Free nclex rn exam practice questions

1. A nurse is caring for a client with pneumonia who suddenly becomes restless and confused. What is the priority action?

A. Administer antibiotics
B. Check oxygen saturation
C. Reassess temperature
D. Give antipyretics

✅ Answer: B — Check oxygen saturation
Restlessness/confusion = early hypoxia → assess O₂ first.

2. Which INR value requires immediate intervention for a client on warfarin?

A. 1.9
B. 2.5
C. 3.0
D. 5.8

✅ Answer: D — 5.8
Very high risk of bleeding.

3. A diabetic patient is sweaty, shaky, and hard to arouse. What should the nurse do FIRST?

A. Give orange juice
B. Obtain glucose level
C. Call rapid response
D. Administer insulin

✅ Answer: C — Call rapid response
Altered LOC = cannot swallow → treat as severe hypoglycemia.

4. Which assessment indicates digoxin toxicity?

A. Heart rate 54 bpm
B. BP 150/90
C. Dry cough
D. Weight gain

✅ Answer: A — HR 54 bpm
Digoxin toxicity → bradycardia + vision changes + GI symptoms.

5. A postoperative client has calf pain, warmth, and swelling. What should the nurse do FIRST?

A. Elevate leg
B. Massage calf
C. Notify provider
D. Apply heat

✅ Answer: C — Notify provider
Classic DVT signs → urgent.

6. Which client should the nurse see FIRST?

A. Asthma client with audible wheezing
B. HF with 2+ edema
C. Diabetes needing insulin
D. Hypertension BP 150/90

✅ Answer: A — Asthma client with wheezing
Airway always top priority.

7. A client receiving a blood transfusion develops back pain and chills. First action?

A. Slow transfusion
B. Stop transfusion
C. Call provider
D. Take vitals

✅ Answer: B — Stop transfusion
Possible hemolytic reaction.

8. Which diet instruction is correct for a client taking furosemide?

A. Avoid bananas
B. Increase potassium-rich foods
C. Limit calcium
D. Increase sodium

✅ Answer: B — Increase potassium foods
Loop diuretics waste potassium.

9. A COPD client on 6 L/min oxygen becomes drowsy. Priority action?

A. Continue oxygen
B. Increase oxygen flow
C. Reduce oxygen to 1–2 L/min
D. Encourage deep breathing

✅ Answer: C — Reduce oxygen
High O₂ → CO₂ retention → narcosis.

10. A client on heparin has which lab that requires immediate action?

A. Hemoglobin 13
B. Platelets 55,000
C. Potassium 4.1
D. aPTT 65 sec

✅ Answer: B — Platelets 55,000
Possible HIT (Heparin-Induced Thrombocytopenia).

11. A heart failure client gained 2 kg in 24 hours. What should the nurse do?

A. Encourage fluids
B. Notify provider
C. Increase activity
D. Give antidiuretics

✅ Answer: B — Notify provider
Significant fluid retention.

12. A child with asthma has difficulty breathing and a silent chest. Priority?

A. Give albuterol
B. Call rapid response
C. Give IV fluids
D. Notify parents

✅ Answer: B — Call rapid response
Silent chest = impending respiratory arrest.

13. What must the nurse do before giving digoxin?

A. Check apical pulse 1 minute
B. Check BP
C. Check bowel sounds
D. Ask about allergies

✅ Answer: A — Check apical pulse
Hold if < 60 (adult).

14. Continuous bubbling in the water seal chamber of a chest tube means:

A. Normal function
B. Air leak
C. Lung reinflation
D. Need more suction

✅ Answer: B — Air leak

15. A client on ACE inhibitors should be monitored for:

A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypokalemia

✅ Answer: A — Hyperkalemia
ACE inhibitors retain potassium.

16. Which finding requires immediate intervention for increased ICP?

A. Mild headache
B. Nausea
C. Unequal pupils
D. Restlessness

✅ Answer: C — Unequal pupils
Sign of brain herniation.

17. Which statement about levothyroxine is correct?

A. “I will take it at bedtime.”
B. “I will take it on an empty stomach.”
C. “I will stop it when symptoms improve.”
D. “I can take it with antacids.”

✅ Answer: B — Empty stomach
Take in the morning, 30–60 min before food.

18. A burn patient’s urine output is 15 mL/hr. What should the nurse do?

A. Increase IV fluids
B. Document
C. Encourage water
D. Check blood sugar

✅ Answer: A — Increase IV fluids
Low UO = inadequate perfusion.

19. A patient develops chest pain. First action?

A. Give morphine
B. Apply oxygen
C. Notify provider
D. Obtain ECG

✅ Answer: B — Apply oxygen
ABCs first.

20. A patient on morphine is difficult to arouse. Priority?

A. Call provider
B. Administer naloxone
C. Recheck vitals
D. Lower dose

✅ Answer: B — Administer naloxone
Opioid overdose antidote.