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NCLEX-RN category

NCLEX Reduction of Risk Potential Practice Questions

Quick answer

Reduction of Risk Potential makes up 9 to 15% of the NCLEX-RN, roughly 8 to 22 questions. It tests whether you can spot a client who is about to develop a complication and act before it happens, which is a different skill from treating the complication once it is there.

  • 10 practice questions
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Most of the questions in this category describe a client who looks fine on the surface and then hand you one finding that should make you stop. A capillary refill that slowed down under a cast. A pulse pressure that keeps getting wider. A pH of 7 on the aspirate from a tube that should be sitting in the stomach. The trap students fall into is answering based on what the client has, instead of what the client could get. If you read "two days post hip repair" and jump straight to pain control, you have skipped the part of the question that is about preventing a clot. The ten questions below are drawn from across the category and stay away from lab values, diagnostic tests and postoperative care, since those each have their own page.

Practice questions

1

A nurse answers a call light and finds a 79 year old client on the floor beside the bed. The client is alert and says they slipped while getting up to the bathroom. The right leg appears shorter than the left and the foot is turned outward, and the client reports groin pain. Which action should the nurse take first?

  1. AHelp the client back into bed with a two person assist
  2. BKeep the client still on the floor, support the leg in the position found, and call for the provider and an x-ray
  3. CHave the client try to stand to see if the leg bears weight
  4. DApply ice to the hip and reassess in 20 minutes
Show answer

Answer: B

A shortened, externally rotated leg with groin pain after a fall is the classic picture of a hip fracture. Moving the client before the hip is stabilized can displace the fracture, damage vessels and nerves, and turn a simple fracture into a much worse one.

Why the others are wrong

Lifting the client into bed moves the hip before anyone knows what is broken. Weight bearing on a possible fracture risks displacement and a second fall. Ice and a 20 minute wait delay the imaging and the pain control that the client needs now.

2

A client admitted after a motorcycle crash with a closed head injury has had the following blood pressures over four hours: 118/76, 126/74, 138/70, 150/62 mm Hg. Heart rate has gone from 88 to 58. Which interpretation should guide the nurse's next action?

  1. AThe client is becoming hypovolemic and needs a fluid bolus
  2. BThe widening pulse pressure and falling heart rate suggest rising intracranial pressure and the provider must be notified now
  3. CThe readings show normal variation and routine monitoring can continue
  4. DThe client is in pain and should receive the ordered opioid
Show answer

Answer: B

Pulse pressure (systolic minus diastolic) has gone from 42 to 88 while the heart rate dropped. A widening pulse pressure with bradycardia is two parts of Cushing's triad, a late sign of rising intracranial pressure, and it needs the provider at once.

Why the others are wrong

Hypovolemia narrows the pulse pressure and raises the heart rate, the opposite of this pattern. Calling this normal variation misses a trend that is heading in one direction. Pain usually raises both heart rate and blood pressure, and sedating a head injured client without ruling out ICP changes would mask the assessment.

3

A client with a fresh fiberglass cast on the right forearm reports pain rated 9 out of 10 that has not eased 30 minutes after an IV opioid. The fingers are pale and the client says they feel tight and tingly. Which action should the nurse take first?

  1. AElevate the arm above the heart and apply ice
  2. BReposition the arm and reassess in 15 minutes
  3. CNotify the provider immediately so the cast can be bivalved
  4. DGive a second dose of the opioid
Show answer

Answer: C

Pain out of proportion to the injury that does not respond to opioids, with pallor and paresthesia, is compartment syndrome until proven otherwise. The pressure has to be released, which means cutting the cast, and that is a provider decision that cannot wait.

Why the others are wrong

Elevating above the heart in compartment syndrome reduces arterial inflow to a limb that already has poor perfusion, and ice makes it worse. Repositioning and waiting 15 minutes wastes time while muscle dies. More opioid will not relieve this pain and will delay the real treatment.

4

A client with type 2 diabetes who takes glipizide every morning is scheduled for a colonoscopy at 10 AM and has been NPO since midnight. The nurse reviews the morning plan with the client. Which statement by the client shows that the teaching was understood?

  1. A"I will take my glipizide with a sip of water at 6 AM like I always do"
  2. B"I will skip my glipizide this morning and tell the nurse right away if I feel shaky, sweaty or confused"
  3. C"I will take half my glipizide and eat a few crackers to balance it out"
  4. D"I do not need my sugar checked today because I am not eating"
Show answer

Answer: B

A sulfonylurea like glipizide stimulates insulin release whether or not the client eats, so taking it while NPO can drive the glucose dangerously low. Holding the dose and knowing the early signs of hypoglycemia is exactly what the nurse wants the client to understand.

Why the others are wrong

Taking the full dose on an empty stomach is the setup for a hypoglycemic episode during sedation, when the client cannot report symptoms. Eating crackers breaks the NPO order and may get the procedure cancelled. Being NPO raises the need for glucose checks, it does not remove it.

5

A client is in skeletal traction with 15 pounds of weight for a femur fracture. Which finding should the nurse report to the provider?

  1. AThe weights hang freely and do not touch the floor
  2. BThe client's heel is slightly off the mattress
  3. CThe ropes are in the center of the pulleys
  4. DThere is a small amount of yellow-green drainage with a foul odor at one pin site
Show answer

Answer: D

Purulent, foul smelling drainage at a pin site is a sign of pin tract infection, which can spread to the bone. It needs to be reported and cultured early.

Why the others are wrong

Freely hanging weights, centered ropes and the heel off the mattress are all correct traction setup. The heel being off the bed prevents pressure injury and is a good finding, not a problem.

6

A client had a closed reduction of a tibial fracture two hours ago and now has a splint and elastic bandage in place. The nurse performs a neurovascular check. Which finding requires immediate action?

  1. ACapillary refill of 2 seconds in the toes
  2. BThe client can wiggle the toes on request
  3. CThe client reports they cannot feel the nurse touching the space between the first and second toes
  4. DThe foot is slightly cooler than the opposite foot but pink
Show answer

Answer: C

Loss of sensation in the web space between the first and second toes points to pressure on the deep peroneal nerve. A new sensory deficit after a reduction means the bandage or splint is too tight and needs to be loosened and the provider told.

Why the others are wrong

Capillary refill under 3 seconds and the ability to move the toes are normal findings. A foot that is a little cooler but pink with a normal refill is often just the effect of the wrap and should be rechecked, not escalated ahead of a nerve finding.

7

A client is scheduled for a bedside bronchoscopy with moderate sedation. The client has a history of a stroke with mild residual dysphagia. Which nursing action lowers this client's risk of aspiration the most?

  1. AConfirm the client has been NPO for at least 6 to 8 hours and position with the head of the bed raised
  2. BGive the client a few sips of water right before the procedure to moisten the throat
  3. CKeep the client flat so the scope passes more easily
  4. DEncourage the client to eat a light breakfast so they are not weak during the procedure
Show answer

Answer: A

An empty stomach and a raised head of bed are the two things the nurse controls that most reduce aspiration during sedation. A client with existing dysphagia has even less protection of the airway once sedated.

Why the others are wrong

Any oral intake before sedation adds to the stomach contents that can come up. Lying flat makes aspiration more likely, not less. A meal before a sedated airway procedure is the opposite of what is needed.

8

An 82 year old client has been on bed rest for five days after a pelvic fracture. The nurse is planning monitoring for this shift. Which assessment finding would be the earliest sign of a complication of immobility that needs to be acted on?

  1. AThe client has not had a bowel movement in 24 hours
  2. BOne calf is 3 cm larger than the other and feels warm
  3. CThe client's appetite is less than it was at home
  4. DThe client asks for help turning in bed
Show answer

Answer: B

A unilateral increase in calf size with warmth is the classic early sign of a deep vein thrombosis, the most dangerous common complication of bed rest in an older adult. It needs to be reported before the clot moves to the lungs.

Why the others are wrong

One day without a bowel movement is not yet constipation and is managed with fluids, fiber and activity. A reduced appetite is worth watching but is not acute. Asking for help turning is expected and actually protects the skin.

9

A client has a nasogastric tube connected to low intermittent suction after a bowel obstruction. Before giving a medication through the tube, the nurse checks the aspirate and the pH reads 7. Which action should the nurse take?

  1. AGive the medication, since the tube was placed yesterday and has been draining
  2. BHold the medication, advance the tube 2 inches and recheck
  3. CHold the medication and notify the provider, because a pH of 7 does not confirm gastric placement
  4. DFlush the tube with 30 mL of water and give the medication
Show answer

Answer: C

Gastric aspirate is normally acidic, with a pH of 5 or less. A pH of 7 suggests the tip has moved into the intestine or the lung, and nothing should go down the tube until placement is confirmed, usually by x-ray.

Why the others are wrong

The tube draining does not prove where the tip is now; tubes migrate with coughing and movement. Advancing a tube blindly without knowing where it is can push it further into the wrong place. Flushing before placement is confirmed puts fluid into whatever space the tube is in.

10

A client has had a chest tube placed to drain a pleural effusion. One hour later the drainage chamber has collected 900 mL of bright red fluid. The client's heart rate is 118 and blood pressure is 92/58 mm Hg. Which action should the nurse take first?

  1. AClamp the chest tube and wait for the provider
  2. BNotify the provider immediately and prepare for possible return to the procedure room
  3. CEmpty the drainage chamber and document the output
  4. DEncourage the client to cough and deep breathe
Show answer

Answer: B

Bright red output above 100 mL per hour, let alone 900 mL in the first hour, with tachycardia and a falling blood pressure, means the client is bleeding internally. This is a surgical emergency and the provider needs to know now.

Why the others are wrong

Clamping a chest tube traps blood and air in the chest and can cause a tension pneumothorax. Emptying and documenting treats an emergency as routine. Coughing is normal chest tube care but does nothing for hemorrhage.

Quick tips

  • Compare the finding to the client's own baseline, not just to the textbook normal. A systolic of 102 is fine for one client and a dangerous drop for another. Orthostatic means a fall of 20 systolic or 10 diastolic, or a pulse rise of 20, within three minutes of sitting or standing, and the client goes back down before anything else.
  • For any limb in a cast, splint, traction or tight dressing, run the 5 Ps every time (pain, pallor, pulselessness, paresthesia, paralysis). Pain that opioids do not touch is the first and most reliable one.
  • On an NG tube, pH under 5 is the bedside check and x-ray is the confirmation. Watch sodium, potassium and chloride too, since suction pulls them out with the gastric fluid.
  • Any chest or abdominal drain gets the same three checks every hour at first: how much, what color, and what the vital signs are doing. Output that suddenly climbs or turns bright red is reported, and output that suddenly stops on a tube that was draining well means a kink or a clot, not a cure.
  • Plaster casts dry over 24 to 72 hours and give off heat while they set. Leave them uncovered on pillows, never let the client push anything down inside to scratch, and treat new numbness or swelling under any cast as a same day report.

Related topics

FAQ

What does reduction of risk potential mean on the NCLEX?

It is the category about catching complications before they happen. The questions give you a client with a procedure, a device or a condition and ask what to monitor, which change to report, or what to do to keep a problem from developing.

How many questions are reduction of risk potential on the NCLEX?

The category is weighted at 9 to 15% of the exam. On a minimum length test of 85 questions that is roughly 8 to 13, and on a longer test it can be 20 or more.

What is the hardest part of reduction of risk potential questions?

Usually it is knowing which abnormal finding is urgent and which can wait. Several options may be true findings, but only one is the early sign of something that will hurt the client, and that is the one the exam wants you to report.

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