Nursing Acceleration Challenge Exam (NACE) Practice Exam

Preparing for the NACE exam can feel uncertain—not because the material is unfamiliar, but because many candidates don’t know what the exam will actually test or how questions will be framed. Reading standards or notes alone doesn’t always translate into exam readiness. What most test takers need is realistic practice that mirrors the way concepts are evaluated under exam conditions.

This NACE Exam Practice Test was created to help you move from passive study to confident application. The questions are structured to reflect the level of reasoning, technical understanding, and decision-making expected on the exam, while the detailed answers explain not just what is correct, but why. That clarity helps you identify gaps early, avoid common mistakes, and study with purpose instead of guesswork.

Rather than overwhelming you with unfocused material, this practice test concentrates on the concepts and scenarios candidates most often struggle with—so your study time is spent where it matters most. Whether you’re preparing for your first attempt or returning after time away from the material, this resource is designed to help you practice efficiently, build confidence, and walk into the exam knowing what to expect.

Who Can Take the NACE Practice Exam?

The NACE Foundations of Nursing Exam is primarily for:

• Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs) seeking advanced placement in an RN bridge program.
• Paramedics transitioning into nursing programs.
• Students in healthcare fields wanting credit for prior experience when entering nursing school.
• Nursing school applicants required by certain universities or colleges to demonstrate academic readiness before admission.

It’s an ideal choice for anyone with prior healthcare training who wants to shorten the pathway to becoming a Registered Nurse.

About Our NACE Practice Questions

This NACE exam practice test is a comprehensive preparation tool designed to mirror the real testing experience. It includes over 750+ updated 2026 multiple-choice questions and answers carefully written to reflect real-world clinical scenarios and align with the official NACE exam content outline.

Each question includes a detailed answer explanation—written in plain nursing language—to help you understand not just what the correct answer is, but why it’s correct. The practice sets are organized by category, allowing you to focus on specific areas of nursing such as pharmacology, pediatrics, or maternal-newborn care before attempting full-length timed exams.

Our NACE exam practice questions are continually updated to reflect the latest NCLEX and NACE test blueprints, ensuring that you study material relevant to modern nursing standards. Every section follows the same reasoning and safety principles used in real clinical settings, so your preparation builds both academic and professional confidence.

Topics Covered in This NACE Practice Test

Our NACE Foundations of Nursing Practice Exam covers all key topics tested on the actual exam, as reflected in the question sets above:

1. Pharmacology and Medication Safety

• Drug classifications, administration routes, and dosage calculation
• Safe medication administration (including insulin, anticoagulants, opioids)
• Adverse effects, contraindications, and antidotes
• Key drug interactions (ACE inhibitors, diuretics, digoxin, antibiotics, antidepressants)

2. Maternal and Newborn Nursing

• Labor stages, postpartum care, and fetal monitoring
• High-risk pregnancy conditions (preeclampsia, placenta previa, abruptio placentae)
• Newborn assessment, thermoregulation, and breastfeeding care
• Medications used in labor, Rhogam protocol, magnesium sulfate monitoring

3. Pediatric Nursing

• Growth and development milestones
• Childhood illnesses (RSV, croup, epiglottitis, dehydration, lead poisoning)
• Pediatric dosage and fluid calculations
• Safety, immunization schedules, and parent education

4. Adult Health / Medical-Surgical Nursing

• Cardiovascular and respiratory disorders (MI, CHF, asthma, COPD)
• Neurologic emergencies (stroke, seizure care, increased ICP)
• Gastrointestinal and renal conditions
• Endocrine disorders such as diabetes management and thyroid disease
• Fluid and electrolyte balance, infection control, and wound care

5. Mental Health Nursing

• Therapeutic communication and patient interaction
• Anxiety, depression, bipolar disorder, and schizophrenia management
• Substance abuse and withdrawal care
• Ethical and legal considerations, patient autonomy, and safety protocols

6. Leadership and Safety

• Delegation and prioritization principles
• Scope of practice for RN, LPN, and UAP
• Emergency response procedures and patient advocacy
• Quality improvement and evidence-based practice concepts

Every section in this NACE practice test strengthens your ability to apply knowledge to patient scenarios, rather than memorizing facts. Each question is written to reflect current nursing judgment and test-taking logic.

Why This Practice Test Is Useful

This resource helps you in multiple ways:

• Familiarizes you with real test format: All questions follow the same difficulty and style as the official exam.
• Improves accuracy under time pressure: Full-length tests simulate the real 200-question format to strengthen focus and pacing.
• Strengthens clinical reasoning: Each question emphasizes why a specific nursing intervention is correct.
• Reduces test anxiety: Practicing in exam conditions builds confidence and readiness.
• Saves study time: Topics are organized into sections matching NACE categories, allowing targeted review.

Using this NACE exam practice test daily for at least 2–3 weeks before your official exam will noticeably improve comprehension, recall, and response accuracy.

What Is the NACE Exam?

The Nursing Acceleration Challenge Exam (NACE) is a nationally recognized standardized test developed by the National League for Nursing (NLN) to help nursing schools assess how much prior knowledge a student has before entering an advanced or accelerated nursing program. It’s commonly used for Licensed Practical Nurses (LPNs), Licensed Vocational Nurses (LVNs), and paramedics who want to transition into a Registered Nurse (RN) program through advanced placement.

The NACE Foundations of Nursing Exam measures essential nursing knowledge, critical thinking, and clinical judgment required for safe and effective patient care. It focuses on the core competencies taught in the first year of nursing school, covering subjects such as medical-surgical care, maternity, pediatrics, pharmacology, and mental health nursing.

Most nursing bridge or accelerated programs require passing the NACE exam with a competitive score for admission or advanced standing. Candidates who perform well may receive credit for prior coursework, reducing the time and cost needed to complete their RN degree. Taking a NACE practice test is one of the most effective ways to prepare, as it familiarizes you with the real exam’s question style, difficulty level, and time pressure.

Study Tips to Pass NACE Exam

1. Start Early: Begin studying 4–6 weeks before your scheduled test date. Break topics into daily sections—such as pharmacology, maternity, and leadership—to avoid cramming.
2. Use Active Recall: Instead of just reading notes, test yourself with NACE exam practice questions to strengthen memory retention and identify weak areas.
3. Focus on Rationales: Review the reasoning behind each answer. Understanding why one answer is correct helps you apply logic to new scenarios.
4. Simulate Exam Conditions: Take at least one full timed NACE practice test each week. Sit quietly without notes, using a timer, to build endurance and time management.
5. Review Lab Values and Calculations: Know normal ranges for electrolytes, ABGs, and glucose, and practice dosage and IV flow rate calculations daily.
6. Prioritize Safety and Nursing Judgment: On the NACE exam, the safest action is often the correct one. Apply the “ABC” (Airway, Breathing, Circulation) principle when in doubt.
7. Balance Study and Rest: Nursing exams test focus as much as knowledge. Get adequate sleep, hydrate, and take short breaks during study sessions to maintain concentration.
8. Stay Updated: Nursing standards evolve. This PrepPool practice test reflects current 2025 guidelines, ensuring your preparation matches the latest evidence-based care standards.

The NACE Foundations of Nursing Exam isn’t just another test—it’s a gateway to advancing your nursing career. Whether you’re an LPN, LVN, or paramedic seeking advanced standing, passing the NACE opens the door to completing your RN degree faster and at lower cost.

This professionally curated NACE practice test equips you with realistic clinical questions, detailed explanations, and a structured study plan that aligns with today’s nursing expectations. By working through these practice sets, you’ll gain the confidence, critical-thinking ability, and test-taking strategy necessary to pass on your first attempt.

If you’re serious about nursing advancement, start your preparation now. Take the next step with the NACE exam practice test—your key to mastering the Foundations of Nursing and accelerating your journey toward becoming a Registered Nurse.

NACE Sample Questions and Answers

1) Airway priority — postoperative hypoxia
A postoperative client is drowsy, RR 8/min, O2 sat 86% on room air, shallow breaths. What is the priority action?
A. Increase IV fluids
B. Reposition to side-lying and apply oxygen
C. Administer PRN morphine
D. Call the provider immediately
Correct: B
Explanation: Airway and breathing come first (ABCs). Hypoventilation with low SpO₂ requires immediate support: reposition to improve ventilation and apply supplemental oxygen. Side-lying helps keep the tongue from occluding the airway in a drowsy patient and reduces aspiration risk. Increasing IV fluids (A) won’t treat hypoxia. Morphine (C) could worsen respiratory depression. You’ll notify the provider after initial stabilization, but delaying oxygen for a call (D) violates the priority to correct life-threatening hypoxia promptly.

2) Isolation precautions — C. difficile
Which PPE is essential when caring for a client with confirmed Clostridioides difficile?
A. Surgical mask and goggles only
B. Gloves and gown; alcohol sanitizer for exit
C. Gloves and gown; soap-and-water hand hygiene
D. N95 respirator and gloves
Correct: C
Explanation: C. difficile requires contact precautions: gloves and gown plus soap-and-water hand hygiene because spores are not reliably killed by alcohol rubs. Masks are not routine unless there is a risk of splashing. Option B is incorrect due to alcohol sanitizer reliance. N95 (D) is for airborne pathogens (e.g., TB). Correct environmental cleaning with sporicidal agents and minimizing unnecessary antibiotics also help prevent transmission.

3) Delegation — UAP scope
Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?
A. Teaching incentive spirometry
B. Assessing pain after analgesic
C. Obtaining a postoperative blood pressure and reporting readings
D. Evaluating IV site for phlebitis
Correct: C
Explanation: UAPs can perform standard, noninvasive, routine measurements (vitals, I&O) and report data; the RN interprets. Teaching (A) and evaluation (B, D) are nursing responsibilities requiring assessment and clinical judgment. Even if a UAP can “look” at an IV site, judging for phlebitis involves assessment. The RN should provide clear parameters (e.g., report SBP <90 or >160) and follow up with clinical interpretation and actions.

4) Medication safety — high-alert insulin
A client with type 1 diabetes has glucose 58 mg/dL and is alert. What is the best action?
A. Administer 10 units rapid-acting insulin
B. Give 4 oz fruit juice and recheck in 15 minutes
C. Start an insulin infusion
D. Notify provider; no interventions until seen
Correct: B
Explanation: This is symptomatic hypoglycemia; the “rule of 15” applies for an alert patient: provide 15 g fast carbohydrate (e.g., 4 oz juice), recheck in ~15 minutes, and repeat if still low. Giving insulin (A, C) would worsen hypoglycemia. Waiting (D) risks deterioration. After correction, provide a complex carbohydrate/protein snack if the next meal is far off, and evaluate insulin dosing, meal timing, and activity to prevent recurrence.

5) Dosage calc — pediatric amoxicillin
Order: Amoxicillin 40 mg/kg/day PO in two divided doses. Child weighs 18 kg. Available: 250 mg/5 mL. How many mL per dose?
A. 5 mL
B. 7 mL
C. 9 mL
D. 10 mL
Correct: B
Explanation: Total daily dose = 40 mg × 18 kg = 720 mg/day. Divided BID = 360 mg/dose. Concentration = 250 mg per 5 mL → 50 mg/mL. Needed volume = 360 ÷ 50 = 7.2 mL ≈ 7 mL (round to measurable mL based on device; many practices would administer 7.2 mL with an oral syringe). Teach caregivers to use a syringe, not kitchen spoons, shake suspensions, and complete the full course to reduce resistance and recurrence.

6) Fluid balance — heart failure
Which assessment best indicates loop diuretic therapy is effective in a client with CHF?
A. Increased thirst
B. Weight decrease of 1 kg in 24 hours
C. BP drop from 130/80 to 90/60
D. Serum potassium 5.6 mEq/L
Correct: B
Explanation: A 1 kg weight loss approximates 1 liter of fluid removed, reflecting diuresis and reduced fluid overload, a key therapeutic endpoint in CHF. Excessive BP drop (C) can signal overdiuresis. Hyperkalemia (D) is not expected with loop diuretics (they often cause hypokalemia). Increased thirst (A) is nonspecific. Monitor electrolytes, daily weights, edema, lung sounds, and kidney function; reinforce sodium restriction and medication adherence.

7) Oxygen therapy — COPD
Which oxygen delivery approach is safest to start for an acute COPD exacerbation with SpO₂ 86%?
A. Nonrebreather at 15 L/min indefinitely
B. Venturi mask titrated to 24–28%
C. Room air with incentive spirometry
D. High-flow nasal cannula 100% FiO₂
Correct: B
Explanation: A Venturi mask provides precise FiO₂ (24–28%), useful in COPD to correct hypoxemia while reducing CO₂ retention risk. Nonrebreather (A) or 100% FiO₂ (D) may be needed briefly for severe hypoxemia, but indiscriminate use can worsen hypercapnia. Room air (C) is inadequate. The nurse titrates to maintain SpO₂ typically 88–92% unless otherwise ordered, reassesses ABGs/CO₂, promotes bronchodilators, steroids, airway clearance, and addresses triggers.

8) Postpartum — fundal assessment
Four hours after vaginal delivery, the fundus is boggy and above the umbilicus with heavy lochia. First action?
A. Notify provider for uterotonics
B. Start IV fluids rapidly
C. Massage the fundus and assist to void
D. Apply perineal ice packs
Correct: C
Explanation: A boggy, high fundus suggests uterine atony and possible bladder distention. Immediate fundal massage stimulates contraction, and assisting to void lowers the uterus and reduces bleeding. If bleeding persists, then uterotonics (oxytocin, methylergonovine if not hypertensive) are indicated. Rapid IV fluids (B) treat hypovolemia but do not correct atony. Ice (D) aids perineal swelling but doesn’t address hemorrhage risk. Continually reassess lochia quantity and vital signs.

9) Therapeutic communication — anxiety
A client awaiting biopsy results says, “I’m sure it’s cancer; I can’t sleep.” Best response?
A. “You need to think positive.”
B. “Let’s talk about what you’re most worried about right now.”
C. “Try melatonin tonight.”
D. “You’re overreacting until we know.”
Correct: B
Explanation: Option B uses open-ended, empathetic communication to explore feelings, which reduces anxiety and builds rapport. Minimizing (A, D) blocks expression and can feel dismissive. Offering sleep aids (C) is premature before assessing coping, safety, and needs. The nurse can also teach brief relaxation strategies, involve support persons, and coordinate with providers for timely results, while monitoring for escalating anxiety, insomnia, or depressive symptoms.

10) Ethics — advance directives
A client with an advance directive declines artificial nutrition. Family insists on tube feeding. The nurse should:
A. Follow family wishes
B. Seek ethics consult and advocate for the client’s directive
C. Insert the tube to avoid conflict
D. Ignore the directive if verbal only
Correct: B
Explanation: Client autonomy guides care. When a valid advance directive exists, it should be honored. The nurse advocates for the client, clarifies the directive, involves the provider, and requests an ethics consult if conflict persists. Family cannot override a competent client’s stated wishes (or a valid directive). Documentation of capacity, the directive, and discussions is essential. Verbal directives can be valid; confirm per policy and state law, then act accordingly.

11) Wound care — pressure injury
A bed-bound client has a reddened sacrum that does not blanch. Best intervention?
A. Massage the area with lotion
B. Reposition at least every 2 hours and offload pressure
C. Apply cold compresses hourly
D. Leave open to air and increase protein
Correct: B
Explanation: Non-blanching erythema is Stage 1 pressure injury; prevention of further pressure is key: turning schedules, floating heels, pressure-redistributing surfaces, moisture control, and nutrition. Massaging (A) can damage fragile tissue. Cold (C) is not standard. Nutrition (D) supports healing but without pressure offloading, the lesion may worsen. Continually reassess skin, document size/appearance, address incontinence, and involve wound care specialists as needed.

12) Cardiac — chest pain protocol
A client with crushing chest pain gets sublingual nitroglycerin. Which finding warrants withholding a second dose?
A. Headache
B. BP 84/52 mmHg
C. Flushing
D. Mild dizziness on standing
Correct: B
Explanation: Nitroglycerin causes vasodilation and can precipitate hypotension. If systolic BP falls below ~90 mmHg or drops >30 mmHg from baseline, hold the next dose and notify the provider. Headache and flushing are common, expected effects. Dizziness can occur, but severe hypotension is the critical safety threshold. Review contraindications (PDE-5 inhibitor use), ensure the client is sitting/lying, reassess pain/ECG, and prepare for further ACS management per protocol.

13) Endocrine — sick-day diabetes
Which statement shows correct sick-day management for type 1 diabetes?
A. “I’ll skip insulin if I’m not eating.”
B. “I’ll check glucose and ketones every 3–4 hours.”
C. “I’ll drink only water until I feel better.”
D. “I’ll double my long-acting insulin.”
Correct: B
Explanation: Illness increases counterregulatory hormones, raising glucose and ketone risk. Clients should monitor glucose/ketones q3–4h, maintain hydration with carbohydrate-containing fluids if needed, and continue basal insulin (never stop long-acting). They may need supplemental rapid-acting insulin per sick-day plan. Skipping insulin (A) risks DKA. Only water (C) may cause hypoglycemia if not eating. Arbitrarily doubling basal (D) risks hypoglycemia; changes should follow a plan or provider guidance.

14) Renal — hyperkalemia management
A client with acute kidney injury has K⁺ 6.5 mEq/L with peaked T waves. Which medication combination is most urgent?
A. Loop diuretic and ACE inhibitor
B. Insulin with dextrose and calcium gluconate
C. Sodium polystyrene alone
D. Sodium bicarbonate only
Correct: B
Explanation: Hyperkalemia with ECG changes is life-threatening. IV calcium gluconate stabilizes cardiac membranes; insulin plus dextrose shifts K⁺ intracellularly, rapidly lowering serum levels. Kayexalate (C) removes K⁺ slowly and is not first-line for ECG changes. Bicarbonate (D) may help in acidosis but is adjunctive. After stabilization, address underlying causes, monitor rhythm and electrolytes, and consider dialysis if refractory or with severe renal failure.

15) Respiratory — pulmonary embolism signs
Which constellation most suggests pulmonary embolism?
A. Gradual dyspnea, productive cough, fever over a week
B. Sudden dyspnea, pleuritic chest pain, tachycardia, anxiety
C. Orthopnea, frothy sputum, bilateral crackles
D. Substernal crushing pain radiating to jaw
Correct: B
Explanation: PE typically presents with abrupt dyspnea, sharp pleuritic pain, tachycardia, tachypnea, and anxiety; hemoptysis may occur. Option A is more like pneumonia. C suggests pulmonary edema/heart failure. D is classic for myocardial ischemia. Risk factors include immobility, surgery, DVT, estrogen therapy, and cancer. Immediate actions: elevate head, O₂, notify provider, anticipate CT angiography, anticoagulation, and monitor for hemodynamic instability.

16) Pediatrics — dehydration assessment
An infant with diarrhea shows sunken fontanel, dry mucosa, ↓ tears, lethargy, capillary refill 4 sec. Priority intervention?
A. Offer plain water
B. Begin oral rehydration solution small frequent amounts
C. Give antidiarrheal loperamide
D. Start high-protein formula
Correct: B
Explanation: Signs indicate moderate dehydration; WHO-style oral rehydration solution (ORS) in small, frequent amounts is first-line when the child can drink and isn’t vomiting persistently. Plain water (A) lacks electrolytes and risks hyponatremia. Loperamide (C) is not recommended in young children due to adverse effects. Protein formula (D) isn’t initial therapy. Monitor intake/output, urine frequency, and escalate to IV fluids if ORS fails or signs of severe dehydration appear.

17) Maternity — magnesium sulfate toxicity
A preeclamptic client on magnesium sulfate has RR 10/min and absent DTRs. First action?
A. Increase infusion rate
B. Administer calcium gluconate and stop infusion
C. Call provider without intervention
D. Lower the head of bed
Correct: B
Explanation: These are classic magnesium toxicity signs (respiratory depression, loss of reflexes). Immediately stop magnesium and give the antidote calcium gluconate per protocol, maintain airway/oxygen, and notify the provider. Increasing the rate (A) is dangerous. Waiting without action (C) risks arrest. Position change (D) does not treat toxicity. Continuous monitoring, strict I&O, and therapeutic serum magnesium range (commonly 4–7 mEq/L) are essential.

18) Mental health — suicidal ideation
A client says, “There’s no point living anymore,” and describes a plan. Best initial action?
A. Explore childhood history
B. Implement one-to-one observation and remove harmful items
C. Offer a PRN anxiolytic and reassess later
D. Ask family to monitor at home
Correct: B
Explanation: A specific plan indicates high suicide risk. Immediate safety measures include constant observation, environmental safety (remove belts, sharps), and notifying the provider for further evaluation and possibly involuntary hold if required. Anxiolytics (C) may help anxiety but do not address imminent risk. Family monitoring (D) is inadequate for acute risk. After safety, complete a thorough risk assessment, involve mental health specialists, and initiate a collaborative safety plan.

19) Pharmacology — warfarin teaching
Which statement shows correct warfarin education?
A. “I’ll keep my vitamin K intake consistent each week.”
B. “I’ll double my dose if I miss one.”
C. “I don’t need INR checks if I feel fine.”
D. “I’ll take ibuprofen daily for aches.”
Correct: A
Explanation: Warfarin’s effect is antagonized by vitamin K; consistent intake (not avoidance) stabilizes INR. Missing doses should not be doubled; call the provider for guidance. INR monitoring is essential regardless of symptoms. NSAIDs like ibuprofen increase bleeding risk; acetaminophen is generally safer but still requires caution. Teach bleeding precautions, drug–herb interactions, and to report dark stools, bleeding gums, or severe headache immediately.

20) Evidence-based practice — levels of evidence
Which source provides the strongest evidence for a practice change?
A. Single case report
B. Expert opinion
C. Systematic review of randomized controlled trials
D. Descriptive cross-sectional study
Correct: C
Explanation: Hierarchies of evidence place systematic reviews/meta-analyses of RCTs at or near the top for questions of intervention efficacy because they synthesize multiple high-quality trials, increasing power and precision. Case reports and expert opinion are weaker due to bias and lack of control. Cross-sectional studies describe prevalence/associations but cannot infer causality well. Implementation still requires clinical judgment, patient values, and resource considerations.

21) Neuro — stroke assessment
A client suddenly has facial droop, slurred speech, and right arm weakness. First action?
A. Give aspirin and observe
B. Perform a focused stroke screen and note last-known-well time
C. Lower BP to normal quickly
D. Offer oral glucose
Correct: B
Explanation: Rapid stroke recognition (FAST), determining last-known-well, and activating the stroke protocol are critical to thrombolysis/thrombectomy eligibility. Aspirin (A) is contraindicated until hemorrhage is excluded by imaging. Aggressive BP lowering (C) can worsen cerebral perfusion pre-treatment. Glucose (D) is only for documented hypoglycemia; check glucose quickly as part of the protocol. Keep NPO, ensure IV access, obtain STAT CT, and monitor airway and neuro status.

22) GI — NG tube confirmation
Which is the most reliable method to confirm initial nasogastric tube placement?
A. Auscultate air over stomach
B. Ask if the client feels the tube in the throat
C. Test pH of aspirate only
D. Obtain an abdominal X-ray
Correct: D
Explanation: Initial placement confirmation requires radiographic verification to prevent pulmonary misplacement and aspiration. Air auscultation is unreliable; throat sensation is not diagnostic; pH testing is helpful for ongoing checks but cannot replace the first X-ray. After confirmation, secure the tube, document depth at nares, monitor for respiratory distress, and reassess placement if the client coughs persistently, oxygenation drops, or external length changes.

23) Oncology — neutropenic precautions
Which instruction is appropriate for a client with ANC 400/mm³?
A. “Fresh flowers are fine if you rinse them.”
B. “Avoid crowds and people with infections.”
C. “Rectal temperatures are acceptable.”
D. “Live vaccines are recommended now.”
Correct: B
Explanation: Severe neutropenia (ANC <500) requires infection prevention: avoid crowds/sick contacts, perform meticulous hand hygiene, avoid raw foods/unwashed produce, and use a soft toothbrush. Fresh flowers/potted plants can harbor microbes. Rectal temps or suppositories increase mucosal injury and infection risk. Live vaccines are contraindicated in significant immunosuppression. Teach to report fever ≥38°C (100.4°F) promptly; neutropenic fever is an oncologic emergency.

24) End-of-life — pain management
A hospice client requests more morphine due to pain 8/10, RR 14/min, awake and oriented. Best action?
A. Decline to avoid addiction
B. Increase dose per order parameters
C. Switch to NSAIDs only
D. Offer distraction instead of medication
Correct: B
Explanation: In palliative care, the priority is comfort. There is no ceiling effect for pure opioid agonists on analgesia; dosing is titrated to effect and side effects. With stable respirations and alertness, escalating within prescribed parameters is appropriate. Fear of addiction (A) is not a barrier in end-of-life care. NSAIDs (C) may be adjunctive but won’t replace opioids for severe pain. Nonpharmacologic methods (D) complement, not replace, adequate analgesia.

25) Musculoskeletal — cast care
A client with a new long-leg cast reports increasing pain, tingling, and pale toes. Priority?
A. Elevate and ice only
B. Assess pulses and notify provider immediately
C. Medicate with stronger opioids
D. Mark the edges of the cast
Correct: B
Explanation: Signs suggest compartment syndrome or neurovascular compromise. Immediate assessment of pulses, capillary refill, movement, and sensation is vital, followed by urgent provider notification for possible bivalving or fasciotomy. Elevation at heart level (not above) and avoiding tight icing may be advised, but definitive action cannot wait. Opioids (C) mask symptoms without correcting ischemia. Delays risk permanent nerve/muscle damage.

26) Electrolytes — hyponatremia
Which manifestation is most concerning in Na⁺ 118 mEq/L?
A. Muscle cramps
B. Nausea
C. Confusion and seizures
D. Thirst
Correct: C
Explanation: Severe hyponatremia can cause cerebral edema, leading to confusion, seizures, and coma—life-threatening findings requiring close monitoring and possibly hypertonic saline per protocol. Cramps and nausea are earlier, less severe signs. Correct sodium carefully to avoid osmotic demyelination; identify causes (SIADH, diuretics, fluid overload), restrict free water if indicated, and monitor serum/urine osmolality and neurologic status frequently.

27) Perioperative — informed consent
A client scheduled for surgery asks detailed risks that the nurse cannot answer. Best response?
A. “Sign now; the surgeon will explain later.”
B. “Let me call the surgeon to discuss risks with you before signing.”
C. “Risks are minimal, don’t worry.”
D. “I’ll explain everything even if I’m unsure.”
Correct: B
Explanation: The surgeon is responsible for explaining risks/benefits/alternatives and answering procedure-specific questions. The nurse verifies the client’s understanding, witnesses the signature, and advocates by contacting the surgeon when clarification is needed. Pressuring to sign (A) or minimizing concerns (C) violates informed consent principles. Providing incomplete/incorrect details (D) risks misinformation and legal issues. Ensure the client is competent and not sedated at consent time.

28) Pediatric immunization — contraindication
Which is a true contraindication for a live attenuated vaccine?
A. Mild afebrile cold symptoms
B. Current high-dose systemic corticosteroids
C. Localized eczema
D. Antibiotic therapy for otitis media
Correct: B
Explanation: Significant immunosuppression (e.g., high-dose steroids, chemotherapy, severe immunodeficiency, pregnancy for certain vaccines) is a contraindication to live vaccines like MMR or varicella. Mild illnesses (A), eczema (C), or routine antibiotics (D) are not contraindications. Nurses should screen carefully, provide Vaccine Information Statements, manage fainting risk in adolescents, and document lot/expiration/site. Post-vaccination observation helps detect immediate reactions.

29) Shock — sepsis early identifiers
Which finding most strongly indicates early sepsis rather than simple dehydration?
A. Dry mucous membranes only
B. Hypotension with narrow pulse pressure
C. Fever, tachycardia, tachypnea, and suspected infection source
D. Isolated elevated BUN/creatinine ratio
Correct: C
Explanation: Systemic inflammatory response with suspected infection—fever, tachycardia, tachypnea—meets sepsis criteria and requires rapid actions: cultures, broad-spectrum antibiotics, fluid resuscitation, lactate measurement, and frequent reassessment. Hypotension (B) suggests progression to septic shock but may be late. Dry mucosa (A) or prerenal azotemia (D) can occur in dehydration without infection. Early recognition reduces mortality; use sepsis bundles and monitor response to therapy.

30) Dosage calc — heparin infusion
Order: Heparin 18 units/kg/hr. Weight: 72 kg. Heparin bag: 25,000 units in 250 mL D5W. What is the mL/hr rate?
A. 10 mL/hr
B. 13 mL/hr
C. 18 mL/hr
D. 32 mL/hr
Correct: C
Explanation: Required dose = 18 × 72 = 1,296 units/hr. Solution concentration = 25,000 units / 250 mL = 100 units/mL. Rate = 1,296 ÷ 100 = 12.96 mL/hr, which rounds to 13 mL/hr if using standard rounding. However, many institutions round to the nearest whole mL/hr; some test banks key 18 mL/hr incorrectly when miscalculating weight or concentration. The accurate calculation is ~13 mL/hr; always follow facility rounding policy and use smart-pump safeguards with independent double-check.

Note: the correct choice should reflect ~13 mL/hr. If your testing standard rounds differently, select the closest permitted whole number and document your calculation. To keep answer alignment with the options given, B (13 mL/hr) is correct.