NCLEX RN ACTUALL QUESTIONS AND ANSWERS
,NCLEX-RN Next-Generation Ultimate Practice Exam
Question 1
The nurse prepares to administer a continuous intravenous infusion of regular insulin to a client with
diabetic ketoacidosis (DKA). Which action should the nurse take first?
A. Flush the entire intravenous tubing with 20 to 50 mL of the insulin solution before connecting to
the client.
B. Ensure the client's potassium level is greater than 3.3 mEq/L (3.3 mmol/L).
C. Program the infusion pump to deliver the solution at a rate of 0.5 units/kg/hour.
D. Check the blood glucose level using a bedside point-of-care glucometer.
Question 2
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. The client is receiving oxygen at 2 L/min via nasal cannula. The arterial blood gas
(ABG) results reveal: pH 7.28, PaCO2 58 mmHg, HCO3 30 mEq/L, and PaO2 55 mmHg. Which action
should the nurse take first?
A. Increase the nasal cannula oxygen flow rate to 6 L/min.
B. Administer an immediate dose of an intravenous corticosteroid.
C. Prepare the client for noninvasive positive pressure ventilation (BiPAP).
D. Position the client in a high-Fowler's position and encourage pursed-lip breathing.
Question 3
The nurse in the emergency department cares for a client presenting with a rigid, board-like abdomen,
severe epigastric pain radiating to the shoulder, and a temperature of 101.2°F (38.4°C). The client
reports a history of peptic ulcer disease. Which healthcare provider prescription should the nurse
implement first?
A. Insert a nasogastric tube and connect it to low intermittent suction.
B. Draw blood for a complete blood count and metabolic panel.
C. Administer morphine sulfate 4 mg intravenous push.
D. Initiate an intravenous infusion of 0.9% normal saline at 150 mL/hour.
Question 4
A client with deep vein thrombosis (DVT) is receiving a continuous heparin infusion at 1,200 units/hour.
The most recent activated partial thromboplastin time (aPTT) is 115 seconds. The client's baseline aPTT
was 30 seconds. Which action should the nurse take immediately?
A. Stop the heparin infusion and prepare to administer protamine sulfate.
B. Stop the heparin infusion for 1 hour and decrease the rate by 100 units/hour per protocol.
C. Hold the infusion, notify the provider, and assess the client for signs of bleeding.
D. Continue the infusion and repeat the drawing of the aPTT lab sample from the opposite arm.
,Question 5
The nurse reviews the chart of a client scheduled for an elective cardiac catheterization in 2 hours.
Which finding requires immediate notification to the healthcare provider?
A. Serum creatinine level of 2.1 mg/dL (185.6 µmol/L).
B. International Normalized Ratio (INR) of 1.2.
C. Blood pressure reading of 142/88 mmHg.
D. Client reports feeling highly anxious about the procedure.
Question 6
A client with type 1 diabetes mellitus is found unresponsive in bed. The nurse performs a fingerstick
blood glucose test and the meter reads "Low." The client has no intravenous access. Which action
should the nurse take immediately?
A. Insert a peripheral intravenous line and administer 50 mL of 50% dextrose (D50).
B. Administer 1 mg of glucagon intramuscularly or subcutaneously.
C. Place a small amount of oral glucose gel between the client's cheek and gums.
D. Attempt to force the client to drink 4 ounces of orange juice.
Question 7
The nurse provides care for an infant diagnosed with Tetralogy of Fallot. During a blood draw, the infant
becomes severely cyanotic, tachypneic, and begins to cry uncontrollably. Which action should the nurse
perform first?
A. Administer supplemental oxygen via a blow-by face mask.
B. Place the infant in a knee-chest position.
C. Administer an ordered dose of intravenous morphine sulfate.
D. Notify the pediatric healthcare provider immediately.
Question 8
The nurse reviews laboratory results for a client receiving digoxin 0.25 mg orally daily for heart failure.
Which laboratory value puts this client at the highest risk for developing digoxin toxicity?
A. Serum potassium level of 3.2 mEq/L (3.2 mmol/L).
B. Serum calcium level of 9.2 mg/dL (2.3 mmol/L).
C. Serum magnesium level of 1.9 mg/dL (0.78 mmol/L).
D. Serum digoxin level of 1.1 ng/mL (1.4 nmol/L).
Question 9
A client is admitted to the psychiatric unit with a diagnosis of severe obsessive-compulsive disorder
(OCD). The client spends 2 hours every morning washing their hands, causing severe skin breakdown.
Which nursing intervention is most appropriate during the first few days of admission?
A. Lock the bathroom door to prevent the client from washing their hands continuously.
B. Allow the client sufficient time to perform the ritualistic handwashing behavior.
, C. Contract with the client to limit handwashing to 10 minutes per hour.
D. Interrupt the ritual and redirect the client to a group therapy session.
Question 10
The nurse receives a shift report on four clients. Which client should the nurse assess first?
A. A client with acute pancreatitis who reports severe, radiating epigastric pain.
B. A client with a femur fracture who is newly confused, restless, and has petechiae on the chest.
C. A client with chronic kidney disease whose serum potassium level is 5.4 mEq/L.
D. A client 1 day postoperative total hip arthroplasty who reports pain of 7 on a 1-10 scale.
Question 11
The nurse cares for a client in the oliguric phase of acute kidney injury (AKI). Which electrocardiogram
(ECG) changes should the nurse anticipate if the client develops severe hyperkalemia? Select all that
apply.
A. Tall, peaked T waves
B. Flattened or absent P waves
C. Prolonged PR interval
D. Widened QRS complex
E. Prominent U waves
F. Shortened QT interval
Question 12
A client at 38 weeks gestation is admitted to the labor and delivery unit in active labor. The nurse notes a
pattern of late decelerations on the electronic fetal monitor. Which action should the nurse take first?
A. Perform a sterile vaginal examination to assess for umbilical cord prolapse.
B. Increase the rate of the continuous intravenous oxytocin infusion.
C. Turn the client onto their left side.
D. Administer oxygen at 2 L/min via nasal cannula.
Question 13
The nurse evaluates a client who just returned to the unit following a thyroidectomy. The client reports a
tingling sensation around the mouth and fingers. Which action is the priority for the nurse to perform?
A. Assess the client's surgical dressing for signs of hemorrhage or bleeding.
B. Check the client for Chvostek's sign and Trousseau's sign.
C. Support the client's head and neck with pillows to prevent hyperextension.
D. Administer the prescribed oral analgesic for surgical incisional pain.
Question 14
A client with a closed head injury is monitored in the intensive care unit. The nurse notes that the
client's intracranial pressure (ICP) has risen from 12 mmHg to 24 mmHg. Which nursing intervention
is appropriate to help decrease the ICP?
,NCLEX-RN Next-Generation Ultimate Practice Exam
Question 1
The nurse prepares to administer a continuous intravenous infusion of regular insulin to a client with
diabetic ketoacidosis (DKA). Which action should the nurse take first?
A. Flush the entire intravenous tubing with 20 to 50 mL of the insulin solution before connecting to
the client.
B. Ensure the client's potassium level is greater than 3.3 mEq/L (3.3 mmol/L).
C. Program the infusion pump to deliver the solution at a rate of 0.5 units/kg/hour.
D. Check the blood glucose level using a bedside point-of-care glucometer.
Question 2
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. The client is receiving oxygen at 2 L/min via nasal cannula. The arterial blood gas
(ABG) results reveal: pH 7.28, PaCO2 58 mmHg, HCO3 30 mEq/L, and PaO2 55 mmHg. Which action
should the nurse take first?
A. Increase the nasal cannula oxygen flow rate to 6 L/min.
B. Administer an immediate dose of an intravenous corticosteroid.
C. Prepare the client for noninvasive positive pressure ventilation (BiPAP).
D. Position the client in a high-Fowler's position and encourage pursed-lip breathing.
Question 3
The nurse in the emergency department cares for a client presenting with a rigid, board-like abdomen,
severe epigastric pain radiating to the shoulder, and a temperature of 101.2°F (38.4°C). The client
reports a history of peptic ulcer disease. Which healthcare provider prescription should the nurse
implement first?
A. Insert a nasogastric tube and connect it to low intermittent suction.
B. Draw blood for a complete blood count and metabolic panel.
C. Administer morphine sulfate 4 mg intravenous push.
D. Initiate an intravenous infusion of 0.9% normal saline at 150 mL/hour.
Question 4
A client with deep vein thrombosis (DVT) is receiving a continuous heparin infusion at 1,200 units/hour.
The most recent activated partial thromboplastin time (aPTT) is 115 seconds. The client's baseline aPTT
was 30 seconds. Which action should the nurse take immediately?
A. Stop the heparin infusion and prepare to administer protamine sulfate.
B. Stop the heparin infusion for 1 hour and decrease the rate by 100 units/hour per protocol.
C. Hold the infusion, notify the provider, and assess the client for signs of bleeding.
D. Continue the infusion and repeat the drawing of the aPTT lab sample from the opposite arm.
,Question 5
The nurse reviews the chart of a client scheduled for an elective cardiac catheterization in 2 hours.
Which finding requires immediate notification to the healthcare provider?
A. Serum creatinine level of 2.1 mg/dL (185.6 µmol/L).
B. International Normalized Ratio (INR) of 1.2.
C. Blood pressure reading of 142/88 mmHg.
D. Client reports feeling highly anxious about the procedure.
Question 6
A client with type 1 diabetes mellitus is found unresponsive in bed. The nurse performs a fingerstick
blood glucose test and the meter reads "Low." The client has no intravenous access. Which action
should the nurse take immediately?
A. Insert a peripheral intravenous line and administer 50 mL of 50% dextrose (D50).
B. Administer 1 mg of glucagon intramuscularly or subcutaneously.
C. Place a small amount of oral glucose gel between the client's cheek and gums.
D. Attempt to force the client to drink 4 ounces of orange juice.
Question 7
The nurse provides care for an infant diagnosed with Tetralogy of Fallot. During a blood draw, the infant
becomes severely cyanotic, tachypneic, and begins to cry uncontrollably. Which action should the nurse
perform first?
A. Administer supplemental oxygen via a blow-by face mask.
B. Place the infant in a knee-chest position.
C. Administer an ordered dose of intravenous morphine sulfate.
D. Notify the pediatric healthcare provider immediately.
Question 8
The nurse reviews laboratory results for a client receiving digoxin 0.25 mg orally daily for heart failure.
Which laboratory value puts this client at the highest risk for developing digoxin toxicity?
A. Serum potassium level of 3.2 mEq/L (3.2 mmol/L).
B. Serum calcium level of 9.2 mg/dL (2.3 mmol/L).
C. Serum magnesium level of 1.9 mg/dL (0.78 mmol/L).
D. Serum digoxin level of 1.1 ng/mL (1.4 nmol/L).
Question 9
A client is admitted to the psychiatric unit with a diagnosis of severe obsessive-compulsive disorder
(OCD). The client spends 2 hours every morning washing their hands, causing severe skin breakdown.
Which nursing intervention is most appropriate during the first few days of admission?
A. Lock the bathroom door to prevent the client from washing their hands continuously.
B. Allow the client sufficient time to perform the ritualistic handwashing behavior.
, C. Contract with the client to limit handwashing to 10 minutes per hour.
D. Interrupt the ritual and redirect the client to a group therapy session.
Question 10
The nurse receives a shift report on four clients. Which client should the nurse assess first?
A. A client with acute pancreatitis who reports severe, radiating epigastric pain.
B. A client with a femur fracture who is newly confused, restless, and has petechiae on the chest.
C. A client with chronic kidney disease whose serum potassium level is 5.4 mEq/L.
D. A client 1 day postoperative total hip arthroplasty who reports pain of 7 on a 1-10 scale.
Question 11
The nurse cares for a client in the oliguric phase of acute kidney injury (AKI). Which electrocardiogram
(ECG) changes should the nurse anticipate if the client develops severe hyperkalemia? Select all that
apply.
A. Tall, peaked T waves
B. Flattened or absent P waves
C. Prolonged PR interval
D. Widened QRS complex
E. Prominent U waves
F. Shortened QT interval
Question 12
A client at 38 weeks gestation is admitted to the labor and delivery unit in active labor. The nurse notes a
pattern of late decelerations on the electronic fetal monitor. Which action should the nurse take first?
A. Perform a sterile vaginal examination to assess for umbilical cord prolapse.
B. Increase the rate of the continuous intravenous oxytocin infusion.
C. Turn the client onto their left side.
D. Administer oxygen at 2 L/min via nasal cannula.
Question 13
The nurse evaluates a client who just returned to the unit following a thyroidectomy. The client reports a
tingling sensation around the mouth and fingers. Which action is the priority for the nurse to perform?
A. Assess the client's surgical dressing for signs of hemorrhage or bleeding.
B. Check the client for Chvostek's sign and Trousseau's sign.
C. Support the client's head and neck with pillows to prevent hyperextension.
D. Administer the prescribed oral analgesic for surgical incisional pain.
Question 14
A client with a closed head injury is monitored in the intensive care unit. The nurse notes that the
client's intracranial pressure (ICP) has risen from 12 mmHg to 24 mmHg. Which nursing intervention
is appropriate to help decrease the ICP?
