NCLEX-RN Practice Test 12
10 free NCLEX-RN practice questions in the real exam format, covering the official content areas, with an explanation for every answer.
Question 1 of 10
Reduction of Risk PotentialMedical Record
Day 1 0640 (Emergency department) — Arrived by ambulance with shortness of breath that has worsened over 4 days and is now present at rest. Has slept sitting up in a recliner for 3 nights and woke last night "gasping for air." Reports running out of furosemide 6 days ago and eating ham, canned soup and deli meats over the holiday weekend. Reports fatigue and generalized weakness for the past week, which began before the breathlessness worsened; too tired to walk to the mailbox. Sitting upright, speaking in 4- to 5-word sentences, using neck accessory muscles. Crackles bilaterally from the bases to the mid-lung fields; frequent cough with white, frothy sputum. S3 heart sound present. Jugular venous distension to the angle of the jaw with head of bed at 45°. 3+ pitting edema of both lower legs to the knees. Skin warm and dry. Alert and oriented × 4. Weight 96.4 kg.
Day 1 0700 — Oxygen at 4 L/min by nasal cannula; SpO2 91%. Positioned in high Fowler position with legs dependent. Peripheral IV inserted in left forearm; laboratory specimens sent. Client states breathing is "a little easier."
71-year-old male admitted through the emergency department with acute decompensated heart failure.
History: heart failure with reduced ejection fraction (LVEF 30% on echocardiogram 4 months ago) from ischemic cardiomyopathy; myocardial infarction with coronary stent in 2019; hypertension; type 2 diabetes mellitus; chronic kidney disease stage 3a (baseline creatinine 1.3 mg/dL). Baseline NYHA class II. Dry weight 91.8 kg at cardiology clinic 2 weeks ago.
Home medications: carvedilol 12.5 mg PO twice daily; sacubitril-valsartan 49/51 mg PO twice daily; spironolactone 25 mg PO daily; furosemide 40 mg PO daily (ran out 6 days ago); empagliflozin 10 mg PO daily; metformin 500 mg PO twice daily; atorvastatin 40 mg PO daily; aspirin 81 mg PO daily.
Allergies: penicillin (rash). Social: lives with wife; retired; former smoker (quit 2019); no alcohol use.
Diagnostics: 12-lead ECG (Day 1 0645) — sinus tachycardia at 116/min, old inferior Q waves, no acute ST-segment changes. Portable chest x-ray (Day 1 0700) — cardiomegaly, bilateral perihilar and interstitial edema, small bilateral pleural effusions.
| Time | Temp | HR (/min) | RR (/min) | BP (mm Hg) | SpO2 | Weight |
|---|---|---|---|---|---|---|
| Day 1 0640 | 36.9 °C (98.4 °F) | 116 (sinus tachycardia) | 30 | 168/96 | 87% room air | 96.4 kg |
| Day 1 0700 | — | 112 | 28 | 164/94 | 91% on 4 L/min NC | — |
| Test | Result | Reference range |
|---|---|---|
| B-type natriuretic peptide (BNP) | 1,620 pg/mL | Less than 100 pg/mL |
| High-sensitivity troponin I | 22 ng/L | 34 ng/L or less |
| Sodium | 132 mEq/L | 135–145 mEq/L |
| Potassium | 3.3 mEq/L | 3.5–5.0 mEq/L |
| Chloride | 96 mEq/L | 98–107 mEq/L |
| Bicarbonate | 25 mEq/L | 22–29 mEq/L |
| Blood urea nitrogen (BUN) | 34 mg/dL | 8–21 mg/dL |
| Creatinine | 1.7 mg/dL | 0.7–1.3 mg/dL |
| Glucose | 182 mg/dL | 70–99 mg/dL (fasting) |
| Magnesium | 1.6 mg/dL | 1.7–2.2 mg/dL |
| Time | Order |
|---|---|
| Day 1 0645 | Oxygen by nasal cannula; titrate to keep SpO2 92% or higher |
| Day 1 0645 | High Fowler position as tolerated |
| Day 1 0645 | Continuous cardiac monitoring |
| Day 1 0645 | Peripheral IV access |
| Day 1 0645 | BNP, high-sensitivity troponin I, basic metabolic panel, magnesium, CBC |
| Day 1 0645 | Portable chest x-ray; 12-lead ECG |
| Day 1 0645 | Strict intake and output; weigh on arrival |
| Day 1 0645 | Cardiology consult; admit to cardiac step-down unit |
The nurse in the emergency department reviews the client's medical record.
For each finding, specify whether it requires follow-up or does not require follow-up.
| Requires follow-up | Does not require follow-up | |
|---|---|---|
| SpO2 87% on room air | ||
| Crackles from the bases to the mid-lung fields | ||
| Temperature 36.9 °C (98.4 °F) | ||
| High-sensitivity troponin I 22 ng/L | ||
| Potassium 3.3 mEq/L | ||
| Creatinine 1.7 mg/dL (baseline 1.3 mg/dL) | ||
| Alert and oriented × 4 | ||
| Bicarbonate 25 mEq/L | ||
| Weight 96.4 kg (dry weight 91.8 kg 2 weeks ago) |