NCLEX-RN practice quiz

Question 1

A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse is reviewing the medication administration record. Which laboratory value should the nurse monitor most closely?

Accepted Answer

International normalized ratio (INR)

Answer

Serum potassium level, which reflects how the drug affects the heart rhythm

Answer

White blood cell count

Answer

Activated partial thromboplastin time (aPTT), which is used to monitor heparin therapy

Question 2

A nurse is caring for a client with a central venous catheter. Which intervention is the MOST effective in preventing catheter-related bloodstream infections?

Accepted Answer

Performing hand hygiene before and after accessing the line

Answer

Administering prophylactic antibiotics daily

Answer

Changing the central line dressing every two hours using clean gloves and tape

Answer

Using antibiotic ointment around the insertion site

Question 3

A charge nurse observes that a newly licensed nurse is administering medications without scanning the barcode on the client's wristband. What is the best initial action?

Accepted Answer

Provide immediate feedback and demonstrate proper scanning technique

Answer

File an incident report immediately

Answer

Notify the nurse manager right away

Answer

Document the error in the client's medical record

Question 4

A community health nurse is planning a smoking cessation program. According to the Health Promotion model, which action should the nurse take FIRST?

Accepted Answer

Conduct a needs assessment to identify barriers to quitting

Answer

Distribute educational pamphlets to all community members

Answer

Set up a quit line for immediate support

Answer

Partner with local pharmacies to offer nicotine replacement

Question 5

A postoperative client reports severe pain rated 9 out of 10. The client has a physician order for morphine 2 mg IV every 4 hours as needed. What should the nurse do FIRST?

Accepted Answer

Administer the morphine and document the pain rating

Answer

Attempt non-pharmacological interventions before medication

Answer

Reassess the client after administering the medication

Answer

Request an increase in the morphine dosage from the physician

Question 6

A client who recently experienced a sexual assault tells the nurse, I feel like it was my fault. What is the nurse's best response?

Accepted Answer

It was not your fault. What happened was a crime against you

Answer

You should talk to a therapist about these feelings

Answer

I understand how you feel, but many survivors blame themselves at first

Answer

Many survivors feel that way, but you should try to move on

Question 7

The nurse is caring for four clients. Which client should the nurse assess FIRST?

Accepted Answer

Client post-thyroidectomy who reports tingling around the mouth

Answer

Client with type 2 diabetes who has a blood glucose level of 180 mg/dL

Answer

Client with a chest tube who has a small amount of serous drainage in the chamber

Answer

Client who is scheduled for discharge and needs teaching about a new medication

Question 8

A client with heart failure is prescribed digoxin. The nurse notes a heart rate of 58 beats per minute. What is the priority nursing action?

Accepted Answer

Hold the medication and contact the provider

Answer

Request an alternative medication from the provider

Answer

Administer the digoxin as ordered

Answer

Administer the digoxin and monitor for toxicity

Question 9

A nurse is caring for a client with Clostridioides difficile. Which precaution should the nurse implement?

Accepted Answer

Contact precautions

Answer

Droplet precautions

Answer

Protective isolation

Answer

Airborne precautions

Question 10

A nurse manager receives a call from a family member complaining about the quality of care. The family member is upset and raising their voice. What is the best initial response?

Accepted Answer

Listen actively, acknowledge the concern, and gather facts

Answer

Explain hospital policy regarding visitor behavior

Answer

Transfer the call to the hospital administrator immediately

Answer

Tell the family member to calm down or leave the unit

Question 11

A client is prescribed metformin for type 2 diabetes. The nurse should monitor which laboratory value most closely?

Accepted Answer

Serum creatinine

Answer

Thyroid-stimulating hormone

Answer

Serum potassium

Answer

HbA1c

Question 12

A client with a nasogastric tube is receiving enteral feedings. The nurse notes that the client has a distended abdomen and reports cramping. What is the priority action?

Accepted Answer

Check for residual volume and slow the feeding rate

Answer

Elevate the head of the bed 30 to 45 degrees

Answer

Flush the tube with cold water and continue the feeding at the same rate

Answer

Increase the rate of the feeding to move the formula through the intestine faster

Question 13

A pregnant client at 28 weeks gestation asks the nurse about warning signs she should report immediately. Which symptom should the nurse instruct the client to report FIRST?

Accepted Answer

Decreased fetal movement

Answer

Mild lower back pain

Answer

Difficulty sleeping on her side

Answer

Mild ankle edema at the end of the day

Question 14

A client with major depressive disorder tells the nurse, I have nothing left to live for. What is the nurse's priority response?

Accepted Answer

Ask directly if the client is thinking about suicide

Answer

Encourage the client to focus on positive experiences

Answer

Notify the provider to increase the antidepressant dose

Answer

Reassure the client that things will get better

Question 15

A nurse is preparing to receive shift report on four clients. Which client should the nurse see FIRST after receiving report?

Accepted Answer

Client who just returned from surgery with a blood pressure of 88/54 mmHg

Answer

Client who is two days postoperative and is ambulating in the hallway independently

Answer

Client with a leg cast who reports mild itching around the edges of the cast

Answer

Client with a urinary tract infection who reports burning on urination

Question 16

A client is prescribed lisinopril for hypertension. Which adverse effect should the nurse teach the client to report immediately?

Accepted Answer

Swelling of the lips or tongue

Answer

Dizziness when standing

Answer

Dry cough

Answer

Increased sensitivity to sunlight

Question 17

A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. The nurse observes a sudden increase in blood pressure and a pounding headache. What should the nurse do FIRST?

Accepted Answer

Sit the client upright and check for bladder or bowel distention

Answer

Notify the physician immediately

Answer

Administer prescribed antihypertensive medication

Answer

Apply a cold compress to the forehead

Question 18

A nurse is caring for a client with active tuberculosis. Which statement by the client indicates understanding of discharge teaching?

Accepted Answer

I will cover my mouth when I cough and complete the full course of treatment

Answer

I can return to work as soon as the first sputum culture is reported as negative

Answer

I should keep my windows closed and avoid all contact with family members for a year

Answer

I can stop taking my medicine once my cough has gone away and I feel better

Question 19

A registered nurse is delegating tasks to an unlicensed assistive personnel. Which task is appropriate to delegate?

Accepted Answer

Ambulating a stable postoperative client

Answer

Administering a prescribed medication

Answer

Teaching a client how to inject insulin

Answer

Assessing a wound for signs of infection

Question 20

A nurse is preparing to float to a medical-surgical unit. The nurse has not worked on that unit before. What is the BEST action?

Accepted Answer

Request an orientation to the unit, medications, and emergency equipment before accepting the assignment

Answer

Ask a coworker to complete the documentation so you can focus on the clients

Answer

Refuse the assignment since the unit is unfamiliar and could be unsafe for clients

Answer

Accept the assignment and learn the unit's routines while caring for the clients