NCLEX-PN Practice Test

159 free NCLEX-PN practice questions with answers and explanations. No signup required. The NCLEX-PN exam is administered by NCSBN, with up to 150 questions and a time limit of 5 hours.

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Question 1 of 159 · Psychosocial IntegrityMedium0/0

A nurse suspects that an older adult client is experiencing abuse by a caregiver. Which is the nurse's MOST appropriate initial action?

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Psychosocial Integrity

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1. A nurse suspects that an older adult client is experiencing abuse by a caregiver. Which is the nurse's MOST appropriate initial action?
- A. Confront the caregiver directly about the suspected abuse
- B. Interview the client privately and document objective findings
- C. Wait for additional incidents before taking any action
- D. Advise the client to move out of the caregiver's home immediately
Show answer & explanation
Answer: B
When abuse is suspected, the nurse should interview the client in a private, safe setting and document objective, factual findings, which supports client safety and required reporting. Confronting the caregiver may endanger the client, waiting delays protection, and directing the client to relocate is not the nurse's role.
2. A licensed practical nurse is caring for a client newly admitted with a diagnosis of major depressive disorder. The client states, "I don't see the point in any of this anymore." Which is the nurse's PRIORITY action?
- A. Reassure the client that things will improve with treatment
- B. Directly ask the client whether they are thinking about harming themselves
- C. Document the statement and continue with the admission assessment
- D. Notify the client's family of the statement
Show answer & explanation
Answer: B
Statements suggesting hopelessness require immediate, direct assessment of suicidal ideation. Asking directly does not increase risk and establishes safety as the priority. Reassurance minimizes feelings, delayed documentation ignores acute risk, and notifying family is not the priority intervention.
3. A nurse observes that a client repeatedly checks and rechecks that the door is locked, causing distress and delaying meals. During the acute phase, which nursing approach is MOST appropriate?
- A. Prevent the client from performing the ritual entirely
- B. Allow time for the ritual while gradually setting reasonable limits and reducing anxiety
- C. Ridicule the behavior so the client recognizes it is irrational
- D. Ignore the client until the ritual stops on its own
Show answer & explanation
Answer: B
Compulsive rituals reduce anxiety for the client; abruptly preventing them increases anxiety. The nurse should allow time for the behavior initially, ensure basic needs are met, and gradually set limits while addressing underlying anxiety. Ridicule and neglect are non-therapeutic.
4. A nurse is providing culturally sensitive care to a client whose cultural practices differ from the nurse's own. Which action BEST reflects culturally competent psychosocial care?
- A. Assume the client shares the beliefs typical of their cultural group
- B. Ask the client about their preferences and incorporate them into the plan of care when safe
- C. Encourage the client to adopt the practices of the majority culture
- D. Avoid discussing cultural topics to prevent discomfort
Show answer & explanation
Answer: B
Culturally competent care individualizes the plan by asking about and respecting the client's specific preferences rather than making assumptions. Stereotyping, pressuring assimilation, and avoiding the topic undermine trust and holistic care.
5. A client on an inpatient unit becomes increasingly loud, paces rapidly, and clenches their fists. Which nursing action BEST demonstrates early de-escalation?
- A. Approach quickly and place a hand on the client's shoulder
- B. Maintain a calm demeanor, ensure personal space, and speak in a low, even tone
- C. Order the client to sit down immediately
- D. Gather several staff members to surround the client
Show answer & explanation
Answer: B
Early de-escalation focuses on a calm presence, respecting personal space, and non-threatening communication to prevent escalation to aggression. Sudden touch, commanding language, and crowding can be perceived as threatening and may provoke violence.
6. A client with alcohol use disorder is admitted for withdrawal. Approximately 12 hours after the last drink, the nurse should monitor MOST closely for which early manifestation?
- A. Tremors, diaphoresis, and elevated vital signs
- B. Complete absence of any symptoms
- C. Profound bradycardia and hypothermia
- D. Sudden euphoria and increased appetite
Show answer & explanation
Answer: A
Early alcohol withdrawal is characterized by autonomic hyperactivity: tremors, diaphoresis, tachycardia, and hypertension. Recognizing these early signs allows intervention before progression to severe withdrawal. Bradycardia, hypothermia, and euphoria are not consistent with withdrawal.
7. A client experiencing an acute panic attack is hyperventilating and states they feel they are "going to die." Which nursing intervention is MOST appropriate initially?
- A. Leave the client alone to reduce external stimulation
- B. Provide detailed teaching about the physiology of anxiety
- C. Stay with the client and use a calm, reassuring voice with short directions
- D. Encourage the client to discuss the underlying cause of the anxiety
Show answer & explanation
Answer: C
During severe anxiety or panic, the client's ability to process information is markedly reduced. Remaining present, staying calm, and giving brief, simple directions promotes safety and de-escalation. Teaching and insight-oriented discussion are inappropriate at peak anxiety, and leaving the client alone heightens fear.
8. A client tells the nurse, "The voices are telling me that no one here can be trusted." Which response by the nurse is MOST therapeutic?
- A. "There are no voices; you are safe in the hospital."
- B. "What exactly are the voices saying to you right now?" asked with alarm
- C. "I understand the voices are real to you, but I do not hear them. You are safe here."
- D. "You should just ignore the voices and they will go away."
Show answer & explanation
Answer: C
The therapeutic approach acknowledges the client's experience as real to them without reinforcing the hallucination, presents reality, and reassures safety. Arguing that the voices do not exist, reacting with alarm, or dismissively telling the client to ignore them are non-therapeutic.
9. A nurse is reinforcing teaching for the family of a client diagnosed with Alzheimer disease who becomes agitated in the late afternoon. Which strategy should the nurse recommend for this sundowning behavior?
- A. Schedule stimulating activities and visitors in the evening
- B. Keep the environment calm and well-lit as evening approaches
- C. Withhold all daytime naps and increase caffeine intake
- D. Frequently move the client to unfamiliar rooms to provide variety
Show answer & explanation
Answer: B
Sundowning agitation is reduced by maintaining a calm, consistent, adequately lit environment as evening approaches and limiting overstimulation. Stimulating evening activity, caffeine, and unfamiliar surroundings tend to worsen confusion and agitation.
10. A nurse is caring for a client who recently lost a spouse and says, "I keep setting the table for two out of habit." Which response by the nurse is MOST therapeutic?
- A. "You should try to stay busy so you don't dwell on it."
- B. "It sounds like adjusting to this loss has been very difficult for you."
- C. "At least you had many good years together."
- D. "You'll feel better once you get back to your normal routine."
Show answer & explanation
Answer: B
Reflecting the client's feelings validates the grief experience and encourages further expression. Offering advice, minimizing with "at least," or providing false reassurance are non-therapeutic communication blocks.
11. A nurse is caring for a client experiencing alcohol withdrawal 24 hours after the last drink. Which finding requires immediate provider notification?
- A. A new onset seizure
- B. Mild hand tremor
- C. Reported difficulty sleeping
- D. Mild anxiety and irritability
Show answer & explanation
Answer: A
Withdrawal seizures indicate escalation toward severe withdrawal and possible delirium tremens, which carries significant mortality and requires immediate intervention. Tremor, insomnia, anxiety and mild autonomic signs are expected early findings that are monitored with a standardized withdrawal assessment scale and treated per protocol.
12. A nurse is caring for a client who is experiencing auditory hallucinations. Which response is therapeutic?
- A. "I do not hear the voices, but I understand they feel real to you. What are they saying?"
- B. "There are no voices; you are imagining things."
- C. "I hear them too, but we can ignore them together."
- D. "Stop listening to the voices and focus on me."
Show answer & explanation
Answer: A
The nurse presents reality without arguing, validates the client's experience as real to them, and assesses content, because command hallucinations directing self-harm or harm to others change the safety plan immediately. Agreeing that the nurse hears them reinforces the hallucination, and flat denial damages trust.

Management of Care

12 of 25 questions loaded

13. A nurse is preparing to delegate to unlicensed assistive personnel. Which task may appropriately be delegated?
- A. Measuring and recording a stable client's intake and output
- B. Administering an oral medication
- C. Inserting an indwelling urinary catheter
- D. Interpreting a change in the client's wound appearance
Show answer & explanation
Answer: A
Unlicensed assistive personnel may perform standardized, predictable tasks on stable clients, including vital signs, intake and output, hygiene, ambulation and feeding. Medication administration, sterile procedures such as catheter insertion, and any task requiring assessment or clinical judgment may not be delegated to UAP.
14. A nurse is documenting in a client's paper medical record and makes an error in an entry. What is the correct correction technique?
- A. Draw a single line through the entry, write the word error or per policy, and initial and date it
- B. Use correction fluid and write over the entry
- C. Erase the entry completely and rewrite it
- D. Black out the entry so it cannot be read
Show answer & explanation
Answer: A
A single line preserves the original entry as legible, which is essential because the record is a legal document. Obliterating an entry with correction fluid, erasure or heavy blacking out suggests concealment and undermines the record's credibility. The corrected entry is then written, initialed and dated.
15. A nurse is caring for a client who has a do-not-resuscitate order and who then stops breathing and has no pulse. What is the nurse's appropriate action?
- A. Provide comfort measures and notify the provider and family; do not initiate CPR
- B. Begin chest compressions until the family arrives
- C. Call a code and initiate full resuscitation
- D. Administer emergency medications but withhold compressions
Show answer & explanation
Answer: A
A valid DNR order directs that cardiopulmonary resuscitation not be initiated. It does not mean withholding other care: comfort measures, symptom management, hygiene and emotional support for the client and family continue. Initiating CPR against a valid DNR is a violation of the client's expressed wishes.
16. A nurse receives a verbal order from a provider during an emergency. What is the correct process?
- A. Write the order down, read it back to the provider for verification, and have it authenticated within the required timeframe
- B. Carry out the order and document it at the end of the shift
- C. Ask another nurse to listen and rely on shared memory
- D. Refuse all verbal orders under any circumstance
Show answer & explanation
Answer: A
Verbal and telephone orders are limited to situations where written entry is impractical and require write-down, read-back and verification with the ordering provider, followed by authentication within the facility's required timeframe. Read-back is the specific safeguard against mishearing sound-alike drug names and numbers.
17. A licensed practical nurse is caring for four clients. Which client should the nurse assess first?
- A. A client with an oxygen saturation of 86 percent on room air and increased work of breathing
- B. A client reporting incisional pain rated 7 out of 10
- C. A client requesting assistance to the bathroom
- D. A client whose family is asking about discharge planning
Show answer & explanation
Answer: A
Prioritization follows airway, breathing, circulation. An oxygen saturation of 86 percent with increased work of breathing is an actual, immediately life-threatening oxygenation problem and outranks pain, elimination needs and discharge questions. Pain is important but is addressed after physiological instability is managed.
18. A nurse discovers a medication error after administering the wrong dose. What is the nurse's first responsibility?
- A. Assess the client, then notify the provider and complete an incident report
- B. Complete the incident report before assessing the client
- C. Document the error only in the incident report, not in the medical record
- D. Wait to see whether the client develops symptoms before reporting
Show answer & explanation
Answer: A
Client safety comes first: assess for effects, then notify the provider so intervention can be ordered, then complete the incident report. Clinical findings and interventions are documented in the medical record, while the incident report is an internal quality document that is not referenced in the chart.
19. A nurse observes a coworker accessing the electronic health record of a neighbor who is not assigned to that coworker. What should the nurse do?
- A. Report the incident through the facility's chain of command, as this is a privacy violation
- B. Say nothing, since no information appears to have been shared outside the facility
- C. Ask the coworker to delete the access log entry
- D. Discuss the neighbor's condition with the coworker to assess intent
Show answer & explanation
Answer: A
Accessing a record without a treatment, payment or operations purpose violates HIPAA regardless of whether information is disclosed further, and audit logs record every access. The nurse must report it internally. Asking the coworker to alter records would compound the violation with record tampering.
20. A nurse discovers that a client's signed surgical consent form does not list the correct surgical site. What is the nurse's best action?
- A. Notify the surgeon and hold the client from transport until the consent is corrected
- B. Correct the site on the form and have the client initial the change
- C. Send the client to surgery and report the discrepancy to the operating room nurse
- D. Ask a family member to confirm the correct site and proceed
Show answer & explanation
Answer: A
Informed consent is obtained by the provider performing the procedure, and the nurse witnesses the signature and verifies the client's understanding. A nurse may not alter the consent document. An incorrect site is a wrong-site surgery risk that must stop the process until the surgeon corrects it.
21. A registered nurse delegates tasks on a medical-surgical unit. Which task is appropriate to assign to a licensed practical nurse?
- A. Reinforcing teaching about a prescribed diet that the RN has already taught
- B. Performing the initial admission assessment on a newly admitted client
- C. Developing the nursing care plan for a complex client
- D. Evaluating the client's response to the overall plan of care
Show answer & explanation
Answer: A
The LPN scope includes reinforcing teaching the RN has initiated, collecting data, administering many medications and performing procedures within state scope. Initial assessment, care plan development and evaluation of the plan remain RN responsibilities under the nursing process, because they require independent nursing judgment.
22. A hospitalized client has a living will declining resuscitation, but the client's adult child demands that "everything be done" if the client's heart stops. What is the licensed practical nurse's best action?
- A. Follow the family's wishes because they are present at the bedside
- B. Remove the living will from the chart until the conflict is settled
- C. Promise the family that resuscitation will be attempted
- D. Report the conflict to the supervising registered nurse so the care team can address it with the family and provider
Show answer & explanation
Answer: D
A valid living will documents the client's own treatment wishes, and family demands do not override it. The LPN's responsibility is to escalate the conflict so the RN, provider, and possibly an ethics resource can clarify the directive with the family. Following the family, concealing the document, or making promises that contradict the client's expressed wishes each violate the client's autonomy and the integrity of the record.
23. A client with pneumonia announces he is leaving the hospital against medical advice. The provider has been notified and the client remains determined to leave. Which statement about this situation is accurate?
- A. Security may hold the client until discharge paperwork is complete
- B. The client forfeits the right to return to the hospital for future care
- C. The nurse should remove the client's IV access only after the client signs a promise to follow up
- D. The client with decision-making capacity may not be physically prevented from leaving, and the risks of leaving should be explained and documented
Show answer & explanation
Answer: D
An adult with intact decision-making capacity retains the right to leave even against medical advice; detaining such a client constitutes false imprisonment. The nurse's role is to ensure the risks were explained, request signature on the against-medical-advice form, remove devices safely, and document thoroughly. Leaving against advice never bars a client from seeking future care, and follow-up promises cannot be made a condition of safe discharge steps.
24. A caller who identifies himself as a client's cousin telephones the unit and asks whether the client has been admitted and how she is doing. The client has not authorized release of information. How should the nurse respond?
- A. Explain that no information can be shared, without confirming whether the client is on the unit
- B. Confirm the admission but decline to give clinical details
- C. Provide a brief update since the caller is a family member
- D. Ask the caller to state the client's diagnosis to verify the relationship
Show answer & explanation
Answer: A
Without the client's authorization, even confirming the presence of the client on the unit is a disclosure of protected health information. The nurse protects confidentiality by declining to share anything, including admission status. Confirming admission, giving an update, or quizzing the caller in a way that implies the client is present all reveal protected information to an unverified person.

Safety and Infection Control

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25. A nurse is caring for a confused older adult who is attempting to climb out of bed. Which intervention should the nurse implement first?
- A. Use the least restrictive measures, such as a bed alarm, frequent checks and moving the client near the nurses' station
- B. Apply wrist restraints to prevent the client from getting up
- C. Raise all four side rails on the bed
- D. Administer a sedative before attempting other measures
Show answer & explanation
Answer: A
Least restrictive alternatives are always tried first. Restraints require a provider order that is time limited, cannot be written as needed, and demand frequent monitoring, release, and attention to skin, circulation and elimination. Four raised side rails constitute a restraint and can increase entrapment and fall injury risk.
26. A nurse is caring for a client in restraints. How frequently must the client generally be monitored, and what must be assessed?
- A. At regular short intervals per policy, assessing circulation, skin integrity, elimination, nutrition and the continued need for restraint
- B. Once per shift, assessing only whether the restraint remains secure
- C. Only when the client complains of discomfort
- D. Once every 24 hours when the order is renewed
Show answer & explanation
Answer: A
Restrained clients require frequent monitoring at intervals set by policy, with periodic release for range of motion, repositioning, toileting, fluids and skin care, and continual reassessment of whether the restraint is still necessary. Orders are time limited and must be renewed, and the least restrictive effective device is used.
27. A nurse is preparing to transfer a client from bed to chair. Which action promotes safe body mechanics for the nurse?
- A. Keep the back straight, bend at the knees and hips, and keep the client close to the body
- B. Bend at the waist and lift with the back muscles
- C. Keep the feet together to maintain a narrow base of support
- D. Twist at the waist while moving the client toward the chair
Show answer & explanation
Answer: A
Safe mechanics use the large leg muscles rather than the back, a wide base of support, and keeping the load close to the center of gravity. Twisting while bearing weight is a common mechanism of back injury; the nurse should pivot the feet instead, and use assistive devices or additional staff when the load warrants.
28. A client is admitted with suspected pulmonary tuberculosis. Which precautions should the nurse implement?
- A. Airborne precautions with a negative pressure room and an N95 respirator
- B. Droplet precautions with a surgical mask within three feet
- C. Contact precautions with gown and gloves only
- D. Standard precautions alone
Show answer & explanation
Answer: A
Tuberculosis, measles and varicella spread by small airborne particles that remain suspended, requiring a negative pressure airborne infection isolation room and a fit-tested N95 or higher respirator. Droplet precautions with a surgical mask apply to larger particles such as influenza, pertussis and meningococcal disease.
29. A nurse is donning personal protective equipment before entering an isolation room. What is the correct sequence?
- A. Gown, mask or respirator, goggles or face shield, then gloves
- B. Gloves, gown, mask, then goggles
- C. Mask, gloves, gown, then goggles
- D. Goggles, gloves, gown, then mask
Show answer & explanation
Answer: A
Donning proceeds gown, mask or respirator, eye protection, then gloves, with gloves last so they cover the gown cuffs. Doffing generally reverses the most contaminated items first: gloves and gown, then eye protection, then the mask or respirator outside the room, with hand hygiene between steps.
30. A client begins to have a generalized tonic-clonic seizure while sitting in a chair. What is the nurse's priority action?
- A. Ease the client to the floor, protect the head, and turn the client to the side
- B. Insert a padded tongue blade into the client's mouth
- C. Restrain the client's extremities to prevent injury
- D. Leave to obtain suction equipment immediately
Show answer & explanation
Answer: A
Protect the client from injury and maintain the airway: lower them to the floor, cushion the head, loosen restrictive clothing and position side-lying so secretions drain. Never place anything in the mouth or restrain the limbs, both of which cause injury. Stay with the client and time the seizure.
31. A client is placed on contact precautions for Clostridioides difficile infection. Which hand hygiene method is required?
- A. Washing with soap and water, because alcohol-based rubs do not kill spores
- B. Alcohol-based hand rub only, as it is faster and more effective
- C. Either method, as both are equally effective against C. difficile
- D. Antiseptic wipes applied to gloved hands
Show answer & explanation
Answer: A
C. difficile forms spores that alcohol does not destroy; the mechanical action of soap and water is required to physically remove them. Contact precautions with gown and gloves apply, and the room requires a sporicidal disinfectant such as a bleach-based product rather than standard cleaning agents.
32. A client with a history of latex allergy is scheduled for a procedure. What is the nurse's most important action?
- A. Ensure the allergy is documented and communicated, and that latex-free supplies are used throughout
- B. Administer an antihistamine before the procedure and use standard supplies
- C. Use latex gloves but change them frequently
- D. Rely on the client to identify latex products during the procedure
Show answer & explanation
Answer: A
Latex allergy is managed by complete avoidance, which requires that the allergy be prominently documented, communicated to every member of the team, and that all supplies including gloves, tourniquets, catheters and tubing be latex free. Premedication does not substitute for avoidance, and reactions can be severe.
33. A nurse on a postpartum unit is reinforcing newborn security instructions with a mother. Which maternal statement indicates correct understanding?
- A. "Anyone wearing scrubs may take my baby to the nursery."
- B. "I will check for the hospital photo identification badge required of staff before handing over my baby."
- C. "I can leave my baby in the room while I shower as long as the door is shut."
- D. "Security bands are only necessary if the nursery is full."
Show answer & explanation
Answer: B
Infant abduction prevention depends on parents releasing the newborn only to staff displaying the specific identification the facility requires, so verifying the badge shows accurate understanding. Scrubs alone prove nothing because abductors often impersonate staff, an unattended infant behind a closed door is unobserved and vulnerable, and matching security bands are worn at all times regardless of census.
34. A client is admitted with suspected bacterial meningitis. In addition to standard precautions, which transmission-based precaution should the nurse implement?
- A. Contact precautions with a gown for all room entry
- B. Airborne precautions with a negative-pressure room
- C. Droplet precautions, wearing a surgical mask when working close to the client
- D. Protective isolation with sterile linens
Show answer & explanation
Answer: C
Bacterial meningitis pathogens spread through large respiratory droplets, so droplet precautions with a surgical mask for close contact are required until effective therapy has been established. Contact precautions target organisms spread by touch, airborne precautions with negative pressure are reserved for small-particle pathogens such as tuberculosis, and protective isolation shields immunocompromised clients rather than containing this infection.
35. A nurse is reinforcing safety teaching for a client who will use home oxygen via nasal cannula. Which client statement indicates a need for further teaching?
- A. "I will post no-smoking signs where visitors can see them."
- B. "I will keep the oxygen concentrator away from the fireplace."
- C. "I can cook at my gas stove while wearing my cannula as long as I am careful."
- D. "I will use water-based lotion instead of petroleum jelly on my nose."
Show answer & explanation
Answer: C
Oxygen accelerates combustion, so wearing flowing oxygen near an open gas flame invites clothing and tubing ignition regardless of how careful the client intends to be, which is why this statement signals a knowledge gap. No-smoking signage, distance from fireplaces, and avoiding petroleum-based products around the face are all correct oxygen-safety behaviors that need no correction.
36. A hospitalized immunocompromised client develops disseminated herpes zoster with widespread lesions. Which precautions should the nurse expect to implement?
- A. Droplet precautions only until lesions crust
- B. Standard precautions only, because zoster is a reactivated infection
- C. Airborne precautions plus contact precautions until all lesions are crusted
- D. Protective environment with positive-pressure ventilation
Show answer & explanation
Answer: C
Disseminated zoster sheds varicella-zoster virus that can transmit both by air and by contact with lesion drainage, so airborne and contact precautions are combined until every lesion has crusted. Droplet precautions target a different transmission mode, standard precautions alone are sufficient only for localized zoster in an immunocompetent host with covered lesions, and positive-pressure environments protect the occupant rather than contain a contagious client.

Physiological Adaptation

12 of 17 questions loaded

37. A client with chronic obstructive pulmonary disease is receiving oxygen. Which nursing consideration is most important?
- A. Titrate oxygen to the prescribed target saturation, avoiding unnecessarily high flow
- B. Administer the highest flow rate available to maximize oxygenation
- C. Withhold oxygen entirely to preserve respiratory drive
- D. Use oxygen only during ambulation
Show answer & explanation
Answer: A
Clients with COPD are managed to a lower target saturation range than most clients, and excessive oxygen can worsen carbon dioxide retention. The correct approach is neither maximal flow nor withholding oxygen; it is titration to the prescribed target with monitoring of respiratory rate, level of consciousness and saturation.
38. A client is admitted with severe dehydration. Which assessment finding is most consistent with this diagnosis?
- A. Elevated heart rate, decreased urine output and dry mucous membranes
- B. Bounding pulses and jugular vein distention
- C. Crackles throughout both lung fields
- D. Rapid weight gain over 24 hours
Show answer & explanation
Answer: A
Fluid volume deficit produces tachycardia as the body compensates, reduced urine output, dry mucous membranes, poor skin turgor and possible orthostatic hypotension. Bounding pulses, jugular distention, crackles and rapid weight gain describe fluid volume excess, the opposite problem.
39. A client with type 1 diabetes is diaphoretic, tremulous, tachycardic and confused. What should the nurse suspect and do first?
- A. Hypoglycemia; check the blood glucose and provide a fast-acting carbohydrate if the client can swallow safely
- B. Hyperglycemia; administer additional rapid-acting insulin
- C. Dehydration; increase intravenous fluids without checking glucose
- D. Anxiety; provide reassurance and reassess in one hour
Show answer & explanation
Answer: A
Cold sweat, tremor, tachycardia and altered mentation are classic adrenergic and neuroglycopenic signs of hypoglycemia, which is immediately dangerous. Confirm with a glucose check and treat with 15 grams of fast-acting carbohydrate, rechecking in 15 minutes. Hyperglycemia presents differently, with polyuria, polydipsia, Kussmaul respirations and fruity breath.
40. A client who is postoperative day two reports sudden shortness of breath and pleuritic chest pain, with a heart rate of 122. What should the nurse suspect?
- A. Possible pulmonary embolism, requiring immediate escalation
- B. Normal postoperative discomfort
- C. Constipation from opioid analgesia
- D. Mild dehydration
Show answer & explanation
Answer: A
Sudden dyspnea with pleuritic pain and tachycardia in a postoperative client is a classic presentation of pulmonary embolism, a life-threatening complication of venous thromboembolism. The nurse escalates immediately and maintains oxygenation. Prevention includes early ambulation, sequential compression devices and prescribed prophylactic anticoagulation.
41. A nurse is caring for a client with a new colostomy. Which stoma assessment finding requires immediate provider notification?
- A. A stoma that appears dusky purple or black
- B. A stoma that appears pink to red and moist
- C. A small amount of bleeding when the stoma is cleaned
- D. Mild swelling of the stoma in the first days after surgery
Show answer & explanation
Answer: A
A healthy stoma is pink to red and moist, similar to the inside of the cheek. A dusky, purple or black stoma indicates impaired perfusion and possible necrosis, which is a surgical emergency. Slight bleeding with cleaning and early postoperative edema are expected findings.
42. A client suddenly develops facial droop, slurred speech and unilateral arm weakness. What is the nurse's priority action?
- A. Note the time of symptom onset and activate the facility's stroke response immediately
- B. Give the client aspirin and reassess in 30 minutes
- C. Offer oral fluids to assess swallowing ability
- D. Place the client in Trendelenburg position
Show answer & explanation
Answer: A
Time of onset determines eligibility for time-sensitive reperfusion therapy, so establishing it and activating the stroke pathway are the priority. Nothing is given by mouth until swallowing is formally screened, because dysphagia and aspiration risk are common after stroke, and aspirin is withheld until imaging excludes hemorrhage.
43. A nurse is caring for a client with heart failure. Which finding best indicates fluid retention is worsening?
- A. A weight gain of 3 pounds over two days
- B. A blood pressure reading of 122/78
- C. A reported appetite decrease
- D. A heart rate of 78 beats per minute
Show answer & explanation
Answer: A
Daily weight is the most sensitive indicator of fluid status, since a rapid gain of two to three pounds reflects retained fluid rather than tissue. Clients are taught to weigh at the same time each day using the same scale and to report rapid gains, along with increasing dyspnea, orthopnea and dependent edema.
44. A nurse is caring for a client whose vital signs are temperature 38.9 C, heart rate 118, respiratory rate 26 and blood pressure 88/50. Which condition should the nurse suspect?
- A. Possible sepsis, requiring prompt provider notification
- B. Expected postoperative variation requiring no action
- C. Hypothyroidism
- D. Fluid volume overload
Show answer & explanation
Answer: A
Fever with tachycardia, tachypnea and hypotension is the classic pattern of a systemic inflammatory response with possible sepsis, which is time critical. Early recognition and escalation matter because outcomes deteriorate rapidly. Fluid overload would present with hypertension, distended neck veins and crackles rather than hypotension.
45. A client is recovering from a chest tube placement for a pneumothorax. The nurse notices continuous vigorous bubbling in the water seal chamber. What does this finding most likely indicate?
- A. The chest tube system is functioning normally.
- B. The client's lung has fully re-expanded.
- C. The suction level is set too low.
- D. There is an air leak in the chest tube system that requires further assessment.
Show answer & explanation
Answer: D
Continuous vigorous bubbling in the water seal chamber, rather than intermittent bubbling with respirations, suggests an air leak somewhere in the chest tube system that needs to be located and addressed, which is different from normal function, lung re-expansion (which typically shows decreasing bubbling and tidaling), or a suction-level issue.
46. A client with a history of peptic ulcer disease reports sudden onset of black, tarry stools and dizziness when standing. Which nursing action is the priority?
- A. Administer a laxative to relieve the presumed constipation.
- B. Assess vital signs for signs of hypovolemia and notify the provider immediately.
- C. Instruct the client to increase dietary fiber intake.
- D. Reassure the client that dark stools are a normal medication side effect without further assessment.
Show answer & explanation
Answer: B
Black, tarry stools (melena) combined with orthostatic dizziness suggest an upper gastrointestinal bleed with possible hypovolemia, so the priority is to assess vital signs for hemodynamic instability and notify the provider urgently, rather than treating the symptom as constipation or dismissing it without assessment.
47. A client with a history of asthma develops audible wheezing, use of accessory muscles, and a respiratory rate of 32 breaths per minute. Which nursing action is the priority?
- A. Have the client lie flat to reduce work of breathing.
- B. Encourage the client to drink cold fluids to soothe the airway.
- C. Administer the prescribed short-acting bronchodilator and reassess respiratory status.
- D. Wait 30 minutes to see if symptoms resolve independently before intervening.
Show answer & explanation
Answer: C
A short-acting bronchodilator provides rapid bronchodilation to relieve airway constriction during an acute asthma exacerbation, and the nurse should administer it promptly and reassess, whereas lying flat can worsen dyspnea, cold fluids do not address bronchospasm, and delaying treatment risks respiratory deterioration.
48. A client with a lower leg cast reports severe, unrelenting pain unrelieved by prescribed analgesics, along with numbness and pallor of the toes. Which complication should the nurse suspect?
- A. Normal postoperative discomfort.
- B. A superficial skin irritation from the cast edge.
- C. A mild allergic reaction to the casting material.
- D. Compartment syndrome.
Show answer & explanation
Answer: D
Severe pain unrelieved by analgesics, along with numbness and pallor, are hallmark signs of compartment syndrome, a limb-threatening emergency caused by increased pressure within a muscle compartment that compromises circulation and nerve function, which is far more serious than ordinary postoperative discomfort or minor skin irritation.

Pharmacological and Parenteral Therapies

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49. A nurse is preparing to mix regular insulin and NPH insulin in the same syringe. What is the correct technique?
- A. Inject air into both vials, then withdraw the regular (clear) insulin before the NPH (cloudy)
- B. Withdraw the NPH insulin first, then the regular insulin
- C. Withdraw each insulin into a separate syringe and combine them afterward
- D. Shake both vials vigorously before withdrawing
Show answer & explanation
Answer: A
Air is injected into the cloudy vial first, then the clear vial, and the clear regular insulin is drawn up before the cloudy NPH, so intermediate-acting insulin cannot contaminate the short-acting vial. The mnemonic is clear before cloudy. NPH is gently rolled rather than shaken to avoid foaming.
50. A client is prescribed intravenous potassium chloride. Which nursing action is essential?
- A. Administer only diluted and by infusion pump; never give potassium by IV push
- B. Administer undiluted by rapid IV push for faster correction
- C. Add the potassium to the intravenous bag at the bedside without inversion
- D. Give intramuscularly if intravenous access is unavailable
Show answer & explanation
Answer: A
Intravenous potassium must always be diluted and infused at a controlled rate through a pump, because a rapid bolus can cause fatal cardiac arrest. Premixed solutions are preferred over bedside additions, and infusion sites are monitored for phlebitis and infiltration. Potassium is never given by IV push or intramuscularly.
51. A nurse notes that a client's intravenous site is cool, pale and swollen, and the infusion has slowed. What is the nurse's first action?
- A. Stop the infusion and remove the catheter, then elevate the extremity
- B. Increase the flow rate to clear the obstruction
- C. Apply a warm compress and continue the infusion
- D. Flush the line vigorously with saline
Show answer & explanation
Answer: A
Coolness, pallor and swelling indicate infiltration, meaning fluid is entering the surrounding tissue. The infusion is stopped and the catheter removed, the limb elevated, and the site monitored. Redness, warmth and a palpable cord along the vein indicate phlebitis instead. Flushing or increasing the rate would worsen tissue injury.
52. Before administering digoxin to an adult client, the nurse should take which action?
- A. Count the apical pulse for one full minute and withhold the dose if it is below 60 beats per minute
- B. Check the radial pulse for 15 seconds and multiply by four
- C. Withhold the dose if the blood pressure is above 140/90
- D. Administer the dose regardless of heart rate and document the rate afterward
Show answer & explanation
Answer: A
Digoxin slows conduction and heart rate, so an apical pulse counted for a full minute is taken before each dose and the dose is withheld and the provider notified for a rate below 60 in an adult. Early toxicity signs include anorexia, nausea, visual disturbances such as halos, and dysrhythmias, and hypokalemia increases toxicity risk.
53. A client receiving warfarin asks about diet. Which instruction is correct?
- A. Maintain a consistent intake of vitamin K-containing foods rather than eliminating them
- B. Eliminate all green leafy vegetables permanently
- C. Increase green leafy vegetables to enhance the medication's effect
- D. Diet has no effect on warfarin therapy
Show answer & explanation
Answer: A
Vitamin K antagonizes warfarin, so wide swings in intake destabilize the INR. Consistency, not elimination, is the instruction. Warfarin therapy is monitored by prothrombin time and INR, and vitamin K is the antidote for excessive anticoagulation, in contrast to heparin which is monitored by aPTT and reversed with protamine sulfate.
54. A provider prescribes 500 mg of a medication. The available supply is 250 mg per tablet. How many tablets should the nurse administer?
- A. 2 tablets
- B. 1 tablet
- C. 0.5 tablet
- D. 4 tablets
Show answer & explanation
Answer: A
Use desired over available: 500 mg desired divided by 250 mg per tablet equals 2 tablets. Dosage calculations should always be checked against a reasonableness estimate, and any result requiring an unusual number of tablets or an unexpectedly large volume should prompt verification of the order before administration.
55. A nurse is administering an oral medication that is enteric coated. Which action is appropriate?
- A. Administer the tablet whole without crushing or splitting it
- B. Crush the tablet and mix it with applesauce for easier swallowing
- C. Dissolve the tablet in warm water before administration
- D. Split the tablet in half to reduce gastric irritation
Show answer & explanation
Answer: A
Enteric coatings protect the drug from gastric acid or protect the stomach from the drug, and destroying the coating can inactivate the medication or cause gastric injury. The same rule applies to sustained- and extended-release forms, where crushing releases the full dose at once and can produce toxicity.
56. A client is to receive 1,000 mL of intravenous fluid over 8 hours using tubing with a drop factor of 15 drops per mL. What is the flow rate in drops per minute?
- A. 31 drops per minute
- B. 21 drops per minute
- C. 42 drops per minute
- D. 125 drops per minute
Show answer & explanation
Answer: A
Total volume times drop factor divided by total minutes: 1,000 times 15 equals 15,000, divided by 480 minutes equals 31.25, rounded to 31 drops per minute. Note that 125 is the hourly volume in mL, a common distractor that confuses the pump rate in mL per hour with a gravity drip rate.
57. A client receiving intravenous vancomycin develops flushing, redness, and itching of the face, neck, and upper torso during the infusion. Which nursing action is most appropriate?
- A. Slow the infusion rate and notify the provider, as this may indicate red man syndrome related to rapid infusion.
- B. Stop all future doses of the medication permanently without provider notification.
- C. Increase the infusion rate to complete the dose more quickly.
- D. Administer a second dose immediately to compensate for the reaction.
Show answer & explanation
Answer: A
Red man syndrome is a histamine-mediated reaction associated with rapid vancomycin infusion rather than a true allergy, so slowing the infusion rate and notifying the provider is the appropriate response, whereas increasing the rate would worsen the reaction, and permanently discontinuing the medication without provider input is not the nurse's independent decision to make.
58. Shortly after a blood transfusion is started, a client reports lower back pain, chills, and dark urine, and the nurse notes a temperature increase. Which nursing action is the priority?
- A. Stop the transfusion immediately, keep the IV line open with normal saline, and notify the provider.
- B. Document the findings and reassess in 30 minutes.
- C. Slow the transfusion rate and continue monitoring.
- D. Administer an antipyretic and continue the transfusion.
Show answer & explanation
Answer: A
These symptoms suggest an acute hemolytic transfusion reaction, a life-threatening emergency requiring the nurse to stop the transfusion immediately, maintain intravenous access with normal saline, and notify the provider promptly, rather than slowing the infusion, treating symptoms while continuing the transfusion, or delaying the response.
59. A nurse is reinforcing teaching for a client newly prescribed an oral corticosteroid for a short-term inflammatory condition. Which instruction is most important?
- A. Stop the medication immediately once symptoms improve.
- B. Do not stop the medication abruptly; the dose must be tapered as directed by the provider.
- C. Double the dose if a dose is missed.
- D. Take the medication on an empty stomach to increase absorption.
Show answer & explanation
Answer: B
Abrupt discontinuation of corticosteroids can cause adrenal insufficiency because the body's natural cortisol production is suppressed during therapy, so the dose must be gradually tapered under provider guidance, whereas stopping suddenly, doubling missed doses, or taking the medication on an empty stomach (which can increase gastrointestinal irritation) are inappropriate instructions.
60. A client is prescribed a beta-blocker for hypertension. Which assessment finding should prompt the nurse to hold the medication and notify the provider?
- A. Blood pressure of 128/78 mm Hg.
- B. Heart rate of 72 beats per minute.
- C. Heart rate of 48 beats per minute with dizziness.
- D. Respiratory rate of 16 breaths per minute.
Show answer & explanation
Answer: C
Beta-blockers slow heart rate and can cause symptomatic bradycardia, so a heart rate of 48 beats per minute accompanied by dizziness indicates the medication should be held and the provider notified, whereas a normal blood pressure, a heart rate within normal limits, and a normal respiratory rate do not indicate a need to withhold the dose.

Health Promotion and Maintenance

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61. A nurse is teaching an adult client about recommended health screening. Which statement reflects appropriate general guidance?
- A. Screening recommendations depend on age, sex, personal and family history, and should be individualized with the provider
- B. All adults require identical screening tests on the same schedule
- C. Screening is unnecessary for anyone without symptoms
- D. Family history has no bearing on screening timing
Show answer & explanation
Answer: A
Preventive screening is risk stratified: age, sex, personal history, family history and risk behaviors all shift what is recommended and when it begins. The purpose of screening is precisely to detect disease before symptoms appear, so the absence of symptoms is not a reason to defer it.
62. A nurse is reinforcing teaching about a low-sodium diet for a client with hypertension. Which food choice indicates the teaching was effective?
- A. Fresh baked chicken breast with herbs
- B. Canned soup with crackers
- C. Processed deli turkey sandwich
- D. Cured ham with pickles
Show answer & explanation
Answer: A
Fresh, unprocessed foods seasoned with herbs and spices instead of salt are the foundation of sodium restriction. Canned soups, cured and processed meats, pickled foods and most convenience products carry very high sodium loads, and clients should be taught to read nutrition labels for sodium content per serving.
63. A nurse is assessing an infant at a well-child visit. Which finding requires further evaluation?
- A. An anterior fontanel that is bulging and tense while the infant is calm and upright
- B. An anterior fontanel that is soft and flat
- C. A posterior fontanel that has closed by two months of age
- D. An infant who tracks a face across the midline
Show answer & explanation
Answer: A
A bulging, tense fontanel in a calm upright infant suggests increased intracranial pressure and requires prompt evaluation, while a sunken fontanel suggests dehydration. A soft flat fontanel is normal, the posterior fontanel typically closes by about two months, and tracking a face is an expected developmental finding.
64. A nurse is reinforcing discharge teaching for an older adult client at risk for falls at home. Which instruction is most appropriate?
- A. Remove loose throw rugs, improve lighting, and install grab bars in the bathroom
- B. Wear loose backless slippers for comfort when walking
- C. Keep the home dimly lit at night to promote sleep
- D. Rise quickly from bed to avoid dizziness
Show answer & explanation
Answer: A
Environmental modification is the core of home fall prevention: eliminating trip hazards, adding lighting and night lights, and installing grab bars and handrails. Footwear should be well fitting with non-skid soles, and clients should rise slowly in stages to reduce orthostatic hypotension rather than quickly.
65. A nurse is reinforcing teaching with a pregnant client in the first trimester about nutrition. Which supplement is most important for preventing neural tube defects?
- A. Folic acid
- B. Vitamin E
- C. Vitamin K
- D. Magnesium
Show answer & explanation
Answer: A
Adequate folic acid before conception and during early pregnancy substantially reduces the risk of neural tube defects, which is why supplementation is recommended for people who may become pregnant. Iron and calcium also matter in pregnancy, but neither addresses neural tube closure, which occurs very early in gestation.
66. A nurse is reinforcing safe sleep teaching with the parents of a one-month-old infant. Which parent statement indicates correct understanding?
- A. "I will place my baby on his back in the crib on a firm mattress with no loose blankets."
- B. "A soft bumper pad will keep my baby from bumping the crib rails."
- C. "Sleeping on his stomach will help my baby avoid choking."
- D. "My baby can sleep in our bed so I can hear him breathing."
Show answer & explanation
Answer: A
Supine positioning on a firm, bare sleep surface is the practice shown to reduce the risk of sudden unexpected infant death. Padded bumpers and loose soft items create suffocation and entrapment hazards, prone sleeping raises rather than lowers risk and does not prevent choking in healthy infants, and adult bed-sharing exposes the infant to overlay and soft bedding dangers even with attentive parents.
67. A perimenopausal client tells the nurse she is worried because she suddenly feels intense warmth and flushing several times a day. Which response by the nurse is most appropriate?
- A. "Those symptoms usually indicate a thyroid tumor and need urgent testing."
- B. "You should avoid all physical activity until the episodes stop."
- C. "Hot flashes are a common response to changing hormone levels; dressing in layers and avoiding triggers like caffeine can help."
- D. "These episodes mean menopause is complete and your periods will stop this month."
Show answer & explanation
Answer: C
Vasomotor hot flashes are an expected response to declining estrogen during the menopausal transition, and practical measures such as layered clothing, cool environments, and avoiding personal triggers reduce their impact. Framing the symptom as a probable tumor causes needless alarm, activity restriction has no basis, and hot flashes often begin well before menstruation ceases, so predicting immediate cessation is inaccurate.
68. A nurse is reinforcing teaching with a first-time mother who is breastfeeding her two-day-old newborn. Which statement by the mother indicates understanding of newborn feeding patterns?
- A. "I should wake the baby only twice during the night to nurse."
- B. "My baby should nurse about four times in twenty-four hours."
- C. "I will give water between feedings so the baby stays hydrated."
- D. "My baby will likely nurse eight to twelve times in twenty-four hours in these early weeks."
Show answer & explanation
Answer: D
Newborns have small stomachs and breast milk digests quickly, so frequent feeding of roughly eight to twelve sessions per day establishes supply and supports weight gain. Limiting night feedings or expecting only four daily feedings risks underfeeding and poor milk production, and supplemental water is unnecessary and can displace nutrient intake while stressing an immature renal system.
69. The parent of a two-year-old expresses concern that the child plays beside other toddlers without interacting with them. How should the nurse respond?
- A. Suggest a developmental evaluation for delayed social skills
- B. Explain that playing alongside, but not with, other children is expected at this age
- C. Recommend enrolling the child in a structured team activity
- D. Advise limiting playdates until the child initiates sharing
Show answer & explanation
Answer: B
Toddlers characteristically engage in parallel play, absorbing themselves in similar activities next to peers without true cooperative interaction, so the observation reflects normal development. Recommending an evaluation pathologizes an expected stage, structured team play is beyond toddler capability, and restricting peer exposure would remove the very opportunities through which cooperative play later emerges.
70. A nurse is reinforcing car safety teaching with the parents of a healthy newborn being discharged. Which instruction is correct?
- A. Position the car seat forward-facing so the infant can be seen in the mirror
- B. Hold the infant in a parent's lap for short trips home from the hospital
- C. Secure the infant in a rear-facing car seat installed in the back seat
- D. Place the rear-facing car seat in the front passenger seat near the airbag
Show answer & explanation
Answer: C
Infants ride rear-facing in the back seat because that orientation cradles the head, neck, and spine in a crash and keeps the child away from front airbag deployment forces. Forward-facing seats expose an infant's heavy head and weak neck to dangerous flexion, lap-holding offers no restraint at any speed, and a front-seat placement puts the infant directly in the path of an inflating airbag.
71. A 16-year-old arrives for a sports physical accompanied by a parent. When gathering information about risk behaviors such as substance use and sexual activity, which approach should the nurse use?
- A. Interview the adolescent privately after asking the parent to step out
- B. Direct all sensitive questions to the parent to verify accuracy
- C. Skip risk-behavior questions to avoid embarrassing the adolescent
- D. Have the adolescent complete the questions in writing while the parent watches
Show answer & explanation
Answer: A
Adolescents disclose risk behaviors far more honestly when interviewed confidentially, so a private conversation with clear limits of confidentiality is the standard approach. Routing questions through the parent yields secondhand and often inaccurate information, omitting the screening abandons an essential part of adolescent preventive care, and written answers under parental observation are no more private than spoken ones.
72. During a wellness visit, a 70-year-old client asks the nurse which vaccination should be repeated every year. Which response is correct?
- A. Pneumococcal vaccine
- B. Influenza vaccine
- C. Zoster vaccine
- D. Tetanus booster
Show answer & explanation
Answer: B
Influenza vaccination is repeated annually because circulating strains change from season to season and older adults face high risk of serious flu complications. Pneumococcal and zoster vaccines are given as limited series rather than yearly, and tetanus boosters are spaced at multi-year intervals, so none of those products requires annual repetition.

Basic Care and Comfort

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73. A nurse is repositioning a client who is at risk for pressure injury. How often should a bedbound client generally be repositioned?
- A. At least every two hours, with the schedule individualized to skin assessment findings
- B. Once per shift
- C. Every eight hours
- D. Only when the client requests a change
Show answer & explanation
Answer: A
Repositioning at least every two hours relieves capillary-occluding pressure over bony prominences, and the interval is shortened if skin shows non-blanchable erythema. Care also includes pressure redistribution surfaces, keeping skin clean and dry, avoiding friction and shear by lifting rather than dragging, and adequate nutrition and hydration.
74. A client with dysphagia following a stroke is being assisted with a meal. Which nursing action promotes safe swallowing?
- A. Position the client upright at 90 degrees and instruct a chin-tuck while swallowing
- B. Have the client recline to 30 degrees to slow the passage of food
- C. Offer thin liquids through a straw to ease intake
- D. Encourage the client to tilt the head back when swallowing
Show answer & explanation
Answer: A
Upright positioning with a chin tuck narrows the airway entrance and directs the bolus toward the esophagus. Thin liquids are the most difficult to control and are often thickened for dysphagia, straws can deliver a bolus too quickly, and head extension opens the airway and increases aspiration risk.
75. A client reports constipation. Which nursing recommendation is most appropriate as an initial measure?
- A. Increase dietary fiber and fluid intake and encourage regular physical activity
- B. Begin daily enemas to establish a routine
- C. Restrict fluids to firm the stool
- D. Encourage prolonged bed rest
Show answer & explanation
Answer: A
First-line management is non-pharmacologic: fiber, adequate fluid, activity and responding promptly to the urge to defecate. Fiber without sufficient fluid can worsen constipation. Routine enema use promotes dependence and can injure the mucosa, and immobility slows peristalsis further.
76. A nurse is assessing a pressure injury and finds partial-thickness skin loss with exposed dermis presenting as a shallow open ulcer with a red-pink wound bed and no slough. How is this staged?
- A. Stage 2
- B. Stage 1
- C. Stage 3
- D. Unstageable
Show answer & explanation
Answer: A
Stage 2 is partial-thickness loss of skin with exposed dermis, appearing as a shallow open ulcer or intact serum-filled blister. Stage 1 is intact skin with non-blanchable erythema. Stage 3 involves full-thickness loss with visible fat, and an injury covered by slough or eschar obscuring the base is unstageable until debrided.
77. A client is prescribed knee-high antiembolism stockings. Which instruction should the nurse reinforce about their use?
- A. Put the stockings on after walking around in the morning
- B. Roll the tops down if they feel snug behind the knee
- C. Fold a pillow under the knees to keep the stockings smooth
- D. Apply the stockings before getting out of bed in the morning, and smooth out any wrinkles
Show answer & explanation
Answer: D
Antiembolism stockings go on before rising, while leg veins are least distended, so the compression can prevent rather than chase venous pooling; wrinkles are smoothed because creases create pressure ridges that damage skin. Applying after ambulation traps blood already pooled in the legs, rolled-down tops form a constricting band that impedes return flow, and pillows pressed behind the knees compress the popliteal vessels.
78. An older adult client reports difficulty falling asleep in the hospital and asks what might help without taking a sleeping pill. Which suggestion by the nurse is most appropriate?
- A. Watch television in bed until drowsiness sets in
- B. Take a long nap in the late afternoon to reduce exhaustion
- C. Follow a consistent bedtime routine and avoid caffeine in the evening
- D. Do vigorous exercises in bed right before turning off the light
Show answer & explanation
Answer: C
A regular pre-sleep routine cues the body for rest, and eliminating evening caffeine removes a common chemical barrier to sleep onset, making this the soundest nonpharmacologic advice. Screen stimulation in bed delays drowsiness and weakens the bed-sleep association, late-day napping reduces nighttime sleep pressure, and vigorous exercise immediately before lights-out raises arousal instead of settling it.
79. A nurse is reinforcing teaching for a client who will use a cane because of right-leg weakness after a stroke. Which instruction is correct?
- A. Hold the cane on the right side and move it together with the left leg
- B. Hold the cane in whichever hand feels stronger that day
- C. Hold the cane on the left side and move it forward together with the right leg
- D. Keep the cane tip about two feet ahead of the body when stepping
Show answer & explanation
Answer: C
The cane belongs in the hand opposite the weak leg and advances with that weak leg, widening the base of support and shifting load away from the affected side; with right-leg weakness, that means the left hand. Carrying the cane on the weak side or switching hands arbitrarily destabilizes gait, and planting the tip far ahead of the body pulls the center of gravity forward and invites a fall.
80. A nurse is preparing to provide oral care for an unconscious client. Which action is essential for this client's safety?
- A. Elevate the head of the bed to high Fowler position with the head midline
- B. Position the client side-lying with the head turned toward the mattress and keep suction available
- C. Give small sips of water afterward to rinse the mouth
- D. Place two fingers between the client's teeth to keep the mouth open
Show answer & explanation
Answer: B
An unconscious client cannot protect the airway, so a side-lying position lets fluid drain out by gravity while suction stands ready to clear secretions, which is the core aspiration safeguard. Upright midline positioning still allows fluid to pool over the airway of a client who cannot swallow, offering sips of water to an unconscious person guarantees aspiration, and inserting fingers between the teeth risks a serious bite injury.
81. A client using crutches after left ankle surgery, with no weight bearing allowed on the left leg, asks how to climb the stairs at home. Which instruction should the nurse reinforce?
- A. Lead with the crutches, letting both feet follow together
- B. Step up first with the right leg, then bring the crutches and left leg up to the same step
- C. Step up first with the left leg to strengthen it gradually
- D. Face sideways and hop up each step holding only the railing
Show answer & explanation
Answer: B
Ascending stairs, the unaffected leg leads because it must lift the body's weight, and the crutches with the affected leg follow to the same step. Leading with the crutches or with the injured leg forces the weak or non-weight-bearing limb to do the lifting, violating restrictions and risking a fall, and sideways hopping without crutch support sacrifices the stability the devices are meant to provide.
82. A nurse is preparing to assist a client who is blind with a meal tray. Which intervention best supports the client's independence?
- A. Describe the location of foods on the plate using the positions of a clock face
- B. Feed the client each bite to prevent spills
- C. Ask the dietary department to send only liquids that are easy to manage
- D. Arrange for a family member to be present at every meal
Show answer & explanation
Answer: A
Orienting the client to the plate with clock positions gives a mental map that allows independent, dignified self-feeding. Spoon-feeding a capable adult strips autonomy and implies helplessness, restricting the diet to liquids sacrifices nutrition and choice for staff convenience, and requiring family presence at each meal builds dependence on others instead of on the client's own skills.
83. A nurse is applying sequential compression devices to a postoperative client's legs. Which action is appropriate?
- A. Apply the sleeves only when the client reports calf pain
- B. Keep the sleeves inflated continuously during ambulation in the hallway
- C. Fasten the sleeves as tightly as possible to maximize compression
- D. Verify a proper fit that allows about two fingers between the sleeve and the leg, and remove the sleeves periodically to inspect the skin
Show answer & explanation
Answer: D
Correct sequential compression use requires a snug but not constrictive fit, commonly checked by sliding two fingers beneath the sleeve, plus scheduled removal for skin assessment and hygiene. New calf pain suggests possible thrombosis and calls for assessment rather than compression, the devices are disconnected for walking because tubing creates a trip hazard, and overtightening impairs the very circulation the device is meant to support.
84. A provider directs warm moist compresses to a client's leg. Which nursing action reflects safe application of heat?
- A. Leave the compress in place for an hour to maximize effect
- B. Apply the compress directly to the skin at the hottest tolerable temperature
- C. Ask the client to report warmth, since redness is the goal
- D. Check the temperature, protect the skin with a barrier, limit the application to about twenty minutes, and inspect the skin during use
Show answer & explanation
Answer: D
Safe heat therapy pairs a verified moderate temperature and a protective layer with a time limit of roughly twenty minutes and periodic skin checks, because vasodilation reverses and burn risk climbs with prolonged exposure. Hour-long application invites tissue injury, maximal heat directly on skin can burn quickly, and treating redness as the goal ignores that persistent erythema is an early warning of thermal damage.

Reduction of Risk Potential

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85. A client is scheduled for surgery and reports taking a daily aspirin. What is the significance of this information?
- A. It increases bleeding risk and must be communicated to the surgical team
- B. It has no bearing on surgical risk
- C. It reduces the need for postoperative pain medication
- D. It eliminates the need for deep vein thrombosis prophylaxis
Show answer & explanation
Answer: A
Aspirin irreversibly inhibits platelet aggregation for the life of the platelet, raising perioperative bleeding risk, and the surgical team decides whether and when to hold it. Herbal supplements including ginkgo, garlic and ginseng also affect bleeding, which is why a complete medication and supplement history is taken preoperatively.
86. A postoperative client is reluctant to move because of incisional pain. Which intervention best reduces the risk of postoperative pneumonia?
- A. Medicate for pain, then encourage deep breathing, coughing and use of an incentive spirometer
- B. Maintain strict bed rest until the incision is fully healed
- C. Restrict fluids to reduce pulmonary secretions
- D. Administer oxygen continuously in place of breathing exercises
Show answer & explanation
Answer: A
Atelectasis from shallow breathing is the precursor to postoperative pneumonia, so lung expansion is the target. Managing pain first makes the exercises effective, and splinting the incision with a pillow reduces discomfort. Early ambulation and adequate hydration to thin secretions support the same goal; prolonged bed rest works against it.
87. A client's serum potassium level is reported as 6.2 mEq/L. Which assessment is the nurse's priority?
- A. Cardiac rhythm, because hyperkalemia can cause life-threatening dysrhythmias
- B. Skin turgor and mucous membranes
- C. Bowel sounds in all four quadrants
- D. Pupillary response to light
Show answer & explanation
Answer: A
The normal potassium range is roughly 3.5 to 5.0 mEq/L, and a level of 6.2 is significant hyperkalemia that can produce peaked T waves, widened QRS and cardiac arrest. Cardiac monitoring is the priority. Muscle weakness and gastrointestinal symptoms also occur but are not the immediately life-threatening manifestation.
88. A nurse is verifying nasogastric tube placement before administering a feeding. Which method is most reliable?
- A. Radiographic confirmation, which is the standard for initial placement verification
- B. Auscultating over the epigastrium while injecting air
- C. Asking the client whether they feel the tube in the stomach
- D. Observing for the absence of coughing
Show answer & explanation
Answer: A
X-ray is the reference standard for initial placement. The air auscultation method is unreliable because sound transmits from the lung as well as the stomach and has led to feedings into the airway. Ongoing checks use measurement of the external tube length and aspirate pH, with a low pH consistent with gastric placement.
89. A nurse is monitoring a client after a cardiac catheterization via the femoral artery. Which finding requires immediate action?
- A. Absent pedal pulse in the affected extremity
- B. Client reports mild discomfort at the insertion site
- C. Blood pressure of 118/74
- D. Client requests to change position slightly in bed
Show answer & explanation
Answer: A
Loss of a distal pulse suggests arterial occlusion or compromised perfusion in the catheterized limb and demands immediate provider notification. Post-procedure monitoring focuses on distal circulation, sensation and movement, bleeding or hematoma at the site, and keeping the extremity straight during the prescribed bed rest period.
90. A nurse is performing tracheostomy suctioning. Which technique is correct?
- A. Apply suction only while withdrawing the catheter, limiting each pass to about 10 to 15 seconds
- B. Apply continuous suction during both insertion and withdrawal
- C. Suction for at least 30 seconds per pass to clear all secretions
- D. Instill saline routinely before each suction pass
Show answer & explanation
Answer: A
Suction is applied only on withdrawal and each pass is brief, because suctioning removes oxygen along with secretions and can cause hypoxemia, bradycardia and mucosal trauma. The client is hyperoxygenated before and between passes. Routine saline instillation is not recommended and can push organisms into the lower airway.
91. A client receiving intravenous heparin has a partial thromboplastin time (PTT) reported as significantly elevated above the therapeutic range. Which nursing action is the priority?
- A. Increase the heparin infusion rate to reach therapeutic effect faster.
- B. Administer an extra dose of heparin to compensate.
- C. Notify the provider and prepare to hold or adjust the infusion per protocol while monitoring for bleeding.
- D. Continue the current rate without any change since PTT naturally fluctuates.
Show answer & explanation
Answer: C
A PTT significantly above therapeutic range indicates an increased bleeding risk, so the nurse should notify the provider and prepare to hold or adjust the infusion according to protocol while closely monitoring for signs of bleeding, rather than increasing the dose, which would further elevate bleeding risk, or ignoring a clinically significant lab result.
92. Six hours after a total knee replacement, a client reports sudden shortness of breath, pleuritic chest pain, and anxiety, with an oxygen saturation of 88%. Which complication should the nurse suspect?
- A. Postoperative pneumonia
- B. Normal postoperative pain response
- C. Pulmonary embolism
- D. Anxiety attack unrelated to the surgery
Show answer & explanation
Answer: C
Sudden onset of dyspnea, pleuritic chest pain, and hypoxia following a major orthopedic procedure such as knee replacement is a classic presentation of pulmonary embolism due to the high risk of venous thromboembolism after lower extremity surgery, and this presentation is inconsistent with pneumonia, which typically develops more gradually, or a simple anxiety attack, which would not explain the hypoxia.
93. A nurse is completing a preoperative assessment for a client scheduled for surgery under general anesthesia. Which finding is most important to report to the anesthesia provider before the procedure?
- A. The client reports a loose tooth and wears a partial denture.
- B. The client's stated preference for a warm blanket in the operating room.
- C. The client's shoe size for postoperative footwear.
- D. The client's preferred visiting hours for family after surgery.
Show answer & explanation
Answer: A
Loose teeth and dental appliances pose a risk of dislodgement and airway obstruction during intubation for general anesthesia, so this finding must be reported to the anesthesia provider before the procedure, whereas blanket preference, shoe size, and visiting hour preferences are not clinically relevant to anesthesia safety.
94. A client is receiving chemotherapy and the nurse notes an absolute neutrophil count indicating neutropenia. Which instruction is most important for the nurse to reinforce?
- A. Increase intake of fresh, unwashed fruits and vegetables for nutrition.
- B. Avoid hand hygiene since neutropenic clients are already protected.
- C. Discontinue all visitors' use of masks since the client is not contagious.
- D. Avoid crowds and people who are ill, and report fever immediately.
Show answer & explanation
Answer: D
Neutropenia significantly increases infection risk, so avoiding exposure to illness and crowds, along with prompt reporting of fever as a possible sign of infection, are priority safety measures, whereas unwashed produce can carry pathogens, hand hygiene remains essential regardless of neutropenia, and masking for visitors may still be appropriate per facility protocol.
95. A client is scheduled for a diagnostic procedure requiring intravenous contrast dye. Which question is most important for the nurse to ask before the procedure?
- A. "Do you have any known allergies to iodine, shellfish, or previous contrast dye reactions?"
- B. "Have you eaten breakfast today?"
- C. "Do you have any tattoos?"
- D. "Do you prefer a warm or cool room temperature?"
Show answer & explanation
Answer: A
Screening for allergies to iodine, shellfish, or prior contrast reactions is essential before administering contrast dye because these clients are at higher risk for an allergic or anaphylactic reaction, which is a critical safety consideration that outweighs other unrelated preprocedure questions.

Safe and Effective Care

5 questions

96. A test-taker answers the minimum number of NCLEX-PN questions and finishes with time to spare. What is the maximum amount of time still theoretically available for a session under the exam's rules, regardless of how many questions were answered?
- A. Up to 300 minutes
- B. Up to 240 minutes
- C. Up to 360 minutes
- D. Exactly 85 minutes
Show answer & explanation
Answer: A
The maximum testing window is 300 minutes (5 hours) and applies to the session as a whole, independent of whether the candidate answers the minimum of 85 or the maximum of 150 questions.
97. During the NCLEX-PN, the number of items a candidate answers can vary from one test-taker to another. Which range represents the possible number of questions?
- A. 75 to 145 questions
- B. 85 to 150 questions
- C. 100 to 200 questions
- D. A fixed 120 questions for everyone
Show answer & explanation
Answer: B
The NCLEX-PN administers between 85 and 150 questions. The count varies by candidate, so a shorter or longer test does not by itself indicate a pass or fail.
98. A nurse identifies a recurring pattern of near-miss medication errors on the unit related to look-alike drug labeling. Which action best reflects a systems-based approach to quality improvement?
- A. Report the pattern through the facility's safety event reporting system to initiate a system-level review.
- B. Remind individual nurses to be more careful when administering medications.
- C. Discipline the nurses involved in the most recent near-miss.
- D. Ignore the pattern since no actual harm occurred.
Show answer & explanation
Answer: A
A systems-based quality improvement approach focuses on identifying and correcting underlying process or environmental factors, such as look-alike labeling, through formal event reporting, rather than placing blame solely on individual nurses, which does not address the root cause and allows the hazard to persist.
99. A nurse is planning care for several clients at the start of a shift. Which framework should guide the nurse in prioritizing which client to assess first?
- A. The order in which clients were admitted to the unit.
- B. The client closest to the nurses' station.
- C. The urgency of each client's physiological and safety needs, using an approach such as Maslow's hierarchy or the ABC (airway, breathing, circulation) principle.
- D. The client who has been waiting longest for the nurse's attention.
Show answer & explanation
Answer: C
Prioritization in nursing practice is grounded in identifying the most urgent physiological and safety threats first, using frameworks like Maslow's hierarchy of needs and the ABC approach, rather than arbitrary factors such as admission order, room location, or wait time, which do not reflect clinical acuity.
100. A nurse questions whether a facility policy is still aligned with current evidence-based guidelines after reading a newly published clinical practice update. Which action best reflects the nurse's responsibility to safe, effective care?
- A. Ignore the new guideline since policies are rarely updated.
- B. Bring the updated evidence to the appropriate committee or nurse manager for review of the current policy.
- C. Independently change personal practice without informing the team.
- D. Wait for a sentinel event before considering a policy change.
Show answer & explanation
Answer: B
Nurses share responsibility for evidence-based practice, so bringing new findings to the appropriate committee or manager allows organized, safe policy review that benefits all clients, whereas ignoring the evidence, quietly deviating from policy alone, or waiting for harm to occur before acting fails this professional responsibility.

Showing 100 of 159 questions.

Key facts: NCLEX-PN exam

Questions: Up to 150
Time limit: 5h
Passing score: Pass/Fail (CAT, 85-150 items)
Exam fee: $200
Governing body: NCSBN

This free NCLEX-PN practice test has 159 original questions written from NCSBN's official sources, last checked against them on September 9, 2026, 100 of them listed on this page and the rest loaded by the drill. Every question shows a worked explanation, and nothing here requires a signup.

The questions are grouped under nine outline areas: Safe and Effective Care, Psychosocial Integrity, Physiological Adaptation, Management of Care, Pharmacological and Parenteral Therapies, Safety and Infection Control, Health Promotion and Maintenance, Reduction of Risk Potential and Basic Care and Comfort.

As of 2026, the NCLEX-PN exam fee is $200.

How the NCLEX-PN practice bank covers the outline

Psychosocial Integrity33 · 21%

Management of Care25 · 16%

Safety and Infection Control20 · 13%

Physiological Adaptation17 · 11%

Pharmacological and Parenteral Therapies16 · 10%

Health Promotion and Maintenance15 · 9%

Basic Care and Comfort14 · 9%

Reduction of Risk Potential14 · 9%

Safe and Effective Care5 · 3%

Counts are the live question bank, grouped by the outline area each question was written to.

159 practice questions across nine outline areas. The largest, Psychosocial Integrity, holds 33 questions (21%).

About these practice questions

Written by Every Exam Prep Editorial TeamSource and review policy

Verified against NCSBN's official sources September 9, 2026

These are original study questions written from published exam objectives—not recalled, copied, or confidential live-exam items. Always confirm current coverage with the official sources linked on this page.

Exam format and study resources

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Official sources

The official documents our facts about this exam are taken from.

Occupational Employment and Wage Statistics, May 2025 — Licensed Practical and Licensed Vocational Nurses (SOC 29-2061)U.S. Bureau of Labor Statisticsbls.goveffective May 31, 2025
NCLEX Fees & PaymentNCSBNnclex.com
NCLEX-PN OverviewNCSBNncsbn.org
2025 NCLEX Examination Statistics, June 2026NCSBNncsbn.org
NCLEX SchedulingNCSBNnclex.com
NCLEX Exam Publications (Test Plans)NCSBNncsbn.org
NCLEX Frequently Asked QuestionsNCSBNnclex.com
NCLEX Computerized Adaptive Testing (CAT)NCSBNnclex.com
NCLEX Pass RatesNCSBNncsbn.org

Last verified against NCSBN's official sources: September 9, 2026

Frequently asked questions

Are these free NCLEX-PN practice questions like the real exam?

Yes — they are written to match the style and coverage of the real NCLEX-PN, including questions on safe care, pharmacology, infection control, and health promotion. Like the real exam, many questions ask you to prioritize or apply nursing judgment rather than just recall facts. The one difference is that the real test is computer-adaptive, so it adjusts difficulty as you go.

How many practice questions should I do before test day?

Work through a large volume of practice questions spread over several weeks — daily consistency matters more than any single marathon session. Aim for a steady routine, such as a focused set of questions each day, and increase your volume as test day approaches. Quality of review matters as much as quantity, so never skip the explanations.

How should I use the answer explanations?

Read the explanation for every question, including the ones you got right. Understanding why the correct answer is best — and why each distractor is wrong — is how you build the clinical judgment the NCLEX-PN actually tests. When you miss a question, note the underlying concept, not just the answer, and revisit that topic before moving on.

How do I know when I'm ready to sit for the NCLEX-PN?

You are likely ready when you consistently answer a strong majority of practice questions correctly across all topic areas, not just your favorites. Watch for steady performance on prioritization and delegation questions, since those reflect the judgment-level thinking the exam emphasizes. If one content area keeps dragging you down, target it with focused sets before booking your test date.

Are these NCLEX-PN practice questions really free? Do I need to sign up?

Yes, the practice questions are completely free, and you don't need to create an account or enter an email to use them. You can start practicing immediately, work through as many questions as you like, and come back anytime. There is no paywall partway through.