NCLEX Practice Questions with Rationales
Six fully worked NCLEX-RN questions. Try each one, then open the rationales — you get an explanation for the correct answer and for every distractor, which is where the exam reasoning actually lives.
A client with heart failure has a serum potassium of 3.1 mEq/L and takes digoxin daily. Which action should the nurse take first?
- A.Hold the digoxin dose and notify the provider
- B.Administer the digoxin and document the potassium
- C.Encourage a diet high in potassium-rich foods
- D.Recheck the potassium level in eight hours
Show answer and rationales
Correct answer: A — Hold the digoxin dose and notify the provider
A. Correct. Hypokalemia potentiates digoxin at the cellular level, so a potassium of 3.1 mEq/L sharply raises the risk of digoxin toxicity and lethal dysrhythmias. Holding the dose and notifying the provider prevents harm before it occurs.
B. Incorrect. Giving digoxin to a hypokalemic client is exactly the combination that produces toxicity — nausea, visual halos, bradycardia and dysrhythmias. Documentation does not neutralize the pharmacologic risk.
C. Incorrect. Dietary potassium is an appropriate long-term teaching point, but food cannot correct a level of 3.1 mEq/L quickly enough to make the pending digoxin dose safe. It does not address the immediate danger.
D. Incorrect. Waiting eight hours leaves the client exposed to toxicity in the meantime. Abnormal labs that change medication safety require action now, not a delayed recheck.
Test-day takeaway: Low potassium plus digoxin equals toxicity risk. Hold and notify.
An arterial blood gas shows pH 7.28, PaCO2 55 mmHg, HCO3- 25 mEq/L. How should the nurse interpret this result?
- A.Respiratory acidosis, uncompensated
- B.Metabolic acidosis, uncompensated
- C.Respiratory alkalosis, partially compensated
- D.Metabolic alkalosis, fully compensated
Show answer and rationales
Correct answer: A — Respiratory acidosis, uncompensated
A. Correct. The pH is low (acidosis) and the CO2 is high, moving in the opposite direction from the pH, which identifies a respiratory cause. Bicarbonate is still normal at 25 mEq/L, so no compensation has begun.
B. Incorrect. A metabolic acidosis would show a low bicarbonate driving the low pH. Here bicarbonate is normal and the CO2 is elevated, so the kidneys are not the source of the problem.
C. Incorrect. Alkalosis requires a pH above 7.45. This pH of 7.28 is acidotic, so the direction is wrong before the compensation question even matters.
D. Incorrect. Full compensation requires a normal pH, and this pH is clearly abnormal. The values also point to acidosis rather than alkalosis.
Test-day takeaway: ROME: Respiratory Opposite, Metabolic Equal. Check pH, then CO2.
The nurse is caring for four clients. Which client should the nurse assess first?
- A.A client with pneumonia whose respiratory rate is 30 and who is using accessory muscles
- B.A client two days post-operative reporting incisional pain rated 7 of 10
- C.A client with diabetes whose morning glucose is 240 mg/dL
- D.A client scheduled for discharge who has questions about home medications
Show answer and rationales
Correct answer: A — A client with pneumonia whose respiratory rate is 30 and who is using accessory muscles
A. Correct. Accessory muscle use with a respiratory rate of 30 signals impending respiratory failure. Airway and breathing outrank every other finding in a priority question, so this client is assessed first.
B. Incorrect. Pain of 7 of 10 needs prompt intervention and is genuinely important, but it is not immediately life-threatening. Comfort follows airway, breathing and circulation.
C. Incorrect. A glucose of 240 mg/dL is elevated and requires treatment, but without ketones, acidosis or altered mental status it is not an emergency compared with respiratory distress.
D. Incorrect. Discharge teaching is essential nursing care but entirely non-urgent. It can be delegated in timing to after the unstable client is assessed.
Test-day takeaway: Unstable beats stable; airway and breathing beat everything else.
A client receiving IV heparin has an aPTT of 95 seconds. What is the nurse's priority action?
- A.Stop the heparin infusion and notify the provider
- B.Slow the infusion rate by half and continue monitoring
- C.Administer vitamin K as the antidote
- D.Draw a repeat aPTT in one hour before acting
Show answer and rationales
Correct answer: A — Stop the heparin infusion and notify the provider
A. Correct. A therapeutic heparin aPTT is roughly 46 to 70 seconds; 95 seconds is well above range and carries a serious bleeding risk. Stopping the infusion and notifying the provider is the safe immediate action, with protamine sulfate available as the antidote.
B. Incorrect. Adjusting an anticoagulant rate independently is outside nursing scope without a provider order or protocol, and the client remains supratherapeutic while the change takes effect.
C. Incorrect. Vitamin K reverses warfarin, not heparin. The heparin antidote is protamine sulfate, so this action would delay effective treatment.
D. Incorrect. Waiting an hour with a supratherapeutic aPTT leaves the client at active bleeding risk. Critical values require action before reconfirmation.
Test-day takeaway: Heparin is aPTT and protamine. Warfarin is INR and vitamin K.
One hour after a vaginal delivery, the nurse finds the client's fundus boggy and displaced to the right. What should the nurse do first?
- A.Massage the fundus
- B.Assist the client to empty her bladder
- C.Administer the ordered oxytocin infusion
- D.Increase the intravenous fluid rate
Show answer and rationales
Correct answer: A — Massage the fundus
A. Correct. A boggy fundus means the uterus is not contracting, which is the leading cause of postpartum hemorrhage. Fundal massage is the immediate, independent nursing action that restores tone before anything else is tried.
B. Incorrect. A full bladder does displace the fundus to the right and must be addressed, but it is the second step. Massage restores uterine tone immediately, which is what stops the bleeding.
C. Incorrect. Oxytocin is appropriate and often follows, but it is a dependent action requiring the order and takes longer to work than massage that can begin this second.
D. Incorrect. Increasing fluids supports volume but does nothing to contract the uterus. It treats a consequence rather than the cause of the bleeding.
Test-day takeaway: Boggy fundus: massage first, then bladder, then oxytocin.
A client says, "There is no point in any of this anymore." Which response by the nurse is most therapeutic?
- A."Are you thinking about hurting yourself?"
- B."You have so much to live for — think about your family."
- C."Things always look worse than they really are."
- D."Why do you feel that way about your treatment?"
Show answer and rationales
Correct answer: A — "Are you thinking about hurting yourself?"
A. Correct. A statement of hopelessness requires a direct, non-judgmental safety assessment. Asking plainly about self-harm does not plant the idea; it establishes risk and is always the priority in a possible suicidal statement.
B. Incorrect. This offers false reassurance and shifts focus to others, which minimizes the client's feelings and closes off disclosure at the exact moment the nurse needs more information.
C. Incorrect. Minimizing the client's experience is a classic non-therapeutic block. It invalidates the feeling and leaves the safety risk unassessed.
D. Incorrect. "Why" questions demand justification and can feel accusatory. It also assumes the statement is about treatment when the risk may be far broader.
Test-day takeaway: Suspected suicidal ideation? Ask directly, every time.
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