Free NCLEX-RN practice questions

1. A. Assisting a stable postoperative patient with ambulation to the bathroomCorrect

   Correct. Ambulation assistance for a stable patient is a routine, predictable task with a known outcome and no assessment or judgment required — the criteria for delegation to a UAP.

2. B. Performing the admission assessment on a newly arrived patient

   Incorrect. Initial assessment is a core nursing function requiring clinical judgment and cannot be delegated. UAPs may collect data such as vital signs, but interpreting and forming the assessment is the RN’s.

3. C. Teaching a newly diagnosed patient how to self-administer insulin

   Incorrect. Patient education requires assessment of learning needs and evaluation of understanding, both of which are nursing responsibilities that cannot be delegated.

4. D. Adjusting the rate of a continuous intravenous infusion

   Incorrect. Titrating or adjusting an IV infusion requires nursing judgment and is outside the UAP scope in every jurisdiction.

Educational objective: Delegate tasks that are routine and predictable with known outcomes; assessment, teaching, evaluation and nursing judgment stay with the registered nurse.

1. A. A patient two days post-thyroidectomy reporting tingling around the mouth and in the fingertipsCorrect

   Correct. Perioral and digital tingling after thyroid surgery suggests hypocalcaemia from inadvertent parathyroid injury, which can progress to laryngospasm, tetany and seizures. This is the finding with the shortest fuse and must be assessed first.

2. B. A patient with pneumonia and an oral temperature of 38.4°C due for scheduled antibiotics

   Incorrect. Fever in pneumonia is an expected finding and the antibiotic is scheduled rather than emergent. Important, but not the priority over an evolving airway risk.

3. C. A patient one day postoperative reporting incisional pain rated 6 out of 10

   Incorrect. Postoperative pain deserves prompt attention and is expected at this stage. It does not outrank a potential airway emergency.

4. D. A newly admitted patient with cellulitis awaiting an admission assessment

   Incorrect. The admission assessment is a required task but the condition is stable, so it can follow the urgent assessment.

Educational objective: Prioritise unexpected findings that threaten airway, breathing or circulation over expected findings and scheduled tasks — perioral tingling after thyroidectomy signals hypocalcaemia and possible laryngospasm.

1. A. Place the patient in a negative-pressure airborne isolation room and wear a fit-tested N95 respiratorCorrect

   Correct. Pulmonary tuberculosis is transmitted by airborne droplet nuclei, which requires a negative-pressure room with the door kept closed and a fit-tested N95 respirator or higher for anyone entering. Precautions begin on suspicion, not on confirmation.

2. B. Place the patient in a private room and wear a surgical mask when within three feet

   Incorrect. This describes droplet precautions, appropriate for organisms such as influenza or pertussis. A surgical mask does not filter airborne droplet nuclei, and a standard private room does not contain them.

3. C. Use contact precautions with gown and gloves for all patient care

   Incorrect. Contact precautions address organisms spread by direct or indirect contact, such as C. difficile or MRSA, and do nothing to prevent airborne transmission.

4. D. Apply standard precautions only until sputum culture results confirm the diagnosis

   Incorrect, and the most dangerous option. Cultures can take weeks, and waiting for confirmation exposes staff and other patients throughout the most infectious period. Isolate on clinical suspicion.

Educational objective: Suspected pulmonary tuberculosis requires airborne precautions — negative-pressure room plus fit-tested N95 — implemented on suspicion rather than after diagnostic confirmation.

1. A. Withhold the digoxin and notify the provider of the symptoms and the potassium levelCorrect

   Correct. Nausea, anorexia and yellow-green visual halos are classic digoxin toxicity, and hypokalaemia from the loop diuretic potentiates it by increasing digoxin binding at the sodium-potassium pump. Holding the dose and reporting both findings together addresses the toxicity and its cause.

2. B. Administer the digoxin as scheduled and document the patient’s complaints

   Incorrect. Giving a further dose in the presence of classic toxicity and a potentiating electrolyte abnormality risks progression to serious dysrhythmia.

3. C. Encourage increased dietary potassium and reassess the patient in the morning

   Incorrect. Correcting potassium is part of the plan, but diet alone is too slow, and deferring action overnight leaves active toxicity untreated.

4. D. Hold the furosemide and administer the digoxin as ordered

   Incorrect. This addresses the contributing cause while still administering the drug the patient is toxic on — exactly backwards in priority.

Educational objective: Hypokalaemia potentiates digoxin toxicity; nausea, anorexia and yellow-green visual halos in a patient on digoxin and a loop diuretic require holding the dose and reporting both the symptoms and the potassium.

1. A. Intravenous calcium gluconateCorrect

   Correct. With ECG changes present, the immediate threat is a lethal dysrhythmia. Calcium gluconate stabilises the myocardium within minutes. It does not lower the potassium at all — it buys time for the treatments that do.

2. B. Intravenous regular insulin with dextrose

   Incorrect as the first agent. Insulin with dextrose shifts potassium intracellularly and is an essential part of management, but it does not protect the myocardium in the interim. It follows calcium when ECG changes are present.

3. C. Oral sodium polystyrene sulfonate

   Incorrect. Cation-exchange resins remove potassium through the gut over hours, far too slowly for a patient with active ECG changes.

4. D. Arrangement of urgent haemodialysis

   Incorrect as the first action. Dialysis is the definitive treatment and should be arranged, but it takes time to initiate — the patient needs myocardial stabilisation now.

Educational objective: In hyperkalaemia with ECG changes, give calcium first to stabilise the myocardium, then shift potassium intracellularly, then remove it from the body.

1. A. Notify the provider immediately, as the findings together suggest hypovolaemia or internal bleedingCorrect

   Correct. Rising heart rate, falling blood pressure and urine output under 30 mL per hour form a coherent picture of hypovolaemia, and a dry dressing does not exclude internal haemorrhage. The trend across parameters — not any single value — is what makes this urgent.

2. B. Document the findings and continue to monitor over the next two hours

   Incorrect. These trends are moving in a dangerous direction simultaneously. Continued observation without escalation risks decompensation.

3. C. Reposition the patient and irrigate the urinary catheter to improve output

   Incorrect. This treats the low output as a mechanical catheter problem while ignoring the tachycardia and hypotension that point to a systemic cause.

4. D. Administer the ordered opioid analgesic, as pain is likely driving the vital sign changes

   Incorrect, and potentially harmful. Pain can raise heart rate but does not lower blood pressure or reduce urine output, and an opioid may worsen hypotension in a hypovolaemic patient.

Educational objective: Interpret postoperative vital signs as a trend across parameters: tachycardia with falling blood pressure and urine output below 30 mL per hour suggests hypovolaemia, and an intact dressing does not rule out internal bleeding.