3100 EXAM 2 PRACTICE NCLEX QUESTIONS 10/28/2022
3100 Exam 2 Practice NCLEX Questions
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A nurse notes a patient has abnormal vital signs. What action by the nurse is best?
A
Document the findings.
B Notify the provider.
C Compare with prior readings.
D
Retake the vital signs in 15 minutes.
2. A patient returned from a procedure and has vital sign measurements ordered every hour. The patient’s
blood pressure has dropped from 132/82 mm Hg an hour ago to 90/66 mm Hg. What priority action by
the nurse is most appropriate?
A Take the vital signs again in another hour.
B
Document the findings in the patient’s chart.
C
Have another nurse recheck the vital signs.
D
Plan to take the vital signs more often.
3. A nurse is told in the hand-off report that a patient is afebrile. What assessment finding correlates with
this statement?
A
Blood pressure 152/98 mm Hg
B
Oral temperature 98.4 F (36.8 C)
C Apical pulse 82 beats/min
D
Oral temperature 100.8 F (38.2 C)
4. A nurse is caring for a patient who has an elevated temperature. The nurse plans to help the patient regain
a normal temperature through conduction. What technique does the nurse use?
A
Placing a cooling fan in the patient’s room
B
Putting ice packs in the patient’s axillae
C
Spraying the patient with a fine mist of water
D
Turning the temperature down in the room
5. A nurse is going to take an oral temperature on a patient who has just consumed a cup of coffee. What
action by the nurse is best?
A
Have the patient drink room temperature water.
B
Return in 30 minutes to take the patient’s temperature.
C Take the patient’s temperature rectally instead.
D
Document that temperature is unable to be obtained.
6. A nurse observes a student taking an adult patient’s tympanic temperature. What action by the student
requires the nurse to intervene?
A
Student washes hands prior to patient contact.
B
Student pulls the pinna of the patient’s ear down and back.
C
Student explains the procedure to the patient.
D
Student pulls the pinna of the patient’s ear up and back.
7. A nurse assesses a patient’s radial pulse rate to be 110 beats/min and regular. What action by the nurse is
best?
A
Assess the patient for causes of tachycardia.
, 3100 EXAM 2 PRACTICE NCLEX QUESTIONS 10/28/2022
B
Take an apical heart rate and compare the two.
C Document the findings in the patient’s chart.
D
Notify the patient’s health care provider.
8. The student nurse is assessing a patient’s pulses. What action by the student requires the nurse to
intervene?
A
Assessing apical pulse between the fifth and sixth intercostal spaces
B Assessing the dorsalis pedis pulse by palpating behind the patient’s knee
C
Assessing the radial pulse on the patient’s wrist
D
Assessing the brachial pulse on the patient’s inner elbow
9. The nurse assesses a patient’s pulse and finds it hard to obliterate with palpation. What action by the
nurse is the most appropriate?
A
Assess the patient for fluid volume overload.
B
Assess the patient for fluid volume deficit.
C Assess the patient’s apical heart rate.
D Assess the patient’s pulse deficit.
10. The nursing faculty member is observing a student taking a patient’s carotid pulse. What action by the
student requires intervention by the faculty member?
A
Counts pulse for 30 seconds and multiplies by two.
B
Performs hand hygiene prior to patient contact.
C
Compares pulses in both carotid arteries at the same time.
D Assesses pulse on one side then assesses the other side.
11. A nurse is caring for a patient who has orthopnea. What action by the nurse is most appropriate?
A
Encourage deep breathing and coughing.
B
Medicate the patient for pain as needed.
C
Keep the head of the bed elevated.
D Monitor the length of time the patient doesn’t breathe.
12. The nurse has applied a pulse oximeter to the finger of a patient who is hypothermic. The pulse oximeter
does not provide a good reading. What action by the nurse is best?
A Move the oximeter probe to another finger.
B
Assess the fingers for good circulation.
C
Document that the reading cannot be obtained.
D
Remove any fingernail polish present on the fingernail.
13. A patient’s blood pressure is 142/76 mm Hg. What does the nurse chart as the pulse pressure?
A
28
B 42
C
58
D
66
14. A nurse performs orthostatic blood pressure readings on a patient with the following results: lying 148/76
mm Hg, standing 110/60 mm Hg. What action by the nurse is best?
A
Instruct the patient not to get up without help.
B Document the findings and continue to monitor.
C
Reassure the patient that these findings are normal.
D
Reassess the blood pressures in 1 hour.
15. The nurse is caring for a woman who had a right-sided mastectomy 2 years ago. What action by the nurse
is most appropriate?
3100 Exam 2 Practice NCLEX Questions
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A nurse notes a patient has abnormal vital signs. What action by the nurse is best?
A
Document the findings.
B Notify the provider.
C Compare with prior readings.
D
Retake the vital signs in 15 minutes.
2. A patient returned from a procedure and has vital sign measurements ordered every hour. The patient’s
blood pressure has dropped from 132/82 mm Hg an hour ago to 90/66 mm Hg. What priority action by
the nurse is most appropriate?
A Take the vital signs again in another hour.
B
Document the findings in the patient’s chart.
C
Have another nurse recheck the vital signs.
D
Plan to take the vital signs more often.
3. A nurse is told in the hand-off report that a patient is afebrile. What assessment finding correlates with
this statement?
A
Blood pressure 152/98 mm Hg
B
Oral temperature 98.4 F (36.8 C)
C Apical pulse 82 beats/min
D
Oral temperature 100.8 F (38.2 C)
4. A nurse is caring for a patient who has an elevated temperature. The nurse plans to help the patient regain
a normal temperature through conduction. What technique does the nurse use?
A
Placing a cooling fan in the patient’s room
B
Putting ice packs in the patient’s axillae
C
Spraying the patient with a fine mist of water
D
Turning the temperature down in the room
5. A nurse is going to take an oral temperature on a patient who has just consumed a cup of coffee. What
action by the nurse is best?
A
Have the patient drink room temperature water.
B
Return in 30 minutes to take the patient’s temperature.
C Take the patient’s temperature rectally instead.
D
Document that temperature is unable to be obtained.
6. A nurse observes a student taking an adult patient’s tympanic temperature. What action by the student
requires the nurse to intervene?
A
Student washes hands prior to patient contact.
B
Student pulls the pinna of the patient’s ear down and back.
C
Student explains the procedure to the patient.
D
Student pulls the pinna of the patient’s ear up and back.
7. A nurse assesses a patient’s radial pulse rate to be 110 beats/min and regular. What action by the nurse is
best?
A
Assess the patient for causes of tachycardia.
, 3100 EXAM 2 PRACTICE NCLEX QUESTIONS 10/28/2022
B
Take an apical heart rate and compare the two.
C Document the findings in the patient’s chart.
D
Notify the patient’s health care provider.
8. The student nurse is assessing a patient’s pulses. What action by the student requires the nurse to
intervene?
A
Assessing apical pulse between the fifth and sixth intercostal spaces
B Assessing the dorsalis pedis pulse by palpating behind the patient’s knee
C
Assessing the radial pulse on the patient’s wrist
D
Assessing the brachial pulse on the patient’s inner elbow
9. The nurse assesses a patient’s pulse and finds it hard to obliterate with palpation. What action by the
nurse is the most appropriate?
A
Assess the patient for fluid volume overload.
B
Assess the patient for fluid volume deficit.
C Assess the patient’s apical heart rate.
D Assess the patient’s pulse deficit.
10. The nursing faculty member is observing a student taking a patient’s carotid pulse. What action by the
student requires intervention by the faculty member?
A
Counts pulse for 30 seconds and multiplies by two.
B
Performs hand hygiene prior to patient contact.
C
Compares pulses in both carotid arteries at the same time.
D Assesses pulse on one side then assesses the other side.
11. A nurse is caring for a patient who has orthopnea. What action by the nurse is most appropriate?
A
Encourage deep breathing and coughing.
B
Medicate the patient for pain as needed.
C
Keep the head of the bed elevated.
D Monitor the length of time the patient doesn’t breathe.
12. The nurse has applied a pulse oximeter to the finger of a patient who is hypothermic. The pulse oximeter
does not provide a good reading. What action by the nurse is best?
A Move the oximeter probe to another finger.
B
Assess the fingers for good circulation.
C
Document that the reading cannot be obtained.
D
Remove any fingernail polish present on the fingernail.
13. A patient’s blood pressure is 142/76 mm Hg. What does the nurse chart as the pulse pressure?
A
28
B 42
C
58
D
66
14. A nurse performs orthostatic blood pressure readings on a patient with the following results: lying 148/76
mm Hg, standing 110/60 mm Hg. What action by the nurse is best?
A
Instruct the patient not to get up without help.
B Document the findings and continue to monitor.
C
Reassure the patient that these findings are normal.
D
Reassess the blood pressures in 1 hour.
15. The nurse is caring for a woman who had a right-sided mastectomy 2 years ago. What action by the nurse
is most appropriate?
