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Reduction of Risk Potential

NCLEX Diagnostic Tests Practice Questions

Quick answer

Diagnostic test questions cover what the nurse does before and after procedures like MRI, cardiac catheterization, colonoscopy, lumbar puncture and biopsies. They sit inside Reduction of Risk Potential, which is 9 to 15 percent of the exam, and these procedure questions are a steady slice of that.

  • 10 practice questions
  • Full rationales
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Most of these questions are not asking you to explain how the test works. They are asking what you check before the client goes, how you position them, and what you watch for when they come back. The usual pattern is one key safety check per procedure: metal before MRI, dye allergy before a cath, gag reflex after a bronchoscopy. The trap students fall into is mixing up positioning. Flat after a lumbar puncture, right side after a liver biopsy, sitting up and leaning forward for a thoracentesis. They all sound similar on a tired brain, and the exam counts on that. Learn the reason behind each position and the answer stops being a guess.

Practice questions

1

A nurse is preparing a client for an MRI of the lumbar spine. Which finding in the history would require the nurse to contact the radiology department before the client is sent for the scan?

  1. AThe client has a history of claustrophobia and received an oral sedative 30 minutes ago
  2. BThe client has a permanent pacemaker that was placed four years ago
  3. CThe client has a titanium hip replacement
  4. DThe client ate breakfast two hours ago
Show answer

Answer: B

An MRI uses a powerful magnetic field, and a pacemaker can malfunction or heat up inside it. Many older pacemakers are not MRI safe, so the radiology team must confirm the device type and clear the client before the scan goes ahead.

Why the others are wrong

Claustrophobia is a known problem and sedation before the scan is the expected plan, not a reason to hold. Titanium joint implants are generally MRI compatible and are documented but do not stop the test. A spine MRI without contrast does not require fasting.

2

A client is scheduled for a cardiac catheterization in the morning. Which statement by the client is the most important for the nurse to report to the provider?

  1. A"I get a rash every time I eat shrimp."
  2. B"I had a cup of coffee last night before bed."
  3. C"My knees ache when I lie flat for a long time."
  4. D"I have not had a cardiac test like this before."
Show answer

Answer: A

A shellfish or iodine reaction is a flag for possible reaction to the iodinated contrast used during the cath. The provider needs to know ahead of time so premedication with steroids and antihistamines can be ordered or an alternative plan made.

Why the others are wrong

Coffee the evening before is outside the NPO window and is not a safety issue. Knee pain with lying flat matters for comfort after the procedure but does not change the plan. Never having had the test only means the client needs more teaching.

3

The nurse reviews the morning labs of a client going for cardiac catheterization with contrast. Which result should the nurse report before the client leaves the unit?

  1. AHemoglobin 13.2 g/dL
  2. BPlatelets 210,000/mm3
  3. CCreatinine 2.4 mg/dL
  4. DSodium 139 mEq/L
Show answer

Answer: C

Iodinated contrast is cleared by the kidneys and can cause contrast induced nephropathy. A creatinine of 2.4 mg/dL means the kidneys are already struggling, so the provider may order IV fluids beforehand, reduce the dye volume, or delay the test.

Why the others are wrong

The hemoglobin, platelet count and sodium are all within normal limits and do not change the plan for the procedure.

4

A client is being admitted the morning of a scheduled cardiac catheterization. Which action should the nurse take first?

  1. AConfirm the client has been NPO for the ordered number of hours
  2. BShave and prep the groin site
  3. CApply a gown and remove the client's jewelry
  4. DReview the consent form for a witness signature
Show answer

Answer: A

Sedation is used during the cath, and a full stomach raises the risk of aspiration. Confirming NPO status is the safety check that can stop or delay the procedure, so the nurse does it first. If the client has eaten, the team needs to know before anything else is done.

Why the others are wrong

Site prep, gowning and jewelry removal are all part of preparation but can wait until NPO status is confirmed. Consent is usually checked at the time of admission paperwork and does not carry the same immediate aspiration risk.

5

A client is scheduled for a colonoscopy in two days. Which statement shows the client understands the preparation teaching?

  1. A"I will have a light breakfast of eggs and toast the morning of the test."
  2. B"I will drink the bowel prep solution and stay near a bathroom until my stools are clear and watery."
  3. C"I can keep eating salads and whole grains right up until the night before."
  4. D"I should take my iron tablets as usual so I do not get weak."
Show answer

Answer: B

The bowel must be clear for the scope to see the lining. The prep causes repeated watery stools, and the goal is output that is clear or pale yellow. The client should also keep drinking fluids to avoid dehydration.

Why the others are wrong

Solid food is stopped the day before the test, so eggs and toast that morning would mean a cancelled procedure. Salads and whole grains are high in fiber and are stopped early because they leave residue. Iron darkens the stool and coats the colon wall, so it is usually held for several days before.

6

A client returns to the unit after a bronchoscopy with moderate sedation. Which action should the nurse take before offering the client anything to drink?

  1. ACheck the oxygen saturation
  2. BConfirm the gag reflex has returned
  3. CAuscultate the lungs for crackles
  4. DAsk the client to rate their sore throat
Show answer

Answer: B

Local anesthetic is sprayed on the throat during a bronchoscopy, and the gag and swallow reflexes stay numb for a while afterward. Giving fluids before those reflexes return can cause aspiration. The nurse touches the back of the throat with a tongue blade or swab and waits for a gag before allowing anything by mouth.

Why the others are wrong

Oxygen saturation and lung sounds are routine post procedure checks but do not decide whether it is safe to swallow. A sore throat is expected after the scope and does not answer the aspiration question.

7

A nurse is assisting with a lumbar puncture. How should the nurse position the client during the procedure?

  1. AProne with a pillow under the abdomen
  2. BSide lying with the knees drawn up to the chest and the chin tucked
  3. CSupine with the head of the bed at 30 degrees
  4. DHigh Fowler's position with the arms resting on the overbed table
Show answer

Answer: B

Curling the back into a C shape opens the spaces between the lumbar vertebrae so the needle can pass into the subarachnoid space. The client lies on their side at the edge of the bed with knees to chest and chin down, and the nurse helps hold them in that position.

Why the others are wrong

Prone and supine positions close the spaces between the vertebrae. High Fowler's with arms on a table is used for a thoracentesis, not a lumbar puncture.

8

A client had a lumbar puncture one hour ago and asks to sit up to watch television. What is the nurse's best response?

  1. A"You may sit up as long as you move slowly."
  2. B"You need to lie flat for a few more hours to lower your chance of a headache."
  3. C"You can sit up if you take some acetaminophen first."
  4. D"Let's get you out of bed and walking so the fluid moves around."
Show answer

Answer: B

Cerebrospinal fluid can keep leaking from the puncture site, and sitting up pulls on the brain and causes a spinal headache. Staying flat for the ordered period, usually several hours, and drinking extra fluid helps the body replace the CSF and lowers the headache risk.

Why the others are wrong

Sitting up slowly still raises the head and does not prevent a leak headache. Acetaminophen treats pain but does not stop the cause. Walking around makes a post puncture headache worse, not better.

9

A client has just returned from a percutaneous liver biopsy. In which position should the nurse place the client?

  1. ARight side lying with a pillow or folded towel under the biopsy site
  2. BLeft side lying with the head of the bed flat
  3. CSupine with the head elevated 45 degrees
  4. DProne with the arms above the head
Show answer

Answer: A

The liver is a very vascular organ and bleeding is the main risk after a biopsy. Lying on the right side presses the liver against the chest wall and the pillow adds pressure over the puncture site, which helps seal the needle track. The client usually stays in this position for a couple of hours while vital signs are checked often.

Why the others are wrong

Left side lying takes the pressure off the biopsy site. Supine with the head up and prone do not apply the needed direct pressure over the right upper abdomen.

10

A client with a large pleural effusion is scheduled for a thoracentesis at the bedside. Which action by the nurse shows correct preparation?

  1. APositioning the client sitting on the edge of the bed, leaning forward over the overbed table
  2. BPositioning the client flat on the affected side
  3. CAsking the client to lie supine with the arms at the sides
  4. DPlacing the client in Trendelenburg to pool fluid at the base
Show answer

Answer: A

Sitting up and leaning forward spreads the ribs apart and lets the fluid collect at the bottom of the pleural space, where the provider inserts the needle. The client is told to stay still and not cough while the needle is in. If the client cannot sit, lying on the unaffected side with the head of the bed raised is the alternative.

Why the others are wrong

Lying flat on the affected side blocks access to the insertion area. Supine and Trendelenburg positions move the fluid away from the usual needle site and make breathing harder for a client who already has an effusion.

Quick tips

  • Before any test with contrast dye, check three things: allergy to iodine or shellfish, the creatinine, and whether metformin is held. The exam rarely asks all three at once, but one of them will be the answer.
  • Paracentesis prep has one step students forget: have the client void right before. A full bladder sits in the needle path. Weigh the client and measure the abdominal girth before and after too.
  • Stress test teaching is mostly about what to skip. No caffeine (coffee, tea, cola, chocolate) for 24 hours, no smoking the morning of, and hold beta blockers only if the provider orders it. Caffeine blocks the drug used in a chemical stress test.
  • For an EEG, the client keeps hair clean and free of products, skips caffeine, and takes usual meds unless told otherwise. If a sleep deprived EEG is ordered, the client stays awake most of the night before so the brain is more likely to show abnormal activity during the test.
  • Match the position to the reason: flat after a lumbar puncture (stop CSF leak headache), right side after a liver biopsy (pressure on the liver), sitting forward for a thoracentesis (open the rib spaces), and side lying curled for the lumbar puncture itself (open the vertebral spaces).

Related topics

FAQ

What do I need to know about MRI for NCLEX?

The main checks are metal and devices. Ask about pacemakers, implanted defibrillators, cochlear implants, aneurysm clips, metal fragments and any patches with foil. Also screen for claustrophobia and arrange sedation if needed. Jewelry, hairpins and anything with a magnetic strip stay outside the room.

Why does the patient have to lie flat after a lumbar puncture?

Spinal fluid can keep leaking through the hole the needle made. When the client sits up, the lower fluid pressure pulls on the covering of the brain and causes a pounding headache. Lying flat and drinking fluids gives the body time to seal the site and replace what was lost.

How long after a bronchoscopy can the patient eat?

Not until the gag reflex is back, which usually takes around two hours but depends on the client. The nurse checks by touching the back of the throat. Once the client gags, start with sips of water, then advance as tolerated. Mild hoarseness and a small amount of blood streaked sputum are expected.

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