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NURS190 Final Exam QBank 2025 | 150 NCLEX-
Style Practice Questions with Answers & Rationales |
Nursing Review Guide
1. A nurse is preparing to administer digoxin to a client. Which assessment is
most important before giving the medication?
A. Respiratory rate
B. Apical pulse
C. Bowel sounds
D. Oxygen saturation
Correct Answer: B. Apical pulse
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and strengthens
cardiac contractions. Before administering, the nurse must assess the apical pulse
for one full minute. If the rate is below 60 beats per minute in adults (or below
age-specific thresholds in children), the dose should be withheld and the provider
notified. This precaution helps prevent digoxin-induced bradycardia or
arrhythmias, which can be life-threatening.
2. A client is placed on contact precautions for Clostridioides difficile (C. diff).
Which personal protective equipment (PPE) is essential before entering the
room?
A. Surgical mask and gloves
B. Face shield and boot covers
C. Gown and gloves
D. N95 respirator only
Correct Answer: C. Gown and gloves
Rationale: C. difficile is transmitted through the fecal-oral route and survives on
surfaces for long periods. Contact precautions require wearing gloves and a
gown to prevent transmission. Hand hygiene should be done with soap and water,
, 2
as alcohol-based sanitizers are ineffective against C. diff spores. Masks and
respirators are not required unless performing aerosol-generating procedures.
3. A nurse notes that a client’s IV site is red, swollen, and warm to the touch.
What complication is most likely occurring?
A. Infiltration
B. Phlebitis
C. Hematoma
D. Fluid overload
Correct Answer: B. Phlebitis
Rationale: Phlebitis is inflammation of the vein often caused by mechanical
irritation, chemical irritation, or infection at the IV site. Symptoms include
redness, warmth, swelling, and tenderness along the vein. The appropriate
nursing action is to discontinue the IV, apply a warm compress, and monitor for
infection. Infiltration, on the other hand, involves coolness and pallor due to fluid
leaking into surrounding tissue.
4. Which intervention is most appropriate for a client at risk for aspiration
during meals?
A. Position the client in high Fowler’s during and after eating
B. Offer large amounts of thin liquids
C. Instruct the client to lie down after meals
D. Administer an antiemetic before feeding
Correct Answer: A. Position the client in high Fowler’s during and after
eating
Rationale: High Fowler’s position (sitting upright at 90 degrees) ensures that
gravity aids in the proper swallowing and movement of food down the esophagus,
reducing the risk of aspiration into the lungs. Thin liquids increase aspiration
risk, while lying down post-meal is contraindicated as it increases the chance of
regurgitation and aspiration.
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5. A nurse teaches a client how to use a metered-dose inhaler (MDI) for
asthma. Which instruction should the nurse include?
A. Inhale quickly and deeply after activating the inhaler
B. Exhale immediately after inhalation
C. Hold breath for 10 seconds after inhaling the medication
D. Use the inhaler without shaking it first
Correct Answer: C. Hold breath for 10 seconds after inhaling the medication
Rationale: After actuating the inhaler and inhaling the medication, the client
should hold their breath for about 10 seconds to allow the drug to be deposited
effectively in the lungs. Rapid inhalation, failing to shake the inhaler, or exhaling
too soon can significantly reduce medication efficacy.
6. A nurse is assessing a client with a sodium level of 128 mEq/L. Which
symptom should the nurse expect?
A. Bradycardia
B. Confusion
C. Dry skin
D. Hypertension
Correct Answer: B. Confusion
Rationale: A sodium level of 128 mEq/L indicates hyponatremia, which affects
neurological function due to cellular swelling. Early signs include confusion,
headache, nausea, and weakness. If not corrected, it can lead to seizures or coma.
Dry skin and hypertension are not typical early signs of hyponatremia.
7. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. What
is the nurse’s priority action?
A. Encourage fluids
B. Raise the head of the bed
C. Lower the oxygen flow rate
D. Provide a high-protein meal
Correct Answer: C. Lower the oxygen flow rate
Rationale: Clients with COPD retain CO₂ and rely on low oxygen levels
, 4
(hypoxic drive) to stimulate breathing. Oxygen flow rates should usually not
exceed 2 L/min unless otherwise ordered. Higher rates can suppress the
respiratory drive, leading to hypoventilation or respiratory arrest.
8. A nurse is caring for a client with heart failure. Which finding should the
nurse report immediately?
A. Pink, frothy sputum
B. 2+ pedal edema
C. Weight gain of 2 pounds in 3 days
D. Fatigue after walking
Correct Answer: A. Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of pulmonary edema, a life-
threatening complication of acute decompensated heart failure. It indicates fluid in
the alveoli and requires immediate intervention (e.g., diuretics, oxygen). Edema
and weight gain are expected, though concerning, and not as emergent.
9. A nurse enters the room and finds a client unresponsive with no pulse. What
is the nurse’s priority action?
A. Call the healthcare provider
B. Begin chest compressions
C. Check blood glucose
D. Administer oxygen
Correct Answer: B. Begin chest compressions
Rationale: If a client is unresponsive and has no pulse, the nurse should
immediately begin CPR starting with chest compressions. Time is critical in
cardiac arrest situations to preserve brain and organ function. Other actions follow
as part of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS)
protocols.
10. A nurse is reviewing lab values for a client on warfarin therapy. Which lab
value is most important to monitor?
NURS190 Final Exam QBank 2025 | 150 NCLEX-
Style Practice Questions with Answers & Rationales |
Nursing Review Guide
1. A nurse is preparing to administer digoxin to a client. Which assessment is
most important before giving the medication?
A. Respiratory rate
B. Apical pulse
C. Bowel sounds
D. Oxygen saturation
Correct Answer: B. Apical pulse
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and strengthens
cardiac contractions. Before administering, the nurse must assess the apical pulse
for one full minute. If the rate is below 60 beats per minute in adults (or below
age-specific thresholds in children), the dose should be withheld and the provider
notified. This precaution helps prevent digoxin-induced bradycardia or
arrhythmias, which can be life-threatening.
2. A client is placed on contact precautions for Clostridioides difficile (C. diff).
Which personal protective equipment (PPE) is essential before entering the
room?
A. Surgical mask and gloves
B. Face shield and boot covers
C. Gown and gloves
D. N95 respirator only
Correct Answer: C. Gown and gloves
Rationale: C. difficile is transmitted through the fecal-oral route and survives on
surfaces for long periods. Contact precautions require wearing gloves and a
gown to prevent transmission. Hand hygiene should be done with soap and water,
, 2
as alcohol-based sanitizers are ineffective against C. diff spores. Masks and
respirators are not required unless performing aerosol-generating procedures.
3. A nurse notes that a client’s IV site is red, swollen, and warm to the touch.
What complication is most likely occurring?
A. Infiltration
B. Phlebitis
C. Hematoma
D. Fluid overload
Correct Answer: B. Phlebitis
Rationale: Phlebitis is inflammation of the vein often caused by mechanical
irritation, chemical irritation, or infection at the IV site. Symptoms include
redness, warmth, swelling, and tenderness along the vein. The appropriate
nursing action is to discontinue the IV, apply a warm compress, and monitor for
infection. Infiltration, on the other hand, involves coolness and pallor due to fluid
leaking into surrounding tissue.
4. Which intervention is most appropriate for a client at risk for aspiration
during meals?
A. Position the client in high Fowler’s during and after eating
B. Offer large amounts of thin liquids
C. Instruct the client to lie down after meals
D. Administer an antiemetic before feeding
Correct Answer: A. Position the client in high Fowler’s during and after
eating
Rationale: High Fowler’s position (sitting upright at 90 degrees) ensures that
gravity aids in the proper swallowing and movement of food down the esophagus,
reducing the risk of aspiration into the lungs. Thin liquids increase aspiration
risk, while lying down post-meal is contraindicated as it increases the chance of
regurgitation and aspiration.
, 3
5. A nurse teaches a client how to use a metered-dose inhaler (MDI) for
asthma. Which instruction should the nurse include?
A. Inhale quickly and deeply after activating the inhaler
B. Exhale immediately after inhalation
C. Hold breath for 10 seconds after inhaling the medication
D. Use the inhaler without shaking it first
Correct Answer: C. Hold breath for 10 seconds after inhaling the medication
Rationale: After actuating the inhaler and inhaling the medication, the client
should hold their breath for about 10 seconds to allow the drug to be deposited
effectively in the lungs. Rapid inhalation, failing to shake the inhaler, or exhaling
too soon can significantly reduce medication efficacy.
6. A nurse is assessing a client with a sodium level of 128 mEq/L. Which
symptom should the nurse expect?
A. Bradycardia
B. Confusion
C. Dry skin
D. Hypertension
Correct Answer: B. Confusion
Rationale: A sodium level of 128 mEq/L indicates hyponatremia, which affects
neurological function due to cellular swelling. Early signs include confusion,
headache, nausea, and weakness. If not corrected, it can lead to seizures or coma.
Dry skin and hypertension are not typical early signs of hyponatremia.
7. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. What
is the nurse’s priority action?
A. Encourage fluids
B. Raise the head of the bed
C. Lower the oxygen flow rate
D. Provide a high-protein meal
Correct Answer: C. Lower the oxygen flow rate
Rationale: Clients with COPD retain CO₂ and rely on low oxygen levels
, 4
(hypoxic drive) to stimulate breathing. Oxygen flow rates should usually not
exceed 2 L/min unless otherwise ordered. Higher rates can suppress the
respiratory drive, leading to hypoventilation or respiratory arrest.
8. A nurse is caring for a client with heart failure. Which finding should the
nurse report immediately?
A. Pink, frothy sputum
B. 2+ pedal edema
C. Weight gain of 2 pounds in 3 days
D. Fatigue after walking
Correct Answer: A. Pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of pulmonary edema, a life-
threatening complication of acute decompensated heart failure. It indicates fluid in
the alveoli and requires immediate intervention (e.g., diuretics, oxygen). Edema
and weight gain are expected, though concerning, and not as emergent.
9. A nurse enters the room and finds a client unresponsive with no pulse. What
is the nurse’s priority action?
A. Call the healthcare provider
B. Begin chest compressions
C. Check blood glucose
D. Administer oxygen
Correct Answer: B. Begin chest compressions
Rationale: If a client is unresponsive and has no pulse, the nurse should
immediately begin CPR starting with chest compressions. Time is critical in
cardiac arrest situations to preserve brain and organ function. Other actions follow
as part of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS)
protocols.
10. A nurse is reviewing lab values for a client on warfarin therapy. Which lab
value is most important to monitor?
