100 Free NCLEX-RN Practice Questions (AI-Generated)
The NCLEX pass rate for first-time US-educated candidates hit 91.2% in 2024, the highest it's been in over a decade. That sounds encouraging. What it actually means is that roughly 1 in 11 nursing graduates fails on the first attempt, and a significant portion of those students prepared the wrong way.
Most NCLEX practice resources hand you questions without teaching you to reason through them. The NCLEX doesn't care whether you can recite potassium's normal range. It wants to know what you do when your patient's potassium is 2.8 and they're on digoxin. That's the gap between recall and application.
These 100 questions are organized by the 2023 NCLEX-RN test plan categories, with the same distribution percentages NCSBN uses. Each question includes four options, the correct answer, and a rationale that explains not just why one answer is right, but why the others are wrong. That second part matters. Understanding why a distractor is tempting teaches you more than confirming the correct answer.
The research on practice testing is consistent. Roediger and Karpicke found in 2006 that students who tested themselves forgot 13% of material over a week, compared to 56% for students who simply re-studied. Dunlosky et al. reviewed 10 study techniques in 2013 and rated practice testing as one of only two with high utility. Reading your notes feels productive. Testing yourself is what actually works.
Use these questions actively. Cover the answer. Work through your reasoning. Then check. If you're wrong, don't just read the rationale and move on — ask yourself what assumption you made that led to the wrong answer. That's where the learning is.
If you want more practice beyond these 100, Quizgecko's AI quiz generator can turn your own notes, textbooks, and PDFs into NCLEX-style questions. You can also turn the same material into a flashcard deck for daily spaced-repetition review. Upload your pharmacology notes, generate a 30-question practice test, and work through it the same way.
Table of contents
- Management of Care — 20 questions (17–23% of exam)
- Safety and Infection Control — 12 questions (9–15% of exam)
- Health Promotion and Maintenance — 8 questions (6–12% of exam)
- Psychosocial Integrity — 10 questions (6–12% of exam)
- Basic Care and Comfort — 8 questions (6–12% of exam)
- Pharmacological and Parenteral Therapies — 18 questions (12–18% of exam)
- Reduction of Risk Potential — 12 questions (9–15% of exam)
- Physiological Adaptation — 12 questions (11–17% of exam)
Management of Care
Management of Care covers 17–23% of the NCLEX-RN — the largest single category. Questions focus on how you organize and prioritize care: who do you see first, what can you delegate, what requires a licensed nurse, and what ethical or legal obligations apply. A common mistake is confusing "stable but concerning" with "unstable." In prioritization questions, patients with new or changing symptoms take precedence over those with expected findings, even if those findings look dramatic.
Question 1
A nurse is caring for four patients. Which patient should the nurse assess first?
A. A 68-year-old post-op day 2 following hip replacement who reports pain of 5/10
B. A 45-year-old with COPD who has oxygen saturation of 91% on 2L/min (their baseline)
C. A 72-year-old admitted for pneumonia who becomes acutely confused and pulls out their IV
D. A 55-year-old with type 2 diabetes awaiting discharge instructions
Correct answer: C
Acute confusion is a new, changing symptom that could indicate hypoxia, sepsis, medication reaction, or worsening infection and requires immediate assessment. Option A describes expected post-surgical pain at a tolerable level. Option B is the patient's established baseline saturation, not a new change. Option D is stable and not time-sensitive.
Question 2
A patient scheduled for a right-sided mastectomy says, "I'm not sure I want to go through with this." The surgeon has already marked the site and the OR team is ready. What should the nurse do first?
A. Reassure the patient that the surgery is necessary and proceed with preparation
B. Contact the surgeon immediately
C. Ask the patient what their specific concerns are
D. Notify the charge nurse that the patient is refusing surgery
Correct answer: C
The nurse's first action is to understand what the patient is actually saying. "I'm not sure" could mean anxiety, a new question about alternatives, an actual change of heart, or something else. Jumping to notify the surgeon or charge nurse without first exploring the concern skips an important assessment step. Option A is inappropriate and potentially violates informed consent. Notifying others is appropriate but comes after the nurse has assessed the situation.
Question 3
A nurse overhears a family member in the hallway asking a nursing assistant for the results of their relative's recent lab work. The nursing assistant begins to answer. What should the nurse do?
A. Allow the nursing assistant to respond, since the family member is a direct relative
B. Interrupt politely and inform the family member that results will be shared by the nurse or provider
C. Document the exchange and report it to the charge nurse after the shift
D. Remind the nursing assistant later to be more careful about HIPAA
Correct answer: B
Lab result disclosure requires clinical interpretation and falls within licensed nursing scope. A nursing assistant should not share results regardless of the family relationship. Option A is incorrect because familial relationship doesn't determine who communicates clinical information. Options C and D don't address the ongoing exchange — it needs to be interrupted now.
Question 4
A charge nurse is assigning tasks for the upcoming shift. Which task is appropriate to delegate to a certified nursing assistant (CNA)?
A. Assessing a patient's bowel sounds after abdominal surgery
B. Teaching a patient with new-onset diabetes how to check blood glucose
C. Providing a bed bath to a stable patient with no skin breakdown
D. Adjusting the flow rate on a patient's IV infusion
Correct answer: C
CNAs can perform activities of daily living for stable patients, including bathing. Assessment (Option A), teaching (Option B), and IV management (Option D) require nursing judgment and fall within RN scope of practice. The common test-taking error is selecting any task that involves physical care as delegable — the key question is whether the task requires assessment or clinical decision-making.
Question 5
A patient with a terminal illness tells the nurse, "I have a living will that says no heroic measures, but my family wants everything done." The patient is currently competent. What should the nurse prioritize?
A. Contact the hospital's ethics committee
B. Facilitate a family meeting with the care team
C. Honor the patient's stated wishes as expressed in the living will
D. Follow the family's request since they are the legal decision-makers
Correct answer: C
A competent adult patient's advance directive reflects their autonomous wishes, and the nurse's role is to advocate for those wishes. A living will is legally valid and takes precedence over family preferences when the patient retains capacity. Option D is incorrect — family members become surrogate decision-makers only when the patient lacks capacity. Ethics consultation and family meetings may be helpful but are not the priority when the patient's wishes are already documented and clear.
Question 6
A nurse is preparing a patient for discharge after a myocardial infarction. Which information is most important to include in the discharge teaching?
A. The importance of avoiding all physical activity for 6 weeks
B. Signs and symptoms of a recurring MI and when to call 911
C. How to adjust their diet to include more protein
D. The timeline for returning to full-time work
Correct answer: B
Discharge teaching after MI must include recognition of warning signs (chest pain, shortness of breath, diaphoresis, radiation to jaw or arm) and the instruction to call 911, not drive or wait. Option A is incorrect — supervised, gradual activity resumption is part of cardiac rehab. Protein intake is not the priority over safety education. Return-to-work timelines depend on the individual and are discussed, but they are not the most critical piece.
Question 7
A nurse reviews orders for a patient with a documented penicillin allergy. The provider has ordered amoxicillin-clavulanate. What is the appropriate nursing action?
A. Administer the medication as ordered, since it is a newer formulation
B. Hold the medication and contact the prescriber to clarify the order
C. Administer the medication with epinephrine available at the bedside
D. Substitute a different antibiotic from the unit stock
Correct answer: B
Amoxicillin is a penicillin-type antibiotic. Administering it to a patient with a documented penicillin allergy requires clarification with the prescriber before proceeding. The nurse cannot substitute medications independently (D) or administer a potentially allergenic drug simply because the formulation is newer (A). Having epinephrine available (C) is not an appropriate substitute for verifying the order.
Question 8
A newly licensed nurse is caring for a patient and is unsure about the correct technique for a specific procedure. What is the most appropriate action?
A. Ask a more experienced nurse to take over the patient's care
B. Review the facility's policy and procedure manual before proceeding
C. Perform the procedure using their best judgment and document it
D. Call the provider for guidance on how to perform the procedure
Correct answer: B
When a nurse is uncertain about a procedure, the appropriate first step is to review the facility's established policy. Policies exist precisely for this situation. Option A is not necessary for knowledge gaps that can be resolved through standard resources. Option C is inappropriate if the nurse lacks competence — proceeding without verification risks patient harm. Option D is incorrect because facility procedures are not within the provider's scope to direct.
Question 9
A nurse is caring for a patient who speaks limited English. Which action best supports effective communication?
A. Speak slowly and loudly to improve comprehension
B. Ask the patient's adult child to interpret clinical information
C. Use a trained medical interpreter service
D. Use hand gestures and written notes to convey all information
Correct answer: C
Professional medical interpreter services ensure accuracy and protect patient privacy. Family members, even if bilingual, may not know medical terminology, may filter information, or may have their own emotional stake in the conversation. Option A is culturally inappropriate and unhelpful. Option D is insufficient for detailed clinical communication. When a trained interpreter is available, it is always the preferred option.
Question 10
A patient asks the nurse, "What are my chances of surviving this surgery?" The patient has been told they need emergency bypass surgery. Which response is most therapeutic?
A. "The surgeon has done hundreds of these successfully. You'll be fine."
B. "It's hard to say. Let's wait until after the surgery to discuss outcomes."
C. "That sounds like something you're worried about. Can you tell me more about what's on your mind?"
D. "Your survival depends on how healthy you were before this happened."
Correct answer: C
This response acknowledges the patient's emotional state, invites them to express their concerns more fully, and creates space for therapeutic communication. Option A offers false reassurance. Option B dismisses the patient's legitimate need to be heard. Option D, while potentially true, is blunt and not supportive — and statistical outcomes are not what the nurse should be discussing in this moment.
Question 11
A nurse is preparing to restrain an agitated patient. Which action should the nurse take first?
A. Apply the restraint and notify the provider within 1 hour
B. Try less restrictive alternatives to manage the patient's behavior
C. Obtain written informed consent from the patient
D. Check the restraint policy to confirm allowable restraint types
Correct answer: B
Restraints are a last resort. Before applying any restraint, the nurse must attempt less restrictive interventions: reorienting the patient, adjusting the environment, engaging the patient verbally, repositioning, offering toileting. If those fail and restraint is necessary, the provider's order must be obtained. Option A gets the order sequence partially right but skips trying alternatives. Option C is not required before applying a restraint in a safety emergency.
Question 12
A patient tells the nurse that the night shift nurse shared details about the patient in the next bed. What is the most appropriate nursing response?
A. Explain that nurses sometimes share patient information for coordination purposes
B. Apologize and document the patient's complaint in the chart
C. Acknowledge the patient's concern and report the incident to the charge nurse
D. Tell the patient that their neighbor's situation is not relevant to their care
Correct answer: C
Sharing another patient's information is a HIPAA violation. The nurse should validate the patient's concern and report the incident through proper channels. Option A minimizes a serious breach. Option B is insufficient — the incident should be escalated, not just documented in the chart. Option D is dismissive.
Question 13
A nurse receives an order for morphine 4 mg IV for a patient in pain. The medication is available as morphine 10 mg/mL. How many mL should the nurse administer?
A. 0.2 mL
B. 0.4 mL
C. 2.5 mL
D. 4.0 mL
Correct answer: B
Desired ÷ Available × Volume: 4 mg ÷ 10 mg × 1 mL = 0.4 mL. Option A (0.2 mL) would deliver 2 mg. Option C (2.5 mL) would deliver 25 mg — a dangerous overdose. Option D (4.0 mL) would deliver 40 mg. Calculation errors in opioid dosing are among the most dangerous medication errors in practice.
Question 14
A patient's family member insists on being present during a procedure the patient has explicitly asked to be private. What is the appropriate nursing action?
A. Allow the family member to stay to prevent conflict
B. Ask the family member to wait outside in accordance with the patient's request
C. Ask the patient to reconsider to avoid family tension
D. Let the provider decide who stays in the room
Correct answer: B
Patient autonomy includes the right to privacy during procedures. The nurse's obligation is to the patient. Option A violates the patient's expressed preference. Option C pressures the patient to compromise their own wishes. Option D delegates a straightforward nursing responsibility unnecessarily.
Question 15
A postpartum patient refuses to let nursing staff bathe her newborn before a specific family ceremony, stating it is against their cultural practice. What is the most appropriate response?
A. Explain that bathing is required for infection prevention and must occur before discharge
B. Document the refusal and proceed with the bath after the patient falls asleep
C. Acknowledge the patient's preference and discuss alternative infection prevention measures
D. Contact the social worker to assess for potential neglect
Correct answer: C
Cultural competence means working with patients to find solutions that respect both their values and clinical needs. Current evidence actually supports delaying the first bath for at least 12–24 hours. Proceeding without consent (B) violates patient rights. Framing cultural practice as neglect (D) is inappropriate and harmful to the therapeutic relationship.
Question 16
A nurse feels overwhelmed and documents vital signs as "within normal limits" without taking them. A patient later deteriorates. What is the most accurate characterization of the nurse's actions?
A. Negligence
B. Malpractice
C. Battery
D. Assault
Correct answer: B
Malpractice is professional negligence — failure to meet the standard of care expected of a licensed professional, resulting in harm. Documenting false vital signs is a breach of professional duty that contributed to patient harm. Negligence (A) is a broader legal term; malpractice is the profession-specific version. Battery (C) involves unauthorized physical contact. Assault (D) involves threatened harm.
Question 17
A nurse is caring for a patient on contact precautions for MRSA. Before leaving the room, PPE should be removed in which order?
A. Mask, gown, gloves, hand hygiene
B. Gloves, hand hygiene, gown, mask, hand hygiene
C. Gown, gloves, mask, hand hygiene
D. Gloves, gown, mask/eyewear, hand hygiene
Correct answer: D
The CDC-recommended order is: gloves first (most contaminated), then gown, then mask/eyewear, then hand hygiene. Gloves come off first because they have the most direct contact with the patient and environment. Option B inserts a hand hygiene step in the middle, which is not the standard sequence.
Question 18
A nurse is assigned to five patients. Which patient should be assessed last?
A. A 60-year-old with heart failure who has gained 3 lbs overnight and has crackles in the lower lung bases
B. A 35-year-old post-op day 1 following appendectomy who rates pain as 3/10 and is waiting for breakfast
C. A 78-year-old with hip fracture who reports worsening pain and has a new change in level of consciousness
D. A 50-year-old with hypertension whose blood pressure is 158/96 and who is asymptomatic
Correct answer: B
The post-op day 1 patient with mild pain and no acute concerns is the most stable. Option C should be the priority — new change in level of consciousness in an elderly patient with a fracture is a red flag for fat embolism, medication reaction, or worsening injury. Option A shows signs of fluid overload that warrant early assessment. Option D has an elevated BP that needs monitoring, but the patient is asymptomatic.
Question 19
Which action by a new nurse should prompt the charge nurse to intervene?
A. Checking the five rights of medication administration before giving insulin
B. Asking a patient to verify their name and date of birth before a procedure
C. Discussing a patient's care plan in detail with their roommate's nurse
D. Reviewing the patient's medication allergies before administering a new medication
Correct answer: C
Discussing a patient's care with anyone not directly involved in that patient's care violates confidentiality, regardless of whether the other person is a nurse. Options A, B, and D all describe correct safety practice.
Question 20
A nurse suspects a colleague is impaired at work. What is the most appropriate first action?
A. Confront the colleague directly and tell them to go home
B. Wait until the end of the shift to see if the behavior continues
C. Report the suspicion to the charge nurse or supervisor immediately
D. Check the medication dispensing records for discrepancies before reporting
Correct answer: C
Patient safety requires immediate action when impairment is suspected. Reporting to the charge nurse is the appropriate step — it is not the individual nurse's role to investigate or confront. Option A may escalate the situation dangerously. Option B delays action while patients are potentially at risk. Option D may be part of an investigation but is not the nurse's first action.
Safety and Infection Control
Safety and Infection Control covers 9–15% of the NCLEX-RN. Know your precaution categories cold: droplet, airborne, and contact — and which conditions require each one. The most tested trap is confusing droplet with airborne precautions.
Question 21
A patient is admitted with suspected active pulmonary tuberculosis. Which type of precautions should the nurse implement?
A. Contact precautions with surgical mask
B. Droplet precautions with face shield
C. Airborne precautions with an N95 respirator
D. Standard precautions with gloves and gown
Correct answer: C
TB is transmitted by airborne droplet nuclei that remain suspended in air, requiring an N95 respirator and a negative-pressure room. Droplet precautions (B) apply to larger respiratory droplets — influenza, meningitis, pertussis — and a surgical mask is sufficient for those. Contact precautions (A) cover direct skin-to-skin or surface contact. Standard precautions alone (D) are insufficient.
Question 22
A patient is diagnosed with Clostridioides difficile (C. diff). Which precaution type and PPE should the nurse use?
A. Droplet precautions; surgical mask
B. Contact precautions; gown and gloves
C. Airborne precautions; N95 respirator
D. Contact precautions; gown, gloves, and N95 respirator
Correct answer: B
C. diff spreads by the fecal-oral route via spores on surfaces and requires contact precautions with gown and gloves. Crucially, hand hygiene with soap and water is preferred over alcohol-based rubs because alcohol does not kill C. diff spores. An N95 is not required (D adds unnecessary respiratory protection).
Question 23
An immunocompromised patient receiving chemotherapy requires protective isolation. Which intervention best prevents infection?
A. Place the patient in a negative air pressure room
B. Require all visitors to wear surgical masks when entering the room
C. Ensure the patient is in a private room with positive air pressure
D. Limit nursing contact to once per shift to reduce exposure
Correct answer: C
Protective isolation for immunocompromised patients uses positive-pressure rooms to keep potentially contaminated air out. Negative pressure (A) is used when the patient poses infection risk to others (TB). Requiring visitor masks alone (B) is insufficient as the primary precaution. Limiting nursing contact (D) is unsafe.
Question 24
A nurse enters a patient's room and finds them on the floor. Bed alarms were in place. Which action should the nurse take first?
A. Notify the charge nurse
B. Help the patient back into bed immediately
C. Assess the patient for injury
D. Document the incident as a fall
Correct answer: C
Before moving a patient who has fallen, the nurse must assess for injury — especially head, neck, and spinal injury. Moving an injured patient without assessment can worsen the injury. Notifying the charge nurse and documenting are appropriate but come after the immediate assessment. Returning the patient to bed happens only after ruling out injury.
Question 25
A nurse is caring for a confused patient in soft wrist restraints. How often should the nurse reassess the patient and the restraints?
A. Every 4 hours
B. Every 2 hours
C. Every hour
D. Every 15 minutes
Correct answer: B
CMS and Joint Commission standards require reassessment of restrained patients at least every 2 hours, including neurovascular checks (circulation, sensation, movement) and behavioral reassessment to determine whether the restraint is still needed. Some facilities require more frequent checks — know your facility's policy. Every 4 hours (A) is insufficient.
Question 26
A nurse is completing a safety assessment for a newly admitted 80-year-old patient. Select all that apply: Which factors increase this patient's fall risk?
A. History of urinary urgency
B. Blood pressure 110/70 when standing (from 130/80 sitting)
C. Currently taking metoprolol and furosemide
D. Alert and oriented x4
E. Bilateral hearing aids in place and functioning
F. New environment unfamiliar to patient
Correct answers: A, B, C, F
Urinary urgency leads to rushed movement to the bathroom — a common fall scenario. The orthostatic drop in blood pressure causes dizziness. Metoprolol (beta-blocker) and furosemide (diuretic) both contribute to orthostatic hypotension and fall risk. A new, unfamiliar environment increases disorientation risk. Alert orientation (D) is protective. Functioning hearing aids (E) actually reduce fall risk by improving spatial awareness.
Question 27
A nurse is about to administer a medication and realizes they prepared it for the wrong patient. The medication has not been given. What should the nurse do first?
A. Administer the medication since it is already drawn up and will not cause harm
B. Discard the medication and prepare the correct dose for the right patient
C. Document the near-miss event in the incident reporting system
D. Notify the charge nurse and the prescribing provider
Correct answer: B
The first action is to prevent harm by not giving the wrong medication. Administering to the wrong patient, even if "harmless," violates the five rights and is never acceptable. After correcting the error, the near-miss should be reported (C) so the facility can identify contributing factors and prevent recurrence — but this comes after the immediate correction.
Question 28
A nurse is caring for a confused patient who is pulling at their central line. What is required before applying wrist restraints?
A. Verbal consent from the patient
B. A written order from the licensed provider
C. Family consent since the patient is confused
D. Nursing supervisor approval
Correct answer: B
A licensed provider's order is required before applying restraints, except in immediate emergencies where a verbal order may be obtained and documented immediately after. Family consent is not required — the provider's order authorizes restraint use. Patient consent is not feasible when the patient is confused and is not a prerequisite.
Question 29
Which of the following patients requires contact precautions?
A. A patient with influenza A
B. A patient with varicella (chickenpox)
C. A patient with a wound infected with vancomycin-resistant Enterococcus (VRE)
D. A patient with pertussis
Correct answer: C
VRE spreads by direct contact and requires contact precautions (gown and gloves). Influenza (A) and pertussis (D) require droplet precautions. Varicella (B) is the exception — it requires both airborne and contact precautions because the virus is airborne and the vesicular lesions transmit by contact.
Question 30
A nurse is caring for a patient with hepatitis B. Select all that apply: Which standard precaution measures apply?
A. Wear gloves when handling blood or body fluids
B. Wear a gown if splashing of blood or fluids is likely
C. Place the patient in a negative pressure room
D. Wear a face shield or mask when splashing is anticipated
E. Discard all sharps in puncture-resistant containers
F. Recap needles after use with two hands
Correct answers: A, B, D, E
Options A, B, D, and E are standard precautions for bloodborne pathogen exposure. Hepatitis B does not require airborne precautions, so a negative pressure room (C) is not indicated. Recapping needles with two hands (F) is a known cause of needlestick injury and is explicitly prohibited — the one-handed scoop technique is used when recapping is necessary.
Question 31
A patient begins showing signs of a blood transfusion reaction 10 minutes after the infusion starts: sudden chills, low back pain, fever of 38.9°C (102°F), and dark urine. What should the nurse do first?
A. Slow the transfusion rate and continue monitoring
B. Stop the transfusion immediately and maintain IV access with normal saline
C. Administer diphenhydramine IV and continue at a slower rate
D. Notify the blood bank and wait for further instructions before taking action
Correct answer: B
Low back pain, fever, chills, and dark urine within the first 15 minutes suggest an acute hemolytic reaction — the most dangerous type. The first action is to stop the transfusion immediately and keep the IV line open with normal saline (not the blood tubing). Options A and C both involve continuing the transfusion, which is dangerous. Notifying the blood bank (D) is necessary but comes after stopping the infusion.
Question 32
A patient is admitted with suspected varicella. The nurse assigned to this patient reports they have never had varicella and are not vaccinated. What is the appropriate action?
A. Assign the same nurse, as standard precautions will protect them adequately
B. Assign a different nurse who has either had varicella or is vaccinated
C. Require the nurse to wear double gloves and a gown for all patient contact
D. Allow the nurse to care for the patient only if wearing an N95 respirator
Correct answer: B
A nurse without immunity is at high risk of infection and should not be assigned to a patient with active varicella. This is both a staff safety issue and an infection control measure. Respiratory protection alone (D) is insufficient given that varicella also requires contact precautions for the vesicular lesions.
Health Promotion and Maintenance
This category covers 6–12% of the exam and tests developmental milestones, prenatal care, immunizations, screening recommendations, and expected age-related changes. These questions often feel straightforward — the errors usually come from outdated knowledge (like the old colorectal cancer screening age) or confusing developmental milestones across age groups.
Question 33
A nurse is teaching a patient who is 8 weeks pregnant about folic acid. Which teaching is most accurate?
A. Take 400 mcg of folic acid daily starting from now through the end of pregnancy
B. Folic acid supplementation is only necessary if there is a family history of neural tube defects
C. The critical period for folic acid to prevent neural tube defects has already passed by 8 weeks
D. Take 4,000 mcg of folic acid daily during the first trimester
Correct answer: C
Neural tube closure occurs between 21 and 28 days after conception — well before most women know they are pregnant. By 8 weeks, that window has closed. The nurse should still reinforce ongoing folic acid intake for other benefits (red blood cell formation, preventing other defects), but the primary teaching for neural tube defect prevention needs to happen before conception. Option A has the correct dose but wrong emphasis for this patient. Option D has a dangerously high dose.
Question 34
A mother brings her 12-month-old to the clinic for a well-child visit. Which vaccine is appropriate at this age?
A. DTaP only
B. MMR and varicella
C. HPV vaccine
D. Meningococcal vaccine
Correct answer: B
MMR and varicella vaccines are both given at 12–15 months. DTaP (A) is given at 2, 4, 6, and 15–18 months, with a booster at 4–6 years, so a 12-month visit would not include DTaP unless the child is behind on doses. HPV (C) begins at age 9–11 years. Meningococcal vaccine (D) is typically given at 11–12 years.
Question 35
A 4-year-old is brought in for a well-child visit. Which absent milestone would cause the nurse concern?
A. Unable to ride a bicycle without training wheels
B. Cannot skip on alternating feet
C. Cannot copy a cross (+) shape drawn by the nurse
D. Does not yet read simple words
Correct answer: C
By age 4, a child should be able to copy a cross (+) shape. Inability to do so is a developmental concern. Bicycle riding without training wheels (A) is expected around age 5–6. Skipping on alternating feet (B) is a 5-year milestone. Reading (D) is a school-age skill.
Question 36
A nurse is teaching a 50-year-old patient of average risk about colorectal cancer screening. Which recommendation is most accurate?
A. Colonoscopy should begin at age 50 and repeat every 5 years
B. Annual fecal occult blood testing is no longer recommended
C. Screening should begin at age 45, with colonoscopy repeating every 10 years if normal
D. Screening is only necessary if the patient has a first-degree relative with colorectal cancer
Correct answer: C
The American Cancer Society updated recommendations in 2018 to begin average-risk colorectal screening at age 45. A normal colonoscopy requires a repeat at 10 years. Annual fecal occult blood testing (B) remains a valid screening option — it was not discontinued. Option A has the outdated starting age of 50. Option D incorrectly limits screening to high-risk patients.
Question 37
A nurse is teaching a new mother about breastfeeding. Select all that apply: Which observations indicate correct technique?
A. The infant's mouth covers most of the areola, not just the nipple
B. The mother hears clicking sounds during feeding
C. The mother feeds the infant on demand, approximately 8–12 times per day
D. The infant is offered a pacifier after each feeding to satisfy sucking needs
E. The mother alternates which breast she starts with at each feeding
F. Breast engorgement in the first few days is expected
Correct answers: A, C, E, F
Correct latch involves covering the areola (A), not just the nipple — this prevents nipple trauma and ensures adequate milk transfer. 8–12 feedings daily is normal for a newborn (C). Alternating starting breasts ensures equal stimulation of both (E). Some engorgement in the first days is normal as milk comes in (F). Clicking sounds (B) suggest a poor latch. Pacifiers (D) are discouraged in the early weeks as they may interfere with breastfeeding establishment.
Question 38
A 52-year-old woman asks about expected changes related to menopause. Which response is most accurate?
A. Menopause is diagnosed after 6 consecutive months without a menstrual period
B. Hot flashes result from declining estrogen levels affecting the hypothalamic thermostat
C. Bone density increases after menopause due to hormonal changes
D. Most women experience menopause between ages 45 and 65
Correct answer: B
Hot flashes result from estrogen deficiency disrupting hypothalamic thermoregulation — this is the mechanism behind vasomotor symptoms. Menopause is diagnosed after 12 consecutive months without a period, not 6 (A is incorrect). Bone density decreases after menopause (C is incorrect). The average age of natural menopause is 51, with a typical range of 45–55 years (D's upper limit of 65 is too broad).
Question 39
A nurse is teaching the parents of a 2-year-old about nutrition. Which statement by a parent indicates a need for further teaching?
A. "We give him whole milk instead of skim milk."
B. "He only eats about 4–5 foods right now, but we keep offering new ones."
C. "We add salt to his food because he refuses to eat otherwise."
D. "He drinks about 16–24 ounces of milk per day."
Correct answer: C
Adding salt to a toddler's food is inappropriate — toddler kidneys are not mature enough to handle excess sodium, and it teaches a preference for salty food. Whole milk (A) is appropriate for ages 1–2 to support brain development. Food jags and limited food preferences (B) are developmentally normal in toddlers. 16–24 ounces of milk per day (D) is within the recommended range.
Question 40
A nurse is teaching a 20-year-old male patient about testicular self-examination. Which instruction is correct?
A. Perform TSE monthly, 1 week after a shower
B. Perform TSE immediately after a warm shower when the scrotum is relaxed
C. Report any new firmness or lumps immediately, even if painless
D. TSE is only recommended for males with a family history of testicular cancer
Correct answer: C
Testicular cancer most commonly presents as a painless lump or firmness — the absence of pain is not reassuring. Any new finding should be reported promptly. TSE is recommended monthly after a warm shower (B describes the correct timing but "immediately after" is slightly imprecise — during or right after is the guidance). TSE is recommended for all males ages 15–35, not only those with family history (D is incorrect).
Psychosocial Integrity
Psychosocial Integrity covers 6–12% of the NCLEX-RN. The most common error is selecting responses that are reassuring but close off communication. When in doubt, reflect the emotion and let the patient talk.
Question 41
A patient just diagnosed with breast cancer says, "I can't believe this is happening. I feel completely numb." Which response is most therapeutic?
A. "I understand. Many of my patients feel the same way at first."
B. "Try not to worry. The treatment options are very good now."
C. "You're feeling overwhelmed right now."
D. "Let's focus on what we can do. The oncologist will explain your options."
Correct answer: C
Reflecting the patient's emotional state without adding commentary, reassurance, or redirection is the most therapeutic response. Option A is a minimizing comparison. Option B offers premature reassurance that dismisses the patient's current experience. Option D redirects to problem-solving before the patient has been heard.
Question 42
A patient whose spouse died 3 months ago says, "I still set the table for two every night. I keep forgetting." Which stage of Kübler-Ross grief does this reflect?
A. Anger
B. Depression
C. Bargaining
D. Denial
Correct answer: D
Acting as if the loss has not occurred reflects denial — disbelief and avoidance of the reality of the death. This is not abnormal 3 months after bereavement. Depression (B) manifests as profound sadness, withdrawal, and expressions of hopelessness. Bargaining (C) involves "what if" or "if only" thinking. Anger (A) involves resentment about the loss.
Question 43
A nurse is assessing a patient in the ED who reports feeling suicidal. Select all that apply: Which factors increase this patient's suicide risk?
A. The patient has a specific plan involving a firearm
B. The patient reports feeling hopeless about the future
C. The patient is 35 years old
D. The patient has a history of a previous suicide attempt
E. The patient has strong family support
F. The patient is male
Correct answers: A, B, D, F
Having a specific plan with a lethal method (A) dramatically increases risk. Hopelessness (B) is one of the strongest predictors of suicidal behavior — more predictive than depression alone. Prior attempts (D) are the single strongest predictor of future attempts. Male sex (F) is associated with higher completion rates, though females attempt more frequently. Age 35 alone (C) is not a specific risk factor. Strong family support (E) is a protective factor, not a risk factor.
Question 44
A patient with depression says, "There's no point. Nothing ever works out for me." Which nursing response is therapeutic?
A. "That's not true. You have so much to be grateful for."
B. "Tell me more about what you mean when you say nothing works out."
C. "Have you been feeling this way long? You should tell your doctor."
D. "I know it feels that way now, but things will get better."
Correct answer: B
An open-ended follow-up invites the patient to elaborate and signals that the nurse is listening without judgment. Option A directly contradicts the patient's experience and is dismissive. Option D offers false reassurance. Option C shifts to a clinical task before the patient has been fully heard.
Question 45
A patient admitted to the ED with alcohol dependence reports their last drink was 6 hours ago. What should the nurse anticipate about alcohol withdrawal?
A. Delirium tremens typically begins within 6–12 hours of the last drink
B. The first symptoms (tremors, diaphoresis, anxiety) typically appear 6–24 hours after cessation
C. Alcohol withdrawal is generally mild and self-limiting
D. Seizure risk is highest in the first 6 hours after cessation
Correct answer: B
Minor withdrawal symptoms — tremor, diaphoresis, anxiety, tachycardia — typically begin 6–24 hours after the last drink. Delirium tremens (A) typically occurs 48–72 hours after cessation. Alcohol withdrawal can be life-threatening (C is incorrect) — it is one of the few withdrawal syndromes that can be fatal without treatment. Seizure risk is highest at 12–48 hours (D is incorrect on timing).
Question 46
A 40-year-old patient has been discharged following treatment for major depressive disorder. Which statement suggests a risk for relapse?
A. "I'm going to keep my follow-up appointment next week."
B. "I stopped taking my medication because I feel so much better now."
C. "My spouse has agreed to come to my next therapy session."
D. "I've been trying to go for a walk every day."
Correct answer: B
Stopping antidepressant medication prematurely because of feeling better is the most common cause of depressive relapse. Most antidepressants require 6–12 months of treatment after remission. Options A, C, and D all reflect healthy engagement with treatment.
Question 47
A patient recently told they have terminal pancreatic cancer says, "If I eat better and start exercising, maybe I can beat this." This reflects which grief response?
A. Rationalization
B. Projection
C. Bargaining
D. Regression
Correct answer: C
Bargaining involves attempting to negotiate to change an outcome — "if I do X, then maybe Y won't happen." Rationalization (A) is creating logical justifications for unacceptable behaviors. Projection (B) attributes one's own feelings to others. Regression (D) is reverting to childlike behaviors under stress.
Question 48
A patient in hospice care has family asking, "Are you going to speed up their death with all these comfort medications?" Which response is most appropriate?
A. "These medications are only given to ease pain and discomfort, not to hasten death."
B. "I understand your concern. You should talk to the hospice doctor about this."
C. "These medications might shorten life slightly, but comfort is the priority."
D. "The goal of hospice is comfort, not treatment, so we do what we need to do."
Correct answer: A
This response directly and honestly addresses the family's fear. Comfort medications in palliative care are given for symptom management, not to hasten death — this is the principle of double effect and it is central to hospice philosophy. Option B deflects an answerable question. Option C introduces a claim about shortened life that the research does not clearly support and would unnecessarily increase distress. Option D is dismissive.
Question 49
A patient with schizophrenia tells the nurse, "The TV is sending me messages that I need to leave the hospital right away." How should the nurse respond?
A. "That sounds frightening. The television isn't sending messages, but let's talk about what's making you want to leave."
B. "I understand you believe that. Tell me more about the messages."
C. "The TV is just showing a regular program. Would you like me to turn it off?"
D. "You're having a hallucination. This is a symptom of your illness."
Correct answer: A
The nurse acknowledges the emotional experience without reinforcing the delusion, then redirects to the actual safety concern — wanting to leave. Option B asks the patient to elaborate on the delusion, which reinforces it. Option C dismisses the emotional component. Option D labels the symptom in a way that is unlikely to be therapeutic.
Question 50
A nurse working in a pediatric clinic suspects a 7-year-old is being physically abused based on patterned bruising inconsistent with the reported mechanism of injury. What is the nurse's legal obligation?
A. Discuss the concern with the parents before making any report
B. Report the suspicion to child protective services
C. Document the findings and consult with the attending physician before reporting
D. Wait for additional physical findings to confirm abuse before reporting
Correct answer: B
Nurses are mandated reporters. Suspicion alone — not confirmed abuse — is sufficient and legally required to trigger a report. Discussing with parents first (A) may alert an abuser and endanger the child. The nurse does not need physician consultation before reporting (C). Waiting for more evidence (D) delays protection of the child.
Basic Care and Comfort
Basic Care and Comfort covers 6–12% of the exam. These questions test mobility, elimination, pain management, nutrition, hygiene, and assistive devices. They can seem deceptively simple. The errors usually involve either missing a safety concern or selecting an intervention that requires nursing judgment instead of a delegable task.
Question 51
A patient who is 2 days post-op following a knee replacement has not had a bowel movement since before surgery. The abdomen is soft and non-tender. What is the most appropriate nursing intervention?
A. Administer a Fleet enema immediately
B. Encourage oral fluid intake and ambulation
C. Insert a nasogastric tube for decompression
D. Administer IV naloxone to reverse opioid-induced constipation
Correct answer: B
Two days without a bowel movement after surgery is expected, particularly with opioid analgesia. First-line intervention for opioid-related constipation is increased fluid intake and ambulation, which stimulate peristalsis. A Fleet enema (A) is premature without attempting non-pharmacological measures first. NGT insertion (C) is not indicated without obstruction. IV naloxone (D) would reverse analgesia entirely — methylnaltrexone (Relistor) is used for opioid-induced constipation without reversing pain relief.
Question 52
A nurse is developing a care plan for a patient at risk for pressure injury. Select all that apply: Which interventions should be included?
A. Reposition the patient every 2 hours
B. Apply a thick layer of moisture barrier ointment to all bony prominences
C. Use a pressure-redistribution mattress or cushion
D. Massage bony prominences vigorously to increase circulation
E. Keep the head of the bed at 30 degrees or lower unless contraindicated
F. Assess and document skin condition at each position change
Correct answers: A, C, E, F
Repositioning every 2 hours (A), pressure-redistribution surfaces (C), maintaining HOB at 30 degrees or lower to reduce shear (E), and regular skin assessment (F) are all evidence-based. Moisture barrier ointment protects skin from incontinence moisture, not pressure — applying it broadly to bony prominences (B) is not the guideline. Massaging bony prominences (D) is explicitly contraindicated because it can damage the fragile tissue that is already at risk.
Question 53
A nurse is verifying placement of a nasogastric tube just inserted. Which method is most reliable?
A. Auscultating over the epigastrium while injecting 10 mL of air
B. Checking that the tube advances without resistance
C. Confirming aspirate pH is 4 or lower, or viewing placement on X-ray
D. Observing that the patient can speak and swallow normally
Correct answer: C
X-ray is the gold standard for NG tube placement confirmation. Aspirate pH of 4 or lower is consistent with gastric placement and acceptable for ongoing confirmation. The auscultation method (A) is no longer considered reliable — air injected into the lungs can also transmit a sound over the epigastrium. Options B and D do not confirm tube placement.
Question 54
A patient with chronic low back pain wants to minimize opioid use. Which non-pharmacological intervention has the strongest evidence base?
A. Therapeutic ultrasound applied twice daily
B. Bed rest for 2–3 days following flare-ups
C. Structured physical therapy and graded exercise
D. Transcutaneous electrical nerve stimulation (TENS) used daily
Correct answer: C
For chronic low back pain, structured physical therapy and graded exercise have the strongest evidence for long-term improvement. Bed rest (B) is counterproductive — it leads to deconditioning and worsening outcomes. Ultrasound (A) and TENS (D) have limited evidence for chronic pain and are not first-line.
Question 55
A nurse is caring for a patient 24 hours after a right total hip replacement. When assisting the patient out of bed, which position should the nurse avoid?
A. Standing with weight bearing on the right side
B. Sitting in a chair with knees lower than hips
C. Bending the right hip more than 90 degrees
D. Abducting the right leg when lying in bed
Correct answer: C
Hip precautions after total hip replacement include avoiding hip flexion greater than 90 degrees, adduction past midline, and internal rotation. Bending the hip more than 90 degrees risks prosthetic dislocation. Option B (knees lower than hips) actually describes the correct sitting position. Weight bearing (A) is typically permitted with a standard hip replacement. Abduction (D) is allowed — it is adduction that must be avoided.
Question 56
A patient receiving continuous nasogastric tube feeding develops diarrhea. What is the priority nursing action?
A. Stop the tube feeding immediately
B. Assess the patient's current medications for osmotic laxatives or antibiotics
C. Switch to a fiber-enriched formula
D. Notify the provider and await new formula orders before taking action
Correct answer: B
The priority is assessment — identifying the cause before intervening. Diarrhea in a tube-fed patient is often medication-related (sorbitol-containing liquid medications, antibiotics) rather than formula-related. Stopping the feeding (A) is premature without identifying the cause. Changing the formula (C) may not address the underlying problem. Waiting for provider orders (D) delays necessary nursing assessment.
Question 57
A nurse is performing oral hygiene for an unconscious patient. What position should the patient be placed in?
A. Supine (flat)
B. High Fowler's position (90 degrees)
C. Lateral position (side-lying)
D. Prone position (face down)
Correct answer: C
Lateral position allows fluids to drain by gravity, reducing aspiration risk during oral care. Supine (A) and Fowler's (B) do not protect the airway from aspiration of secretions and fluids. Prone (D) is impractical and not used for oral hygiene.
Question 58
A patient is 6 hours post-op following an appendectomy under general anesthesia with mild incisional pain (4/10) and is reluctant to ambulate. What is the most important reason to encourage early ambulation?
A. To improve the patient's mood and reduce anxiety
B. To prevent post-operative atelectasis and deep vein thrombosis
C. To assess the patient's readiness for discharge
D. To reduce the need for ongoing opioid analgesia
Correct answer: B
Early ambulation prevents two common post-operative complications: pulmonary atelectasis (from shallow breathing and secretion pooling) and deep vein thrombosis (from venous stasis). Mood improvement (A) and reduced opioid use (D) may occur but are secondary benefits. Discharge readiness assessment (C) is not why ambulation is clinically important.
Pharmacological and Parenteral Therapies
This is one of the highest-weighted categories at 12–18%, and pharmacology is consistently where students lose the most points. Questions test adverse effects, monitoring parameters, drug interactions, IV therapy, and dosage calculations.
Learn your priority monitoring for high-alert medications: digoxin (apical pulse, potassium, drug level), warfarin (INR/PT), lithium (serum level, renal function, toxicity signs), heparin (aPTT), and vancomycin (troughs, renal function). Don't memorize everything — memorize the mechanism, and the monitoring follows logically.
Question 59
A patient taking warfarin for atrial fibrillation asks which over-the-counter medication is safe to take for a headache. Which response is most accurate?
A. "Ibuprofen is the safest choice for headaches while taking warfarin."
B. "Aspirin in low doses is fine since it also helps your heart."
C. "Acetaminophen is the preferred choice; avoid NSAIDs and aspirin."
D. "Any over-the-counter pain reliever is safe in recommended doses."
Correct answer: C
NSAIDs (including ibuprofen) and aspirin both increase bleeding risk through antiplatelet effects and GI irritation, which is dangerous in combination with warfarin. Acetaminophen is the safest analgesic for patients on anticoagulation, though high doses over time can still elevate INR. Option D is dangerous.
Question 60
A patient on digoxin 0.25 mg daily reports nausea, decreased appetite, and seeing yellow-green halos around lights. Current potassium is 3.0 mEq/L. What is the nurse's priority action?
A. Administer the next scheduled dose and recheck potassium in 4 hours
B. Hold the digoxin and notify the provider immediately
C. Administer a potassium supplement and then give the digoxin as scheduled
D. Check a digoxin level before deciding whether to hold the dose
Correct answer: B
This patient has classic digoxin toxicity: GI symptoms (nausea, anorexia) and visual disturbances (yellow-green halos). Hypokalemia (K+ 3.0) potentiates digoxin toxicity by increasing the drug's binding to myocardial cells. Hold the dose and notify the provider immediately. Giving a potassium supplement and then the digoxin (C) does not address the current toxicity. Checking a level first (D) delays the critical action of holding the dose.
Question 61
A patient with type 1 diabetes requires both NPH insulin and regular insulin at breakfast. In which order should the nurse draw up the insulins?
A. NPH first, then regular insulin in the same syringe
B. Regular insulin first, then NPH in the same syringe
C. Always administer them in separate syringes
D. The order does not matter as long as they are given together
Correct answer: B
"Clear before cloudy": regular insulin (clear) is drawn first to prevent contaminating the regular insulin vial with NPH (cloudy). If NPH were drawn first, the cloudy insulin could contaminate the regular vial and alter its onset profile.
Question 62
A nurse is preparing to administer furosemide IV to a patient. Which assessment is most important before administration?
A. Blood pressure and current weight
B. Current potassium level and urinary output
C. BUN and creatinine levels
D. Recent chest X-ray results
Correct answer: B
Furosemide is a loop diuretic that promotes potassium excretion along with sodium and water. Hypokalemia is the most significant adverse effect — especially dangerous in patients on digoxin or with cardiac arrhythmia history. Urinary output assesses whether the kidneys can respond to the diuretic. Blood pressure (A) is relevant but secondary. BUN/creatinine (C) is important for renal assessment but not the immediate priority.
Question 63
A provider orders gentamicin 5 mg/kg IV every 24 hours for a patient who weighs 176 pounds. How many mg should the nurse administer per dose?
A. 400 mg
B. 440 mg
C. 880 mg
D. 350 mg
Correct answer: A
Convert weight: 176 lbs ÷ 2.2 = 80 kg. Then: 5 mg/kg × 80 kg = 400 mg. Option B (440 mg) results from using the pound weight with a different error. Option C (880 mg) is a dangerous double dose. Weight conversion is a frequent source of error — always convert pounds to kilograms first.
Question 64
A patient with type 2 diabetes is scheduled for a CT scan with contrast dye tomorrow morning. Which medication should the nurse flag for the provider?
A. Glipizide (sulfonylurea)
B. Metformin (biguanide)
C. Sitagliptin (DPP-4 inhibitor)
D. Insulin glargine (basal insulin)
Correct answer: B
Metformin is held before and 48 hours after iodinated contrast dye because the combination can cause contrast-induced nephropathy, which impairs metformin excretion and increases the risk of lactic acidosis. The other agents do not carry this specific risk with contrast.
Question 65
A patient is receiving IV morphine for pain management. Select all that apply: Which findings are expected adverse effects to monitor for?
A. Urinary retention
B. Tachycardia
C. Respiratory depression
D. Constipation
E. Hypertension
F. Nausea and vomiting
Correct answers: A, C, D, F
Opioid adverse effects include urinary retention (A), respiratory depression (C), constipation (D), and nausea/vomiting (F). Tachycardia (B) is not a typical opioid side effect — bradycardia can occur, but not tachycardia. Hypertension (E) is not typical; opioids cause hypotension via vasodilation.
Question 66
A patient on unfractionated heparin infusion has an aPTT result of 120 seconds (therapeutic range 60–100 seconds for this indication). What should the nurse do?
A. Continue the infusion at the current rate
B. Increase the infusion rate per protocol
C. Hold the infusion and notify the provider
D. Administer protamine sulfate IV immediately
Correct answer: C
An aPTT of 120 seconds is supratherapeutic. Hold the infusion and notify the provider. Protamine sulfate (D) is the heparin antidote but is reserved for significant bleeding or extreme values — it is not administered automatically for an elevated aPTT. Option B would worsen over-anticoagulation.
Question 67
A patient on lithium for bipolar disorder reports coarse hand tremors, confusion, slurred speech, and muscle twitching. Their last lithium level was 1.8 mEq/L (therapeutic range 0.6–1.2 mEq/L). What is the nurse's priority action?
A. Administer the next scheduled lithium dose and recheck levels in 12 hours
B. Hold lithium, implement seizure precautions, and notify the provider immediately
C. Encourage the patient to increase fluid and sodium intake
D. Administer furosemide to promote lithium excretion
Correct answer: B
A lithium level of 1.8 mEq/L is above the toxic threshold (> 1.5 mEq/L). The clinical picture confirms toxicity: coarse tremors, confusion, slurred speech, muscle twitching. This is a medical emergency. Seizure precautions are warranted. Furosemide (D) is contraindicated — it promotes sodium excretion, and sodium depletion increases lithium reabsorption, worsening toxicity. Increasing fluids and sodium (C) can help mild toxicity but is insufficient here.
Question 68
A patient newly prescribed lisinopril for hypertension develops a dry, persistent cough 3 weeks after starting the medication. What is the appropriate nursing response?
A. Reassure the patient that the cough will resolve within 1–2 weeks
B. Document the finding and notify the provider — an alternative medication may be needed
C. Instruct the patient to take lisinopril with food to reduce the cough
D. Advise the patient to take an OTC cough suppressant
Correct answer: B
Dry, persistent cough is a well-known adverse effect of ACE inhibitors, caused by bradykinin accumulation. It does not resolve with time (A is incorrect). It is not related to food intake (C). Cough suppressants (D) will not address the cause. The provider should be notified because the patient may need to switch to an ARB, which does not cause this side effect.
Question 69
A patient receiving vancomycin IV develops progressive flushing and redness of the face, neck, and upper torso during the infusion. What is the most likely cause and appropriate action?
A. Anaphylaxis; stop the infusion and administer epinephrine immediately
B. Red Man Syndrome; slow the infusion rate and administer diphenhydramine if needed
C. Septic shock; obtain blood cultures and notify the provider
D. Cellulitis from extravasation; stop the infusion and apply warm compresses
Correct answer: B
Red Man Syndrome is a non-immunologic, infusion-rate-related reaction to vancomycin characterized by flushing and erythema of the face, neck, and upper body. It is not anaphylaxis. Treatment is slowing the infusion rate (ideally over 60–90 minutes minimum) and antihistamines if needed. Anaphylaxis (A) would present with urticaria, bronchospasm, hypotension, and angioedema.
Question 70
A nurse is about to administer potassium chloride 40 mEq IV to a patient with hypokalemia. Which action is correct?
A. Administer the potassium as a rapid IV push to quickly restore serum levels
B. Dilute and administer via IV infusion at no more than 10–20 mEq per hour
C. Mix with normal saline in a 1:1 ratio and administer over 30 minutes
D. Administer undiluted in 50 mL of D5W over 15 minutes
Correct answer: B
IV potassium must never be given as a push — it can cause fatal cardiac arrhythmia. It must be diluted and administered at a controlled rate, typically no more than 10–20 mEq/hour peripherally (higher rates require central venous access and cardiac monitoring). Options A, C, and D all describe unsafe administration methods.
Question 71
A provider orders amoxicillin 500 mg PO three times daily. The medication is available as amoxicillin 250 mg/5 mL suspension. How many mL should the nurse administer per dose?
A. 5 mL
B. 10 mL
C. 15 mL
D. 20 mL
Correct answer: B
500 mg ÷ 250 mg × 5 mL = 10 mL. Each 5 mL contains 250 mg, so 10 mL contains 500 mg.
Question 72
A patient who has been taking prednisone 40 mg daily for 3 weeks asks if they can stop since they feel much better. Which response is most appropriate?
A. "Yes, if you feel better, you can stop it. Call the clinic if symptoms return."
B. "You should taper the dose gradually as directed — do not stop it abruptly."
C. "You can stop taking it on weekends while continuing during the week."
D. "The medication is safe to stop any time once symptoms resolve."
Correct answer: B
Corticosteroids suppress the HPA (hypothalamic-pituitary-adrenal) axis. Abrupt discontinuation after more than 2 weeks of use can cause adrenal insufficiency, which can be life-threatening. The dose must be tapered to allow adrenal glands to resume cortisol production. Options A, C, and D all describe unsafe discontinuation patterns.
Question 73
A patient with chronic heart failure is started on carvedilol. Select all that apply: Which assessments should the nurse perform before each dose?
A. Apical heart rate
B. Blood pressure
C. Serum potassium level
D. Blood glucose in diabetic patients
E. Respiratory status and breath sounds
F. Renal function labs (BUN, creatinine) daily
Correct answers: A, B, D, E
Beta-blockers cause bradycardia (check apical rate — hold if < 60 bpm) and hypotension (check BP — hold if systolic < 90 mmHg). In diabetic patients, beta-blockers can mask hypoglycemia symptoms (tachycardia), so blood glucose monitoring matters (D). Beta-blockers can cause bronchoconstriction, so respiratory status should be assessed (E). Daily renal labs (F) are not standard for routine beta-blocker administration. Potassium (C) is not a standard pre-administration check specific to carvedilol.
Question 74
A patient post-coronary stent placement 2 days ago wants to stop clopidogrel because it causes stomach upset. What is the most accurate nursing response?
A. Talk to your cardiologist — stopping clopidogrel early after a stent can cause the stent to clot
B. You can stop the medication but should take aspirin instead
C. Take it with food to reduce the stomach upset, but do not stop it without medical guidance
D. Both A and C
Correct answer: D
Both providing practical advice for the side effect (take with food) and emphasizing the danger of early discontinuation (stent thrombosis is highest risk in the first 30 days) are important nursing responses. Stent thrombosis from premature antiplatelet discontinuation is a well-documented and potentially fatal complication. Option B — substituting aspirin for clopidogrel — is incorrect.
Question 75
A nurse administering IV chemotherapy notices the patient reports pain and swelling at the IV site. The area appears pale and cool. What should the nurse do first?
A. Flush the IV line with normal saline to clear residual drug
B. Stop the infusion immediately and disconnect the IV tubing
C. Apply a warm compress to promote absorption
D. Slow the infusion rate and monitor for 15 minutes
Correct answer: B
Pallor, pain, swelling, and cool skin indicate extravasation of a vesicant chemotherapy agent. Stop the infusion immediately and disconnect the tubing — do not flush (A), as that pushes more drug into surrounding tissue and worsens the injury. Specific antidote treatment depends on the drug. Warm compresses (C) may be appropriate for some agents but contraindicated for others — the specific protocol must be followed.
Question 76
A patient receiving IV morphine develops a respiratory rate of 8 breaths/minute, is difficult to arouse, and has pinpoint pupils. What is the nurse's priority action?
A. Stop the morphine infusion and administer oxygen via face mask
B. Administer naloxone (Narcan) 0.4–2 mg IV and notify the provider
C. Obtain arterial blood gas results before administering any reversal agents
D. Increase the oxygen flow rate and wait 15 minutes to reassess
Correct answer: B
This is opioid toxicity — respiratory depression, sedation, and miosis. The priority is reversal with naloxone. Waiting for ABG results (C) delays treatment of a potentially fatal situation. Oxygen (A) is supportive but does not address the cause. Option D is insufficient for a patient with RR 8 who cannot be easily aroused.
Reduction of Risk Potential
Reduction of Risk Potential covers 9–15% of the NCLEX-RN. Questions focus on pre- and post-procedure care, laboratory value interpretation, monitoring, and recognizing impending complications before they become emergencies.
Question 77
A nurse is caring for a patient who is 4 hours post-op following a thyroidectomy. Which finding requires immediate intervention?
A. Blood pressure 128/82 mmHg and pulse 84 bpm
B. Temperature 37.4°C (99.3°F)
C. Reports of tingling in the lips and fingertips
D. Soft voice and complaint of sore throat
Correct answer: C
Tingling in the lips and fingertips (perioral and periorbital paresthesias) suggests hypocalcemia from inadvertent damage or removal of the parathyroid glands during thyroidectomy. This can progress to tetany and seizures. Options A and B are normal findings. A soft voice and sore throat (D) are expected post-thyroidectomy.
Question 78
A nurse receives a critical lab value: potassium 6.2 mEq/L on a patient currently receiving IV potassium supplementation. What is the priority nursing action?
A. Reassess the patient and obtain a repeat sample — lab errors are common
B. Stop any ongoing IV potassium infusion and notify the provider immediately
C. Place the patient on continuous cardiac monitoring only
D. Administer insulin and 50% dextrose per protocol without waiting for orders
Correct answer: B
Hyperkalemia (K+ > 6.0 mEq/L) is a medical emergency due to risk of fatal cardiac dysrhythmias. If the patient is receiving IV potassium, stop it first, then notify the provider. Cardiac monitoring (C) is important but not the first action. Insulin/dextrose (D) may be ordered as treatment but requires a provider order. Waiting to reassess (A) delays action on a critical lab value.
Question 79
A patient is scheduled for an elective surgical procedure tomorrow morning. Select all that apply: Which preoperative safety checks should the nurse complete?
A. Confirm the patient has a signed informed consent
B. Verify the patient has been NPO per protocol
C. Check that surgical site marking has been performed by the surgeon
D. Ensure the patient has completed all post-operative physical therapy
E. Verify allergies are documented and communicated
F. Review baseline vital signs
Correct answers: A, B, C, E, F
Post-operative physical therapy (D) is not a preoperative check — it is planned for after surgery. All other options are standard components of preoperative safety assessment, including surgical site verification (part of the Joint Commission's Universal Protocol to prevent wrong-site surgery).
Question 80
A patient's troponin I is reported as 2.8 ng/mL (normal < 0.04 ng/mL) 6 hours after onset of chest pain. What does this indicate?
A. The patient has ruled out myocardial infarction — this level is below the critical threshold
B. This is consistent with myocardial infarction; the provider should be notified immediately
C. The elevated troponin is likely due to chronic kidney disease and is expected
D. A single elevated troponin is not diagnostic — wait for a 12-hour repeat
Correct answer: B
Troponin I of 2.8 ng/mL is nearly 70 times the upper limit of normal. In the context of chest pain, this confirms myocardial injury. Option A is completely incorrect. Option C — renal failure can cause mild troponin elevation — but 2.8 ng/mL is far above what chronic kidney disease alone would produce. Option D is incorrect; this single result is diagnostic in context.
Question 81
A patient develops stridor and worsening dyspnea 30 minutes after returning from bronchoscopy under moderate sedation. What is the nurse's priority?
A. Administer oxygen by nasal cannula and monitor
B. Document the finding and notify the provider at the next opportunity
C. Initiate the facility's emergency response immediately
D. Reposition the patient and reassess in 15 minutes
Correct answer: C
Stridor and progressive dyspnea post-bronchoscopy indicate laryngospasm, bronchospasm, or airway edema — airway emergencies requiring immediate intervention. This is not a "monitor and reposition" situation. Options A, B, and D all delay the urgent response required.
Question 82
A patient's blood glucose is 52 mg/dL and the patient is conscious and able to swallow. What is the most appropriate initial treatment?
A. Administer 1 mg glucagon IM
B. Give 15–20 grams of fast-acting carbohydrate orally
C. Establish IV access and administer 50 mL of D50W
D. Administer 10 units of regular insulin to stabilize glucose
Correct answer: B
For a conscious patient who can swallow, oral carbohydrates (15–20 grams = 4 glucose tablets, 4 oz orange juice, or 8 oz milk) are first-line treatment. IV dextrose (C) and glucagon IM (A) are for unconscious patients or those who cannot swallow. Insulin (D) would lower glucose further and is contraindicated.
Question 83
A patient's telemetry shows no discernible P waves, irregular R-R intervals, and a fibrillatory baseline between QRS complexes. What is this rhythm?
A. Atrial flutter
B. Ventricular fibrillation
C. Atrial fibrillation
D. Sinus tachycardia with PVCs
Correct answer: C
Atrial fibrillation: absent P waves (replaced by irregular fibrillatory baseline), irregularly irregular R-R intervals, and normal-appearing QRS complexes. Atrial flutter (A) shows a regular sawtooth pattern. Ventricular fibrillation (B) has chaotic, irregular wide waveforms with no organized QRS and is a cardiac arrest emergency. Sinus tachycardia with PVCs (D) would have identifiable P waves.
Question 84
A patient's morning potassium is 2.9 mEq/L. The patient is on digoxin 0.125 mg daily and furosemide 40 mg daily. What is the nurse's priority action?
A. Administer both medications and recheck potassium in 4 hours
B. Administer the furosemide but hold the digoxin
C. Hold both medications and notify the provider
D. Give both medications and increase dietary potassium intake
Correct answer: C
Hypokalemia potentiates digoxin toxicity. With a potassium of 2.9 mEq/L, administering digoxin risks serious cardiac arrhythmia. Furosemide will further lower potassium. Both medications should be held pending provider notification and likely potassium replacement. Option B addresses only part of the problem. Options A and D are unsafe.
Question 85
A patient is scheduled for a lumbar puncture. In which position should the nurse assist the patient?
A. Supine with a pillow under the lumbar spine
B. Lateral recumbent with knees drawn to the chest and chin tucked
C. Prone with legs extended
D. Sitting upright at the edge of the bed with arms overhead
Correct answer: B
The lateral recumbent fetal position (knees to chest, chin tucked) maximally opens the intervertebral spaces for safe needle insertion between L3–L4 or L4–L5. A sitting position leaning forward is an alternative, but the description in Option D (arms overhead) would not adequately open the intervertebral spaces. Supine (A) and prone (C) do not allow LP access.
Question 86
A patient returns from cardiac catheterization via the right femoral artery. Select all that apply: Which nursing assessments are priorities in the first hour?
A. Assess the right groin site for bleeding or hematoma
B. Check bilateral pedal pulses
C. Monitor blood pressure and heart rate every 15 minutes
D. Encourage the patient to ambulate immediately
E. Assess the right leg for temperature, color, and sensation
F. Keep the right leg straight and head of bed at 30 degrees or lower
Correct answers: A, B, C, E, F
After femoral artery access, priorities include monitoring the access site for bleeding (A), assessing distal perfusion (B, E), hemodynamic monitoring (C), and maintaining bed rest with the leg straight (F). Immediate ambulation (D) is contraindicated — the patient typically remains flat for 2–6 hours depending on the arteriotomy closure method.
Question 87
A post-operative patient's respiratory rate has decreased to 8 breaths/minute and they are becoming difficult to arouse. ABG: pH 7.28, PaCO2 58, PaO2 80, HCO3 24. How should this ABG be interpreted?
A. Metabolic acidosis, uncompensated
B. Respiratory acidosis, uncompensated
C. Metabolic alkalosis, partially compensated
D. Respiratory alkalosis, fully compensated
Correct answer: B
pH 7.28 is acidotic. PaCO2 58 is elevated — the lungs are retaining CO2 (respiratory cause). HCO3 24 is normal, meaning the kidneys have not yet compensated. This is uncompensated respiratory acidosis, consistent with opioid-induced respiratory depression. Metabolic acidosis (A) would have low HCO3. Alkalosis (C, D) requires pH > 7.45.
Question 88
A nurse receives an order to insert a urinary catheter for urinary retention. Before inserting, which assessment is essential?
A. Confirm the patient's most recent urinalysis results
B. Verify the patient's allergy history, particularly to latex or povidone-iodine
C. Ensure the patient has voided within the past 4 hours
D. Confirm the patient has signed a procedure consent form
Correct answer: B
Before inserting a urinary catheter, checking for latex and antiseptic allergies prevents a potentially severe allergic reaction. Latex catheters and povidone-iodine prep solution are commonly used and can cause serious reactions in sensitized patients. Urinalysis (A) is useful but not essential before insertion. The patient clearly has not voided if being catheterized for retention (C is irrelevant). Signed consent for catheterization is not typically required (D).
Physiological Adaptation
Physiological Adaptation covers 11–17% of the NCLEX-RN. These questions test your ability to respond to acute changes, manage medical emergencies, and apply pathophysiology. Know your emergencies cold — the sequence of interventions for DKA, MI, anaphylaxis, and septic shock comes up repeatedly.
Question 89
A patient with asthma arrives in the ED in acute respiratory distress: using accessory muscles, bilateral expiratory wheezing, SpO2 88%, and becoming confused. What is the nurse's priority action?
A. Prepare to assist with intubation
B. Administer a short-acting beta-2 agonist (albuterol) via nebulizer immediately
C. Place the patient in a supine position with legs elevated
D. Obtain IV access and begin IV corticosteroids
Correct answer: B
Immediate bronchodilation with a short-acting beta-2 agonist is the first intervention for acute asthma. Albuterol acts within minutes. IV corticosteroids (D) are also important but work over hours, not immediately. Supine positioning (C) would worsen dyspnea. Intubation (A) may become necessary if the patient fails maximal bronchodilator therapy, but it is not the first intervention.
Question 90
A patient is admitted with diabetic ketoacidosis. Blood glucose 480 mg/dL, pH 7.22, alert. Which intervention should the nurse perform first?
A. Begin insulin infusion at 0.1 units/kg/hour IV
B. Initiate IV fluid resuscitation with 0.9% normal saline
C. Administer sodium bicarbonate to correct the acidosis
D. Place the patient on continuous cardiac monitoring
Correct answer: B
The first intervention in DKA is aggressive IV fluid resuscitation with isotonic normal saline. DKA patients are profoundly dehydrated from osmotic diuresis. Insulin (A) is started after fluids are running — insulin without adequate fluids can cause dangerous hypovolemic shock as glucose drives potassium into cells. Sodium bicarbonate (C) is generally not used unless pH < 6.9. Cardiac monitoring (D) is important but not the first action.
Question 91
A patient in acute MI reports chest pain 8/10, diaphoresis, and nausea. Which intervention should the nurse implement first?
A. Obtain a 12-lead ECG
B. Establish IV access
C. Administer aspirin 325 mg orally as ordered
D. Apply supplemental oxygen at 2L/min
Correct answer: C
Aspirin is the most time-critical pharmacological intervention in acute MI — antiplatelet therapy limits thrombus progression. A 12-lead ECG (A) should happen immediately and confirms the diagnosis; in practice, these actions occur simultaneously. The key NCLEX principle is that aspirin should never be delayed. Oxygen (D) is now evidence-based only for patients with SpO2 below 94%.
Question 92
A patient in the ICU develops sudden hypotension (BP 78/40), tachycardia (HR 128), fever of 39.4°C (103°F), and altered mental status. Blood cultures are pending. Which diagnosis should the nurse suspect?
A. Hypovolemic shock
B. Neurogenic shock
C. Septic shock
D. Cardiogenic shock
Correct answer: C
Septic shock: hypotension, tachycardia, fever (or hypothermia), altered mental status with evidence of infection. Hypovolemic shock (A) does not cause fever. Neurogenic shock (B) causes bradycardia and hypothermia from sympathetic disruption. Cardiogenic shock (D) includes heart failure signs — elevated JVP, pulmonary crackles, low cardiac output — without fever.
Question 93
A patient with a traumatic brain injury has a GCS that dropped from 14 to 9 over the past hour. Blood pressure is now 170/60 mmHg and heart rate is 44 bpm. What does this pattern indicate?
A. Autonomic dysreflexia
B. Cushing's triad from increased intracranial pressure
C. Neurogenic shock
D. SIADH
Correct answer: B
Cushing's triad is a late, ominous sign of increased intracranial pressure: hypertension with widened pulse pressure, bradycardia, and irregular respirations. The declining GCS confirms neurological deterioration. Autonomic dysreflexia (A) occurs in spinal cord injury above T6 in response to a stimulus. Neurogenic shock (C) causes bradycardia with hypotension, not hypertension. SIADH (D) causes hyponatremia and does not present this way acutely.
Question 94
A patient with COPD is admitted for an exacerbation. Select all that apply: Which nursing interventions are appropriate?
A. Administer supplemental oxygen to maintain SpO2 88–92%
B. Administer high-flow oxygen at 10–15 L/min via non-rebreather mask
C. Position the patient in high Fowler's or leaning forward in tripod position
D. Administer bronchodilators as ordered
E. Encourage the patient to breathe rapidly to improve oxygenation
F. Teach pursed-lip breathing to help with exhalation
Correct answers: A, C, D, F
COPD patients may rely on a hypoxic drive — oxygen is titrated to maintain SpO2 88–92%, not higher (A). High-flow O2 (B) can suppress their hypoxic respiratory drive. Upright positioning (C) maximizes diaphragmatic excursion. Bronchodilators (D) address bronchoconstriction. Rapid breathing (E) worsens air trapping. Pursed-lip breathing (F) prolongs exhalation and reduces air trapping.
Question 95
A patient has burns to the anterior trunk and both anterior lower extremities. Using the Rule of Nines, what percentage of TBSA is affected?
A. 27%
B. 36%
C. 45%
D. 18%
Correct answer: B
Anterior trunk = 18%. Each anterior lower extremity = 9% (2 × 9% = 18%). Total: 18% + 18% = 36%.
Question 96
A patient in acute kidney injury has a potassium of 6.0 mEq/L and is oliguric. Which dietary restriction is the priority?
A. Restrict phosphorus-containing foods
B. Restrict potassium-containing foods
C. Restrict protein intake
D. Restrict sodium-containing foods
Correct answer: B
In AKI with hyperkalemia and oliguria, potassium restriction is the immediate priority — the kidneys cannot excrete excess potassium and fatal dysrhythmias can result. Phosphorus restriction (A) and protein restriction (C) are important in CKD management but are less immediately life-threatening than a potassium of 6.0. Sodium restriction (D) is also relevant but not the priority here.
Question 97
A patient presents with sudden right-sided facial drooping, slurred speech, and right arm weakness beginning 90 minutes ago. Which intervention is the priority?
A. Prepare the patient for tPA administration
B. Obtain a non-contrast CT scan of the head
C. Establish large-bore IV access and begin heparin infusion
D. Place the patient on continuous cardiac monitoring
Correct answer: B
Before any treatment for suspected ischemic stroke, a non-contrast CT must rule out hemorrhagic stroke. Administering tPA (A) to a patient with a hemorrhagic stroke would be fatal. The CT comes first. Heparin (C) is not standard first-line treatment for ischemic stroke. Cardiac monitoring (D) is important but not the first priority.
Question 98
A patient who received an IV antibiotic 5 minutes ago develops sudden urticaria, angioedema, stridor, and hypotension. What is the nurse's first action?
A. Stop the antibiotic infusion and administer diphenhydramine IV
B. Stop the antibiotic infusion, administer epinephrine 0.3–0.5 mg IM, and call for emergency assistance
C. Slow the antibiotic infusion and monitor vital signs every 5 minutes
D. Administer methylprednisolone 125 mg IV and oxygen via face mask
Correct answer: B
Anaphylaxis (urticaria + angioedema + stridor + hypotension) is a life-threatening emergency. Epinephrine IM (vastus lateralis) is the only treatment that reverses all four components: bronchospasm, vasodilation, increased vascular permeability, and hypotension. Diphenhydramine (A) and corticosteroids (D) are adjuncts, not first-line. Slowing the infusion (C) does not treat anaphylaxis.
Question 99
A patient with chronic heart failure reports increasing dyspnea, leg edema, and 4-pound weight gain in 2 days. Which assessment finding is most consistent with decompensated heart failure?
A. Blood pressure 145/90 mmHg
B. Bibasilar crackles that do not clear with coughing
C. Irregularly irregular heart rhythm
D. Jugular venous distension at 30 degrees
Correct answer: B
Bibasilar crackles that do not clear with coughing indicate fluid in the alveoli — pulmonary edema from left-sided heart failure decompensation. The weight gain and edema corroborate fluid overload. Atrial fibrillation (C) is common in heart failure but is not specific to decompensation. JVD at 30 degrees (D) suggests elevated right-sided filling pressure but is less specific than pulmonary crackles for left-sided failure.
Question 100
A patient with type 1 diabetes is found unresponsive. Blood glucose reads "LOW" on the glucometer. What should the nurse do first?
A. Administer 1 mg glucagon IM or subcutaneously
B. Administer 50 mL of 50% dextrose (D50W) IV push
C. Attempt to give orange juice orally
D. Check a repeat blood glucose on the other finger
Correct answer: B
For an unconscious patient with severe hypoglycemia, D50W IV push is the treatment of choice when IV access is available. It rapidly restores blood glucose. Glucagon IM (A) is used when IV access is not available and may take 5–15 minutes to work via glycogenolysis. Oral glucose (C) is never appropriate for an unconscious patient — aspiration risk. A repeat glucose check (D) delays life-saving treatment.
Scoring guide
90–100 correct: Strong content mastery across categories. Focus on test-taking strategy, SATA mechanics, and timed practice.
75–89 correct: Solid foundation with gaps. Look at the categories where you missed 2 or more questions and determine whether the errors were content gaps or reasoning errors. Content gaps need more study. Reasoning errors need more practice.
60–74 correct: Several content areas need attention. For each wrong answer, identify the underlying concept — not just the question — and study it before re-testing.
Below 60: Work through every rationale before re-testing, including the rationales for wrong answers. Understanding why a distractor is tempting teaches you more than confirming the correct choice.
What to do next
One hundred questions covers the surface. The NCLEX draws from thousands of items across all content areas. You need sustained, repeated practice — not a single session.
The research on this is unambiguous. Dunlosky et al. found that distributed practice is one of only two study techniques with high utility. Thirty questions a day for 10 days beats 300 questions in a single session, even if the total number is the same.
Test yourself from your own materials. Your pharmacology notes, clinical scenarios from lectures, care plans from clinicals — these are exactly what you should be practicing from, because they contain the content you've actually studied. Quizgecko's AI quiz generator turns your uploaded notes into NCLEX-style practice questions in about 30 seconds. Upload your drug card notes, generate a 25-question pharmacology test, and work through it the same way you did here.
Study your wrong answers harder than your right ones. If you answered correctly because you guessed between two options, that's not mastery. Know why the correct answer is correct and why each wrong answer is wrong. That kind of reasoning transfers to questions you've never seen.
You can generate unlimited practice questions from your own materials, or explore the full Quizgecko features for NCLEX prep, including spaced repetition flashcards and AI-generated study notes.
The NCLEX tests clinical judgment. Build the reasoning, not the list.
