NCLEX questions: NCLEX practice questions, practice tests and an AI prep course

B. Hold the digoxin and notify the provider

This is textbook digoxin toxicity, and the potassium is the reason it developed. Hypokalemia potentiates digoxin at the cellular level, so a client can become toxic while the serum digoxin level still reads within range. The visual disturbance described, yellow or green halos around lights, together with nausea and a potassium of 3.1, is enough to withhold the dose. Option A administers a drug to a client showing signs of toxicity, which is the harm. Option C is not wrong as a longer-term measure but it treats a nursing intervention as sufficient for a situation that needs a provider now. Option D actively worsens things: furosemide is a potassium-wasting loop diuretic and is a large part of why the potassium fell in the first place. When a question pairs digoxin with any potassium-wasting diuretic, check the potassium before you do anything else.

B. A client with chest tube drainage who now has tracheal deviation and absent breath sounds on the right

Tracheal deviation with unilaterally absent breath sounds in a client with a chest tube is a tension pneumothorax until proven otherwise, and it kills within minutes as rising intrathoracic pressure compresses the great vessels and collapses cardiac output. That is an airway and circulation emergency and it outranks everything else here. Option C is the strongest distractor, because a potassium of 5.4 is genuinely abnormal, but the client is already awaiting definitive treatment and that value alone is not immediately lethal. Option A describes a low-grade fever that is common on post-operative day 2 and usually atelectasis. Option D is real suffering and needs prompt attention, but pain does not outrank a collapsing airway. Work these questions with ABCs first, then acute over chronic, then unstable over stable, and only then comfort.

C. Airborne precautions with an N95 respirator and a negative pressure room

Tuberculosis spreads by droplet nuclei small enough to stay suspended in air and travel on air currents, which is exactly what airborne precautions exist to contain. That requires a fit-tested N95 or higher respirator and a negative pressure room, and it starts on suspicion rather than on confirmation. Option A is the most commonly chosen wrong answer because droplet precautions sound close enough, but a surgical mask does not filter particles of that size and droplet organisms such as influenza and pertussis fall out of the air within a few feet. The memorable set for airborne is tuberculosis, measles, varicella and disseminated zoster. Option D is the dangerous one: waiting for culture confirmation, which can take weeks, would expose staff and other clients for the entire period.

C. The combination of hypotension and new confusion

This question tests the first two steps of the clinical judgment model, recognizing cues and analyzing them, and the skill being scored is seeing the pattern rather than ranking individual numbers. Every value listed is abnormal, but fever, tachycardia and tachypnea are expected findings in an infected post-operative client. What changes the picture is hypotension with new confusion, because together they say the infection is no longer local: perfusion has fallen far enough to affect the brain. That is the transition from infection to sepsis with organ dysfunction, and it is a time-critical finding. Options A, B and D are all real cues and all belong in your report, but treating any one of them as the priority means reading the vital signs as a list instead of a trajectory. On Next Generation items, look for the finding that changes what the others mean.

B. Assisting a stable client with a bed bath and recording intake and output

The rule worth memorizing is that assessment, teaching, evaluation and nursing judgment cannot be delegated, and neither can the care of an unstable client. Hygiene and measuring intake and output on a stable client are routine, standardized tasks with predictable outcomes, which is precisely what unlicensed personnel are trained and permitted to do. Option A is teaching, option C is assessment and option D is evaluation, so all three sit with the nurse regardless of how capable or experienced the assistive personnel are. Notice the word stable doing real work in the correct answer. The same bed bath on a hemodynamically unstable client would not be appropriate to delegate, because the person performing it also has to recognize deterioration. Delegation questions are answered by the nature of the task and the stability of the client, not by how busy the nurse is.

B. Hold the lithium and notify the provider

The therapeutic range for lithium is roughly 0.6 to 1.2 mEq/L, and 1.9 is frankly toxic. The symptoms match: gastrointestinal upset, a coarse tremor rather than the fine tremor seen at therapeutic levels, and ataxia. Lithium has a narrow therapeutic index, so the gap between an effective dose and a dangerous one is small enough that levels are monitored routinely. Option A gives more of the drug the client already has too much of. Option C is the trap that rewards understanding the mechanism: lithium and sodium are handled similarly by the kidney, so restricting sodium causes lithium retention and drives the level higher. Increasing sodium and fluid loss through dehydration, low-salt diets or diuretics is a common route to toxicity. Option D normalizes symptoms that need action.

B. Reposition the client to a lateral position and stop the oxytocin

Decelerations that begin after the peak of the contraction and recover after it ends are late decelerations, and they indicate uteroplacental insufficiency: the placenta is not delivering enough oxygen when the contraction squeezes its blood supply. The intrauterine resuscitation sequence starts with repositioning the client off her back to relieve pressure on the vena cava and improve placental perfusion, and with stopping any oxytocin, which is making contractions stronger and more frequent and therefore making the problem worse. Oxygen, an intravenous fluid bolus and notifying the provider follow. Option A confuses these with early decelerations, which mirror the contraction and reflect harmless head compression. Option C worsens the exact mechanism causing the problem. Option D may eventually be needed but it is not the first nursing action.

B. Grilled chicken breast with white rice and green beans

Monoamine oxidase inhibitors block the enzyme that breaks down tyramine, so dietary tyramine accumulates and triggers a massive release of norepinephrine. The result can be hypertensive crisis, which presents with severe occipital headache, and it can be fatal. The foods to avoid are the ones where tyramine has been produced by aging, fermenting, curing or smoking. Fresh chicken, plain rice and fresh vegetables contain essentially none, which makes option B a safe meal. Option A stacks three high-tyramine items at once. Option C looks healthy and is the strongest distractor, but soy products and sauerkraut are both fermented and both high in tyramine. Option D combines cured meat, aged cheese and tap beer. The rule that answers nearly every version of this question: fresh is safe, aged and fermented is not.