Practice Reduction of Risk Potential questions for the National Council Licensure Examination — RN. Every question includes a full explanation of why the correct answer is right and why the tempting distractors are wrong.
51 questions available · hard difficulty · NCLEX-RN · Free, no registration required
10 example questions with full explanations. Use the interactive practice above to work through the complete set.
Question 1hard
A nurse is caring for a postoperative patient who received neomycin bowel prep preoperatively and is now on gentamicin for a wound infection. The patient's serum creatinine has risen from 0.9 mg/dL to 1.8 mg/dL over 48 hours. The nurse should recognize this as an expected, non-urgent finding related to normal postoperative kidney stress and continue monitoring without escalating to the provider.
Correct answer: B
This statement is FALSE and represents a dangerous misconception. A doubling of the serum creatinine within 48 hours meets the KDIGO criteria for Acute Kidney Injury (AKI), which is a critical, reportable finding — not a benign expected postoperative change. The combination of neomycin (a poorly absorbed aminoglycoside with nephrotoxic potential if any absorption occurs through inflamed bowel) and systemic gentamicin (a nephrotoxic aminoglycoside) creates a significant compounding nephrotoxicity risk. The nurse must immediately notify the provider, anticipate medication review or discontinuation of gentamicin, and monitor urine output closely. Dismissing a creatinine that has doubled as 'normal postoperative stress' could lead to irreversible renal failure.
Question 2hard
A patient with a serum sodium of 118 mEq/L and new-onset confusion is receiving a continuous infusion of 3% hypertonic saline. The nurse notes the serum sodium has risen by 14 mEq/L over the past 8 hours. The nurse should maintain the current infusion rate because the goal is to correct hyponatremia as rapidly as possible to prevent cerebral herniation.
Correct answer: B
This statement is FALSE. While severe symptomatic hyponatremia (confusion, seizures) does warrant urgent correction with hypertonic saline, the rate of correction must never exceed 8–12 mEq/L in any 24-hour period (and some guidelines restrict this to 10 mEq/L/24 hours in high-risk patients). An 8-hour rise of 14 mEq/L already approaches or exceeds the safe 24-hour limit, placing the patient at serious risk for osmotic demyelination syndrome (ODS), formerly called central pontine myelinolysis — a potentially irreversible and fatal neurological complication. The nurse must immediately stop or reduce the infusion and notify the provider for urgent reassessment. Rapid correction is indicated only to stop acute symptoms (e.g., active seizures), not to normalize the sodium level as quickly as possible.
Question 3hard
A patient on digoxin with a current serum digoxin level of 1.8 ng/mL (therapeutic range 0.5–2.0 ng/mL) and a serum potassium of 3.1 mEq/L reports nausea, yellow-green visual halos, and bradycardia of 52 beats/minute. Because the digoxin level is within the therapeutic range, the nurse should administer the next scheduled digoxin dose and continue monitoring.
Correct answer: B
This statement is FALSE and illustrates a critical clinical reasoning error. Hypokalemia (K+ 3.1 mEq/L) potentiates digoxin toxicity even when the serum digoxin level appears therapeutic, because low potassium increases the binding of digoxin to myocardial Na+/K+-ATPase, amplifying its effects. The classic triad of nausea, xanthopsia (yellow-green visual halos), and bradycardia are hallmark signs of digoxin toxicity regardless of the reported serum drug level. The nurse must withhold the digoxin dose, notify the provider immediately, and anticipate orders for potassium replacement, cardiac monitoring, and possible digoxin dose adjustment. Relying solely on a 'therapeutic' drug level without integrating electrolyte status and clinical symptoms reflects incomplete clinical judgment.
Question 4hard
During a seizure in a hospitalized patient, the nurse observes that the patient's jaw is clenched. To maintain airway patency and prevent the patient from biting their tongue, the nurse should insert a padded tongue blade or bite block between the patient's teeth.
Correct answer: B
This statement is FALSE. Inserting any object — including a padded tongue blade or bite block — into the mouth of a seizing patient is contraindicated and has been removed from safe seizure management guidelines. Forcing an object into a clenched jaw can fracture teeth, lacerate oral tissue, break the object creating an aspiration hazard, and injure the nurse. The American Epilepsy Society and nursing standards clearly state nothing should ever be placed in the mouth during a seizure. Correct seizure management includes: turning the patient on their side (lateral positioning) to protect the airway and reduce aspiration risk, protecting the head, removing nearby hazards, calling for help, timing the seizure, and having oxygen and suctioning equipment ready for the postictal period.
Question 5hard
A nurse aspirates gastric contents from a patient's nasogastric (NG) tube and measures a pH of 6.2 using pH paper before administering an enteral feeding. Because the aspirate confirms the tube is in the stomach (gastric pH is typically acidic), it is safe to proceed with the feeding.
Correct answer: B
This statement is FALSE. While gastric pH is generally acidic, a pH of 6.2 does NOT confirm safe gastric placement. The accepted threshold for gastric placement confirmation via pH testing is ≤ 5.5. A pH of 6.0 or higher is ambiguous and may represent respiratory secretions (if the tube has migrated into the lungs), intestinal fluid, or gastric contents in patients receiving proton pump inhibitors, H2 blockers, or continuous tube feedings — all of which raise gastric pH. Instilling feeding into a tube with a pH of 6.2 without further verification risks pulmonary aspiration, a potentially fatal complication. The nurse must withhold the feeding and obtain radiographic confirmation (chest/abdominal X-ray) as the gold standard before proceeding, and notify the provider of the equivocal pH result.
Question 6hard
A nurse is caring for a postoperative client who returned from abdominal surgery 2 hours ago. Assessment findings include: blood pressure 88/54 mmHg, heart rate 118 beats/min, respiratory rate 22 breaths/min, temperature 36.8°C, urine output 18 mL over the past hour, and the abdominal dressing has a 4 cm area of serosanguineous drainage. The client rates pain at 6/10. Which assessment finding should prompt the nurse to notify the provider FIRST?
- A.Respiratory rate of 22 breaths/min
- B.Abdominal dressing with 4 cm serosanguineous drainage
- C.Pain rating of 6 out of 10
- D.Urine output of 18 mL over the past hour✓
Correct answer: D
Urine output of 18 mL over one hour (less than 30 mL/hr) combined with hypotension (88/54 mmHg) and tachycardia (118 bpm) indicates inadequate renal perfusion and strongly suggests hypovolemic shock — a life-threatening complication requiring immediate provider notification. While the hypotension and tachycardia are also alarming, the oliguria confirms that these hemodynamic changes are already compromising end-organ perfusion. Serosanguineous drainage on the abdominal dressing is expected postoperatively and is not immediately alarming. Pain of 6/10 requires management but is not the priority over signs of shock.Drespiratory rate of 22 is mildly elevated and less immediately concerning than evidence of circulatory collapse and renal compromise.
Question 7hard
A nurse is assessing a client who was admitted for deep vein thrombosis (DVT) of the left leg and is receiving a heparin infusion. The client suddenly reports severe shortness of breath and right-sided chest pain that worsens with inspiration. Vital signs are: BP 100/60 mmHg, HR 128 beats/min, RR 28 breaths/min, SpO2 88% on room air. The client is anxious and diaphoretic. Which action should the nurse take FIRST?
- A.Apply supplemental oxygen and elevate the head of the bed to 30–45 degrees✓
- B.Stop the heparin infusion immediately and notify the provider
- C.Prepare the client for stat CT pulmonary angiography
- D.Obtain a 12-lead ECG to assess for right heart strain
Correct answer: A
The client is exhibiting classic signs of pulmonary embolism (sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxia) with SpO2 of 88%, which is critically low. Using the ABCs framework, airway and breathing are the immediate priority — applying supplemental oxygen to improve oxygenation and positioning the client upright to maximize respiratory effort must be done first. Stopping the heparin infusion would be contraindicated in suspected PE, as anticoagulation is therapeutic and should continue unless bleeding is suspected. Obtaining an ECG and preparing for CT pulmonary angiography are both appropriate subsequent actions but cannot take precedence over correcting life-threatening hypoxia, which must be addressed within seconds.
Question 8hard
A nurse is caring for a client with a stage 2 pressure injury on the sacrum. The wound measures 3 cm × 2 cm with partial-thickness skin loss and a moist pink wound bed. The client is incontinent of stool, has a Braden Scale score of 13, and is able to reposition independently when reminded. The provider orders a moisture barrier ointment and a hydrocolloid dressing. Which intervention should the nurse prioritize to address the greatest ongoing risk for wound deterioration?
- A.Instruct the client to reposition every 2 hours independently using a written schedule
- B.Implement a structured bowel management program to minimize fecal contamination of the wound✓
- C.Increase dietary protein intake and consult nutrition services for wound healing support
- D.Apply the hydrocolloid dressing and change it every 3–5 days or when the seal is broken
Correct answer: B
In a client with a sacral pressure injury and fecal incontinence, uncontrolled stool contamination is the greatest ongoing risk for wound deterioration and infection, as fecal bacteria rapidly degrade wound tissue and undermine any dressing applied. Implementing a bowel management program addresses the root cause perpetuating the wound's environment and supersedes other wound care measures. Applying the hydrocolloid dressing is appropriate but will be repeatedly disrupted by stool contamination if the incontinence is not managed. Repositioning is essential for pressure offloading (Braden score of 13 indicates moderate risk), but the client can reposition independently with reminders, making this a lower-acuity concern. Nutritional support promotes healing and is important but is not the most urgent intervention compared to eliminating the direct contamination source.
Question 9hard
A nurse is caring for a 68-year-old client on warfarin therapy for atrial fibrillation. The morning lab results show an INR of 4.9. The client is alert, denies bleeding, and has no bruising visible. The provider is notified and asks the nurse to hold the next warfarin dose and repeat the INR in 24 hours. Which assessment finding, if present, would require the nurse to escalate care BEYOND the provider's current orders?
- A.The client's blood pressure is 138/86 mmHg
- B.The client reports mild joint stiffness in the morning
- C.The client develops a new onset headache described as the worst of their life✓
- D.The client's urine appears slightly darker than yesterday
Correct answer: C
A supratherapeutic INR of 4.9 places the client at high risk for hemorrhage.Asudden, severe headache described as 'the worst of my life' is the classic presentation of an intracranial hemorrhage (subarachnoid or intracerebral), which is a life-threatening emergency requiring immediate escalation beyond simply holding warfarin — including emergent imaging and possible reversal with vitamin K or 4-factor PCC. Mild joint stiffness is unrelated to anticoagulation status. Slightly darker urine alone is nonspecific and does not constitute a critical bleeding emergency requiring escalation beyond current orders.ABP of 138/86 mmHg is mildly elevated but not a critical finding requiring immediate escalation in this context. The key reasoning is that a neurologic symptom in the setting of supratherapeutic anticoagulation represents a potentially fatal complication that cannot wait for a repeat INR.
Question 10hard
A nurse is preparing a 72-year-old client for an elective right knee arthroplasty. During the pre-operative checklist, the client states, 'I signed the consent form yesterday and I want to get this over with.' The client also mentions taking aspirin 325 mg daily for a previous cardiac stent placed 8 months ago and reports a latex allergy. The surgeon's pre-operative orders do not mention latex precautions or aspirin management. Which action by the nurse is the HIGHEST priority?
- A.Verify that the signed informed consent matches the procedure listed on today's surgical schedule
- B.Confirm the client has been NPO since midnight and document the time of the last oral intake
- C.Remove the client's jewelry and apply compression stockings per protocol
- D.Contact the surgeon to clarify management of the client's daily aspirin and initiate latex precautions✓
Correct answer: D
While all pre-operative actions listed are important, the highest priority involves patient safety from two simultaneous high-risk issues: an unaddressed latex allergy in a surgical environment (latex is pervasive in the OR and can cause anaphylaxis) and antiplatelet therapy with aspirin in a client with a coronary stent (abrupt discontinuation risks stent thrombosis; continuation risks surgical bleeding). The surgeon's orders do not address either issue, requiring immediate clarification before the case proceeds. Consent verification is essential but would be a problem only if a discrepancy existed — the client confirmed consent voluntarily. NPO status and jewelry removal are routine pre-op actions that do not carry the same immediate physiologic risk. The nurse's professional and legal responsibility is to prevent foreseeable harm by advocating for clarification of these two clinically significant omissions before the client enters the OR.