NCLEX Case Study Type Quizes

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Sample questions from NCLEX Case Study Type Quizes

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift in a medical-surgical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 35-year-old with diabetes who has a blood glucose of 240 mg/dL and is waiting for a scheduled correction dose
   • B.A 46-year-old admitted with pneumonia who is newly restless, has an SpO2 of 88% on 2 L/min oxygen, and is using accessory muscles
   • C.A 72-year-old 6 hours after hip replacement who reports pain of 8/10 and has a dry surgical dressing
   • D.A 58-year-old with heart failure who has gained 1 kg (2.2 lb) since yesterday and has bilateral ankle edema

   Rationale: The client with pneumonia has worsening oxygenation, increased work of breathing, and new restlessness, which may indicate acute respiratory deterioration and requires immediate assessment. Severe postoperative pain needs treatment, but a dry dressing and stable postoperative status do not take priority over impaired breathing. The weight gain and edema suggest fluid retention that requires follow-up, but no acute respiratory distress is described. The elevated glucose requires management, but it is less urgent than the client's airway and breathing.

2. 2.On a pediatric unit, a 9-year-old recovering from an uncomplicated appendectomy is alert, tolerating liquids, and has stable vital signs. Which task is appropriate for the registered nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Evaluate whether the prescribed analgesic relieved the child's pain
   • B.Assess the child's abdomen for increasing tenderness before ambulation
   • C.Measure and record the child's intake and output for the shift
   • D.Teach the parent how to support the incision when the child coughs

   Rationale: Measuring and recording intake and output is a routine, predictable task that can be delegated to a competent UAP, with the RN retaining responsibility for interpreting the findings. Abdominal assessment requires nursing judgment and must be performed by the RN. Teaching incision support is also an RN responsibility because it requires assessment of learning and evaluation of understanding. Evaluating the response to analgesia requires clinical judgment and cannot be delegated.

3. 3.Refer to the client's chart. Which actions should the nurse take now to coordinate care and reduce the risk of further deterioration? Select all that apply.

   • A.Administer the prescribed isotonic fluid bolus and reassess the client's response
   • B.Document that the low blood pressure is expected because the client has a fever
   • C.Ask the UAP to repeat the blood pressure in 30 minutes before taking further action
   • D.Notify the rapid response team and the provider about the client's worsening perfusion and mental status
   • E.Obtain ordered blood cultures promptly, without delaying the prescribed antimicrobial

   Rationale: The client's falling blood pressure, rising heart rate, delayed capillary refill, and new confusion support urgent escalation and implementation of the prescribed fluid bolus. Ordered blood cultures should be obtained promptly to support treatment decisions, but collection should not delay the prescribed antimicrobial. Waiting 30 minutes for a UAP to repeat the pressure delays needed RN assessment and action. Fever does not make hypotension and worsening perfusion expected, so documenting them as expected would be unsafe.

4. 4.In a preoperative clinic, a 16-year-old scheduled for an elective procedure says, "I signed the paper, but I still don't understand what they are going to do." The parent is present, and the procedure is scheduled in 1 hour. What is the nurse's best action?

   • A.Ask the parent to explain the procedure because the consent form is already signed
   • B.Proceed because the signed form confirms that informed consent has been obtained
   • C.Explain the procedure's risks and benefits, then ask the adolescent to sign a new consent form
   • D.Pause preoperative preparation and notify the surgeon that the adolescent needs further explanation

   Answer and rationale are in the full material.

5. 5.A provider prescribes digoxin for a 74-year-old client with atrial fibrillation. Before administering the dose, the nurse notes an apical pulse of 54/min, nausea, and a serum potassium of 3.0 mEq/L (reference range 3.5-5.0 mEq/L). Which action should the nurse take?

   • A.Hold the dose and notify the provider of the findings
   • B.Ask the UAP to obtain another pulse and administer the dose if it is at least 50/min
   • C.Administer the dose with food and reassess the pulse in 1 hour
   • D.Give the dose and request a potassium supplement for the next medication pass

   Answer and rationale are in the full material.