NCLEX-PN Practice Test.
Free practice exam — 159 quality-checked questions, instant feedback.

1. A client is recovering from a chest tube placement for a pneumothorax. The nurse notices continuous vigorous bubbling in the water seal chamber. What does this finding most likely indicate?

• A. The client's lung has fully re-expanded.
• B. The suction level is set too low.
• C. The chest tube system is functioning normally.
• D. There is an air leak in the chest tube system that requires further assessment.

2. A nurse is reinforcing teaching for a client newly prescribed phenytoin for seizure control. Which instruction should the nurse include regarding oral care?

• A. Use only very hot water when rinsing the mouth to reduce medication residue.
• B. Avoid brushing teeth entirely while taking this medication.
• C. Maintain consistent oral hygiene and report any gum swelling or bleeding, as phenytoin can cause gingival hyperplasia.
• D. Phenytoin has no effect on oral tissue and no special oral care is needed.

3. A nurse is giving a change-of-shift report on an assigned client. Which information is most important to include?

• A. The client's complete medical history from previous admissions
• B. Recent changes in the client's condition and any assessments or treatments still pending
• C. Routine tasks that were completed exactly as scheduled
• D. The nurse's personal opinion of the client's family dynamics

4. A licensed practical nurse is caring for a client newly admitted with a diagnosis of major depressive disorder. The client states, "I don't see the point in any of this anymore." Which is the nurse's PRIORITY action?

• A. Document the statement and continue with the admission assessment
• B. Reassure the client that things will improve with treatment
• C. Notify the client's family of the statement
• D. Directly ask the client whether they are thinking about harming themselves

5. A client experiencing an acute panic attack is hyperventilating and states they feel they are "going to die." Which nursing intervention is MOST appropriate initially?

• A. Stay with the client and use a calm, reassuring voice with short directions
• B. Encourage the client to discuss the underlying cause of the anxiety
• C. Provide detailed teaching about the physiology of anxiety
• D. Leave the client alone to reduce external stimulation

6. A nurse is caring for a client who recently lost a spouse and says, "I keep setting the table for two out of habit." Which response by the nurse is MOST therapeutic?

• A. "You'll feel better once you get back to your normal routine."
• B. "At least you had many good years together."
• C. "It sounds like adjusting to this loss has been very difficult for you."
• D. "You should try to stay busy so you don't dwell on it."

7. A client with alcohol use disorder is admitted for withdrawal. Approximately 12 hours after the last drink, the nurse should monitor MOST closely for which early manifestation?

• A. Profound bradycardia and hypothermia
• B. Tremors, diaphoresis, and elevated vital signs
• C. Complete absence of any symptoms
• D. Sudden euphoria and increased appetite

8. A nurse is reinforcing teaching for the family of a client diagnosed with Alzheimer disease who becomes agitated in the late afternoon. Which strategy should the nurse recommend for this sundowning behavior?

• A. Withhold all daytime naps and increase caffeine intake
• B. Frequently move the client to unfamiliar rooms to provide variety
• C. Keep the environment calm and well-lit as evening approaches
• D. Schedule stimulating activities and visitors in the evening

9. A nurse observes that a client repeatedly checks and rechecks that the door is locked, causing distress and delaying meals. During the acute phase, which nursing approach is MOST appropriate?

• A. Ignore the client until the ritual stops on its own
• B. Allow time for the ritual while gradually setting reasonable limits and reducing anxiety
• C. Prevent the client from performing the ritual entirely
• D. Ridicule the behavior so the client recognizes it is irrational

10. A client on an inpatient unit becomes increasingly loud, paces rapidly, and clenches their fists. Which nursing action BEST demonstrates early de-escalation?

• A. Approach quickly and place a hand on the client's shoulder
• B. Maintain a calm demeanor, ensure personal space, and speak in a low, even tone
• C. Order the client to sit down immediately
• D. Gather several staff members to surround the client

11. A client tells the nurse, "The voices are telling me that no one here can be trusted." Which response by the nurse is MOST therapeutic?

• A. "You should just ignore the voices and they will go away."
• B. "There are no voices; you are safe in the hospital."
• C. "What exactly are the voices saying to you right now?" asked with alarm
• D. "I understand the voices are real to you, but I do not hear them. You are safe here."

12. A nurse is providing culturally sensitive care to a client whose cultural practices differ from the nurse's own. Which action BEST reflects culturally competent psychosocial care?

• A. Avoid discussing cultural topics to prevent discomfort
• B. Assume the client shares the beliefs typical of their cultural group
• C. Ask the client about their preferences and incorporate them into the plan of care when safe
• D. Encourage the client to adopt the practices of the majority culture

13. A nurse suspects that an older adult client is experiencing abuse by a caregiver. Which is the nurse's MOST appropriate initial action?

• A. Wait for additional incidents before taking any action
• B. Advise the client to move out of the caregiver's home immediately
• C. Interview the client privately and document objective findings
• D. Confront the caregiver directly about the suspected abuse

14. During the NCLEX-PN, the number of items a candidate answers can vary from one test-taker to another. Which range represents the possible number of questions?

• A. 85 to 150 questions
• B. A fixed 120 questions for everyone
• C. 100 to 200 questions
• D. 75 to 145 questions

15. A test-taker answers the minimum number of NCLEX-PN questions and finishes with time to spare. What is the maximum amount of time still theoretically available for a session under the exam's rules, regardless of how many questions were answered?

• A. Up to 360 minutes
• B. Exactly 85 minutes
• C. Up to 240 minutes
• D. Up to 300 minutes

16. A client is prescribed a beta-blocker for hypertension. Which assessment finding should prompt the nurse to hold the medication and notify the provider?

• A. Respiratory rate of 16 breaths per minute.
• B. Heart rate of 72 beats per minute.
• C. Blood pressure of 128/78 mm Hg.
• D. Heart rate of 48 beats per minute with dizziness.

17. A client asks the nurse, "Is my tumor cancer? I want the truth." The biopsy result, which the provider has already discussed with the client's family but not the client, confirms malignancy. The nurse encourages the provider to speak honestly with the client. Which ethical principle is the nurse supporting?

• A. Veracity
• B. Justice
• C. Fidelity
• D. Nonmaleficence

18. Before administering a scheduled oral medication, the nurse checks the client's identity. Which combination of identifiers is acceptable?

• A. The client's room number and bed position
• B. The client's first name and the diagnosis on the whiteboard
• C. The client's full name and date of birth compared against the identification band and medication record
• D. A visitor's confirmation of who the client is

19. A nurse is reinforcing teaching with a client in the second trimester of pregnancy about warning signs. Which symptom should the client report to the provider immediately?

• A. Occasional heartburn after large meals
• B. Whitish vaginal discharge without odor
• C. Bright red vaginal bleeding
• D. Mild ankle swelling at the end of the day

20. A nurse is providing perineal care for a female client with an indwelling urinary catheter. Which technique is correct?

• A. Scrub the catheter tubing vigorously toward the meatus
• B. Cleanse from the front toward the back, using a clean area of the cloth for each stroke
• C. Use the same section of washcloth throughout to conserve linens
• D. Cleanse from the rectal area upward to ensure thorough coverage

21. A client is receiving chemotherapy and the nurse notes an absolute neutrophil count indicating neutropenia. Which instruction is most important for the nurse to reinforce?

• A. Increase intake of fresh, unwashed fruits and vegetables for nutrition.
• B. Avoid crowds and people who are ill, and report fever immediately.
• C. Discontinue all visitors' use of masks since the client is not contagious.
• D. Avoid hand hygiene since neutropenic clients are already protected.

22. A client receiving intravenous heparin has a partial thromboplastin time (PTT) reported as significantly elevated above the therapeutic range. Which nursing action is the priority?

• A. Increase the heparin infusion rate to reach therapeutic effect faster.
• B. Administer an extra dose of heparin to compensate.
• C. Continue the current rate without any change since PTT naturally fluctuates.
• D. Notify the provider and prepare to hold or adjust the infusion per protocol while monitoring for bleeding.

23. A licensed practical nurse is caring for four clients. Which client should the nurse assess first?

• A. A client reporting incisional pain rated 7 out of 10
• B. A client whose family is asking about discharge planning
• C. A client with an oxygen saturation of 86 percent on room air and increased work of breathing
• D. A client requesting assistance to the bathroom

24. A registered nurse delegates tasks on a medical-surgical unit. Which task is appropriate to assign to a licensed practical nurse?

• A. Reinforcing teaching about a prescribed diet that the RN has already taught
• B. Developing the nursing care plan for a complex client
• C. Evaluating the client's response to the overall plan of care
• D. Performing the initial admission assessment on a newly admitted client

25. A nurse is preparing to delegate to unlicensed assistive personnel. Which task may appropriately be delegated?

• A. Measuring and recording a stable client's intake and output
• B. Inserting an indwelling urinary catheter
• C. Administering an oral medication
• D. Interpreting a change in the client's wound appearance

26. A nurse discovers that a client's signed surgical consent form does not list the correct surgical site. What is the nurse's best action?

• A. Ask a family member to confirm the correct site and proceed
• B. Notify the surgeon and hold the client from transport until the consent is corrected
• C. Send the client to surgery and report the discrepancy to the operating room nurse
• D. Correct the site on the form and have the client initial the change

27. A nurse is caring for a client who has a do-not-resuscitate order and who then stops breathing and has no pulse. What is the nurse's appropriate action?

• A. Begin chest compressions until the family arrives
• B. Call a code and initiate full resuscitation
• C. Administer emergency medications but withhold compressions
• D. Provide comfort measures and notify the provider and family; do not initiate CPR

28. A nurse observes a coworker accessing the electronic health record of a neighbor who is not assigned to that coworker. What should the nurse do?

• A. Say nothing, since no information appears to have been shared outside the facility
• B. Ask the coworker to delete the access log entry
• C. Discuss the neighbor's condition with the coworker to assess intent
• D. Report the incident through the facility's chain of command, as this is a privacy violation

29. A client is placed on contact precautions for Clostridioides difficile infection. Which hand hygiene method is required?

• A. Alcohol-based hand rub only, as it is faster and more effective
• B. Antiseptic wipes applied to gloved hands
• C. Washing with soap and water, because alcohol-based rubs do not kill spores
• D. Either method, as both are equally effective against C. difficile

30. A client is admitted with suspected pulmonary tuberculosis. Which precautions should the nurse implement?

• A. Contact precautions with gown and gloves only
• B. Airborne precautions with a negative pressure room and an N95 respirator
• C. Droplet precautions with a surgical mask within three feet
• D. Standard precautions alone

31. A nurse is donning personal protective equipment before entering an isolation room. What is the correct sequence?

• A. Goggles, gloves, gown, then mask
• B. Mask, gloves, gown, then goggles
• C. Gloves, gown, mask, then goggles
• D. Gown, mask or respirator, goggles or face shield, then gloves

32. A client begins to have a generalized tonic-clonic seizure while sitting in a chair. What is the nurse's priority action?

• A. Leave to obtain suction equipment immediately
• B. Restrain the client's extremities to prevent injury
• C. Ease the client to the floor, protect the head, and turn the client to the side
• D. Insert a padded tongue blade into the client's mouth

33. A nurse is caring for a confused older adult who is attempting to climb out of bed. Which intervention should the nurse implement first?

• A. Administer a sedative before attempting other measures
• B. Use the least restrictive measures, such as a bed alarm, frequent checks and moving the client near the nurses' station
• C. Apply wrist restraints to prevent the client from getting up
• D. Raise all four side rails on the bed

34. A nurse is teaching an adult client about recommended health screening. Which statement reflects appropriate general guidance?

• A. Screening is unnecessary for anyone without symptoms
• B. Screening recommendations depend on age, sex, personal and family history, and should be individualized with the provider
• C. Family history has no bearing on screening timing
• D. All adults require identical screening tests on the same schedule

35. A nurse is reinforcing teaching with a pregnant client in the first trimester about nutrition. Which supplement is most important for preventing neural tube defects?

• A. Vitamin K
• B. Magnesium
• C. Folic acid
• D. Vitamin E

36. A nurse is assessing an infant at a well-child visit. Which finding requires further evaluation?

• A. A posterior fontanel that has closed by two months of age
• B. An anterior fontanel that is bulging and tense while the infant is calm and upright
• C. An anterior fontanel that is soft and flat
• D. An infant who tracks a face across the midline

37. A nurse is reinforcing discharge teaching for an older adult client at risk for falls at home. Which instruction is most appropriate?

• A. Remove loose throw rugs, improve lighting, and install grab bars in the bathroom
• B. Keep the home dimly lit at night to promote sleep
• C. Rise quickly from bed to avoid dizziness
• D. Wear loose backless slippers for comfort when walking

38. A nurse is caring for a client experiencing alcohol withdrawal 24 hours after the last drink. Which finding requires immediate provider notification?

• A. A new onset seizure
• B. Reported difficulty sleeping
• C. Mild anxiety and irritability
• D. Mild hand tremor

39. A nurse is monitoring a client after a cardiac catheterization via the femoral artery. Which finding requires immediate action?

• A. Absent pedal pulse in the affected extremity
• B. Blood pressure of 118/74
• C. Client reports mild discomfort at the insertion site
• D. Client requests to change position slightly in bed

40. A client with major depressive disorder suddenly appears calm and energized after weeks of profound withdrawal. What is the nurse's priority concern?

• A. The change indicates the development of mania
• B. The medication dose should be reduced immediately
• C. The client has recovered and can be prepared for discharge
• D. The client may now have the energy to act on suicidal thoughts and requires close assessment

41. A client states, "I have nothing left to live for." Which is the nurse's most appropriate initial response?

• A. "Why would you feel that way?"
• B. "Things will look better in the morning."
• C. "Are you thinking about killing yourself?"
• D. "You have so much to live for; think of your family."

42. A nurse is caring for a client who is experiencing auditory hallucinations. Which response is therapeutic?

• A. "I do not hear the voices, but I understand they feel real to you. What are they saying?"
• B. "Stop listening to the voices and focus on me."
• C. "I hear them too, but we can ignore them together."
• D. "There are no voices; you are imagining things."

43. A nurse is repositioning a client who is at risk for pressure injury. How often should a bedbound client generally be repositioned?

• A. Only when the client requests a change
• B. Every eight hours
• C. At least every two hours, with the schedule individualized to skin assessment findings
• D. Once per shift

44. A nurse is assessing a pressure injury and finds partial-thickness skin loss with exposed dermis presenting as a shallow open ulcer with a red-pink wound bed and no slough. How is this staged?

• A. Stage 3
• B. Unstageable
• C. Stage 1
• D. Stage 2

45. A nurse is caring for a client with heart failure. Which finding best indicates fluid retention is worsening?

• A. A weight gain of 3 pounds over two days
• B. A reported appetite decrease
• C. A heart rate of 78 beats per minute
• D. A blood pressure reading of 122/78

46. A client with dysphagia following a stroke is being assisted with a meal. Which nursing action promotes safe swallowing?

• A. Position the client upright at 90 degrees and instruct a chin-tuck while swallowing
• B. Have the client recline to 30 degrees to slow the passage of food
• C. Offer thin liquids through a straw to ease intake
• D. Encourage the client to tilt the head back when swallowing

47. A client reports constipation. Which nursing recommendation is most appropriate as an initial measure?

• A. Increase dietary fiber and fluid intake and encourage regular physical activity
• B. Begin daily enemas to establish a routine
• C. Encourage prolonged bed rest
• D. Restrict fluids to firm the stool

48. Before administering digoxin to an adult client, the nurse should take which action?

• A. Count the apical pulse for one full minute and withhold the dose if it is below 60 beats per minute
• B. Withhold the dose if the blood pressure is above 140/90
• C. Administer the dose regardless of heart rate and document the rate afterward
• D. Check the radial pulse for 15 seconds and multiply by four

49. A client is prescribed intravenous potassium chloride. Which nursing action is essential?

• A. Add the potassium to the intravenous bag at the bedside without inversion
• B. Give intramuscularly if intravenous access is unavailable
• C. Administer only diluted and by infusion pump; never give potassium by IV push
• D. Administer undiluted by rapid IV push for faster correction

50. A client receiving warfarin asks about diet. Which instruction is correct?

• A. Eliminate all green leafy vegetables permanently
• B. Increase green leafy vegetables to enhance the medication's effect
• C. Maintain a consistent intake of vitamin K-containing foods rather than eliminating them
• D. Diet has no effect on warfarin therapy

51. A nurse is preparing to mix regular insulin and NPH insulin in the same syringe. What is the correct technique?

• A. Inject air into both vials, then withdraw the regular (clear) insulin before the NPH (cloudy)
• B. Withdraw each insulin into a separate syringe and combine them afterward
• C. Shake both vials vigorously before withdrawing
• D. Withdraw the NPH insulin first, then the regular insulin

52. A nurse is administering an oral medication that is enteric coated. Which action is appropriate?

• A. Dissolve the tablet in warm water before administration
• B. Administer the tablet whole without crushing or splitting it
• C. Split the tablet in half to reduce gastric irritation
• D. Crush the tablet and mix it with applesauce for easier swallowing

53. A provider prescribes 500 mg of a medication. The available supply is 250 mg per tablet. How many tablets should the nurse administer?

• A. 2 tablets
• B. 0.5 tablet
• C. 1 tablet
• D. 4 tablets

54. A client is to receive 1,000 mL of intravenous fluid over 8 hours using tubing with a drop factor of 15 drops per mL. What is the flow rate in drops per minute?

• A. 31 drops per minute
• B. 125 drops per minute
• C. 42 drops per minute
• D. 21 drops per minute

55. A nurse notes that a client's intravenous site is cool, pale and swollen, and the infusion has slowed. What is the nurse's first action?

• A. Apply a warm compress and continue the infusion
• B. Stop the infusion and remove the catheter, then elevate the extremity
• C. Flush the line vigorously with saline
• D. Increase the flow rate to clear the obstruction

56. A client's serum potassium level is reported as 6.2 mEq/L. Which assessment is the nurse's priority?

• A. Skin turgor and mucous membranes
• B. Cardiac rhythm, because hyperkalemia can cause life-threatening dysrhythmias
• C. Pupillary response to light
• D. Bowel sounds in all four quadrants

57. A nurse is verifying nasogastric tube placement before administering a feeding. Which method is most reliable?

• A. Auscultating over the epigastrium while injecting air
• B. Observing for the absence of coughing
• C. Asking the client whether they feel the tube in the stomach
• D. Radiographic confirmation, which is the standard for initial placement verification

58. A client is scheduled for surgery and reports taking a daily aspirin. What is the significance of this information?

• A. It increases bleeding risk and must be communicated to the surgical team
• B. It has no bearing on surgical risk
• C. It reduces the need for postoperative pain medication
• D. It eliminates the need for deep vein thrombosis prophylaxis

59. A postoperative client is reluctant to move because of incisional pain. Which intervention best reduces the risk of postoperative pneumonia?

• A. Administer oxygen continuously in place of breathing exercises
• B. Restrict fluids to reduce pulmonary secretions
• C. Maintain strict bed rest until the incision is fully healed
• D. Medicate for pain, then encourage deep breathing, coughing and use of an incentive spirometer

60. A client with type 1 diabetes is diaphoretic, tremulous, tachycardic and confused. What should the nurse suspect and do first?

• A. Hyperglycemia; administer additional rapid-acting insulin
• B. Dehydration; increase intravenous fluids without checking glucose
• C. Hypoglycemia; check the blood glucose and provide a fast-acting carbohydrate if the client can swallow safely
• D. Anxiety; provide reassurance and reassess in one hour

61. A client with chronic obstructive pulmonary disease is receiving oxygen. Which nursing consideration is most important?

• A. Use oxygen only during ambulation
• B. Administer the highest flow rate available to maximize oxygenation
• C. Titrate oxygen to the prescribed target saturation, avoiding unnecessarily high flow
• D. Withhold oxygen entirely to preserve respiratory drive

62. A client suddenly develops facial droop, slurred speech and unilateral arm weakness. What is the nurse's priority action?

• A. Note the time of symptom onset and activate the facility's stroke response immediately
• B. Place the client in Trendelenburg position
• C. Give the client aspirin and reassess in 30 minutes
• D. Offer oral fluids to assess swallowing ability

63. A client is admitted with severe dehydration. Which assessment finding is most consistent with this diagnosis?

• A. Bounding pulses and jugular vein distention
• B. Crackles throughout both lung fields
• C. Rapid weight gain over 24 hours
• D. Elevated heart rate, decreased urine output and dry mucous membranes

64. A nurse is caring for a client with a new colostomy. Which stoma assessment finding requires immediate provider notification?

• A. A small amount of bleeding when the stoma is cleaned
• B. A stoma that appears dusky purple or black
• C. A stoma that appears pink to red and moist
• D. Mild swelling of the stoma in the first days after surgery

65. A nurse is performing tracheostomy suctioning. Which technique is correct?

• A. Apply continuous suction during both insertion and withdrawal
• B. Suction for at least 30 seconds per pass to clear all secretions
• C. Instill saline routinely before each suction pass
• D. Apply suction only while withdrawing the catheter, limiting each pass to about 10 to 15 seconds

66. A nurse discovers a medication error after administering the wrong dose. What is the nurse's first responsibility?

• A. Assess the client, then notify the provider and complete an incident report
• B. Complete the incident report before assessing the client
• C. Wait to see whether the client develops symptoms before reporting
• D. Document the error only in the incident report, not in the medical record

67. A nurse receives a verbal order from a provider during an emergency. What is the correct process?

• A. Refuse all verbal orders under any circumstance
• B. Carry out the order and document it at the end of the shift
• C. Ask another nurse to listen and rely on shared memory
• D. Write the order down, read it back to the provider for verification, and have it authenticated within the required timeframe

68. A nurse is documenting in a client's paper medical record and makes an error in an entry. What is the correct correction technique?

• A. Use correction fluid and write over the entry
• B. Draw a single line through the entry, write the word error or per policy, and initial and date it
• C. Erase the entry completely and rewrite it
• D. Black out the entry so it cannot be read

69. A nurse is caring for a client whose vital signs are temperature 38.9 C, heart rate 118, respiratory rate 26 and blood pressure 88/50. Which condition should the nurse suspect?

• A. Hypothyroidism
• B. Fluid volume overload
• C. Expected postoperative variation requiring no action
• D. Possible sepsis, requiring prompt provider notification

70. A nurse is preparing to transfer a client from bed to chair. Which action promotes safe body mechanics for the nurse?

• A. Twist at the waist while moving the client toward the chair
• B. Bend at the waist and lift with the back muscles
• C. Keep the feet together to maintain a narrow base of support
• D. Keep the back straight, bend at the knees and hips, and keep the client close to the body

71. A nurse is reinforcing teaching about a low-sodium diet for a client with hypertension. Which food choice indicates the teaching was effective?

• A. Fresh baked chicken breast with herbs
• B. Processed deli turkey sandwich
• C. Canned soup with crackers
• D. Cured ham with pickles

72. A nurse is caring for a client in restraints. How frequently must the client generally be monitored, and what must be assessed?

• A. Once per shift, assessing only whether the restraint remains secure
• B. Only when the client complains of discomfort
• C. At regular short intervals per policy, assessing circulation, skin integrity, elimination, nutrition and the continued need for restraint
• D. Once every 24 hours when the order is renewed

73. A client with a history of latex allergy is scheduled for a procedure. What is the nurse's most important action?

• A. Rely on the client to identify latex products during the procedure
• B. Ensure the allergy is documented and communicated, and that latex-free supplies are used throughout
• C. Use latex gloves but change them frequently
• D. Administer an antihistamine before the procedure and use standard supplies

74. A client who is postoperative day two reports sudden shortness of breath and pleuritic chest pain, with a heart rate of 122. What should the nurse suspect?

• A. Normal postoperative discomfort
• B. Mild dehydration
• C. Possible pulmonary embolism, requiring immediate escalation
• D. Constipation from opioid analgesia

75. A nurse is completing a preoperative assessment for a client scheduled for surgery under general anesthesia. Which finding is most important to report to the anesthesia provider before the procedure?

• A. The client reports a loose tooth and wears a partial denture.
• B. The client's stated preference for a warm blanket in the operating room.
• C. The client's shoe size for postoperative footwear.
• D. The client's preferred visiting hours for family after surgery.

76. A client undergoing a paracentesis for ascites has 2 liters of fluid removed. Which finding after the procedure requires the nurse to notify the provider immediately?

• A. Blood pressure dropping significantly with reported dizziness and tachycardia.
• B. Mild soreness at the puncture site.
• C. Blood pressure within the client's baseline range.
• D. A small amount of serous drainage on the dressing.

77. A client with acute kidney injury has a urine output of 15 mL over the past hour and rising serum creatinine. Which finding should the nurse also monitor closely as a priority complication?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypocalcemia
• D. Hyponatremia

78. A licensed practical nurse is assigned to complete the initial comprehensive admission assessment for a newly admitted client. Which action by the LPN is most appropriate?

• A. Inform the registered nurse that the initial admission assessment must be performed by the RN, and offer to collect supporting data
• B. Ask unlicensed assistive personnel to obtain the admission history
• C. Delay the assessment until the provider arrives to examine the client
• D. Complete the admission assessment and document the findings

79. A client slides from a chair to the floor and is uninjured. After completing an incident report, which documentation by the nurse in the medical record is correct?

• A. No entry, because the incident report replaces charting for the event
• B. "Incident report completed and forwarded to risk management."
• C. An objective description of the event, the client's condition, and the care provided, without mentioning the incident report
• D. "Client fell because the aide left the room; incident report filed."

80. A client refuses the prescribed evening dose of an oral antihypertensive medication. Which action should the nurse take first?

• A. Ask the client to describe the reason for refusing the medication
• B. Crush the medication and mix it into the client's dessert
• C. Document the refusal and move on to the next client
• D. Tell the client the medication is required by the provider's order

81. A hospitalized client has a living will declining resuscitation, but the client's adult child demands that "everything be done" if the client's heart stops. What is the licensed practical nurse's best action?

• A. Remove the living will from the chart until the conflict is settled
• B. Report the conflict to the supervising registered nurse so the care team can address it with the family and provider
• C. Promise the family that resuscitation will be attempted
• D. Follow the family's wishes because they are present at the bedside

82. A caller who identifies himself as a client's cousin telephones the unit and asks whether the client has been admitted and how she is doing. The client has not authorized release of information. How should the nurse respond?

• A. Confirm the admission but decline to give clinical details
• B. Provide a brief update since the caller is a family member
• C. Explain that no information can be shared, without confirming whether the client is on the unit
• D. Ask the caller to state the client's diagnosis to verify the relationship

83. A licensed practical nurse who normally works on a medical unit is floated to a busy orthopedic unit for the shift. Which action by the nurse is most appropriate?

• A. Accept the assignment and ask the charge nurse for tasks that match the nurse's demonstrated competencies, with orientation to unfamiliar equipment
• B. Accept the assignment and perform all tasks, including unfamiliar ones, without comment
• C. Refuse the float assignment and go home for the shift
• D. Ask another LPN on the orthopedic unit to trade assignments after report

84. A nurse witnesses a client sign the consent form for a scheduled procedure. What does the nurse's signature as a witness legally verify?

• A. That the client will not experience complications
• B. That the nurse explained the procedure and its risks
• C. That the procedure is medically necessary
• D. That the client is the person who signed and did so voluntarily and without apparent coercion

85. The laboratory telephones the unit with a critical potassium result for an assigned client. Which action by the nurse reflects correct handling of the call?

• A. File the value with routine results for the provider's next visit
• B. Ask the laboratory to call back when the provider is on the unit
• C. Write down the value, read it back to the caller for confirmation, and report it promptly to the appropriate provider
• D. Memorize the value and chart it at the end of the shift

86. At the start of a shift, a nurse notices that a coworker smells of alcohol and has slurred speech while preparing to give medications. What should the nurse do?

• A. Wait and discuss the concern with the coworker after the shift ends
• B. Privately suggest the coworker drink coffee and take a break
• C. Watch the coworker closely during the shift and intervene only if an error occurs
• D. Report the observation to the nursing supervisor immediately so the coworker is relieved of client care

87. A client with pneumonia announces he is leaving the hospital against medical advice. The provider has been notified and the client remains determined to leave. Which statement about this situation is accurate?

• A. The client with decision-making capacity may not be physically prevented from leaving, and the risks of leaving should be explained and documented
• B. Security may hold the client until discharge paperwork is complete
• C. The nurse should remove the client's IV access only after the client signs a promise to follow up
• D. The client forfeits the right to return to the hospital for future care

88. A licensed practical nurse is working with unlicensed assistive personnel to care for a group of stable clients. Which task must the nurse perform rather than delegate?

• A. Recording the oral fluid intake of a client on intake and output monitoring
• B. Repositioning a client who is on a turning schedule
• C. Determining how a client's skin has responded to a new pressure-relief mattress
• D. Assisting a client with a bed bath and hygiene care

89. A nurse is reinforcing discharge instructions for a client who speaks very limited English. The client's teenage son offers to translate. What is the nurse's best action?

• A. Accept the son's offer because he knows the client best
• B. Give the client written instructions in English to read at home
• C. Arrange for a qualified medical interpreter before continuing the teaching
• D. Speak slowly and loudly in English while using gestures

90. During a mass-casualty event, the unit must free beds for incoming victims. Which current client is most appropriate for the nurse to recommend for early discharge?

• A. A client three days after an uncomplicated hernia repair who is ambulating and tolerating a regular diet
• B. A client receiving continuous intravenous antibiotics for sepsis
• C. A client two hours post upper endoscopy still recovering from sedation
• D. A client admitted this morning with chest pain awaiting cardiac workup

91. The spouse of an assigned client asks the licensed practical nurse to explain the results of the client's biopsy, which the provider has not yet discussed with the client. Which response is most appropriate?

• A. Summarize the results in simple terms so the spouse is not left waiting
• B. State that nurses are never told test results
• C. Suggest the spouse look up the result in the client's online portal
• D. Explain that the provider will review the results with the client and offer to let the provider know the family has questions

92. A nurse is preparing the room of a client who is neutropenic following chemotherapy. Which item should the nurse remove from the room?

• A. The client's own clean bathrobe from home
• B. A sealed bottle of drinking water
• C. A framed family photograph on the bedside table
• D. A vase of fresh-cut flowers delivered by a florist

93. A client is admitted with suspected bacterial meningitis. In addition to standard precautions, which transmission-based precaution should the nurse implement?

• A. Airborne precautions with a negative-pressure room
• B. Droplet precautions, wearing a surgical mask when working close to the client
• C. Protective isolation with sterile linens
• D. Contact precautions with a gown for all room entry

94. A nurse has finished providing wound care for a client on contact precautions and is preparing to leave the room wearing a gown and gloves. Which item of personal protective equipment should be removed first?

• A. Whichever item feels most contaminated
• B. The mask, by touching only the elastic bands
• C. The gloves, using a glove-to-glove then skin-to-skin technique
• D. The gown, by breaking the neck ties

95. A nurse discovers a small fire in a trash can in an occupied client room. What is the nurse's first action?

• A. Locate a fire extinguisher and attempt to put out the fire
• B. Activate the nearest fire alarm pull station
• C. Close all doors along the corridor
• D. Move the client out of the room to a safe area

96. While setting up an infusion pump, the nurse notices that its power cord is frayed with exposed wire. Which action should the nurse take?

• A. Use the pump but plug it into an outlet farther from the bed
• B. Wrap the frayed section in tape and continue the infusion
• C. Remove the pump from use, tag it as defective, and report it for biomedical inspection
• D. Run the pump on battery power for the rest of the shift

97. A nurse has just administered a subcutaneous injection using a needle equipped with a safety device. Which action should the nurse take next?

• A. Bend the needle so it cannot be reused before discarding it in the trash
• B. Recap the needle carefully using both hands before disposal
• C. Activate the safety device and place the entire unit in a puncture-resistant sharps container
• D. Set the syringe on the medication tray to dispose of after leaving the room

98. A client with a history of asthma develops audible wheezing, use of accessory muscles, and a respiratory rate of 32 breaths per minute. Which nursing action is the priority?

• A. Administer the prescribed short-acting bronchodilator and reassess respiratory status.
• B. Wait 30 minutes to see if symptoms resolve independently before intervening.
• C. Have the client lie flat to reduce work of breathing.
• D. Encourage the client to drink cold fluids to soothe the airway.

99. A nurse is reinforcing safety teaching for a client who will use home oxygen via nasal cannula. Which client statement indicates a need for further teaching?

• A. "I will post no-smoking signs where visitors can see them."
• B. "I will keep the oxygen concentrator away from the fireplace."
• C. "I can cook at my gas stove while wearing my cannula as long as I am careful."
• D. "I will use water-based lotion instead of petroleum jelly on my nose."

100. A nurse is assisting with a sterile dressing change and has set up a sterile field. Which action contaminates the field?

• A. Keeping gloved hands above waist level throughout the procedure
• B. Placing sterile gauze well inside the edges of the drape
• C. Reaching over the center of the sterile field to reposition supplies on the far side
• D. Facing the sterile field at all times while working

101. While preparing a disinfectant solution, a nursing assistant splashes an unfamiliar cleaning chemical on her forearm and asks the nurse what to do after initial rinsing. Which resource should the nurse consult for definitive first-aid and handling guidance?

• A. The product's marketing brochure
• B. Another nurse who has used the product before
• C. The unit's medication reference application
• D. The safety data sheet for that chemical

102. A nurse on a postpartum unit is reinforcing newborn security instructions with a mother. Which maternal statement indicates correct understanding?

• A. "I will check for the hospital photo identification badge required of staff before handing over my baby."
• B. "Anyone wearing scrubs may take my baby to the nursery."
• C. "I can leave my baby in the room while I shower as long as the door is shut."
• D. "Security bands are only necessary if the nursery is full."

103. A hospitalized immunocompromised client develops disseminated herpes zoster with widespread lesions. Which precautions should the nurse expect to implement?

• A. Droplet precautions only until lesions crust
• B. Airborne precautions plus contact precautions until all lesions are crusted
• C. Standard precautions only, because zoster is a reactivated infection
• D. Protective environment with positive-pressure ventilation

104. A nurse is reinforcing car safety teaching with the parents of a healthy newborn being discharged. Which instruction is correct?

• A. Secure the infant in a rear-facing car seat installed in the back seat
• B. Place the rear-facing car seat in the front passenger seat near the airbag
• C. Hold the infant in a parent's lap for short trips home from the hospital
• D. Position the car seat forward-facing so the infant can be seen in the mirror

105. A client who is 10 weeks pregnant asks the nurse which immunizations she should avoid during pregnancy. Which vaccine should the nurse identify as contraindicated?

• A. Tetanus, diphtheria, and pertussis vaccine
• B. Hepatitis B vaccine
• C. Measles, mumps, and rubella vaccine
• D. Inactivated influenza vaccine

106. A nurse is reinforcing teaching with a first-time mother who is breastfeeding her two-day-old newborn. Which statement by the mother indicates understanding of newborn feeding patterns?

• A. "My baby will likely nurse eight to twelve times in twenty-four hours in these early weeks."
• B. "I will give water between feedings so the baby stays hydrated."
• C. "My baby should nurse about four times in twenty-four hours."
• D. "I should wake the baby only twice during the night to nurse."

107. A client with type 1 diabetes presents with fruity-smelling breath, deep rapid breathing, and a blood glucose of 480 mg/dL. Which condition should the nurse suspect?

• A. Somogyi effect resolving on its own
• B. Hypoglycemic reaction
• C. Normal postprandial glucose elevation
• D. Diabetic ketoacidosis

108. The parent of a two-year-old expresses concern that the child plays beside other toddlers without interacting with them. How should the nurse respond?

• A. Suggest a developmental evaluation for delayed social skills
• B. Explain that playing alongside, but not with, other children is expected at this age
• C. Recommend enrolling the child in a structured team activity
• D. Advise limiting playdates until the child initiates sharing

109. A 16-year-old arrives for a sports physical accompanied by a parent. When gathering information about risk behaviors such as substance use and sexual activity, which approach should the nurse use?

• A. Direct all sensitive questions to the parent to verify accuracy
• B. Skip risk-behavior questions to avoid embarrassing the adolescent
• C. Interview the adolescent privately after asking the parent to step out
• D. Have the adolescent complete the questions in writing while the parent watches

110. During a wellness visit, a 70-year-old client asks the nurse which vaccination should be repeated every year. Which response is correct?

• A. Pneumococcal vaccine
• B. Influenza vaccine
• C. Zoster vaccine
• D. Tetanus booster

111. A nurse is reinforcing teaching about testicular self-examination with a young adult client. Which instruction is appropriate?

• A. Perform the examination only when discomfort is noticed
• B. Expect both testes to feel firm, fixed, and irregular
• C. Report any difference in size between the two testes as an emergency
• D. Examine the testes about once a month after a warm shower when the scrotum is relaxed

112. A client with a history of peptic ulcer disease reports sudden onset of black, tarry stools and dizziness when standing. Which nursing action is the priority?

• A. Administer a laxative to relieve the presumed constipation.
• B. Assess vital signs for signs of hypovolemia and notify the provider immediately.
• C. Instruct the client to increase dietary fiber intake.
• D. Reassure the client that dark stools are a normal medication side effect without further assessment.

113. A perimenopausal client tells the nurse she is worried because she suddenly feels intense warmth and flushing several times a day. Which response by the nurse is most appropriate?

• A. "You should avoid all physical activity until the episodes stop."
• B. "Those symptoms usually indicate a thyroid tumor and need urgent testing."
• C. "These episodes mean menopause is complete and your periods will stop this month."
• D. "Hot flashes are a common response to changing hormone levels; dressing in layers and avoiding triggers like caffeine can help."

114. A nurse is reinforcing safe sleep teaching with the parents of a one-month-old infant. Which parent statement indicates correct understanding?

• A. "I will place my baby on his back in the crib on a firm mattress with no loose blankets."
• B. "Sleeping on his stomach will help my baby avoid choking."
• C. "A soft bumper pad will keep my baby from bumping the crib rails."
• D. "My baby can sleep in our bed so I can hear him breathing."

115. A client hospitalized with anorexia nervosa has just finished a supervised meal. Which nursing action is most important immediately afterward?

• A. Remain with the client for a period of observation after the meal
• B. Allow the client private time in the bathroom to freshen up
• C. Encourage the client to walk the hallway to aid digestion
• D. Weigh the client to document intake success

116. A client in an acute manic episode has not sat down long enough to finish a meal in two days. Which nursing intervention is most appropriate?

• A. Offer high-calorie finger foods and fluids the client can consume while moving about
• B. Serve three large meals daily and remove snacks to encourage mealtime hunger
• C. Schedule group activities during meals to make eating social
• D. Insist the client remain seated in the dining room until the tray is finished

117. A client with a delusional belief states, "The kitchen staff are putting poison in my food." Which nursing response is most therapeutic?

• A. "You are right to be careful; I will ask what the kitchen is putting in the meals."
• B. "Let's list all the reasons your belief about the kitchen makes no logical sense."
• C. "That is not true, and you must stop saying it so other clients don't get upset."
• D. "That sounds frightening. I have not seen anything harmful in the food; would you like to eat something in a sealed container today?"

118. During an intake interview, a nurse notices bruises in various stages of healing on a client whose partner answers every question and refuses to leave the room. What should the nurse do?

• A. Give the client a domestic violence brochure in front of the partner
• B. Ask the partner directly whether he caused the injuries
• C. Document the bruises and continue the interview with the partner present
• D. Create an opportunity to interview the client alone, such as during a screening test or procedure

119. A veteran hospitalized on a medical unit wakes shouting from a nightmare, appears disoriented, and is drenched in sweat. The client has a history of posttraumatic stress disorder. What should the nurse do first?

• A. Ask the client to describe the traumatic event in detail
• B. Administer the client's as-needed sleep medication immediately
• C. Speak calmly, identify yourself, and reorient the client to the time and place
• D. Turn off the lights and shut the door so the client can settle

120. A nurse enters the room of a client who was told an hour ago that her cancer has spread. The client is staring at the window, tearful and silent. Which nursing action is most therapeutic?

• A. Sit quietly with the client and remain present without forcing conversation
• B. Redirect the client's attention to the dinner menu choices
• C. Remind the client that new treatments are developed every year
• D. Return later so the client can process the news alone

121. A client admitted after a suicide attempt is placed on suicide precautions. Which environmental intervention should the nurse implement?

• A. Assign the client to a private room at the far end of the hallway
• B. Allow the client to keep personal medications for comfort
• C. Check on the client at the start and end of each shift
• D. Remove belts, shoelaces, cords, and sharp objects from the client's room and belongings

122. Two days after a mastectomy, a client keeps her eyes averted whenever the dressing is changed and has not looked at the surgical site. Which nursing approach is most appropriate?

• A. Ask the surgeon to order a psychiatric consultation immediately
• B. Tell the client she must look at the incision before discharge
• C. Accept the client's current coping and provide openings to discuss her feelings when she is ready
• D. Describe the incision in detail so the client does not have to look

123. A client who received a new diagnosis of type 2 diabetes yesterday tells the nurse, "The laboratory must have mixed up my blood with someone else's." How should the nurse initially respond to this defense mechanism?

• A. Repeat the diagnostic evidence firmly until the client agrees it is accurate
• B. Postpone all diabetes teaching until the client fully accepts the diagnosis
• C. Notify the provider that the client is refusing all diabetes care
• D. Recognize the denial as an early coping response and gently continue offering accurate information and support

124. A client with schizophrenia says to the nurse, "The train of purple Mondays sails under my thinking cap." Which is the nurse's best response?

• A. "I'm having trouble understanding you. It sounds like something is on your mind — can you tell me more about how you're feeling?"
• B. Nod and smile as though the meaning is clear
• C. "That sentence makes no sense; try again when you can speak clearly."
• D. Change the subject to the day's activity schedule

125. The family of a client who is actively dying angrily tells the nurse that "nobody in this hospital has done anything right." The nurse has observed attentive, appropriate care. Which response is best?

• A. Provide a detailed list of all care that has been delivered correctly
• B. Ask the family to direct complaints to the patient advocate office and leave the room
• C. Explain that anger interferes with the client's peaceful death
• D. Listen to the family's concerns without becoming defensive, recognizing anger as part of anticipatory grief

126. A nurse is reinforcing teaching for a client who will use a cane because of right-leg weakness after a stroke. Which instruction is correct?

• A. Hold the cane in whichever hand feels stronger that day
• B. Hold the cane on the left side and move it forward together with the right leg
• C. Hold the cane on the right side and move it together with the left leg
• D. Keep the cane tip about two feet ahead of the body when stepping

127. A client using crutches after left ankle surgery, with no weight bearing allowed on the left leg, asks how to climb the stairs at home. Which instruction should the nurse reinforce?

• A. Step up first with the left leg to strengthen it gradually
• B. Face sideways and hop up each step holding only the railing
• C. Lead with the crutches, letting both feet follow together
• D. Step up first with the right leg, then bring the crutches and left leg up to the same step

128. A nurse is applying sequential compression devices to a postoperative client's legs. Which action is appropriate?

• A. Fasten the sleeves as tightly as possible to maximize compression
• B. Verify a proper fit that allows about two fingers between the sleeve and the leg, and remove the sleeves periodically to inspect the skin
• C. Apply the sleeves only when the client reports calf pain
• D. Keep the sleeves inflated continuously during ambulation in the hallway

129. An older adult client reports difficulty falling asleep in the hospital and asks what might help without taking a sleeping pill. Which suggestion by the nurse is most appropriate?

• A. Take a long nap in the late afternoon to reduce exhaustion
• B. Watch television in bed until drowsiness sets in
• C. Do vigorous exercises in bed right before turning off the light
• D. Follow a consistent bedtime routine and avoid caffeine in the evening

130. A provider directs warm moist compresses to a client's leg. Which nursing action reflects safe application of heat?

• A. Apply the compress directly to the skin at the hottest tolerable temperature
• B. Check the temperature, protect the skin with a barrier, limit the application to about twenty minutes, and inspect the skin during use
• C. Leave the compress in place for an hour to maximize effect
• D. Ask the client to report warmth, since redness is the goal

131. A nurse is caring for a client with an indwelling urinary catheter connected to a drainage bag. Which observation requires the nurse to intervene?

• A. The tubing is coiled loosely on the bed beside the client
• B. The bag is emptied using a separate clean container for the client
• C. Urine in the tubing flows freely toward the bag
• D. The drainage bag is hanging on the bed frame above the level of the client's bladder during transport

132. A nurse is preparing to assist a client who is blind with a meal tray. Which intervention best supports the client's independence?

• A. Describe the location of foods on the plate using the positions of a clock face
• B. Feed the client each bite to prevent spills
• C. Arrange for a family member to be present at every meal
• D. Ask the dietary department to send only liquids that are easy to manage

133. A client is prescribed knee-high antiembolism stockings. Which instruction should the nurse reinforce about their use?

• A. Apply the stockings before getting out of bed in the morning, and smooth out any wrinkles
• B. Put the stockings on after walking around in the morning
• C. Fold a pillow under the knees to keep the stockings smooth
• D. Roll the tops down if they feel snug behind the knee

134. A nurse is preparing to provide oral care for an unconscious client. Which action is essential for this client's safety?

• A. Place two fingers between the client's teeth to keep the mouth open
• B. Give small sips of water afterward to rinse the mouth
• C. Position the client side-lying with the head turned toward the mattress and keep suction available
• D. Elevate the head of the bed to high Fowler position with the head midline

135. A client with agoraphobia related to panic disorder has been housebound for six months and tells the nurse, 'I want to leave the house but I'm terrified I'll panic in public.' Which teaching point should the nurse reinforce?

• A. Panic attacks in public are dangerous and should be avoided at all costs.
• B. Medication alone will resolve the fear without any behavioral practice.
• C. Gradual, graded exposure to feared situations paired with coping skills can reduce avoidance over time.
• D. Avoiding public places entirely is the safest long-term strategy.

136. A client in early recovery from opioid use disorder tells the nurse, 'I know I should be stronger than this craving.' Which response by the nurse is most therapeutic?

• A. You're right, staying strong is the key to recovery.
• B. Cravings are a normal part of recovery, not a sign of weakness; let's talk about what triggered it.
• C. Try not to think about it and it will pass on its own.
• D. If you were truly committed, you wouldn't be having cravings.

137. A client on an inpatient psychiatric unit repeatedly requests special privileges from a newer nurse and becomes hostile when told the request must follow unit policy. Which nursing action best demonstrates therapeutic limit-setting?

• A. Calmly restate the unit policy and the reason for it in a consistent, matter-of-fact manner.
• B. Avoid the client for the rest of the shift to prevent further hostility.
• C. Tell the client that continued hostility will result in punishment.
• D. Grant the request this one time to avoid conflict.

138. At a 6-week postpartum visit, a client tells the nurse, 'I feel like I'm failing as a mother and I cry every day, but I love my baby.' Which nursing action is most appropriate?

• A. Administer a validated postpartum depression screening tool and refer for further evaluation as indicated.
• B. Tell the client to focus on bonding activities to eliminate the sadness.
• C. Reassure the client that all new mothers feel this way and no further action is needed.
• D. Advise the client that these feelings will resolve once the baby sleeps through the night.

139. A client with generalized anxiety disorder reports constant worry about work, finances, and family that interferes with sleep. Which coping strategy should the nurse reinforce as a nonpharmacologic intervention?

• A. Avoiding all situations that could cause worry.
• B. Practicing diaphragmatic breathing and progressive muscle relaxation techniques.
• C. Increasing caffeine intake to improve alertness during the day.
• D. Suppressing worried thoughts through willpower alone.

140. A nurse is reinforcing teaching to parents of a 2-year-old who insists on doing tasks independently and has frequent tantrums when assistance is offered. According to Erikson's stages of development, which explanation should the nurse provide?

• A. The tantrums indicate the child needs stricter, more consistent punishment.
• B. This behavior suggests insecure attachment to the primary caregiver.
• C. The child is showing signs of a behavioral disorder that requires evaluation.
• D. The child is developing autonomy, and allowing safe independent choices supports this developmental task.

141. A client with bipolar disorder in a manic episode is talking rapidly, has purchased $4,000 of merchandise online overnight, and states, 'I have a brilliant plan to save the hospital.' Which nursing intervention is most appropriate?

• A. Allow the client unrestricted access to a phone and computer to reduce frustration.
• B. Point out that the plan is unrealistic and that the spending was irresponsible.
• C. Set clear, consistent limits and redirect the client to structured, low-stimulation activities.
• D. Encourage the client to elaborate fully on the plan to build rapport.

142. A dying client from a faith tradition unfamiliar to the nurse requests time for a specific prayer ritual before family arrives. Which nursing action best reflects culturally sensitive end-of-life care?

• A. Explain that hospital policy does not allow religious rituals at the bedside.
• B. Perform the ritual on the client's behalf to save time.
• C. Facilitate privacy and time for the ritual and ask the client what support, if any, is needed.
• D. Delay the ritual until a chaplain of the same faith becomes available, regardless of the client's timeline.

143. A nurse is planning care for several clients at the start of a shift. Which framework should guide the nurse in prioritizing which client to assess first?

• A. The client closest to the nurses' station.
• B. The order in which clients were admitted to the unit.
• C. The urgency of each client's physiological and safety needs, using an approach such as Maslow's hierarchy or the ABC (airway, breathing, circulation) principle.
• D. The client who has been waiting longest for the nurse's attention.

144. A nurse identifies a recurring pattern of near-miss medication errors on the unit related to look-alike drug labeling. Which action best reflects a systems-based approach to quality improvement?

• A. Ignore the pattern since no actual harm occurred.
• B. Report the pattern through the facility's safety event reporting system to initiate a system-level review.
• C. Discipline the nurses involved in the most recent near-miss.
• D. Remind individual nurses to be more careful when administering medications.

145. A nurse questions whether a facility policy is still aligned with current evidence-based guidelines after reading a newly published clinical practice update. Which action best reflects the nurse's responsibility to safe, effective care?

• A. Ignore the new guideline since policies are rarely updated.
• B. Wait for a sentinel event before considering a policy change.
• C. Bring the updated evidence to the appropriate committee or nurse manager for review of the current policy.
• D. Independently change personal practice without informing the team.

146. Six hours after a total knee replacement, a client reports sudden shortness of breath, pleuritic chest pain, and anxiety, with an oxygen saturation of 88%. Which complication should the nurse suspect?

• A. Postoperative pneumonia
• B. Normal postoperative pain response
• C. Pulmonary embolism
• D. Anxiety attack unrelated to the surgery

147. A client's cardiac monitor shows a regular rhythm with a heart rate of 150 beats per minute and narrow QRS complexes, and the client reports palpitations and lightheadedness. Which nursing action is the priority?

• A. Notify the provider immediately and prepare to assess the client's hemodynamic stability.
• B. Encourage the client to walk to see if symptoms resolve.
• C. Administer a full glass of a caffeinated beverage to help identify the cause.
• D. Wait until the next scheduled vital sign check to reassess.

148. A client is scheduled for a diagnostic procedure requiring intravenous contrast dye. Which question is most important for the nurse to ask before the procedure?

• A. "Have you eaten breakfast today?"
• B. "Do you have any tattoos?"
• C. "Do you have any known allergies to iodine, shellfish, or previous contrast dye reactions?"
• D. "Do you prefer a warm or cool room temperature?"

149. A client returns to the unit after a lumbar puncture. Which instruction should the nurse provide to help reduce the risk of a post-procedure headache?

• A. Restrict oral fluid intake for the next several hours.
• B. Sit upright in a chair for several hours immediately after the procedure.
• C. Ambulate immediately to promote circulation.
• D. Remain lying flat as instructed and increase oral fluid intake as tolerated.

150. A client reports crushing substernal chest pain radiating to the left arm, accompanied by diaphoresis and nausea. Which nursing action is the priority?

• A. Have the client walk to the bathroom to see if the pain resolves.
• B. Obtain a 12-lead electrocardiogram and notify the provider immediately while maintaining the client on bed rest.
• C. Document the complaint and continue with routine scheduled tasks.
• D. Administer a full glass of water and reassess in one hour.

151. A client with advanced cirrhosis becomes increasingly confused, with asterixis noted on examination. Which finding in the client's recent history is most consistent with this presentation?

• A. A recent decrease in serum bilirubin.
• B. Improved liver synthetic function on recent labs.
• C. Elevated serum ammonia levels due to impaired liver clearance.
• D. A recent decrease in dietary protein intake.

152. Shortly after receiving an intravenous antibiotic, a client develops hives, facial swelling, wheezing, and a blood pressure of 78/42 mm Hg. Which nursing action is the priority?

• A. Stop the infusion immediately, maintain the airway, and call for emergency assistance.
• B. Document the reaction and notify the provider at the next rounding visit.
• C. Administer an oral antihistamine and continue the infusion.
• D. Slow the infusion rate and reassess in 15 minutes.

153. A client with a lower leg cast reports severe, unrelenting pain unrelieved by prescribed analgesics, along with numbness and pallor of the toes. Which complication should the nurse suspect?

• A. Normal postoperative discomfort.
• B. A mild allergic reaction to the casting material.
• C. Compartment syndrome.
• D. A superficial skin irritation from the cast edge.

154. A client receiving intravenous morphine for postoperative pain has a respiratory rate of 8 breaths per minute and is difficult to arouse. Which nursing action is the priority?

• A. Administer the next scheduled dose of morphine as ordered.
• B. Reposition the client and recheck respirations in one hour.
• C. Withhold the next dose, stimulate the client, notify the provider, and prepare naloxone per protocol.
• D. Encourage the client to take deep breaths and go back to sleep.

155. A client receiving intravenous vancomycin develops flushing, redness, and itching of the face, neck, and upper torso during the infusion. Which nursing action is most appropriate?

• A. Stop all future doses of the medication permanently without provider notification.
• B. Increase the infusion rate to complete the dose more quickly.
• C. Administer a second dose immediately to compensate for the reaction.
• D. Slow the infusion rate and notify the provider, as this may indicate red man syndrome related to rapid infusion.

156. A nurse is reinforcing teaching for a client newly prescribed an oral corticosteroid for a short-term inflammatory condition. Which instruction is most important?

• A. Take the medication on an empty stomach to increase absorption.
• B. Stop the medication immediately once symptoms improve.
• C. Do not stop the medication abruptly; the dose must be tapered as directed by the provider.
• D. Double the dose if a dose is missed.

157. Shortly after a blood transfusion is started, a client reports lower back pain, chills, and dark urine, and the nurse notes a temperature increase. Which nursing action is the priority?

• A. Stop the transfusion immediately, keep the IV line open with normal saline, and notify the provider.
• B. Document the findings and reassess in 30 minutes.
• C. Slow the transfusion rate and continue monitoring.
• D. Administer an antipyretic and continue the transfusion.

158. A client taking lithium for bipolar disorder reports nausea, vomiting, diarrhea, blurred vision, and a coarse hand tremor. Which nursing action is the priority?

• A. Reassure the client that these are minor, expected side effects requiring no action.
• B. Encourage the client to increase salt intake to manage symptoms.
• C. Administer the next scheduled dose as ordered.
• D. Hold the next dose and notify the provider, as these findings suggest lithium toxicity.

159. A nurse is reinforcing dietary teaching for a client newly prescribed a monoamine oxidase inhibitor (MAOI) for depression. Which food should the client be instructed to avoid?

• A. Plain white rice.
• B. Plain grilled chicken breast.
• C. Aged cheeses and cured meats high in tyramine.
• D. Fresh steamed vegetables.