NCLEXRN National Council Licensure Examination(NCLEXRN) Free Practice Test — 30 Questions

Question 1

Anya, a critical care nurse, is simultaneously caring for three unstable patients: Mr. Henderson, who is on mechanical ventilation and suddenly desaturating; Ms. Davies, who requires immediate titration of a vasoactive infusion for a severe hypertensive crisis; and Mr. Chen, who is exhibiting signs of post-operative bleeding from a surgical site. Anya also has a newly graduated nurse and an unlicensed assistive personnel (UAP) available for assistance. Which of Anya\'s actions should be performed first?

Accepted Answer

Directly assess and manage Mr. Henderson's airway and oxygenation status.

Question 2

A registered nurse is assigned to care for five patients on a medical-surgical unit. The nurse has just received change-of-shift report and is assessing the immediate needs of each patient. Patient A requires continuous cardiac monitoring due to a recent myocardial infarction. Patient B is stable and awaiting discharge instructions for wound care. Patient C is reporting severe, unrelieved pain at a level of 9 out of 10. Patient D has a new prescription for intravenous antibiotics to be initiated within the next hour. Patient E, a post-operative patient, requires assistance with ambulation to prevent complications. Which patient should the nurse assess and intervene for first?

Accepted Answer

Patient C

Question 3

A charge nurse observes a newly graduated nurse attempting to manage a patient\'s care team, which includes a physician with a differing treatment perspective, an anxious family member, and a CNA expressing concerns about their workload. Which of the following actions by the charge nurse best demonstrates the behavioral competency of leadership potential in this complex situation?

Accepted Answer

Facilitating a structured interdisciplinary team meeting to discuss the patient's care plan, ensuring all voices are heard and collaboratively identifying solutions.

Question 4

A charge nurse is supervising a team consisting of one Registered Nurse (RN), one Licensed Practical Nurse (LPN), and one Certified Nursing Assistant (CNA). The RN is caring for a patient with unstable vital signs and a new onset of confusion. The LPN is managing a patient requiring a complex sterile wound dressing change and debridement. The CNA is assigned to assist a patient with ambulation and perineal care. The charge nurse observes the LPN preparing to administer a new intravenous antibiotic to a stable patient, while the RN is attending to the confused patient. Which of the following assignments would be the most appropriate reallocation of tasks to ensure optimal patient care and adherence to scope of practice?

Accepted Answer

Assign the stable patient requiring intravenous antibiotic administration to the RN and delegate the ambulation and perineal care to the LPN.

Question 5

Anya, a critical care nurse, is managing four patients, each requiring complex interventions. Patient A is on mechanical ventilation with a new onset of bilateral crackles, Patient B is experiencing a significant drop in blood pressure requiring vasopressor titration, Patient C is post-operative from a major surgery and requires close neurological monitoring, and Patient D is stable but requires routine medication administration. Suddenly, Mr. Henderson, Patient A, experiences a precipitous drop in oxygen saturation and becomes bradycardic. Anya has been continuously reassessing and re-prioritizing her interventions based on the dynamic patient statuses. Which of the following actions demonstrates the most effective **adaptability and flexibility** in managing this emergent situation?

Accepted Answer

Complete the detailed shift report for the outgoing nurse before attending to Mr. Henderson.

Question 6

A pediatric unit, already operating with minimal staffing, is unexpectedly overwhelmed by a sudden influx of children presenting with severe respiratory distress, coinciding with a critical shortage of specialized pediatric nurses due to unforeseen staff absences. The nurse manager must immediately reconfigure the unit\'s operational plan to ensure adequate patient care. Which primary behavioral competency is most crucial for the nurse manager to effectively navigate this emergent situation?

Accepted Answer

Adaptability and Flexibility

Question 7

A nurse is assigned to care for a 78-year-old male patient recovering from abdominal surgery. The patient, who is alert and oriented, expresses a clear desire not to receive a prescribed opioid analgesic for post-operative pain, stating, \"I don\'t want anything that will make me drowsy or constipated.\" The attending physician has ordered the medication every four hours as needed for pain. The nurse observes the patient exhibiting signs of moderate discomfort, including grimacing and guarding his abdomen. The nurse is aware that the prescribed medication is effective for pain relief but carries a risk of drowsiness and constipation. Which of the following actions is the most appropriate initial step for the nurse to take?

Accepted Answer

Discuss the patient's concerns with the physician, explaining the patient's refusal and exploring alternative pain management strategies that align with the patient's preferences and clinical needs.

Question 8

Elara, a registered nurse in a busy intensive care unit, is simultaneously managing four critically ill patients. While reviewing Mr. Henderson\'s telemetry, she notes a sudden onset of ST-segment elevation, indicating an acute myocardial infarction. Concurrently, a new admission is en route to her unit, with limited information provided during the transfer report. A fellow nurse approaches Elara, requesting immediate assistance with a complex dressing change for another patient. Which of the following actions should Elara prioritize to ensure optimal patient outcomes and unit efficiency?

Accepted Answer

Initiate immediate advanced cardiac life support protocols for Mr. Henderson while simultaneously requesting another nurse to assess the new admission and assist the colleague.

Question 9

As the charge nurse on a busy medical-surgical unit, Anya is informed of an unexpected staff shortage due to a colleague calling in sick, reducing the available registered nurses (RNs) by one. The unit currently has three RNs, one licensed practical nurse (LPN), and one newly licensed nurse (NLN) who is on their third day of orientation with a preceptor. Patient acuity is high, with several patients requiring complex wound care, frequent monitoring, and medication administration. Anya must immediately reassign tasks to ensure safe and effective patient care. Which of the following delegation strategies would be most appropriate in this situation?

Accepted Answer

Assign the LPN to administer medications for stable patients, have an experienced RN perform the complex wound dressing changes, and assign the NLN to assist the experienced RN with patient ambulation and basic care, with Anya providing direct observation and feedback to the NLN during these activities.

Question 10

A nurse is caring for a patient with a life-threatening condition. The attending physician orders a novel, unproven therapeutic intervention, stating it is a \"cutting-edge approach\" that might offer a better outcome. The nurse, having reviewed current literature, finds no supporting evidence for this intervention and notes potential risks that have not been adequately addressed. The physician is insistent on proceeding with the order. Which of the following actions should the nurse take first?

Accepted Answer

Seek clarification and express concerns regarding the evidence base and potential risks of the ordered intervention to the physician.

Question 11

A nurse is caring for a client experiencing a severe anaphylactic reaction. The facility\'s emergency protocol for this specific situation is temporarily unavailable due to a system-wide electronic health record outage. The client\'s condition is rapidly deteriorating, and a newly approved anaphylaxis treatment, not yet incorporated into the facility\'s formulary, is available in the unit. What is the nurse\'s *most* appropriate immediate action?

Accepted Answer

Administer the new medication after assessing the client's current vital signs and contacting the on-call physician for verbal orders.

Question 12

A charge nurse is overseeing a busy medical-surgical unit during a sudden increase in patient admissions. A new graduate nurse expresses anxiety about managing their assigned patients. The charge nurse observes the new graduate demonstrating proficiency in basic assessments but appearing overwhelmed by the pace. Which action by the charge nurse best demonstrates leadership potential in this scenario?

Accepted Answer

Assign the new graduate nurse to monitor a stable patient, providing specific, time-bound instructions for reporting observations, while remaining available for consultation.

Question 13

A registered nurse (RN) is preparing to discharge a patient with a stable chronic condition requiring daily oral medication and routine vital sign monitoring. The RN has a licensed practical nurse (LPN) and a certified nursing assistant (CNA) available to assist with the discharge process. Which of the following responsibilities associated with the patient\'s discharge *should not* be delegated by the RN?

Accepted Answer

Conducting the initial comprehensive discharge assessment to determine the patient's readiness for home care and developing the patient's home care teaching plan.

Question 14

Anya, a registered nurse on a pediatric oncology unit, is tasked with implementing a recently updated chemotherapy administration protocol that mandates altered infusion rates and novel monitoring techniques. Simultaneously, she is caring for a young patient experiencing severe mucositis, necessitating frequent pain management interventions, and another child who has developed neutropenic fever, requiring strict isolation and continuous assessment. Adding to the complexity, a family is expressing heightened distress regarding their child\'s treatment trajectory and has requested an urgent consultation with the attending physician. Anya must seamlessly integrate the new protocol, manage her current high-acuity patient assignments, and address the family\'s immediate emotional and informational needs. Which of the following nursing actions best exemplifies the application of critical competencies in this dynamic and demanding clinical environment?

Accepted Answer

Immediately delegate the initiation of the new chemotherapy protocol to a less experienced nurse while Anya focuses on managing the neutropenic patient and meeting with the anxious family, subsequently reviewing the protocol documentation later.

Question 15

A pediatric unit is experiencing an unprecedented influx of young patients presenting with a novel respiratory illness, leading to a rapid escalation of acuity and a critical shortage of isolation rooms. The nurse manager, Elara, must immediately reconfigure staffing assignments, reallocate existing resources, and establish new protocols for patient management and infection control. Which of Elara\'s leadership competencies is most prominently demonstrated in this rapidly evolving crisis scenario?

Accepted Answer

Strategic vision and decisive action in resource allocation and protocol development

Question 16

A Registered Nurse (RN) is caring for a patient newly diagnosed with hypertension who has been prescribed a new antihypertensive medication. The RN has provided initial education to the patient regarding the medication\'s purpose, dosage, and common side effects. The patient\'s Unlicensed Assistive Personnel (UAP) has expressed a willingness to assist with patient education. Which of the following actions by the RN best demonstrates appropriate delegation and adherence to scope of practice while promoting patient understanding?

Accepted Answer

Instruct the UAP to review the medication administration record and remind the patient to take the medication at the prescribed times.

Question 17

A nurse manager is overseeing the rollout of a new electronic health record (EHR) system across a busy hospital unit. During a team meeting, the manager presents the implementation timeline and key functionalities, then actively solicits questions and concerns from the nursing staff. After listening attentively to feedback regarding potential workflow disruptions and the need for additional training modules, the manager acknowledges the validity of the concerns and proposes a revised training schedule and a pilot testing phase for specific new features before full integration. The manager also emphasizes the importance of the team\'s input in refining the process.

Which of the following leadership competencies is most prominently demonstrated by the nurse manager\'s actions in this scenario?

Accepted Answer

Adaptability and Flexibility, coupled with Leadership Potential

Question 18

A hospital unit has recently adopted a new intravenous antibiotic protocol for a complex infection, but the nursing staff received only a brief overview during a mandatory meeting without hands-on practice or detailed guideline review. During rounds, a newly admitted patient requires this specific antibiotic. The primary nurse, recalling the limited training, feels uncertain about the correct dilution, infusion rate, and potential drug interactions not covered in the overview. The charge nurse is currently managing a code blue in another room. What is the most prudent immediate action for the primary nurse to take regarding the administration of this new antibiotic to the patient?

Accepted Answer

Inform the charge nurse of the concerns regarding the protocol and request a delay in administration until adequate training and resources are available.

Question 19

A registered nurse is assigned to a unit experiencing an unexpected staff shortage during a shift change. The nurse is responsible for five patients: a post-operative patient with a PCA pump experiencing increased pain, a patient with a new onset of shortness of breath requiring immediate assessment and potential intervention, a patient requiring routine medication administration, a patient with a stable but chronic condition who needs vital signs checked, and a newly admitted patient who requires initial assessment and vital signs. The available staff includes one licensed practical nurse (LPN) and one unlicensed assistive personnel (UAP). How should the nurse best prioritize and delegate tasks to ensure the most critical patient needs are addressed promptly and safely?

Accepted Answer

The nurse should personally assess the patient with shortness of breath, administer the post-operative patient's pain medication, and then delegate vital sign checks for the stable patient and the newly admitted patient to the UAP, assigning the LPN to administer routine medications and the post-operative patient's PCA pump.

Question 20

A nurse manager is tasked with transitioning a large hospital unit to a new, complex electronic health record (EHR) system. The implementation timeline is aggressive, and initial staff feedback indicates significant apprehension regarding data migration accuracy and workflow disruption. The manager decides to implement the system in phases, focusing on one core patient care module per month, coupled with mandatory, hands-on training sessions for all staff before each module\'s activation. A dedicated team of experienced nurses is identified as \"super-users\" to provide immediate, on-the-floor support during the initial weeks of each phase. Regular huddles are scheduled to address emerging issues and collect user feedback for rapid system adjustments. Which primary behavioral competency is the nurse manager demonstrating by employing this multi-faceted implementation strategy?

Accepted Answer

Adaptability and Flexibility

Question 21

Anya, a registered nurse in the intensive care unit, is assigned four critically ill patients. Suddenly, Patient A develops acute respiratory distress requiring immediate intubation. Simultaneously, Patient B experiences a precipitous drop in blood pressure, necessitating rapid fluid administration and vasopressor adjustment. Concurrently, Patient C\'s cardiac monitor reveals new-onset ventricular tachycardia. Anya must also ensure accurate and timely documentation and communicate critical updates to the attending physician. Which of the following nursing actions best exemplifies effective crisis management and prioritization in this scenario?

Accepted Answer

Delegate the initial assessment and vital sign monitoring of Patient C to a less experienced nurse while personally managing the immediate life-saving interventions for Patients A and B, and directing the physician to Patient A for intubation.

Question 22

A registered nurse is assigned to a unit with four high-acuity patients. Suddenly, one patient becomes hypotensive and tachycardic, requiring immediate intervention. Another patient requires the administration of a complex intravenous medication with a strict time window. A third patient is exhibiting new neurological symptoms that warrant close observation. The fourth patient requires routine post-operative care. The nurse has only one available unlicensed assistive personnel (UAP) to assist. Which action best demonstrates the nurse\'s adaptability and effective priority management in this dynamic situation?

Accepted Answer

Immediately initiate advanced cardiac life support protocols for the hypotensive patient, delegate vital sign monitoring for the other three patients to the UAP, and notify the charge nurse of the emergent situation to request additional support.

Question 23

Anya, an experienced emergency department nurse, is faced with a sudden influx of critical events. She receives an urgent call from the laboratory reporting a critical potassium level for a patient in another bay, Mr. Chen, whom she is not currently assigned to. Almost simultaneously, a distressed family member of her assigned patient, Mrs. Rodriguez, approaches her requesting an immediate medication adjustment. As if this were not enough, a new patient has just arrived via ambulance and requires immediate triage and assessment. Which of the following nursing actions best demonstrates effective priority management and adaptability in this complex, high-acuity situation?

Accepted Answer

Immediately contact the physician about Mr. Chen's critical lab value, perform a rapid triage of the new arrival, and then communicate with Mrs. Rodriguez's family member to set realistic expectations for when their request can be addressed.

Question 24

A pediatric patient receiving methylphenidate for attention deficit hyperactivity disorder (ADHD) presents to the clinic with uncharacteristic drowsiness, decreased motor activity, and a seemingly relaxed demeanor, which is a significant departure from their baseline presentation of hyperactivity and inattention. The nurse suspects a paradoxical reaction to the medication. Which of the following actions should the nurse prioritize?

Accepted Answer

Conduct a thorough assessment of the patient's vital signs and neurological status.

Question 25

A charge nurse on a busy medical-surgical unit must reallocate patient assignments due to an emergent staffing deficit, impacting the care of patients with diverse acuity levels and psychosocial needs. Considering the team\'s available skill sets and expressed professional interests, which delegation strategy would best promote both immediate patient safety and long-term team development?

Accepted Answer

Assign the most critically ill patients requiring advanced monitoring to the RN who recently completed specialized telemetry training, delegate patients needing extensive family education to the RN with strong interpersonal and teaching skills, and utilize the LPN for routine medication administration and vital sign checks across multiple stable patients.

Question 26

Anya, an experienced medical-surgical nurse, is managing a full patient assignment, including a newly admitted patient with complex post-operative pain management needs and a long-term patient requiring frequent wound care. While reviewing her patients\' charts, she notices a potential interaction between a new antibiotic prescribed for Mr. Henderson, a patient on her assignment but not her primary focus for that shift, and his existing beta-blocker for hypertension. The interaction could lead to bradycardia. Anya has not been directly involved in Mr. Henderson\'s hypertension management but recognizes the significance of this potential drug-drug interaction. Which nursing action best demonstrates Anya\'s adaptability and problem-solving abilities in this situation?

Accepted Answer

Immediately notify Mr. Henderson's primary physician about the potential drug interaction and suggest an alternative antibiotic.

Question 27

Anya, a registered nurse on a medical-surgical unit, is admitting a patient with a new diagnosis of pneumonia. While reviewing the patient\'s chart, she is notified that Mr. Henderson, one of her assigned stable patients, has suddenly become hypotensive and diaphoretic. Simultaneously, her colleague, Ben, who was caring for two other patients on the unit, has just informed the charge nurse he is experiencing a severe migraine and must leave for the day. The unit is already operating at minimal staffing. Which of the following actions should Anya prioritize?

Accepted Answer

Immediately assess and stabilize Mr. Henderson, then notify the charge nurse of the staffing shortage and request assistance for patient assignments.

Question 28

A registered nurse is assigned to a patient in the intensive care unit who suddenly becomes cyanotic, tachypneic, and exhibits shallow breathing. The patient\'s oxygen saturation has dropped to $82\%$ on room air. Which of the following actions should the nurse implement *first* to address this emergent respiratory compromise?

Accepted Answer

Apply a non-rebreather mask at $15$ L/min and assess the patient's response.

Question 29

A nurse is caring for a client experiencing acute respiratory distress. The physician orders an endotracheal tube for immediate intubation. Upon opening the intubation kit, the nurse discovers the prescribed size of endotracheal tube is missing, and only a smaller size is available. Simultaneously, the client\'s oxygen saturation drops to $82\%$. Which immediate action demonstrates the most effective problem-solving and adaptability in this critical situation?

Accepted Answer

Attempt intubation with the available smaller-sized endotracheal tube, notifying the physician immediately of the situation and the chosen course of action.

Question 30

Anya, a registered nurse in a busy emergency department, is simultaneously caring for two critically ill patients. The first patient presents with sudden onset shortness of breath and chest pain, with initial assessment raising suspicion for a pulmonary embolism. The second patient has developed new-onset atrial fibrillation with a rapid ventricular response, exhibiting palpitations and mild dizziness. A nursing assistant is available to provide assistance. Which action by Anya demonstrates the most effective prioritization and delegation to manage these critical situations?

Accepted Answer

Anya administers oxygen and prepares for potential thrombolytic therapy for the suspected pulmonary embolism patient, while directing the nursing assistant to obtain a complete set of vital signs and remain with the patient experiencing atrial fibrillation with rapid ventricular response.

NCLEXRN National Council Licensure Examination(NCLEXRN) Free Practice Test — 30 Questions

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