NCLEX-RN (National Council Licensure Examination for Registered Nurses) — Questions and Answers

Question 1: A nurse is assessing a febrile 3-year-old with a temperature of 39.5°C (103.1°F). Which initial nursing action is most appropriate?

Administer acetaminophen per protocol (Correct answer)
Restrict oral fluids to prevent vomiting
Apply a cooling blanket immediately
Obtain blood cultures before any intervention

Correct answer: Administer acetaminophen per protocol

Administering antipyretics such as acetaminophen per protocol is the priority intervention to safely reduce fever and improve the child's comfort.

Question 2: A community health nurse is calculating the incidence rate of new HIV diagnoses in a city. Which data are required to calculate the incidence rate?

Number of new HIV cases in a specified time period divided by the at-risk population (Correct answer)
Number of HIV-related deaths divided by the total number of HIV cases
Number of new cases divided by the total number of previously existing cases
Total number of people currently living with HIV divided by the total population

Correct answer: Number of new HIV cases in a specified time period divided by the at-risk population

Incidence rate measures new cases over a defined period in the population at risk; it differs from prevalence, which counts all existing cases.

Question 3: A patient with obsessive-compulsive disorder (OCD) spends 3 hours each morning washing their hands. Which nursing intervention is most appropriate?

Distract the patient by immediately redirecting to another activity
Prevent the patient from washing their hands to extinguish the behavior
Tell the patient the behavior is irrational and encourage willpower to stop
Allow the ritual while gradually working with the treatment team to set limits over time (Correct answer)

Correct answer: Allow the ritual while gradually working with the treatment team to set limits over time

Abruptly preventing rituals causes severe anxiety; the goal is gradual reduction through exposure and response prevention therapy in collaboration with the team.

Question 4: Which statement by a patient taking selective serotonin reuptake inhibitors (SSRIs) indicates correct understanding of the medication?

'I may not notice a full improvement in my mood for 4–6 weeks.' (Correct answer)
'I can stop taking the medication as soon as I feel normal again.'
'I should take an extra dose if I feel especially depressed one day.'
'I should feel better within 2–3 days of starting the medication.'

Correct answer: 'I may not notice a full improvement in my mood for 4–6 weeks.'

SSRIs have a delayed therapeutic onset of 4–6 weeks due to the time required for neuroadaptive changes in serotonin receptor sensitivity.

Question 5: The nurse should apply lengthy, firm strokes from the distal to the proximal areas when bathing the patient's extremities. This approach:

Causes vasoconstriction and increases circulation.
Increases venous blood return. (Correct answer)
Provides an opportunity for skin assessment.
Avoids undue strain on the nurse.

Correct answer: Increases venous blood return.

By stimulating venous blood flow, washing from distal to proximal locations prevents venous stasis. While keeping good personal hygiene is crucial for skin health, it also plays a significant part in preserving self-worth and quality of life. A crucial part of nursing care is assisting patients in maintaining their personal hygiene.

Question 6: Over the course of the 12-hour shift, six clients will be attended by a registered nurse. The RN is in charge of all aspects of care, including developing the care plan, making interventions, and monitoring the care during her shift. The RN will hand off this responsibility to the following RN in charge when her shift is through. What kind of approach is demonstrated by this nursing care?

Functional method
Team method
Primary nursing method
Case method (Correct answer)

Correct answer: Case method

Case Management. For the duration of her whole shift, the nurse is solely responsible for attending to the patient's needs.

Question 7: A patient with chronic kidney disease (CKD) has a potassium level of 6.4 mEq/L. Which assessment finding is most concerning?

Blood pressure of 148/90 mmHg
Serum sodium of 138 mEq/L
Urine output of 40 mL/hr
Tall peaked T waves on the ECG (Correct answer)

Correct answer: Tall peaked T waves on the ECG

Peaked T waves are an early ECG sign of hyperkalemia, which can progress to life-threatening dysrhythmias if not treated.

Question 8: A nurse manager transferred an RN from the children unit to the telemetry unit. The RN was given charge of three patients. Which patient(s) from the list below shouldn't be given to the floating nurse?

A young infant after pyloromyotomy (Correct answer)
A 9-year-old child diagnosed with rheumatic fever
A 4-year-old with VSD following cardiac catheterization
A 5-month-old with Kawasaki disease

Correct answer: A young infant after pyloromyotomy

The nurse who was floated from the telemetry unit would not be well-equipped to care for a small child who has recently undergone GI surgery and needs a strict feeding schedule.

Question 9: Under the HIPAA Privacy Rule, which action is permissible without patient authorization?

Providing records to a friend of the patient
Disclosing PHI to law enforcement for a court order (Correct answer)
Sharing records with an employer for job screening
Selling patient data to a pharmaceutical company

Correct answer: Disclosing PHI to law enforcement for a court order

HIPAA permits disclosure of PHI to law enforcement when required by a court order or subpoena.

Question 10: A nurse is prioritizing care using Maslow's Hierarchy of Needs. Which patient need should be addressed first?

A patient who requests a specific type of pillow for comfort
A patient who feels isolated and wants visitors
A patient with acute urinary retention causing significant pain and bladder distension (Correct answer)
A patient who is anxious about an upcoming surgery scheduled for tomorrow

Correct answer: A patient with acute urinary retention causing significant pain and bladder distension

Acute urinary retention is a physiological need causing physical harm and must be addressed before psychological or comfort needs.

Question 11: The ventilator of a patient sounds the high-pressure alarm. The oxygen saturation meter in the patient's room indicates 87% when you walk in to evaluate the ARDS patient, who is also having trouble sitting up. Which move ought to you make next?

Increase the fraction of inspired oxygen on the ventilator to 100% in preparation for endotracheal suctioning.
Insert an oral airway to prevent the patient from biting on the endotracheal tube.
Manually ventilate the patient while assessing possible reasons for the high-pressure alarm. (Correct answer)
Reassure the patient that the ventilator will do the work of breathing for him.

Correct answer: Manually ventilate the patient while assessing possible reasons for the high-pressure alarm.

You can give the patient 100% FiO2 by manually ventilating them while you try to figure out what's causing the high-pressure alarm. Safe ventilation parameters for each patient and their conditions should be taken into account while using proper ventilation strategies with the BVM.

Question 12: A patient who is getting oxygen through a nasal cannula at a flow rate of 6 L/min complains of nasal passage irritation, the nursing assistant informs you. What course of action might you recommend to enhance the patient's comfort in light of this issue?

Suggest that a simple face mask be used instead of a nasal cannula.
Suggest that the patient be provided with an extra pillow.
Suggest that the patient's oxygen be humidified. (Correct answer)
Suggest that the patient sit up in a chair at the bedside.

Correct answer: Suggest that the patient's oxygen be humidified.

The mucous membranes may dry out when the oxygen flow rate exceeds 4 L/min. The best course of action is to upgrade the oxygen delivery system with humidification. For patients who need high-flow oxygen systems for longer than 24 hours or who complain of upper airway irritation owing to dryness, it is permissible to utilize humidified oxygen. It can also be beneficial to apply a water-soluble jelly to the nares to lessen mucosal irritation. None of the alternative solutions will address the issue.

Question 13: A patient in seclusion begins to bang their head against the wall. What is the nurse's immediate response?

Enter the room with sufficient staff to ensure patient safety and prevent self-injury (Correct answer)
Observe through the window and document the behavior without entering
Increase the time in seclusion as a consequence of the behavior
Call a code and wait for the response team

Correct answer: Enter the room with sufficient staff to ensure patient safety and prevent self-injury

The nurse must enter the seclusion room with adequate staff to protect the patient from self-harm, which is the priority in seclusion monitoring.

Question 14: A nurse uses the SBAR communication tool when handing off a deteriorating patient. What does the 'R' stand for?

Review
Report
Response
Recommendation (Correct answer)

Correct answer: Recommendation

In SBAR, 'R' stands for Recommendation — the nurse's suggested action or plan for addressing the patient's condition.

Question 15: A nurse is caring for a patient on contact precautions. Which task is safe to delegate to a UAP?

Educating the patient about hand hygiene importance
Deciding whether to continue the contact precautions
Assisting the patient with a bed bath using proper PPE (Correct answer)
Assessing skin integrity during bath

Correct answer: Assisting the patient with a bed bath using proper PPE

Assisting with a bed bath is a routine personal care task within UAP scope, provided they use appropriate PPE for contact precautions.

Question 16: The nursing assistant takes the patient's vital signs after the respiratory therapist suctions an intubated patient. Which vital sign value needs to be reported right away to the licensed nurse by the nursing assistant?

Heart rate of 98 beats/min
Tympanic temperature of 101.4ºF (38.6ºC) (Correct answer)
Blood pressure of 168/90 mm Hg
Respiratory rate of 24 breaths/min

Correct answer: Tympanic temperature of 101.4ºF (38.6ºC)

The risk of infection for a patient undergoing mechanical breathing never goes away. Bypassing the body's natural air-filtering systems, the endotracheal tube gives bacteria and viruses a direct path to the lower respiratory system.

Question 17: A nurse working at a county health department is notified of a confirmed case of meningococcal meningitis in a college dormitory. What is the nurse's priority public health action?

Wait for the laboratory to confirm the bacterial strain before taking action
Close the dormitory and test all 500 residents
Administer the meningococcal vaccine to all close contacts immediately
Identify close contacts and coordinate prophylactic antibiotic treatment for them (Correct answer)

Correct answer: Identify close contacts and coordinate prophylactic antibiotic treatment for them

Close contacts (roommates, household members) are at highest risk and should receive chemoprophylaxis (rifampin or ciprofloxacin) as soon as possible to prevent secondary cases.

Question 18: A laboring patient's external fetal monitor shows variable decelerations with cord compression pattern. Which nursing action is the priority?

Change the patient's position and administer oxygen via face mask (Correct answer)
Document the finding and reassess in 15 minutes
Increase the IV oxytocin infusion rate
Prepare for immediate cesarean delivery

Correct answer: Change the patient's position and administer oxygen via face mask

Position changes (e.g., lateral decubitus or knee-chest) relieve cord compression, and supplemental oxygen improves fetal oxygenation.

Question 19: A patient post-hip replacement surgery asks why they must avoid crossing their legs. The nurse's best response is:

It causes unnecessary pressure on the surgical wound
Crossing the legs can dislocate the new hip joint (Correct answer)
It impairs circulation to the operative extremity
It increases the risk of blood clots in the legs

Correct answer: Crossing the legs can dislocate the new hip joint

Adduction and internal rotation of the hip—as occurs when crossing the legs—can displace the prosthetic femoral head from the acetabular cup.

Question 20: Which electrolyte imbalance increases a patient's risk for digoxin toxicity?

Hypernatremia
Hypokalemia (Correct answer)
Hypercalcemia
Hyperkalemia

Correct answer: Hypokalemia

Hypokalemia potentiates digoxin toxicity because low potassium levels increase myocardial sensitivity to the drug.

Question 21: A patient who is 3 days postpartum and exclusively breastfeeding reports nipple soreness with latching. What is the most helpful nursing intervention?

Advise the patient to supplement with formula to give the nipples a rest
Observe a feeding session and evaluate the infant's latch for correct positioning (Correct answer)
Instruct the patient to use a nipple shield during all feedings
Tell the patient that nipple soreness is normal and will resolve on its own

Correct answer: Observe a feeding session and evaluate the infant's latch for correct positioning

Nipple soreness is most often caused by a poor latch; directly observing and correcting the feeding technique addresses the root cause.

Question 22: Despite using a non-rebreather mask to deliver oxygen to a patient with acute respiratory distress syndrome (ARDS), arterial blood gas readings still indicate low oxygenation. You would anticipate a doctor's order for what action as the nurse in charge of this patient's care, wouldn't you?

Perform endotracheal intubation and initiate mechanical ventilation. (Correct answer)
Administer furosemide (Lasix) 100 mg IV push stat.
Call a code for respiratory arrest.
Immediately begin continuous positive airway pressure (CPAP) via the patient's nose and mouth.

Correct answer: Perform endotracheal intubation and initiate mechanical ventilation.

A non-rebreather mask can provide almost all of the oxygen needed. Refractory hypoxemia is observed when the patient's oxygenation status does not significantly improve in response to the supply of oxygen at this high dosage. The patient is typically exerting a lot of effort to breathe at this point and risking respiratory arrest unless medical professionals step in and administer intubation and mechanical ventilation to lessen the patient's labor of breathing.

Question 23: The pediatric unit's charge nurse is not present. The nursing supervisor made the decision to transfer the obstetrics unit's nurse to the pediatrics unit. What patients from the list below could the nurse manager trustfully provide the float nurse?

A child receiving an IV chelating therapy for lead poisoning
A child who had multiple injuries from a serious vehicle accident
A child who has had a nephrectomy for Wilm’s tumor (Correct answer)
A child diagnosed with Kawasaki disease and with cardiac complications

Correct answer: A child who has had a nephrectomy for Wilm’s tumor

Because this nurse has previous experience caring for patients who have had cesarean births, she should be able to care for a client who needs significant abdominal surgery.

Question 24: A community health nurse is using Maslow's hierarchy of needs to prioritize care for a homeless shelter resident. Which need must be addressed first?

Safety from domestic violence
Belonging and social connections
Food, shelter, and warmth (physiological needs) (Correct answer)
Self-esteem and recognition

Correct answer: Food, shelter, and warmth (physiological needs)

Maslow's hierarchy places physiological needs (food, water, shelter, warmth) at the base; these must be met before higher-level needs can be addressed.

Question 25: A nurse receives a telephone order from a physician. Which is the BEST action to ensure accuracy?

Ask the physician to enter the order directly into the electronic health record
Repeat the order back only if it involves a controlled substance
Read back the complete order to the physician and document 'T.O. read back and verified' (Correct answer)
Write the order immediately and have the charge nurse cosign it

Correct answer: Read back the complete order to the physician and document 'T.O. read back and verified'

Reading back the entire order and documenting verification is the safest practice to prevent miscommunication errors with telephone orders.

Question 26: A nursing diagnostic of sleep deprivation due to a disrupted sleep cycle is given to a patient with sleep apnea. Which task ought to you assign the nursing assistant?

Remind the patient to sleep on his side instead of his back. (Correct answer)
Discuss weight-loss strategies such as diet and exercise with the patient.
Teach the patient how to set up the BiPAP machine before sleeping.
Administer modafinil (Provigil) to promote daytime wakefulness.

Correct answer: Remind the patient to sleep on his side instead of his back.

The nursing assistant can remind patients to perform tasks that are specified in their care plan and have already been taught to them by the nurse. The appropriate person must be given the appropriate tasks and responsibilities under the appropriate conditions. Following that, the nurse who assigned the tasks and jobs must interact with and supervise the person performing them. The nurse oversees the individual and judges whether or not the task was completed in a proper, suitable, safe, and competent manner.

Question 27: A nurse is assessing a 1-day-old newborn and notes jaundice extending to the chest and abdomen. The nurse is aware that jaundice appearing before 24 hours of life is:

Physiological and expected at this stage
Pathological and requires immediate investigation (Correct answer)
Related to normal meconium passage
A sign of breastfeeding jaundice

Correct answer: Pathological and requires immediate investigation

Jaundice appearing in the first 24 hours of life is always pathological (commonly hemolytic disease) and requires urgent evaluation to prevent kernicterus.

Question 28: A patient returns from a left-sided cardiac catheterization via the femoral artery. Which assessment finding requires immediate nursing intervention?

Patient reporting a need to void
Mild bruising at the puncture site
Absence of dorsalis pedis pulse in the left foot (Correct answer)
Blood pressure of 128/80 mmHg in the right arm

Correct answer: Absence of dorsalis pedis pulse in the left foot

Loss of the pulse distal to the puncture site indicates arterial occlusion or hematoma compression, requiring immediate notification of the provider.

Question 29: Which of the following tasks CANNOT be delegated to an unlicensed assistive personnel (UAP) by an RN?

Measuring and recording urine output
Performing a focused respiratory assessment on a patient with new-onset shortness of breath (Correct answer)
Obtaining a routine set of vital signs on a stable patient
Ambulating a stable postoperative patient in the hallway

Correct answer: Performing a focused respiratory assessment on a patient with new-onset shortness of breath

Assessment is a cognitive, clinical judgment task that falls exclusively within the RN scope of practice and cannot be delegated to UAP.

Question 30: A nurse assesses a newborn at 1 minute of life and assigns the following: heart rate 118 bpm, weak cry, some flexion of extremities, grimace to suction, body pink with blue extremities. What is the Apgar score?

7
8
6 (Correct answer)
5

Correct answer: 6

Scoring: HR >100 (2), weak cry (1), some flexion (1), grimace (1), body pink with acrocyanosis (1) = 6 total.

Question 31: Which antidote should the nurse have readily available when administering IV opioids?

Vitamin K (phytonadione)
Flumazenil (Romazicon)
Protamine sulfate
Naloxone (Narcan) (Correct answer)

Correct answer: Naloxone (Narcan)

Naloxone reverses opioid-induced respiratory depression by competitively binding mu-opioid receptors.

NCLEX-RN (National Council Licensure Examination for Registered Nurses)

The NCLEX-RN is the standardized national licensing exam required for BSN graduates to practice as registered nurses, assessing knowledge, skills, and clinical judgment essential to safe and effective entry-level nursing practice across all client need categories.

100

Questions

300 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. We have not yet matched this exam's facts to an official source, so confirm fees, dates and rules with the exam body. Not reviewed by a subject-matter expert. Editorial policy