Comprehensive NCLEX Readiness Practice Exam B

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Sample questions from Comprehensive NCLEX Readiness Practice Exam B

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

1. 1.A 68-year-old client is admitted to the medical unit with pneumonia. The client is newly confused, has a temperature of 39.1 C (102.4 F), blood pressure of 86/48 mm Hg, heart rate of 126/min, and oxygen saturation of 89% on room air. Which action should the nurse take first?

   • A.Apply oxygen and activate the rapid response system while initiating urgent assessment
   • B.Obtain a sputum specimen before starting prescribed antibiotics
   • C.Administer the prescribed acetaminophen and reassess in 1 hour
   • D.Ask the unlicensed assistive personnel to obtain a complete set of vital signs

   Rationale: The hypotension, tachycardia, hypoxemia, and acute confusion suggest sepsis with impaired perfusion, requiring immediate escalation and oxygen support. A sputum specimen is useful but must not delay stabilization; acetaminophen does not treat the immediate threat, and routine vital signs alone are inadequate. The exam takeaway is to recognize instability and intervene before completing routine diagnostic tasks.

2. 2.A 74-year-old client with heart failure is admitted to a telemetry unit. The client reports sudden shortness of breath and has crackles, oxygen saturation of 84% on room air, and a blood pressure of 168/92 mm Hg. Which action should the nurse take first?

   • A.Place the client in high-Fowler position and apply oxygen
   • B.Obtain a daily weight before providing interventions
   • C.Encourage the client to drink water to thin secretions
   • D.Prepare teaching about a low-sodium diet

   Rationale: High-Fowler positioning and oxygen support address the immediate gas-exchange problem associated with acute pulmonary congestion. A weight and dietary teaching are important for ongoing heart failure care but do not stabilize respiratory distress, and fluids may worsen congestion. The exam takeaway is to address airway and breathing before routine assessment or education.

3. 3.A 32-year-old client arrives at the emergency department after a motor vehicle collision. The client is restless, has a respiratory rate of 32/min, blood pressure of 88/54 mm Hg, heart rate of 132/min, and cool clammy skin. Which action is the priority?

   • A.Establish two large-bore IV lines and begin the prescribed isotonic fluid resuscitation
   • B.Administer an oral analgesic for reported pain
   • C.Obtain a detailed medication and allergy history
   • D.Prepare the client for discharge instructions about concussion symptoms

   Rationale: The findings indicate shock, so rapid vascular access and prescribed fluid resuscitation are priorities while the trauma team evaluates the cause. Oral medication and a detailed history can wait until perfusion is addressed, and discharge teaching is inappropriate for an unstable client. The exam takeaway is to treat signs of impaired circulation promptly.

4. 4.A 22-year-old client with type 1 diabetes is being treated in the emergency department for diabetic ketoacidosis. The client's glucose is 560 mg/dL, potassium is 5.6 mEq/L, pH is 7.18, and blood pressure is 94/60 mm Hg. Which prescription should the nurse implement first?

   • A.Begin the prescribed 0.9% sodium chloride infusion
   • B.Start the IV regular insulin infusion
   • C.Administer IV potassium chloride
   • D.Give sodium bicarbonate IV push

   Answer and rationale are in the full material.

5. 5.A 59-year-old client is admitted to the neurologic unit with a new stroke. The client has facial droop and slurred speech, is alert, and has an oxygen saturation of 97% on room air. Which action should the nurse take before offering oral medication?

   • A.Perform a swallow screening according to facility protocol
   • B.Crush the medication and mix it with applesauce
   • C.Ask the family whether the client has difficulty swallowing
   • D.Give the medication with a small sip of water and observe

   Answer and rationale are in the full material.