NCLEX practice test
Free NCLEX practice test
The charge nurse receives reports on four clients at the start of the shift. All require nursing intervention. Using the ABC prioritization framework, which client should be seen first?
The nurse is beginning the evening shift on a medical unit. Drag each client to the correct priority level based on current assessment data.
Drag each item to the correct category.
Drag an option into place, or select it and then choose where it goes.
The charge nurse is assigning priority levels at the start of the shift. For each client finding, select the priority tier that best applies using the ABCs framework.
For each row, select one option.
| Finding | Intervene now | Routine care | Assess within 15 min |
|---|---|---|---|
| Client receiving blood transfusion who develops sudden back pain, hematuria, and fever | |||
| Client post-appendectomy day 2 requesting scheduled oral analgesic for pain rated 4/10 | |||
| Client with pneumonia: SpO2 dropped from 95% to 87% on room air over the past 20 minutes | |||
| Client with heart failure: mild ankle edema unchanged, SpO2 95% on room air, no dyspnea |
The nurse is reviewing the pre-operative chart for a client scheduled for a right inguinal hernia repair. Read the following informed consent note and click to highlight every phrase that contains a deficiency requiring correction before the procedure can proceed.
Click to highlight the 4 findings representing errors or rights violations.
Informed consent obtained by Dr. Halvorsen for left inguinal hernia repair. Client verbally confirmed understanding of the procedure and stated he had no further questions. Consent form signed by client. Witness signature: R. Ng, RN. Date of consent: blank. Time of consent: blank. Interpreter services not documented despite the client's primary language being Portuguese. Risks discussed: bleeding, infection, and anesthesia reaction. The client was alert and oriented at the time of consent.
A 68-year-old client is recovering from a left-hemisphere stroke with residual right-sided weakness. The client reports difficulty bathing, dressing, and preparing meals independently.
Which referral should the nurse initiate first?
During a home health visit, a nurse notices bruising in various stages of healing on an 80-year-old client with dementia. The client's adult child is the sole caregiver and denies any injury.
Which action should the nurse take?
A nurse is preparing to care for a client admitted with influenza.
Which personal protective equipment is required before entering the room?
A nurse is applying sterile gloves using open technique.
After donning the first glove, the nurse's next correct action is which of the following?
A 74-year-old client with Parkinson's disease is admitted for medication adjustment. The client has a Morse Fall Scale score of 75 and has experienced two freezing episodes during ambulation today.
Which safety device intervention is the priority?
A chemical plant explosion releases a toxic gas cloud. Twelve workers arrive at the emergency department simultaneously. One worker is unconscious with no spontaneous breathing after airway repositioning and no palpable pulse. A second worker is confused, breathing at 28 breaths per minute, with an SpO2 of 88%.
Using START triage, which classification is correct for these two clients?
During a busy shift, the nurse manager asks the RN to orient a first-day student nurse to the unit and allow the student to perform a physical assessment independently on one of the RN's assigned clients. The RN's client load is heavy and the RN is unable to directly supervise the student. Which response by the RN is most appropriate?
A 67-year-old client with atrial fibrillation and an implanted pacemaker inserted 3 years ago is scheduled for a non-urgent brain MRI to evaluate cognitive decline. The client states the cardiologist said the pacemaker "should be fine" for MRI.
Which action by the nurse is most appropriate before the MRI is performed?
A nurse is caring for an immunocompromised client post-allogenic stem cell transplant. The physician orders protective (reverse) isolation. While preparing to enter the room, the nurse notes a new visitor wearing fresh street clothes and no mask.
What is the nurse's most appropriate next action?
The RN is about to delegate wound irrigation for a clean surgical wound to an LPN. As the RN reviews the task, which finding should cause the RN to reconsider the delegation?
A client on long-term prednisone abruptly stopped 5 days ago. Now: BP 74/46, HR 118, Na+ 128, K+ 5.8, glucose 48 mg/dL, fever 38.9°C.
What is the priority treatment?
Which cues are relevant to this client's current presentation?
Select all that apply.
For each finding, identify the category it most closely represents.
| Finding | Sign/Symptom of Toxicity | Risk Factor for Toxicity | Unrelated Finding |
|---|---|---|---|
| Yellow-green visual halos | |||
| Serum potassium 3.2 mEq/L (hypokalemia) | |||
| CKD stage 3 (reduced renal clearance) | |||
| Bradycardia with irregular rhythm | |||
| Concurrent furosemide use | |||
| Client's temperature 37.0°C |
Which statement best describes the mechanism of action of digoxin?
Place the nurse's actions in the correct order of priority, from first to last.
Drag an option into place, or select it and then choose where it goes.
For each potential action, identify whether it is appropriate, contraindicated, or non-essential at this time.
| Finding | Contraindicated | Appropriate | Non-Essential |
|---|---|---|---|
| Hold the digoxin dose | |||
| Administer the scheduled digoxin dose as ordered | |||
| Obtain a stat ECG to assess for dysrhythmias | |||
| Administer IV potassium replacement per protocol | |||
| Administer an additional PRN dose of furosemide | |||
| Arrange a dietary consult for future meal planning |
Complete the evaluation note by selecting the correct option for each blank.
Six hours after digoxin was held and potassium repletion began, the client's serum potassium is 4.0 mEq/L and heart rate is 68/min and regular. The visual disturbances have resolved. The nurse determines the client's response to treatment is . The repeat digoxin level is 1.4 ng/mL, which is now the therapeutic range. The provider will digoxin dose once renal function is reassessed.
A 4-hour-old term neonate undergoes the first bath in the transition nursery. Prior to bathing, the nurse notes a rectal temperature of 36.1°C (97.0°F), respiratory rate of 48, heart rate of 136, and SpO2 of 97%. The infant's skin is covered in thick vernix caseosa. The mother asks to have the vernix wiped off completely since it looks 'dirty.' The student nurse prepares a basin of warm water for a full immersion bath.
Which nursing action reflects the most current evidence-based newborn bathing practice?
A 45-year-old woman with no personal history of cancer presents for a routine wellness visit. Her family history includes a mother diagnosed with breast cancer at age 38 and an aunt (maternal) diagnosed with ovarian cancer at age 52. The client has never had genetic counseling. She asks the nurse when she should begin mammography screening, stating, 'My friend said I don't need to start until 50 like everyone else.'
Which nursing response is most accurate?
A 65-year-old man with a 25-pack-year smoking history (quit 8 years ago) presents for a wellness visit with no prior cancer screening since age 45
Select the screening recommendations that are current, evidence-based, and appropriate for this client.
Select all that apply.
The nurse is caring for four postoperative clients in the surgical unit. Which client is the priority for immediate assessment?
A 26-year-old woman presents for a routine visit. Her BMI is 23 kg/m², within normal range. She reports recurrent episodes, at least twice weekly for the past 4 months, of consuming large quantities of food within a 2-hour period with a sense of loss of control, followed by self-induced vomiting and laxative misuse. She denies any period of significant weight loss or fear of normal body weight, and expresses intense guilt and shame after each episode.
What is the most likely diagnosis?
A nurse is participating in mass casualty triage following a building collapse. A 28-year-old victim is found unconscious (GCS 3) with absent radial pulse and no spontaneous respirations even after the airway is repositioned. A 45-year-old victim nearby is conscious, alert, and ambulatory with a closed femur fracture and HR 108. A 52-year-old has a tension pneumothorax with absent breath sounds on the left and tracheal deviation.
Under START triage, which client receives the BLACK tag?
The adult son of a 78-year-old man actively dying from end-stage heart failure approaches the hospice nurse in the hallway and states, 'I already feel like he’s gone. I’ve been crying for weeks before anything has even happened. Is something wrong with me? Am I grieving for someone who isn’t even dead yet?' The client is alive, minimally responsive, and expected to die within 24–48 hours.
Which nursing response most accurately names the diagnosis and normalizes its mechanism?
A 72-year-old woman with osteoarthritis of both knees and mild left-sided weakness from a prior CVA is being discharged home with a standard walker. Her home has three entry steps without a railing. During discharge teaching, her daughter asks the nurse, 'How should my mother go up and down those steps with the walker?'
Which nursing instruction is most accurate for this situation?
A nurse is preparing to insert a peripheral IV in a 7-year-old boy scheduled for a tonsillectomy. He is tearful and tells his mother, 'I don't want the needle because it's going to hurt forever.' His mother asks whether anything can be done beyond just doing it quickly. The child life specialist is unavailable.
Which combination of comfort measures most accurately reflects evidence-based pharmacologic and nonpharmacologic procedural pain management for a school-age child?
A 66-year-old man underwent a transurethral resection of the prostate (TURP) 8 hours ago and has a three-way indwelling urinary catheter with continuous bladder irrigation (CBI) running at 100 mL/hour. The nurse notes the drainage bag output is 80 mL over the past hour and the irrigant inflow is confirmed patent. The client reports increasing suprapubic pressure and appears restless. The drainage is dark pink with visible clots at the catheter tip.
What is the most likely cause of this presentation?
A 62-year-old woman with type 2 diabetes and peripheral neuropathy reports foot pain she describes as 'burning, electric-shock-like jolts that happen even when nothing touches my feet, and sometimes the bed sheet touching my skin is unbearable.' She rates the pain 7/10 and reports it is worse at night, disrupting sleep. Her fasting glucose has been consistently between 180–220 mg/dL. Ibuprofen provides minimal relief.
What is the most likely diagnosis, and what is the primary cause?
A 29-year-old woman at 10 weeks gestation presents to the obstetric clinic with severe first-trimester nausea and vomiting. Her OB provider has recommended dietary modifications and small frequent meals, but nausea remains 8/10 and is affecting her ability to work. She prefers to avoid medication during the first trimester and asks the nurse about non-pharmacologic options. The nurse mentions acupressure. The client asks which specific acupressure point is most studied for nausea and vomiting.
Which nursing response is most accurate?
A 44-year-old woman with hyponatremia (serum sodium 118 mEq/L) is admitted for correction. The primary health care provider prescribes 3% hypertonic saline at a controlled rate. Her serum sodium rises from 118 to 134 mEq/L over the first 6 hours of the infusion and her mental status initially improves. Three days later she develops new confusion, headache, and reports her vision is 'going blurry.'
What complication has most likely occurred, and what is its primary cause?
A 68-year-old man is admitted from the ED for community-acquired pneumonia. During medication reconciliation, the admitting nurse reviews his home medication list provided by his wife, which includes: lisinopril 10 mg daily, atorvastatin 40 mg nightly, metformin 1000 mg twice daily, apixaban 5 mg twice daily, and omeprazole 20 mg daily. The ED physician has prescribed azithromycin 500 mg IV daily and ceftriaxone 1g IV daily. The nurse notices that apixaban is not included in the admission prescriptions.
Which nursing action most accurately reflects medication reconciliation standards?
Which cues are relevant to this client's presentation?
Select all that apply.
For each finding, identify the category it most closely represents.
| Finding | Consistent with DKA | Compensatory Response | Not Directly Related to DKA |
|---|---|---|---|
| Blood glucose 486 mg/dL | |||
| Kussmaul respirations | |||
| Serum bicarbonate 10 mEq/L | |||
| Heart rate 118/min | |||
| Positive serum ketones | |||
| Temperature 37.2°C |
Place the nurse's actions in the correct order, from first to last.
Drag an option into place, or select it and then choose where it goes.
For each potential action, identify whether it is appropriate, contraindicated, or non-essential at this time.
| Finding | Non-Essential | Contraindicated | Appropriate |
|---|---|---|---|
| Initiate isotonic IV fluids immediately | |||
| Begin insulin infusion before fluid resuscitation is started | |||
| Hold insulin infusion until potassium is confirmed above 3.3 mEq/L | |||
| Administer sodium bicarbonate routinely for all DKA | |||
| Monitor blood glucose and electrolytes hourly | |||
| Schedule outpatient endocrinology follow-up |
For each finding, identify whether it is more consistent with starvation ketosis, diabetic ketoacidosis (DKA), or both.
| Finding | Starvation Ketosis | Diabetic Ketoacidosis | Both |
|---|---|---|---|
| Blood glucose markedly elevated (>250 mg/dL) | |||
| Blood glucose within normal to mildly low range | |||
| Positive serum and urine ketones | |||
| Severe dehydration from osmotic diuresis | |||
| Mild dehydration from decreased oral intake | |||
| Absolute insulin deficiency |
Complete the evaluation note by selecting the correct option for each blank.
After 6 hours of fluid resuscitation and insulin infusion, the client's blood glucose is 210 mg/dL, arterial pH is 7.32, and serum bicarbonate is 18 mEq/L. Potassium remains stable at 4.2 mEq/L. The nurse determines the client's metabolic status is . The insulin infusion rate will be per protocol as glucose approaches target, and the team will plan to to subcutaneous insulin once the anion gap has closed.
A 58-year-old man with hypertension and type 2 diabetes has been taking lisinopril 10 mg daily for 6 months. He presents to the clinic reporting a persistent dry, non-productive cough for the past 8 weeks. He denies fever, chest pain, or dyspnea at rest. His lung exam is clear and SpO2 is 99%. He previously tried OTC cough suppressants without relief. His BP is 128/78 mmHg and his last eGFR was 64 mL/min/1.73m².
What is the most accurate explanation for the cause of this symptom?
A 71-year-old woman on warfarin 5 mg daily for mechanical heart valve replacement has a routine INR of 4.8 (therapeutic target 2.5–3.5 for mechanical valve). She has no active bleeding, and her last dose was taken this morning. She reports starting clarithromycin 500 mg twice daily 4 days ago for a respiratory infection. She asks, 'Should I just take half my dose tonight to bring the number down?'
Which nursing response is most accurate?
A 58-year-old woman with gram-negative bacteremia is receiving gentamicin 5 mg/kg IV once daily (extended-interval dosing). She is on day 9 of therapy and reports new onset bilateral tinnitus and a sensation that 'sounds seem muffled' over the past 2 days. Her serum creatinine has remained stable at 1.0 mg/dL throughout treatment. Her gentamicin trough level today is <1 mg/L (within target).
What is the most likely cause of this presentation?
A 68-year-old man with COPD and a 40-pack-year smoking history is admitted for an acute exacerbation. His arterial blood gas results on 2L nasal cannula are: pH 7.32, PaCO2 58 mmHg, HCO3 31 mEq/L, PaO2 54 mmHg, SaO2 84%. His baseline ABG from 6 months ago showed: pH 7.36, PaCO2 52 mmHg, HCO3 29 mEq/L.
What is the most accurate interpretation of today's ABG in context of his baseline?
A 58-year-old man with decompensated cirrhosis and large-volume ascites undergoes paracentesis with drainage of 7 liters of ascitic fluid. No albumin infusion was ordered or administered. Six hours later, the nurse assesses him and finds: BP dropped from 122/74 to 88/52 mmHg, HR 112 bpm, urine output 18 mL over the past 2 hours, serum creatinine rising from 1.1 to 1.8 mg/dL, and the client reporting dizziness on sitting up.
What is the most likely diagnosis and cause?
An 84-year-old man with advanced dementia is admitted from a nursing home. He is minimally verbal and unable to request water independently. His skin turgor is poor, mucous membranes are parched, and urine specific gravity is 1.032. Labs return: sodium 158 mEq/L, BUN 48 mg/dL, creatinine 1.6 mg/dL (baseline 1.0 mg/dL), serum osmolality 336 mOsm/kg. He is not on any diuretics and has no history of diabetes insipidus. His fluid intake record from the nursing home shows 280 mL over the past 24 hours.
What is the most likely cause of his hypernatremia?
A 52-year-old woman with a small bowel obstruction has been on continuous low nasogastric suction for 3 days, with 1,800–2,200 mL of gastric drainage daily. Her morning labs return: sodium 132 mEq/L, potassium 3.0 mEq/L, chloride 88 mEq/L, bicarbonate 34 mEq/L, pH 7.52 (venous). She reports muscle cramping and tingling in her hands.
What is the most likely diagnosis caused by prolonged nasogastric suction?
A client who is 8 hours postoperative from a thyroidectomy reports perioral numbness and tingling of the fingers, and the serum calcium is 6.6 mg/dL. Select the actions indicated for this finding.
Select all that apply.
Match each device alarm or finding to the MOST appropriate immediate nursing action.
| Finding | Increase pacemaker output | Manually bag-ventilate | Apply 100% O2 via NRB |
|---|---|---|---|
| Ventilator high-pressure alarm with SpO2 drop to 82% | |||
| TCP spikes without consistent QRS capture | |||
| SpO2 98% in confirmed carbon monoxide exposure | |||
| Ventilator disconnection with client distress | |||
| Cherry-red skin, HR 118, confusion post-house fire |
A post-op day 2 client develops sudden pleuritic chest pain, SpO₂ drops to 87%, HR 122, and RR 28.
What is the most likely diagnosis?
A 74-year-old type 2 diabetic presents: glucose 920 mg/dL, serum osmolality 362 mOsm/kg, Na+ 148, no ketones, pH 7.38.
What distinguishes this from DKA?
A 48-year-old with septic shock develops bilateral pulmonary infiltrates, PaO₂/FiO₂ ratio of 88, and PCWP of 10 mmHg. The client is having difficulty breathing with diffuse bilateral crackles. The client is resistant to oxygen therapy via NRB mask. The client shows no signs of obstructed pulmonary arteries.
What is the most accurate diagnosis and mechanism?
Minutes after a kidney is reperfused in the OR, the surgical team notes the graft becomes mottled, cyanotic, and non-functional immediately. No urine output occurs.
What is the mechanism of this irreversible event?
A post-cardiac surgery client in the ICU has SvO₂ of 48% on PA catheter monitoring. CO is 3.1 L/min and hemoglobin is 7.2 g/dL.
What is the most accurate interpretation and priority intervention?
Which cues are relevant to this delegation concern?
Select all that apply.
For each finding, identify the category it most closely represents.
- Scope of Practice Violation - the finding describes the act itself, or its repetition, performed outside the UAP's legal scope. - Client Safety Concern - the finding is not itself an act outside the UAP's scope, but it leaves the client at ongoing risk and changes what the nurse must do now. - Not Directly Relevant - the finding is background context about the circumstances or the outcome so far and does not change the nurse's required response.
For each row, select one option.
| Finding | Client Safety Concern | Scope of Practice Violation | Not Directly Relevant |
|---|---|---|---|
| UAP administered a medication without licensure to do so | |||
| No nursing assessment was performed prior to administration | |||
| This occurred repeatedly over two shifts | |||
| The client experienced no adverse effects this time | |||
| The UAP remains assigned to this client and is unaware that medication administration is outside her scope | |||
| The unit is currently short-staffed |
Place the nurse's actions in the correct order, from first to last.
Drag an option into place, or select it and then choose where it goes.
For each potential action, identify whether it is appropriate, contraindicated, or non-essential at this time.
| Finding | Appropriate | Contraindicated | Non-Essential |
|---|---|---|---|
| Immediately stop the UAP from administering further medications | |||
| Allow the practice to continue since no harm has occurred | |||
| Assess the client for any effects of the unsupervised administration | |||
| Report the incident to the nurse manager per facility policy | |||
| Terminate the UAP without following facility disciplinary procedures | |||
| Schedule a full unit staffing review for next quarter |
Which actions should the nurse take now?
Select all that apply.
Complete the evaluation note by selecting the correct option for each blank.
Following the incident, the nurse manager meets with the UAP to reinforce scope-of-practice boundaries, and a mandatory delegation competency review is scheduled for all UAPs on the unit. Two weeks later, chart audits show no further instances of medication administration by UAP staff. The nurse determines that the corrective action has been . This situation illustrates that the licensed nurse retains for tasks that are delegated, and that ongoing of delegated tasks is an essential nursing responsibility.
A nurse on a busy medical unit is administering heparin subcutaneously to a client with a history of hepatitis C. No sharps container is available in the client's room. After withdrawing the needle, the nurse attempts to recap the needle and sustains an injury to the left thumb. The needle had been used on the client.
Select up to 2 causes (left), 1 potential condition (middle) and up to 2 actions (right).
Drag an option into place, or select it and then choose where it goes.
Complete the statement about therapeutic communication techniques using the word bank. Select one option per blank.
When a client expresses hopelessness, restating their underlying feeling back to them is called while asking 'What do you mean by that?' is an example of . Telling a client 'Don't worry, everything will be fine' is a non-therapeutic technique known as .
A child weighing 18 kg is prescribed amoxicillin 45 mg/kg/day by mouth, divided into three equal doses. The oral suspension is supplied as 250 mg per 5 mL. How many millilitres should the nurse give for one dose?
A nurse is preparing to transfuse a unit of packed red blood cells. Which action is the priority immediately before the transfusion is started?
A client scheduled for a mastectomy tomorrow says quietly, "I suppose there is no point worrying, everyone says I will be fine." Which response by the nurse is most therapeutic?
A nurse is teaching parents the order in which fine motor skills typically emerge during the first 18 months.
Place the skills in the order a child usually achieves them, from earliest to latest.
Drag an option into place, or select it and then choose where it goes.
A 22-year-old client with type 1 diabetes is admitted with 2 days of vomiting. Blood glucose is 486 mg/dL, arterial pH 7.18, bicarbonate 12 mEq/L, anion gap 24, serum potassium 5.4 mEq/L, and there are large ketones in the urine. Respirations are deep and rapid at 32 per minute and the breath has a fruity odour.
Complete the diagram: select 2 contributing factors, 1 potential condition, and 2 actions to take.
Drag an option into place, or select it and then choose where it goes.
A client is 6 hours postpartum following a vaginal birth. Review the assessment note below.
Highlight the 4 findings that require immediate nursing intervention.
Postpartum assessment, 1400
Temperature 37.2°C (99.0°F). Blood pressure 152/98 mmHg. Heart rate 92. Respiratory rate 18.
Fundus boggy and displaced two fingerbreadths above the umbilicus and to the right. Lochia rubra, saturating one perineal pad in 20 minutes with several small clots. Perineum intact with a small first-degree laceration, edges approximated, mild edema.
Client reports a headache described as dull and frontal, and cramping with breastfeeding. Bladder palpable above the symphysis pubis; has not voided since the birth. Breasts soft and non-tender, colostrum expressed. Homans sign negative, calves soft and non-tender bilaterally. Ambulated to the bathroom once without dizziness.
Complete the teaching note by selecting the correct option for each blank.
A client is starting warfarin after a deep vein thrombosis. The nurse explains that the effect of warfarin is monitored using the , and that it takes several days to reach a therapeutic effect because the drug acts by rather than by inactivating clotting factors already in the circulation. The client should be taught to keep intake of consistent from week to week rather than avoiding it entirely.
