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NCLEX-RN Changes in condition practice questions

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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.

What this topic covers

Changes in condition sits inside the Reduction of Risk Potential category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Changes in condition sample questions

Question 1

A 50-year-old client with a history of cirrhosis is admitted with acute gastrointestinal bleeding. The nurse assesses the client and notes the following: heart rate 118 beats/min, blood pressure 90/56 mm Hg, respiratory rate 24 breaths/min, and oxygen saturation 94% on room air. The client reports feeling lightheaded. Which nursing action should the nurse perform first?

  1. A Obtain a STAT complete blood count and coagulation panel
  2. B Notify the healthcare provider of the vital signs and symptoms
  3. C Prepare the client for an urgent upper endoscopy
  4. D Administer a bolus of 0.9% sodium chloride 500 mL intravenously
Show the answer and explanation

Correct answer: D

Tachycardia, hypotension and lightheadedness show hypovolemic shock from active bleeding. Restoring intravascular volume with an isotonic bolus, per protocol or prescription, is the first priority to maintain organ perfusion.

Why the other options are wrong:
A: Blood counts and coagulation studies guide care but do not correct the hemodynamic instability.
B: The provider must be notified, but restoring circulating volume comes first in an unstable client.
C: Endoscopy is the definitive treatment, but the client must be resuscitated and stabilized first.

Question 2

A 34-year-old client with a history of asthma is admitted for an acute exacerbation. The nurse notes the client is using accessory muscles, has a respiratory rate of 30 breaths/min, oxygen saturation of 89% on 4 L nasal cannula, and peak expiratory flow rate is 40% of predicted. The client's breath sounds have wheezing in all fields. Which change in condition requires immediate action?

  1. A Peak expiratory flow rate increases to 55% of predicted.
  2. B Oxygen saturation improves to 94% on 2 L nasal cannula.
  3. C Respiratory rate decreases to 22 breaths/min after albuterol treatment.
  4. D Wheezing suddenly stops and breath sounds become inaudible.
Show the answer and explanation

Correct answer: D

A sudden loss of wheezing with inaudible breath sounds, a silent chest, means air movement has nearly stopped. It signals impending respiratory failure and requires immediate action.

Why the other options are wrong:
A: A rise in peak flow to 55% of predicted shows improving airflow.
B: Better saturation on less oxygen shows improving gas exchange.
C: A slower respiratory rate after albuterol indicates a positive response to treatment.

Question 3

A 45-year-old client is receiving a transfusion of packed red blood cells for severe anemia. Fifteen minutes after the transfusion begins, the client reports chills and low back pain. The nurse notes a temperature of 100.8°F (38.2°C), blood pressure 100/64 mm Hg, and heart rate 104 beats per minute. Which action should the nurse take first?

  1. A Administer acetaminophen 650 mg by mouth for the fever and chills
  2. B Notify the healthcare provider and document the client's response
  3. C Slow the transfusion rate to 50 mL/hr and continue to monitor
  4. D Stop the transfusion and keep the IV line open with 0.9% sodium chloride
Show the answer and explanation

Correct answer: D

Chills, fever, back pain and tachycardia early in a transfusion signal a possible hemolytic or febrile reaction. The nurse stops the transfusion immediately and keeps the IV open with 0.9% sodium chloride through new tubing.

Why the other options are wrong:
A: Acetaminophen treats the fever but lets the reaction continue.
B: The provider must be notified, but stopping the transfusion comes first.
C: Slowing the rate still infuses the blood causing the reaction.

Question 4

A 68-year-old client in the intensive care unit, 2 days after coronary artery bypass grafting, has a heart rate of 98/min, blood pressure 102/68 mm Hg, and central venous pressure 6 mm Hg. The nurse notes the client's urine output has decreased from 60 mL/hr to 15 mL/hr over the past 4 hours, and the client reports mild nausea. Which action should the nurse take first?

  1. A Check the serum potassium and blood urea nitrogen levels
  2. B Increase the intravenous fluid rate by 50 mL/hr
  3. C Notify the healthcare provider of the change in urine output
  4. D Administer metoclopramide 10 mg intravenously for nausea
Show the answer and explanation

Correct answer: C

A drop in urine output from 60 to 15 mL/hr after cardiac surgery may signal low cardiac output or acute kidney injury. The nurse should notify the provider promptly so the cause can be evaluated and treated.

Why the other options are wrong:
A: Laboratory tests may be needed, but checking them first delays reporting a significant change.
B: Changing the IV rate requires an order and could cause fluid overload in a client with heart disease.
D: Treating the nausea addresses a minor symptom while the more serious drop in urine output goes unreported.

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