NCLEX-RN Practice Test Bank Verified Questions,
Correct Answers, and Detailed Explanations for
Science Students||Already Graded A+
1. A nurse is caring for a client receiving IV morphine. Which assessment
finding requires immediate intervention?
A. Respiratory rate of 10/min
B. Blood pressure 100/60 mmHg
C. Pain score 3/10
D. Urinary output 40 mL/hr
Answer: A
Morphine can cause respiratory depression; a rate of 10/min is below safe
limits and requires prompt action.
2. Which position best reduces the risk of aspiration in an unconscious client?
A. Supine
B. Trendelenburg
C. Side-lying
D. High-Fowler’s
Answer: C
Side-lying allows secretions to drain and prevents airway obstruction.
3. A client with diabetes reports shakiness and diaphoresis. Which action
should the nurse take first?
A. Administer insulin
B. Check blood glucose
C. Give orange juice
D. Notify the provider
Answer: B
Assessment comes first; confirming hypoglycemia guides appropriate
intervention.
,4. Which lab value indicates effective warfarin therapy?
A. INR 1.0
B. INR 1.5
C. INR 2.5
D. INR 4.5
Answer: C
Therapeutic INR for most conditions is 2–3.
5. The nurse is teaching a client about furosemide. Which statement
indicates understanding?
A. “I will limit foods high in potassium.”
B. “I will report muscle weakness.”
C. “I should take this at bedtime.”
D. “Weight gain is expected.”
Answer: B
Furosemide causes potassium loss; muscle weakness may indicate
hypokalemia.
6. Which finding is an early sign of hypoxia?
A. Cyanosis
B. Bradycardia
C. Confusion
D. Hypotension
Answer: C
Neurological changes such as restlessness and confusion occur early.
7. A client receiving blood develops chills and fever. What is the nurse’s
priority action?
A. Slow the infusion
B. Administer acetaminophen
, C. Stop the transfusion
D. Obtain blood cultures
Answer: C
Signs suggest transfusion reaction; stopping the blood prevents further
exposure.
8. Which intervention best prevents catheter-associated UTIs?
A. Frequent catheter irrigation
B. Routine antibiotic use
C. Daily perineal care
D. Keeping catheter for convenience
Answer: C
Good hygiene reduces bacterial entry.
9. A nurse is preparing to administer digoxin. Which finding requires
withholding the medication?
A. Apical pulse 72/min
B. Blood pressure 130/80 mmHg
C. Potassium 3.0 mEq/L
D. Weight gain of 1 kg
Answer: C
Hypokalemia increases risk of digoxin toxicity.
10. Which client is at greatest risk for pressure injury?
A. Ambulatory older adult
B. Immobile client with incontinence
C. Client with controlled diabetes
D. Post-operative client day 2
Answer: B
Immobility and moisture significantly increase skin breakdown risk.
Correct Answers, and Detailed Explanations for
Science Students||Already Graded A+
1. A nurse is caring for a client receiving IV morphine. Which assessment
finding requires immediate intervention?
A. Respiratory rate of 10/min
B. Blood pressure 100/60 mmHg
C. Pain score 3/10
D. Urinary output 40 mL/hr
Answer: A
Morphine can cause respiratory depression; a rate of 10/min is below safe
limits and requires prompt action.
2. Which position best reduces the risk of aspiration in an unconscious client?
A. Supine
B. Trendelenburg
C. Side-lying
D. High-Fowler’s
Answer: C
Side-lying allows secretions to drain and prevents airway obstruction.
3. A client with diabetes reports shakiness and diaphoresis. Which action
should the nurse take first?
A. Administer insulin
B. Check blood glucose
C. Give orange juice
D. Notify the provider
Answer: B
Assessment comes first; confirming hypoglycemia guides appropriate
intervention.
,4. Which lab value indicates effective warfarin therapy?
A. INR 1.0
B. INR 1.5
C. INR 2.5
D. INR 4.5
Answer: C
Therapeutic INR for most conditions is 2–3.
5. The nurse is teaching a client about furosemide. Which statement
indicates understanding?
A. “I will limit foods high in potassium.”
B. “I will report muscle weakness.”
C. “I should take this at bedtime.”
D. “Weight gain is expected.”
Answer: B
Furosemide causes potassium loss; muscle weakness may indicate
hypokalemia.
6. Which finding is an early sign of hypoxia?
A. Cyanosis
B. Bradycardia
C. Confusion
D. Hypotension
Answer: C
Neurological changes such as restlessness and confusion occur early.
7. A client receiving blood develops chills and fever. What is the nurse’s
priority action?
A. Slow the infusion
B. Administer acetaminophen
, C. Stop the transfusion
D. Obtain blood cultures
Answer: C
Signs suggest transfusion reaction; stopping the blood prevents further
exposure.
8. Which intervention best prevents catheter-associated UTIs?
A. Frequent catheter irrigation
B. Routine antibiotic use
C. Daily perineal care
D. Keeping catheter for convenience
Answer: C
Good hygiene reduces bacterial entry.
9. A nurse is preparing to administer digoxin. Which finding requires
withholding the medication?
A. Apical pulse 72/min
B. Blood pressure 130/80 mmHg
C. Potassium 3.0 mEq/L
D. Weight gain of 1 kg
Answer: C
Hypokalemia increases risk of digoxin toxicity.
10. Which client is at greatest risk for pressure injury?
A. Ambulatory older adult
B. Immobile client with incontinence
C. Client with controlled diabetes
D. Post-operative client day 2
Answer: B
Immobility and moisture significantly increase skin breakdown risk.
