NCLEX-RN Reduction of Risk Potential Practice Questions

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

Below are 13 practice questions for this domain — 9 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN 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 Select all that apply

1. Post-endoscopy aspiration prevention

A client has just returned to the unit after an upper endoscopy performed under moderate sedation with a topical pharyngeal anesthetic. The client is drowsy but rousable and asks for a drink of water.

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

  1. Keep the client NPO until the gag reflex has returned.
  2. Monitor for signs of perforation such as severe pain, fever, or rigidity.
  3. Assess respiratory status and level of consciousness for residual sedation.
  4. Give the client a large glass of cold water right away to soothe the throat.
  5. Place the client flat and supine and leave the side rails down.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . The topical anesthetic suppresses the protective gag reflex, so oral intake before it returns risks aspiration. Confirming the reflex is the priority before any fluids.
  • B. Correct . Perforation is a serious post-endoscopy complication; early recognition of these red-flag findings allows prompt intervention.
  • C. Correct . Sedation can cause delayed respiratory depression, so airway and neurologic monitoring are essential in the recovery period.
  • D. Incorrect . Offering fluids before the gag reflex returns can cause aspiration; oral intake must wait until the reflex is confirmed intact.
  • E. Incorrect . A drowsy, recently sedated client should be positioned to protect the airway with safety rails up; lying flat raises aspiration and fall risk.

Reference: NCLEX-RN post-procedure sedation and aspiration-prevention standards

Easy Multiple choice

2. Telemetry flat line — first action

A nurse working at the central telemetry station sees a client's monitor suddenly display a flat line with no QRS complexes. Moments earlier the same client's rhythm was normal sinus at 78/min.

Which action should the nurse take first?

  1. Go to the client's room and check responsiveness and a central pulse.
  2. Call a code blue and start chest compressions from the nursing station.
  3. Increase the gain on the monitor and document the tracing.
  4. Charge the defibrillator and prepare to deliver a shock.
Show the answer and rationales

Correct answer: A

  • A. Correct . A sudden flat line is far more often a disconnected lead than true asystole. ACLS guidance is to confirm an apparent lethal rhythm by assessing the actual client before initiating a code, so the nurse must lay eyes on the client first.
  • B. Incorrect . Initiating CPR based only on the monitor risks compressing a fully conscious client whose lead simply fell off. The rhythm must be confirmed at the bedside before treatment begins.
  • C. Incorrect . Adjusting the monitor delays direct assessment of a potentially pulseless client. Equipment troubleshooting never comes before checking the person.
  • D. Incorrect . Asystole is not a shockable rhythm, and no rhythm should be treated until it is confirmed at the bedside. Defibrillation here is both premature and inappropriate.

Reference: 2020 AHA ACLS adult cardiac arrest algorithm (asystole confirmation)

Medium Multiple choice

3. Cultures before antibiotics

A client with suspected sepsis has new orders for two sets of blood cultures and an IV broad-spectrum antibiotic. The medication is already prepared at the bedside and the IV is patent.

Which action should the nurse take?

  1. Draw the blood cultures first, then start the antibiotic.
  2. Start the antibiotic first, then draw the cultures once it is infusing.
  3. Hold the antibiotic until final culture results return in 48 to 72 hours.
  4. Draw a single culture from the IV start site to save the client a stick.
Show the answer and rationales

Correct answer: A

  • A. Correct . Cultures should be obtained before the first antibiotic dose so the organism can still be identified, as long as collection does not meaningfully delay therapy. Antibiotics given first can sterilize the sample and mask the pathogen.
  • B. Incorrect . Giving the antibiotic before the cultures can suppress bacterial growth in the sample, reducing the chance of identifying the pathogen and tailoring therapy.
  • C. Incorrect . Delaying antibiotics in suspected sepsis increases mortality; therapy must begin promptly after cultures are collected, not after results return.
  • D. Incorrect . Two sets from separate sites are ordered to distinguish true bacteremia from contamination; a single set is inadequate for diagnosis.

Reference: Surviving Sepsis Campaign — cultures before antimicrobial therapy

Medium Select all that apply

4. Endotracheal suctioning technique

A nurse is preparing to perform endotracheal suctioning on a mechanically ventilated client whose breath sounds reveal coarse secretions. The client's baseline SpO2 is 96 percent on the ventilator.

Which actions should the nurse include? Select all that apply.

  1. Hyperoxygenate the client before and after each suction pass.
  2. Limit each suction pass to no more than 15 seconds.
  3. Apply suction only while withdrawing the catheter, not while advancing it.
  4. Monitor SpO2 and heart rhythm and stop if bradycardia or desaturation occurs.
  5. Instill 5 to 10 mL of normal saline before each pass to loosen secretions.
  6. Suction the airway on a fixed schedule every hour even when it sounds clear.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Suctioning removes oxygen along with secretions, so pre- and post-oxygenation guards against hypoxemia and is a core safety step.
  • B. Correct . Keeping each pass to 15 seconds or less minimizes hypoxemia, mucosal trauma, and vagal stimulation during the procedure.
  • C. Correct . Suctioning on withdrawal only prevents prolonged airway occlusion and reduces trauma to the tracheal mucosa.
  • D. Correct . Suctioning can trigger vagally mediated bradycardia and hypoxemia, so the nurse must watch these parameters and halt the procedure if they develop.
  • E. Incorrect . Routine saline instillation is not recommended; it can worsen oxygenation and push organisms into the lower airway rather than help clear secretions.
  • F. Incorrect . Suctioning is performed only when assessment indicates a need, such as audible or visible secretions, rising airway pressures, or desaturation. Routine scheduled suctioning adds mucosal trauma and hypoxemia risk without benefit.

Reference: AARC Clinical Practice Guideline — Artificial Airway Suctioning

Medium Multiple choice

5. Hypoglycemia — conscious client

A nurse is monitoring a client with type 1 diabetes who suddenly becomes shaky, diaphoretic, and irritable before lunch. A bedside capillary glucose reads 58 mg/dL. The client is alert, oriented, and able to swallow safely.

Which action should the nurse take first?

  1. Give 15 grams of a fast-acting oral carbohydrate and recheck glucose in 15 minutes.
  2. Administer IV dextrose 50 percent immediately.
  3. Give intramuscular glucagon and call the provider.
  4. Encourage the client to eat the upcoming lunch tray when it arrives.
Show the answer and rationales

Correct answer: A

  • A. Correct . For a conscious client who can swallow, the 15-15 rule applies: 15 grams of fast-acting carbohydrate, then recheck in 15 minutes. It corrects the low quickly while avoiding overtreatment and rebound hyperglycemia.
  • B. Incorrect . IV dextrose is reserved for clients who cannot safely swallow or are unconscious; this alert client should be treated orally first.
  • C. Incorrect . Glucagon is for hypoglycemia when the client cannot take oral carbohydrate; it is unnecessary here because the client can swallow.
  • D. Incorrect . Waiting for a full meal is too slow for active hypoglycemia and contains fat and protein that delay glucose absorption; rapid carbohydrate is needed now.

Reference: American Diabetes Association Standards of Care — hypoglycemia (Rule of 15)

Medium Select all that apply

6. Indwelling catheter — CAUTI prevention

A nurse is caring for a client with a newly placed indwelling urinary catheter following surgery. The nurse wants to reduce the client's risk of a catheter-associated urinary tract infection.

Which actions reduce the client's CAUTI risk? Select all that apply.

  1. Keep the drainage bag below the level of the bladder at all times.
  2. Maintain a closed sterile drainage system and avoid disconnecting it.
  3. Review the ongoing need for the catheter daily and advocate for early removal.
  4. Secure the catheter to prevent traction and keep the tubing free of kinks.
  5. Irrigate the catheter with sterile saline every shift to keep it patent.
  6. Rest the drainage bag on the floor during client transport.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Positioning the bag below the bladder lets urine drain by gravity and prevents reflux of contaminated urine back toward the bladder.
  • B. Correct . Every break in the closed system is an entry point for bacteria, so keeping it intact is a primary CAUTI-prevention measure.
  • C. Correct . Duration of catheterization is the strongest risk factor for CAUTI, so removing the catheter as soon as it is no longer needed lowers the risk.
  • D. Correct . Securement and unobstructed flow prevent urethral trauma and urine stasis, both of which contribute to infection.
  • E. Incorrect . Routine irrigation opens the closed system unnecessarily and is not recommended; it raises rather than lowers infection risk.
  • F. Incorrect . The bag must never touch the floor, a contaminated surface; doing so introduces organisms to the system.

Reference: CDC Guideline for Prevention of Catheter-Associated Urinary Tract Infections

Medium Multiple choice

7. Post-op hemorrhage — early detection

Two hours after a total hip arthroplasty, a client's heart rate has climbed from 78 to 116/min and blood pressure has fallen from 128/76 to 96/58 mm Hg. The surgical dressing appears dry and intact, and the client reports feeling anxious and lightheaded.

Which action should the nurse take first?

  1. Inspect underneath the client and the bed linens for pooled blood.
  2. Document the vital signs and recheck them in one hour.
  3. Raise the head of the bed to 60 degrees to improve comfort.
  4. Offer oral fluids to address the lightheadedness.
Show the answer and rationales

Correct answer: A

  • A. Correct . Rising heart rate with falling blood pressure signals hemorrhage, and a dry top dressing can hide bleeding that tracks by gravity beneath the client. Checking underneath confirms concealed blood loss before escalating.
  • B. Incorrect . These trends point to active bleeding; waiting an hour delays recognition of impending hypovolemic shock.
  • C. Incorrect . Sitting a hypotensive, bleeding client upright can worsen cerebral perfusion and does nothing to find or stop the blood loss.
  • D. Incorrect . Oral fluids do not treat acute blood loss and may be unsafe if the client deteriorates and needs surgery; assessment and provider notification come first.

Reference: NCLEX-RN hemorrhage and hypovolemic shock assessment standards

Medium Select all that apply

8. Post-paracentesis monitoring

A nurse is caring for a client who has just had a large-volume paracentesis with approximately 6 liters of ascitic fluid removed for tense ascites. The client returns to the unit with a dressing over the puncture site.

Which actions should the nurse include in post-procedure care? Select all that apply.

  1. Monitor vital signs frequently for hypotension and tachycardia.
  2. Inspect the puncture site for bleeding or leakage of ascitic fluid.
  3. Measure and document the amount, color, and clarity of the fluid removed.
  4. Anticipate that albumin may be ordered after large-volume drainage.
  5. Encourage the client to ambulate in the hallway immediately to prevent clots.
  6. Keep the client NPO for 24 hours because the bowel was entered.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Removing large fluid volumes causes intravascular fluid shifts that can produce hypotension and tachycardia, so frequent vital-sign monitoring is essential to catch hemodynamic compromise early.
  • B. Correct . Persistent leakage or bleeding at the site is a recognized complication and must be detected promptly to prevent infection and fluid loss.
  • C. Correct . Recording fluid characteristics and volume supports diagnosis and helps anticipate fluid-shift complications after large-volume removal.
  • D. Correct . Albumin is often given when more than about 5 liters is removed to offset circulatory dysfunction from massive fluid shifts.
  • E. Incorrect . Immediate ambulation risks falls in a client who may become hypotensive from fluid shifts; the client should be monitored and rest before activity.
  • F. Incorrect . Paracentesis removes peritoneal fluid and does not enter the bowel, so prolonged NPO status is not indicated.

Reference: StatPearls Paracentesis; post-procedure nursing care standards

Medium Multiple choice

9. Transfusion — bedside verification

A nurse has retrieved a unit of packed red blood cells from the blood bank for a client with symptomatic anemia. The provider's order and consent are in place, and an 18-gauge IV with normal saline is patent.

Which action is essential immediately before the nurse hangs the unit?

  1. Verify the client identifiers and the unit's ABO and Rh type with a second qualified person at the bedside.
  2. Prime the blood tubing with a dextrose 5 percent in water solution.
  3. Premedicate the client with diphenhydramine for every transfusion.
  4. Warm the unit in a basin of hot water to body temperature.
Show the answer and rationales

Correct answer: A

  • A. Correct . A two-person bedside check matching the client's wristband to the blood product label and ABO/Rh type is the single most important safeguard against a fatal hemolytic reaction, and it must be done before the unit is started.
  • B. Incorrect . Blood is incompatible with dextrose solutions, which cause hemolysis. Only normal saline may share the line, so this action is unsafe.
  • C. Incorrect . Routine premedication is not standard and requires a provider order; it does not replace the mandatory identity and compatibility verification.
  • D. Incorrect . Blood must never be warmed in tap water, which can hemolyze cells and introduce infection; only an approved blood warmer may be used, and only when indicated.

Reference: AABB Standards; Joint Commission transfusion two-person verification

Medium Multiple choice

10. Transfusion reaction — first action

Fifteen minutes into a transfusion of packed red blood cells, a client reports chills and low back pain. The temperature has risen from 37.0 to 38.6 degrees C, heart rate is 118/min, and blood pressure has fallen to 92/54 mm Hg.

Which action should the nurse take first?

  1. Stop the transfusion immediately.
  2. Slow the transfusion rate and continue monitoring.
  3. Administer the next dose of an antipyretic and reassess.
  4. Notify the blood bank and complete the reaction paperwork.
Show the answer and rationales

Correct answer: A

  • A. Correct . Fever, chills, flank or back pain, tachycardia, and hypotension early in a transfusion suggest an acute hemolytic reaction. Stopping the infusion at once halts delivery of incompatible blood and is the first priority.
  • B. Incorrect . Continuing to infuse any amount of suspected incompatible blood worsens hemolysis. The unit must be stopped, not merely slowed.
  • C. Incorrect . Treating the fever without stopping the transfusion ignores a possible life-threatening hemolytic reaction and delays the critical first step.
  • D. Incorrect . The blood bank must be notified, but only after the transfusion is stopped and the line is kept open with normal saline through new tubing.

Reference: AABB Standards; Versiti acute transfusion reaction nursing guidance

Hard Multiple choice

11. Contrast CT — renal safety priority

A nurse is preparing four clients for contrast-enhanced CT scans. Before the studies proceed, the nurse reviews each chart for contraindications.

Which finding should the nurse report to the provider immediately?

  1. A client with an estimated glomerular filtration rate of 24 mL/min who takes metformin daily.
  2. A client who reports a mild itchy rash after eating shellfish years ago.
  3. A client with normal renal function who is mildly anxious about the scan.
  4. A client with a serum potassium of 4.2 mEq/L and an eGFR of 88 mL/min.
Show the answer and rationales

Correct answer: A

  • A. Correct . An eGFR below 30 mL/min in a client receiving iodinated contrast warrants holding metformin and provider notification, because impaired clearance raises the risk of contrast-associated kidney injury and metformin accumulation. This finding needs to be reported before the scan.
  • B. Incorrect . Shellfish allergy is not a contraindication to iodinated contrast; the old belief linking them is a misconception, so this alone does not require urgent reporting.
  • C. Incorrect . Procedural anxiety is common and addressed with teaching and support; it is not a safety contraindication to contrast.
  • D. Incorrect . Both values are within normal limits, so this client has no contrast- related contraindication requiring urgent provider notification.

Reference: ACR Manual on Contrast Media (2023) — metformin and renal function

Hard Multiple choice

12. Post-liver-biopsy — priority finding

A nurse is monitoring four clients on a medical unit. The nurse must decide which client needs to be assessed first one hour after their procedures.

Which client should the nurse assess first?

  1. A client one hour post percutaneous liver biopsy reporting right shoulder pain with a heart rate of 112/min and blood pressure of 94/56 mm Hg.
  2. A client post upper endoscopy with a mildly sore throat and stable vital signs awaiting return of the gag reflex.
  3. A client post paracentesis with a dry dressing and blood pressure of 118/72 mm Hg who reports feeling better.
  4. A client post bronchoscopy requesting a snack now that the gag reflex has returned.
Show the answer and rationales

Correct answer: A

  • A. Correct . The liver is highly vascular, and referred right shoulder pain with tachycardia and falling blood pressure suggests intraperitoneal hemorrhage. This client shows signs of a life-threatening bleed and must be seen first.
  • B. Incorrect . A sore throat after endoscopy is expected, and stable vital signs make this a lower priority than a client with signs of bleeding.
  • C. Incorrect . Stable vital signs, a dry site, and symptom relief indicate this client is doing well and does not need to be seen first.
  • D. Incorrect . A returned gag reflex means it is safe to resume intake; this client is stable and is not the priority.

Reference: AASLD/SIR liver biopsy bleeding-risk guidance; NCLEX prioritization standards

Hard Multiple choice

13. Pre-procedure coagulation review

A nurse is reviewing morning labs for a client scheduled for an elective percutaneous liver biopsy later today. The client takes warfarin for atrial fibrillation. Today's INR is 3.4 and the platelet count is 210,000/microL.

Which action should the nurse take?

  1. Hold the biopsy preparation and notify the provider of the elevated INR.
  2. Send the client to the procedure suite, since the platelet count is normal.
  3. Administer the next scheduled warfarin dose to keep the level steady.
  4. Document the values and proceed with routine pre-procedure teaching only.
Show the answer and rationales

Correct answer: A

  • A. Correct . An INR of 3.4 far exceeds the safe threshold for a percutaneous liver biopsy, which is a high-bleeding-risk procedure usually requiring an INR near or below 1.5. The nurse must hold and notify the provider so the anticoagulation can be corrected before proceeding.
  • B. Incorrect . A normal platelet count does not offset a markedly elevated INR; the coagulation deficit still creates a serious bleeding risk for an invasive liver biopsy.
  • C. Incorrect . Giving more warfarin would raise the INR further and increase bleeding risk before an invasive procedure; warfarin is held, not continued, for this situation.
  • D. Incorrect . Documenting without acting overlooks a critical safety finding; the supratherapeutic INR must be communicated to the provider before the biopsy can safely occur.

Reference: SIR periprocedural coagulation guidelines; perioperative warfarin management (CHEST 2022)

Keep practising

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