Nle Practice Exam Quiz

Q: How should I handle stems that say “initial” versus “best” or “most appropriate”?

Initial asks for the first safe step in sequence, often assessment unless an ABC or safety threat exists. Best/most appropriate asks for the highest-value action overall, which can be an intervention, escalation, or prevention step. Rewrite the question in your own words before reading options.

Q: I miss questions because of distractor wording. What practice helps the most?

Label each option as assess , intervene , delegate , escalate , or educate , then match it to the task word in the stem. If you want extra reps on option-elimination mechanics, use the Nursing Entrance Exam Practice Test With Answers, then return here for prioritization, delegation, infection control, and medication-safety decision stems.

18 Questions 12 min

This NLE (PNLE) practice quiz focuses on bedside clinical reasoning across fundamentals, med-surg, maternal-child, psychiatric, and community health nursing. You will work through prioritization, delegation, isolation precautions, and medication-safety decisions that mirror common exam stems and ward workflow. It fits graduating nursing students, nurse interns, and staff nurses who want faster, safer single-best-answer judgment.

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Part 1 — Questions

Answer each question on paper. Do not turn the page until you are ready to check your work.

You are doing rounds when four call lights come on at once. Which client should you assess first?

Client with chronic back pain requesting the next PRN analgesic
Client 2 hours post-thyroidectomy with new stridor
Client with BP 150/92 asking for morning antihypertensive medication
Client reporting nausea after taking oral antibiotics

A surgical mask is adequate protection when caring for a patient with suspected pulmonary tuberculosis.

True
False

Standard precautions are used for all patients, regardless of suspected or confirmed infection.

True
False

When giving an IM vaccine in the deltoid, you should aspirate for blood before injecting.

True
False

A client has a documented penicillin allergy (hives). A new order is written for amoxicillin. What is the most appropriate nursing action?

Document the allergy and give the first dose now
Give the dose with an antihistamine available
Hold the dose and call the prescriber
Administer the dose and monitor closely for rash

Which task is most appropriate to delegate to a UAP?

Assess a newly admitted client’s lung sounds
Obtain routine vital signs for a stable client
Titrate nasal cannula oxygen to keep SpO2 above 94%
Teach incentive spirometer use after surgery

In nursing priorities, assessment always comes before intervention.

True
False

A postpartum client has heavy lochia and a boggy uterus. What is your priority action?

Start a large-bore IV line
Notify the provider immediately
Massage the fundus firmly
Apply an ice pack to the perineum

After removing gloves, what is the best hand hygiene after caring for a client with C. difficile diarrhea?

Wipe hands with antiseptic towelettes
Alcohol-based hand rub
Put on a new pair of gloves and remove them again
Soap and water handwashing

10.

A client says, “I have a plan to kill myself tonight.” What is your priority action?

Leave briefly to notify the provider and security
Ask the client to sign a no-harm contract
Stay with the client and initiate safety precautions
Offer PRN medication for anxiety and reassess in 30 minutes

11.

The nurse should check the apical pulse for 1 full minute before administering digoxin.

True
False

12.

Amoxicillin suspension is available as 250 mg per 5 mL. The provider orders 500 mg PO. How many mL will you administer?

8 mL
5 mL
10 mL
12 mL

13.

A diabetic client is diaphoretic and shaky. Capillary glucose is 48 mg/dL, and the client is awake and can swallow. What is the best initial action?

Administer glucagon IM
Give 15 g of fast-acting oral carbohydrate
Start an IV infusion of D10W
Give sliding-scale regular insulin

14.

Droplet precautions require a negative-pressure room.

True
False

15.

A provider writes, “KCl 20 mEq IV push now” for a client with K 2.9 mEq/L. What should you do?

Administer IV push very slowly
Clarify the order and request IV infusion
Dilute in 10 mL and give over 5 minutes
Hold the dose and recheck potassium later

16.

A pregnant client at 34 weeks reports severe headache and “seeing spots,” and also has epigastric pain. What is the priority interpretation?

Possible severe preeclampsia requiring urgent evaluation
Likely gastroesophageal reflux disease only
Expected discomfort of late pregnancy
Normal signs of fetal engagement

17.

A client taking lithium reports vomiting and diarrhea and has a coarse hand tremor. What is the most appropriate nursing action?

Give the next lithium dose with food
Hold lithium and notify the provider
Encourage extra fluids and continue lithium
Give an antidiarrheal and recheck tomorrow

18.

Which task should be assigned to the RN rather than the LPN?

Administer scheduled oral medications to a stable client
Start the first unit of packed RBCs
Remove a peripheral IV catheter
Change a simple dry dressing

19.

A client has chest pain, and nitroglycerin SL is ordered. Vital signs are BP 86/50, HR 102. What is the most appropriate action?

Encourage deep breathing and reassess in 15 minutes
Administer nitroglycerin SL now
Hold nitroglycerin and notify the provider
Administer morphine first, then nitroglycerin

20.

A mother asks if her child can still receive scheduled vaccines today because the child has a mild runny nose but is playing normally. What is the best response?

Mild illness is usually not a contraindication, so vaccines can be given as scheduled
Vaccines should be avoided whenever a child is taking antibiotics
Postpone all vaccines until the child is completely symptom-free
Only live vaccines should be postponed for any respiratory symptoms

21.

A postpartum client continues to bleed heavily. The uterus is boggy despite firm fundal massage, and the bladder feels distended. What is the best next action?

Delay interventions and reassess pad count in 30 minutes
Assist the client to empty the bladder or catheterize
Stop the oxytocin infusion
Apply an ice pack to the perineum

22.

A client says, “The voices are telling me to jump out the window.” What is the most appropriate initial nursing action?

Stay with the client and assess the command content while ensuring safety
Redirect the client to attend group therapy
Tell the client the voices are not real and to ignore them
Leave the room to call the provider immediately

23.

You are the RN and must delegate. Which task is most appropriate to assign to the LPN?

Provide discharge teaching for new wound care
Initiate a blood transfusion
Give scheduled oral medications to a stable client
Initial assessment of a newly admitted client

24.

A child weighs 18 kg. Ceftriaxone is ordered at 75 mg/kg/day divided every 12 hours. The vial concentration after reconstitution is 100 mg/mL. How many mL will you administer per dose?

13.5 mL
1.4 mL
6.8 mL
3.4 mL

Part 2 — Answer key

Compare your answers after you have finished Part 1.

You are doing rounds when four call lights come on at once. Which client should you assess first?
Client 2 hours post-thyroidectomy with new stridor
A surgical mask is adequate protection when caring for a patient with suspected pulmonary tuberculosis.
False
Standard precautions are used for all patients, regardless of suspected or confirmed infection.
True
When giving an IM vaccine in the deltoid, you should aspirate for blood before injecting.
False
A client has a documented penicillin allergy (hives). A new order is written for amoxicillin. What is the most appropriate nursing action?
Hold the dose and call the prescriber
Which task is most appropriate to delegate to a UAP?
Obtain routine vital signs for a stable client
In nursing priorities, assessment always comes before intervention.
False
A postpartum client has heavy lochia and a boggy uterus. What is your priority action?
Massage the fundus firmly
After removing gloves, what is the best hand hygiene after caring for a client with C. difficile diarrhea?
Soap and water handwashing
A client says, “I have a plan to kill myself tonight.” What is your priority action?
Stay with the client and initiate safety precautions
The nurse should check the apical pulse for 1 full minute before administering digoxin.
True
Amoxicillin suspension is available as 250 mg per 5 mL. The provider orders 500 mg PO. How many mL will you administer?
10 mL
A diabetic client is diaphoretic and shaky. Capillary glucose is 48 mg/dL, and the client is awake and can swallow. What is the best initial action?
Give 15 g of fast-acting oral carbohydrate
Droplet precautions require a negative-pressure room.
False
A provider writes, “KCl 20 mEq IV push now” for a client with K 2.9 mEq/L. What should you do?
Clarify the order and request IV infusion
A pregnant client at 34 weeks reports severe headache and “seeing spots,” and also has epigastric pain. What is the priority interpretation?
Possible severe preeclampsia requiring urgent evaluation
A client taking lithium reports vomiting and diarrhea and has a coarse hand tremor. What is the most appropriate nursing action?
Hold lithium and notify the provider
Which task should be assigned to the RN rather than the LPN?
Start the first unit of packed RBCs
A client has chest pain, and nitroglycerin SL is ordered. Vital signs are BP 86/50, HR 102. What is the most appropriate action?
Hold nitroglycerin and notify the provider
A mother asks if her child can still receive scheduled vaccines today because the child has a mild runny nose but is playing normally. What is the best response?
Mild illness is usually not a contraindication, so vaccines can be given as scheduled
A postpartum client continues to bleed heavily. The uterus is boggy despite firm fundal massage, and the bladder feels distended. What is the best next action?
Assist the client to empty the bladder or catheterize
A client says, “The voices are telling me to jump out the window.” What is the most appropriate initial nursing action?
Stay with the client and assess the command content while ensuring safety
You are the RN and must delegate. Which task is most appropriate to assign to the LPN?
Give scheduled oral medications to a stable client
A child weighs 18 kg. Ceftriaxone is ordered at 75 mg/kg/day divided every 12 hours. The vial concentration after reconstitution is 100 mg/mL. How many mL will you administer per dose?
6.8 mL

1You are doing rounds when four call lights come on at once. Which client should you assess first?

2A surgical mask is adequate protection when caring for a patient with suspected pulmonary tuberculosis.

True / False

3Standard precautions are used for all patients, regardless of suspected or confirmed infection.

True / False

4When giving an IM vaccine in the deltoid, you should aspirate for blood before injecting.

True / False

5A client has a documented penicillin allergy (hives). A new order is written for amoxicillin. What is the most appropriate nursing action?

6Which task is most appropriate to delegate to a UAP?

7In nursing priorities, assessment always comes before intervention.

True / False

8A postpartum client has heavy lochia and a boggy uterus. What is your priority action?

9After removing gloves, what is the best hand hygiene after caring for a client with C. difficile diarrhea?

10A client says, “I have a plan to kill myself tonight.” What is your priority action?

11The nurse should check the apical pulse for 1 full minute before administering digoxin.

True / False

12Amoxicillin suspension is available as 250 mg per 5 mL. The provider orders 500 mg PO. How many mL will you administer?

13A diabetic client is diaphoretic and shaky. Capillary glucose is 48 mg/dL, and the client is awake and can swallow. What is the best initial action?

14Droplet precautions require a negative-pressure room.

True / False

15A provider writes, “KCl 20 mEq IV push now” for a client with K 2.9 mEq/L. What should you do?

16A pregnant client at 34 weeks reports severe headache and “seeing spots,” and also has epigastric pain. What is the priority interpretation?

17A client taking lithium reports vomiting and diarrhea and has a coarse hand tremor. What is the most appropriate nursing action?

18Which task should be assigned to the RN rather than the LPN?

19A client has chest pain, and nitroglycerin SL is ordered. Vital signs are BP 86/50, HR 102. What is the most appropriate action?

20A mother asks if her child can still receive scheduled vaccines today because the child has a mild runny nose but is playing normally. What is the best response?

21A postpartum client continues to bleed heavily. The uterus is boggy despite firm fundal massage, and the bladder feels distended. What is the best next action?

22A client says, “The voices are telling me to jump out the window.” What is the most appropriate initial nursing action?

23You are the RN and must delegate. Which task is most appropriate to assign to the LPN?

24A child weighs 18 kg. Ceftriaxone is ordered at 75 mg/kg/day divided every 12 hours. The vial concentration after reconstitution is 100 mg/mL. How many mL will you administer per dose?

High-Frequency NLE Misses: Stem Wording, Safety Order, and Scope Errors

1) Missing the task word in the stem

NLE items often turn on one word: initial, priority, best, most appropriate, or further teaching needed. Restate the ask in one line before reading options. Example: “Which action prevents immediate harm right now?”

2) Treating “assessment first” as absolute

Assessment comes first unless there is an airway, breathing, circulation threat or a clear safety emergency. If the patient is choking, actively seizing, or hemorrhaging, act to protect life and prevent injury before completing a full assessment.

3) Choosing the “ideal” intervention that ignores the setting

PNLE stems often include constraints like staffing, supplies, or isolation capacity. If an option requires unavailable resources, pick the safest feasible step: stabilize, call for help, escalate, then implement provider orders.

4) Delegating tasks that require nursing judgment

Common traps assign teaching, triage, interpretation, or evaluation to UAP. Keep assessment, planning, education, and evaluation with the RN. Delegate predictable, stable tasks with clear parameters.

5) Infection-control shortcuts

Mix-ups happen with droplet vs airborne and with PPE sequencing. Use the organism clue and transmission route. If two answers feel close, choose the one that prevents spread before comfort or convenience.

6) Medication math without a sanity check

After calculating, estimate if the dose “looks right.” Recheck unit conversions, concentration (mg/mL), and maximum safe dose logic, especially for pediatrics and high-alert meds. If the order is unsafe, hold and clarify per policy.

Printable PNLE/NLE Quick Sheet: Priority Rules, Delegation Lines, and Precaution Clues

Print/save as PDF: Use this page as a one-sheet reference during practice sessions, then annotate the rules you miss most often.

Rapid priority ordering (single-best-answer)

ABCs first: airway obstruction, stridor, severe dyspnea, SpO2 falling, cyanosis.
Circulation threats: active bleeding, shock signs, chest pain with instability, new neuro deficits.
Safety next: fall risk, aspiration risk, suicidal intent, violent behavior, medication error risk, infection spread.
Unstable beats stable: new onset, sudden change, abnormal vital signs outrank chronic controlled issues.
Time-sensitive meds and therapies: insulin for severe hyperglycemia per protocol, antibiotics for suspected sepsis once cultures are drawn, uterotonics for postpartum hemorrhage per order.

Delegation and assignment quick filter

RN keeps: initial assessment, triage, care plan, nursing diagnosis, teaching, evaluation, blood transfusion initiation, handling unstable patients.
LPN/LVN (if applicable in the item): focused data collection on stable patients, routine meds (facility dependent), reinforcement of teaching, wound care per plan.
UAP: vitals on stable patients, hygiene, feeding if no swallowing risk, ambulation with safety instructions, specimen collection if trained.

Isolation precautions: fast cues

Airborne: TB, measles, varicella. Use respirator and negative-pressure room if available.
Droplet: influenza, meningococcal disease, pertussis. Use surgical mask and eye protection if splash risk.
Contact: C. difficile, draining wounds, many MDROs. Gloves and gown, dedicate equipment.

PPE sequence (common exam point)

Don: gown, mask or respirator, goggles or face shield, gloves.
Doff: gloves, goggles or face shield, gown, mask or respirator.

Medication-safety mini-checklist

Verify the 10 rights expected by your school or facility, then reassess for allergies and contraindications.
High-alert examples: insulin, heparin, potassium concentrates, opioids. Use independent double-check if indicated.
For calculations, confirm units, route, concentration, and a plausibility estimate before documenting.

Worked NLE-Style Scenarios: Prioritization + Delegation With Rationale

Scenario 1: Who do you see first?

Stem: You are the RN receiving four patients at start of shift. Who is the priority to assess?

Patient A: Post-op day 1, SpO2 88% on room air, RR 30, using accessory muscles.
Patient B: Type 2 DM, capillary glucose 240 mg/dL, requesting snacks.
Patient C: Postpartum 6 hours, lochia moderate, fundus firm, reports perineal pain 7/10.
Patient D: Schizophrenia, calm, asking for scheduled antipsychotic.

Step-by-step reasoning:

Identify the task word: priority to assess.
Scan for ABC threats. Patient A has hypoxemia and respiratory distress.
Rule out distractors. Hyperglycemia at 240 is not immediately life-threatening without symptoms. Postpartum pain with a firm fundus suggests stability. Scheduled psych meds matter, but not before breathing compromise.
Best answer: Patient A first. Immediate nursing actions include positioning, applying oxygen per protocol, rapid focused respiratory assessment, and calling for help or escalating as needed.

Scenario 2: What can you delegate?

Stem: You must delegate tasks for stable patients. Which task is best for UAP?

Teach incentive spirometry after abdominal surgery.
Measure and record intake and output for a stable patient on diuretics.
Assess a new-onset rash after starting an antibiotic.
Evaluate pain relief 30 minutes after IV opioid administration.

Elimination: Teaching, assessment, and evaluation stay with the RN. Intake and output measurement is predictable and task-based.

Best answer: UAP measures and records intake and output, then reports abnormalities to the RN.

PNLE/NLE Practice FAQ: Stems, Priorities, and Exam-Style Reasoning

How should I handle stems that say “initial” versus “best” or “most appropriate”?

Initial asks for the first safe step in sequence, often assessment unless an ABC or safety threat exists. Best/most appropriate asks for the highest-value action overall, which can be an intervention, escalation, or prevention step. Rewrite the question in your own words before reading options.

What priority framework matches NLE-style items most often?

Use a fast stack: ABC threats, then circulation threats like active bleeding or shock, then immediate safety risks like aspiration, falls, self-harm, medication error, or infection spread. If two patients are both stable, prioritize new onset and abnormal vitals over chronic controlled problems.

What are common delegation traps on PNLE questions?

Options often hide nursing judgment inside a task. Teaching, triage, interpretation of data, and evaluation of response belong to the RN. UAP tasks stay predictable, stable, and procedure-based, with clear reporting parameters. If the patient is unstable or the outcome is uncertain, keep it with the RN.

How can I decide between droplet and airborne precautions quickly?

Airborne is for organisms that remain suspended, such as TB, measles, and varicella. Droplet is for larger respiratory particles, such as influenza, pertussis, and meningococcal disease. If the stem mentions negative-pressure rooms or respirators, it is pointing to airborne.

I miss questions because of distractor wording. What practice helps the most?

Label each option as assess, intervene, delegate, escalate, or educate, then match it to the task word in the stem. If you want extra reps on option-elimination mechanics, use the Nursing Entrance Exam Practice Test With Answers, then return here for prioritization, delegation, infection control, and medication-safety decision stems.

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