls further.

Why the other options are wrong:
B: A respiratory rate of 22 is only mildly elevated and is not the most urgent finding.
C: A blood pressure of 100/58 is low-normal but not yet hypotensive, so it needs close monitoring rather than being the primary concern.
D: An oxygen saturation of 96% on room air is normal.

Question 2

A 68-year-old client with a recent right hip replacement is 2 days postoperative. The nurse observes the client attempting to get out of bed independently by twisting the right leg toward the floor. Which action should the nurse take first?

  1. A Assist the client back into bed and reinforce the need to use the trapeze bar for repositioning.
  2. B Call the charge nurse to report the client's noncompliance with postoperative hip precautions.
  3. C Place a pillow between the client's legs before allowing the client to stand to prevent dislocation.
  4. D Apply an abduction pillow and instruct the client to logroll to the side of the bed before standing.
Show the answer and explanation

Correct answer: A

Twisting the operative leg while getting up risks hip dislocation and a fall. The nurse's first action is to stop the movement and help the client back into a safe position, then reinforce hip precautions and the use of the trapeze for repositioning.

Why the other options are wrong:
B: Calling the charge nurse delays the immediate action needed to protect the client.
C: A pillow does not correct the twisting motion already under way, and letting the client stand now remains unsafe.
D: Abduction devices and safe transfer technique come after the client is stopped and returned to a safe position.

Question 3

A 28-year-old client with acute asthma exacerbation is receiving a continuous albuterol nebulizer treatment. The client's respiratory rate is 38 breaths/min, SpO2 89% on 4 L oxygen via nasal cannula, and peak expiratory flow rate is 30% of predicted. Which intervention should the nurse anticipate next?

  1. A Discontinue the nebulizer and administer intravenous aminophylline.
  2. B Prepare for noninvasive positive pressure ventilation.
  3. C Switch to a metered-dose inhaler with a spacer.
  4. D Apply a non-rebreather mask at 15 L/min.
Show the answer and explanation

Correct answer: D

Despite continuous albuterol, the client remains hypoxemic with an SpO2 of 89%, a respiratory rate of 38, and a peak flow of 30% of predicted. Correcting hypoxemia is the immediate need, so the nurse should anticipate higher-concentration oxygen by non-rebreather mask while other asthma treatment continues.

Why the other options are wrong:
A: Aminophylline is not recommended for acute asthma because of poor efficacy and toxicity, and stopping albuterol removes effective therapy.
B: Noninvasive ventilation is not a routine step in asthma; a client who tires despite treatment is prepared for intubation.
C: A client this breathless cannot use an inhaler effectively, and switching would reduce bronchodilator delivery.

Question 4

A nurse in the emergency department is caring for a 34-year-old client who was exposed to an unknown chemical powder on the skin and clothing during a workplace accident. The client is alert, with heart rate 112/min, respiratory rate 24/min, and blood pressure 138/86 mm Hg. Which action should the nurse take first?

  1. A Administer supplemental oxygen via non-rebreather mask at 15 L/min
  2. B Apply a surgical mask to the client to prevent inhalation
  3. C Remove the client's contaminated clothing and rinse skin with water
  4. D Call the poison control center for decontamination instructions
Show the answer and explanation

Correct answer: C

For chemical exposure on skin and clothing, immediate removal of contaminants and flushing with water is the priority to reduce absorption and injury. Applying a surgical mask (the option "Apply a surgical mask to the client to prevent inhalation" does not address skin exposure and may not protect against chemical vapors. Calling poison control (the option "Call the poison control center for decontamination instructions" is important but should not delay decontamination. Administering oxygen (the option "Administer supplemental oxygen via non-rebreather mask at 15 L/min" may be needed later but does not remove the chemical from the skin.

Question 5

A 34-year-old client with a history of bipolar disorder is admitted to the psychiatric unit after a manic episode. The client becomes agitated, clenches fists, and states, "I am going to hurt someone if you don't let me leave." Which action should the nurse take first?

  1. A Administer a prescribed intramuscular antipsychotic as needed.
  2. B Maintain a calm demeanor and offer the client a choice to sit quietly.
  3. C Call security to escort the client to a seclusion room.
  4. D Place the client in four-point restraints for safety of staff and others.
Show the answer and explanation

Correct answer: B

Verbal de-escalation is the least restrictive first step. A calm approach and offering the client a choice gives a sense of control and can defuse the threat before more restrictive measures are needed.

Why the other options are wrong:
A: Medication is considered if verbal de-escalation fails.
C: Seclusion is restrictive and can escalate agitation if used before de-escalation.
D: Restraints are a last resort when less restrictive measures fail and harm is imminent.

Question 6

A charge nurse on a medical-surgical unit is making client assignments for the day shift and must assign one client to a licensed practical nurse (LPN) working under RN supervision. Which client is most appropriate for this assignment?

  1. A A 74-year-old client newly admitted with chest pain who requires an admission history and physical.
  2. B A 68-year-old client with a stable colostomy who needs a pouch change and abdominal assessment.
  3. C A 45-year-old client receiving a first unit of packed red blood cells for symptomatic anemia.
  4. D A 52-year-old client who is 2 hours postoperative from bowel resection and needs first ambulation.
Show the answer and explanation

Correct answer: B

A stable client with an established colostomy has a predictable course, and the pouch change with focused data collection fits within LPN practice under RN supervision.

Why the other options are wrong:
A: A new admission with chest pain needs RN assessment and close monitoring for a cardiac event.
C: A first unit of blood requires RN monitoring for transfusion reactions.
D: A client only 2 hours after bowel resection is not yet stable, and first ambulation requires RN assessment.

Question 7

A 58-year-old client in the intensive care unit is receiving a continuous intravenous infusion of unfractionated heparin for a deep vein thrombosis. The current aPTT is 95 seconds; the prescribed therapeutic range is 60 to 80 seconds. The nurse's priority action is to:

  1. A Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours.
  2. B Stop the heparin infusion immediately and notify the healthcare provider of the aPTT value.
  3. C Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose.
  4. D Continue the infusion at the current rate and document the aPTT result in the electronic record.
Show the answer and explanation

Correct answer: B

The correct answer is to stop the heparin infusion immediately and notify the healthcare provider because the aPTT of 95 seconds is above the therapeutic range, placing the client at high risk for bleeding. The nurse must hold the infusion to prevent hemorrhage and then obtain further orders. Decreasing the infusion rate (the option "Decrease the heparin infusion rate by 2 mL/hr and recheck the aPTT in 6 hours." may be considered after notification, but immediate discontinuation is the safest first step. Administering protamine sulfate (the option "Administer protamine sulfate 25 mg intravenously over 10 minutes as a stat dose." is reserved for reversal of heparin in life-threatening bleeding, not for a supratherapeutic aPTT without signs of bleeding. Continuing the infusion (the option "Continue the infusion at the current rate and document the aPTT result in the electronic r..." ignores the elevated aPTT and exposes the client to unnecessary bleeding risk.

Question 8

A 58-year-old client with type 1 diabetes mellitus is admitted with nausea, vomiting, and abdominal pain. Blood glucose is 420 mg/dL, serum potassium is 5.8 mEq/L, and arterial pH is 7.18. The nurse administers intravenous fluids and an insulin drip as prescribed. Which laboratory value requires the nurse's immediate reassessment after starting the insulin infusion?

  1. A Serum potassium level
  2. B White blood cell count
  3. C Hemoglobin A1c level
  4. D Serum creatinine level
Show the answer and explanation

Correct answer: A

Insulin drives potassium into the cells, so the initial hyperkalemia of diabetic ketoacidosis can quickly turn into hypokalemia once the insulin infusion starts. Close potassium monitoring is essential to prevent life-threatening dysrhythmias and to guide potassium replacement.

Why the other options are wrong:
B: The white blood cell count may be elevated from stress or infection, but it is not changed by the insulin infusion.
C: Hemoglobin A1c reflects average glucose over about 3 months and has no role in acute DKA management.
D: Creatinine reflects kidney function and should be monitored, but it does not shift rapidly with insulin the way potassium does.

Question 9

A quality improvement team on a medical-surgical unit reviews data showing that 12% of clients with indwelling urinary catheters develop a catheter-associated urinary tract infection (CAUTI) within 72 hours. The team implements a new protocol requiring daily nurse assessment of catheter necessity and removal of catheters that are no longer indicated. Which outcome measure best indicates that this intervention is effective?

  1. A A reduction in the CAUTI rate to 4% over the next 3 months.
  2. B A higher rate of client satisfaction scores on nursing communication.
  3. C An increase in the number of catheter kits ordered by the unit each month.
  4. D A decrease in the average length of stay for all hospitalized clients.
Show the answer and explanation

Correct answer: A

The protocol targets catheter-associated urinary tract infections, so the most direct outcome measure is the CAUTI rate itself. A fall from 12% to 4% shows the intervention is working.

Why the other options are wrong:
B: Satisfaction with nursing communication does not measure infection rates.
C: More catheter kits ordered suggests more catheter use, the opposite of the protocol's goal.
D: Length of stay for all clients depends on many factors and is not specific to CAUTI prevention.

Question 10

A 45-year-old client is admitted to the medical-surgical unit with acute pancreatitis. The nurse notes severe epigastric pain radiating to the back, nausea, and vomiting. Vital signs: temperature 38.5°C, heart rate 110 bpm, blood pressure 90/60 mm Hg, respiratory rate 22 breaths/min. Which laboratory value is most consistent with this condition?

  1. A Serum amylase 800 U/L
  2. B Blood urea nitrogen 12 mg/dL
  3. C Serum glucose 90 mg/dL
  4. D Serum bilirubin 0.8 mg/dL
Show the answer and explanation

Correct answer: A

Acute pancreatitis releases pancreatic enzymes into the bloodstream. A serum amylase of 800 U/L is several times the upper limit of normal and, with severe epigastric pain radiating to the back, is the finding most consistent with this condition.

Why the other options are wrong:
B: A BUN of 12 mg/dL is normal and does not suggest pancreatitis.
C: A glucose of 90 mg/dL is normal; pancreatitis more often raises glucose.
D: A bilirubin of 0.8 mg/dL is normal and does not support the diagnosis.

Question 11

A 34-year-old female client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis. The nurse initiates an intravenous insulin infusion at 0.1 units/kg/hr per protocol. The client's blood glucose is 520 mg/dL. One hour later, the blood glucose is 490 mg/dL. Which action should the nurse take?

  1. A Increase the insulin infusion to 0.14 units/kg/hr and recheck the blood glucose in 1 hour.
  2. B Continue the current infusion rate and monitor the blood glucose level every 2 hours.
  3. C Administer a 10-unit intravenous bolus of regular insulin and continue the current infusion.
  4. D Decrease the insulin infusion to 0.05 units/kg/hr to prevent hypoglycemia and recheck in 2 hours.
Show the answer and explanation

Correct answer: A

In DKA, glucose should fall about 50 to 75 mg/dL per hour. A drop of only 30 mg/dL in the first hour is inadequate, so the infusion is titrated upward per protocol and glucose is rechecked hourly.

Why the other options are wrong:
B: Keeping the same rate ignores an inadequate response, and checks every 2 hours are too infrequent during an insulin infusion.
C: A fixed 10-unit bolus is not weight-based and is not the protocol's titration step; it would need a separate prescription.
D: Decreasing the rate would slow glucose and ketone correction further when the response is already too slow.

Question 12

A 58-year-old client post-abdominal surgery has a surgical wound with a closed drainage system. On day 3, the nurse observes that the wound drainage has changed from serosanguineous to purulent, and the client’s temperature is 38.6°C (101.5°F). The wound edges are red and edematous. Which action should the nurse take first?

  1. A Notify the healthcare provider of the change in wound status
  2. B Remove the drainage system and apply a dry sterile dressing
  3. C Irrigate the wound with sterile normal saline and pack it
  4. D Obtain a wound culture and then apply a sterile dressing
Show the answer and explanation

Correct answer: A

Purulent drainage, fever of 38.6°C, and red, swollen wound edges on day 3 indicate a surgical site infection. The provider must be notified promptly to evaluate the wound and order cultures and antibiotics.

Why the other options are wrong:
B: Removing a surgical drain requires a provider order and does not treat the infection.
C: Irrigating and packing the wound requires an order and should follow the provider's evaluation.
D: A culture is usually needed, but it requires an order, and notifying the provider of the infection comes first.

The whole NCLEX-RN bank

2,666 verified questions with explanations, timed category tests and an 85-item full-length practice test, a review pool that brings back what you missed until you get it right, and an AI tutor that explains why. One payment per exam, or one bundle for all of them.

NCLEX-RN practice opens soon: 2,666 questions verified so far. Purchase opens automatically when the bank is complete. About the NCLEX-RN

Related pages

Management of Care questions with explanations Pharmacological and Parenteral Therapies questions with explanations Safety and Infection Control questions with explanations TEAS 7 sample questions with explanations HESI A2 sample questions with explanations

TEAS is a registered trademark of Assessment Technologies Institute, LLC; HESI is a registered trademark of Elsevier Inc. NCLEX and NCLEX-RN are registered trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN). AdmitNurse is an independent practice service, not affiliated with or endorsed by any of these organizations.