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

Question 1: A postoperative patient who had abdominal surgery 2 days ago reports sudden onset of severe shortness of breath, chest pain, and apprehension. The nurse suspects pulmonary embolism. Which action takes priority?

Obtain a 12-lead ECG before calling the provider
Encourage the patient to take slow, deep breaths
Position the patient in Trendelenburg to improve perfusion
Administer oxygen and notify the provider immediately (Correct answer)

Correct answer: Administer oxygen and notify the provider immediately

Suspected pulmonary embolism is a medical emergency; administering oxygen to treat hypoxemia and immediately notifying the provider are the priority actions.

Question 2: A nurse manager notices consistent conflict between two staff RNs regarding patient assignments. What is the most appropriate first action?

Meet with both nurses individually to understand each perspective before facilitating a joint resolution (Correct answer)
Ignore the situation and wait to see if it resolves on its own
Report both nurses to administration for disciplinary action
Separate the nurses by assigning them to different shifts immediately

Correct answer: Meet with both nurses individually to understand each perspective before facilitating a joint resolution

Gathering each party's perspective individually is the first step in conflict resolution, allowing the manager to facilitate a fair, informed discussion.

Question 3: Which electrolyte imbalance is most likely to precipitate digoxin toxicity?

Hypernatremia
Hypermagnesemia
Hypokalemia (Correct answer)
Hyperkalemia

Correct answer: Hypokalemia

Hypokalemia enhances digoxin binding to cardiac Na+/K+-ATPase receptors, increasing toxicity risk.

Question 4: Which principle guides the nurse in prioritizing care using Maslow's hierarchy of needs?

Psychosocial needs are always addressed before physiological needs
All needs are equal and should be addressed simultaneously
Safety needs take priority over all other needs
Physiological needs must be met before higher-level needs can be addressed (Correct answer)

Correct answer: Physiological needs must be met before higher-level needs can be addressed

Maslow's hierarchy places physiological needs (airway, breathing, circulation) at the base, meaning they must be addressed first.

Question 5: 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?

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

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 6: The emergency department charge nurse must prioritize four patients arriving simultaneously. Which patient is triaged as emergent (highest priority)?

A 45-year-old with a laceration requiring sutures and stable vital signs
A 25-year-old with a sprained ankle, pain rated 6/10
A 60-year-old with diaphoresis, jaw pain, and a blood pressure of 90/60 mmHg (Correct answer)
A 70-year-old with a urinary tract infection and low-grade fever

Correct answer: A 60-year-old with diaphoresis, jaw pain, and a blood pressure of 90/60 mmHg

Diaphoresis, jaw pain, and hypotension are classic signs of acute myocardial infarction with hemodynamic compromise, requiring immediate intervention.

Question 7: A patient with a urinary tract infection is prescribed trimethoprim-sulfamethoxazole (TMP-SMX). Which allergy history is a contraindication to this medication?

Contrast dye allergy
Sulfa drug allergy (Correct answer)
Aspirin-exacerbated respiratory disease
Penicillin allergy

Correct answer: Sulfa drug allergy

TMP-SMX contains a sulfonamide component; a documented sulfa allergy is a contraindication due to the risk of severe hypersensitivity reactions.

Question 8: When using a PCA (patient-controlled analgesia) pump, which action by the patient's family member requires immediate nurse intervention?

Keeping a pain diary on behalf of the patient
Reporting unrelieved pain to the nursing staff
Pressing the PCA button while the patient is sleeping (Correct answer)
Reminding the patient to press the button before ambulation

Correct answer: Pressing the PCA button while the patient is sleeping

Only the patient should activate the PCA; proxy dosing by a family member bypasses the safety mechanism and can cause respiratory depression.

Question 9: When delegating, the RN is responsible for which of the following?

Performing the task alongside the delegate every time
Accepting sole accountability only if the delegate makes an error
Delegating based on the delegate's personal preference
Supervising and evaluating the outcome of the delegated task (Correct answer)

Correct answer: Supervising and evaluating the outcome of the delegated task

The RN retains accountability for the outcome and must supervise and evaluate whether the delegated task was completed safely and correctly.

Question 10: A patient who is 2 hours postpartum has a boggy uterus palpated at 2 fingerbreadths above the umbilicus. The priority nursing action is:

Massage the uterine fundus firmly until it becomes firm (Correct answer)
Assist the patient to the bathroom to empty the bladder
Apply ice packs to the fundus to promote vasoconstriction
Increase the IV oxytocin infusion rate immediately

Correct answer: Massage the uterine fundus firmly until it becomes firm

Uterine massage stimulates the uterine muscles to contract and is the first-line intervention for a boggy (atonic) uterus.

Question 11: A nurse is caring for a newborn receiving phototherapy for hyperbilirubinemia. Which action is essential during phototherapy?

Keep the newborn fully clothed to maintain warmth
Turn the phototherapy lights off during feedings and keep them off for 1 hour after
Decrease feeding frequency to rest the newborn's gastrointestinal system
Cover the newborn's eyes with phototherapy eye shields (Correct answer)

Correct answer: Cover the newborn's eyes with phototherapy eye shields

Phototherapy light can cause retinal damage; eye shields protect the newborn's eyes throughout the treatment.

Question 12: A patient with schizophrenia is receiving clozapine (Clozaril). Which potentially life-threatening adverse effect requires regular monitoring with a complete blood count?

Tardive dyskinesia
Neuroleptic malignant syndrome
QT prolongation
Agranulocytosis (Correct answer)

Correct answer: Agranulocytosis

Clozapine can cause agranulocytosis (severe reduction in white blood cells), making regular CBC monitoring mandatory per the Clozapine REMS program.

Question 13: All of the nursing unit clients' medications are administered by the nurse in the medication unit. The head nurse is coordinating the activities for clients with other departments while making rounds with the doctor. The nurse's aide answers call lights and adjusts bed lines. A licensed practitioner nurse collects vital signs and bathes the patients; a second nurse is assigned to change the wound dressings. What kind of nursing care method does this illustrate?

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

Correct answer: Functional method

It speaks of practical nursing. Instead of specific clients, staff members are assigned to certain tasks.

Question 14: When implementing the SBAR communication tool, what information is conveyed in the 'Assessment' component?

The patient's name, age, and admitting diagnosis
The nurse's clinical judgment about what is happening with the patient (Correct answer)
Specific actions the nurse wants the provider to take
Recent changes in vital signs and test results

Correct answer: The nurse's clinical judgment about what is happening with the patient

The 'A' in SBAR is the nurse's clinical interpretation or assessment of the patient's current problem.

Question 15: A patient with a lower extremity amputation is complaining of pain in the amputated limb. The nurse correctly documents this as:

Phantom limb pain (Correct answer)
Residual limb pain
Neuropathic referred pain
Psychosomatic pain

Correct answer: Phantom limb pain

Phantom limb pain is real pain perceived in the absent limb due to persistent neural signals from the spinal cord and brain.

Question 16: A patient post-hip replacement surgery asks why they must avoid crossing their legs. The nurse's best response is:

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

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 17: A nurse is caring for a patient with increased intracranial pressure (ICP). Which position is contraindicated?

Head of bed elevated 30°
Trendelenburg (head-down) position (Correct answer)
Slight reverse Trendelenburg
Head midline and neutral

Correct answer: Trendelenburg (head-down) position

Trendelenburg increases venous pressure in the cerebral vasculature, further elevating intracranial pressure.

Question 18: 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?

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

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 19: A freshly hired nurse with three months of experience on an adult medicine unit was asked to float to pediatrics. The nurse balks at performing pediatric skills and is given an engaging but intimidating assignment. The nurse needs to:

Resign on the spot from the nursing position and apply for a position that does not require floating
Ask several other nurses how they feel about pediatrics and find someone else who is willing to accept the assignment
Refuse the assignment and leave the unit requesting a vacation a day
Inform the nursing supervisor and the charge nurse on the pediatric floor about the nurse’s lack of skill and feelings of hesitations and request assistance (Correct answer)

Correct answer: Inform the nursing supervisor and the charge nurse on the pediatric floor about the nurse’s lack of skill and feelings of hesitations and request assistance

The nurse has an ethical duty to disclose her level of expertise to the individual in charge of the assignment and the individual in charge of the unit. As a result, the nurse prevents leaving clients behind and putting them in danger.

Question 20: A nurse suspects a colleague is diverting controlled substances. What is the nurse's most appropriate first action?

Document personal observations and wait to gather more evidence before reporting
Contact the state board of nursing anonymously
Confront the colleague directly and privately
Report the suspicion to the nurse manager or appropriate supervisor (Correct answer)

Correct answer: Report the suspicion to the nurse manager or appropriate supervisor

Reporting suspected diversion to the supervisor is the mandatory first step, as the institution must investigate to protect patients and the colleague.

Question 21: A patient is scheduled for a colonoscopy. Which bowel preparation instruction is most important to emphasize?

A light meal of white rice and chicken is acceptable the evening before
Consume only clear liquids the day before the procedure and complete the full bowel prep (Correct answer)
Consume a high-fiber diet for 3 days prior to the procedure
Discontinue all medications 48 hours before the procedure

Correct answer: Consume only clear liquids the day before the procedure and complete the full bowel prep

An adequate bowel prep with clear liquids and the prescribed laxative solution ensures visualization of the colon mucosa and prevents procedure cancellation.

Question 22: 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
Prepare for immediate cesarean delivery
Increase the IV oxytocin infusion rate

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 23: 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 who is anxious about an upcoming surgery scheduled for tomorrow
A patient with acute urinary retention causing significant pain and bladder distension (Correct answer)

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

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 25: A patient is admitted with acute pancreatitis. Which position will the nurse place the patient in to reduce abdominal pain?

Fetal position (knees drawn to chest) (Correct answer)
High Fowler's (90-degree sitting)
Supine with legs elevated 30 degrees
Prone position (lying on the stomach)

Correct answer: Fetal position (knees drawn to chest)

The fetal position reduces tension on the inflamed pancreas and peritoneum, providing pain relief in acute pancreatitis.

Question 26: The following nursing care is the most crucial nursing intervention to treat dry skin:

Consult the dietitian about increasing the patient’s fat intake, and take necessary measures to prevent infection.
Encourage the patient to increase his fluid intake, use non-irritating soap when bathing the patient, and apply lotion to the involved areas. (Correct answer)
Ask the physician to refer the patient to a dermatologist, and suggest that the patient wear home-laundered sleepwear.
Avoid bathing the patient until the condition is remedied, and notify the physician.

Correct answer: Encourage the patient to increase his fluid intake, use non-irritating soap when bathing the patient, and apply lotion to the involved areas.

Eventually, dry skin will crack, making the patient more vulnerable to infection. To avoid this, the nurse should make sure the patient drinks enough fluids, bathe them in non-irritating soaps or not at all, and apply moisturizer to their skin. Most of the time, lifestyle changes like using moisturizers and avoiding lengthy, hot baths and showers work well for treating dry skin. In order to prevent water from evaporating through the skin, moisturizers offer a seal. After a shower and numerous times throughout the day, moisturize.

Question 27: A patient with anorexia nervosa is admitted for medical stabilization. Which laboratory finding is the most life-threatening concern during refeeding?

Mild hyponatremia (sodium 133 mEq/L)
Severe hypophosphatemia (refeeding syndrome) (Correct answer)
Low hemoglobin of 10.5 g/dL
Elevated liver enzymes

Correct answer: Severe hypophosphatemia (refeeding syndrome)

Refeeding syndrome causes a dangerous shift of phosphate into cells as metabolism resumes, leading to cardiac arrhythmias and respiratory failure.

Question 28: A patient is admitted after a serious suicide attempt. After stabilization, the patient tells the nurse, 'I feel better now. I don't need to be here.' How should the nurse interpret this statement?

The patient has experienced genuine remission and may be ready for discharge
This is a normal response after a failed suicide attempt
The statement may indicate the patient has made a decision to complete the act and feels relief (Correct answer)
The patient is using manipulation to get an early discharge

Correct answer: The statement may indicate the patient has made a decision to complete the act and feels relief

Sudden calm or resolution of distress after a serious attempt can indicate the patient has accepted a plan and feels relieved of their burden—not improvement.

Question 29: An infant is admitted with pyloric stenosis. Which laboratory finding is most expected due to repeated vomiting?

Metabolic alkalosis with hypokalemia and hypochloremia (Correct answer)
Respiratory alkalosis with hypernatremia
Respiratory acidosis with hyponatremia
Metabolic acidosis with hyperkalemia

Correct answer: Metabolic alkalosis with hypokalemia and hypochloremia

Repeated projectile vomiting of gastric contents causes loss of hydrochloric acid and potassium, resulting in metabolic alkalosis with hypokalemia and hypochloremia.

Question 30: A nurse working in a community health center uses the epidemiological triad to analyze the spread of tuberculosis. Which component of the triad represents Mycobacterium tuberculosis?

Environment
Agent (Correct answer)
Vector
Host

Correct answer: Agent

In the epidemiological triad, the agent is the causative organism—in this case, Mycobacterium tuberculosis.

Question 31: A nurse working in a long-term care facility is planning assignments for a 12-hour shift. Which nursing task must be performed by an RN, not an LPN?

Administering routine scheduled medications
Changing a stable wound dressing per established protocol
Completing the comprehensive nursing assessment and updating the care plan (Correct answer)
Providing basic wound care for a small stage I pressure injury

Correct answer: Completing the comprehensive nursing assessment and updating the care plan

Comprehensive nursing assessment and care plan development are RN-specific responsibilities that cannot be delegated to an LPN.

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.

Questions

35 min

Time Limit

70%

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