NCLEX-RN Practice Questions: Nursing Fundamentals
Single-Best-Answer Questions
Scenario: A 72-year-old post-op hip replacement patient is on
the surgical unit. Nursing assistant reports the following: "BP
86/54 mmHg, HR 120 bpm, pale and diaphoretic, patient says 'I
feel dizzy'." Which cue is the most urgent for the nurse to
recognize?
A. Pale and diaphoretic appearance
B. Blood pressure 86/54 mmHg
C. Heart rate 120 bpm
D. Patient complaint "I feel dizzy"
Answer: B. Blood pressure 86/54 mmHg
Rationales
• A. Pale and diaphoretic appearance — Important sign of
perfusion compromise, but less specific than a numeric
hypotensive reading for immediate hemodynamic
instability. Not the single most urgent cue.
• B. Blood pressure 86/54 mmHg — Correct. This numeric
cue indicates hypotension and risk for inadequate organ
perfusion after surgery; it is the most objective, immediate
life-threatening cue requiring prompt action.
• C. Heart rate 120 bpm — Tachycardia is an important
compensatory sign and contributes to concern, but
, hypotension is the most urgent single cue indicating
potential shock or bleeding.
• D. Patient complaint "I feel dizzy" — Subjective and
important, but in isolation less specific than the
hypotensive reading. Combined with hypotension it
supports urgency.
Q2 — (CJMM: Analyze cues)
Scenario: A nurse reviews morning vitals for a 54-year-old with
COPD: SpO₂ 88% on room air, RR 28, HR 102, BP 138/82, temp
37.2°C. The patient is alert but using accessory muscles. Which
statement best explains the abnormal SpO₂?
A. The patient is hyperventilating causing low oxygen
saturation.
B. In COPD, hypoxemia is expected due to ventilation–perfusion
mismatch.
C. The SpO₂ reading is falsely low because of tachycardia.
D. A temperature of 37.2°C indicates infection causing hypoxia.
Answer: B. In COPD, hypoxemia is expected due to
ventilation–perfusion mismatch.
Rationales
• A. The patient is hyperventilating causing low oxygen
saturation. Hyperventilation typically causes low CO₂
, (respiratory alkalosis) but does not directly lower SpO₂; not
the best explanation.
• B. In COPD, hypoxemia is expected due to ventilation–
perfusion mismatch — Correct. COPD causes airway
obstruction and V/Q mismatch, which commonly results in
reduced PaO₂/SpO₂ especially during exacerbation or when
oxygenation is impaired.
• C. The SpO₂ reading is falsely low because of tachycardia.
Tachycardia does not reliably cause false low SpO₂; poor
perfusion or movement might, but accessory muscle use
and RR 28 support true hypoxemia.
• D. A temperature of 37.2°C indicates infection causing
hypoxia. 37.2°C is essentially normal/low-grade and is not
a strong cause for hypoxemia; infection may cause hypoxia
but the COPD diagnosis explains the SpO₂ more directly.
Q3 — (CJMM: Decide / Prioritize)
Scenario: On a med-surg unit the nurse must prioritize care for
four patients. Which patient should the nurse see first?
A. 68-year-old with Type 2 DM scheduled for discharge
teaching.
B. 45-year-old postoperative appendectomy with pain 5/10 and
pulse 92.
C. 54-year-old with chest pain, sudden onset, diaphoretic, BP
160/96, HR 110.
, D. 82-year-old with UTI who needs medication reconciliation
before transfer.
Answer: C. 54-year-old with chest pain, sudden onset,
diaphoretic, BP 160/96, HR 110.
Rationales
• A. 68-year-old with discharge teaching — Important but
not urgent; can be delegated or scheduled after acute
issues.
• B. 45-year-old postoperative with moderate pain and
stable vitals — Manageable but not highest priority.
• C. 54-year-old with acute chest pain — Correct. Acute
chest pain with diaphoresis and tachycardia is potentially
life-threatening (ACS) and requires immediate
assessment/intervention.
• D. 82-year-old needing med reconciliation —
Administrative/transfer task, lower priority than an acute
chest pain case.
Q4 — (CJMM: Act)
Scenario: A client with suspected aspiration has sudden
coughing, decreased O₂ sat to 86% and gurgling breath sounds.
After recognizing cues and deciding on interventions, which
immediate action should the nurse take?
Single-Best-Answer Questions
Scenario: A 72-year-old post-op hip replacement patient is on
the surgical unit. Nursing assistant reports the following: "BP
86/54 mmHg, HR 120 bpm, pale and diaphoretic, patient says 'I
feel dizzy'." Which cue is the most urgent for the nurse to
recognize?
A. Pale and diaphoretic appearance
B. Blood pressure 86/54 mmHg
C. Heart rate 120 bpm
D. Patient complaint "I feel dizzy"
Answer: B. Blood pressure 86/54 mmHg
Rationales
• A. Pale and diaphoretic appearance — Important sign of
perfusion compromise, but less specific than a numeric
hypotensive reading for immediate hemodynamic
instability. Not the single most urgent cue.
• B. Blood pressure 86/54 mmHg — Correct. This numeric
cue indicates hypotension and risk for inadequate organ
perfusion after surgery; it is the most objective, immediate
life-threatening cue requiring prompt action.
• C. Heart rate 120 bpm — Tachycardia is an important
compensatory sign and contributes to concern, but
, hypotension is the most urgent single cue indicating
potential shock or bleeding.
• D. Patient complaint "I feel dizzy" — Subjective and
important, but in isolation less specific than the
hypotensive reading. Combined with hypotension it
supports urgency.
Q2 — (CJMM: Analyze cues)
Scenario: A nurse reviews morning vitals for a 54-year-old with
COPD: SpO₂ 88% on room air, RR 28, HR 102, BP 138/82, temp
37.2°C. The patient is alert but using accessory muscles. Which
statement best explains the abnormal SpO₂?
A. The patient is hyperventilating causing low oxygen
saturation.
B. In COPD, hypoxemia is expected due to ventilation–perfusion
mismatch.
C. The SpO₂ reading is falsely low because of tachycardia.
D. A temperature of 37.2°C indicates infection causing hypoxia.
Answer: B. In COPD, hypoxemia is expected due to
ventilation–perfusion mismatch.
Rationales
• A. The patient is hyperventilating causing low oxygen
saturation. Hyperventilation typically causes low CO₂
, (respiratory alkalosis) but does not directly lower SpO₂; not
the best explanation.
• B. In COPD, hypoxemia is expected due to ventilation–
perfusion mismatch — Correct. COPD causes airway
obstruction and V/Q mismatch, which commonly results in
reduced PaO₂/SpO₂ especially during exacerbation or when
oxygenation is impaired.
• C. The SpO₂ reading is falsely low because of tachycardia.
Tachycardia does not reliably cause false low SpO₂; poor
perfusion or movement might, but accessory muscle use
and RR 28 support true hypoxemia.
• D. A temperature of 37.2°C indicates infection causing
hypoxia. 37.2°C is essentially normal/low-grade and is not
a strong cause for hypoxemia; infection may cause hypoxia
but the COPD diagnosis explains the SpO₂ more directly.
Q3 — (CJMM: Decide / Prioritize)
Scenario: On a med-surg unit the nurse must prioritize care for
four patients. Which patient should the nurse see first?
A. 68-year-old with Type 2 DM scheduled for discharge
teaching.
B. 45-year-old postoperative appendectomy with pain 5/10 and
pulse 92.
C. 54-year-old with chest pain, sudden onset, diaphoretic, BP
160/96, HR 110.
, D. 82-year-old with UTI who needs medication reconciliation
before transfer.
Answer: C. 54-year-old with chest pain, sudden onset,
diaphoretic, BP 160/96, HR 110.
Rationales
• A. 68-year-old with discharge teaching — Important but
not urgent; can be delegated or scheduled after acute
issues.
• B. 45-year-old postoperative with moderate pain and
stable vitals — Manageable but not highest priority.
• C. 54-year-old with acute chest pain — Correct. Acute
chest pain with diaphoresis and tachycardia is potentially
life-threatening (ACS) and requires immediate
assessment/intervention.
• D. 82-year-old needing med reconciliation —
Administrative/transfer task, lower priority than an acute
chest pain case.
Q4 — (CJMM: Act)
Scenario: A client with suspected aspiration has sudden
coughing, decreased O₂ sat to 86% and gurgling breath sounds.
After recognizing cues and deciding on interventions, which
immediate action should the nurse take?
