Next Gen NCLEX Quiz: Can You Make The Right Call?

1. A client with pneumonia has a temperature of 39.2°C and is on antibiotics. When should antibiotics be reassessed?

After 24 hours if no improvement

After 48–72 hours of therapy

Only if fever increases further

After 7 days regardless of response

2. A client with a new diagnosis of tuberculosis asks about medication adherence. Which statement by the client indicates understanding?

I can stop taking medication once symptoms disappear

I must complete the full course even when feeling better

I only take medication when I feel sick

I can skip doses if side effects occur

3. A client is being weaned from mechanical ventilation. Which assessment indicates readiness?

Respiratory rate 12–20, FiO2 ≤0.40, PEEP ≤5 cm H2O

Respiratory rate 24–30 and SpO2 88%

Minute ventilation >15 L/min

Tidal volume

4. A client with end-stage renal disease reports nausea and bone pain. Which medication addresses both symptoms?

Phosphate binder and antiemetic

Erythropoietin and ondansetron

Vitamin D analog and antiemetic

Calcium supplement and metoclopramide

5. A client with acute pancreatitis has severe epigastric pain. Which intervention should be implemented first?

Place NPO and start IV fluids

Administer analgesics and anticholinergics

Begin enteral nutrition immediately

Perform abdominal massage gently

6. A client reports severe pain after orthopedic surgery. Pain is 9/10 and unrelieved by last dose of opioid. Which is the nurse's priority?

Reassure client and wait for next scheduled dose

Assess for complications and notify provider

Administer non-opioid analgesics only

Document pain and continue current regimen

7. A client with bipolar disorder is started on lithium. Which laboratory value requires monitoring?

Lithium level and renal and thyroid function

Only serum lithium concentration

Liver function tests and albumin

White blood cell count and hemoglobin

8. A client with cirrhosis develops ascites. Which dietary modification is most important?

Increase protein to 100 g daily

Restrict sodium to 500–1000 mg daily

Eliminate all fat from diet

Increase carbohydrates to 300 g daily

9. A client receiving heparin has an aPTT of 85 seconds (normal 25–35). What is the appropriate nursing response?

Continue heparin at current dose; level is therapeutic

Notify the provider; dose may need adjustment

Administer protamine sulfate immediately

Increase heparin rate to achieve higher anticoagulation

10. A client with a spinal cord injury at T4 develops symptoms of autonomic dysreflexia. Which action is most urgent?

Place client supine and lower legs

Sit client upright and check for bladder distention

Administer antihypertensive medication

Apply ice to lower extremities

11. A client with acute myocardial infarction reports chest pain unrelieved by rest. Which intervention should the nurse prioritize?

Administer oxygen and establish IV access

Perform a 12-lead ECG and notify the provider

Obtain vital signs and assess pain characteristics

Administer aspirin and morphine immediately

12. A postpartum client reports severe headache and visual changes. Which complication should the nurse suspect?

Migraine headache

Preeclampsia or eclampsia

Tension headache from labor

Dehydration from blood loss

13. A client with COPD has a respiratory rate of 28 and uses accessory muscles. What is the nurse's priority assessment?

Check oxygen saturation and breath sounds

Obtain arterial blood gas immediately

Measure peak flow and FEV1

Assess for signs of cor pulmonale

14. A client is admitted with a suspected stroke. Time of onset is unknown. Which diagnostic test is the priority?

CT or MRI of the brain without contrast

Carotid ultrasound

Lumbar puncture

Transcranial Doppler study

15. A client with heart failure reports dyspnea and has crackles on auscultation. Which medication should the nurse anticipate?

Beta-blocker and ACE inhibitor

Diuretic and vasodilator

Antibiotic and bronchodilator

Anticoagulant and inotrope

16. A diabetic client's blood glucose is 45 mg/dL and the client is conscious. Which intervention is appropriate?

Administer 15 grams of fast-acting carbohydrates orally

Give glucagon 1 mg intramuscularly

Start an IV and infuse dextrose 50%

Place NPO and monitor glucose every 30 minutes

17. A client receiving chemotherapy develops neutropenia. Which precaution is most critical?

Place on airborne isolation immediately

Implement strict hand hygiene and protective isolation

Restrict all visitors without exception

Administer prophylactic antibiotics only if febrile

18. A client with chronic kidney disease has a serum potassium of 6.2 mEq/L. What is the nurse's most appropriate action?

Encourage potassium-rich foods to maintain levels

Notify the provider and prepare for interventions

Obtain an ECG and administer calcium gluconate

Restrict all fluids and monitor intake and output

19. When caring for a client with sepsis, which nursing action reflects appropriate NGN Clinical Judgment?

Monitor vital signs and report fever above 38.5°C only

Recognize early signs and initiate sepsis protocol promptly

Wait for culture results before starting antibiotics

Administer fluids without assessing baseline urine output

20. A postoperative client develops signs of deep vein thrombosis. Which assessment finding is most consistent with this condition?

Unilateral leg edema, warmth, and calf tenderness

Bilateral leg weakness and decreased sensation

Pale, cool lower extremities bilaterally

Localized rash on the anterior tibia

Next Gen NCLEX Quiz: Can You Make the Right Call?