NCLEX Practice Questions — Set 6
How to use this set
Run it as a timed block rather than dipping in and out. 100 items at roughly a minute each is close to the pace the real exam asks for, and pacing is a skill that only improves under a clock. Answer every item before you open a single rationale — checking as you go turns a test into a reading exercise and hides the questions you were unsure about.
These sets are numbered rather than sorted by subject. The questions come from a general NCLEX bank that carries no topic field, and labelling them by eye would put a share of them under the wrong heading, so they are presented as mixed sets — which is how the exam itself arrives.
The 100 questions
In reviewing the laboratory and x-ray reports of an elderly client, which findings should a nurse identify as being consistent with a diagnosis of emphysema?
Show answer and rationale
Correct answer: B. Increased PCO2, increased hematocrit, and hyperinflated alveoli.
emphysema is an obstructive pulmonary disease that traps air in the alveoli. The gas exchange is impaired as CO2 increases. The body attempts to improve oxygenation by producing more red blood cells. There are immature RBCs that result in a more sluggish circulation.
When a nurse shines a penlight into an elderly client’s eyes to check pupil reaction, the nurse notes that one of the eyes is very cloudy and the pupil does not react. The nurse should:
Show answer and rationale
Correct answer: C. Check vision in the cloudy eye.
these are signs of cataracts, which can affect the client’s vision.
An elderly client with a history of congestive heart failure (CHF) and hypertension (HTN) had a hip prosthesis inserted. Blood pressure is 80/50 mm Hg; heart rate is 80; urine output is 15 mL during the last hour. The most appropriate nursing action would be to:
Show answer and rationale
Correct answer: B. Give NS 250 mL over 15 minutes, check vital signs (VS) and lung sounds.
the low blood pressure and low urine output suggest fluid volume deficit, which should be treated with normal saline. Although it is usual to expect tachycardia in clients with hypotension, it is likely that the CHF and HTN are being managed with a beta blocker, which prevents the reflex tachycardia. Due to the client’s age and heart problems, a small dose of normal saline should be given and evaluated.
Following general anesthesia for a hip replacement, an elderly client’s vital signs are: P: 80, R: 14, BP 110/78 mm Hg; O2 saturation is 100% on 40% mask; and pain is 2/10. The client is shivering and complains of being cold. The first nursing priority should be to:
Show answer and rationale
Correct answer: D. Apply warm blankets.
shivering increases oxygen consumption. Hypothermia associated with the perioperative period may cause arrhythmia, clotting problems, and impaired wound healing.
A 78-year-old client with CHF is being discharged home where his wife, who has chronic obstructive pulmonary disease (COPD), plans to care for him. The wife indicates that the family will help. The correct action by a nurse would be to:
Show answer and rationale
Correct answer: B. Offer to make referrals for community resources to assist the couple.
this action supports the client and wife in this decision.
A client with age-related hearing loss is complaining to a nurse about being frustrated with hearing difficulties. Which sound is most difficult for the client to hear?
Show answer and rationale
Correct answer: A. Young children talking.
higher pitched sounds typically made by children are more difficult to hear.
Which conditions increase the risk of the older adult client developing a decubitus ulcer? Select all that apply.
Show answer and rationale
Correct answer: D. Impaired circulation.
impaired circulation will lead to skin breakdown and a decubitus ulcer.
An older client complains of colored rings around the lightbulbs in the room. The correct response by a nurse would be:
Show answer and rationale
Correct answer: D. "Have you had your eyes checked for glaucoma?"
colored rings or halos are characteristic of glaucoma.
Which condition is most likely to cause chronic pain in an older adult?
Show answer and rationale
Correct answer: A. Osteoarthritis.
osteoarthritis is a common cause of chronic pain related to the aging process.
The care plan for an older adult with asthma, chronic obstructive pulmonary disease (COPD), and chronic anxiety should include: Select all that apply.
Show answer and rationale
Correct answer: D. Inhalation therapy and instruction about methods of conserving energy.
the actions are appropriate for the older adult and will improve ventilation.
Which sign/symptom in an older adult is most indicative of a urinary tract infection?
Show answer and rationale
Correct answer: B. Confusion.
by the time a UTI is diagnosed, the older adult may begin to show signs of urosepsis, with altered mental status.
A nurse should include the risk of developing vaginitis when teaching an older adult woman about:
Show answer and rationale
Correct answer: A. Prolonged antibiotic therapy.
antibiotic therapy alters the normal protective organisms and allows fungal or yeast infections to develop.
An elderly client, who underwent a total hip replacement 3 days ago, asks why "crossing my legs" is prohibited. The correct response by a nurse is based on the knowledge that:
Show answer and rationale
Correct answer: C. Adduction can cause dislocation of the prosthesis.
crossing the legs, or bringing the legs together, exerts pressure on the hip and increases the risk of dislocation.
An older adult with osteoarthritis reports pain, stiffness, and deformities of the fingers. Which nursing actions would be appropriate? Select all that apply.
Show answer and rationale
Correct answer: A. Application of cold packs.
cold or heat will help the pain, but not flexibility.
Which older adult client is at greatest risk of developing hypothermia?
Show answer and rationale
Correct answer: B. A client with a sedentary lifestyle.
the older client who is inactive is likely to have poor circulation and loss of subcutaneous fat.
A nurse is teaching an elderly client with right hemiplegia and severe speech impairment how to dress. An appropriate first step in the teaching would be to:
Show answer and rationale
Correct answer: D. Demonstrate the correct way to put on a shirt.
demonstration is the best approach to teaching this client.
To prevent injury, a nurse should advise an older adult who is taking tricyclic antidepressants to:
Show answer and rationale
Correct answer: A. Stand up slowly from sitting or lying positions.
tricyclic antidepressants cause orthostatic hypotension.
A nurse should monitor an older adult more closely for adverse reactions to medications if the client history includes:
Show answer and rationale
Correct answer: D. Hepatitis and glomerulonephritis.
drugs are detoxified by the liver or the kidney. The client would be at risk for adverse drug effects when the function of the liver or kidneys is impaired.
After reviewing an older adult client’s history, a nurse should include teaching about fall prevention if the client has been taking:
Show answer and rationale
Correct answer: C. Diphenhydramine (Benadryl).
Benadryl causes drowsiness.
While waiting to be seen in an emergency department (ED) for possible CHF, an elderly client with moderate dementia jumps up and says, "I have to go feed my chickens now." A triage nurse’s most appropriate response is:
Show answer and rationale
Correct answer: B. "Please tell us about your chickens."
unlike techniques used with the client who is mentally ill, the nurse would not attempt to orient the client with moderate or severe dementia to person, place, or thing.
To improve an older adult’s sense of security, a nurse should:
Show answer and rationale
Correct answer: B. Review comforting memories using reminiscence.
focusing on longterm memory helps maintain self-worth and self-esteem in the client.
A healthy, older adult client complains of dry, itchy skin. The correct response by the nurse is:
Show answer and rationale
Correct answer: D. "Take fewer baths, use soap sparingly, and apply lotion afterward."
this response will lessen the dryness and relieve the itching.
A 90-year-old client’s condition is one of lethargy, poor capillary perfusion, and urinary incontinence. These findings should indicate to a nurse that this client is at greatest risk for:
Show answer and rationale
Correct answer: D. Skin breakdown.
all of the conditions are risk factors for skin breakdown-inactivity, poor circulation, and skin wet from urine.
An 80-year-old client complains of sleeping less and awakens several times during the night. The client takes acetaminophen at bedtime and does not drink caffeine. Which response by a nurse is most appropriate?
Show answer and rationale
Correct answer: D. Tell the client that the sleeping pattern is a normal age-related change.
the older adult does experience changes in sleeping. It is important to rule out any pathological patterns.
Assessment of an older adult with pneumonia will often reveal: Select all that apply.
Show answer and rationale
Correct answer: A. Anorexia and changes in behavior.
the signs of pneumonia are more subtle and subjective and are related to developing sepsis.
A 73-year-old client is admitted for rehabilitation after a mild stroke. The client complains of not feeling rested, begins to nap during the day, and sleeps only 4 to 5 hours nightly. The most appropriate nursing action is to:
Show answer and rationale
Correct answer: D. Assess the client’s sleep-wake cycle to determine necessary interventions.
these are strategies to promote better sleep.
An 87-year-old man, who has been living independently, is entering a nursing home. To help him adjust, the most effective action is to:
Show answer and rationale
Correct answer: C. Suggest that he bring his favorite things from home to make his room seem familiar.
it is important to create a familiar environment.
When preparing to perform discharge teaching with an older adult client, which nursing actions will facilitate learning? Select all that apply.
Show answer and rationale
Correct answer: C. Involving family members in the teaching sessions.
family members provide a source for reinforcement as well as valuable assessment information about the client’s living situation and learning needs.
In preparing a health education presentation for older adults, a nurse should keep in mind that:
Show answer and rationale
Correct answer: A. Older adult learners need more than a single teaching session.
a single teaching strategy is rarely adequate. Learning takes time. Follow-up sessions are important to building confidence in the client and to assess the effectiveness of prior teaching.
Which statement by the family caregiver of an older woman with incontinence requires teaching by a nurse?
Show answer and rationale
Correct answer: D. "It is too bad incontinence occurs with aging."
incontinence is not a normal consequence of aging. Age-related changes in the urinary tract predispose the older client to incontinence, but incontinence is a symptom of many possible disorders-not just aging.
A 63-year-old client is returning home after being hospitalized for injuries received during a home invasion and robbery. Although neighborhood robberies are rampant, the client has lived in the same house for 50 years and does not want to move. The client receives a monthly social security check in the mail. The most appropriate action by a home health nurse would be to: Select all that apply.
Show answer and rationale
Correct answer: C. Advise the client to have the social security check deposited directly to the bank.
removing the target (the Social Security check) reduces the risk. Answer 3 is correct because a dog will likely deter a robber.
A nurse in a senior adult day care program observes that the participants have long toenails, corns, calluses, and other problems indicating a need for foot care. What is a nurse’s correct action?
Show answer and rationale
Correct answer: C. Schedule podiatry services at the site after a class on foot care.
ideally foot care should be provided by podiatric care providers. The service is covered by insurance.
The incidence of tuberculosis in the older adult is significantly increased among individuals who:
Show answer and rationale
Correct answer: A. Reside in institutions.
the spread of the infection increases in crowded, close living conditions since TB is spread from person to person by airborne transmission- droplets from talking, coughing, sneezing, laughing, or singing.
The daughter of a client with Alzheimer’s disease becomes frustrated when talking to her father. What should a nurse suggest to improve communication?
Show answer and rationale
Correct answer: C. Answer his questions simply even if the question is asked repeatedly.
the client with Alzheimer’s disease typically has lost short-term memory. Understanding of the father’s disease will decrease the daughter’s frustration.
Which suggestion would be most accurate for a nurse to make to the family of a client who has Alzheimer’s disease?
Show answer and rationale
Correct answer: B. Avoid getting upset in front of the client.
if the family becomes upset and angry, the client’s agitation and anxiety will likely increase.
A family member asks a nurse about possible treatments for Stage III Alzheimer’s disease (AD). Which statement by the nurse is correct?
Show answer and rationale
Correct answer: D. The risks of herbals, such as ginkgo biloba, are greater than any benefit.
families are often desperate to find a treatment, and there may be serious side effects. They need to discuss alternative therapies with the physician.
Which assessment findings are consistent with a diagnosis of Alzheimer’s disease (AD)? Select all that apply.
Show answer and rationale
Correct answer: A. Remote and recent memory impairment.
there is recent and remote memory impairment, as well as anomia, agnosia, and aphasia.
A 76-year-old client with hypertension, type 2 diabetes, and a known allergy to seafood is scheduled for a cardiac catheterization. Which orders should a nurse recognize as appropriate for this client? Select all that apply.
Show answer and rationale
Correct answer: C. Administration of methylprednisolone (Solu-Medrol).
antihistamines (Solu-Medrol) may be ordered before the procedure because of the known allergy to seafood.
A home health nurse is visiting an older client. The client asks the nurse about splitting the simvastatin tablet that has been ordered. Which response should client teaching include?
Show answer and rationale
Correct answer: C. Wash and dry the tablet-splitting device after each use.
if splitting can be done, an approved device should be used. Clean between usages.
A home health nurse is making a follow-up visit to an older adult following discharge from a hospital. Which action by the nurse is most important regarding medication administration in the home setting?
Show answer and rationale
Correct answer: A. Provide comprehensive teaching.
effectiveness of the discharge orders will depend on the client understanding the regimen.
A nursing priority when administering a blood transfusion is to:
Show answer and rationale
Correct answer: C. Infuse blood slowly the first 20 minutes.
a hemolytic reaction will most likely occur during the first 20 minutes.
Blood sugar management for a client who has type 2 diabetes with nausea and decreased appetite should include:
Show answer and rationale
Correct answer: C. Continuing insulin even if the client is vomiting.
during illness the cells still need insulin. Failure to give it will likely put the client into a hyperosmolar, if nonketotic state (type 1 diabetes is more likely to cause ketoacidosis). Since the client will not be eating very much, the insulin dose may be reduced, and it is hard to predict by how much. Clients with diabetes need to prepare a "sick day strategy," which will include checking blood sugar, and possibly ketone level, more frequently.
Which finding indicates that epoetin alfa (Epogen) has been effective?
Show answer and rationale
Correct answer: C. Hematocrit of 33%.
epoetin alfa (Epogen) stimulates the development of red blood cells (RBCs). It is given to anemic clients to increase hematocrit (Hct).
A nurse should locate and remove a client’s clonidine patch if:
Show answer and rationale
Correct answer: B. The blood pressure is 80/50 mm Hg.
clonidine is an alpha-2 receptor stimulator, working at the presynaptic receptor of the sympathetic nervous system. Thus, it reduces the output of norepinephrine and is used to treat hypertension. If the BP is too low, antihypertensive medications should not be given. It is important for the nurse to remember that drugs in patches are in a constant state of "being given," and the patch would need to be removed.
Managing a sodium level of 120 in a client with diabetic ketoacidosis is correctly accomplished with:
Show answer and rationale
Correct answer: D. Insulin and 0.9% sodium chloride.
high blood sugar increases the osmolarity of the blood and stimulates the body to secrete antidiuretic hormone (ADH) to help the kidneys to retain free water, which dilutes the sodium. Obligate diuresis from the osmotic action of sugar in the tubules of the kidneys forces water and sodium loss even though the client is dehydrated. Clients in diabetic ketoacidosis need fluid replacement with normal saline and insulin to return the blood sugar to a normal level.
The correct time for a nurse to administer pancrelipase (Pancrease) is:
Show answer and rationale
Correct answer: A. With meals.
this medication is replacing enzymes that would be released by the pancreas in response to food intake. Taking it with meals stimulates the normal pancreatic activity and helps with the digestion of proteins, starches, and fats.
Before administering furosemide (Lasix), a nurse should verify that:
Show answer and rationale
Correct answer: C. The potassium is over 4 mg/dL.
this diuretic will cause potassium to be lost in the urine. Clients receiving furosemide often need K+ replacement.
One hour after starting the insulin drip at 10 units/hr, the client’s blood sugar has fallen from 899 to 750. Which action should a nurse take?
Show answer and rationale
Correct answer: C. Decrease the insulin drip rate to 7 units/hr.
rapid reduction in blood glucose reduces serum osmolarity and may shift fluids into cells, causing cerebral edema. The blood glucose should not fall by more than 15% an hour. Slow the insulin infusion rate.
Which IV fluid order is most appropriate for a client on dialysis?
Show answer and rationale
Correct answer: C. D5 1 /2NS at 20 mL/hr.
clients on dialysis should receive minimal fluids and no potassium, since these agents cannot be removed until the next dialysis treatment.
Teaching for a client starting on spironolactone (Aldactone) should include:
Show answer and rationale
Correct answer: C. The purpose of this drug is to prevent fibrosis in the heart.
spironolactone has antiproliferative effects and prevents fibrotic remodeling of heart tissue. It is the only diuretic that reduces mortality in heart failure.
A nurse should hold administration of a nitrate if:
Show answer and rationale
Correct answer: A. Blood pressure is less than 90/50 mm Hg.
nitrates are potent vasodilators. This reduces the venous return, cardiac output, and BP. The drug should be held if the BP is too low.
A client has a blood pressure of 145/83 mm Hg and an ejection fraction of 50%. Before discharge from the hospital, the client will need instructions on taking which drug(s)?
Show answer and rationale
Correct answer: B. A beta blocker and an ACE inhibitor.
the ejection fraction is low, indicating a problem with cardiac output. The ejection fraction of a healthy heart is 60% to 70%. Beta blockers and ACE inhibitors reduce morbidity and mortality in heart failure.
A client with a sexually transmitted infection (STI) is to receive azithromycin. Before the medication is given, which nursing assessment is a priority?
Show answer and rationale
Correct answer: D. Ask the client about allergies.
clients should always be questioned about allergies before medications are administered.
Which intervention would most likely prevent nausea in a client receiving cisplatin chemotherapy?
Show answer and rationale
Correct answer: B. Administering dexamethasone and ondansetron prior to chemotherapy.
there is often specific matching of nausea treatments and chemotherapeutic agents. Nausea is better prevented than treated by giving the antiemetic before the chemotherapy.
The most important nursing assessment to make before a client is started on indomethacin is:
Show answer and rationale
Correct answer: B. Asking if there is a history of sulfa allergies.
a side effect of indomethacin is gastrointestinal bleeding. This risk is greater in clients with history of GI bleeding.
A client, who is postoperative, has the anesthetic bupivacaine infusing into an epidural catheter for pain control. On assessment, a nurse notes the client has decreased sensation and numbness in the lower abdomen. The pain level is 3/10. The nurse should:
Show answer and rationale
Correct answer: D. Record this expected finding.
bupivacaine blocks neuron transmission, numbing tissue and reducing pain. This is the desired effect and the data should be recorded.
A client who is postoperative needs to walk, but even turning in bed is very painful. A patient-controlled analgesia (PCA) pump is set with a lock-out of 6 minutes. A nurse notes 45 attempts to get medication and 2 injections received in the last 2 hours. The correct nursing action is to:
Show answer and rationale
Correct answer: A. Teach client how and why to use the pump more effectively.
with lock-out of 6 minutes, the client could have received 20 injections over the last 2 hours, yet only received 2. The high pain level will prevent the client from engaging in health promoting activities: 45 attempts indicates that the client wants more medicine. Teaching is required to help the client spread out the attempts.
A client is due to receive Novolog insulin. When should it be administered?
Show answer and rationale
Correct answer: A. 15 minutes before the meal.
the "log" ending indicates this drug is one of the insulin analogues. Very small changes in the amino acid sequence facilitate rapid absorption of this drug.
A client with a duodenal ulcer has been taking sucralfate (Carafate). Which statement by the client would be a priority for a nurse to address?
Show answer and rationale
Correct answer: B. "I don’t like the taste, so I mix it in pudding."
Carafate should be given alone 30 to 60 minutes before mealtime. It is activated by stomach acid and coats a stomach ulcer.
A nurse is concerned that a client may be at risk for oversedation from opioid therapy using a patient-controlled analgesia pump. The most reliable assessment for possible oversedation would be to check:
Show answer and rationale
Correct answer: B. The level of carbon dioxide in the blood using capnography.
opioids will depress ventilation, causing a buildup of carbon dioxide in the blood. If hypoventilation is present, measuring the level of carbon dioxide is the most reliable indication of possible respiratory depression. Capnography measures breath by breath the level of CO2 and is most often used during anesthesia, in critical care, and in emergency medicine to prevent respiratory depression. If capnography is not available with the client who is on PCA, monitoring the client’s respiratory rate and depth and assessing sedation levels is essential.
For optimal effects from thrombolytic therapy given for a brain attack (cerebrovascular accident [CVA]), treatment should be given:
Show answer and rationale
Correct answer: A. Within 3 hours of the onset of symptoms.
administration of therapy within 3 hours decreases the size of the stroke and improves client outcome.
What observation should indicate to a nurse that the therapeutic effect of calcium gluconate has been achieved?
Show answer and rationale
Correct answer: D. Trousseau’s sign is absent.
Trousseau’s sign is present with hypocalcemia. The carpal spasm will not occur if treatment has been effective.
Which common systemic side effect of chemotherapy will a nurse note in an oncology client?
Show answer and rationale
Correct answer: B. Leukopenia.
chemotherapy causes myelosuppression (depression of bone marrow function). WBCs, RBCs and platelets are decreased.
Which order by a physician should a nurse question?
Show answer and rationale
Correct answer: D. A client with COPD who is prescribed metoprolol (Lopressor).
beta blockers (metoprolol) cause bronchoconstriction. Note that the client already has a respiratory problem.
Which prescribed drugs would a nurse most likely give the client for respiratory stridor, with wheezing, and hypotension after a bee sting? Select all that apply.
Show answer and rationale
Correct answer: A. Epinephrine.
subcutaneous epinephrine is the first line of treatment. Clients with bee sting allergies should carry an EpiPen.
During cardiopulmonary resuscitation (CPR) for ventricular fibrillation, which drug would an RN most likely prepare first?
Show answer and rationale
Correct answer: C. Epinephrine.
epinephrine (adrenalin) is a first-line drug used during CPR to stimulate cardiac activity.
A nurse should teach a client with angina about the common side effects of nitroglycerin, including: Select all that apply.
Show answer and rationale
Correct answer: B. Headache.
the vasodilating effect of the drug causes increased cerebral blood flow and headache.
The cardiac glycosides are essential in the therapy of a client with a myocardial infarction (MI). What should indicate to a nurse that a therapeutic response to this medication has been achieved?
Show answer and rationale
Correct answer: A. Diminished crackles in the lungs.
improved cardiac contractions will increase cardiac output. Crackles would be heard if heart failure were present.
To prevent a common adverse effect of prolonged use of phenytoin sodium (Dilantin), a client should be instructed to:
Show answer and rationale
Correct answer: D. Report gum swelling or bleeding to the physician.
gingival hyperplasia is a noninflammatory enlargement of the gingiva from an increase in normal cells. Good dental hygiene may reduce the swelling.
A client is being discharged and instructed to take furosemide (Lasix) every morning. A nurse tells the client to notify the health provider in the event of:
Show answer and rationale
Correct answer: B. Leg cramps.
leg cramps could indicate excessive loss of potassium.
A client is planning a cruise and wants to use the scopolamine patch. Which frequent side effect should a nurse tell the client to expect?
Show answer and rationale
Correct answer: C. Dry mouth.
scopolamine has the same effects as atropine, which is used to dry secretions preoperatively.
A nurse instructs a client about taking an angiotensinconverting enzyme (ACE). The client should be warned to continue therapy even when which common side effect occurs?
Show answer and rationale
Correct answer: D. A dry, persistent cough.
a dry cough might be annoying, but would not place the client at increased risk for injury or debilitation.
Which solution will a client most likely receive for fluid replacement in the first 24 hours after a burn injury that covers a large area?
Show answer and rationale
Correct answer: D. Lactated Ringer’s.
a crystalloid, such as lactated Ringer’s, will correct the volume deficit, sodium loss, and metabolic acidosis that is present in the client with burns.
A client is to receive oxycodone for acute pain. Adverse effects of opioid analgesics include: Select all that apply.
Show answer and rationale
Correct answer: B. Constipation.
opioids do affect the GI tract. Constipation will persist even with long-term use of opioids.
The treatment for a client suffering from hypovolemic shock following extensive burns will focus on controlling fluid loss and replacing fluid volume. A nurse should expect the client with burns to receive solutions that expand volume. To pull fluid from the interstitial spaces, which solutions should the nurse prepare? Select all that apply.
Show answer and rationale
Correct answer: C. Hespan (hetastarch).
this solution is classified as a hypertonic volume expander, pulling fluids from the tissues.
During a blood transfusion, a client reports a throbbing headache, chills, and nausea. What ordered drugs should a nurse prepare for administration? Select all that apply.
Show answer and rationale
Correct answer: B. Sodium bicarbonate.
the client is experiencing hemolytic shock and sodium bicarbonate will be needed to reverse metabolic acidosis.
Upon discharge from a hospital, teaching for a client with osteoporosis about proper administration of calcium supplements should include:
Show answer and rationale
Correct answer: D. Taking calcium with vitamin D to increase absorption.
400 to 800 IU of vitamin D is needed a day for proper absorption and metabolism of calcium.
A common symptom for Sjogren’s syndrome, an autoimmune disorder in women, is dry eyes. A client asks a nurse what she can do for relief. Which suggestion given by the nurse would be correct for initial treatment?
Show answer and rationale
Correct answer: C. Use artificial tears 3 to 4 times a day.
overthe-counter artificial tears are effective for dry eyes initially.
Epidural analgesia has been started for a client who is experiencing chronic pain that is unrelieved by other methods. Proper positioning of the client should include: Select all that apply.
Show answer and rationale
Correct answer: B. Side-lying, semi-Fowler’s.
the client’s head is elevated, which prevents the analgesia from affecting the respiratory muscles.
The correct nursing actions when administering a vesicant chemotherapeutic agent are to: Select all that apply.
Show answer and rationale
Correct answer: B. Assess the site for swelling, redness, or presence of vesicles.
these are local signs of tissue damage from infiltration of a vesicant, which causes blistering or necrosis with infiltration.
A client reports unexplained weight loss and palpitations. Assessment findings include: exophthalmos, tachycardia, decreased thyroid-stimulating hormone (TSH), and increased triiodothyronine (T3) and thyroxine (T4). Which treatments would be most appropriate for this client? Select all that apply.
Show answer and rationale
Correct answer: C. Radioactive iodine.
radioactive iodine is an appropriate drug treatment for hyperthyroidism.
A client with diabetes is admitted with symptoms of diabetic ketoacidosis. Which type of insulin IV should a nurse expect to administer?
Show answer and rationale
Correct answer: D. Regular.
regular insulin is the only form of insulin that can be given IV.
Which combination of insulins, if ordered, should a nurse question?
Show answer and rationale
Correct answer: A. Lantus and Lispro.
when Lantus is mixed with other insulins, it is rendered useless. Lantus is a long-acting insulin with no peak.
When drawing up two different insulins in one syringe, which insulin should a nurse draw up first?
Show answer and rationale
Correct answer: D. Lispro.
Lispro is a rapid-acting insulin and should always be drawn up first, to avoid contaminating the bottle of the fast-acting insulin with intermediate- or slow-acting insulin.
When administering nitroglycerin to a client for chest pain, a nurse knows that a second dose can be safely given in:
Show answer and rationale
Correct answer: B. 5 minutes.
following the first dose, a second or third dose can be given in 5-minute intervals.
A client is to start on an enteral tube feeding. What should a nurse do to make this as comfortable as possible for the client?
Show answer and rationale
Correct answer: B. Start the tube feeding slowly.
giving the feeding too fast could upset the client’s stomach and cause diarrhea.
A physician orders furosemide (Lasix) for a client. What should a nurse tell the client to expect if the medication is having the desired effect?
Show answer and rationale
Correct answer: A. More frequent urination.
the drug is a diuretic and there should be an increase in frequency and volume of urine if furosemide is working.
When administering a beta blocker, a nurse should first:
Show answer and rationale
Correct answer: D. Take the client’s blood pressure and heart rate.
a beta blocker can decrease blood pressure and heart rate to unsafe levels.
Maintaining the infusion rate of total parenteral nutrition (TPN) is a nursing responsibility. If the infusion rate is too rapid, which side effects would the nurse observe?
Show answer and rationale
Correct answer: A. Increased blood pressure and hyperglycemia.
TPN is a high-glucose and hyperosmolar solution that would result in increased vascular volume.
An older client complains that, in the past, some analgesics have caused urinary retention and constipation. Which analgesic should a nurse tell the client would not cause those problems?
Show answer and rationale
Correct answer: D. Meperidine.
meperidine produces less constipation. However, all opioids used in the management of pain can cause constipation.
A client weighing 70 kg has received 10 mg of morphine sulfate (MS) IM for pain rated at 5/10 postappendectomy. Which outcome should a nurse expect?
Show answer and rationale
Correct answer: C. Moderate pain will be relieved for 4 hours.
without any further client information, this is an appropriate dosage for relief of moderate pain.
A nursing student asks an RN why clients who have had myocardial infarctions (MIs) should receive medications intravenously rather than intramuscularly. The best response by the RN would be:
Show answer and rationale
Correct answer: C. "Tissue perfusion is poor and venous return is diminished following an MI, which affects results."
drug effectiveness would be less predictable with the change in perfusion.
A client with a history of alcohol abuse returns to a postanesthesia care unit (PACU) following abdominal surgery. A nurse knows pain management may be more difficult because of:
Show answer and rationale
Correct answer: C. Possible drug tolerance requiring higher dosages to produce desired effects.
the client will likely need a higher dose because alcohol is a CNS depressant. The client will have developed a drug tolerance to a standard does of pain medication.
A client, who is gravida 6, para 4, has blood drawn for routine prenatal first-trimester laboratory work. Upon reviewing the client’s laboratory results, which result should a nurse consider within normal limits for this stage of pregnancy?
Show answer and rationale
Correct answer: B. Hemoglobin of 11 gm/dL.
blood volume increases by 30% to 50% in pregnancy. This causes hemodilution of RBCs and physiological anemia. Normal hemoglobin levels in pregnancy range from 11 to 12 gm/dL.
A client, who is gravida 1, para 0, is admitted with a diagnosis of severe preeclampsia. A nurse starts the client on intravenous magnesium sulfate. For which expected side effect should the nurse closely observe the client?
Show answer and rationale
Correct answer: A. Hypersomnolence.
hypersomnolence (excessive sleepiness) is an expected side effect not associated with magnesium toxicity, an unexpected side effect related to a high serum level.
A client, who is gravida 5, para 3, requests epidural anesthesia to relieve the discomfort of labor. After placement of her epidural and a loading dose of medication, which assessment should be a nurse’s priority?
Show answer and rationale
Correct answer: B. Checking the client’s blood pressure.
checking the client’s blood pressure is most important with epidural anesthesia.
A client, who is gravida 2, para 1, is at 42 weeks’ gestation with gestational diabetes that is controlled with diet. A physician orders an intravenous infusion of oxytocin for the induction of labor due to postdates pregnancy. When caring for the client who is receiving intravenous oxytocin, the nurse should monitor for:
Show answer and rationale
Correct answer: A. Fetal bradycardia.
oxytocin administration can be associated with tetanic contractions and inadequate resting period between contractions, resulting in fetal bradycardia.
A client, who is gravida 2, para 1 at 14 weeks gestation, has a routine ultrasound that shows no fetal cardiac motion. Which medication should a nurse anticipate being ordered for this client?
Show answer and rationale
Correct answer: D. Misoprostol (Cytotec).
this client has a fetus that has died. Cytotec is an appropriate treatment for inducing delivery of a fetal demise.
A client, who is gravida 1, para 0 with severe preeclampsia, has been on a magnesium sulfate infusion at 2 gm/hr for the past 6 hours. Her recent assessment reveals a blood pressure 150/88 mm Hg, pulse 88, respirations 16, 1+ deep tendon reflexes, with 80 mL of urinary output during the past hour. Which action should a nurse take?
Show answer and rationale
Correct answer: B. Continue the infusion of magnesium sulfate and monitor the client’s blood pressure.
the assessment findings are normal for this client; continuing the infusion is the appropriate action for the nurse.
A client is having severe pain in the lower back and left leg. The client has sensation in all extremities, but is not moving the left leg. While waiting for a diagnostic x-ray, the client asks for pain medication. The correct response by the nurse would be to:
Show answer and rationale
Correct answer: B. Request order for an opioid to achieve maximum relief.
pain needs to be treated immediately and maximally, to avoid potential complications such as shock.
What to do with your score
Score the set, then spend longer on the review than you did on the questions. For every item you missed, decide which of three things went wrong: you did not know the fact, you misread what the item was asking, or you knew the fact and still chose second-best. Those need three different fixes — content review, slower reading, and priority-framework practice — and lumping them together is why question banks stop working for people.
Read the rationale on the items you got right as well. Arriving at the correct option for the wrong reason is common, and it does not survive a harder version of the same question.
More NCLEX practice and review
Everything on this site tagged NCLEX lives in the NCLEX category.
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