NCLEX-RN Form 178 Exam With Actual
120 Questions & Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
NCLEX-RN Form 178 Exam – Practice Test
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment is most important before giving the medication?
a. Respiratory rate
b. Blood pressure
c. Apical pulse
d. Oxygen saturation
Rationale: Digoxin can cause bradycardia. The nurse must assess the apical pulse for
a full minute and withhold the drug if it is below 60 beats/min.
2. A client with type 1 diabetes is found unconscious. Which intervention should the
nurse implement first?
a. Call the healthcare provider
b. Administer glucagon
c. Start IV fluids
d. Recheck blood glucose in 15 minutes
Rationale: An unconscious diabetic client likely has severe hypoglycemia. Immediate
administration of glucagon or IV dextrose is life-saving.
3. The nurse is caring for a patient receiving a blood transfusion. The patient develops
chills, fever, and low back pain. What should the nurse do first?
a. Notify the provider
b. Stop the transfusion
c. Administer acetaminophen
d. Monitor vital signs
, Rationale: These are signs of a hemolytic transfusion reaction. The transfusion should
be stopped immediately to prevent further complications.
4. A nurse teaches a client prescribed warfarin about dietary restrictions. Which food
should the client avoid?
a. Apples
b. Milk
c. Spinach
d. Bananas
Rationale: Spinach is high in vitamin K, which can reduce the effectiveness of
warfarin therapy.
5. Which finding requires immediate intervention in a client receiving IV furosemide?
a. Weight loss of 2 pounds in 24 hours
b. Potassium level of 2.8 mEq/L
c. Increased urine output
d. Mild dizziness on standing
Rationale: A potassium level of 2.8 mEq/L indicates severe hypokalemia, which can
lead to life-threatening arrhythmias.
6. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The nurse’s
priority action is to:
a. Encourage coughing and deep breathing
b. Reduce oxygen flow rate
c. Position the client supine
d. Increase fluids
Rationale: Clients with COPD rely on hypoxic drive. High oxygen flow may suppress
their drive to breathe, so oxygen should be kept at 1–2 L/min.
7. A nurse is preparing to insert an indwelling urinary catheter for a female patient.
Which action is correct?
a. Inflate the balloon before insertion
b. Position the client supine with arms above head
c. Clean the perineal area with sterile solution before insertion
d. Insert the catheter without lubrication
Rationale: Cleaning the perineal area with sterile solution reduces infection risk.
Sterile and lubricated insertion is essential.
8. Which client should the nurse see first after receiving report?
a. Post-op patient requesting pain medication
b. Patient with asthma who is wheezing and has labored breathing
c. Patient scheduled for dressing change
d. Patient asking about discharge instructions
, Rationale: Airway and breathing issues are always the highest priority. The asthmatic
client is at risk for respiratory failure.
9. A nurse cares for a client with a chest tube. Which finding requires immediate
action?
a. 50 mL of drainage in one hour
b. Continuous bubbling in the water-seal chamber
c. Fluctuations with respiration in the water-seal chamber
d. Dressing intact at the insertion site
Rationale: Continuous bubbling indicates an air leak, which must be addressed
immediately.
10. A client with schizophrenia says, “The government has inserted a chip in my brain.”
The nurse’s best response is:
a. “You should not say things that are not true.”
b. “I understand that you believe this. Can you tell me more about your thoughts?”
c. “The government does not put chips in people’s brains.”
d. “That’s not possible, let’s talk about something else.”
Rationale: The best approach is to acknowledge the client’s feelings without
reinforcing delusions and encourage discussion.
11. A nurse is caring for a client receiving total parenteral nutrition (TPN). Which finding
requires immediate action?
a. Mild nausea
b. Fever and chills
c. Slight hyperglycemia
d. Slight weight gain
Rationale: Fever and chills may indicate a catheter-related infection or sepsis, which
requires immediate intervention.
12. A client with a history of myocardial infarction reports chest pain rated 8/10. Which
action should the nurse take first?
a. Apply oxygen
b. Assess vital signs and administer nitroglycerin
c. Notify the provider
d. Obtain an ECG
Rationale: Chest pain in a post-MI client could indicate reinfarction. Prompt
assessment and nitroglycerin administration are priorities.
13. A nurse is teaching a client with asthma about using a metered-dose inhaler (MDI).
Which instruction is correct?
a. Shake the inhaler for 10 seconds before use
b. Exhale fully, then inhale slowly while pressing the inhaler
120 Questions & Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
NCLEX-RN Form 178 Exam – Practice Test
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment is most important before giving the medication?
a. Respiratory rate
b. Blood pressure
c. Apical pulse
d. Oxygen saturation
Rationale: Digoxin can cause bradycardia. The nurse must assess the apical pulse for
a full minute and withhold the drug if it is below 60 beats/min.
2. A client with type 1 diabetes is found unconscious. Which intervention should the
nurse implement first?
a. Call the healthcare provider
b. Administer glucagon
c. Start IV fluids
d. Recheck blood glucose in 15 minutes
Rationale: An unconscious diabetic client likely has severe hypoglycemia. Immediate
administration of glucagon or IV dextrose is life-saving.
3. The nurse is caring for a patient receiving a blood transfusion. The patient develops
chills, fever, and low back pain. What should the nurse do first?
a. Notify the provider
b. Stop the transfusion
c. Administer acetaminophen
d. Monitor vital signs
, Rationale: These are signs of a hemolytic transfusion reaction. The transfusion should
be stopped immediately to prevent further complications.
4. A nurse teaches a client prescribed warfarin about dietary restrictions. Which food
should the client avoid?
a. Apples
b. Milk
c. Spinach
d. Bananas
Rationale: Spinach is high in vitamin K, which can reduce the effectiveness of
warfarin therapy.
5. Which finding requires immediate intervention in a client receiving IV furosemide?
a. Weight loss of 2 pounds in 24 hours
b. Potassium level of 2.8 mEq/L
c. Increased urine output
d. Mild dizziness on standing
Rationale: A potassium level of 2.8 mEq/L indicates severe hypokalemia, which can
lead to life-threatening arrhythmias.
6. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The nurse’s
priority action is to:
a. Encourage coughing and deep breathing
b. Reduce oxygen flow rate
c. Position the client supine
d. Increase fluids
Rationale: Clients with COPD rely on hypoxic drive. High oxygen flow may suppress
their drive to breathe, so oxygen should be kept at 1–2 L/min.
7. A nurse is preparing to insert an indwelling urinary catheter for a female patient.
Which action is correct?
a. Inflate the balloon before insertion
b. Position the client supine with arms above head
c. Clean the perineal area with sterile solution before insertion
d. Insert the catheter without lubrication
Rationale: Cleaning the perineal area with sterile solution reduces infection risk.
Sterile and lubricated insertion is essential.
8. Which client should the nurse see first after receiving report?
a. Post-op patient requesting pain medication
b. Patient with asthma who is wheezing and has labored breathing
c. Patient scheduled for dressing change
d. Patient asking about discharge instructions
, Rationale: Airway and breathing issues are always the highest priority. The asthmatic
client is at risk for respiratory failure.
9. A nurse cares for a client with a chest tube. Which finding requires immediate
action?
a. 50 mL of drainage in one hour
b. Continuous bubbling in the water-seal chamber
c. Fluctuations with respiration in the water-seal chamber
d. Dressing intact at the insertion site
Rationale: Continuous bubbling indicates an air leak, which must be addressed
immediately.
10. A client with schizophrenia says, “The government has inserted a chip in my brain.”
The nurse’s best response is:
a. “You should not say things that are not true.”
b. “I understand that you believe this. Can you tell me more about your thoughts?”
c. “The government does not put chips in people’s brains.”
d. “That’s not possible, let’s talk about something else.”
Rationale: The best approach is to acknowledge the client’s feelings without
reinforcing delusions and encourage discussion.
11. A nurse is caring for a client receiving total parenteral nutrition (TPN). Which finding
requires immediate action?
a. Mild nausea
b. Fever and chills
c. Slight hyperglycemia
d. Slight weight gain
Rationale: Fever and chills may indicate a catheter-related infection or sepsis, which
requires immediate intervention.
12. A client with a history of myocardial infarction reports chest pain rated 8/10. Which
action should the nurse take first?
a. Apply oxygen
b. Assess vital signs and administer nitroglycerin
c. Notify the provider
d. Obtain an ECG
Rationale: Chest pain in a post-MI client could indicate reinfarction. Prompt
assessment and nitroglycerin administration are priorities.
13. A nurse is teaching a client with asthma about using a metered-dose inhaler (MDI).
Which instruction is correct?
a. Shake the inhaler for 10 seconds before use
b. Exhale fully, then inhale slowly while pressing the inhaler
