NCLEX NGN RN EXAM 2 – Complete
Exam Questions Practice Examination with
rationales
SECTION 1: STAND-ALONE MULTIPLE CHOICE (Questions 1–80)
1. The nurse assesses an 82-year-old who reports feeling "tired all the time," has
lost 12 pounds in 5 months without trying, and walks slower than last year. Which
finding is most consistent with frailty?
A. Body mass index 32
B. Grip strength 18 kg (female)
C. Hemoglobin 14.2 g/dL
D. Serum albumin 4.0 g/dL
☑ Correct Answer: B – Grip strength 18 kg (low)
Rationale: Frailty includes weakness (low grip strength: <16 kg female, <27 kg
male). Weight loss, exhaustion, slow gait are other criteria.
2. A nurse reviews medications for an 85-year-old with history of falls. Which
medication should be deprescribed first?
A. Levothyroxine 75 mcg daily
B. Lorazepam 0.5 mg twice daily as needed for anxiety
C. Lisinopril 10 mg daily
D. Acetaminophen 650 mg every 6 hours PRN pain
,☑ Correct Answer: B – Lorazepam
Rationale: Benzodiazepines are on Beers Criteria as potentially inappropriate,
increase fall risk, cognitive impairment.
3. A frail older adult with HFpEF is admitted with dyspnea. Which medication has
been shown to reduce hospitalizations in HFpEF?
A. Digoxin
B. Empagliflozin
C. Metoprolol tartrate
D. Hydralazine
☑ Correct Answer: B – Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce HF
hospitalizations in HFpEF.
4. An 87-year-old with dementia is prescribed memantine. Which statement about
memantine is true?
A. It is a cholinesterase inhibitor
B. It is an NMDA receptor antagonist
C. It is first-line for agitation
D. It cures Alzheimer's disease
☑ Correct Answer: B – NMDA receptor antagonist
Rationale: Memantine blocks NMDA receptors, regulates glutamate.
Cholinesterase inhibitors (donepezil, rivastigmine) are different.
,5. Which laboratory finding in an older adult with chronic kidney disease (CKD)
stage 4 requires immediate intervention?
A. Potassium 5.1 mEq/L
B. Hemoglobin 10.2 g/dL
C. Calcium 8.5 mg/dL
D. Phosphorus 6.5 mg/dL
☑ Correct Answer: D – Phosphorus 6.5 mg/dL (elevated)
Rationale: Severe hyperphosphatemia (>6.0) increases cardiovascular risk. Treat
with phosphate binders, dietary restriction.
6. A patient with advanced COPD has a respiratory rate of 28 and SpO2 88% on 2
L nasal cannula. Which action should the nurse take first?
A. Increase oxygen to 4 L
B. Assess work of breathing and auscultate lungs
C. Intubate immediately
D. Administer IV furosemide
☑ Correct Answer: B – Assess work of breathing and auscultate lungs
Rationale: Always assess first. Titrate oxygen to SpO2 88-92% in COPD (avoid
hypercapnia).
7. Which immunization is recommended annually for all older adults?
A. Tdap
B. Influenza
, C. Pneumococcal polysaccharide (PPSV23)
D. Herpes zoster (RZV)
☑ Correct Answer: B – Influenza (annually)
Rationale: Influenza vaccine is yearly. Pneumococcal and shingles are one-time or
two-dose series, not annual.
8. An older adult reports dizziness when standing up from a seated position. Which
assessment should the nurse perform first?
A. Orthostatic blood pressures
B. Electrocardiogram
C. Serum cortisol
D. Carotid ultrasound
☑ Correct Answer: A – Orthostatic blood pressures
Rationale: Orthostatic hypotension is a common cause. Measure BP and HR
supine, sitting, standing.
9. A patient with Parkinson's disease has freezing of gait. Which intervention is
most effective?
A. Increase carbidopa-levodopa dose
B. Provide visual or auditory cues (laser cane, metronome)
C. Use a wheelchair at all times
D. Restrict fluids
☑ Correct Answer: B – Visual or auditory cues
Rationale: Cues help initiate stepping. PT referral for gait training.
Exam Questions Practice Examination with
rationales
SECTION 1: STAND-ALONE MULTIPLE CHOICE (Questions 1–80)
1. The nurse assesses an 82-year-old who reports feeling "tired all the time," has
lost 12 pounds in 5 months without trying, and walks slower than last year. Which
finding is most consistent with frailty?
A. Body mass index 32
B. Grip strength 18 kg (female)
C. Hemoglobin 14.2 g/dL
D. Serum albumin 4.0 g/dL
☑ Correct Answer: B – Grip strength 18 kg (low)
Rationale: Frailty includes weakness (low grip strength: <16 kg female, <27 kg
male). Weight loss, exhaustion, slow gait are other criteria.
2. A nurse reviews medications for an 85-year-old with history of falls. Which
medication should be deprescribed first?
A. Levothyroxine 75 mcg daily
B. Lorazepam 0.5 mg twice daily as needed for anxiety
C. Lisinopril 10 mg daily
D. Acetaminophen 650 mg every 6 hours PRN pain
,☑ Correct Answer: B – Lorazepam
Rationale: Benzodiazepines are on Beers Criteria as potentially inappropriate,
increase fall risk, cognitive impairment.
3. A frail older adult with HFpEF is admitted with dyspnea. Which medication has
been shown to reduce hospitalizations in HFpEF?
A. Digoxin
B. Empagliflozin
C. Metoprolol tartrate
D. Hydralazine
☑ Correct Answer: B – Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce HF
hospitalizations in HFpEF.
4. An 87-year-old with dementia is prescribed memantine. Which statement about
memantine is true?
A. It is a cholinesterase inhibitor
B. It is an NMDA receptor antagonist
C. It is first-line for agitation
D. It cures Alzheimer's disease
☑ Correct Answer: B – NMDA receptor antagonist
Rationale: Memantine blocks NMDA receptors, regulates glutamate.
Cholinesterase inhibitors (donepezil, rivastigmine) are different.
,5. Which laboratory finding in an older adult with chronic kidney disease (CKD)
stage 4 requires immediate intervention?
A. Potassium 5.1 mEq/L
B. Hemoglobin 10.2 g/dL
C. Calcium 8.5 mg/dL
D. Phosphorus 6.5 mg/dL
☑ Correct Answer: D – Phosphorus 6.5 mg/dL (elevated)
Rationale: Severe hyperphosphatemia (>6.0) increases cardiovascular risk. Treat
with phosphate binders, dietary restriction.
6. A patient with advanced COPD has a respiratory rate of 28 and SpO2 88% on 2
L nasal cannula. Which action should the nurse take first?
A. Increase oxygen to 4 L
B. Assess work of breathing and auscultate lungs
C. Intubate immediately
D. Administer IV furosemide
☑ Correct Answer: B – Assess work of breathing and auscultate lungs
Rationale: Always assess first. Titrate oxygen to SpO2 88-92% in COPD (avoid
hypercapnia).
7. Which immunization is recommended annually for all older adults?
A. Tdap
B. Influenza
, C. Pneumococcal polysaccharide (PPSV23)
D. Herpes zoster (RZV)
☑ Correct Answer: B – Influenza (annually)
Rationale: Influenza vaccine is yearly. Pneumococcal and shingles are one-time or
two-dose series, not annual.
8. An older adult reports dizziness when standing up from a seated position. Which
assessment should the nurse perform first?
A. Orthostatic blood pressures
B. Electrocardiogram
C. Serum cortisol
D. Carotid ultrasound
☑ Correct Answer: A – Orthostatic blood pressures
Rationale: Orthostatic hypotension is a common cause. Measure BP and HR
supine, sitting, standing.
9. A patient with Parkinson's disease has freezing of gait. Which intervention is
most effective?
A. Increase carbidopa-levodopa dose
B. Provide visual or auditory cues (laser cane, metronome)
C. Use a wheelchair at all times
D. Restrict fluids
☑ Correct Answer: B – Visual or auditory cues
Rationale: Cues help initiate stepping. PT referral for gait training.
