NCLEX-RN Practice Test —
Question 1
A charge nurse is making shift assignments on a busy medical-surgical unit. Which client is
most appropriate to assign to an experienced Licensed Practical Nurse (LPN)?
A. A newly admitted client with diabetic ketoacidosis (DKA) requiring continuous IV regular
insulin titration.
B. A client with chronic obstructive pulmonary disease (COPD) who is stable and requires
scheduled oral bronchodilators and routine daily vital signs.
C. A client who experienced a sudden ischemic stroke 2 hours ago and is exhibiting fluctuating
neurological signs.
D. A client scheduled for discharge today who requires comprehensive initial education
regarding newly prescribed heart failure medications.
* Correct Answer: B
* Rationale: LPNs can care for stable clients with predictable outcomes and administer
scheduled oral medications. Unstable clients, titratable IV drips, new stroke evaluations, and
initial discharge teaching require the clinical judgment of an RN.
Question 2
A nurse is reviewing morning lab results for four adult clients. Which result requires the nurse's
immediate notification of the healthcare provider?
A. Serum potassium level of 3.4 mEq/L in a client receiving oral furosemide.
B. International Normalized Ratio (INR) of 4.8 in a client taking warfarin for atrial fibrillation.
C. Fasting blood glucose of 118 mg/dL in a client receiving total parenteral nutrition (TPN).
D. Serum creatinine level of 1.1 mg/dL in a client with a history of benign prostatic hyperplasia.
* Correct Answer: B
* Rationale: An INR of 4.8 is significantly above the therapeutic target range (2.0–3.0) for atrial
fibrillation, placing the client at high risk for major hemorrhage. Potassium of 3.4 mEq/L is mildly
low and expected with loop diuretics, while the other results are stable or normal.
Question 3
An emergency department nurse is triaging four clients. Which client requires the most rapid
medical and nursing intervention?
A. A 7-year-old child with a temperature of 39.2°C (102.5°F), barking cough, and clear lung
sounds.
B. A 50-year-old client with sudden right-sided facial drooping, slurred speech, and weakness
starting 45 minutes ago.
C. A 22-year-old college student with a localized second-degree thermal burn on the left
forearm from boiling water.
D. A 60-year-old client with chronic gout reporting severe throbbing pain and swelling in the right
great toe.
* Correct Answer: B
,* Rationale: Sudden focal neurological deficits starting 45 minutes ago indicate an acute
ischemic stroke within the strict window for life-saving thrombolytic therapy (alteplase/tPA). Time
is brain, making this a critical medical emergency.
Question 4
A nurse is supervising an Unlicensed Assistive Personnel (UAP) who is caring for a group of
clients. Which task can the nurse safely delegate to the UAP?
A. Feeding a stroke client who has a documented history of severe dysphagia and coughing
episodes.
B. Documenting the oral fluid intake and urine output volume for a client with acute
glomerulonephritis.
C. Assessing the surgical wound site for signs of early dehiscence in a client 2 days
post-appendectomy.
D. Providing discharge instructions regarding dietary sodium restrictions to a client with
new-onset heart failure.
* Correct Answer: B
* Rationale: Measuring, recording, and reporting routine input and output (I&O) volumes for
stable clients is a standard, repetitive, and safe task that can be delegated to a UAP.
Assessment, education, and feeding dysphagic clients require professional nursing clinical
judgment.
Question 5
A nurse receives report on four clients admitted to a mental health and medical unit. Which
client should the nurse assess first?
A. A client with major depressive disorder who is sitting quietly in bed, refusing to speak or eat
lunch.
B. A client with bipolar disorder experiencing an acute manic episode who has not slept in 48
hours and is pacing the hallway.
C. A client with schizophrenia who reports hearing command hallucinations telling them to strike
nearby staff members.
D. A client with generalized anxiety disorder who is pacing and expressing intense fear about
upcoming family visits.
* Correct Answer: C
* Rationale: Command hallucinations instructing harm toward others represent an immediate
safety threat to staff and patients on the unit, requiring urgent de-escalation, seclusion/restraint
protocols, and antipsychotic intervention.
Question 6
A nurse in a postpartum unit is caring for four clients. Which client finding requires the nurse's
immediate intervention?
A. A client 12 hours postpartum who reports moderate cramping and passes a small
walnut-sized blood clot.
B. A client 24 hours postpartum whose temperature is 37.8°C (100.0°F) and experiences
postpartum chills.
, C. A client 6 hours postpartum who has saturated two perineal pads within 30 minutes and has
a boggy uterus.
D. A client 18 hours postpartum who expresses sadness and cries intermittently when
discussing newborn care.
* Correct Answer: C
* Rationale: Saturating two pads in 30 minutes combined with a boggy (hypotonic) uterus
indicates acute postpartum hemorrhage (PPH) due to uterine atony. Immediate nursing action
(fundal massage, uterotonics) is required to prevent hemorrhagic shock.
Question 7
A nurse is preparing to administer medications to four adult clients. Which medication order
should the nurse question before administering?
A. Digoxin 0.25 mg oral daily for a client with heart failure.
B. Potassium chloride IV push undiluted for a client with severe hypokalemia (2.6 mEq/L).
C. Furosemide 40 mg IV push over 2 minutes for a client with fluid overload.
D. Levothyroxine 50 mcg PO daily for a client with hypothyroidism.
* Correct Answer: B
* Rationale: Potassium chloride must NEVER be administered via IV push, as direct bolus
administration causes rapid hyperkalemia leading to cardiac arrest and instant death. It must
always be diluted and infused slowly via an infusion pump.
Question 8
A nurse is caring for an adult client with a suspected diagnosis of bacterial meningitis. Which
nursing intervention should be performed first?
A. Administer the prescribed broad-spectrum IV antibiotics immediately.
B. Initiate strict droplet isolation precautions in a private room.
C. Assist the healthcare provider with performing a lumbar puncture.
D. Administer prescribed intravenous dexamethasone.
* Correct Answer: B
* Rationale: Infection control and preventing transmission to staff and other patients via
respiratory droplets is the immediate priority upon suspecting bacterial meningitis. Droplet
precautions must be set up prior to or simultaneously with entry into the room.
Question 9
A nurse is monitoring four clients receiving blood transfusions. Which client requires the
immediate discontinuation of the blood transfusion?
A. A client receiving packed red blood cells (PRBCs) who develops a mild temperature elevation
from 37.0°C to 37.5°C with no other symptoms.
B. A client receiving PRBCs who reports low back pain, chills, and anxiety within 10 minutes of
starting the infusion.
C. A client receiving platelets who has mild urticaria (hives) on the trunk, which resolves after
receiving diphenhydramine.
D. A client receiving fresh frozen plasma who reports minor fatigue and mild discomfort at the IV
insertion site.
Question 1
A charge nurse is making shift assignments on a busy medical-surgical unit. Which client is
most appropriate to assign to an experienced Licensed Practical Nurse (LPN)?
A. A newly admitted client with diabetic ketoacidosis (DKA) requiring continuous IV regular
insulin titration.
B. A client with chronic obstructive pulmonary disease (COPD) who is stable and requires
scheduled oral bronchodilators and routine daily vital signs.
C. A client who experienced a sudden ischemic stroke 2 hours ago and is exhibiting fluctuating
neurological signs.
D. A client scheduled for discharge today who requires comprehensive initial education
regarding newly prescribed heart failure medications.
* Correct Answer: B
* Rationale: LPNs can care for stable clients with predictable outcomes and administer
scheduled oral medications. Unstable clients, titratable IV drips, new stroke evaluations, and
initial discharge teaching require the clinical judgment of an RN.
Question 2
A nurse is reviewing morning lab results for four adult clients. Which result requires the nurse's
immediate notification of the healthcare provider?
A. Serum potassium level of 3.4 mEq/L in a client receiving oral furosemide.
B. International Normalized Ratio (INR) of 4.8 in a client taking warfarin for atrial fibrillation.
C. Fasting blood glucose of 118 mg/dL in a client receiving total parenteral nutrition (TPN).
D. Serum creatinine level of 1.1 mg/dL in a client with a history of benign prostatic hyperplasia.
* Correct Answer: B
* Rationale: An INR of 4.8 is significantly above the therapeutic target range (2.0–3.0) for atrial
fibrillation, placing the client at high risk for major hemorrhage. Potassium of 3.4 mEq/L is mildly
low and expected with loop diuretics, while the other results are stable or normal.
Question 3
An emergency department nurse is triaging four clients. Which client requires the most rapid
medical and nursing intervention?
A. A 7-year-old child with a temperature of 39.2°C (102.5°F), barking cough, and clear lung
sounds.
B. A 50-year-old client with sudden right-sided facial drooping, slurred speech, and weakness
starting 45 minutes ago.
C. A 22-year-old college student with a localized second-degree thermal burn on the left
forearm from boiling water.
D. A 60-year-old client with chronic gout reporting severe throbbing pain and swelling in the right
great toe.
* Correct Answer: B
,* Rationale: Sudden focal neurological deficits starting 45 minutes ago indicate an acute
ischemic stroke within the strict window for life-saving thrombolytic therapy (alteplase/tPA). Time
is brain, making this a critical medical emergency.
Question 4
A nurse is supervising an Unlicensed Assistive Personnel (UAP) who is caring for a group of
clients. Which task can the nurse safely delegate to the UAP?
A. Feeding a stroke client who has a documented history of severe dysphagia and coughing
episodes.
B. Documenting the oral fluid intake and urine output volume for a client with acute
glomerulonephritis.
C. Assessing the surgical wound site for signs of early dehiscence in a client 2 days
post-appendectomy.
D. Providing discharge instructions regarding dietary sodium restrictions to a client with
new-onset heart failure.
* Correct Answer: B
* Rationale: Measuring, recording, and reporting routine input and output (I&O) volumes for
stable clients is a standard, repetitive, and safe task that can be delegated to a UAP.
Assessment, education, and feeding dysphagic clients require professional nursing clinical
judgment.
Question 5
A nurse receives report on four clients admitted to a mental health and medical unit. Which
client should the nurse assess first?
A. A client with major depressive disorder who is sitting quietly in bed, refusing to speak or eat
lunch.
B. A client with bipolar disorder experiencing an acute manic episode who has not slept in 48
hours and is pacing the hallway.
C. A client with schizophrenia who reports hearing command hallucinations telling them to strike
nearby staff members.
D. A client with generalized anxiety disorder who is pacing and expressing intense fear about
upcoming family visits.
* Correct Answer: C
* Rationale: Command hallucinations instructing harm toward others represent an immediate
safety threat to staff and patients on the unit, requiring urgent de-escalation, seclusion/restraint
protocols, and antipsychotic intervention.
Question 6
A nurse in a postpartum unit is caring for four clients. Which client finding requires the nurse's
immediate intervention?
A. A client 12 hours postpartum who reports moderate cramping and passes a small
walnut-sized blood clot.
B. A client 24 hours postpartum whose temperature is 37.8°C (100.0°F) and experiences
postpartum chills.
, C. A client 6 hours postpartum who has saturated two perineal pads within 30 minutes and has
a boggy uterus.
D. A client 18 hours postpartum who expresses sadness and cries intermittently when
discussing newborn care.
* Correct Answer: C
* Rationale: Saturating two pads in 30 minutes combined with a boggy (hypotonic) uterus
indicates acute postpartum hemorrhage (PPH) due to uterine atony. Immediate nursing action
(fundal massage, uterotonics) is required to prevent hemorrhagic shock.
Question 7
A nurse is preparing to administer medications to four adult clients. Which medication order
should the nurse question before administering?
A. Digoxin 0.25 mg oral daily for a client with heart failure.
B. Potassium chloride IV push undiluted for a client with severe hypokalemia (2.6 mEq/L).
C. Furosemide 40 mg IV push over 2 minutes for a client with fluid overload.
D. Levothyroxine 50 mcg PO daily for a client with hypothyroidism.
* Correct Answer: B
* Rationale: Potassium chloride must NEVER be administered via IV push, as direct bolus
administration causes rapid hyperkalemia leading to cardiac arrest and instant death. It must
always be diluted and infused slowly via an infusion pump.
Question 8
A nurse is caring for an adult client with a suspected diagnosis of bacterial meningitis. Which
nursing intervention should be performed first?
A. Administer the prescribed broad-spectrum IV antibiotics immediately.
B. Initiate strict droplet isolation precautions in a private room.
C. Assist the healthcare provider with performing a lumbar puncture.
D. Administer prescribed intravenous dexamethasone.
* Correct Answer: B
* Rationale: Infection control and preventing transmission to staff and other patients via
respiratory droplets is the immediate priority upon suspecting bacterial meningitis. Droplet
precautions must be set up prior to or simultaneously with entry into the room.
Question 9
A nurse is monitoring four clients receiving blood transfusions. Which client requires the
immediate discontinuation of the blood transfusion?
A. A client receiving packed red blood cells (PRBCs) who develops a mild temperature elevation
from 37.0°C to 37.5°C with no other symptoms.
B. A client receiving PRBCs who reports low back pain, chills, and anxiety within 10 minutes of
starting the infusion.
C. A client receiving platelets who has mild urticaria (hives) on the trunk, which resolves after
receiving diphenhydramine.
D. A client receiving fresh frozen plasma who reports minor fatigue and mild discomfort at the IV
insertion site.
