1 | Page
Full NCLEX-RN Practice Exam 220 Questions with Verified
Answers & Detailed Rationales – 2025 Ultimate Prep
Question 1
A patient with pneumonia reports fever, chills, and productive cough. Which action should the
nurse take first?
a. Administer antipyretics
b. Obtain sputum culture
c. Encourage fluid intake
d. Provide oxygen
ANS: b
Rationale: Obtaining a sputum culture before starting antibiotics ensures accurate identification
of the causative organism. Antipyretics, fluids, and oxygen are supportive but not the priority for
diagnosis.
DIF: Moderate | OBJ: Infection Management | TOP: Pneumonia | MSC: Safe and Effective Care
Question 2
,2 | Page
A patient with type 1 diabetes reports sweating, shakiness, and confusion. What is the first
nursing action?
a. Administer rapid-acting insulin
b. Give 15 g of fast-acting carbohydrate
c. Encourage exercise
d. Check hemoglobin A1c
ANS: b
Rationale: Symptoms indicate hypoglycemia. Immediate administration of a fast-acting
carbohydrate prevents progression to severe hypoglycemia. Insulin or exercise would worsen the
condition.
DIF: Moderate | OBJ: Diabetes Management | TOP: Hypoglycemia | MSC: Physiological
Integrity
Question 3
A patient with heart failure presents with shortness of breath, edema, and weight gain. What
should the nurse do first?
a. Assess lung sounds and oxygen saturation
b. Encourage ambulation
c. Provide a high-sodium diet
d. Reassure the patient
ANS: a
Rationale: Airway and oxygenation assessment are priority because fluid overload can lead to
,3 | Page
pulmonary edema. Diet and ambulation are secondary concerns.
DIF: Hard | OBJ: Cardiac Assessment | TOP: Heart Failure | MSC: Physiological Integrity
Question 4
A post-operative patient has a temperature of 101.8°F and redness around the surgical site.
Nursing priority:
a. Administer antibiotics as ordered
b. Monitor vital signs
c. Notify provider
d. Encourage ambulation
ANS: c
Rationale: Signs of infection require immediate provider notification. Antibiotics and
monitoring follow provider orders.
DIF: Moderate | OBJ: Postoperative Care | TOP: Infection | MSC: Safe and Effective Care
Question 5
A patient with COPD is using accessory muscles and has an SpO₂ of 88%. Nursing intervention:
a. Increase oxygen to 6 L/min without order
b. Assess airway and breathing and notify provider
c. Encourage ambulation
d. Provide oral fluids
, 4 | Page
ANS: b
Rationale: Acute respiratory distress requires immediate assessment and provider notification.
Unsupervised oxygen increase can suppress respiratory drive.
DIF: Hard | OBJ: Respiratory Assessment | TOP: COPD | MSC: Physiological Integrity
Question 6
A patient with CKD has potassium 6.9 mEq/L. Which action should the nurse take first?
a. Encourage high-potassium foods
b. Assess ECG and notify provider
c. Restrict fluids only
d. Provide potassium supplements
ANS: b
Rationale: Hyperkalemia can cause fatal arrhythmias. ECG monitoring and provider notification
are urgent. Dietary adjustments or supplements are inappropriate until addressed.
DIF: Hard | OBJ: Electrolyte Management | TOP: CKD | MSC: Physiological Integrity
Question 7
A patient with DVT is prescribed low-molecular-weight heparin. Nursing intervention:
a. Monitor for bleeding and assess aPTT
b. Encourage ambulation without precautions
Full NCLEX-RN Practice Exam 220 Questions with Verified
Answers & Detailed Rationales – 2025 Ultimate Prep
Question 1
A patient with pneumonia reports fever, chills, and productive cough. Which action should the
nurse take first?
a. Administer antipyretics
b. Obtain sputum culture
c. Encourage fluid intake
d. Provide oxygen
ANS: b
Rationale: Obtaining a sputum culture before starting antibiotics ensures accurate identification
of the causative organism. Antipyretics, fluids, and oxygen are supportive but not the priority for
diagnosis.
DIF: Moderate | OBJ: Infection Management | TOP: Pneumonia | MSC: Safe and Effective Care
Question 2
,2 | Page
A patient with type 1 diabetes reports sweating, shakiness, and confusion. What is the first
nursing action?
a. Administer rapid-acting insulin
b. Give 15 g of fast-acting carbohydrate
c. Encourage exercise
d. Check hemoglobin A1c
ANS: b
Rationale: Symptoms indicate hypoglycemia. Immediate administration of a fast-acting
carbohydrate prevents progression to severe hypoglycemia. Insulin or exercise would worsen the
condition.
DIF: Moderate | OBJ: Diabetes Management | TOP: Hypoglycemia | MSC: Physiological
Integrity
Question 3
A patient with heart failure presents with shortness of breath, edema, and weight gain. What
should the nurse do first?
a. Assess lung sounds and oxygen saturation
b. Encourage ambulation
c. Provide a high-sodium diet
d. Reassure the patient
ANS: a
Rationale: Airway and oxygenation assessment are priority because fluid overload can lead to
,3 | Page
pulmonary edema. Diet and ambulation are secondary concerns.
DIF: Hard | OBJ: Cardiac Assessment | TOP: Heart Failure | MSC: Physiological Integrity
Question 4
A post-operative patient has a temperature of 101.8°F and redness around the surgical site.
Nursing priority:
a. Administer antibiotics as ordered
b. Monitor vital signs
c. Notify provider
d. Encourage ambulation
ANS: c
Rationale: Signs of infection require immediate provider notification. Antibiotics and
monitoring follow provider orders.
DIF: Moderate | OBJ: Postoperative Care | TOP: Infection | MSC: Safe and Effective Care
Question 5
A patient with COPD is using accessory muscles and has an SpO₂ of 88%. Nursing intervention:
a. Increase oxygen to 6 L/min without order
b. Assess airway and breathing and notify provider
c. Encourage ambulation
d. Provide oral fluids
, 4 | Page
ANS: b
Rationale: Acute respiratory distress requires immediate assessment and provider notification.
Unsupervised oxygen increase can suppress respiratory drive.
DIF: Hard | OBJ: Respiratory Assessment | TOP: COPD | MSC: Physiological Integrity
Question 6
A patient with CKD has potassium 6.9 mEq/L. Which action should the nurse take first?
a. Encourage high-potassium foods
b. Assess ECG and notify provider
c. Restrict fluids only
d. Provide potassium supplements
ANS: b
Rationale: Hyperkalemia can cause fatal arrhythmias. ECG monitoring and provider notification
are urgent. Dietary adjustments or supplements are inappropriate until addressed.
DIF: Hard | OBJ: Electrolyte Management | TOP: CKD | MSC: Physiological Integrity
Question 7
A patient with DVT is prescribed low-molecular-weight heparin. Nursing intervention:
a. Monitor for bleeding and assess aPTT
b. Encourage ambulation without precautions
