Mini Mock, Items 1 to 13

The blueprint. These 25 items are distributed across the eight client-needs areas at the midpoint of each currently published range in the NCSBN NCLEX-RN Test Plan, and the distribution is redrawn at every reprint. A 25-item set is a diagnostic instrument and nothing more. It does not produce a score, a percentage, or a prediction of any kind, and no number you generate from it means anything about your exam.

Mock rules. One sitting. No notes, no lookups, no rationales until every item is answered. Flag rather than stall. If you use the page 9 interrupt, put a mark beside that item number.

1. A nurse receives report on four clients on a post-operative unit. Which client should the nurse assess first?

1. A client one day after abdominal surgery who rates incisional pain 8 out of 10 and is asking for the next dose
2. A client four hours after a thyroidectomy who is speaking in a hoarse whisper and says the dressing feels tight
3. A client two days after a knee replacement who is refusing to use the incentive spirometer
4. A client one day after a hysterectomy whose intravenous site is reddened and tender

2. During bedside handoff, the off-going nurse states that a client is receiving a continuous heparin infusion. The rate displayed on the pump does not match the rate written in the most recent order. Which action should the oncoming nurse take first?

1. Record the discrepancy in the handoff note and continue the shift
2. Stop the infusion and wait for the prescriber to round
3. Verify the prescribed rate against the original order and the pump settings with the off-going nurse, at the bedside, before handoff ends
4. Reset the pump to the rate written in the order and continue handoff

3. A client is admitted with suspected pulmonary tuberculosis and airborne precautions are prescribed. Which actions should the nurse take? Select all that apply.

1. Place the client in a single room with negative pressure and keep the door closed
2. Put on a fit-tested respirator before entering the room
3. Put on a surgical mask before entering the room
4. Place a surgical mask on the client for transport out of the room
5. Keep visitors at least three feet from the client instead of having them mask
6. Perform hand hygiene before and after client contact

4. A client receiving a continuous heparin infusion is scheduled for a cardiac catheterization later today. The morning coagulation result returns above the reference interval and within the range the prescriber documented as this client's therapeutic target. Which action should the nurse take?

1. Hold the infusion and notify the prescriber that a critical result has returned
2. Document the result, continue the infusion as prescribed, and report the value during the pre-procedure handoff
3. Ask the laboratory to redraw and repeat the specimen before the procedure
4. Administer the prescribed reversal agent and recheck the value in one hour

5. A client is being monitored after a blunt abdominal injury. Which finding should the nurse recognize as the earliest indication that the client is entering shock?

1. Restlessness with a rising heart rate and a narrowing pulse pressure
2. Cool, mottled skin over both knees
3. Urine output below the hourly target for two consecutive hours
4. A fall in systolic blood pressure below the client's own baseline

6. A client on a medical unit becomes acutely short of breath and the rapid response team has been called. Place the nurse's actions in the order in which they should be performed.

1. Raise the head of the bed and check airway patency and breathing effort
2. Apply oxygen by the device kept at the bedside under the unit's standing protocol
3. Attach the pulse oximeter and obtain a full set of vital signs
4. Give the responding team a structured report of the change
5. Document the event, the actions taken, and the client's response

7. A nurse notes a nonblanchable area of redness over the sacrum of a client who has been on bed rest and cannot reposition without help. Which action should the nurse take?

1. Place a ring-shaped cushion under the sacrum to offload the area
2. Turn the client to a side-lying position tilted off the sacrum and start a repositioning schedule
3. Raise the head of the bed to a high position so the client can see the room
4. Massage the reddened area to restore circulation to the tissue

8. A nurse is preparing discharge teaching for a client on the second day after an uncomplicated vaginal birth. Which statements should the nurse include? Select all that apply.

1. "Call us if you soak a pad in an hour or less, or if you pass a clot larger than an egg."
2. "Call us if you have a fever, chills, or discharge that smells foul."
3. "Your uterus should feel firm and low in your pelvis. If it feels soft, rub it, and call us if it does not firm up."
4. "Your postpartum visit has been entered in the chart for six weeks from today."
5. "Empty your bladder often, because a full bladder can keep the uterus from staying firm."
6. "Take a tub bath every evening to help the stitches heal faster."

9. A client admitted for intravenous antibiotics tells the nurse, "I'm done. I'm going home today whether anyone likes it or not." Which response should the nurse make first?

1. "Leaving now would put you at real risk of this infection coming right back."
2. "I'll let the provider know so the paperwork for leaving against advice can be started."
3. "Tell me what is making you want to leave today."
4. "You'll feel differently once this next dose is in and you've had some rest."

10. A nurse walks into a room and finds an older client with new confusion sitting on the edge of the bed, the bed in a high position, with one leg already over the side rail. Which action should the nurse take first?

1. Complete a fall risk reassessment in the electronic record
2. Lower the bed, stay with the client, and help the client back into a safe position
3. Request an order for a bed exit alarm
4. Call the family to ask whether this confusion is new for the client

11. A nurse is teaching a client who will begin taking warfarin at home. Which instructions should the nurse include? Select all that apply.

1. "Keep the amount of green leafy vegetables you eat about the same from week to week."
2. "Come in for your scheduled blood draws so your dose can be adjusted."
3. "Use a soft toothbrush and an electric razor."
4. "This medicine does not require routine blood testing."
5. "Tell every prescriber and every dentist that you take this medicine, before any procedure."
6. "Take aspirin whenever you have a headache."

12. A nurse reviews the record of a client who received intravenous contrast for an imaging study yesterday. Hourly urine output has fallen steadily across the shift and is now roughly half of what this client was producing hourly before the study, and the serum creatinine has risen from the client's admission value. Which action is most appropriate?

1. Continue to monitor, because the urine output is still within the volume expected for an adult
2. Report the downward trend in urine output together with the rise in creatinine from this client's own baseline to the prescriber
3. Restrict the client's oral fluids until the next creatinine result returns
4. Insert an indwelling urinary catheter so that output can be measured more accurately

13. A charge nurse is assigning work on a short-staffed shift. Which task is appropriate to delegate to an experienced assistive personnel?

1. Obtaining vital signs on a stable client who is being discharged this afternoon
2. Obtaining vital signs on a client whose blood pressure has fallen with each of the last three sets
3. Repositioning a client who returned from the intensive care unit one hour ago on a new oxygen device
4. Feeding a client admitted this morning who has not yet had a swallow screen

☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10 ☐ 11 ☐ 12 ☐ 13

Margin noteanswer it, don't audit it.

Watch outTurning back to a rationale mid-set destroys the diagnostic value of the entire sitting. There is nothing to salvage after that, only a second, worse mock.

TakeawayThirteen items, one sitting, no peeking, then stop.