NCLEX-RN Original Question Guide

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Sample questions from NCLEX-RN Original Question Guide

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.The nurse receives report on four clients. Which client should the nurse assess first?

   • A.A. A client with heart failure who has unchanged ankle edema and requests help ordering breakfast
   • B.B. A client six hours after surgery who is newly restless, has a respiratory rate of 30 breaths/minute, and has an oxygen saturation of 88%
   • C.C. A client with diabetes who needs reinforcement of home glucose monitoring
   • D.D. A client with pneumonia whose temperature decreased after a prescribed antipyretic

   Rationale: B is correct because new restlessness, tachypnea, and hypoxemia suggest acute respiratory compromise. A describes stable chronic findings. C is an important but nonurgent teaching need. D describes an expected response without evidence of deterioration.

2. 2.A client has a potassium level of 6.7 mEq/L and new ECG changes. The clinician prescribes intravenous calcium gluconate. What is the primary purpose of this medication?

   • A.A. Remove potassium through the kidneys
   • B.B. Shift potassium permanently into skeletal muscle
   • C.C. Stabilize the myocardial membrane
   • D.D. Correct the underlying renal failure

   Rationale: C is correct because calcium reduces the immediate cardiac membrane effects of severe hyperkalemia. A is incorrect because calcium does not promote potassium elimination. B is incorrect because calcium does not shift potassium into cells; insulin can produce a temporary shift. D is incorrect because calcium does not reverse renal failure.

3. 3.An alert adult with diabetes has a glucose level of 58 mg/dL and can swallow safely. Which action is best?

   • A.A. Give 15 g of rapid-acting carbohydrate and recheck glucose in 15 minutes
   • B.B. Administer the scheduled rapid-acting insulin before treating the low glucose
   • C.C. Give a high-fat snack and wait one hour to recheck
   • D.D. Withhold treatment until a venous laboratory sample confirms the result

   Rationale: A is correct for an alert adult with safe swallowing. B could worsen hypoglycemia. C delays absorption and reassessment; rapidly absorbed carbohydrate is preferred initially. D unnecessarily delays treatment of a clinically important low glucose result.

4. 4.A client develops fever, chills, dyspnea, and back pain shortly after a blood transfusion begins. What should the nurse do first?

   • A.A. Reduce the infusion rate and reassess in 15 minutes
   • B.B. Give the next scheduled analgesic
   • C.C. Obtain a urine specimen before interrupting the transfusion
   • D.D. Stop the transfusion

   Answer and rationale are in the full material.

5. 5.Which task is most appropriate for the RN to delegate to trained assistive personnel?

   • A.A. Determine whether a newly admitted client's shortness of breath represents anxiety
   • B.B. Measure and record urine output for a stable client, with instructions to report specified low values
   • C.C. Teach a client to adjust insulin for meals
   • D.D. Evaluate whether an intravenous diuretic improved pulmonary edema

   Answer and rationale are in the full material.