A 68-year-old client with heart failure has been taught about a 2-gram sodium diet. Which lunch selection indicates that the teaching was effective?

Grilled chicken, baked potato, and fresh broccoli

Canned chicken noodle soup with saltine crackers

Ham sandwich on rye bread with a large dill pickle spear

Frozen turkey dinner with gravy and bread stuffing

A 52-year-old client who was just told that her breast cancer has metastasized says, "I have prayed every day of my life, and now God has abandoned me." Which response by the nurse is MOST therapeutic?

"You feel that your faith has let you down right now. Tell me more about that."

"God has a plan for everyone, even when we cannot understand what it is."

"Would you like me to call the hospital chaplain to come and see you?"

"Many people feel angry with God at first, and the feeling usually passes in time."

A nurse calls the provider about a 74-year-old client who had a total hip replacement yesterday. The client's blood pressure is 88/50 mm Hg (baseline 132/80), pulse 118/min, and urine output 20 mL/hr for the past 2 hours. Using SBAR, which statement represents the 'R' component?

I'd like you to come evaluate him and consider an IV fluid bolus.

His blood pressure is now 88/50 and his heart rate is 118/min.

He had a hip replacement yesterday and has heart failure history.

I think he may be developing hypovolemia from surgical blood loss.

A 57-year-old client receives IV vancomycin every 12 hours, with the next dose due at 10:00 a.m. The provider orders a trough level. When should the nurse plan to have the blood drawn?

Within 30 minutes before the 10:00 a.m. dose

Immediately after the 10:00 a.m. infusion ends

One hour after the 10:00 a.m. infusion ends

At any time convenient for the laboratory

Braden subscale Score Sensory perception 3 Moisture 2 Activity 2 Mobility 2 Nutrition 2 Friction and shear 1 A nurse completes a Braden Scale assessment for a 79-year-old client recovering from pneumonia. Based on the scores shown, which interpretation is correct?

Total of 12, indicating high risk

Total of 12, indicating mild risk

Total of 14, indicating moderate risk

Total of 16, indicating mild risk

The nurse observes an assistive personnel (AP) caring for a 76-year-old client receiving continuous enteral feeding. Which observation indicates that the AP needs further instruction?

Lowers the bed flat for a bath while the feeding runs

Raises the head of the bed to 30 degrees after turning

Reports the client's coughing during the feeding

Provides oral care with a moistened soft toothbrush

A 48-year-old client with type 2 diabetes treated with glipizide tells the clinic nurse that she is Muslim and plans to fast from dawn to sunset during the coming month of Ramadan. Which plan by the nurse BEST demonstrates culturally congruent care?

Ask how she observes the fast and work with the provider on a safe dosing plan.

Explain that people with diabetes are exempt from fasting, so she should not fast at all.

Advise her to take glipizide at its usual morning time and check glucose at night.

Give her the clinic's standard handout that describes the rules of Muslim fasting.

A nurse records a 71-year-old client's vital signs every hour on a flowsheet. At 1400 the client suddenly becomes confused, with SpO2 86% on room air. The nurse applies oxygen and calls the rapid response team. How should the nurse document this event?

Record the data on the flowsheet and write a narrative note of the event

Record only the vital signs on the flowsheet, since they show the event

Document the event in the shift handoff report rather than in the client's chart

Wait for the rapid response team's note and then cosign that note

A 79-year-old client with malnutrition takes phenytoin for a seizure disorder. The total phenytoin level is 14 mcg/mL (reference 10 to 20 mcg/mL), and the serum albumin is 2.3 g/dL. For which finding should the nurse assess the client?

Gingival bleeding and petechiae

NACE I PN-RN

Free NACE I PN-RN Practice Questions

10 sample questions for the NACE I PN-RN, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Basic Physiologic Needs, Basic Psychosocial Needs, Communication, Medication Administration, Moral, Ethical, Legal Issues.

Question 1 · Basic Physiologic Needs
A nurse inspects the sacrum of an 84-year-old client admitted from home after a fall. The area shows a shallow open wound with a moist, pink-red wound bed, no slough, and no visible fat. How should the nurse document this finding?
- A.Stage 1 pressure injury
- B.Stage 3 pressure injury
- C.Deep tissue pressure injury
- D.Stage 2 pressure injury
Show answer and explanation
Answer: D. Stage 2 pressure injury
Partial-thickness loss of skin with exposed, viable pink or red dermis and no slough or visible fat defines a Stage 2 pressure injury. Stage 1 is intact skin with nonblanchable erythema, Stage 3 is full-thickness loss in which adipose tissue may be visible, and a deep tissue pressure injury is persistent deep red, maroon, or purple discoloration under intact or blistered skin.
Question 2 · Basic Physiologic Needs
A 68-year-old client with heart failure has been taught about a 2-gram sodium diet. Which lunch selection indicates that the teaching was effective?
- A.Canned chicken noodle soup with saltine crackers
- B.Grilled chicken, baked potato, and fresh broccoli
- C.Ham sandwich on rye bread with a large dill pickle spear
- D.Frozen turkey dinner with gravy and bread stuffing
Show answer and explanation
Answer: B. Grilled chicken, baked potato, and fresh broccoli
Fresh, minimally processed foods prepared without added salt are naturally low in sodium. Canned soups, crackers, cured meats such as ham, pickles, and frozen convenience meals with gravy are among the highest-sodium choices and show the client needs further teaching.
Question 3 · Basic Psychosocial Needs
A 52-year-old client who was just told that her breast cancer has metastasized says, "I have prayed every day of my life, and now God has abandoned me." Which response by the nurse is MOST therapeutic?
- A."God has a plan for everyone, even when we cannot understand what it is."
- B."You feel that your faith has let you down right now. Tell me more about that."
- C."Would you like me to call the hospital chaplain to come and see you?"
- D."Many people feel angry with God at first, and the feeling usually passes in time."
Show answer and explanation
Answer: B. "You feel that your faith has let you down right now. Tell me more about that."
Reflecting the client's feeling and inviting her to elaborate is the most therapeutic first response and allows the nurse to assess the nature of her spiritual distress. Offering a chaplain visit is appropriate once the concern is explored and the client agrees, but as an immediate reply it shifts the conversation away from her. Stating that God has a plan imposes the nurse's beliefs, and generalizing her reaction minimizes her feelings.
Question 4 · Communication
A nurse calls the provider about a 74-year-old client who had a total hip replacement yesterday. The client's blood pressure is 88/50 mm Hg (baseline 132/80), pulse 118/min, and urine output 20 mL/hr for the past 2 hours. Using SBAR, which statement represents the 'R' component?
- A.I'd like you to come evaluate him and consider an IV fluid bolus.
- B.His blood pressure is now 88/50 and his heart rate is 118/min.
- C.He had a hip replacement yesterday and has heart failure history.
- D.I think he may be developing hypovolemia from surgical blood loss.
Show answer and explanation
Answer: A. I'd like you to come evaluate him and consider an IV fluid bolus.
The Recommendation component states what the nurse is requesting, such as an in-person evaluation, a test, or a treatment. The current vital signs describe the Situation, the surgery and history are Background, and the nurse's conclusion about possible hypovolemia is the Assessment.
Question 5 · Medication Administration
A 57-year-old client receives IV vancomycin every 12 hours, with the next dose due at 10:00 a.m. The provider orders a trough level. When should the nurse plan to have the blood drawn?
- A.Immediately after the 10:00 a.m. infusion ends
- B.Within 30 minutes before the 10:00 a.m. dose
- C.One hour after the 10:00 a.m. infusion ends
- D.At any time convenient for the laboratory
Show answer and explanation
Answer: B. Within 30 minutes before the 10:00 a.m. dose
A trough reflects the lowest serum concentration, so it is drawn just before the next scheduled dose (usually within 30 minutes). Levels drawn after the infusion measure the peak, not the trough, and a randomly timed draw cannot be interpreted against the target range.
Question 6 · Basic Physiologic Needs
Braden subscale Score
Sensory perception 3
Moisture 2
Activity 2
Mobility 2
Nutrition 2
Friction and shear 1
A nurse completes a Braden Scale assessment for a 79-year-old client recovering from pneumonia. Based on the scores shown, which interpretation is correct?
- A.Total of 12, indicating mild risk
- B.Total of 12, indicating high risk
- C.Total of 14, indicating moderate risk
- D.Total of 16, indicating mild risk
Show answer and explanation
Answer: B. Total of 12, indicating high risk
The subscale scores add to 3 + 2 + 2 + 2 + 2 + 1 = 12. On the Braden Scale, lower scores mean greater risk: 15 to 18 is mild risk, 13 to 14 moderate, 10 to 12 high, and 9 or below very high, so 12 is high risk. Calling 12 mild risk reverses the direction of the scale.
Question 7 · Basic Physiologic Needs
The nurse observes an assistive personnel (AP) caring for a 76-year-old client receiving continuous enteral feeding. Which observation indicates that the AP needs further instruction?
- A.Raises the head of the bed to 30 degrees after turning
- B.Reports the client's coughing during the feeding
- C.Lowers the bed flat for a bath while the feeding runs
- D.Provides oral care with a moistened soft toothbrush
Show answer and explanation
Answer: C. Lowers the bed flat for a bath while the feeding runs
Keeping the head of the bed elevated at least 30 to 45 degrees during continuous feeding is a key aspiration precaution; if the client must lie flat, the feeding should be paused first. Elevating the head after turning, reporting coughing (a possible sign of aspiration), and providing regular oral care are all correct actions.
Question 8 · Basic Psychosocial Needs
A 48-year-old client with type 2 diabetes treated with glipizide tells the clinic nurse that she is Muslim and plans to fast from dawn to sunset during the coming month of Ramadan. Which plan by the nurse BEST demonstrates culturally congruent care?
- A.Explain that people with diabetes are exempt from fasting, so she should not fast at all.
- B.Advise her to take glipizide at its usual morning time and check glucose at night.
- C.Give her the clinic's standard handout that describes the rules of Muslim fasting.
- D.Ask how she observes the fast and work with the provider on a safe dosing plan.
Show answer and explanation
Answer: D. Ask how she observes the fast and work with the provider on a safe dosing plan.
Culturally congruent care begins with asking the individual how she practices rather than assuming, then adapting care; sulfonylureas such as glipizide carry a high risk of hypoglycemia during daytime fasting, so the timing or dose must be adjusted with the provider. Telling her not to fast disregards her autonomy and the personal nature of religious decisions. Taking the usual morning dose while fasting risks hypoglycemia, and a standard handout assumes all Muslims practice identically.
Question 9 · Communication
A nurse records a 71-year-old client's vital signs every hour on a flowsheet. At 1400 the client suddenly becomes confused, with SpO2 86% on room air. The nurse applies oxygen and calls the rapid response team. How should the nurse document this event?
- A.Record only the vital signs on the flowsheet, since they show the event
- B.Document the event in the shift handoff report rather than in the client's chart
- C.Record the data on the flowsheet and write a narrative note of the event
- D.Wait for the rapid response team's note and then cosign that note
Show answer and explanation
Answer: C. Record the data on the flowsheet and write a narrative note of the event
Flowsheets efficiently capture routine, repeated data, but a significant change in condition requires a narrative note describing the findings, the nurse's actions, notifications, and the client's response. Handoff reports are not part of the legal record, and each nurse must document her own observations and actions rather than relying on another team's note.
Question 10 · Medication Administration
A 79-year-old client with malnutrition takes phenytoin for a seizure disorder. The total phenytoin level is 14 mcg/mL (reference 10 to 20 mcg/mL), and the serum albumin is 2.3 g/dL. For which finding should the nurse assess the client?
- A.Gingival bleeding and petechiae
- B.Hyperglycemia and polyuria
- C.Tinnitus and hearing loss
- D.Nystagmus and an unsteady gait
Show answer and explanation
Answer: D. Nystagmus and an unsteady gait
Phenytoin is highly protein bound, and low albumin leaves more unbound (active) drug, so toxicity such as nystagmus, ataxia, and confusion can occur even when the total level appears therapeutic. Gingival hyperplasia, not bleeding, is a chronic phenytoin effect, and tinnitus is associated with salicylate or aminoglycoside toxicity.

Braden subscale	Score
Sensory perception	3
Moisture	2
Activity	2
Mobility	2
Nutrition	2
Friction and shear	1

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