NCLEX Reduction of Risk Potential Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Interpreting Laboratory Values | Which number, which action | 5 |
| Diagnostic Tests and Procedures | Before, during and after | 4 |
| Recognising Complications | The findings that mean act now | 4 |
| Vital Signs and Early Warning | Recognising deterioration before it declares itself | 3 |
| Tubes, Drains and Monitoring Devices | Chest tubes, nasogastric tubes and catheters | 3 |
| Perioperative Nursing | Preparation, positioning and recovery | 2 |
Item formats in this test: Multiple choice, Select all that apply, Fill in the blank. This is test 6 of 9 — there is one for every client-need category.
The 21 questions
A nurse reviews morning laboratory results. Which value requires the most immediate action?
Show answer and rationale
Correct answer: B. Potassium 2.6 mEq/L
A potassium of 2.6 mEq/L is critically low and predisposes the client to lethal dysrhythmias, particularly if they are also taking digoxin or a diuretic. It requires immediate reporting and replacement.
Why the other options are wrong
- A. A sodium of 133 is mildly low and warrants monitoring rather than immediate action.
- C. A haemoglobin of 11.2 is slightly low and rarely requires urgent intervention on its own.
- D. A creatinine of 1.3 is marginally elevated and is followed as a trend.
Following a lumbar puncture, which nursing action is most appropriate?
Show answer and rationale
Correct answer: A. Keep the client flat and encourage fluid intake
Lying flat and increasing fluid intake reduces the incidence and severity of post-lumbar-puncture headache, which results from continued cerebrospinal fluid leak and low pressure.
Why the other options are wrong
- B. Early ambulation increases the likelihood of a positional headache.
- C. Sitting upright lowers cerebrospinal fluid pressure at the puncture site and worsens headache.
- D. Fluids are encouraged, not restricted, to help replace cerebrospinal fluid volume.
When is the best time to teach a client about incentive spirometry for an elective surgery?
Show answer and rationale
Correct answer: A. In the pre-operative period before surgery
Teaching is most effective when the client is alert, comfortable and not in pain. Practising the technique before surgery means the client can perform it correctly when it matters most, in the first hours after anaesthesia.
Why the other options are wrong
- B. A client emerging from anaesthesia cannot retain new information.
- C. By the second day, preventable atelectasis may already have developed.
- D. Discharge teaching is far too late for a technique needed immediately after surgery.
Which laboratory value is most specific for myocardial injury?
Show answer and rationale
Correct answer: A. Troponin I
Troponin is a cardiac-specific contractile protein released when myocardial cells are damaged, making it the most specific and sensitive marker in current use.
Why the other options are wrong
- B. Myoglobin rises early but is released from any muscle, so it lacks specificity.
- C. Aspartate aminotransferase is found in liver, cardiac and skeletal muscle.
- D. The white cell count rises with any inflammation or infection.
A client returns to the unit after an upper gastrointestinal endoscopy with moderate sedation. Which action should the nurse take before offering fluids?
Show answer and rationale
Correct answer: A. Confirm the return of the gag reflex
A topical anaesthetic is used to suppress the gag reflex during upper endoscopy. Giving fluids before the reflex returns risks aspiration.
Why the other options are wrong
- B. Sitting ability relates to sedation recovery but does not protect the airway during swallowing.
- C. Orientation is important but does not confirm airway protection.
- D. Bowel sounds are relevant after abdominal surgery, not after upper endoscopy.
A client taking warfarin has an international normalised ratio of 6.4 and reports bleeding gums. Which prescribed medication should the nurse anticipate?
Show answer and rationale
Correct answer: B. Vitamin K
Warfarin blocks vitamin K dependent clotting factor synthesis. Vitamin K is the specific reversal agent for a supratherapeutic international normalised ratio with bleeding.
Why the other options are wrong
- A. Protamine sulfate reverses heparin, which is monitored with the activated partial thromboplastin time.
- C. Naloxone reverses opioids.
- D. Acetylcysteine is the antidote for acetaminophen overdose.
A client who is three days after hip replacement suddenly develops dyspnoea, pleuritic chest pain and a heart rate of 122 beats per minute. Which action should the nurse take first?
Show answer and rationale
Correct answer: A. Raise the head of the bed and administer oxygen
This presentation suggests pulmonary embolism. Raising the head of the bed and giving oxygen addresses the immediate hypoxaemia and is done while calling for help and arranging diagnostics.
Why the other options are wrong
- B. Diagnostic imaging is necessary but does not treat the immediate hypoxaemia.
- C. Breathing exercises are for atelectasis prevention and do not treat an embolism.
- D. Ambulating a client with a suspected embolism can dislodge further clot and worsen the situation.
A client with type 2 diabetes is scheduled for a computed tomography scan with iodinated contrast. Which nursing actions are appropriate? Select all that apply.
- AAsk about previous reactions to contrast or iodine
- BReview the serum creatinine
- CHold metformin as prescribed before and after the study
- DRestrict all fluids for 24 hours after the study
- EConfirm the client is not pregnant
Show answer and rationale
Correct answers: A. Ask about previous reactions to contrast or iodine; B. Review the serum creatinine; C. Hold metformin as prescribed before and after the study; E. Confirm the client is not pregnant
Contrast carries risks of allergic reaction and nephropathy, so allergy history and renal function are checked. Metformin is held because contrast-induced renal impairment raises the risk of lactic acidosis. Pregnancy status is confirmed before ionising radiation.
Why the other options are wrong
- D. Fluids are encouraged after contrast to promote excretion, not restricted.
Which set of vital signs most suggests early compensated shock in an adult?
Show answer and rationale
Correct answer: A. Heart rate 118, blood pressure 112/86, respirations 26, cool clammy skin
Tachycardia, a narrowed pulse pressure, tachypnoea and cool clammy skin describe compensation: the body maintains blood pressure by vasoconstricting and speeding the heart. Hypotension appears only when compensation fails.
Why the other options are wrong
- B. These are normal vital signs.
- C. Mildly elevated blood pressure with a normal heart rate does not suggest shock.
- D. A slightly low blood pressure with a normal heart rate and warm dry skin does not fit a compensating shock picture.
A nurse observes continuous vigorous bubbling in the water seal chamber of a client’s chest drainage system. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Check the tubing and connections for an air leak
Continuous bubbling in the water seal chamber indicates an air leak. The nurse first checks the system itself, tracing from the client to the drainage unit for loose connections or a dislodged dressing, before concluding the leak is from the client.
Why the other options are wrong
- A. Intermittent bubbling on expiration can be expected, but continuous vigorous bubbling is not.
- C. Clamping traps air in the pleural space and can cause a tension pneumothorax.
- D. Increasing suction does not fix a leak and may worsen air entrainment.
Which method most reliably confirms correct placement of a newly inserted nasogastric tube before first use?
Show answer and rationale
Correct answer: B. Radiographic confirmation
Radiographic confirmation is the standard for initial verification of a blindly inserted feeding tube, because it directly visualises the tip. Subsequent checks use pH testing and external markings.
Why the other options are wrong
- A. The air insufflation and auscultation method is unreliable and has been implicated in fatal misplacements.
- C. A client can speak with a tube in the airway, particularly a small-bore tube.
- D. The absence of coughing does not exclude airway placement, especially in a sedated or neurologically impaired client.
A client receiving chemotherapy has an absolute neutrophil count of 420 per cubic millimetre and a temperature of 38.3 degrees Celsius. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Notify the provider immediately
Fever in a severely neutropenic client is a medical emergency because the usual signs of infection are absent and sepsis can progress rapidly. Cultures and broad-spectrum antibiotics are needed urgently.
Why the other options are wrong
- A. Treating the fever masks the only sign of infection the client can mount and delays antibiotics.
- C. Supportive measures do not address a potentially life-threatening infection.
- D. Cooling does not treat the underlying infection.
A client reports new unilateral calf pain and the nurse notes warmth, redness and swelling of that leg. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Keep the client on bed rest and notify the provider
These findings suggest deep vein thrombosis. The leg is not manipulated, because dislodging clot can cause a pulmonary embolism. The provider is notified for imaging and anticoagulation decisions.
Why the other options are wrong
- A. Massage can dislodge a clot and cause an embolism.
- C. Ambulating before the diagnosis is established and anticoagulation started increases embolism risk.
- D. Passive movement of the affected limb carries the same risk as massage.
Which situations can produce an inaccurate pulse oximetry reading? Select all that apply.
- APoor peripheral perfusion with cold hands
- BDark nail polish on the finger being used
- CCarbon monoxide poisoning
- DClient movement or shivering
- EA client who is sleeping quietly
Show answer and rationale
Correct answers: A. Poor peripheral perfusion with cold hands; B. Dark nail polish on the finger being used; C. Carbon monoxide poisoning; D. Client movement or shivering
Pulse oximetry depends on detecting a pulsatile signal through tissue. Poor perfusion, nail polish and motion all interfere with the signal, and carbon monoxide binds haemoglobin in a way the sensor reads as oxygenated, producing a falsely high value.
Why the other options are wrong
- E. Quiet sleep provides ideal conditions for an accurate reading.
When should the nurse draw a vancomycin trough level?
Show answer and rationale
Correct answer: B. Immediately before the next scheduled dose
A trough represents the lowest concentration in the dosing interval, which is immediately before the next dose. It is the value used to confirm the drug remains above the effective threshold without accumulating to toxic levels.
Why the other options are wrong
- A. Shortly after an infusion the level is near its peak, not its trough.
- C. A mid-interval level is neither a peak nor a trough and cannot be interpreted against reference ranges.
- D. Timing is what gives a drug level meaning; an untimed sample is uninterpretable.
Which items should be kept at the bedside of a client with a new tracheostomy? Select all that apply.
- AThe obturator for the tracheostomy tube
- BA spare tracheostomy tube of the same size
- CSuction equipment
- DA pair of sterile scissors to cut the ties
- EA spare tracheostomy tube one size smaller
Show answer and rationale
Correct answers: A. The obturator for the tracheostomy tube; B. A spare tracheostomy tube of the same size; C. Suction equipment; E. A spare tracheostomy tube one size smaller
The obturator is required to reinsert the tube. A same-size tube allows immediate replacement, and a smaller tube provides a fallback if the stoma has narrowed. Suction must be immediately available for secretions.
Why the other options are wrong
- D. Scissors near a tracheostomy risk cutting the tube or the client and are not part of the standard emergency setup.
A client’s blood pressure is 128 systolic while lying and 104 systolic after standing for two minutes. What is the drop in systolic pressure in millimetres of mercury? Record your answer as a whole number.
Show answer and rationale
Answer: 24
128 minus 104 equals 24 millimetres of mercury. A systolic drop of 20 or more on standing is a positive orthostatic finding and suggests volume depletion or medication effect.
Two hours after a femoral cardiac catheterisation, the nurse notes a rapidly expanding firm swelling at the insertion site. Which action should the nurse take first?
Show answer and rationale
Correct answer: A. Apply firm manual pressure above the insertion site and call for help
An expanding firm swelling indicates arterial bleeding into the tissue. Direct manual pressure above the puncture site controls the bleeding while help is summoned, and it is the only action that addresses the haemorrhage immediately.
Why the other options are wrong
- B. Elevating the head does not control arterial bleeding and may increase pressure at the site.
- C. Flexing the leg after femoral access encourages bleeding, which is why the leg is kept straight.
- D. Heat causes vasodilation and worsens bleeding.
A client with a newly applied fibreglass cast on the left forearm reports severe pain that has not improved after two doses of opioid analgesia, and pain worsens when the fingers are passively extended. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Notify the provider immediately and prepare for cast removal or bivalving
Pain out of proportion, unrelieved by opioids, and worsened by passive stretch is the classic early presentation of compartment syndrome. Pressure must be relieved urgently to prevent irreversible muscle and nerve damage.
Why the other options are wrong
- A. Elevating above heart level reduces arterial inflow and worsens ischaemia in compartment syndrome.
- C. Repeated analgesia delays recognition of a limb-threatening emergency.
- D. Movement increases pain and does not relieve the compartment pressure.
On the fourth day after abdominal surgery a client coughs forcefully and then reports that something has given way. The nurse finds a loop of bowel protruding through the incision. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Cover the area with sterile saline-soaked gauze and position the client with knees flexed
Evisceration is a surgical emergency. Covering the protruding tissue with sterile saline-soaked gauze prevents drying and further contamination, and flexing the knees reduces abdominal tension. The surgeon is called immediately.
Why the other options are wrong
- A. Never attempt to replace eviscerated tissue. It contaminates the abdomen and can damage the bowel.
- C. A tight binder over exposed bowel causes further injury.
- D. The client is kept nil by mouth in anticipation of emergency surgery.
Thirty-six hours after a femoral shaft fracture, a client becomes confused and dyspnoeic, and a petechial rash appears across the chest and axillae. Which complication should the nurse suspect?
Show answer and rationale
Correct answer: A. Fat embolism syndrome
Fat embolism syndrome typically appears 24 to 72 hours after a long bone fracture. The triad of respiratory distress, neurological change and a petechial rash over the chest and axillae is characteristic.
Why the other options are wrong
- B. Compartment syndrome causes severe local limb pain and neurovascular change, not a systemic petechial rash.
- C. Infection would present with fever and local wound findings over a longer course.
- D. Hypoglycaemia causes confusion but not dyspnoea with a petechial rash.
What to do with your score
A single 21-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
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