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NCLEX-RN practice questions and answers
20 free questions from our 300-question NCLEX-RN bank, each with the correct answer, explanation, and source note. Official format: 85–150 items (CAT) · 5-hour limit · pass/fail against a fixed standard.
Pharmacology
1. A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse is reviewing the medication administration record. Which laboratory value should the nurse monitor most closely?
Answer: A. Warfarin is an anticoagulant that requires INR monitoring to ensure therapeutic effectiveness and prevent bleeding complications. The target INR for atrial fibrillation is typically 2.0 to 3.0. Hemoglobin and platelet count are not specific to warfarin therapy, and WBC is unrelated to anticoagulation monitoring.
Source: Physiological Integrity — Pharmacological Therapies
Infection Control
2. A nurse is caring for a client with a central venous catheter. Which intervention is the MOST effective in preventing catheter-related bloodstream infections?
Answer: D. The keyed answer is "Performing hand hygiene before and after accessing the line". Hand hygiene before and after accessing any vascular access device is the single most effective measure to prevent catheter-related bloodstream infections. Changing dressings every 72 hours is not evidence-based, antibiotic ointment increases infection risk, and prophylactic antibiotics promote resistance. This item tests Infection Control in the context of Safe Care Environment — Infection Control. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Infection Control
Management
3. A charge nurse observes that a newly licensed nurse is administering medications without scanning the barcode on the client's wristband. What is the best initial action?
Answer: A. The keyed answer is "Provide immediate feedback and demonstrate proper scanning technique". The charge nurse should provide immediate feedback to correct the behavior and prevent harm. Filing an incident report or notifying the manager before addressing the issue directly is premature. The priority is correcting the unsafe practice in real time. This item tests Management in the context of Safe Care Environment — Management of Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Management of Care
Health Promotion
4. A community health nurse is planning a smoking cessation program. According to the Health Promotion model, which action should the nurse take FIRST?
Answer: A. The keyed answer is "Conduct a needs assessment to identify barriers to quitting". A needs assessment is the foundation of any health promotion program. The nurse must first identify the specific barriers, readiness to change, and resources available in the community before implementing interventions. This item tests Health Promotion in the context of Health Promotion — Health Promotion and Maintenance. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Health Promotion — Health Promotion and Maintenance
Basic Care
5. A postoperative client reports severe pain rated 9 out of 10. The client has a physician order for morphine 2 mg IV every 4 hours as needed. What should the nurse do FIRST?
Answer: A. The keyed answer is "Administer the morphine and document the pain rating". With severe pain rated 9/10 and an existing order, the nurse should administer the medication promptly and document. Reassessment occurs after administration. Non-pharmacological methods are adjuncts, not replacements for severe acute pain. This item tests Basic Care in the context of Physiological Integrity — Basic Care and Comfort. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Physiological Integrity — Basic Care and Comfort
Psychosocial
6. A client who recently experienced a sexual assault tells the nurse, I feel like it was my fault. What is the nurse's best response?
Answer: A. The keyed answer is "It was not your fault. What happened was a crime against you". The nurse should validate the client's feelings while clearly stating that sexual assault is never the victim's fault. Reporting and therapy recommendations are important but secondary to addressing the client's immediate emotional state and dispelling self-blame. This item tests Psychosocial in the context of Psychosocial Integrity — Psychosocial Adaptation. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Psychosocial Integrity — Psychosocial Adaptation
Prioritization
7. The nurse is caring for four clients. Which client should the nurse assess FIRST?
Answer: A. The keyed answer is "Client post-thyroidectomy who reports tingling around the mouth". Tingling around the mouth after thyroidectomy may indicate hypocalcemia from parathyroid gland damage, which can rapidly progress to tetany and respiratory compromise. This is the most life-threatening situation requiring immediate assessment. This item tests Prioritization in the context of Safe Care Environment — Management of Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Management of Care
Pharmacology
8. A client with heart failure is prescribed digoxin. The nurse notes a heart rate of 58 beats per minute. What is the priority nursing action?
Answer: A. The keyed answer is "Hold the medication and contact the provider". Digoxin should be held if the heart rate is below 60 bpm because the drug slows the heart rate further. Administering it could cause dangerous bradycardia. The nurse must hold the dose and notify the provider for further instructions. This item tests Pharmacology in the context of Physiological Integrity — Pharmacological Therapies. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Physiological Integrity — Pharmacological Therapies
Infection Control
9. A nurse is caring for a client with Clostridioides difficile. Which precaution should the nurse implement?
Answer: A. The keyed answer is "Contact precautions". C. difficile is transmitted via the fecal-oral route through contact with contaminated surfaces and equipment. Contact precautions, including gown and gloves, are required. Hand hygiene with soap and water is preferred over alcohol-based hand rub. This item tests Infection Control in the context of Safe Care Environment — Infection Control. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Infection Control
Management
10. A nurse manager receives a call from a family member complaining about the quality of care. The family member is upset and raising their voice. What is the best initial response?
Answer: D. The keyed answer is "Listen actively, acknowledge the concern, and gather facts". Active listening and acknowledging the family's concerns de-escalates the situation and demonstrates empathy. Telling them to leave or quoting policy is dismissive. Escalating before gathering information is premature. This item tests Management in the context of Safe Care Environment — Management of Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Management of Care
Pharmacology
11. A client is prescribed metformin for type 2 diabetes. The nurse should monitor which laboratory value most closely?
Answer: A. The keyed answer is "Serum creatinine". Metformin is contraindicated in clients with renal impairment because it can cause lactic acidosis. Serum creatinine should be monitored regularly to assess kidney function. HbA1c is monitored for diabetes control but not for metformin safety. This item tests Pharmacology in the context of Physiological Integrity — Pharmacological Therapies. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Physiological Integrity — Pharmacological Therapies
Basic Care
12. A client with a nasogastric tube is receiving enteral feedings. The nurse notes that the client has a distended abdomen and reports cramping. What is the priority action?
Answer: A. Checking residual volume helps determine if the feedings are being absorbed properly. A high residual with distention suggests intolerance. Slowing the rate and checking for residual are appropriate interventions. Elevating the head of bed is always important but does not address the acute issue.
Source: Physiological Integrity — Basic Care and Comfort
Health Promotion
13. A pregnant client at 28 weeks gestation asks the nurse about warning signs she should report immediately. Which symptom should the nurse instruct the client to report FIRST?
Answer: C. The keyed answer is "Decreased fetal movement". Decreased fetal movement can indicate fetal distress and is an emergency requiring immediate evaluation. Mild ankle edema, sleep difficulty, and lower back pain are common in pregnancy and do not require urgent intervention. This item tests Health Promotion in the context of Health Promotion — Antepartum Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Health Promotion — Antepartum Care
Psychosocial
14. A client with major depressive disorder tells the nurse, I have nothing left to live for. What is the nurse's priority response?
Answer: D. The keyed answer is "Ask directly if the client is thinking about suicide". When a client expresses hopelessness, the nurse must assess for suicidal ideation by asking directly. Research shows that asking about suicide does not increase risk. Reassurance without assessment is inappropriate and may dismiss the client's distress. This item tests Psychosocial in the context of Psychosocial Integrity — Mental Health Concepts. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Psychosocial Integrity — Mental Health Concepts
Prioritization
15. A nurse is preparing to receive shift report on four clients. Which client should the nurse see FIRST after receiving report?
Answer: D. The keyed answer is "Client who just returned from surgery with a blood pressure of 88/54 mmHg". A blood pressure of 88/54 mmHg after surgery indicates possible hypovolemic shock or hemorrhage. This client requires immediate assessment. The other clients are stable or have non-urgent needs. This item tests Prioritization in the context of Safe Care Environment — Management of Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Management of Care
Pharmacology
16. A client is prescribed lisinopril for hypertension. Which adverse effect should the nurse teach the client to report immediately?
Answer: C. The keyed answer is "Swelling of the lips or tongue". Swelling of the lips or tongue indicates angioedema, a potentially life-threatening allergic reaction to ACE inhibitors that requires immediate medical attention. A dry cough is common but not dangerous. Dizziness may require dose adjustment but is not emergent. This item tests Pharmacology in the context of Physiological Integrity — Pharmacological Therapies. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Physiological Integrity — Pharmacological Therapies
Basic Care
17. A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. The nurse observes a sudden increase in blood pressure and a pounding headache. What should the nurse do FIRST?
Answer: A. The keyed answer is "Sit the client upright and check for bladder or bowel distention". Autonomic dysreflexia is triggered by noxious stimuli below the level of injury, most commonly bladder or bowel distention. Sitting the client upright lowers blood pressure, and checking for distention identifies and removes the trigger. This item tests Basic Care in the context of Physiological Integrity — Reduction of Risk Potential. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Physiological Integrity — Reduction of Risk Potential
Infection Control
18. A nurse is caring for a client with active tuberculosis. Which statement by the client indicates understanding of discharge teaching?
Answer: A. Clients with TB must complete the full course of treatment, typically 6 to 9 months, even if symptoms improve. Stopping early promotes drug resistance. Covering the mouth when coughing reduces transmission. Returning to work before treatment completion risks spreading infection.
Source: Safe Care Environment — Infection Control
Delegation
19. A registered nurse is delegating tasks to an unlicensed assistive personnel. Which task is appropriate to delegate?
Answer: C. The keyed answer is "Ambulating a stable postoperative client". Ambulating a stable client is within the scope of delegation to UAP. Assessment, medication administration, and client teaching are nursing responsibilities that cannot be delegated to unlicensed personnel. This item tests Delegation in the context of Safe Care Environment — Delegation and Supervision. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Delegation and Supervision
Management
20. A nurse is preparing to float to a medical-surgical unit. The nurse has not worked on that unit before. What is the BEST action?
Answer: C. The keyed answer is "Request an orientation to the unit, medications, and emergency equipment before accepting the ass...". The nurse should request an orientation to the unit to ensure safe care. Refusing or passing the assignment without attempting accommodation is inappropriate. Accepting without orientation may compromise client safety. This item tests Management in the context of Safe Care Environment — Management of Care. Apply the rule only under the conditions stated in the stem, and compare the distractors with the keyed answer before using the rule in a different situation.
Source: Safe Care Environment — Management of Care
That’s the free set. The full bank has 300.
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