Free NCLEX Practice Questions

Rationale: Perioral tingling after a thyroidectomy suggests hypocalcemia from parathyroid injury. It can progress to tetany and laryngospasm, which threatens the airway. An SpO2 of 88-92% is often an acceptable target in COPD, and the pain and glucose findings are expected or non-urgent.

Rationale: UAP can collect routine vital signs on a stable client. Teaching, assessment, and evaluation require nursing judgment and stay with the RN.

Rationale: LPNs care for stable clients with predictable outcomes and can give scheduled subcutaneous medications. New admissions, the start of a blood transfusion, and initial teaching require RN assessment and judgment.

Rationale: TB spreads by airborne droplet nuclei. The client needs a negative-pressure (airborne infection isolation) room, and staff wear a fit-tested N95 respirator.

Rationale: C. difficile spores are not reliably killed by alcohol-based hand rub. Soap and water physically remove spores, and contact (enteric) precautions with a gown and gloves prevent spread.

Rationale: Bradycardia plus hypokalemia raises the risk of digoxin toxicity and dysrhythmias. Hold the dose and notify the provider. Hypokalemia increases digoxin's effect on the heart.

Rationale: Unfractionated heparin is titrated to the aPTT or anti-Xa level. PT/INR is used for warfarin. Also watch platelets for heparin-induced thrombocytopenia. The antidote is protamine sulfate.

Rationale: Vitamin K reverses warfarin. Protamine reverses heparin, naloxone reverses opioids, and flumazenil reverses benzodiazepines.

Rationale: Low sodium or dehydration raises lithium levels and causes toxicity, so intake should stay steady. GI loss and coarse tremor are signs of toxicity. NSAIDs raise lithium levels, and stopping abruptly risks relapse.

Rationale: Clear before cloudy: draw up regular insulin first so the regular vial is not contaminated with NPH. Air is injected into both vials, NPH first. Roll NPH gently; do not shake it.

Rationale: DKA causes severe dehydration from osmotic diuresis. Isotonic fluid resuscitation comes first, followed by an IV regular insulin infusion once potassium is known to be adequate.

Rationale: Continuous bubbling in the water seal chamber signals an air leak. Check connections from the dressing to the unit. Gentle intermittent bubbling or tidaling with breathing is expected. Prolonged clamping can cause a tension pneumothorax.

Rationale: A cool extremity with an absent pulse suggests arterial occlusion from a thrombus or hematoma. Notify the provider immediately. Minor bruising is expected, and the client can use a bedpan while on bed rest.

Rationale: Hypokalemia causes flattened T waves, prominent U waves, and ST depression. Peaked T waves and a sine-wave pattern are seen with hyperkalemia.

Rationale: Contrast can worsen kidney function. With impaired renal function, metformin raises the risk of lactic acidosis, so it is usually held around contrast studies. The provider needs this information before the scan.

Rationale: Cushing's triad (rising systolic BP with a widening pulse pressure, bradycardia, and irregular respirations) is a late sign of increased ICP and impending herniation.

Rationale: Sitting upright with the chin tucked helps protect the airway. Straws and thin liquids increase aspiration risk, and the client should stay upright for about 30 minutes after eating.

Rationale: Regular repositioning relieves pressure. Massaging reddened areas damages tissue, donut cushions reduce blood flow to the center, and a high head of bed increases shear on the sacrum.

Rationale: Toddlers engage in parallel play and build gross motor skills. Push-pull toys and large blocks fit that stage. Small pieces are a choking hazard.

Rationale: A firm fundus that is high and displaced to one side usually means a full bladder. A distended bladder can keep the uterus from contracting well. Have the client void, then reassess.

Rationale: Late decelerations reflect uteroplacental insufficiency. Stop the oxytocin, reposition the client to her side, give an IV fluid bolus, and notify the provider.

Rationale: Statements like this can signal suicidal intent. Asking directly and clearly about suicide is safe and necessary for assessment. The other responses dismiss the client, ask for justification, or change the subject.

Rationale: These are signs of alcohol withdrawal. Benzodiazepines such as lorazepam or chlordiazepoxide treat withdrawal symptoms and help prevent seizures. The others are for maintaining abstinence.

Rationale: Follow RACE: Rescue, Alarm, Contain (close doors), then Extinguish or Evacuate. Removing clients from immediate danger comes first.

Rationale: Use two identifiers, such as name and date of birth, confirmed against the wristband and the medication record. Room numbers and bed labels are not identifiers, and yes/no questions invite a wrong answer.

Rationale: Fever, tachycardia, hypotension, and a lactate of 4 or higher point to sepsis with tissue hypoperfusion (possible septic shock). An SpO2 of 97% and a glucose of 118 mg/dL do not need immediate action.

Rationale: This is opioid-induced respiratory depression. Naloxone reverses it. Monitor closely afterward, because naloxone can wear off before the opioid does.

Rationale: Use the rule of 15: give 15 g of fast-acting carbohydrate and recheck in 15 minutes. Glucagon or IV dextrose is for clients who cannot swallow safely.

Rationale: These are signs of an acute hemolytic reaction. Stop the transfusion first, keep the IV open with 0.9% saline through new tubing, notify the provider and blood bank, and return the blood bag and tubing.

Rationale: The provider explains the procedure and obtains consent. The nurse witnesses the signature, confirms the client is competent and not sedated, and notifies the provider if the client does not understand.

Rationale: Daily weights detect fluid retention early, and rapid gain should be reported. Sodium restriction limits fluid overload. Diuretics should be taken as prescribed.

Rationale: Examining the throat can trigger laryngospasm and complete airway obstruction in epiglottitis. Keep the child calm and upright, and have airway equipment ready.

Rationale: Measuring intake and output on a stable client is within UAP scope. Reinforcing teaching fits the LPN. Checking an incision is assessment, and explaining a new diet is initial teaching, both of which stay with the RN.

Rationale: pH is low (acidosis) and PaCO2 is high, so the cause is respiratory. HCO3 is normal, so the kidneys have not compensated yet. Hypoventilation from opioids retains CO2.

Rationale: pH is high (alkalosis) and PaCO2 is low from blowing off CO2, so it is respiratory. HCO3 is normal, so it is uncompensated. Coach slow breathing.

Rationale: pH is low and HCO3 is low, so it is metabolic acidosis. PaCO2 is low because the lungs are blowing off CO2 to compensate (Kussmaul respirations), but pH is still abnormal, so it is partially compensated.

Rationale: pH is high and HCO3 is high, so it is metabolic alkalosis from loss of gastric acid. PaCO2 is elevated as the lungs retain CO2 to compensate, but pH is still abnormal, so it is partially compensated.

Rationale: pH is normal but on the acidic side of 7.40. PaCO2 is high (respiratory acidosis) and HCO3 is high because the kidneys have retained bicarbonate. With pH back in range, it is fully compensated, a common baseline in COPD.

Rationale: Measles is spread by the airborne route. The child needs a negative-pressure room with the door closed, and staff wear N95 respirators.

Rationale: Pertussis is spread by respiratory droplets, so droplet precautions apply: a surgical mask when entering the room, plus standard precautions.

Rationale: Alendronate is poorly absorbed with food or calcium and can cause esophageal irritation. Take it on an empty stomach with plain water and stay upright for 30 minutes.