NCLEX-RN Nursing — All Questions

A charge nurse is assigning tasks at the start of a shift. Which task is appropriate to delegate to unlicensed assistive personnel (UAP)?

• a.Adjusting the flow rate of a continuous IV infusion
• b.Taking vital signs on a stable postoperative client✓
• c.Performing the initial assessment of a newly admitted client
• d.Teaching a client how to use an incentive spirometer

UAP may perform routine, standardized tasks such as vital signs on stable clients. Assessment, IV titration, and client teaching require the judgment of a licensed nurse and cannot be delegated.

A nurse must see four clients. Which client should the nurse assess FIRST?

• a.A client requesting oral pain medication for a mild headache
• b.A client asking for help ambulating to the bathroom after lunch
• c.A client scheduled for discharge who still needs some teaching
• d.A client reporting new-onset shortness of breath and chest tightness✓

Airway and breathing problems take priority. New shortness of breath with chest tightness may signal a life-threatening event and must be evaluated before less urgent needs.

Which nursing task is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)?

• a.Providing discharge teaching about a newly made diagnosis
• b.Administering an oral medication to a stable client✓
• c.Performing triage of new arrivals in the emergency department
• d.Developing the initial nursing plan of care for admission

LPNs/LVNs may administer many routine medications and reinforce teaching for stable clients. Care planning, initial teaching, and triage require the broader scope of the registered nurse.

The nurse is caring for four clients. Applying the ABC framework, which finding requires the most immediate action?

• a.Blood pressure of 148/88 mm Hg while seated
• b.Oxygen saturation of 86% on room air✓
• c.Reports of mild pain at the incision site
• d.Tympanic temperature of 100.8 F (38.2 C)

An oxygen saturation of 86% reflects a breathing and oxygenation emergency and takes priority over an elevated blood pressure, a low-grade fever, or mild pain.

A nurse delegates client hygiene to a UAP. Which statement reflects the nurse's continued accountability?

• a.No follow-up is required once the task is given to an experienced UAP
• b.The UAP is fully responsible for the outcome once the task is assigned
• c.Accountability shifts to the provider who wrote the client's orders
• d.The nurse remains accountable for the overall client outcome and must follow up✓

Delegation transfers the task, not the accountability. The RN retains responsibility for the outcome and must supervise and evaluate the delegated care.

Which situation is the highest priority for the nurse to report to the oncoming shift during handoff?

• a.A client whose surgical dressing was changed two hours ago
• b.A client with a newly inserted chest tube and unstable vital signs✓
• c.A client who ambulated in the hallway this evening without difficulty
• d.A client who ate 100% of the evening meal without nausea

Handoff should emphasize the least stable, highest-risk client. A new chest tube with unstable vital signs requires close monitoring and clear communication to ensure continuity of care.

A nurse observes a coworker preparing to administer a medication without checking the client's identification band. What is the nurse's best initial action?

• a.Say nothing for now, because no harm has come to the client yet
• b.Document the observation in the client's chart after the medication is given
• c.Report the coworker to the state board of nursing before speaking to anyone
• d.Remind the coworker to verify two client identifiers before administration✓

The immediate priority is client safety. Reminding the coworker to verify two identifiers prevents a potential error. Formal reporting is reserved for repeated or unresolved unsafe practice.

The nurse is planning care for a group of clients. Which client is most appropriate to assign to a newly graduated RN?

• a.A client requiring hourly titration of a vasoactive drip
• b.A client being emergently transferred to the intensive care unit
• c.A stable client needing routine postoperative care on day two✓
• d.A client actively receiving blood who is having a transfusion reaction

A new graduate should be assigned stable, predictable clients. Complex, rapidly changing situations such as drip titration, transfusion reactions, and ICU transfers require experienced staff.

A client refuses a prescribed treatment. Which action by the nurse best respects client autonomy?

• a.Administering the treatment because the provider ordered it
• b.Telling the client they will be discharged if they refuse
• c.Documenting the refusal and notifying the provider✓
• d.Waiting until a family member can convince the client

Competent clients have the right to refuse treatment. The nurse documents the informed refusal and notifies the provider, respecting autonomy while ensuring continuity of care.

Which of the following is the nurse's primary responsibility when a client signs a surgical consent form?

• a.Guaranteeing that the surgery will be successful before the signature
• b.Deciding whether the client should proceed with the planned surgery
• c.Verifying that the client's consent is voluntary and witnessing the signature✓
• d.Explaining the surgical risks, benefits, and alternatives to the client

The provider is responsible for explaining risks, benefits, and alternatives. The nurse verifies that consent is voluntary and informed and witnesses the signature.

A nurse is prioritizing care using Maslow's hierarchy of needs. Which client need should be met first?

• a.A client's difficulty maintaining a patent airway✓
• b.A client's concern about the cost of the hospital stay
• c.A client's need for reassurance about tomorrow's surgery
• d.A client's request for the hospital chaplain to visit

Physiological needs such as a patent airway are the base of Maslow's hierarchy and take priority over safety, love and belonging, esteem, and self-actualization needs.

The nurse receives report on four clients. Which client should the nurse plan to reassess first after receiving report?

• a.A client with chronic stable heart failure who is awaiting discharge
• b.A client who received IV morphine 15 minutes ago and is now very drowsy✓
• c.A client requesting a bedtime snack from the unit kitchen tonight
• d.A client with a healing surgical wound scheduled for a dressing change

A client who is increasingly drowsy after IV opioids may be developing respiratory depression and must be reassessed first to prevent harm.

Which task can the RN appropriately delegate to a UAP for a client on strict intake and output monitoring?

• a.Interpreting the significance of a low hourly urine output
• b.Emptying the urinary drainage bag and recording the amount✓
• c.Deciding whether to notify the provider about the low output
• d.Adjusting the client's prescribed fluid restriction

Measuring and recording output is a routine task suitable for UAP. Interpreting values, clinical decision-making, and modifying the plan of care remain RN responsibilities.

A nurse is coordinating a client's discharge. Which action best demonstrates effective case management?

• a.Arranging home health services and follow-up appointments before discharge✓
• b.Delaying discharge until every family question is answered in person
• c.Providing only verbal discharge instructions to save the client time
• d.Leaving the medication reconciliation to the community pharmacy later

Effective case management coordinates resources across the continuum of care. Arranging home health and follow-up appointments promotes continuity and reduces readmission risk.

The nurse identifies a near-miss medication error that did not reach the client. What is the appropriate action?

• a.Complete an incident and occurrence report to support system improvement✓
• b.Report it directly to the state licensing board so that they can investigate
• c.Ignore it entirely, since no harm reached the client and nothing needs filing
• d.Record the near miss in the client's medical record as a medication error

Near-miss and error events are documented on an incident report for quality improvement. The report is not filed in the medical record, and licensing boards address serious professional issues only.

A nurse is supervising a UAP. Which observed action requires the nurse to intervene?

• a.The UAP offers a bedpan to a client who is on strict bed rest
• b.The UAP reports a blood pressure reading to the nurse right away
• c.The UAP applies a vest restraint without a current provider order✓
• d.The UAP raises two side rails after repositioning a client

Restraints require a current provider order and specific criteria. Applying a restraint without an order is unsafe and unlawful, so the nurse must intervene immediately.

Which principle should guide the nurse when assigning client care during a staffing shortage?

• a.Distribute clients randomly to save time
• b.Give all unstable clients to a single nurse to concentrate care
• c.Match client acuity and complexity to staff competency✓
• d.Assign the most clients to the least experienced staff

Safe assignment matches client acuity to the skill and scope of the staff member. Overloading unstable clients on one nurse or assigning complex clients to novices threatens safety.

A nurse witnesses a colleague documenting care that was not actually provided. Which ethical principle is most directly violated?

• a.Beneficence
• b.Veracity✓
• c.Justice
• d.Autonomy

Veracity is the duty to tell the truth. Falsifying documentation violates veracity and is both an ethical breach and a legal risk.

During a unit outbreak of Clostridioides difficile, a nurse cares for a client on contact precautions. Which action is correct?

• a.Wear an N95 respirator to filter the spores
• b.Wash hands with soap and water after client contact✓
• c.Use alcohol-based hand rub after glove removal
• d.Place the client in a negative-pressure room

Alcohol does not remove C. difficile spores, and CDC encourages washing with soap and water after caring for these clients during an outbreak. Note the nuance: outside an outbreak CDC still prefers alcohol-based hand rub for routine care, because studies have not shown a clear prevention benefit for soap and water and dropping the rub lowers overall hand-hygiene compliance. In either setting the highest-value action is correct glove and gown use. C. difficile requires contact, not airborne, precautions.

Which client requires airborne precautions?

• a.A client with scabies on the hands and forearms
• b.A client with a draining surgical wound infection
• c.A client with seasonal influenza and fever
• d.A client with active pulmonary tuberculosis✓

Pulmonary tuberculosis is spread by airborne droplet nuclei and requires a negative-pressure room and an N95 respirator. Wound infections and scabies need contact precautions, and influenza needs droplet precautions.

When donning personal protective equipment (PPE), which sequence is correct?

• a.Gown, mask, goggles, gloves✓
• b.Goggles, gloves, gown, mask
• c.Gloves, gown, mask, goggles
• d.Mask, gloves, gown, goggles

The correct donning sequence is gown, then mask or respirator, then goggles or face shield, then gloves. The correct order reduces contamination risk to the wearer.

A nurse is assessing fall risk. Which client is at highest risk for falling?

• a.A 30-year-old ambulating independently in the hall
• b.An 82-year-old taking a sedative who is confused✓
• c.A 25-year-old awaiting discharge later today
• d.A 45-year-old on bed rest with two side rails raised

Advanced age, a sedating medication, and confusion together create a high fall risk. Interventions such as frequent rounding and bed alarms should be prioritized for this client.

Which action best prevents catheter-associated urinary tract infection (CAUTI)?

• a.Removing the indwelling catheter as soon as it is no longer needed✓
• b.Disconnecting the tubing at the catheter to obtain urine samples
• c.Keeping the drainage bag above the bladder so urine drains back slowly
• d.Routinely irrigating the catheter with sterile saline every shift

Early removal of an unnecessary catheter is the most effective way to prevent CAUTI. The bag should stay below the bladder, the system should remain closed, and routine irrigation is not recommended.

A nurse discovers a small fire in a client's trash can. Using the RACE protocol, what is the first action?

• a.Extinguish the fire with an extinguisher
• b.Rescue any clients in immediate danger✓
• c.Activate the fire alarm
• d.Confine the fire by closing doors

RACE stands for Rescue, Alarm, Confine, and Extinguish. The first priority is to rescue anyone in immediate danger before activating the alarm and containing the fire.

A client is receiving oxygen at 4 L/min by nasal cannula. Which instruction promotes safety?

• a.Increase the flow rate without an order if the client is anxious
• b.Apply petroleum-based lubricant to the client's dry lips and nares
• c.Allow smoking in the room if the client sits six feet from the tank
• d.Post no-smoking signs and keep open flames away from the oxygen✓

Oxygen supports combustion, so no smoking or open flames are permitted near it, and only water-based lubricants should be used. Flow rate changes require a provider order.

The nurse is preparing to move a heavy client up in bed. Which technique protects the nurse from injury?

• a.Keep the feet close together for a narrow base of support
• b.Use a friction-reducing device and additional staff✓
• c.Twist at the trunk to move the client without stepping
• d.Bend at the waist and lift using the back muscles

Safe patient handling uses mechanical aids and adequate help, a wide base of support, and the leg muscles rather than the back. Twisting and bending at the waist cause injury.

A nurse is verifying a client before a blood transfusion. Which action is essential to prevent a transfusion error?

• a.Verify the client and blood product with a second qualified nurse✓
• b.Use a standard IV line shared with a dextrose solution infusion
• c.Skip the baseline vital signs so the unit is not wasted
• d.Begin the transfusion rapidly so the unit does not spoil

Two qualified staff must independently verify the client identity and the blood product to prevent an ABO incompatibility reaction. Blood is infused with normal saline only, and baseline vital signs are required.

Which environmental modification best prevents falls for a confused older adult at home?

• a.Keeping the client in a dimly lit room to promote rest
• b.Using throw rugs to mark walking paths
• c.Removing clutter and ensuring adequate lighting✓
• d.Placing frequently used items on high shelves

Removing clutter and improving lighting reduces trip and fall hazards. Throw rugs, poor lighting, and out-of-reach items increase fall risk.

A nurse receives a client with a suspected external chemical exposure. What is the priority action?

• a.Decontaminate the client before further care✓
• b.Administer pain medication first
• c.Bring the client into the main unit for assessment
• d.Obtain a detailed medical history before any intervention

Decontamination prevents ongoing harm to the client and protects staff and other clients from secondary contamination. It precedes routine assessment and treatment.

The nurse is teaching a client about safe medication storage at home. Which statement indicates a need for further teaching?

• a.I will keep expired medications in case I need them later✓
• b.I will store all medicines in a locked cabinet away from children
• c.I will keep my medications in their original labeled containers
• d.I will not share my prescriptions with family members

Expired medications should be discarded because potency and safety cannot be assured. Keeping them for later use is unsafe and indicates a need for further teaching.

A nurse is caring for a client with a seizure disorder. Which item should be available at the bedside?

• a.A bright overhead light kept on at all times
• b.Functioning suction and oxygen equipment✓
• c.Wrist restraints to prevent movement
• d.A padded tongue blade to insert during a seizure

Suction and oxygen should be ready to maintain the airway during and after a seizure. Nothing should be inserted into the mouth, and restraints and constant stimulation are not appropriate.

Which client should be placed in a private room with droplet precautions?

• a.A client with methicillin-resistant Staphylococcus aureus in a wound
• b.A client with meningococcal meningitis✓
• c.A client with a Clostridioides difficile infection
• d.A client with measles

Meningococcal meningitis is transmitted by respiratory droplets and requires droplet precautions. MRSA wounds and C. difficile need contact precautions, and measles requires airborne precautions.

A nurse identifies a client with a latex allergy. Which action is appropriate?

• a.Assume powdered latex gloves are safe because the powder is a barrier
• b.Use only sterile latex gloves, since sterility prevents a reaction
• c.Ensure latex-free supplies and place an allergy alert on the chart✓
• d.Keep latex products at the bedside in case they are needed later

Clients with a latex allergy require latex-free supplies and clear allergy alerts to prevent an anaphylactic reaction. Powdered latex gloves increase airborne allergen exposure and are unsafe.

The nurse is applying restraints to an agitated client per provider order. Which action is correct?

• a.Leave the client alone in the room so that less stimulation calms the agitation
• b.Tie the restraint to the movable side rail so it moves with the client
• c.Secure the restraint with a quick-release knot to the bed frame✓
• d.Check circulation once every four hours with the routine vital signs

Restraints are tied with a quick-release knot to a fixed part of the bed frame, never the side rails. Circulation, skin, and needs must be checked frequently, typically every 15 to 30 minutes.

A nurse is teaching an adult about routine health screening. Which recommendation is appropriate for colorectal cancer screening in average-risk adults?

• a.Begin screening only after age 70
• b.Begin screening at age 25
• c.Begin screening at age 45✓
• d.Screening is unnecessary without symptoms

Current guidelines recommend that average-risk adults begin colorectal cancer screening at age 45. Waiting for symptoms delays detection of early, treatable disease.

A pregnant client at 12 weeks' gestation asks about weight gain. Which teaching is appropriate for a client of normal pre-pregnancy weight?

• a.Weight gain should be avoided during pregnancy
• b.Weight should be gained only in the first trimester
• c.A gain of 50 to 60 pounds is expected
• d.A total gain of 25 to 35 pounds is recommended✓

A woman with a normal pre-pregnancy body mass index is advised to gain about 25 to 35 pounds. Adequate, gradual gain supports fetal growth without excess maternal risk.

The nurse is teaching parents about infant nutrition. When is it generally appropriate to introduce solid foods?

• a.Around 6 months of age✓
• b.As soon as the newborn shows hunger cues
• c.At 2 months of age
• d.At 12 months of age

Solid foods are typically introduced around 6 months, when the infant can sit with support and has lost the tongue-thrust reflex. Earlier introduction increases the risk of choking and allergies.

A nurse is providing immunization teaching. Which vaccine is a live attenuated vaccine that is contraindicated during pregnancy?

• a.Measles, mumps, and rubella (MMR) vaccine✓
• b.Tetanus, diphtheria, and pertussis (Tdap) vaccine
• c.Hepatitis B vaccine
• d.Inactivated influenza vaccine

MMR is a live attenuated vaccine and is contraindicated during pregnancy. Inactivated influenza and Tdap are recommended in pregnancy to protect the mother and infant.

The nurse is assessing developmental milestones. Which gross motor skill is expected of a typical 12-month-old?

• a.Riding a tricycle independently outdoors
• b.Walking up a full flight of stairs independently
• c.Skipping on alternating feet while playing outside
• d.Pulling to stand and cruising along furniture✓

By about 12 months, infants typically pull to stand and cruise while holding furniture, and many take their first independent steps. Stair climbing, tricycle riding, and skipping are later skills.

A nurse teaches a postmenopausal client about osteoporosis prevention. Which action best supports bone health?

• a.Avoiding all weight-bearing activity so that fragile bones are not stressed
• b.Increasing daily caffeine and carbonated soda intake because their phosphate hardens bone
• c.Performing regular weight-bearing exercise and ensuring adequate calcium and vitamin D✓
• d.Limiting sun exposure completely and relying on stored vitamin D reserves

Weight-bearing exercise plus adequate calcium and vitamin D strengthens bone. Inactivity and excess caffeine or soda contribute to bone loss.

A nurse is counseling an adult on tobacco cessation. Which statement reflects effective health promotion?

• a.Setting a quit date and using support resources improves success✓
• b.Cutting back gradually is impossible, so it is not worth attempting
• c.Nicotine replacement never helps people quit and only prolongs the habit
• d.You must quit all tobacco today or the attempt is not worth making

Setting a specific quit date combined with behavioral support and, when appropriate, nicotine replacement improves cessation success. Supportive, nonjudgmental counseling promotes readiness to change.

The nurse teaches a new mother about breastfeeding. Which sign indicates the infant is adequately hydrated?

• a.A sunken anterior fontanel
• b.Dark, concentrated urine
• c.Fewer than two wet diapers per day
• d.Six or more wet diapers per day✓

Six or more wet diapers a day indicate adequate intake and hydration in a breastfeeding infant. Few wet diapers, concentrated urine, and a sunken fontanel suggest dehydration.

A nurse provides teaching about a heart-healthy diet. Which choice best fits this diet?

• a.Fried chicken with buttered mashed potatoes
• b.A processed deli meat sandwich with chips
• c.A cheeseburger with bacon and fries
• d.Baked salmon with steamed vegetables✓

Baked fish rich in omega-3 fatty acids with vegetables supports cardiovascular health. Fried, high-saturated-fat, and processed high-sodium foods increase cardiac risk.

The nurse is teaching an older adult about safe physical activity. Which recommendation is appropriate for most healthy older adults?

• a.Aim for about 150 minutes of moderate activity weekly plus balance exercises✓
• b.Avoiding all exercise to prevent injury, because rest alone preserves strength with age
• c.Exercising only when pain is present, using the pain as the signal to move
• d.Performing only high-intensity workouts, since moderate activity gives no benefit

Most healthy older adults benefit from about 150 minutes of moderate aerobic activity weekly plus muscle-strengthening and balance exercises to reduce falls and chronic disease risk.

A nurse assesses a 4-year-old's language development. Which finding is expected?

• a.Speaks in sentences of three to four words and is understood by strangers✓
• b.Reads simple printed storybook sentences aloud fluently and without adult help
• c.Speaks only in single words that family members interpret for others
• d.Uses no recognizable words and communicates only by pointing at items

A typical 4-year-old speaks in short sentences that strangers can generally understand. Single-word speech is expected earlier, and fluent reading comes later.

A nurse is teaching about skin cancer prevention. Which statement indicates correct understanding?

• a.A base tan protects me from sun damage for the rest of the summer
• b.Sunscreen is only needed on very hot days when the sun feels strong on my skin
• c.I will apply broad-spectrum sunscreen and reapply every two hours outdoors✓
• d.I only need sunscreen at the beach, not while running errands

Broad-spectrum sunscreen reapplied every two hours, plus protective clothing and shade, reduces skin cancer risk. Ultraviolet exposure occurs on cloudy and cool days, and a tan is a sign of skin damage.

The nurse discusses recommended cervical cancer screening. Which schedule is generally appropriate for an average-risk woman aged 30?

• a.Cervical screening is unnecessary at any age for a woman with no symptoms
• b.Screening should begin only after menopause, when cervical risk first appears
• c.A Papanicolaou (Pap) test every three years, or co-testing options per guidelines✓
• d.Daily self-collected home swabs that the client reads and interprets herself

Average-risk women aged 30 may have a Pap test every three years or human papillomavirus co-testing at extended intervals. Screening should not be delayed until menopause.

A nurse counsels an adult on alcohol use. Which statement reflects moderate drinking guidelines for health promotion?

• a.There is no upper limit to safe alcohol intake for an otherwise healthy adult
• b.Binge drinking on weekends is safe as long as no alcohol is taken on weekdays
• c.Some daily alcohol is required for everyone to protect the heart
• d.Moderate intake means up to one drink per day for women and two for men✓

Moderate drinking is defined as up to one drink per day for women and two for men. Binge drinking is harmful, and lower intake is generally healthier.

A client newly diagnosed with cancer says, 'I just can't believe this is happening to me.' Which response is most therapeutic?

• a.This must be very difficult for you. Tell me what you are feeling✓
• b.Many people do very well with this diagnosis, so try not to worry
• c.At least it was caught early, so staying positive will help you heal
• d.You should focus on your treatment plan instead of your feelings

Acknowledging the client's emotion and inviting them to share feelings uses empathy and open-ended communication. False reassurance and changing the focus block therapeutic dialogue.

A nurse is caring for a client with major depressive disorder who states, 'Life isn't worth living anymore.' What is the nurse's priority action?

• a.Directly ask the client if they are thinking of suicide✓
• b.Change the subject so the client is not upset
• c.Reassure the client that the feelings will pass
• d.Document the statement and continue with routine care

Safety is the priority. Directly asking about suicidal ideation assesses risk and does not increase the likelihood of self-harm; it opens the door to protective intervention.