Nlcex RN

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Sample questions from Nlcex RN

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 74-year-old client is 6 hours postoperative after a hip replacement. The client is restless, has an oxygen saturation of 88% on room air, respiratory rate 28/min, and heart rate 112/min. Which action should the nurse take first?

   • A.Apply oxygen and assess respiratory status
   • B.Administer the prescribed opioid for pain
   • C.Notify the surgeon of the restlessness
   • D.Check the surgical dressing for bleeding

   Rationale: The low oxygen saturation and tachypnea indicate impaired oxygenation, so the nurse should support breathing and reassess immediately. Opioids could worsen respiratory compromise, making pain medication unsafe as the first action. Notifying the surgeon and checking the dressing do not address the immediate breathing problem; the exam takeaway is to prioritize airway and breathing.

2. 2.A 68-year-old client with heart failure is admitted to a medical unit. The client has new crackles, oxygen saturation 89% on room air, and increasing work of breathing. Which action should the nurse take first?

   • A.Place the client in high-Fowler position and apply oxygen as prescribed
   • B.Obtain a daily weight
   • C.Review the client's sodium intake
   • D.Ask the client when the swelling began

   Rationale: Positioning upright and providing prescribed oxygen address the immediate respiratory compromise. Daily weights and sodium review are important heart-failure management but do not stabilize breathing now. Asking about symptom onset adds assessment data but should not delay immediate support; prioritize the acute threat.

3. 3.A 42-year-old client with suspected sepsis is in the emergency department. Temperature is 39.2 C, heart rate 128/min, blood pressure 84/50 mm Hg, and lactate 4.1 mmol/L. Which action is the priority?

   • A.Initiate prescribed isotonic IV fluid resuscitation
   • B.Obtain a detailed dietary history
   • C.Administer an antipyretic and reassess in 1 hour
   • D.Encourage oral fluids

   Rationale: Hypotension and elevated lactate indicate poor perfusion, requiring prompt IV fluid resuscitation as prescribed. A dietary history is not urgent, and an antipyretic alone does not correct shock. Oral fluids are inadequate and may be unsafe in an unstable client; recognize and treat impaired perfusion promptly.

4. 4.A 59-year-old client arrives in the emergency department with crushing chest pressure, diaphoresis, and nausea. Blood pressure is 138/82 mm Hg, oxygen saturation 96%, and ECG shows ST-segment elevation. Which action should the nurse take first?

   • A.Activate the facility's emergency reperfusion pathway
   • B.Give the client food to prevent nausea
   • C.Obtain a complete family history
   • D.Ask the client to walk to reduce anxiety

   Answer and rationale are in the full material.

5. 5.A 23-year-old client with type 1 diabetes is confused and diaphoretic. The bedside glucose is 42 mg/dL, and the client cannot swallow safely. Which action should the nurse take?

   • A.Administer IV dextrose according to protocol
   • B.Give 15 g of oral glucose gel
   • C.Recheck glucose in 30 minutes before intervening
   • D.Administer the scheduled insulin dose

   Answer and rationale are in the full material.