NCLEX Practice Questions Red
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A patient with suspected ulcers is scheduled for a diagnostic gastroscopy. During the insertion of the scope the patient experiences a vasovagal response. The nurse should expect all except:
The patient is given atropine before the procedure.
The patient’s pupils become dilated.
A patient has an increase in gastric secretions.
The patient has a decrease in heart rate.
Question 1 Explanation:
Rationale: Stimulation of the vagus nerve does not dilate the pupils.
A patient presents to the emergency room with the following symptoms: Anxiety, dyspnea, rhonchi, fever, Oxygen saturation of 88%, and a pH of 7.21. The nurse realized that the patient suffering from:
Question 2 Explanation:
Rationale: One of the key symptoms of respiratory distress syndrome is the inability of the respiratory system to exchange gases, resulting in respiratory acidosis.
A patient has a chest tube placement post right thoracotomy. During assessment the nurse expects all of the following findings except:
Use of accessory muscles with respirations.
Water level in the chamber rises and falls with each respiration.
Chest drainage flows into the first chamber.
Evaluate tidaling by disconnecting chest tube from wall suction.
Question 3 Explanation:
Use of the accessory muscles is an abnormal finding that could indicate air in the pleural sac.
The AIDS virus can be transmitted under specific conditions and through infected bodily fluids except:
Question 4 Explanation:
Rationale: Feces is correct because it is the only answer mentioned in this question that is a bodily fluid but does not transmit the HIV virus.
Which ethical principle is the nurse utilizing when supporting the decision of a client to terminate chemotherapy treatments?
Question 5 Explanation:
Rationale: The ethical principle supported in this situation represents the client’s autonomy or right to make his/her own decisions.
Which element legally defines the nursing scope of practice for nursing?
Hospital standards of care
Nurse Practice Acts
Professional nursing organizations
Question 6 Explanation:
Rationale: The State Practice Acts help determine the legal nursing scope of practice for nurses in each state.
During the initial 24 hours after an above-the-knee amputation, the nurse performs which priority action to properly manage the surgical site?
Elevate the residual limb
Loosen the dressing every 4 hours
Maintain the residual limb in a dependent position
Change the dressing as often as needed
Question 7 Explanation:
Rationale: Elevating the limb during the first 24 hours facilitates venous return, decreases swelling and promotes comfort.
A client has had an open reduction internal fixation (ORIF) of the right hip two days ago. There is a Jackson-Pratt (JP) suction device for drainage at the site and staple sutures which are open to air. Which assessment finding needs to be reported to the provider immediately?
Absence of draining into the Jackson-Pratt
Bright red drainage from the suture site
A temperature of 98.0F
Pain scale rating of 6 out of 10
Question 8 Explanation:
Rationale: Bright red drainage from the suture site indicates that hemorrhage is occurring and must be reported immediately to the surgeon.
The charge nurse has assigned a client with an open burn wound to the licensed practical nurse (LPN). Which instruction should the charge nurse give to the licensed practical nurse (LPN)?
Administer a tetanus toxoid vaccine as ordered
Assess wounds for signs of infection
Tell the client cough and breathe deeply
Perform hand washing upon entering room
Question 9 Explanation:
Rationale: Hand washing is the most effective for preventing infection transmission especially with a burn client.
A client develops a loud, brassy cough after a burn. What ordered intervention by the nurse is a priority?
Administer oxygen as ordered
Give the client small quantities of ice chips to suck on
Request an order for an antitussive agent
Tell the respiratory therapist to give the client humidified oxygen
Question 10 Explanation:
Rationale: Brassy cough and wheezing signs seen of inhalation injury. The first action by the nurse is to administer oxygen.
A patient who is receiving lovastatin [Mevacor] experiences chest pain. CK level is 580 units/mL (CK-MM 99%) and troponin T 0.02 g/mL. Which organ is a priority for the nurse to monitor?
Question 11 Explanation:
Rationale: Troponin and CK-MM are specific to the heart.
Which laboratory result would increase the risk of Torsades?
Potassium 3.4 mEq/L
Potassium 5.4 mEq/L
Sodium 132 mEq/L
Magnesium 1.0 mEq/L
Question 12 Explanation:
Rationale: Normal Mg is 1.5-2.5 mEq/L. Low magnesium levels increases the risk of Torsades a ventricular dysrhythmia.
What effects of angiotensin-converting enzyme (ACE) inhibitors most often results in the provider changing the treatment plan to an angiotensin receptor blocker [ARB]?
Nagging nonproductive cough
Question 13 Explanation:
Rationale: Due to the release of bradykinin , ACE Inhibitors cause a nagging, dry, hacking nonproductive cough.
The nurse is caring for a patient taking furosemide (Lasix). Which finding is most indicative of an adverse effect with this drug?
Na 136 mEq/L
Potassium 3.6 mEq/L
Chloride 98 mEq/L
Uric acid 15 mg/dL
Question 14 Explanation:
Rationale: Hyperuricemia is an adverse effect of furosemide [Lasix]. Uric acid levels are extremely elevated.
A patient arrives in the emergency department with severe chest pain. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
Blood pressure of 96/66 mm Hg
History of hepatitis
History of congestive heart failure
History of heart attack 1 year ago
Question 15 Explanation:
Rationale: Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease.
Which medication use by the client with a history of chronic kidney disease (CKD) requires further teaching?
Milk of magnesia (MOM)
Calcium phosphate (PhosLo)
Ascorbic acid (Vitamin C)
Question 16 Explanation:
Rationale: Pharmacokinetically, magnesium is excreted by the kidneys. A client with chronic kidney disease should not use any products containing magnesium.
Which medication can be used in a client with chronic kidney disease (CKD) to help stimulate red blood cell production?
Cobalamin (Vitamin B-12)
Question 17 Explanation:
Rationale: Erythropoietin controls red blood cell production. It is used to treat anemia as a result of diminished endogenous production of erythropoietin in clients with chronic kidney disease.
A client develops sudden onset dyspnea, a respiratory rate of 36 breaths per minute, and pink, frothy sputum. Which diuretic should the nurse anticipate administering as ordered?
Question 18 Explanation:
Rationale: The client is manifesting signs of pulmonary edema such as pink, frothy sputum, sudden onset difficulty breathing and rapid respiratory rate. The diuretic indicated is Furosemide (Lasix). Lasix is a potent loop diuretic used for rapid depletion of fluids.
Which laboratory diagnostic is useful when evaluating improvement in kidney function for a client with acute kidney injury (AKI)?
Blood urea nitrogen (BUN) level
Glomerular filtration rate (GFR)
Serum creatinine level
Question 19 Explanation:
Rationale: GFR is the preferred diagnostic method for evaluating renal function.
Which menu items are good choices for a client on hemodialysis?
Egg white omelet, toasted plain bagel, and apple juice
Oatmeal with skim milk, half a banana, and coffee
Lentil soup, whole-grain toast, and whole milk
Swiss cheese sandwich, cream of broccoli soup, and orange juice
Question 20 Explanation:
Rationale: Egg white omelet provides high-quality protein, and the apple juice is very low in potassium.
All of the following effects on cardiac output ( CO) are true EXCEPT:
If the heart rate is decreased the cardiac output is decreased
If strove volume is increased the cardiac output is decreased
If there is a decrease in preload the stroke volume will be decreased
If the afterload is decreased there is an increase in cardiac output
Question 21 Explanation:
Rationale: When the stroke volume is increased, the cardiac output is increased.
Cardiovascular drugs whose typical actions block the sympathetic stimulation to the heart and decrease the heart hate are called?
Question 22 Explanation:
Rationale: Beta blockers such as propranolol (Inderal) target the beta cells in the heart thereby slowing it down.
The nurse notes spasms of the right hand while checking the client’s morning blood pressure. Which action should the nurse take?
Assess the blood pressure
Check the calcium level
Perform a neurovascular assessment
Notify the provider
Question 23 Explanation:
Rationale: Spasms of the hand during blood pressure read is indicative of a Trousseau sign which is manifested when the Calcium level is below 8.6 mEq/L.
A client on digoxin [Lanoxin] reports nausea, vomiting, and seeing yellow halos. Which laboratory finding should the nurse report immediately?
BUN 8 mg/dL
Magnesium 1.4 mEq/L
pH 7. 46
Potassium 3.2 mEq/L
Question 24 Explanation:
Rationale: The client on digoxin [Lanoxin] is at risk for digoxin toxicity as a result of hypokalemia. Toxicity is manifested by nausea, vomiting, abdominal cramps, anorexia and visual disturbances, such as halos.
The nurse is caring for a client after receiving burns to more than 40% of the body. Which laboratory result is a priority to report in the first 24 hours?
Serum glucose 115 mg/dL
Blood urea nitrogen 30 mg/dL
White blood count 10,000/mm3
Question 25 Explanation:
Rationale: The rate at which the glomerular filters [GFT] will be diminished in the first 24 hour in response to extensive burns along with shift in fluid status.
A nurse is taking the health history of a client. What information would she consider significant in regards to cardiovascular health?
A history of metastatic cancer
Frequent viral bronchitis
Use of calcium supplements
Use of recreational drugs
Question 26 Explanation:
Rationale: The use of recreational drugs, especially stimulants such as cocaine is a growing cause of heart irregularities.
A client diagnosed with acute pericarditis has a nursing diagnosis of pain related to pericardial inflammation. The appropriate nurse involvement would include:
Administering opioids every four hours as directed
Encouraging relaxation exercises such as deep breathing
Positioning the client on the left side with head elevated 20 degrees
Positioning the client in a Fowler position with an over-the-bed table to lean on
Question 27 Explanation:
Rationale: Relief from pericardial pain is often obtained by sitting up and leaning forward.
The American Nurses Association definition of nursing identifies which of the following activities that are in congruence with the Nurse Scope of Practice:
Explaining the danger involved in a surgical procedure
Discussing the risk of taking an investigational medication
Determining the amount of IV fluid replacement needed for a patient admitted after a motor vehicle accident
Contributing evidence to nursing research through nursing based studies on the effects of health policies on various cultural populations
Question 28 Explanation:
Rationale: All of the other options are not in the nurses’ scope of practice.
The nurse has made an error in documenting client care. Which appropriate action should the nurse take?
Draw a line through error, initial, date and document correct information
Document a late addendum to the nursing note in the client’s chart
Tear the documented note out of the chart
Delete the error by using whiteout
Question 29 Explanation:
Rationale: An error in documentation requires that the nurse draw a single line through the error, initial and date the line, then document the factual and correct documentation in the medical record.
The nurse on the day shift reports that the narcotic count is incorrect. What is the most appropriate nursing action?
Report discrepancy to nurse manager and pharmacy immediately
Report the incident to the local board of nursing
Do a recount with another staff nurse
Report the incident to the state nurses association
Question 30 Explanation:
Rationale: The nurse manager and pharmacy must be alerted immediately of any discrepancy in the narcotic count. These substances are regulated by the Drug Enforcement Agency. An incident report must also be completed.
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