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NCLEX-RN Therapeutic procedures 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

Therapeutic procedures 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.

Therapeutic procedures sample questions

Question 1

A 72-year-old client in the medical-surgical unit has a chest tube connected to a water-seal drainage system. The nurse notes that the fluid in the water-seal chamber has stopped fluctuating and the client reports new-onset dyspnea with oxygen saturation of 89% on room air. Which action should the nurse take first?

  1. A Notify the healthcare provider of the change in the client's condition
  2. B Increase the supplemental oxygen to 4 L/min via nasal cannula
  3. C Assess the chest tube insertion site and tubing for kinks or disconnection
  4. D Milk the chest tube toward the drainage collection chamber to clear clots
Show the answer and explanation

Correct answer: C

Loss of tidaling with new dyspnea and hypoxemia suggests the drainage system is obstructed or disconnected. The nurse first checks the insertion site and tubing for kinks, clots or disconnection so the problem can be corrected right away.

Why the other options are wrong:
A: The provider should be informed, but a quick check of the system may reveal a correctable cause first.
B: Extra oxygen treats the symptom but not the blocked or disconnected system.
D: Milking or stripping the tubing can create dangerous negative pressure and is done only if prescribed after assessment.

Question 2

A 55-year-old client with chronic kidney disease is scheduled for an arteriovenous fistula placement in the left forearm. The nurse is providing preoperative teaching. Which statement by the client indicates a need for further teaching?

  1. A I will avoid having blood drawn from my left arm after the surgery
  2. B I can expect to hear a buzzing feeling over the fistula site soon after surgery
  3. C I will need to keep my left arm bent at the elbow for the first 24 hours
  4. D I should report any numbness or tingling in my left hand to the nurse
Show the answer and explanation

Correct answer: C

After fistula creation, the arm should stay extended and elevated to prevent kinking of the new access and to reduce swelling. Planning to keep the elbow bent shows a need for more teaching.

Why the other options are wrong:
A: Avoiding blood draws in the fistula arm is correct and protects the access.
B: A buzzing thrill and whooshing bruit are expected signs that the fistula is patent.
D: Numbness or tingling can signal ischemia or nerve injury and should be reported.

Question 3

A 38-year-old client with end-stage renal disease is scheduled for placement of an arteriovenous (AV) fistula in the left arm. Which nursing action is most appropriate to reduce the risk of complications during the preoperative period?

  1. A Administer an oral anticoagulant as prescribed the morning of surgery
  2. B Perform venipuncture and IV line insertion in the left arm for preoperative fluids
  3. C Apply a warm compress to the left arm for 20 minutes before surgery
  4. D Place the blood pressure cuff on the right arm for all preoperative measurements
Show the answer and explanation

Correct answer: D

The arm planned for an AV fistula must be protected from compression and vessel trauma. Taking all blood pressures on the right arm preserves the left arm's vessels for fistula creation and maturation.

Why the other options are wrong:
A: Anticoagulants are usually held before surgery to limit bleeding, so giving one the morning of surgery should be clarified, not done.
B: Venipuncture and IV lines in the planned fistula arm can damage the veins needed for the access.
C: Warm compresses are not part of preoperative preparation for fistula placement.

Question 4

A 55-year-old client with end-stage renal disease is scheduled for an arteriovenous fistula creation in the left forearm. Which nursing action is most appropriate during the preoperative preparation?

  1. A Administer a subcutaneous injection of heparin 5000 units as prescribed.
  2. B Apply a warm compress to the left forearm to dilate the veins before the procedure.
  3. C Avoid taking blood pressure or drawing blood from the left arm.
  4. D Place the client in a supine position with the left arm elevated on pillows.
Show the answer and explanation

Correct answer: C

The left forearm will hold the new fistula, so its vessels must be protected. Avoiding blood pressure measurements, venipuncture and IV lines in that arm preserves the veins and arteries needed for the access.

Why the other options are wrong:
A: Routine preoperative heparin is not standard for fistula creation and adds bleeding risk.
B: Warm compresses are not part of preoperative preparation for this procedure.
D: Elevating the arm is a postoperative measure to reduce swelling, not a preoperative one.

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