NCLEX-RN NCLEX-RN Practice Test 2025

The correct answer is (c) Obtaining vital signs on a stable postoperative patient who is 2 days post-cholecystectomy. Obtaining vital signs on a stable patient is a routine, non-invasive task that falls within the UAP scope of practice. The patient is stable and 2 days postoperative, indicating a predictable condition that does not require nursing judgment for this task.

(a) Performing the initial assessment on a newly admitted patient with chest pain -- Initial assessments require nursing judgment and clinical decision-making, which are outside the scope of practice for UAPs. This task requires the RN because it involves data collection that will guide the plan of care for an acute presentation.

(b) Administering oral medications to a patient with a nasogastric tube -- Medication administration requires knowledge of pharmacology, assessment of NG tube placement, and clinical judgment. This task is within the LPN scope (under RN supervision) but is never appropriate for a UAP.

(d) Teaching a newly diagnosed diabetic patient how to self-administer insulin -- Patient education and teaching are core RN responsibilities that require professional nursing judgment, assessment of learning readiness, and the ability to evaluate comprehension. This cannot be delegated to either an LPN or a UAP.

The correct answer is (b) Measles, mumps, and rubella (MMR) vaccine. The first dose of the MMR vaccine is recommended at 12-15 months of age. At the 12-month well-child visit, the nurse should anticipate administering this vaccine along with other vaccines due at this age (such as varicella, hepatitis A, and the fourth dose of PCV13).

(a) Rotavirus vaccine -- The rotavirus vaccine series is completed by 8 months of age. The first dose is given at 2 months, the second at 4 months, and the third (if using RotaTeq) at 6 months. It would not be given at 12 months.

(c) Human papillomavirus (HPV) vaccine -- The HPV vaccine is recommended beginning at age 11-12 years, not at 12 months. It is given as a two-dose series if started before age 15.

(d) Tdap vaccine -- The Tdap booster is recommended at age 11-12 years. Infants receive the DTaP series (different formulation) at 2, 4, 6, and 15-18 months. At 12 months, the fourth dose of DTaP is not yet due.

The correct answer is (d) "It sounds like you are feeling overwhelmed about how this diagnosis will affect your family. Tell me more about what concerns you most." This response uses two key therapeutic communication techniques: reflection (acknowledging the patient feelings of being overwhelmed) and open-ended exploration (inviting the patient to elaborate on her concerns). It validates the patient emotions without offering false reassurance.

(a) "Do not worry, many people survive breast cancer these days. You will be fine." -- This response offers false reassurance and minimizes the patient legitimate concerns. It blocks therapeutic communication by dismissing her feelings.

(b) "You should speak to the hospital chaplain. They can help you with these feelings." -- While referral to spiritual care may eventually be appropriate, this response deflects the patient immediate emotional needs and implies the nurse cannot or will not address them.

(c) "I had a family member with cancer, and they did very well with treatment." -- Sharing personal experiences shifts the focus away from the patient and onto the nurse. This is a non-therapeutic technique that may minimize the uniqueness of the patient situation.

The correct answer is (b) Withhold the medication and notify the healthcare provider. Digoxin is a cardiac glycoside that slows the heart rate. The standard nursing guideline is to withhold digoxin and notify the provider if the apical heart rate is below 60 beats per minute in an adult. This patient heart rate of 54 bpm, combined with dizziness (a symptom of decreased cardiac output from bradycardia), suggests possible digoxin toxicity or an exaggerated therapeutic effect. The provider needs to evaluate the patient, potentially check a serum digoxin level and electrolytes (particularly potassium, as hypokalemia potentiates digoxin toxicity).

(a) Administer the medication as prescribed since the heart rate is close to normal -- A heart rate of 54 bpm is below the threshold of 60 bpm for safe digoxin administration. Combined with dizziness, administering the medication could further decrease the heart rate.

(c) Administer the medication and recheck the heart rate in one hour -- Administering digoxin when the heart rate is below the threshold is inappropriate. Even with plans to recheck, giving the drug could worsen the bradycardia.

(d) Withhold the medication and administer it at the next scheduled dose -- Simply withholding without notifying the provider is insufficient. The bradycardia and dizziness require medical evaluation to rule out toxicity and adjust the treatment plan.

The correct answer is (c) Discontinue the IV infusion and remove the catheter. The clinical findings described -- coolness, edema, pallor around the insertion site, pain, and decreased flow rate -- are classic signs of infiltration, which occurs when IV fluid leaks into the surrounding subcutaneous tissue. The priority action is to stop the infusion and remove the catheter to prevent further fluid accumulation in the tissue. After removal, the nurse should elevate the affected extremity, apply a warm or cold compress as appropriate, document the event, and restart the IV at a new site.

(a) Slow the infusion rate and continue to monitor the site -- Slowing the rate does not address infiltration. The fluid is already leaking into the tissue, and continuing the infusion at any rate would worsen the edema.

(b) Apply a warm compress to the site and flush the catheter with normal saline -- Flushing the catheter would force additional fluid into the subcutaneous tissue and is contraindicated when infiltration is suspected.

(d) Elevate the arm and increase the infusion rate to maintain patency -- Increasing the infusion rate would accelerate fluid leakage into the tissue, worsening the infiltration.

The correct answer is (a) Serum potassium of 6.8 mEq/L. A potassium level of 6.8 mEq/L represents severe hyperkalemia, which is a medical emergency. Critically elevated potassium levels can cause life-threatening cardiac arrhythmias, including ventricular fibrillation and cardiac arrest. This requires immediate intervention such as cardiac monitoring, administration of calcium gluconate (to stabilize the myocardium), insulin with glucose (to shift potassium intracellularly), and/or emergent dialysis.

(b) Serum sodium of 136 mEq/L -- This value is at the lower end of the normal range (136-145 mEq/L) and does not require immediate intervention.

(c) BUN of 58 mg/dL -- While elevated, an elevated BUN is expected in patients with chronic kidney disease on dialysis. This is addressed through routine dialysis sessions and dietary management.

(d) Serum creatinine of 8.2 mg/dL -- Elevated creatinine is expected in dialysis patients and reflects the underlying chronic kidney disease. While high, it is routinely managed through the dialysis schedule.

The correct answer is (b) Begin CPR and call for the defibrillator. The cardiac monitor pattern described -- a chaotic, irregular waveform with no discernible P waves, QRS complexes, or T waves -- is ventricular fibrillation (V-fib). According to the American Heart Association ACLS algorithm, ventricular fibrillation is a shockable rhythm. When a patient is found pulseless with V-fib, the immediate priority is to begin high-quality CPR (starting with chest compressions) and prepare for defibrillation as quickly as possible. Early defibrillation is the single most important intervention to restore a perfusing rhythm.

(a) Administer a precordial thump and assess for a pulse -- Precordial thump is no longer routinely recommended in current ACLS guidelines and should not delay CPR or defibrillation.

(c) Administer epinephrine 1 mg IV push immediately -- While epinephrine is part of the ACLS algorithm for cardiac arrest, it is not the first intervention in V-fib. CPR and defibrillation take priority. Epinephrine is administered after the first or second unsuccessful shock.

(d) Administer amiodarone 300 mg IV push immediately -- Amiodarone is used in refractory V-fib/pulseless V-tach, but it is given after initial defibrillation attempts and epinephrine have been unsuccessful.

The correct answer is (c) A 55-year-old man reporting substernal chest pain radiating to his left arm, diaphoresis, and shortness of breath. This presentation is highly suspicious for an acute myocardial infarction (AMI), which is a life-threatening emergency requiring immediate assessment and intervention. According to triage principles (ABCs -- airway, breathing, circulation), this patient has a potentially fatal cardiovascular emergency that takes priority. Time to treatment directly affects outcomes in AMI.

(a) A 22-year-old woman with a 2-day history of sore throat, fever of 101.2 degrees F, and difficulty swallowing -- While this patient needs evaluation, the presentation is not immediately life-threatening.

(b) A 68-year-old man with a swollen, painful right knee who reports he fell while gardening 3 hours ago -- This patient likely has a musculoskeletal injury that is painful but not life-threatening.

(d) A 10-year-old child with a 3-cm laceration to the forearm that is bleeding but controlled with direct pressure -- While this child needs wound care, the bleeding is controlled, indicating it is not a hemorrhagic emergency.

The correct answer is (d) Grilled chicken with steamed rice and fresh vegetables. Celiac disease is an autoimmune disorder triggered by ingestion of gluten, a protein found in wheat, barley, and rye. Rice is naturally gluten-free, as are plain meats, fruits, and vegetables. A meal of grilled chicken with steamed rice and fresh vegetables contains no sources of gluten and is safe for patients with celiac disease.

(a) Whole wheat pasta with marinara sauce and a side salad -- Whole wheat pasta is made from wheat flour, which contains gluten. This would trigger an immune response in a patient with celiac disease.

(b) Oatmeal with fresh berries and a slice of rye toast -- Rye is one of the primary gluten-containing grains and must be strictly avoided. While oats are naturally gluten-free, they are frequently cross-contaminated with wheat during processing.

(c) A turkey sandwich on sourdough bread with a side of barley soup -- Both sourdough bread (made from wheat flour) and barley contain gluten. Barley is one of the three primary grains that must be eliminated in a gluten-free diet.

The correct answer is (a) Airborne precautions with placement in a negative-pressure isolation room. Pulmonary tuberculosis is transmitted via airborne droplet nuclei (particles smaller than 5 micrometers) that remain suspended in the air for prolonged periods. Airborne precautions require: (1) placement in an airborne infection isolation room (AIIR) with negative pressure, at least 6-12 air exchanges per hour, and air exhausted directly outside or through HEPA filtration; (2) the door must remain closed; (3) anyone entering must wear an N95 respirator or higher-level respiratory protection; and (4) the patient must wear a surgical mask when transported outside the room.

(b) Droplet precautions with a surgical mask when within 3 feet of the patient -- Droplet precautions are for organisms transmitted by large respiratory droplets (larger than 5 micrometers), such as influenza or pertussis. TB requires the more stringent airborne precautions.

(c) Contact precautions with gown and gloves upon entering the room -- Contact precautions are for organisms spread by direct or indirect contact, such as MRSA or C. difficile. TB is not primarily transmitted by contact.

(d) Standard precautions only, since the patient is already receiving anti-tuberculosis medications -- Standard precautions alone are inadequate for active pulmonary TB. Airborne precautions must be maintained until three consecutive negative AFB sputum smears are obtained on different days with clinical improvement.