WorksheetsAdvanced NCLEX-Style Set (Quizizz Format)
Total questions: 100
Worksheet time: 55mins
A patient with HIV has a CD4 count of 180/μL and reports a white coating in the mouth with painful swallowing. Which action is PRIORITY?
Administer nystatin oral suspension
Increase oral fluids
Notify infection control
Encourage vitamin supplements
A patient develops hypotension, wheezing, and hives 10 minutes after starting IV antibiotics. Which intervention should the nurse perform FIRST?
Stop the infusion
Administer diphenhydramine
Call the provider
Apply oxygen
A patient with COPD is on 4 L/min nasal cannula oxygen. The nurse notes RR 8, O2 sat 95%, patient drowsy. Which is the most appropriate action?
Increase oxygen to 6 L/min
Decrease oxygen to 2 L/min
Encourage pursed-lip breathing
Prepare for intubation
A client with active TB asks, “When will I no longer be contagious?” Best response:
A patient receiving prednisone for lupus reports fever and productive cough. Which nursing action is most appropriate?
Administer albuterol inhaler
Notify the provider immediately
Encourage increased activity
Withhold fluids
A nurse receives report: COPD patient, pneumonia, O₂ sat 85% on 2 L NC, crackles, temp 101.8°F. Which order should the nurse implement FIRST?
Obtain sputum culture
Administer acetaminophen
Ambulate the patient
Start incentive spirometry
A nurse teaches a patient prescribed rifampin for TB. Which statement indicates correct understanding?
I should stop the medication if my urine turns orange.
I will use a barrier method of birth control.
I can drink alcohol occasionally.
I only need to take the drug for 2 weeks.
The nurse is caring for four patients. Which patient should be seen FIRST?
Asthma patient with wheezing after albuterol
COPD patient with SpO₂ 89% on 2 L NC
Pneumonia patient with pleuritic chest pain
Anaphylaxis patient with stridor after epinephrine
A nurse cares for a patient with suspected Guillain-Barré syndrome. Which finding is most concerning?
Ascending weakness
Decreased deep tendon reflexes
Which finding indicates latent TB rather than active TB?
Weight loss, fever, night sweats
Positive Mantoux test, negative sputum
Hemoptysis and productive cough
CXR showing cavitation
A patient with myasthenia gravis reports increasing difficulty swallowing. Which nursing action is PRIORITY?
Provide small frequent meals
Offer liquids with meals
Encourage ambulation
Withhold medications
A nurse is preparing discharge teaching for a lupus patient prescribed hydroxychloroquine. Which statement by the patient requires further teaching?
I should schedule regular eye exams.
I can stop taking this medication if I feel better.
This drug may take months to work.
I should take the drug with food.
Which patient is at highest risk for hypoxemia?
23-year-old with mild asthma
58-year-old with COPD and pneumonia
40-year-old with hypertension
76-year-old with controlled diabetes
A nurse receives morning report. Which patient should be assessed FIRST?
Asthma patient with SpO2: 90% after albuterol
TB patient with fever and night sweats
COPD patient with clubbing and pursed-lip breathing
Pneumothorax patient with tracheal deviation
A patient with pneumonia is ordered antibiotics, oxygen, and fluids. Which should be done FIRST?
Start IV antibiotics
Administer oxygen
Encourage ambulation
Obtain sputum culture
The nurse is teaching a patient about ART therapy for HIV. Which patient statement indicates a need for further teaching?
If I miss a dose, I’ll take it as soon as I remember.
I can skip doses if my viral load is low.
I must take these drugs every day.
Missing doses could lead to resistance.
A nurse is assessing a patient with asthma. Which finding indicates impending respiratory failure?
Audible wheezing
Silent chest
Cough with sputum
Tachypnea
A nurse is caring for a lupus patient receiving IVIG. Ten minutes into infusion, the patient develops dizziness and abdominal cramps. Which medication should the nurse anticipate giving?
Diphenhydramine
Epinephrine
Prednisone
Albuterol
A nurse cares for a patient with COPD. Which nursing intervention BEST promotes effective gas exchange?
Provide small frequent high-calorie meals
Encourage fluid restriction
Teach patient to avoid pursed-lip breathing
Position patient supine
Case: A 70-year-old COPD patient admitted with pneumonia. Vitals: RR 32, O₂ sat 84% on 2 L, HR 118, BP 98/64. Which order should the nurse question?
Titrate O₂ to 4 L NC
Start IV fluids
Encourage ambulation
Obtain ABG
A patient with Guillain-Barré syndrome is receiving IVIG. Which finding requires IMMEDIATE intervention?
Muscle weakness
Dyspnea and low SpO₂
Fatigue
Paresthesias
A patient with TB asks about precautions at home. Which teaching is correct?
Use separate dishes and utensils.
Cover your mouth when coughing.
Avoid touching children.
Wear gloves when cooking.
A nurse is caring for a patient with asthma. Which diagnostic test best evaluates reversibility of airway obstruction?
Chest X-ray
Spirometry before and after bronchodilator
ABG
Sputum culture
A patient presents with sharp pleuritic chest pain, dyspnea, and absent breath sounds on the right. Which is PRIORITY?
Apply oxygen
Obtain sputum culture
Start incentive spirometry
Give antibiotics
A patient with pneumonia has ABGs: pH 7.31, PaCO₂: 49, HCO₃: 24. Which interpretation is correct?
Respiratory acidosis (based on the ABG values)
Metabolic alkalosis (based on the ABG values)
Respiratory alkalosis (based on the ABG values)
Metabolic acidosis (based on the ABG values)
A patient with lupus is prescribed prednisone. Which findings require IMMEDIATE follow-up?
Temperature 101.5°F
Weight gain 4 lbs in 2 weeks
Blood glucose 250 mg/dL
Report of blurred vision
Mild ankle edema
A patient with HIV is prescribed Biktarvy (bictegravir/emtricitabine/tenofovir). Which teaching is PRIORITY?
Avoid herbal supplements without approval.
Stop the drug if you feel tired.
You can miss a dose once in a while.
Take with grapefruit juice daily.
The nurse prepares to give vancomycin IV. Which finding requires holding the dose?
WBC 12,000/μL
Creatinine 2.1 mg/dL
Temp 101.3°F
Platelets 250,000/μL
A patient receiving isoniazid (INH) for TB should be taught to report:
Fatigue and loss of appetite
Constipation
Runny nose
Insomnia
Which patient statement shows understanding of epinephrine auto-injector use?
I’ll inject it into my arm.
I’ll inject into the thigh muscle.
I can reuse it if I don’t push all the way.
I’ll take an oral pill instead if available.
A 38-year-old with lupus on prednisone reports facial swelling, acne, and weight gain. Which condition is most likely?
Addison’s disease
Cushingoid side effects
Myasthenia gravis
Opportunistic infection
Case continuation: Which nursing intervention is MOST appropriate?
Stop the drug
Reassure patient this is expected with long-term steroids
Reduce the dose independently
Encourage high-sodium diet
Which assessment finding indicates epinephrine was effective in anaphylaxis?
O2 sat increases to 95%
HR decreases to 40 bpm
Patient becomes drowsy
Wheezing increases
Which staff member should NOT be delegated to suction a tracheostomy?
Respiratory therapist
RN
LPN
UAP
Which is a PRIORITY nursing intervention for Guillain-Barré?
Provide passive ROM
Assess respiratory effort frequently
Give pain meds
Encourage ambulation
Which teaching is most important for a patient with MG?
Take meds at bedtime
Schedule rest periods to conserve energy
Avoid all exercise
Double dose if missed
A patient with MG is at highest risk for which complication?
Seizures
Aspiration
DVT
Hypertension
A patient with pneumonia reports pleuritic chest pain and fever. Which intervention should the nurse implement FIRST?
Administer antibiotics
Give oxygen
Start IV fluids
Obtain sputum culture
Which finding suggests impaired diffusion?
Crackles in lung bases
Low PaO₂ despite normal ventilation
Tracheal deviation
Wheezing
Which ABG result indicates metabolic acidosis?
pH 7.28, HCO₃ 18
pH 7.46, PaCO₂ 30
pH 7.50, HCO₃ 33
pH 7.32, PaCO₂ 50
Which is the earliest indicator of worsening hypoxemia?
Cyanosis
Restlessness
Bradycardia
Decreased LOC
A 74-year-old with COPD admitted for pneumonia. ABG: pH 7.30, PaCO2: 60, HCO3 26. Interpretation?
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Normal
Case continuation: Which order should the nurse question?
Albuterol nebulizer PRN
Oxygen 5 L NC continuous
Incentive spirometer use
Broad-spectrum antibiotics
Which finding indicates impending respiratory failure in asthma?
Wheezing with cough
Silent chest
Tachypnea
Sputum production
A child with asthma has PEF 45% of baseline. Which zone of the Asthma Action Plan is this?
Green
Yellow
Red
Normal
Which statement shows correct inhaler technique teaching?
I will exhale after using the inhaler.
I will hold my breath for 10 seconds after inhaling.
I don’t need to rinse my mouth after steroids.
I can use my LABA for sudden shortness of breath.
Which precaution is required for active TB?
Droplet
Airborne
Contact
Reverse isolation
A patient with TB is prescribed isoniazid. Which vitamin supplement prevents peripheral neuropathy?
Vitamin D
Pyridoxine (B6)
Vitamin C
Folic acid
Which finding is most concerning in tension pneumothorax?
Absent breath sounds on one side
Tracheal deviation with hypotension
Chest pain on inspiration
Coarse crackles
Which intervention is PRIORITY after thoracentesis?
Encourage ambulation
Monitor for pneumothorax
Give antibiotics
Start incentive spirometry
Case: A 25-year-old develops itching, dizziness, and difficulty breathing after a bee sting. Which action is PRIORITY?
Apply oxygen
Start IV fluids
Give diphenhydramine
Notify provider
Case continuation: The patient receives epinephrine IM. Which finding BEST shows improvement?
BP 82/50
SpO2: rises from 85% to 96%
HR drops to 40
Patient becomes lethargic
The nurse is caring for four patients. Which should be assessed FIRST?
COPD with O2 sat 90% on 2 L NC
Asthma with wheezing and accessory muscle use
Pneumonia with fever 101°F
TB patient requesting pain meds
Which task can the RN delegate to a UAP?
Suctioning tracheostomy
Educating COPD patient
Obtaining vital signs
Titrating oxygen
The nurse cares for four patients. Which order is MOST urgent?
Obtain ABG for COPD patient with confusion
Administer acetaminophen for fever
Teach asthma inhaler technique
Collect sputum for culture
Which symptoms are expected in active TB? (SATA)
Hemoptysis
Night sweats
Weight gain
Fatigue
Sudden stridor
Which are common side effects of corticosteroids?
Hyperglycemia
Osteoporosis
Immunosuppression
Hypotension
Cushingoid appearance
Which findings indicate anaphylaxis? (SATA)
Hypotension
Wheezing
Urticaria
Bradycardia
Anxiety
Case: A 62-year-old with COPD reports weight loss, fatigue, and clubbing. Which intervention is MOST important?
Offer high-calorie meals
Encourage fluid restriction
Encourage lying flat
Discontinue O₂ therapy
A 45-year-old with pneumonia has WBC 16,000, fever 102°F, SpO₂ 87%. Which order should the nurse implement FIRST?
Administer antibiotics
Apply oxygen
Case: A lupus patient on prednisone develops 3+ pitting edema, hematuria, and creatinine 2.0 mg/dL. Which complication is most likely?
Cushing’s syndrome
Lupus nephritis
TB
Anemia
A 71-year-old with COPD on home O₂ arrives confused and very drowsy. Vitals: RR 8, SpO₂ 95% on 6 L NC, ABG: pH 7.25, PaCO₂ 72, HCO₃ 28. Priority action?
Increase O₂ to 8 L
Decrease O₂ and stimulate breathing
Give IV bicarbonate
Place patient flat in bed
Which assessment best differentiates pleural effusion from pneumonia?
Fever
Dullness to percussion with ↓ breath sounds over fluid
Productive cough with crackles
Egophony (“E → A”)
64. A patient started on isoniazid reports dark urine and right upper quadrant pain. What is the first action?
Discontinue isoniazid immediately
Increase the dose of isoniazid
Reassure the patient and continue therapy
Start corticosteroids
Which medication is FIRST-line controller therapy to reduce airway inflammation in persistent asthma?
SABA
LAMA
ICS
Theophyllline
Case: A 56-year-old on high-dose prednisone for SLE is being discharged. Which instruction is MOST important?
Avoid crowds and sick contacts.
Stop the drug if you feel better.
Double doses on stressful days.
Limit calcium intake.
For a COPD patient with cachexia and early satiety, which nursing plan is BEST?
3 large meals/day, low fat
Small, frequent, high-calorie/protein meals
Fluid restriction to 1 L/day
Fasting before bedtime
Which patient requires airborne isolation?
Suspected TB
Influenza
MRSA wound
RSV
A nurse precepts a new grad caring for a patient with anaphylaxis. Which statement needs correction?
I’ll inject epinephrine IM into the thigh.
I’ll place the patient supine with legs elevated.
The nurse evaluates teaching for a patient using an ICS inhaler. Which action indicates correct technique?
Exhales immediately after inhalation
Rinses mouth after each use
Uses ICS only for rescue
Shares inhaler spacer with family
71. Case: A 43-year-old with asthma: PEF 48% of personal best, speaking in words, RR 34, SpO2 88% on room air. First action?
Teach pursed-lip breathing
Administer SABA via nebulizer
Obtain sputum culture
Start incentive spirometry
In which situation is a sputum culture MOST essential before first antibiotic dose?
Community viral bronchitis
Suspected bacterial pneumonia
Mild COPD exacerbation
Allergic rhinitis
Which finding after thoracentesis requires immediate provider notification?
Mild soreness at the site
New unilateral absent breath sounds
Small serosanguinous drainage
Temporary cough
A patient with HIV asks why multiple ART drugs are necessary. Best response:
To reduce cost and pill number.
To prevent resistance and suppress replication.
To boost your antibody production.
To cure HIV faster.
Which are clinical manifestations of pneumonia?
Pleuritic chest pain
Egophony (“E → A”)
Hyperresonance to percussion
↑ tactile fremitus
Tracheal deviation
Case (delegation): Which task is appropriate for the UAP caring for a stable COPD patient?
Educate on pursed-lip breathing
Adjust O₂ from 2 L to 4 L
Obtain post-ambulation pulse oximetry
Teach use of incentive spirometer
A newly admitted patient with suspected TB needs which initial action?
Start empiric antibiotics
Place in negative-pressure room
Start droplet precautions
Begin INH immediately without testing
Case: A 50-year-old with PJP presents with RR 30, SpO₂ 84% on room air. ABG: pH 7.33, PaCO₂ 37, PaO₂ 52, HCO₃ 21. Which interpretation?
Hypoxemic respiratory failure
Hypercapnic respiratory failure
Metabolic alkalosis
Normal ventilation and oxygenation
Teach a patient on rifampin to:
Expect orange body fluids
Use nonhormonal contraception
Avoid alcohol
Stop drug if urine changes color
Report easy bruising
Which breathing strategy improves ventilation in COPD with air trapping?
A patient with MG is scheduled for meals. What is the BEST timing for anticholinesterase meds?
At bedtime
Immediately after meals
30–60 minutes before meals
Every 4 hours PRN
Case: Post-thoracentesis, the patient suddenly becomes tachycardic and hypotensive with tracheal deviation. Priority intervention?
Apply non-rebreather
Notify provider and prepare for needle decompression
Start incentive spirometry
Place patient prone
Which COPD patient finding requires urgent assessment?
Clubbing
New onset confusion
Chronic cough
Barrel chest
Which are secondary prevention strategies for TB?
Routine chest X-ray for everyone
Mantoux testing for high-risk groups
IGRA testing for healthcare workers
BCG vaccination
Sputum culture for symptomatic patients
Case: Elderly resident with dull chest pain, dyspnea, ↓ breath sounds at bases, ultrasound shows effusion. Best initial management?
High-dose steroids
Treat underlying cause and consider therapeutic thoracentesis
Which lab most directly reflects oxygen-carrying capacity?
Hematocrit
Hemoglobin
WBC
Platelets
A patient with suspected PE likely exhibits which V/Q pattern?
Low V/Q
High V/Q
Normal
Shunt equals dead space
Case: A 29-year-old with severe asthma attack; after repeated SABA, wheeze decreases and breath sounds become very quiet; patient fatigued. Next action?
Reassure improvement
Prepare for possible intubation
Start incentive spirometry
Obtain sputum
Long-term prednisone teaching should include:
Do not stop abruptly
Monitor glucose
Increase infection precautions
Restrict calcium
Expect weight loss
Which assessment is MOST specific for lung consolidation?
Hypoxia
Egophony
Wheezing
Hyperresonance
Case: HIV patient on ART misses doses frequently. Viral load is rising; CD4 dropping. Nursing priority?
Switch to herbal therapy
Assess barriers and reinforce adherence strategies
Stop ART for a month
Double doses when remembered
Which vaccination is primary prevention for impaired gas exchange in older adults?
Tdap
Pneumococcal
BCG
MMR
A patient on vancomycin IV develops flushing of neck/face and pruritus during infusion. BP stable, airway patent. First action?
Stop drug permanently
Slow infusion rate and give antihistamine
Give epinephrine IM
Switch to oral vancomycin
SATA: Which findings suggest tension pneumothorax?
Hypotension
Distended neck veins
Tracheal deviation
Bilateral crackles
Bradycardia
Which test confirms reversible airway obstruction?
Peak flow alone
Spirometry improvement after bronchodilator
ABG
CXR
77-year-old with suspected pneumonia. Which diagnostic should be obtained first?
(a)
Which statement by a patient on oseltamivir indicates correct understanding?
This will kill the flu virus instantly.
It works best if started within 48 hours of symptoms.
I can stop once the fever ends.
It prevents all complications.
Delegation: Which task can the RN safely assign to an experienced LPN?
Initial teaching about TB medications
Titration of oxygen for unstable COPD
Administer scheduled nebulized bronchodilator to stable patient
Admission assessment for acute asthma
Case (prioritization): Four patients call out simultaneously. Who is seen FIRST?
COPD patient requesting pain meds
Asthma patient with new onset stridor
TB patient asking for water
Pneumonia patient with temp 100.8°F
Core nursing outcomes for COPD discharge teaching include:
Demonstrates pursed-lip breathing
Maintains SpO₂ 88–92% at rest
Avoids vaccinations
Identifies early signs of exacerbation
Eats two large meals/day
