Free NCLEX-RN Reduction of Risk questions
25 original Reduction of Risk questions on changes in vital signs, diagnostic tests, laboratory values, complications of tests, treatments, procedures, complications of surgery and health alterations, in Next Generation NCLEX formats.
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NCLEX-RN Reduction of Risk questions
- 25 questions
- Reduction of Risk
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The nurse reviews morning laboratory results for four clients. Which result requires the nurse's immediate follow-up?
Correct answer: C
Potassium governs the heart's electrical activity, so hyperkalemia can cause dysrhythmias and cardiac arrest. Among several abnormal results, the one that threatens circulation most is the priority. Mild sodium and calcium deviations matter but are not immediately life-threatening in an otherwise stable client.
- A A sodium only slightly below range is a concern to report, but it is far less immediately dangerous than a potassium that can stop the heart.
- B A calcium just above range can cause nausea or constipation over time; it is not the most urgent result here.
- C Correct: a potassium of 6.2 mEq/L is well above range and can cause life-threatening dysrhythmias, so it needs immediate follow-up.
- D An INR of 1.0 is within the normal range for a client who is not taking warfarin.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 15.4 Electrolytes · MedlinePlus: High potassium level · MedlinePlus: Prothrombin time (PT) ·
The nurse is reviewing laboratory results on a medical unit. For each result, indicate whether it is within the expected range or requires follow-up.
Within expected range Requires follow-up INR 2.5 for a client taking warfarin for atrial fibrillation (target 2.0–3.0) INR 4.2 for a client taking warfarin (target 2.0–3.0) Platelets 42,000/mcL (150,000–400,000/mcL) Fasting glucose 92 mg/dL (70–99 mg/dL) Capillary glucose 58 mg/dL in a client receiving insulin (low: below 70 mg/dL) Potassium 4.4 mEq/L (3.5–5.1 mEq/L) Select one option in each row.
Correct answer: INR 2.5 for a client taking warfarin for atrial fibrillation (target 2.0–3.0): Within expected range; INR 4.2 for a client taking warfarin (target 2.0–3.0): Requires follow-up; Platelets 42,000/mcL (150,000–400,000/mcL): Requires follow-up; Fasting glucose 92 mg/dL (70–99 mg/dL): Within expected range; Capillary glucose 58 mg/dL in a client receiving insulin (low: below 70 mg/dL): Requires follow-up; Potassium 4.4 mEq/L (3.5–5.1 mEq/L): Within expected range
Interpret each value against the range that applies to that client. For a client on warfarin, the therapeutic INR target (usually 2.0–3.0) replaces the normal 0.8–1.1 range, so 2.5 is on target and 4.2 means higher bleeding risk. A platelet count under 50,000/mcL and a glucose under 70 mg/dL both need prompt action.
- INR 2.5 for a client taking warfarin for atrial fibrillation (target 2.0–3.0) Within expected range: an INR of 2.5 is inside the usual warfarin target of 2.0–3.0.
- INR 4.2 for a client taking warfarin (target 2.0–3.0) Requires follow-up: an INR above 3.0 on warfarin puts the client at higher risk of bleeding.
- Platelets 42,000/mcL (150,000–400,000/mcL) Requires follow-up: below 50,000/mcL, bleeding risk is high even with everyday activity.
- Fasting glucose 92 mg/dL (70–99 mg/dL) Within expected range: a fasting glucose of 70–99 mg/dL is normal.
- Capillary glucose 58 mg/dL in a client receiving insulin (low: below 70 mg/dL) Requires follow-up: a glucose below 70 mg/dL is hypoglycemia and needs treatment now.
- Potassium 4.4 mEq/L (3.5–5.1 mEq/L) Within expected range: 4.4 mEq/L is inside the 3.5–5.1 mEq/L range.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: Prothrombin time (PT) · MedlinePlus: Platelet count · MedlinePlus: Blood sugar test · MedlinePlus: Low blood sugar · Open RN Nursing Fundamentals 2e, 15.4 Electrolytes ·
A client with type 2 diabetes who receives insulin reports feeling shaky and sweaty before lunch. The client is alert and able to swallow. The capillary glucose is 62 mg/dL (low: below 70 mg/dL). The nurse should first and then .
Choose the best option from each list to complete the sentence.
Correct answer: give 15–20 g of fast-acting carbohydrate; recheck the glucose in 15 minutes
A glucose below 70 mg/dL is hypoglycemia. For an alert client who can swallow, the treatment is 15–20 g of fast-acting carbohydrate, a recheck in 15 minutes, and repeat treatment until the glucose is back in range. Glucagon is reserved for severe lows when oral treatment is not possible.
- Fast-acting carbohydrate (o2) raises the glucose quickly in an alert client; insulin would lower it further, glucagon is for severe lows, and withholding food delays treatment.
- Recheck in 15 minutes (o3) shows whether the treatment worked; waiting 1 hour is too long, a second dose before rechecking is not based on data, and the episode cannot be called resolved without a recheck.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: NIDDK: Low Blood Glucose (Hypoglycemia) · MedlinePlus: Low blood sugar ·
A client had abdominal surgery 6 hours ago. Over the last 2 hours the heart rate has risen from 82 to 114/min and the blood pressure has fallen from 132/80 to 96/62 mm Hg. The abdominal dressing shows a spreading area of bright red drainage. Which action should the nurse take first?
Correct answer: D
Rising heart rate, falling blood pressure and fresh bleeding at the site point to postoperative hemorrhage, a threat to circulation. The first action is to control bleeding with pressure while staying with the client and calling for help so the surgeon is notified at once. Circulation problems come before comfort and documentation.
- A Waiting 30 minutes delays care for a client whose trend already shows hemorrhage.
- B Removing the dressing delays bleeding control; the first step for active bleeding is pressure over the site.
- C Pain relief matters, but it does not address the bleeding that threatens circulation.
- D Correct: applying pressure is the first step for active postoperative bleeding, followed by calling for help and notifying the surgeon.
Learn this topic: Which postoperative complications should a nurse watch for? 5-minute lesson
Source: OpenStax Medical-Surgical Nursing, 27.3 Hospitalized Postoperative Patient · OpenStax Fundamentals of Nursing, 31.4 Postoperative Phase · OpenStax Medical-Surgical Nursing, 23.2 Hypovolemic Shock ·
The nurse is planning care for a client on the first day after open abdominal surgery. Which actions help prevent atelectasis? Select all that apply.
Select all that apply.
Correct answer: A, C, D
Atelectasis develops when pain, anesthesia and immobility keep the client from breathing deeply. Incentive spirometry, deep breathing and coughing, frequent repositioning and early ambulation help keep the alveoli open. Splinting the incision with a pillow supports it while the client coughs.
- A Correct: the incentive spirometer encourages deep breaths that re-expand the alveoli.
- B Lying flat and still reduces lung expansion and raises the risk of atelectasis.
- C Correct: early ambulation improves lung expansion and also reduces DVT risk.
- D Correct: deep breathing and coughing clear secretions and open the airways; splinting eases pain.
- E Frequent repositioning helps prevent atelectasis, so limiting position changes increases risk.
Learn this topic: Which postoperative complications should a nurse watch for? 5-minute lesson
Source: OpenStax Medical-Surgical Nursing, 27.3 Hospitalized Postoperative Patient · OpenStax Medical-Surgical Nursing, 27.4 Postoperative Nursing Care Plan · OpenStax Fundamentals of Nursing, 31.4 Postoperative Phase ·
The nurse is assessing several clients on a surgical unit. For each finding, indicate the postoperative complication it most likely suggests.
Atelectasis Deep vein thrombosis Paralytic ileus Wound dehiscence Diminished breath sounds at the lung bases and SpO2 lower than baseline Swelling, warmth, redness and pain in the right calf only Distended abdomen with no bowel sounds heard Incision edges pulling apart with a sudden increase in drainage Shallow, rapid breathing in a client who avoids the incentive spirometer Nausea and vomiting with a firm, bloated abdomen Select one option in each row.
Correct answer: Diminished breath sounds at the lung bases and SpO2 lower than baseline: Atelectasis; Swelling, warmth, redness and pain in the right calf only: Deep vein thrombosis; Distended abdomen with no bowel sounds heard: Paralytic ileus; Incision edges pulling apart with a sudden increase in drainage: Wound dehiscence; Shallow, rapid breathing in a client who avoids the incentive spirometer: Atelectasis; Nausea and vomiting with a firm, bloated abdomen: Paralytic ileus
Each complication has a signature: atelectasis shows decreased breath sounds, low SpO2, dyspnea and tachypnea; DVT shows one-sided leg swelling, pain, warmth and redness; paralytic ileus shows abdominal distension, absent bowel sounds, nausea and vomiting; dehiscence shows wound edges separating with increased drainage. Matching the finding to the body system narrows the hypothesis quickly.
- Diminished breath sounds at the lung bases and SpO2 lower than baseline Atelectasis: collapsed alveoli reduce breath sounds and oxygen saturation.
- Swelling, warmth, redness and pain in the right calf only Deep vein thrombosis: one-sided calf swelling, warmth, redness and pain are classic DVT findings.
- Distended abdomen with no bowel sounds heard Paralytic ileus: a distended abdomen with absent bowel sounds means the bowel is not moving.
- Incision edges pulling apart with a sudden increase in drainage Wound dehiscence: separation of the incision edges with more drainage defines dehiscence.
- Shallow, rapid breathing in a client who avoids the incentive spirometer Atelectasis: shallow breathing and not using the incentive spirometer let alveoli collapse; tachypnea is a sign.
- Nausea and vomiting with a firm, bloated abdomen Paralytic ileus: nausea and vomiting with abdominal distension fit a bowel that has stopped moving.
Learn this topic: Which postoperative complications should a nurse watch for? 5-minute lesson
Source: OpenStax Medical-Surgical Nursing, 27.3 Hospitalized Postoperative Patient · OpenStax Fundamentals of Nursing, 31.4 Postoperative Phase ·
The nurse reviews vital-sign trends for four adult clients on a medical unit. Which trend should the nurse follow up on immediately?
Correct answer: B
A change in respiratory rate is an early sign that a client is deteriorating, and new restlessness can reflect low oxygen or high carbon dioxide. A rate of 26/min is above the adult range of 12–20/min, so this client needs a full assessment and prompt reporting. The other trends stay within normal limits or have an obvious harmless cause.
- A Both temperatures are within the normal oral range, so this small rise is not urgent.
- B Correct: a rising respiratory rate above 20/min with new restlessness is an early warning of deterioration.
- C A small rise in blood pressure that stays near normal does not need immediate action.
- D A modest rise in heart rate right after activity is expected and stays within 60–100/min.
Learn this topic: How do vital-sign trends warn you that a client is getting worse? 5-minute lesson
Source: Open RN Nursing Skills 2e, 10.3 Respiratory Assessment · Open RN Nursing Skills 2e, 1.3 Vital Signs ·
Over 4 hours after surgery, a client's heart rate rises from 78 to 96 to 112/min while the blood pressure stays 128/78, 126/80 and 118/76 mm Hg. The client says, "I feel anxious." The nurse recognizes that the near-normal blood pressure , because in early blood loss the body . A urine output of would show that perfusion has become inadequate.
Choose the best option from each list to complete the sentence.
Correct answer: does not rule out bleeding; speeds up the heart and constricts blood vessels; 22 mL/hr
When blood volume falls, the sympathetic nervous system speeds up the heart and constricts blood vessels, which holds blood pressure near normal at first. That is why a climbing heart rate and anxiety can be the earliest clues, and blood pressure falls later. Urine output of 30 mL/hr or less is a sign of advanced hypovolemic shock.
- A near-normal blood pressure does not rule out bleeding (o2); compensation can hide early blood loss, and pain alone does not explain a steady climb with anxiety.
- The compensatory response speeds up the heart and constricts vessels (o3); the heart does not slow, and vessels constrict rather than dilate.
- 22 mL/hr (o1) is below the minimum of 30 mL/hr; 45 and 60 mL/hr meet the target.
Learn this topic: How do vital-sign trends warn you that a client is getting worse? 5-minute lesson
Source: OpenStax Medical-Surgical Nursing, 23.1 Shock Overview · OpenStax Medical-Surgical Nursing, 23.2 Hypovolemic Shock ·
A 72-year-old client who started a new blood pressure medication reports light-headedness when getting out of bed. The nurse measures orthostatic vital signs. Click to highlight the findings that require follow-up.
Lying for 5 minutes: blood pressure , pulse . After standing for 3 minutes: blood pressure , pulse . The client . Temperature . SpO2 on room air.
Click each part of the text to highlight it. Click again to remove the highlight.
Correct answer: 92/66 mm Hg; 110/min; says she feels light-headed and grabs the bed rail
Orthostatic hypotension is a fall of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing, and a pulse rise of 30/min or more is also significant. Here the systolic pressure falls 24 mm Hg and the pulse rises 34/min, and the client has symptoms. Orthostatic hypotension raises the risk of falls, especially in older adults, so these findings need follow-up.
- 116/74 mm Hg A lying blood pressure of 116/74 mm Hg is in the normal range.
- 76/min A lying pulse of 76/min is within 60–100/min.
- 92/66 mm Hg Requires follow-up: a systolic drop from 116 to 92 mm Hg (24 mm Hg) on standing meets the definition of orthostatic hypotension.
- 110/min Requires follow-up: a pulse rise from 76 to 110/min (34/min) on standing is a significant change.
- says she feels light-headed and grabs the bed rail Requires follow-up: light-headedness on standing with a drop in pressure puts the client at risk of falling.
- 98.4°F (36.9°C) 98.4°F (36.9°C) is a normal oral temperature.
- 97% An SpO2 of 97% is within 95–100%.
Learn this topic: How do vital-sign trends warn you that a client is getting worse? 5-minute lesson
Source: Open RN Nursing Skills 2e, 3.2 Blood Pressure Basics · Open RN Nursing Skills 2e, 1.3 Vital Signs · Open RN Nursing Skills 2e, 10.3 Respiratory Assessment ·
An alert, oriented client scheduled for a cardiac catheterization is handed the consent form and says, "I'm not really sure what they are going to do to me." What should the nurse do?
Correct answer: D
The provider explains the procedure and its risks and is legally responsible for that teaching; the nurse confirms that the client understands before the form is signed. A client who does not understand the procedure is not ready to sign, so the nurse holds the form and tells the provider the client needs more information.
- A Explaining the procedure and its risks is the provider's responsibility, not the nurse's.
- B A signature without understanding is not informed consent, however common the procedure.
- C This alert, oriented client is the person who gives consent; a family member does not sign in their place.
- D Correct: the nurse confirms understanding and returns the teaching to the provider when it is missing.
Learn this topic: How do you keep a client safe before and after a diagnostic procedure? 5-minute lesson
Source: OpenStax Medical-Surgical Nursing, 20.4 Disorders of the Prostate · MedlinePlus: Cardiac catheterization ·
The nurse is caring for four clients after diagnostic procedures. For each procedure, indicate the post-procedure nursing action that applies to it.
Withhold food and fluids until the gag reflex returns Keep the client lying flat for a few hours and check the groin site Check the urine for heavy bleeding Esophagogastroduodenoscopy (EGD) Arteriogram through the femoral artery in the groin Percutaneous kidney biopsy Cardiac catheterization through the femoral artery Select one option in each row.
Correct answer: Esophagogastroduodenoscopy (EGD): Withhold food and fluids until the gag reflex returns; Arteriogram through the femoral artery in the groin: Keep the client lying flat for a few hours and check the groin site; Percutaneous kidney biopsy: Check the urine for heavy bleeding; Cardiac catheterization through the femoral artery: Keep the client lying flat for a few hours and check the groin site
After-care follows the route of the procedure. After an EGD the throat may be numb and the scope may cause gagging, so food and fluids wait until the gag reflex returns to prevent choking. After a groin artery puncture (arteriogram or cardiac catheterization), the client lies flat for a few hours to prevent bleeding. After a kidney biopsy, urine is checked for heavy bleeding, although a small amount of blood is expected.
- Esophagogastroduodenoscopy (EGD) EGD: no food or liquid until the gag reflex returns so the client does not choke.
- Arteriogram through the femoral artery in the groin Arteriogram through the groin: lying flat for a few hours helps avoid bleeding at the puncture site.
- Percutaneous kidney biopsy Kidney biopsy: the urine is checked for heavy bleeding, the main risk after this biopsy.
- Cardiac catheterization through the femoral artery Femoral cardiac catheterization: lying flat for a few to several hours helps avoid bleeding at the groin.
Learn this topic: How do you keep a client safe before and after a diagnostic procedure? 5-minute lesson
Source: MedlinePlus: EGD - esophagogastroduodenoscopy · MedlinePlus: Arteriogram · MedlinePlus: Kidney biopsy · MedlinePlus: Cardiac catheterization ·
A client is preparing for a colonoscopy next week. The nurse teaches the client to have on the day before the test. The client takes an iron supplement and is told to stop it a few days before the test, as instructed, because iron can . When the client asks about stopping daily aspirin, the nurse explains that the client should .
Choose the best option from each list to complete the sentence.
Correct answer: clear liquids only; turn the stool dark black and hide the bowel lining; follow the provider's instructions and not stop it on their own
The bowel must be completely clean so problems are not missed, so the client takes clear liquids only the day before and completes the bowel prep. Iron makes the stool dark black, which makes it harder to see the inside of the bowel. Aspirin and other blood thinners are often continued; the client follows the provider's instructions and does not stop them without talking to the provider, especially with a heart problem.
- Clear liquids only (o2) the day before helps empty and clean the bowel.
- Iron turns the stool dark black (o3), which makes it harder for the doctor to see inside the bowel.
- Aspirin is stopped only if the provider says so (o1); many times it is continued, and ibuprofen is another drug the client may be told to stop.
Learn this topic: How do you keep a client safe before and after a diagnostic procedure? 5-minute lesson
Source: MedlinePlus: Colonoscopy ·
A client had a chest tube placed for a hemothorax 3 hours ago. For each of the last 2 hours, 250 mL of bright red drainage has collected in the drainage unit. What should the nurse do?
Correct answer: C
A sudden increase in bright red drainage of more than 200 mL per hour may mean a vascular injury that needs surgical repair. The nurse obtains vital signs, assesses the client's heart and lung status and reports the amount and color of the drainage to the provider. Clamping, stripping and lifting the unit above the chest are all unsafe.
- A Routine clamping is not recommended because it risks a tension pneumothorax.
- B Stripping creates high pressure in the tube that can cause a life-threatening pneumothorax.
- C Correct: more than 200 mL/hour of bright red drainage is assessed and reported at once.
- D The unit stays below the chest so drainage does not flow back into the chest.
Learn this topic: How do you manage a chest tube and know when something is wrong? 5-minute lesson
Source: Open RN Nursing Advanced Skills, 6.4 Troubleshooting Problems and Complications · Open RN Nursing Advanced Skills, 6.3 Nursing Responsibilities for Clients With Chest Tube Drainage Systems ·
A client's chest tube was removed by the provider at 1000. The nurse reviews the 1030 assessment. Click to highlight the findings that require follow-up.
1030: Client reports . Respirations . SpO2 on room air (97% before removal). Skin around the site . Occlusive dressing . Trachea . Rates pain at the site , the same as before removal.
Click each part of the text to highlight it. Click again to remove the highlight.
Correct answer: new shortness of breath; 26/min and shallow; 90%; puffy and crackles when pressed
After a chest tube is removed, the nurse checks the client at least every 15 minutes for the first hour, listens to the lungs and feels around the site for subcutaneous emphysema. New dyspnea, fast shallow breathing, a falling SpO2 and crackling under the skin are signs of respiratory distress and subcutaneous emphysema, so they are reported to the provider right away. A dry dressing, a midline trachea and unchanged pain are reassuring.
- new shortness of breath Requires follow-up: new shortness of breath after removal is a sign of respiratory distress.
- 26/min and shallow Requires follow-up: rapid, shallow breathing is a change from the expected unlabored respirations.
- 90% Requires follow-up: SpO2 has dropped from 97% to 90%.
- puffy and crackles when pressed Requires follow-up: puffiness and crackling under the skin are signs of subcutaneous emphysema.
- dry and intact A dry, intact occlusive dressing is expected.
- midline A midline trachea is normal; a shift would suggest a tension pneumothorax.
- 3/10 Pain that is unchanged and low is not a new concern.
Learn this topic: How do you manage a chest tube and know when something is wrong? 5-minute lesson
Source: Open RN Nursing Advanced Skills, 6.8 Assisting With Chest Tube Removal · Open RN Nursing Advanced Skills, 6.3 Nursing Responsibilities for Clients With Chest Tube Drainage Systems · Open RN Nursing Advanced Skills, 6.4 Troubleshooting Problems and Complications · Open RN Nursing Advanced Skills, 6.2 Basic Concepts (tension pneumothorax) ·
A client with a chest tube connected to wall suction is going to the radiology department by stretcher. Which actions should the nurse take? Select all that apply.
Select all that apply.
Correct answer: B, C, D
For transport, the chest tube is not clamped. The suction tubing is disconnected from the wall source, and the system keeps draining fluid by gravity and air through the water seal. The unit stays upright and below the chest, and the emergency supplies go with the client.
- A The tube is not clamped for transport, because clamping risks a tension pneumothorax.
- B Correct: disconnecting from wall suction lets the system work by gravity and water seal.
- C Correct: an upright unit below the chest prevents backflow and loss of the water seal.
- D Correct: safety equipment stays with the client, including during transport.
- E A unit at or above chest level lets fluid flow back into the chest.
Learn this topic: How do you manage a chest tube and know when something is wrong? 5-minute lesson
Source: Open RN Nursing Advanced Skills, 6.3 Nursing Responsibilities for Clients With Chest Tube Drainage Systems · Open RN Nursing Advanced Skills, 6.5 Checklist: Manage a Closed Chest Tube Drainage System ·
The nurse reviews a client's morning electrolyte results. Which result is within the normal range?
Correct answer: D
Compare each value with the range printed next to it. Only the potassium falls inside its range. The sodium, calcium and magnesium are all below range and need follow-up.
- A A sodium of 132 mEq/L is below the 136–145 mEq/L range (hyponatremia).
- B A calcium of 7.9 mg/dL is below the 8.6–10.2 mg/dL range (hypocalcemia).
- C A magnesium of 1.4 mg/dL is below the 1.7–2.2 mg/dL range (hypomagnesemia).
- D Correct: 4.2 mEq/L is inside the 3.5–5.1 mEq/L potassium range.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 15.4 Electrolytes · MedlinePlus: Magnesium blood test ·
A client with heart failure takes digoxin and furosemide. Today's results are potassium 3.1 mEq/L (3.5–5.1 mEq/L) and digoxin 1.2 ng/mL (0.8–2.0 ng/mL). Why does the nurse report the potassium result promptly?
Correct answer: B
Safety first: hypokalemia increases the effect of digoxin and can lead to digoxin toxicity, even when the digoxin level itself is in range. A potassium below 3.5 mEq/L in a client on digoxin should be reported to the provider right away.
- A The risk with low potassium is a stronger digoxin effect and toxicity, not a false lab value.
- B Correct: hypokalemia increases digoxin's effect and the risk of toxicity, so it must be reported.
- C The digoxin level of 1.2 ng/mL is inside the 0.8–2.0 ng/mL range, so nothing suggests the dose is too low.
- D Diuretics that waste potassium can lower it, but a low potassium is not safe for a client taking digoxin.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: Open RN Nursing Pharmacology, 6.7 Cardiac Glycosides · Open RN Nursing Fundamentals 2e, 15.4 Electrolytes ·
The nurse reviews four abnormal results. For each result, indicate what it mainly tells the nurse about.
Kidney function Liver cell injury Breathing (CO₂ removal) Bleeding risk Creatinine 2.1 mg/dL (0.7–1.3 mg/dL for males) ALT 112 U/L (4–36 U/L) PaCO₂ 54 mm Hg (35–45 mm Hg) Platelets 48,000/mcL (150,000–400,000/mcL) Select one option in each row.
Correct answer: Creatinine 2.1 mg/dL (0.7–1.3 mg/dL for males): Kidney function; ALT 112 U/L (4–36 U/L): Liver cell injury; PaCO₂ 54 mm Hg (35–45 mm Hg): Breathing (CO₂ removal); Platelets 48,000/mcL (150,000–400,000/mcL): Bleeding risk
Link each lab to the organ or process it reflects. The kidneys remove creatinine, ALT leaks from injured liver cells, the lungs control PaCO₂ through breathing rate and depth, and a low platelet count raises the risk of bleeding.
- Creatinine 2.1 mg/dL (0.7–1.3 mg/dL for males) Kidney function: creatinine is removed by the kidneys, so a high level suggests the kidneys are not working well.
- ALT 112 U/L (4–36 U/L) Liver cell injury: ALT is an enzyme found mostly in the liver and is released into the blood when liver cells are injured.
- PaCO₂ 54 mm Hg (35–45 mm Hg) Breathing: the lungs regulate CO₂ by changing the rate and depth of breathing, so a high PaCO₂ means CO₂ is not being removed.
- Platelets 48,000/mcL (150,000–400,000/mcL) Bleeding risk: below 50,000/mcL, bleeding can happen even with everyday activities.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: Creatinine blood test · MedlinePlus: Alanine transaminase (ALT) blood test · Open RN Nursing Fundamentals 2e, 15.5 Acid-Base Balance · MedlinePlus: Platelet count ·
A female client's results are WBC 15,200/mcL (4,500–11,000/mcL), hemoglobin 13.9 g/dL (12.1–15.1 g/dL for females) and platelets 260,000/mcL (150,000–400,000/mcL). The result outside the normal range is the , which can be a sign of .
Choose the best option from each list to complete the sentence.
Correct answer: WBC count; infection
Only the WBC count is outside its range. A high WBC count (leukocytosis) can be caused by infection, most often bacterial, as well as inflammation, stress or some medicines.
- The WBC count of 15,200/mcL is above 11,000/mcL; the hemoglobin and platelets are both within range.
- Infection is a common cause of a high WBC count. This client's hemoglobin and platelets are normal, which does not point to anemia or a bleeding problem.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: WBC count · MedlinePlus: Hemoglobin · MedlinePlus: Platelet count ·
A client who does not take warfarin or other blood thinners has an INR of 1.6 (0.8–1.1). How should the nurse interpret this result?
Correct answer: C
For a client not taking a blood thinner, the normal INR is 0.8–1.1. An INR above 1.1 means the blood is clotting more slowly than normal. The 2.0–3.0 target applies only to clients taking warfarin.
- A A higher INR means slower clotting, not faster clotting.
- B The 2.0–3.0 target is for clients on warfarin; this client takes no blood thinner, so 0.8–1.1 applies.
- C Correct: an INR above 1.1 in a client not taking warfarin means the blood clots more slowly than normal.
- D The INR measures clotting time; the platelet count is a separate test.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: Prothrombin time (PT) ·
A client with no history of diabetes has an A1C of 6.1% (normal: below 5.7%). How should the nurse interpret this result?
Correct answer: B
When A1C is used to screen for diabetes, below 5.7% is normal, 5.7% to 6.4% is prediabetes and 6.5% or higher is diabetes. A result of 6.1% falls in the prediabetes range.
- A 6.1% is above the normal cutoff of below 5.7%.
- B Correct: 6.1% is inside the 5.7%–6.4% prediabetes range.
- C The diabetes range starts at 6.5%.
- D A1C reflects average blood sugar over time; a high A1C does not mean low blood sugar.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: A1C test ·
The nurse reviews results for a female client. Which results are outside the normal range for this client? Select all that apply.
Select all that apply.
Correct answer: B, C, D
Some ranges differ by sex, so use the female range for a female client. The creatinine and hematocrit would be normal for a male but are high for a female, and the WBC count is above range for everyone.
- A 12.6 g/dL is inside the female range of 12.1–15.1 g/dL, even though it would be low for a male.
- B Outside: 1.2 mg/dL is above the female range of 0.5–0.95 mg/dL.
- C Outside: 13,200/mcL is above 11,000/mcL.
- D Outside: 46% is above the female range of 34%–43%.
- E 210,000/mcL is inside the 150,000–400,000/mcL range.
- F 4.6 million/mcL is inside the female range of 3.8–5.1 million/mcL.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: Hemoglobin · MedlinePlus: Creatinine blood test · MedlinePlus: WBC count · MedlinePlus: Hematocrit · MedlinePlus: Platelet count · MedlinePlus: RBC count ·
A client has a urine specific gravity of 1.034 (1.005–1.030) and a BUN of 24 mg/dL (6–20 mg/dL). Which condition do these results most likely point to?
Correct answer: D
Both results are high. Loss of body fluid (dehydration) can raise urine specific gravity because the urine is concentrated, and it can also raise the BUN. Dehydration is the only choice that fits both results.
- A Drinking too much fluid lowers urine specific gravity and can lower the BUN.
- B Liver failure is a cause of a low BUN, not a high one.
- C Diabetes insipidus causes dilute urine with a low specific gravity.
- D Correct: dehydration can raise both urine specific gravity and BUN.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: MedlinePlus: Urine specific gravity test · MedlinePlus: BUN - blood test ·
The nurse reviews laboratory results for four clients. Which result should the nurse report to the provider first?
Correct answer: B
Report the result with the greatest immediate risk to life first. A lithium level above 2.5 mEq/L is a medical emergency, even if the client has no symptoms. The other results are only slightly outside their ranges.
- A A BUN slightly above range needs follow-up, but it is not as urgent as a toxic lithium level.
- B Correct: a lithium level above 2.5 mEq/L is a medical emergency, even without symptoms.
- C A slightly low albumin needs follow-up, but it is not an emergency.
- D A slightly high bilirubin needs follow-up, but it is not as urgent as lithium toxicity.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: Open RN Nursing: Mental Health and Community Concepts 2e, 6.4 Mood Stabilizers · MedlinePlus: BUN - blood test · MedlinePlus: Albumin blood (serum) test · MedlinePlus: Bilirubin blood test ·
A client's sodium is 128 mEq/L (136–145 mEq/L). Which findings should the nurse watch for?
Correct answer: A
Low sodium (hyponatremia) mainly affects the brain. Watch for headache and confusion, which can progress to coma.
- A Correct: headache and confusion are signs of hyponatremia.
- B Chvostek and Trousseau signs point to low calcium, not low sodium.
- C Hunger and sweating are signs of low blood sugar.
- D Visual changes such as halos are a sign of digoxin toxicity.
Learn this topic: Which lab values should make a nurse act right away? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 15.4 Electrolytes · MedlinePlus: Low blood sugar · Open RN Nursing Pharmacology, 6.7 Cardiac Glycosides ·
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About this NCLEX-RN Reduction of Risk practice test
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NCLEX-RN format
| Client needs category | Share of the exam |
|---|---|
| Management of Care | 15–21% |
| Safety and Infection Prevention and Control | 10–16% |
| Health Promotion and Maintenance | 6–12% |
| Psychosocial Integrity | 6–12% |
| Basic Care and Comfort | 6–12% |
| Pharmacological and Parenteral Therapies | 13–19% |
| Reduction of Risk Potential | 9–15% |
| Physiological Adaptation | 11–17% |
The exam has 85 to 150 questions in up to 5 hours, including 15 unscored pretest questions and three unfolding case studies. An on-screen calculator is provided.
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