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NCLEX-RN Vital signs 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

Vital signs 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.

Vital signs 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 30-year-old client admitted for observation after a motor vehicle collision has the following vital signs: heart rate 104/min, blood pressure 100/62 mm Hg, respiratory rate 22/min, oxygen saturation 97% on room air, and temperature 98.6°F (37.0°C). The client is alert and oriented, with no visible injuries. Which vital sign change should the nurse report to the provider as the earliest sign of potential hypovolemic shock?

  1. A Blood pressure of 100/62 mm Hg, which is at the lower end of the normal range.
  2. B Respiratory rate of 22/min, which is above the normal range of 12-20/min.
  3. C Heart rate of 104/min, which is above the normal resting range of 60-100/min.
  4. D Temperature of 98.6°F (37.0°C), which is within the normal range.
Show the answer and explanation

Correct answer: C

Tachycardia is the earliest compensatory sign of blood loss and often appears before blood pressure falls. After a collision, a heart rate of 104 should be reported because it may signal occult bleeding.

Why the other options are wrong:
A: Blood pressure usually stays normal until significant volume is lost, so it is a later sign.
B: A respiratory rate of 22 may reflect pain or anxiety and is less specific than tachycardia.
D: A normal temperature is not a sign of shock.

Question 3

A 58-year-old client returns from a laparoscopic cholecystectomy 2 hours ago. The nurse measures vital signs: blood pressure 88/54 mm Hg, heart rate 112 beats/min, respiratory rate 24 breaths/min, oxygen saturation 95% on room air, and temperature 37.1°C. The client reports mild incisional pain. What is the nurse's priority action?

  1. A Reposition the client onto the left side with legs elevated.
  2. B Document the findings as expected post-anesthesia effects.
  3. C Administer the prescribed intravenous opioid analgesic for pain.
  4. D Increase the rate of the intravenous lactated Ringer's infusion.
Show the answer and explanation

Correct answer: D

Hypotension and tachycardia 2 hours after surgery suggest hypovolemia from fluid loss or bleeding. Increasing the IV fluid rate, per prescription or protocol, supports perfusion while the nurse continues to assess and reports the findings.

Why the other options are wrong:
A: Repositioning may help briefly but does not correct the volume deficit.
B: These values are abnormal and need intervention, not documentation as expected anesthesia effects.
C: An opioid can lower the blood pressure further, and the client's pain is only mild.

Question 4

A 77-year-old client in the long-term care facility has a blood pressure of 88/56 mm Hg, heart rate 112 beats/min, respiratory rate 24 breaths/min, and temperature 38.9°C (102°F). The client's usual blood pressure is 130/70 mm Hg. Which finding should the nurse report to the healthcare provider first?

  1. A Heart rate of 112 beats/min
  2. B Blood pressure of 88/56 mm Hg
  3. C Temperature of 38.9°C (102°F)
  4. D Respiratory rate of 24 breaths/min
Show the answer and explanation

Correct answer: B

The blood pressure of 88/56 mm Hg represents a significant drop from the client's baseline of 130/70 mm Hg and indicates possible sepsis or hypovolemia, which requires immediate intervention. While the heart rate of 112 beats/min (first option) and respiratory rate of 24 breaths/min (second option) are abnormal, they are compensatory responses to the hypotension and fever. The temperature of 38.9°C (fourth option) is elevated and needs treatment, but the hypotensive blood pressure is the most life-threatening finding and should be reported first to prevent shock.

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