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

Question 1: A nurse is providing education to a 22-year-old client newly prescribed fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI). Which instruction is most critical for the nurse to include?

"It is crucial to immediately report any increase in suicidal thoughts or behaviors." (Correct answer)
"You can stop taking the medication as soon as you start to feel better."
"You must avoid eating aged cheese and cured meats while on this medication."
"The medication should provide full relief from your symptoms within one week."

Correct answer: "It is crucial to immediately report any increase in suicidal thoughts or behaviors."

All antidepressant medications, including SSRIs, carry a black box warning from the FDA regarding an increased risk of suicidal thinking and behavior, particularly in children, adolescents, and young adults (up to age 24) during the initial weeks of treatment. This is the most critical safety instruction. The dietary restrictions mentioned apply to MAOIs, therapeutic effects take several weeks to develop, and the medication should never be stopped abruptly.

Question 2: A nurse identifies that a patient's respiratory rate has increased from 16 to 28 breaths/min over two hours. Which NCJMM cognitive skill is the nurse applying when noting this change?

Evaluate Outcomes
Generate Solutions
Recognize Cues (Correct answer)
Take Action

Correct answer: Recognize Cues

Recognize Cues is the initial skill of noticing and identifying relevant patient information that may require attention, such as a significant change in vital signs.

Question 3: An adult client who is a Jehovah's Witness has been in a motor vehicle accident and requires emergency surgery for internal bleeding. The client is alert and oriented and has a signed advance directive refusing all blood products. Which action should the nurse take?

Inform the surgeon to proceed with the transfusion because it is a life-threatening emergency.
Explain to the client that a court order will be obtained to administer the necessary blood.
Advocate for the client's wishes and explore bloodless alternative treatments with the healthcare team. (Correct answer)
Contact the hospital's ethics committee to get an order to override the client's refusal.

Correct answer: Advocate for the client's wishes and explore bloodless alternative treatments with the healthcare team.

A mentally competent adult has the legal and ethical right to refuse medical treatment, including life-saving blood transfusions, based on their religious beliefs. The nurse's primary role is to act as a patient advocate, respecting their autonomy and communicating their wishes to the team. The team should then explore all available bloodless alternatives, such as volume expanders or cell-saver technology. Overriding a competent adult's wishes is a violation of their rights.

Question 4: A nurse is caring for an older adult client who has been on bed rest for 3 days following hip surgery. The client reports new-onset tenderness and visible swelling in their left calf. What is the nurse's priority action?

Massage the affected leg to promote circulation.
Keep the client's leg elevated on pillows and notify the healthcare provider. (Correct answer)
Apply a warm, moist compress to the area for 20 minutes.
Encourage the client to perform active range-of-motion exercises.

Correct answer: Keep the client's leg elevated on pillows and notify the healthcare provider.

The client's signs and symptoms (unilateral calf tenderness and swelling) are classic indicators of a potential deep vein thrombosis (DVT), a serious complication of immobility. The priority is to maintain the client on bed rest, elevate the affected limb to promote venous return without dislodging a potential clot, and immediately notify the healthcare provider for further diagnostic evaluation and treatment. Massaging the leg is contraindicated as it could dislodge a thrombus, leading to a pulmonary embolism.

Question 5: A nurse is caring for a client who has just undergone a lumbar puncture. To reduce the risk of a post-dural puncture headache, which intervention should the nurse implement?

Encourage immediate ambulation to promote circulation.
Restrict oral fluid intake for the first 4 hours.
Instruct the client to remain in a flat or supine position. (Correct answer)
Administer a prophylactic sedative medication.

Correct answer: Instruct the client to remain in a flat or supine position.

Positioning the client flat (supine) after a lumbar puncture helps to decrease the leakage of cerebrospinal fluid (CSF) from the puncture site. This reduces the risk of developing a post-dural puncture headache, which is caused by a decrease in intracranial pressure from CSF loss. Ambulation is discouraged, fluids are encouraged to help replace CSF, and sedatives are not a primary preventative measure.

Question 6: A nurse is reviewing the laboratory results for a client receiving intravenous furosemide for acute heart failure. Which laboratory value requires the most immediate intervention?

Blood urea nitrogen (BUN) 25 mg/dL
Serum sodium 137 mEq/L
Serum creatinine 1.2 mg/dL
Serum potassium 2.8 mEq/L (Correct answer)

Correct answer: Serum potassium 2.8 mEq/L

Furosemide is a potent loop diuretic that causes the excretion of potassium. A serum potassium level of 2.8 mEq/L is critically low (hypokalemia) and places the client at high risk for life-threatening cardiac dysrhythmias. This finding must be reported to the provider immediately. The other lab values are either within normal limits or not as immediately critical.

Question 7: A client with acute decompensated heart failure is receiving a high-dose intravenous infusion of furosemide, a loop diuretic. Which electrolyte imbalance is the client at the highest risk for developing?

Hyponatremia
Hypermagnesemia
Hypokalemia (Correct answer)
Hypercalcemia

Correct answer: Hypokalemia

Loop diuretics, such as furosemide, work by inhibiting the reabsorption of sodium and chloride in the loop of Henle, which also leads to significant excretion of potassium. This puts the client at a high risk for developing hypokalemia (low potassium). While hyponatremia, hypomagnesemia, and hypocalcemia can also occur, hypokalemia is the most common and concerning imbalance due to its potential to cause life-threatening cardiac dysrhythmias.

Question 8: A nurse is assessing a client who sustained multiple traumatic injuries and is in the compensatory stage of hypovolemic shock. Which clinical manifestation should the nurse expect?

Bradycardia
Hypotension
Decreased respiratory rate
Cool, clammy skin (Correct answer)

Correct answer: Cool, clammy skin

In the compensatory stage of hypovolemic shock, the sympathetic nervous system is activated to maintain perfusion to vital organs. This causes peripheral vasoconstriction, shunting blood from the skin to the core, which results in cool, clammy skin. The compensatory response also includes tachycardia (increased heart rate) and tachypnea (increased respiratory rate) to improve oxygen delivery. Blood pressure is often maintained during this initial stage and only drops significantly in the later, progressive stage of shock.

Question 9: A nurse is initiating a transfusion of packed red blood cells (PRBCs) for a client. Which of the following actions is most critical for the nurse to perform within the first 15 minutes of the infusion?

Remain with the client and monitor vital signs. (Correct answer)
Increase the infusion rate to the prescribed maximum.
Administer an antihistamine to prevent a reaction.
Document the client's baseline intake and output.

Correct answer: Remain with the client and monitor vital signs.

The majority of severe, life-threatening transfusion reactions occur within the first 15 minutes or the first 50 mL of the infusion. It is a critical safety standard for the nurse to remain with the client during this period to monitor for signs of a reaction, such as fever, chills, back pain, shortness of breath, or hives, and to monitor vital signs per facility policy.

Question 10: A nurse is planning a health promotion program for a group of older adults at a senior center. To promote musculoskeletal health and reduce the risk of falls, which activity would be most appropriate to include?

High-impact aerobic exercises.
Detailed instruction on a low-fat, low-sodium diet.
Annual cognitive screening tests.
Balance and weight-bearing exercises. (Correct answer)

Correct answer: Balance and weight-bearing exercises.

Balance and weight-bearing exercises, such as tai chi or light weight training, are most effective for improving stability, strengthening bones (reducing osteoporosis risk), and maintaining muscle mass in older adults. This directly addresses the risk of falls, a major health concern in this population. High-impact aerobics can be unsafe, and while diet and cognitive screening are important, they do not directly target musculoskeletal strength and balance.

Question 11: A nurse is preparing a client for a computed tomography (CT) scan of the abdomen with intravenous contrast. Which of the following findings in the client's record requires the most immediate intervention by the nurse?

A serum creatinine level of 2.5 mg/dL. (Correct answer)
A documented history of claustrophobia.
A reported allergy to shellfish.
The client is currently prescribed metformin.

Correct answer: A serum creatinine level of 2.5 mg/dL.

Intravenous contrast dye is nephrotoxic and can cause acute kidney injury. An elevated serum creatinine level (normal range is typically 0.6-1.3 mg/dL) indicates significant renal impairment. This finding must be reported to the provider immediately as it is a major contraindication to receiving contrast media. While claustrophobia and metformin use are important considerations, severe renal impairment poses the most immediate risk of a serious physiological complication.

Question 12: A nurse is reviewing the arterial blood gas (ABG) results for a client with an acute exacerbation of chronic obstructive pulmonary disease (COPD). The results are: pH 7.28, PaCO2 58 mm Hg, PaO2 65 mm Hg, and HCO3 25 mEq/L. Which acid-base imbalance should the nurse identify?

Metabolic alkalosis, uncompensated
Respiratory alkalosis, partially compensated
Metabolic acidosis, uncompensated
Respiratory acidosis, uncompensated (Correct answer)

Correct answer: Respiratory acidosis, uncompensated

The pH of 7.28 is below the normal range (7.35-7.45), indicating acidosis. The PaCO2 of 58 mm Hg is elevated (normal: 35-45 mm Hg), indicating a respiratory cause for the acidosis. The HCO3 of 25 mEq/L is within the normal range (22-26 mEq/L), signifying that the kidneys have not yet started to compensate for the imbalance. Therefore, the client has uncompensated respiratory acidosis, a common finding in COPD exacerbations where CO2 is retained.

Question 13: A nurse is preparing to enter the room of a client who has active pulmonary tuberculosis. Which of the following pieces of personal protective equipment (PPE) is essential for the nurse to wear?

Sterile gloves
Surgical mask
Face shield
N95 respirator (Correct answer)

Correct answer: N95 respirator

Tuberculosis (TB) is transmitted via airborne particles. Therefore, healthcare workers must wear an N95 respirator, which is designed to filter out these small particles, when entering the room of a client with active TB. A surgical mask is insufficient for airborne precautions.

Question 14: A nurse is caring for a client who is confused and has been pulling at their intravenous (IV) lines. The nurse has attempted reorientation and distraction techniques without success. Which of the following actions is appropriate when applying wrist restraints?

Secure the restraint straps to the side rails of the bed.
Use a square knot to ensure the restraints are secure.
Attach the restraints to the bed frame using a quick-release knot. (Correct answer)
Ensure the restraints are tight enough to prevent any wrist movement.

Correct answer: Attach the restraints to the bed frame using a quick-release knot.

Restraints must be attached to a part of the bed frame that moves with the client, not the side rails, to prevent injury if the rail is lowered. A quick-release knot must be used for easy removal in an emergency.

Question 15: A nurse assesses a client receiving morphine via a patient-controlled analgesia (PCA) pump. The client's respiratory rate is 7 breaths/min and they are difficult to arouse. After stopping the PCA infusion, what is the nurse's next priority action?

Check the client's oxygen saturation level.
Administer naloxone as prescribed by standing order. (Correct answer)
Document the client's status in the electronic health record.
Notify the healthcare provider of the findings.

Correct answer: Administer naloxone as prescribed by standing order.

The client is exhibiting signs of severe opioid-induced respiratory depression, which is a life-threatening emergency. After stopping the opioid infusion to prevent further administration, the priority action is to reverse the respiratory depression by administering the opioid antagonist, naloxone. While checking oxygen saturation and notifying the provider are important, they are not the immediate priority over administering the life-saving antidote.

Question 16: Describes the profession's central beliefs and helps to control practice •Primary obligations, values, and ideals of nursing are explained Nurse's contract with our profession Nurse's contract with client Nurse's contract with the public/society

ANA Social Policy Statement
The Nursing Code of Ethics:
Institute of Medicine
ANA Code of Ethics (Correct answer)

Correct answer: ANA Code of Ethics

The American Nurses Association (ANA) Code of Ethics is a foundational document that outlines the ethical standards and principles that guide the nursing profession. It describes the central beliefs, values, and obligations of nursing practice, emphasizing the nurse's commitment to providing safe, compassionate, and ethical care to individuals, families, and communities. The Code of Ethics serves as a contract between nurses and their profession, as well as between nurses and their clients (patients), and the broader society.

Question 17: A client who was recently diagnosed with type 2 diabetes mellitus states, 'There's no way I have diabetes. The lab must have made a mistake with my blood work. I feel perfectly fine.' The nurse recognizes the client is using which defense mechanism?

Projection
Sublimation
Denial (Correct answer)
Rationalization

Correct answer: Denial

Denial is the refusal to accept reality or facts to avoid dealing with the emotional impact. The client is refusing to accept the diagnosis despite evidence. Projection is attributing one's own unacceptable thoughts to another person. Rationalization is justifying behavior with logical-sounding reasons. Sublimation is channeling unacceptable impulses into socially acceptable actions.

Question 18: Normal Hgb (M/F):

6-20 mg/dl
M: 13.2-17.3 g/dL F: 11.7-15.5 g/dL (Correct answer)
0.6-1.3 mg/dl
M: 39%-50% f: 35%-47%

Correct answer: M: 13.2-17.3 g/dL F: 11.7-15.5 g/dL

Normal Hemoglobin (Hgb) Levels: Males: 13.2-17.3 grams per deciliter (g/dL) Females: 11.7-15.5 grams per deciliter (g/dL) These values represent the typical range of hemoglobin concentrations found in the blood of healthy adult individuals. Hemoglobin is an important protein in red blood cells that carries oxygen from the lungs to tissues throughout the body.

Question 19: A client is admitted with a diagnosis of influenza. Which of the following transmission-based precautions should the nurse initiate?

Airborne precautions
Droplet precautions (Correct answer)
Protective precautions
Contact precautions

Correct answer: Droplet precautions

Influenza is transmitted through large respiratory droplets. Therefore, droplet precautions are required. This includes wearing a surgical mask when within 3 to 6 feet of the client and placing the client in a private room or cohorting with a client who has the same infection.

Question 20: A nurse is providing prenatal education to a client in her first trimester. Which of the following topics is most crucial to include to prevent congenital neural tube defects?

Strategies for managing morning sickness effectively.
The importance of avoiding unpasteurized dairy products.
The schedule for glucose tolerance testing during pregnancy.
The need for adequate daily intake of folic acid. (Correct answer)

Correct answer: The need for adequate daily intake of folic acid.

Adequate intake of folic acid (at least 400 mcg per day) before and during the early weeks of pregnancy is proven to significantly reduce the risk of neural tube defects like spina bifida. While the other topics are important aspects of prenatal care, folic acid supplementation is directly linked to the prevention of this specific birth defect.

Question 21: ‥ Believes that patients' interests are best served by a health care system in which many different types of qualified professionals are available, accessible, and working together - collaboratively Important for scope of practice to reflect a professional's true expertise

Professional Organizations (ANA)- Roles in Practice Guidelines
Ethical Dilemma
ANA (Correct answer)
Professional Standards of Care

Correct answer: ANA

The ANA, as a leading professional organization in nursing, advocates for comprehensive and collaborative healthcare systems that leverage the expertise of various healthcare professionals to meet patients' needs effectively. The organization emphasizes the importance of aligning scope of practice with nurses' true expertise, ensuring that nurses can practice to the full extent of their education, training, and competence.

Question 22: After implementing a nursing intervention, a patient's oxygen saturation improves from 89% to 96%. Which NCJMM cognitive skill is the nurse using when interpreting this finding?

Generate Solutions
Prioritize Hypotheses
Evaluate Outcomes (Correct answer)
Analyze Cues

Correct answer: Evaluate Outcomes

Evaluate Outcomes is the cognitive skill of determining whether nursing actions achieved the desired patient outcomes, such as improved oxygenation.

Question 23: Which strategy BEST supports development of clinical judgment in nursing students and new graduates?

Memorizing pharmacology reference guides
Limiting patient assignments to reduce errors
Focusing solely on procedural skills competency
Exposure to high-fidelity simulation with structured debriefing (Correct answer)

Correct answer: Exposure to high-fidelity simulation with structured debriefing

High-fidelity simulation with structured debriefing allows learners to practice decision-making in realistic scenarios and reflect on their reasoning process, which builds clinical judgment.

Question 24: Which of the following actions by the nurse demonstrates the most effective method for preventing the spread of infection among clients?

Wearing gloves for all client contact.
Placing all clients on contact precautions.
Performing consistent and thorough hand hygiene. (Correct answer)
Administering prophylactic antibiotics to all clients.

Correct answer: Performing consistent and thorough hand hygiene.

The single most effective way to prevent the transmission of infection is through proper and frequent hand hygiene. While other measures are important for specific situations, hand hygiene is a component of standard precautions applied to all patients.

Question 25: A nurse is preparing to administer an intravenous infusion of vancomycin. To prevent the occurrence of vancomycin flushing syndrome ("Red Man Syndrome"), which nursing action is most appropriate?

Infuse the medication over at least 60 minutes. (Correct answer)
Administer a rapid IV bolus over 5 minutes.
Pre-medicate the client with an antiemetic.
Cover the client with a warming blanket during the infusion.

Correct answer: Infuse the medication over at least 60 minutes.

Vancomycin flushing syndrome is a rate-dependent infusion reaction caused by histamine release, not a true allergic reaction. The primary strategy to prevent it is to infuse the medication slowly, over a period of at least 60 to 90 minutes. Administering it as a rapid bolus would cause the reaction. Pre-medication with antihistamines, not antiemetics, may also be ordered.

Question 26: Which of the following actions is essential for a nurse to perform to prevent a catheter-associated urinary tract infection (CAUTI) for a client with an indwelling urinary catheter?

Ensuring the drainage bag is kept below the level of the bladder. (Correct answer)
Irrigating the catheter with sterile saline every 12 hours.
Disconnecting the catheter from the tubing to obtain a urine sample.
Changing the indwelling catheter every 72 hours.

Correct answer: Ensuring the drainage bag is kept below the level of the bladder.

To prevent CAUTI, it is critical to maintain a closed, sterile drainage system and prevent the backflow of urine. Keeping the drainage bag below the level of the bladder uses gravity to ensure urine flows away from the bladder, which minimizes the risk of infection. Routine irrigation and catheter changes are not recommended as they can introduce bacteria into the system. The system should only be opened when necessary, and samples should be collected from the designated port.

Question 27: An older adult client is brought to the emergency department from an un-airconditioned home during a heat wave. The client has an altered mental status, a temperature of 105.1°F (40.6°C), and hot, dry skin. The nurse should recognize these findings as characteristic of which condition?

Heat stroke (Correct answer)
Sepsis
Malignant hyperthermia
Heat exhaustion

Correct answer: Heat stroke

Heat stroke is a medical emergency characterized by a core body temperature above 104°F (40°C), central nervous system dysfunction (e.g., altered mental status, confusion), and anhidrosis (the absence of sweating), which leads to hot, dry skin. This indicates a failure of the body's thermoregulatory mechanisms. In contrast, heat exhaustion involves profuse sweating and less severe neurological impairment.

Question 28: A nurse is providing discharge teaching to a client newly prescribed warfarin. Which statement by the client indicates a need for further education?

"I must report any signs of dark, tarry stools to my provider."
"I understand I will need to have my blood tested regularly."
"I will start taking ibuprofen for my occasional headaches." (Correct answer)
"I will use an electric razor for shaving instead of a disposable razor."

Correct answer: "I will start taking ibuprofen for my occasional headaches."

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen increase the risk of bleeding when taken concurrently with warfarin. The nurse must instruct the client to use acetaminophen for pain relief instead. The other statements indicate a correct understanding of bleeding precautions and the required laboratory monitoring (INR/PT).

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

The NCLEX-RN is the standardized licensure exam administered by NCSBN that nursing graduates must pass to obtain RN licensure in the US and Canada. It uses Computerized Adaptive Testing (CAT) with Next Generation NCLEX (NGN) question formats to assess clinical judgment across eight client needs categories.

Questions

40 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds