NCLEX-PN Reduction of Risk Potential Practice Questions

Reducing the risk of complications from procedures, diagnostics, and treatments at the PN level. It sits under Physiological Integrity on the NCLEX-PN test plan and carries an approximate weight of 12% of the exam.

Below are 10 practice questions for this domain — 6 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Multiple choice

1. Acting on a low glucometer reading

A nurse checks the capillary blood glucose of a client with diabetes who feels shaky and sweaty before lunch. The glucometer reads 58 mg/dL. The client is alert and able to swallow safely.

Which action should the nurse take first?

  1. Give 15 grams of a fast-acting carbohydrate such as 4 ounces of fruit juice.
  2. Recheck the blood glucose in 15 minutes before treating.
  3. Offer the client a peanut butter sandwich.
  4. Notify the provider before giving anything by mouth.
Show the answer and rationales

Correct answer: A

  • A. Correct . A reading of 58 mg/dL is below the hypoglycemia threshold of 70 mg/dL. For a conscious client who can swallow, the rule of 15 directs giving 15 grams of fast-acting carbohydrate, then rechecking in 15 minutes.
  • B. Incorrect . Rechecking is the step that comes after treatment. Delaying the carbohydrate while the glucose is already low risks the client becoming more symptomatic.
  • C. Incorrect . Fat and protein slow carbohydrate absorption, so they raise the glucose too slowly for acute hypoglycemia; a fast-acting simple carbohydrate is needed first.
  • D. Incorrect . Treating symptomatic hypoglycemia with a fast carbohydrate is a standard action that should not be delayed to make a call; the provider is informed after the client is treated.

Reference: CDC treatment of low blood sugar and ADA Standards of Care hypoglycemia guidance

Easy Multiple choice

2. Resuming intake after upper endoscopy

A nurse is monitoring a client who has returned from an upper endoscopy in which the throat was numbed with a local anesthetic spray. The client asks for a drink of water.

Which finding indicates it is safe for the nurse to offer fluids?

  1. The client's gag reflex has returned.
  2. The client states feeling hungry and thirsty.
  3. The client is alert and oriented to person and place.
  4. The client's vital signs are within normal limits.
Show the answer and rationales

Correct answer: A

  • A. Correct . The throat is anesthetized for an upper endoscopy, so food and fluids are withheld until the gag reflex returns. Its return shows the airway can again protect against aspiration.
  • B. Incorrect . Hunger and thirst are common after a fasting procedure but say nothing about whether the protective gag reflex has come back.
  • C. Incorrect . Alertness shows the sedation is wearing off, but a client can be awake and still have a numbed throat with an absent gag reflex.
  • D. Incorrect . Stable vital signs are reassuring but do not confirm the gag reflex has returned, which is the specific finding needed before offering fluids.

Reference: MedlinePlus EGD post-procedure care guidance

Medium Select all that apply

3. Caring for a fresh surgical dressing

A nurse is caring for a client on the first day after abdominal surgery. The original dressing the surgeon applied in the operating room is intact, and a small amount of serosanguineous drainage is visible at one edge.

Which actions are appropriate for the nurse to take? Select all that apply.

  1. Document the color, amount, and odor of the drainage.
  2. Reinforce the dressing if it becomes saturated and notify the RN.
  3. Outline the edge of the drainage on the dressing and note the time.
  4. Keep the dressing clean, dry, and intact.
  5. Remove the original dressing to inspect the incision.
  6. Independently switch to a different type of dressing.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Describing drainage by color, amount, consistency, and odor creates a baseline so any change can be recognized and reported.
  • B. Correct . The first surgical dressing is reinforced rather than removed, and a saturated dressing signals drainage that the RN needs to know about.
  • C. Correct . Marking the drainage border with a time lets the team see at a glance whether the drainage is expanding, which would warrant notification.
  • D. Correct . A clean, dry, intact dressing protects the incision and lowers the risk of contamination and infection.
  • E. Incorrect . The surgeon performs or orders the first dressing change; removing the original dressing without an order exposes the wound and is not the nurse's independent action.
  • F. Incorrect . Changing the dressing type requires a provider order; selecting a different product independently is outside the nurse's scope.

Reference: MedlinePlus surgical wound care and CDC surgical dressing guidance

Medium Select all that apply

4. Collecting a clean-catch urine culture

A nurse is collecting a clean-catch midstream urine specimen from a female client so that a urine culture can be sent before antibiotics are started.

Which actions should the nurse take to collect the specimen correctly? Select all that apply.

  1. Have the client clean the perineal area from front to back before voiding.
  2. Have the client start the urine stream into the toilet, then catch the midstream portion.
  3. Label the specimen container at the bedside in front of the client.
  4. Send the specimen to the lab promptly, or refrigerate it if there will be a delay.
  5. Collect the very first urine at the start of voiding.
  6. Collect the specimen after the first dose of antibiotic has been given.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Cleansing front to back before collection reduces contamination from skin and perineal bacteria, keeping the culture result accurate.
  • B. Correct . The first part of the stream flushes the urethra, so collecting midstream yields a less contaminated sample.
  • C. Correct . Labeling at the bedside in front of the client prevents mislabeling and mix-ups with another person's specimen.
  • D. Correct . Urine should reach the lab within about an hour or be refrigerated; otherwise bacterial overgrowth can distort the culture result.
  • E. Incorrect . The initial stream is the most contaminated portion and should be discarded, not collected, for a clean-catch culture.
  • F. Incorrect . Cultures are collected before the first antibiotic dose so the pathogen can still be detected and identified.

Reference: MedlinePlus clean catch urine specimen instructions

Medium Multiple choice

5. Flat line on the telemetry monitor

A nurse is monitoring clients on a telemetry unit. The central monitor suddenly shows a flat line for one client. Moments earlier that client was resting comfortably and talking with a visitor.

Which action should the nurse take first?

  1. Go to the client and check responsiveness and the pulse.
  2. Call a code blue immediately based on the monitor.
  3. Document the rhythm change and continue monitoring the other clients.
  4. Reposition the monitor leads from the nurses' station.
Show the answer and rationales

Correct answer: A

  • A. Correct . Always assess the client, not just the monitor. A sudden flat line in a client who was just talking is most often a loose lead, so confirming responsiveness and pulse comes before any emergency response.
  • B. Incorrect . Acting on the tracing alone risks initiating a code on a client with a detached lead. The client must be assessed to confirm a true arrest first.
  • C. Incorrect . Documenting without assessing could miss a genuine emergency; the client must be checked promptly to determine whether the finding is real.
  • D. Incorrect . Leads cannot be adjusted remotely, and assuming an artifact without seeing the client could delay care if the rhythm is real; assess the client first.

Reference: AHA 2020 BLS guidance and telemetry artifact recognition principles

Medium Multiple choice

6. Post-liver biopsy positioning

A nurse is caring for a client who returned to the unit 15 minutes ago after a percutaneous liver biopsy. The client is awake and the vital signs are stable.

Which action should the nurse take?

  1. Position the client lying on the right side.
  2. Position the client on the left side with the knees drawn up.
  3. Assist the client to ambulate in the hallway to prevent clots.
  4. Encourage the client to drink several glasses of water.
Show the answer and rationales

Correct answer: A

  • A. Correct . Lying on the right side places pressure against the highly vascular liver, which helps control bleeding at the puncture site, the chief risk after a liver biopsy.
  • B. Incorrect . The left side does not compress the biopsy site, so it fails to tamponade the vascular liver and does not reduce the bleeding risk.
  • C. Incorrect . Early ambulation increases the risk of bleeding from the fresh puncture site; the client needs a period of bed rest with site pressure first.
  • D. Incorrect . Oral fluids do not address the bleeding risk and are not the priority immediately after the biopsy; positioning to control bleeding comes first.

Reference: MedlinePlus and NIDDK liver biopsy aftercare guidance

Medium Select all that apply

7. Recognizing a surgical site infection

A nurse is collecting data from a client on the third day after surgery. The normal white blood cell range used by the facility is 4,500 to 11,000 cells per microliter.

Which findings should the nurse report to the RN as possible signs of a surgical site infection? Select all that apply.

  1. An oral temperature of 101.4 F (38.6 C).
  2. Thick, cloudy yellow drainage coming from the incision.
  3. Redness and warmth spreading outward from the incision.
  4. A white blood cell count of 15,200 cells per microliter.
  5. Incision edges that are well approximated with no drainage.
  6. Incisional pain rated 2 out of 10 and controlled with oral analgesics.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . A new fever is a systemic sign of infection and warrants notifying the RN for further evaluation.
  • B. Correct . Purulent (pus-like) drainage at a surgical site is a cardinal sign of infection and should be reported.
  • C. Correct . Spreading redness and warmth are local signs of infection at the wound and need to be reported for assessment.
  • D. Correct . This value is well above the upper limit of 11,000 and an elevated WBC count points to a systemic infection.
  • E. Incorrect . Clean, well-approximated edges with no drainage describe normal healing, not infection.
  • F. Incorrect . Mild, well-controlled pain is expected after surgery and is not by itself a sign of infection.

Reference: CDC surgical site infection criteria and MedlinePlus WBC count reference range

Medium Multiple choice

8. Screening before an abdominal X-ray

A nurse is preparing a 28-year-old female client for an abdominal X-ray that does not involve contrast dye. The nurse is collecting data before the client goes to the radiology department.

Which question is most important for the nurse to ask?

  1. Is there any chance you could be pregnant, or when was your last menstrual period?
  2. Have you had anything to eat or drink in the last 8 hours?
  3. Are you allergic to shellfish or iodine?
  4. Do you have any loose or removable dental work?
Show the answer and rationales

Correct answer: A

  • A. Correct . X-rays use ionizing radiation that can harm a developing fetus, so women of childbearing age must be screened for possible pregnancy before any X-ray so the provider can weigh the risk or choose a different study.
  • B. Incorrect . Fasting is not required for a plain abdominal X-ray, so this question is not the priority here.
  • C. Incorrect . Allergy screening applies to iodinated contrast dye, and this X-ray uses no contrast. Shellfish allergy is also not a reliable predictor of contrast reactions.
  • D. Incorrect . Dental work matters for head and neck imaging, not a routine abdominal X-ray, so it is not the most important question in this situation.

Reference: MedlinePlus X-ray safety guidance on radiation and pregnancy

Hard Select all that apply

9. Monitoring for postoperative hemorrhage

A nurse is monitoring a client several hours after major abdominal surgery. The admission vital signs were a heart rate of 78/min and a blood pressure of 124/78 mmHg.

Which findings should the nurse report to the RN as possible signs of hemorrhage? Select all that apply.

  1. The heart rate has risen to 118/min.
  2. The blood pressure has dropped to 92/56 mmHg.
  3. The client has become restless and increasingly anxious.
  4. The dressing is saturated and blood is pooling underneath the client.
  5. The urine output has been 60 mL per hour.
  6. The oral temperature is 98.8 F (37.1 C).
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . A climbing heart rate is an early compensatory response to blood loss and is a warning sign of hemorrhage that must be reported.
  • B. Correct . A falling blood pressure paired with rising heart rate points toward hypovolemia from bleeding and needs prompt notification.
  • C. Correct . Restlessness and anxiety can be early signs of inadequate perfusion as the body responds to blood loss, so they are reportable.
  • D. Correct . Blood pools by gravity, so checking beneath the client is essential; a saturated dressing with pooling is direct evidence of active bleeding.
  • E. Incorrect . A urine output of 60 mL per hour is adequate and reflects good perfusion, not hemorrhage.
  • F. Incorrect . A normal temperature is not a sign of bleeding and does not need to be reported as a hemorrhage concern.

Reference: MedlinePlus postoperative bleeding and shock recognition guidance

Hard Multiple choice

10. MRI safety screening before transport

A nurse is preparing a client for an MRI of the brain. While collecting data for the pre-procedure checklist, the nurse reviews the client's history and belongings.

Which finding should the nurse report to the charge nurse before the client is transported?

  1. The client has an implanted cardiac pacemaker.
  2. The client is wearing a gold wedding ring.
  3. The client states feeling nervous about the enclosed scanner.
  4. The client has several small skin tags on the neck.
Show the answer and rationales

Correct answer: A

  • A. Correct . The MRI magnet can disrupt or heat implanted metal devices, so a pacemaker is a serious safety hazard. It must be reported so the team can verify whether the device is MRI compatible before any scan proceeds.
  • B. Incorrect . A removable metal object is a real concern, but the nurse simply removes and secures it; it is not a finding that requires escalation before transport.
  • C. Incorrect . Claustrophobia is common and may need comfort measures or premedication, but it is not the life-threatening safety hazard that an implanted device is.
  • D. Incorrect . Skin tags contain no metal and pose no MRI hazard, so they do not need to be reported before the scan.

Reference: FDA MRI safety guidance on implanted devices and metallic objects

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain

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