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NCLEX-RN 2025 Practice Questions | 300 Realistic Exam
Q&As with Detailed Rationales for Guaranteed NCLEX
Success"
1. Priority – Airway/Breathing/Circulation (ABCs)
A nurse is caring for a postoperative client who reports sudden shortness of breath and chest
pain. The nurse notices the client’s oxygen saturation is 84%. What is the priority nursing
action?
A. Administer prescribed pain medication
B. Elevate the head of the bed
C. Encourage the client to cough and deep breathe
D. Notify the healthcare provider
Answer: B. Elevate the head of the bed
Rationale:
The client is experiencing acute respiratory distress, and oxygenation is the immediate priority
according to the ABCs (airway, breathing, circulation). Elevating the head of the bed facilitates
lung expansion and improves oxygen exchange, which can increase oxygen saturation quickly.
, 2
While notifying the provider is essential, the nurse must first take an immediate action to
improve oxygenation before making the call. Administering pain medication or encouraging
coughing would not address the urgent hypoxemia and could delay life-saving interventions.
2. SATA – Infection Control
Which actions should the nurse implement for a client diagnosed with Clostridioides difficile
infection? (Select all that apply)
A. Wear a surgical mask
B. Wear gloves and gown when entering the room
C. Use alcohol-based hand sanitizer after client care
D. Wash hands with soap and water after client care
E. Clean surfaces with a bleach-based solution
Answer: B, D, E
Rationale:
C. difficile requires strict contact precautions to prevent spore transmission. The nurse must
always wear gloves and a gown before entering the room to prevent contamination of clothing
and skin. Hand hygiene must be performed with soap and water because C. difficile spores are
resistant to alcohol-based sanitizers. Environmental cleaning is crucial, and bleach-based
solutions are the most effective against spores. A surgical mask is unnecessary unless there is a
risk of splashing bodily fluids, and alcohol hand rubs alone are ineffective against this pathogen.
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3. Dosage Calculation – IV Drip
The provider prescribes dopamine 400 mg in 250 mL D5W at 5 mcg/kg/min for a 70-kg client.
How many mL/hr will the nurse set on the infusion pump?
Answer: 13.1 mL/hr
Rationale:
To calculate the infusion rate, the nurse first converts the ordered dose into micrograms per
milliliter. Since 400 mg equals 400,000 mcg and the solution is in 250 mL, each mL contains
1,600 mcg. The prescribed dose is 5 mcg/kg/min, which equals 350 mcg/min for a 70-kg client.
Dividing 350 mcg/min by 1,600 mcg/mL gives 0.21875 mL/min. Multiplying this by 60 converts
it to 13.1 mL/hr. Accurate calculations are critical with vasoactive medications because even
small errors can lead to severe hypotension or arrhythmias.
4. NGN Case – Fluid & Electrolytes
A client with heart failure is admitted with hyponatremia (Na+ 125 mEq/L).
Findings: Confusion, muscle weakness, crackles in lungs, BP 100/60.
Which provider prescription should the nurse question?
A. Fluid restriction to 1 L/day
B. Furosemide 40 mg IV push
C. Sodium chloride 0.9% IV at 50 mL/hr
D. D5W IV at 100 mL/hr
Answer: D. D5W IV at 100 mL/hr
, 4
Rationale:
Clients with heart failure and hyponatremia are often fluid overloaded, and giving hypotonic
solutions like D5W can worsen the sodium imbalance. Once dextrose is metabolized, D5W
behaves like free water, which dilutes serum sodium and can exacerbate cerebral edema or
neurological symptoms such as confusion. The other interventions—fluid restriction, loop
diuretics, and cautious isotonic saline—are appropriate because they help remove excess fluid
while avoiding further sodium dilution.
5. Priority – Pediatric Fever
A 2-year-old child is admitted with sepsis and a rectal temp of 40°C (104°F). Which action is
priority?
A. Administer acetaminophen
B. Apply a cooling blanket
C. Initiate IV antibiotics as prescribed
D. Encourage oral fluids
Answer: C. Initiate IV antibiotics as prescribed
Rationale:
Sepsis in a young child is a medical emergency because it can progress rapidly to septic shock
and multi-organ failure. While fever-reducing interventions such as acetaminophen or cooling
blankets are helpful for comfort, they do not address the underlying infection. Oral fluids support
hydration but are not urgent in the initial stabilization phase. Administering antibiotics
NCLEX-RN 2025 Practice Questions | 300 Realistic Exam
Q&As with Detailed Rationales for Guaranteed NCLEX
Success"
1. Priority – Airway/Breathing/Circulation (ABCs)
A nurse is caring for a postoperative client who reports sudden shortness of breath and chest
pain. The nurse notices the client’s oxygen saturation is 84%. What is the priority nursing
action?
A. Administer prescribed pain medication
B. Elevate the head of the bed
C. Encourage the client to cough and deep breathe
D. Notify the healthcare provider
Answer: B. Elevate the head of the bed
Rationale:
The client is experiencing acute respiratory distress, and oxygenation is the immediate priority
according to the ABCs (airway, breathing, circulation). Elevating the head of the bed facilitates
lung expansion and improves oxygen exchange, which can increase oxygen saturation quickly.
, 2
While notifying the provider is essential, the nurse must first take an immediate action to
improve oxygenation before making the call. Administering pain medication or encouraging
coughing would not address the urgent hypoxemia and could delay life-saving interventions.
2. SATA – Infection Control
Which actions should the nurse implement for a client diagnosed with Clostridioides difficile
infection? (Select all that apply)
A. Wear a surgical mask
B. Wear gloves and gown when entering the room
C. Use alcohol-based hand sanitizer after client care
D. Wash hands with soap and water after client care
E. Clean surfaces with a bleach-based solution
Answer: B, D, E
Rationale:
C. difficile requires strict contact precautions to prevent spore transmission. The nurse must
always wear gloves and a gown before entering the room to prevent contamination of clothing
and skin. Hand hygiene must be performed with soap and water because C. difficile spores are
resistant to alcohol-based sanitizers. Environmental cleaning is crucial, and bleach-based
solutions are the most effective against spores. A surgical mask is unnecessary unless there is a
risk of splashing bodily fluids, and alcohol hand rubs alone are ineffective against this pathogen.
, 3
3. Dosage Calculation – IV Drip
The provider prescribes dopamine 400 mg in 250 mL D5W at 5 mcg/kg/min for a 70-kg client.
How many mL/hr will the nurse set on the infusion pump?
Answer: 13.1 mL/hr
Rationale:
To calculate the infusion rate, the nurse first converts the ordered dose into micrograms per
milliliter. Since 400 mg equals 400,000 mcg and the solution is in 250 mL, each mL contains
1,600 mcg. The prescribed dose is 5 mcg/kg/min, which equals 350 mcg/min for a 70-kg client.
Dividing 350 mcg/min by 1,600 mcg/mL gives 0.21875 mL/min. Multiplying this by 60 converts
it to 13.1 mL/hr. Accurate calculations are critical with vasoactive medications because even
small errors can lead to severe hypotension or arrhythmias.
4. NGN Case – Fluid & Electrolytes
A client with heart failure is admitted with hyponatremia (Na+ 125 mEq/L).
Findings: Confusion, muscle weakness, crackles in lungs, BP 100/60.
Which provider prescription should the nurse question?
A. Fluid restriction to 1 L/day
B. Furosemide 40 mg IV push
C. Sodium chloride 0.9% IV at 50 mL/hr
D. D5W IV at 100 mL/hr
Answer: D. D5W IV at 100 mL/hr
, 4
Rationale:
Clients with heart failure and hyponatremia are often fluid overloaded, and giving hypotonic
solutions like D5W can worsen the sodium imbalance. Once dextrose is metabolized, D5W
behaves like free water, which dilutes serum sodium and can exacerbate cerebral edema or
neurological symptoms such as confusion. The other interventions—fluid restriction, loop
diuretics, and cautious isotonic saline—are appropriate because they help remove excess fluid
while avoiding further sodium dilution.
5. Priority – Pediatric Fever
A 2-year-old child is admitted with sepsis and a rectal temp of 40°C (104°F). Which action is
priority?
A. Administer acetaminophen
B. Apply a cooling blanket
C. Initiate IV antibiotics as prescribed
D. Encourage oral fluids
Answer: C. Initiate IV antibiotics as prescribed
Rationale:
Sepsis in a young child is a medical emergency because it can progress rapidly to septic shock
and multi-organ failure. While fever-reducing interventions such as acetaminophen or cooling
blankets are helpful for comfort, they do not address the underlying infection. Oral fluids support
hydration but are not urgent in the initial stabilization phase. Administering antibiotics
