NCLEX-RN PRACTICE
QUESTIONS |NCLEX
QUESTIONS FOR RN EXAM
PREP & NURSING STUDENTS
• [Multiple choice | Safety / Physiological Integrity]
Scenario: A 72-year-old man is 2 hours post-op after
abdominal surgery. He has a PCA pump with
hydromorphone. He is difficult to arouse, respirations
are 7/min, SpO₂ is 84% on 2 L/min nasal cannula, and his
skin is dusky.
Stem: Which action should the nurse take first?
A. Encourage the client to cough and deep breathe
B. Increase the PCA dose for better pain control
C. Administer naloxone as prescribed
D. Reassess in 15 minutes
Correct: C
Rationale: Naloxone reverses opioid-induced
respiratory depression and addresses the most
immediate threat: inadequate ventilation. Coughing and
deep breathing are not enough for a client who is barely
, arousable, increasing the PCA would worsen the
problem, and waiting is unsafe.
• [Select all that apply | Infection control]
Scenario: A 54-year-old woman has watery diarrhea
and abdominal cramping. Her stool is positive for
Clostridioides difficile.
Stem: Which actions should the nurse take?
A. Perform hand hygiene with soap and water after care
B. Wear gown and gloves in the room
C. Use alcohol-based hand sanitizer before and after
care
D. Dedicate client-care equipment to this client
E. Place the client in a positive-pressure room
Correct: A, B, D
Rationale: Soap-and-water handwashing removes C.
difficile spores, contact precautions require gown and
gloves, and dedicated equipment reduces spread.
Alcohol sanitizer is not sufficient for spores, and
positive-pressure rooms are used for select airborne
precautions, not C. difficile.
• [Multiple choice | Reduction of risk potential]
Scenario: A 63-year-old man with chronic kidney
disease has a serum potassium of 6.9 mEq/L, muscle
weakness, and peaked T waves on ECG.
Stem: Which prescription should the nurse anticipate
implementing first?
, A. Sodium polystyrene sulfonate by mouth
B. IV calcium gluconate
C. Oral potassium chloride
D. Spironolactone
Correct: B
Rationale: IV calcium gluconate stabilizes the
myocardium and is the priority with dangerous ECG
changes from hyperkalemia. Sodium polystyrene
sulfonate works more slowly, potassium chloride would
worsen the problem, and spironolactone can increase
potassium.
• [Multiple choice | Pharmacology]
Scenario: A 28-year-old woman with type 1 diabetes
feels shaky and sweaty before lunch. Her bedside blood
glucose is 52 mg/dL. She is awake, alert, and able to
swallow.
Stem: Which action should the nurse take first?
A. Give 4 oz of orange juice
B. Administer long-acting insulin
C. Recheck the glucose in 1 hour
D. Hold all food until the provider is notified
Correct: A
Rationale: A fast-acting carbohydrate is the immediate
intervention for mild hypoglycemia in a client who can
swallow. Long-acting insulin would worsen
hypoglycemia, waiting is unsafe, and withholding food
does not correct the low glucose.
, • [Multiple choice | Management of care / Delegation]
Scenario: A charge nurse is assigned four clients. One
has new chest pain, one is receiving IV potassium, one is
2 days post-op and stable, and one is newly admitted
with shortness of breath. A licensed practical nurse and
an unlicensed assistive personnel (UAP) are available.
Stem: Which task is appropriate for the nurse to
delegate to the UAP?
A. Assess the client with new chest pain
B. Teach the client how to use an incentive spirometer
C. Ambulate the stable 2-day post-op client
D. Evaluate the IV potassium infusion site
Correct: C
Rationale: Ambulation of a stable client is an
appropriate UAP task. Assessment, teaching, and
evaluation require nursing judgment and must remain
with the RN.
• [Multiple choice | Physiological adaptation / Sepsis]
Scenario: A 79-year-old woman has pneumonia. Her
temperature is 39.3°C (102.7°F), HR 128/min, RR
28/min, BP 86/48 mmHg, and urine output has dropped
to 15 mL/hr.
Stem: Which action should the nurse take first?
A. Administer acetaminophen
B. Obtain a sputum specimen
C. Start the prescribed 0.9% normal saline bolus
D. Place the client on droplet precautions only
QUESTIONS |NCLEX
QUESTIONS FOR RN EXAM
PREP & NURSING STUDENTS
• [Multiple choice | Safety / Physiological Integrity]
Scenario: A 72-year-old man is 2 hours post-op after
abdominal surgery. He has a PCA pump with
hydromorphone. He is difficult to arouse, respirations
are 7/min, SpO₂ is 84% on 2 L/min nasal cannula, and his
skin is dusky.
Stem: Which action should the nurse take first?
A. Encourage the client to cough and deep breathe
B. Increase the PCA dose for better pain control
C. Administer naloxone as prescribed
D. Reassess in 15 minutes
Correct: C
Rationale: Naloxone reverses opioid-induced
respiratory depression and addresses the most
immediate threat: inadequate ventilation. Coughing and
deep breathing are not enough for a client who is barely
, arousable, increasing the PCA would worsen the
problem, and waiting is unsafe.
• [Select all that apply | Infection control]
Scenario: A 54-year-old woman has watery diarrhea
and abdominal cramping. Her stool is positive for
Clostridioides difficile.
Stem: Which actions should the nurse take?
A. Perform hand hygiene with soap and water after care
B. Wear gown and gloves in the room
C. Use alcohol-based hand sanitizer before and after
care
D. Dedicate client-care equipment to this client
E. Place the client in a positive-pressure room
Correct: A, B, D
Rationale: Soap-and-water handwashing removes C.
difficile spores, contact precautions require gown and
gloves, and dedicated equipment reduces spread.
Alcohol sanitizer is not sufficient for spores, and
positive-pressure rooms are used for select airborne
precautions, not C. difficile.
• [Multiple choice | Reduction of risk potential]
Scenario: A 63-year-old man with chronic kidney
disease has a serum potassium of 6.9 mEq/L, muscle
weakness, and peaked T waves on ECG.
Stem: Which prescription should the nurse anticipate
implementing first?
, A. Sodium polystyrene sulfonate by mouth
B. IV calcium gluconate
C. Oral potassium chloride
D. Spironolactone
Correct: B
Rationale: IV calcium gluconate stabilizes the
myocardium and is the priority with dangerous ECG
changes from hyperkalemia. Sodium polystyrene
sulfonate works more slowly, potassium chloride would
worsen the problem, and spironolactone can increase
potassium.
• [Multiple choice | Pharmacology]
Scenario: A 28-year-old woman with type 1 diabetes
feels shaky and sweaty before lunch. Her bedside blood
glucose is 52 mg/dL. She is awake, alert, and able to
swallow.
Stem: Which action should the nurse take first?
A. Give 4 oz of orange juice
B. Administer long-acting insulin
C. Recheck the glucose in 1 hour
D. Hold all food until the provider is notified
Correct: A
Rationale: A fast-acting carbohydrate is the immediate
intervention for mild hypoglycemia in a client who can
swallow. Long-acting insulin would worsen
hypoglycemia, waiting is unsafe, and withholding food
does not correct the low glucose.
, • [Multiple choice | Management of care / Delegation]
Scenario: A charge nurse is assigned four clients. One
has new chest pain, one is receiving IV potassium, one is
2 days post-op and stable, and one is newly admitted
with shortness of breath. A licensed practical nurse and
an unlicensed assistive personnel (UAP) are available.
Stem: Which task is appropriate for the nurse to
delegate to the UAP?
A. Assess the client with new chest pain
B. Teach the client how to use an incentive spirometer
C. Ambulate the stable 2-day post-op client
D. Evaluate the IV potassium infusion site
Correct: C
Rationale: Ambulation of a stable client is an
appropriate UAP task. Assessment, teaching, and
evaluation require nursing judgment and must remain
with the RN.
• [Multiple choice | Physiological adaptation / Sepsis]
Scenario: A 79-year-old woman has pneumonia. Her
temperature is 39.3°C (102.7°F), HR 128/min, RR
28/min, BP 86/48 mmHg, and urine output has dropped
to 15 mL/hr.
Stem: Which action should the nurse take first?
A. Administer acetaminophen
B. Obtain a sputum specimen
C. Start the prescribed 0.9% normal saline bolus
D. Place the client on droplet precautions only
