NCLEX Readiness Exam 2025
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests ANS: 2. Assessing the client's dietary intake
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks." ANS: 2. "I will notify my health care
provider if I start having low back aches."
During the first prenatal assessment, the client reports the last normal menstrual period starting on
March 1 and ending on March 5, but also slight spotting on March 23. The client had unprotected
intercourse on March 15. Using Naegele's rule, what is the estimated date of birth?
1. December 8
2. December 12
3. December 22
4. December 30 ANS: 1. December 8
A female client with liver cirrhosis and chronic anemia is hospitalized for a deep venous thrombosis. The
client is receiving a heparin infusion and suddenly develops epistaxis. Which laboratory value would
indicate that the heparin infusion needs to be turned off?
1. Hematocrit of 30% (0.30)
,2. Partial thromboplastin time of 110 seconds
3. Platelet count of 80,000/mm3 (80 x 109/L)
4. Prothrombin time of 11 seconds ANS: 2. Partial thromboplastin time of 110 seconds
A major earthquake has occurred. Local gas lines and water pipes are breaking with resulting fires and
flooding in collapsed buildings. Multiple victims arrive at the triage area. Which client should the nurse
care for first?
1. Client with charred, leathery skin over entire back, chest, and legs
2. Client with cool skin, shivering from sitting in water until rescued
3. Client with diabetes who was unable to take prescribed insulin today
4. Client with high-pitched, crowing inspiratory respirations ANS: 4. Client with high-pitched, crowing
inspiratory respirations
The nurse prepares to administer clozapine to a client with schizophrenia. Which client statement would
require priority investigation before administering the medication?
1. "I have gained a few pounds since I started this medication."
2. "I have had a sore throat for 3 days and feel feverish today."
3. "I have noticed increased salivation and drooling."
4. "I often feel sleepy when I take this medication." ANS: 2. "I have had a sore throat for 3 days and feel
feverish today."
The post-anesthesia care unit nurse receives report on a client after abdominal surgery. What sounds
would the nurse expect to hear when auscultating the bowel?
1. Absent bowel sounds
2. Borborygmi sounds
3. High-pitched and gurgling sounds
4. Swishing or buzzing sounds ANS: 1. Absent bowel sounds
,The nurse is admitting a client with a possible diagnosis of Guillain-Barré syndrome. When collecting
data to develop a plan of care for the client, the nurse should give priority to which of the following
items?
1. Orthostatic blood pressure changes
2. Presence or absence of knee reflexes
3. Pupil size and reaction to light
4. Rate and depth of respirations ANS: 4. Rate and depth of respirations
The unlicensed assistive personnel on the cardiac floor reports to the registered nurse that during the
first vital sign measurement on the shift, a client's blood pressure measured 198/102 mm Hg on the
automated blood pressure machine. What action should the nurse take first?
1. Have the unlicensed assistive personnel recheck the client's blood pressure
2. Immediately notify the health care provider
3. Obtain the client's PRN labetalol from the medication dispensing machine
4. Recheck the client's blood pressure with a manual cuff ANS: 4. Recheck the client's blood pressure
with a manual cuff
The nurse is triaging clients in the emergency department. Which client needs to be seen first?
1. 18-year-old female with fever, suprapubic pain, and dysuria
2. 21-year-old male with diffuse abdominal pain and a rigid abdomen
3. 64-year-old male with a pulsatile mass in the periumbilical area and back pain
4. 75-year-old with nausea, fever, and left lower quadrant pain ANS: 3. 64-year-old male with a pulsatile
mass in the periumbilical area and back pain
The nurse working on an orthopedic unit is receiving report on 4 clients with recent fractures. Which
client should the nurse assess first?
1. Client who has a femur fracture with a rash of pin-sized red spots on the chest and increased
restlessness
, 2. Client who has purulent drainage oozing from a skeletal traction pin insertion site and a temperature
of 100.8 F (38.2 C)
3. Client with a hip fracture receiving continuous IV saline with bilateral 2+ pitting leg edema and a blood
pressure of 176/89 mm Hg
4. Client with a rib fracture who is breathing at a rate of 23/min and is reporting 8/10 pain that is worse
with inspiration ANS: 1. Client who has a femur fracture with a rash of pin-sized red spots on the chest
and increased restlessness
The nurse plans discharge teaching for a client with active herpes lesions who has a new prescription for
oral acyclovir and topical lidocaine. What information will the nurse include in the teaching plan?
1. Adhesive bandaging should remain on the lesions to prevent virus shedding
2. Blood tests will be drawn to ensure the virus is eradicated
3. Condoms should be used during intercourse until the lesions are healed
4. Gloves should be used to apply the medication to the lesions ANS: 4. Gloves should be used to apply
the medication to the lesions
The nurse receives an obese client in the postanesthesia care unit who underwent a procedure under
general anesthesia. The nurse notes an oxygen saturation of 88%. Which is the most appropriate initial
intervention?
1. Assess pupillary response
2. Auscultate lung sounds
3. Inform anesthesia professional
4. Perform head tilt and chin lift ANS: 4. Perform head tilt and chin lift
A newly reassigned nurse enters a hospital room at the beginning of the shift and finds the client
unconscious and unresponsive. Resuscitation is initiated and then continued by the rapid response
team. The nurse
realizes that there is a do not resuscitate (DNR) prescription posted in the client's chart. Which action is
correct?
1. Stop all resuscitation activity immediately
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests ANS: 2. Assessing the client's dietary intake
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks." ANS: 2. "I will notify my health care
provider if I start having low back aches."
During the first prenatal assessment, the client reports the last normal menstrual period starting on
March 1 and ending on March 5, but also slight spotting on March 23. The client had unprotected
intercourse on March 15. Using Naegele's rule, what is the estimated date of birth?
1. December 8
2. December 12
3. December 22
4. December 30 ANS: 1. December 8
A female client with liver cirrhosis and chronic anemia is hospitalized for a deep venous thrombosis. The
client is receiving a heparin infusion and suddenly develops epistaxis. Which laboratory value would
indicate that the heparin infusion needs to be turned off?
1. Hematocrit of 30% (0.30)
,2. Partial thromboplastin time of 110 seconds
3. Platelet count of 80,000/mm3 (80 x 109/L)
4. Prothrombin time of 11 seconds ANS: 2. Partial thromboplastin time of 110 seconds
A major earthquake has occurred. Local gas lines and water pipes are breaking with resulting fires and
flooding in collapsed buildings. Multiple victims arrive at the triage area. Which client should the nurse
care for first?
1. Client with charred, leathery skin over entire back, chest, and legs
2. Client with cool skin, shivering from sitting in water until rescued
3. Client with diabetes who was unable to take prescribed insulin today
4. Client with high-pitched, crowing inspiratory respirations ANS: 4. Client with high-pitched, crowing
inspiratory respirations
The nurse prepares to administer clozapine to a client with schizophrenia. Which client statement would
require priority investigation before administering the medication?
1. "I have gained a few pounds since I started this medication."
2. "I have had a sore throat for 3 days and feel feverish today."
3. "I have noticed increased salivation and drooling."
4. "I often feel sleepy when I take this medication." ANS: 2. "I have had a sore throat for 3 days and feel
feverish today."
The post-anesthesia care unit nurse receives report on a client after abdominal surgery. What sounds
would the nurse expect to hear when auscultating the bowel?
1. Absent bowel sounds
2. Borborygmi sounds
3. High-pitched and gurgling sounds
4. Swishing or buzzing sounds ANS: 1. Absent bowel sounds
,The nurse is admitting a client with a possible diagnosis of Guillain-Barré syndrome. When collecting
data to develop a plan of care for the client, the nurse should give priority to which of the following
items?
1. Orthostatic blood pressure changes
2. Presence or absence of knee reflexes
3. Pupil size and reaction to light
4. Rate and depth of respirations ANS: 4. Rate and depth of respirations
The unlicensed assistive personnel on the cardiac floor reports to the registered nurse that during the
first vital sign measurement on the shift, a client's blood pressure measured 198/102 mm Hg on the
automated blood pressure machine. What action should the nurse take first?
1. Have the unlicensed assistive personnel recheck the client's blood pressure
2. Immediately notify the health care provider
3. Obtain the client's PRN labetalol from the medication dispensing machine
4. Recheck the client's blood pressure with a manual cuff ANS: 4. Recheck the client's blood pressure
with a manual cuff
The nurse is triaging clients in the emergency department. Which client needs to be seen first?
1. 18-year-old female with fever, suprapubic pain, and dysuria
2. 21-year-old male with diffuse abdominal pain and a rigid abdomen
3. 64-year-old male with a pulsatile mass in the periumbilical area and back pain
4. 75-year-old with nausea, fever, and left lower quadrant pain ANS: 3. 64-year-old male with a pulsatile
mass in the periumbilical area and back pain
The nurse working on an orthopedic unit is receiving report on 4 clients with recent fractures. Which
client should the nurse assess first?
1. Client who has a femur fracture with a rash of pin-sized red spots on the chest and increased
restlessness
, 2. Client who has purulent drainage oozing from a skeletal traction pin insertion site and a temperature
of 100.8 F (38.2 C)
3. Client with a hip fracture receiving continuous IV saline with bilateral 2+ pitting leg edema and a blood
pressure of 176/89 mm Hg
4. Client with a rib fracture who is breathing at a rate of 23/min and is reporting 8/10 pain that is worse
with inspiration ANS: 1. Client who has a femur fracture with a rash of pin-sized red spots on the chest
and increased restlessness
The nurse plans discharge teaching for a client with active herpes lesions who has a new prescription for
oral acyclovir and topical lidocaine. What information will the nurse include in the teaching plan?
1. Adhesive bandaging should remain on the lesions to prevent virus shedding
2. Blood tests will be drawn to ensure the virus is eradicated
3. Condoms should be used during intercourse until the lesions are healed
4. Gloves should be used to apply the medication to the lesions ANS: 4. Gloves should be used to apply
the medication to the lesions
The nurse receives an obese client in the postanesthesia care unit who underwent a procedure under
general anesthesia. The nurse notes an oxygen saturation of 88%. Which is the most appropriate initial
intervention?
1. Assess pupillary response
2. Auscultate lung sounds
3. Inform anesthesia professional
4. Perform head tilt and chin lift ANS: 4. Perform head tilt and chin lift
A newly reassigned nurse enters a hospital room at the beginning of the shift and finds the client
unconscious and unresponsive. Resuscitation is initiated and then continued by the rapid response
team. The nurse
realizes that there is a do not resuscitate (DNR) prescription posted in the client's chart. Which action is
correct?
1. Stop all resuscitation activity immediately
