Free NCLEX-RN practice test — 85 items incl. NGN case studies 🇺🇸

8 original practice questions written by Myndaq in the NCLEX-RN style. They are not taken from this mock paper or from official past papers. Try each one, then open the answer.

1. Question 1Management of CareOne correct answer

   After receiving the morning handoff report, a medical-surgical nurse plans the order of client assessments. Which client should the nurse assess first?

   1. A. A client 2 days after a total hip arthroplasty who rates pain as 6 on a 0-10 scale and whose next oral analgesic dose is due in 30 minutes
   2. B. A client with type 2 diabetes whose capillary blood glucose before breakfast is 188 mg/dL
   3. C. A client with community-acquired pneumonia who has become restless and has an SpO2 of 86% on 2 L/min oxygen by nasal cannula
   4. D. A client with chronic heart failure whose weight is 0.4 kg higher than yesterday
   Show answer and explanation

   Answer: C

   Use the ABCs: new restlessness with an SpO2 of 86% despite supplemental oxygen signals worsening hypoxemia, a breathing problem that can deteriorate quickly. This client needs assessment and intervention (positioning, oxygen adjustment per protocol, provider notification) before anyone else.

   The hip arthroplasty client has moderate, expected postoperative pain with a dose due soon; it matters but is not life-threatening. A pre-breakfast glucose of 188 mg/dL is above target and can be managed with the prescribed insulin plan. A 0.4 kg overnight gain is below the usual heart failure reporting threshold of about 1 kg (2.2 lb) in a day, so it calls for monitoring, not immediate action.

2. Question 2Safety and Infection ControlOne or more correct answers

   A client with a 6-week history of productive cough, night sweats and a cavitary lesion on chest x-ray is admitted with suspected pulmonary tuberculosis. Which actions should the nurse include in the plan of care? Select all that apply.

   1. A. Place the client in an airborne infection isolation room with negative pressure.
   2. B. Wear a fit-tested N95 respirator or higher-level respirator when entering the room.
   3. C. Keep the door to the client's room closed except when entering or leaving.
   4. D. Have the client wear a surgical mask if transport out of the room is necessary.
   5. E. Wear a surgical mask when entering the room to provide care.
   6. F. Assign the client to a semi-private room with another client on droplet precautions.
   Show answer and explanation

   Answer: A, B, C, D

   Tuberculosis is spread by droplet nuclei that stay suspended in air, so airborne precautions are required: a negative-pressure airborne infection isolation room, a closed door so air does not flow into the hallway, a fit-tested N95 (or higher) respirator for anyone entering, and a surgical mask on the client whenever leaving the room is unavoidable.

   A surgical mask worn by staff does not filter the tiny airborne particles, so it is not adequate protection. Sharing a room with another client, especially one on droplet precautions for a different infection, exposes both clients and breaks isolation requirements.

3. Question 3Pharmacological and Parenteral TherapiesType a numeric answer

   A client weighing 72 kg is prescribed a continuous heparin infusion at 18 units/kg/hour. The pharmacy supplies heparin 25,000 units in 500 mL of 5% dextrose in water. At what rate, in mL/hour, should the nurse set the infusion pump? Record your answer to one decimal place.

   Show answer and explanation

   Answer: 25.9

   Hourly dose: 18 units/kg/hour × 72 kg = 1,296 units/hour.

   Concentration: 25,000 units ÷ 500 mL = 50 units/mL.

   Rate: 1,296 units/hour ÷ 50 units/mL = 25.92 mL/hour, which rounds to 25.9 mL/hour on a pump programmed in tenths. A common error is forgetting to multiply by weight (giving 0.4 mL/hour) or inverting the concentration; heparin is a high-alert medication, so the calculation and pump settings should be independently double-checked.

4. Question 4Pharmacological and Parenteral TherapiesOne correct answer

   A 78-year-old client with heart failure takes oral digoxin 0.125 mg and furosemide 40 mg each morning. Before the morning medications, the client reports nausea, poor appetite and seeing yellowish rings around the lights. The apical pulse is 54/min and irregular. This morning's serum potassium is 3.1 mEq/L.

   Which action should the nurse take?

   1. A. Give the digoxin with breakfast to reduce the nausea.
   2. B. Withhold the digoxin and notify the health care provider.
   3. C. Give the furosemide as scheduled and recheck the potassium level in 4 hours.
   4. D. Encourage potassium-rich foods and give the digoxin as scheduled.
   Show answer and explanation

   Answer: B

   Anorexia, nausea, visual changes such as yellow halos and a slow irregular pulse are classic signs of digoxin toxicity. Hypokalemia (normal about 3.5 to 5.0 mEq/L) increases the heart's sensitivity to digoxin and the risk of dangerous dysrhythmias. The safe action is to hold the digoxin and report the findings so the provider can order a digoxin level and potassium replacement.

   Taking digoxin with food does nothing for toxicity. Giving the loop diuretic without direction would push the potassium lower. Dietary potassium works too slowly to correct a level of 3.1 mEq/L, and giving the digoxin would worsen the toxicity.

5. Question 5Physiological AdaptationOne or more correct answers

   A 67-year-old client is on postoperative day 2 after an open sigmoid colectomy. Admission weight was 76 kg.

   Nurses' notes, 0800: Last evening the client was alert and oriented to person, place and time. This morning the client is oriented to person and place only and keeps pulling at the oxygen cannula. Incisional pain is rated 4 on a 0-10 scale, unchanged from yesterday. The abdominal dressing has a small spot of serosanguineous drainage. Bowel sounds are hypoactive in all four quadrants and the client has not passed flatus. Skin is warm and flushed.

   Vital signs: temperature 38.9 °C (102.0 °F), heart rate 116/min, respiratory rate 26/min, blood pressure 88/52 mm Hg, SpO2 94% on 2 L/min by nasal cannula. The indwelling urinary catheter has drained a total of 55 mL over the past 3 hours.

   Which findings require immediate follow-up? Select all that apply.

   1. A. Temperature of 38.9 °C (102.0 °F)
   2. B. Blood pressure of 88/52 mm Hg
   3. C. Urine output of 55 mL over 3 hours
   4. D. New disorientation to time
   5. E. Small spot of serosanguineous drainage on the dressing
   6. F. Hypoactive bowel sounds with no flatus
   Show answer and explanation

   Answer: A, B, C, D

   Together, fever, hypotension, tachycardia, tachypnea, new confusion and low urine output point to sepsis with poor organ perfusion, possibly from an anastomotic leak. These findings need prompt escalation (rapid response or provider notification, cultures, fluids and antibiotics as ordered).

   Urine output is about 18 mL/hour (55 ÷ 3), below the minimum of 0.5 mL/kg/hour, which for 76 kg is 38 mL/hour. A systolic pressure under 90 mm Hg and an acute change in mental status are signs of hypoperfusion.

   A small amount of serosanguineous drainage is expected in the first 2 to 3 days after surgery. Hypoactive bowel sounds and no flatus on day 2 after bowel surgery are expected, because bowel function usually takes several days to return.

6. Question 6Reduction of Risk PotentialOne correct answer

   Ninety minutes after returning from a coronary angiogram in which the right femoral artery was used for access, a client is assessed by the nurse. Which finding should the nurse act on first?

   1. A. The client has needed to urinate several times since returning to the unit.
   2. B. The right foot is cool and pale, and the right dorsalis pedis pulse, strong before the procedure, cannot be palpated.
   3. C. The groin dressing is dry and intact, with a small area of bruising around the puncture site.
   4. D. Blood pressure is 138/84 mm Hg; before the procedure it was 132/80 mm Hg.
   Show answer and explanation

   Answer: B

   A cool, pale foot with a pulse that was present before the procedure and is now absent suggests arterial occlusion from a thrombus, embolus or hematoma compressing the vessel. Circulation to the limb is threatened, so the nurse should check the pulse with a Doppler, compare it with the left foot and notify the provider immediately.

   Frequent urination is expected because contrast dye causes an osmotic diuresis, and fluids are encouraged. A dry dressing with a small bruise is expected; only an expanding hematoma or bleeding would need action. A slight rise in blood pressure is not clinically significant.

7. Question 7Health Promotion and MaintenanceOne correct answer

   During a well-child visit, the nurse assesses a 6-month-old infant who was born at term. Which finding should the nurse report to the health care provider?

   1. A. The infant has not yet said any recognizable words.
   2. B. The infant shows marked head lag when pulled from lying to sitting.
   3. C. The infant cannot yet pull to a standing position.
   4. D. The infant picks up small objects with a raking motion rather than a pincer grasp.
   Show answer and explanation

   Answer: B

   Head lag should have disappeared by about 4 months of age. Marked head lag at 6 months suggests poor muscle tone or delayed motor development and needs further evaluation.

   The other findings are normal for this age. At 6 months infants babble, and first meaningful words usually appear around 12 months. Pulling to stand usually happens around 9 months. A raking grasp is typical at 6 to 7 months, and the pincer grasp develops around 9 to 10 months.

8. Question 8Psychosocial IntegrityOne correct answer

   A 22-year-old client admitted with major depressive disorder started sertraline 12 days ago. Staff report that the client, who had been withdrawn and tearful, now seems calm and cheerful and has given a favorite watch and several books to other clients on the unit.

   Which action should the nurse take first?

   1. A. Record the improved mood and encourage the client to join group activities.
   2. B. Ask the client directly whether they are thinking about killing themselves.
   3. C. Explain that sertraline usually takes several weeks to reach its full effect.
   4. D. Collect the client's remaining valuables and store them for safekeeping.
   Show answer and explanation

   Answer: B

   A sudden calm after deep depression, together with giving away valued possessions, is a warning sign that the client may have decided on a suicide plan. Early in antidepressant treatment, energy can return before mood improves, and young adults under 25 have a higher risk of suicidal thinking at this stage. Safety comes first, so the nurse should ask directly about suicidal thoughts, a plan and access to means. Asking directly does not put the idea in the client's head, and the answer guides the level of observation.

   Recording the change as improvement misses the risk. Teaching about how long the drug takes to work is accurate but not the priority. Storing valuables does not assess or reduce the risk of suicide.