NCLEX-RN Nursing — All Questions

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.

A client experiencing a panic attack is hyperventilating and pacing. Which nursing action is most appropriate?

• a.Provide detailed teaching about the physiology of anxiety and its triggers
• b.Stay with the client and speak calmly using short, simple statements✓
• c.Leave the client alone in a quiet room until the hyperventilation stops
• d.Encourage the client to describe every worry in detail to release the tension

During a panic attack the nurse should stay with the client, remain calm, and use brief, clear communication. Complex teaching and detailed discussion overwhelm the client until the acute anxiety subsides.

A client with anorexia nervosa is admitted for treatment. Which finding is the priority concern?

• a.The client's preoccupation with calories
• b.The client's distorted body image
• c.The client's refusal to discuss feelings
• d.Bradycardia and electrolyte imbalance✓

Physiological instability such as bradycardia and electrolyte imbalance can be life-threatening in anorexia nervosa and takes priority over the important psychological issues.

A nurse uses therapeutic communication with a grieving client. Which technique best encourages the client to continue talking?

• a.Asking rapid closed-ended questions
• b.Offering personal opinions about the loss
• c.Reassuring the client that grief will pass quickly
• d.Using silence and attentive presence✓

Silence and attentive presence give the grieving client time to process and express feelings. Opinions, closed questions, and false reassurance interrupt therapeutic communication.

A client with schizophrenia says, 'The voices are telling me I am worthless.' Which response is most therapeutic?

• a.You should not listen to those voices, so keep your mind busy with the group activity
• b.Tell me what the voices sound like and try answering them aloud so that I can listen
• c.The voices are not real, so ignore them completely and they will soon stop bothering you
• d.I do not hear the voices, but I understand they seem real and upsetting to you✓

The nurse presents reality without arguing and acknowledges the client's experience and distress. Denying the client's perception or dismissing it damages trust.

A nurse is caring for a client in the manic phase of bipolar disorder. Which intervention supports the client's needs?

• a.Encourage participation in a competitive group game with peers
• b.Provide a calm, low-stimulation environment and finger foods✓
• c.Schedule several stimulating group activities back to back
• d.Serve large plated meals at a crowded communal table

During mania, clients are easily overstimulated and may not sit to eat. A low-stimulation environment and portable, high-calorie finger foods support rest and nutrition.

A client discloses a history of intimate partner violence. What is the nurse's priority action?

• a.Tell the client the abuse is not their fault and end the conversation
• b.Advise the client to leave the relationship immediately
• c.Assess the client's immediate safety and provide resources✓
• d.Contact the partner to discuss the situation

Assessing immediate safety and offering resources respects autonomy while protecting the client. Directing the client to leave or contacting the partner can increase danger.

A nurse is supporting a client through the stages of grief. A client who says, 'If I had only gone to the doctor sooner' is likely in which stage?

• a.Acceptance
• b.Bargaining✓
• c.Frustration
• d.Disbelief

Statements involving 'if only' and attempts to undo the loss reflect the bargaining stage of grief. Recognizing the stage helps the nurse respond supportively.

A client with alcohol use disorder is 12 hours into withdrawal. Which finding requires immediate attention?

• a.Mild hand tremors
• b.Requests for a cigarette
• c.Seizure activity✓
• d.Increased appetite

Seizures during alcohol withdrawal are a medical emergency and require immediate intervention. Mild tremors are common early findings but are less urgent.

A nurse is caring for a client experiencing acute confusion (delirium). Which intervention is most appropriate?

• a.Frequently reorient the client and provide familiar objects✓
• b.Restrain the client in bed to prevent wandering at night
• c.Keep the room dark and quiet at all times, even during the day
• d.Rotate caregivers each shift so the client gets variety

Frequent reorientation, familiar objects, and consistent caregivers reduce confusion in delirium. Restraints and frequent caregiver changes can worsen agitation.

A client is angry and shouting at the nurse about a delayed procedure. Which response best de-escalates the situation?

• a.You need to lower your voice right now or step out of the room
• b.If you keep yelling at me, I will have to leave the room until you calm down
• c.I can see you are frustrated. Let's talk about what is upsetting you✓
• d.There is nothing that I can do about the surgery schedule today

Acknowledging the client's feelings and inviting discussion de-escalates anger and builds rapport. Commanding or threatening the client escalates the conflict.

A nurse is assessing a client for postpartum depression. Which finding warrants further evaluation?

• a.Excitement about caring for and feeding the newborn at home each day
• b.Occasional tearfulness that resolves on its own within the first two weeks
• c.Persistent sadness and disinterest in the infant after three weeks✓
• d.Fatigue related to nighttime feedings that improves after a daytime nap

Persistent sadness and lack of interest in the infant beyond two weeks suggest postpartum depression rather than transient baby blues, and require further evaluation and support.

A nurse cares for a dying client's family. Which action best supports the family during end-of-life care?

• a.Providing privacy and encouraging expression of feelings✓
• b.Avoiding any discussion of the client's condition with the family
• c.Encouraging the family to stay positive in front of the client
• d.Limiting the family's visiting hours to reduce their fatigue

Providing privacy and encouraging the family to express feelings supports coping during end-of-life care. Restricting presence and avoiding honest discussion isolate the family.

A 54-year-old client waiting for breast biopsy results tells the nurse, 'I keep imagining the worst thing they could tell me.' Which response by the nurse is therapeutic?

• a.Tell me more about what you have imagined.✓
• b.Try not to dwell on it before you know.
• c.Has your family arranged a ride home for you?
• d.Why let yourself think that way now?

Inviting the client to say more about the specific fear is an open, exploring response that keeps her talking about her own experience. Telling her not to dwell on it minimizes the fear, 'why let yourself think that way' asks her to justify a feeling, and the question about a ride home changes the subject.

A client whose permanent colostomy was created four days ago turns away during the pouch change and says, 'My wife is not going to want to be near me now.' Which response by the nurse is therapeutic?

• a.Your wife has visited every day, so she clearly still cares.
• b.You sound worried about how your wife will see you.✓
• c.Are you able to look at the stoma without feeling upset?
• d.Ask your wife to join the next teaching session.

Restating the client's concern as a feeling is reflection, and it invites him to expand on the fear he just raised. Pointing to the visits is false reassurance, telling him to bring his wife to teaching is advice rather than exploration, and a yes-or-no question about looking at the stoma limits him to one word.

A nurse manager listens while a newly hired nurse interviews a client who stopped taking a prescribed antihypertensive. Which statement by the new nurse requires follow-up by the manager?

• a.Walk me through a usual day with your medicines.
• b.Why did you decide to stop taking the medication?✓
• c.Tell me what you noticed after your last refill.
• d.What was going on around the time that you stopped?

A 'why' question asks the client to justify a decision and typically produces defensiveness or silence instead of history, so it is the statement the manager must address. The other three are open invitations that gather the same information without putting the client on the defensive.

A home health nurse visits an 84-year-old client who lives with an adult child. Which finding most strongly suggests neglect?

• a.The client keeps a cane beside the recliner and walks slowly.
• b.The client is dehydrated and has a stage 3 sacral pressure injury.✓
• c.The client has a bruise on the shin from bumping a coffee table.
• d.The client's child manages the mail and pays the household bills.

Neglect is the failure to meet an older adult's basic needs for food, water, hygiene, and medical care, and dehydration together with an advanced pressure injury shows those needs went unmet. Handling a parent's mail is not by itself financial exploitation, and a shin bruise with a matching explanation or a cane in regular use are ordinary findings.

An emergency department nurse cares for a 3-year-old who has spiral fractures of both forearms, and the caregiver's account of the injury changes twice during the visit. What should the nurse do?

• a.Wait for the radiologist to confirm the fracture pattern.
• b.Confront the caregiver about the changing account.
• c.Collect photographs of the injuries before reporting.
• d.Report the suspicion to child protective services.✓

A nurse is a mandated reporter and the legal threshold is reasonable suspicion, so the report is made now; confirming abuse is the investigating agency's job, not the nurse's. Gathering photographs or waiting for a radiology reading builds a case the nurse is not required to build and delays a report the nurse must personally make, and confronting the caregiver can place the child at greater risk.

A clinic nurse suspects intimate partner violence in a 29-year-old client whose partner answers every question for her and will not leave the room. Which action should the nurse take first?

• a.Ask the partner to describe how the injuries happened.
• b.Give the client a shelter brochure to take home.
• c.Interview the client alone in a private room.✓
• d.Document that the partner appears to be controlling.

Screening only produces a truthful answer when it happens in a safe, private setting, so separating the client from the partner comes before any other step. A brochure carried home can be found by the partner and increase danger, and questioning the partner or charting an impression never obtains the client's own account.

A client hospitalized for pancreatitis reports the last alcoholic drink was three days ago. The client is now disoriented to place, grabbing at objects that are not there, temperature 38.4 C (101.1 F), heart rate 128. Which action should the nurse take first?

• a.Apply soft wrist restraints to stop the grabbing.
• b.Dim the lights and let the client rest undisturbed.
• c.Reorient the client and recheck the vital signs in an hour.
• d.Notify the provider of alcohol withdrawal delirium.✓

Disorientation with hallucinations, fever, and tachycardia appearing more than 48 hours after the last drink describes delirium tremens, which is treated urgently with benzodiazepines and carries mortality up to about 37% when untreated, so the provider is told now. Reorienting and rechecking in an hour delays that treatment, and darkness or restraints address neither the autonomic instability nor its cause.

A client with long-standing alcohol use disorder is admitted with confusion, nystagmus, and an unsteady gait. Orders include IV thiamine and IV dextrose 5% in water. Which action by the nurse is correct?

• a.Ask the provider to switch to oral thiamine.
• b.Hold the thiamine until the gait is retested.
• c.Start the dextrose first to lift the confusion.
• d.Give the thiamine before the dextrose.✓

Confusion, abnormal eye movements, and ataxia are the classic triad of Wernicke encephalopathy from thiamine deficiency, and glucose oxidation consumes the thiamine that remains, so parenteral thiamine goes in first. Delaying it for another gait check or switching to an oral dose delays the only treatment that prevents the permanent memory loss of Korsakoff syndrome, which follows in about 80% of untreated survivors.

Fourteen hours after admission a client has dilated pupils, runny nose, gooseflesh, repeated yawning, abdominal cramping, and three loose stools. Which condition do these findings indicate?

• a.Anticholinergic toxicity
• b.Neuroleptic malignant syndrome
• c.Opioid overdose toxicity
• d.Opioid withdrawal syndrome✓

Dilated pupils with rhinorrhea, piloerection, yawning, cramping, and diarrhea are the autonomic and gastrointestinal signs scored on the Clinical Opiate Withdrawal Scale. Opioid toxicity produces the opposite pupil finding, pinpoint pupils with respiratory depression, and anticholinergic toxicity dilates pupils but dries secretions and slows the gut instead of causing rhinorrhea and diarrhea.

A nurse screens a 38-year-old male client for risky alcohol use at a community clinic. Which report by the client meets the definition of binge drinking and calls for a fuller assessment?

• a.Six beers within three hours at a Saturday cookout✓
• b.One beer with dinner on most evenings of the week
• c.Two glasses of wine on Friday and two more on Sunday
• d.Three beers spread across an entire weekend camping trip

The CDC defines binge drinking as five or more drinks for a man on a single occasion, so six beers in three hours is a positive screen and warrants a fuller assessment of the client's drinking. One beer with dinner most evenings stays within the moderate-drinking limit of two drinks in a day for men and is not a binge episode.

A client with moderate Alzheimer disease becomes upset at the dinner table and insists she must leave to pick up her children from school. Which response by the nurse is most appropriate?

• a.Ask her why she believes school is letting out right now.
• b.Explain that her children are grown adults with families.
• c.Tell her to sit down and finish the meal before leaving.
• d.Acknowledge her worry and walk with her down the hall.✓

Guidance for dementia care is to stay calm, avoid arguing or correcting, and redirect, because the person cannot reason her way out of the belief and being corrected increases distress. Telling her the children are grown argues with the illness, a 'why' question demands reasoning she no longer has, and a command escalates the agitation.

A 19-year-old admitted with anorexia nervosa and a body mass index of 13 begins nutritional rehabilitation. Which laboratory value should the nurse monitor most closely during the first 72 hours?

• a.Serum bilirubin level
• b.Serum amylase level
• c.Serum uric acid level
• d.Serum phosphorus level✓

Hypophosphatemia is the hallmark of refeeding syndrome: reintroduced carbohydrate triggers insulin release that drives phosphate into cells, and the resulting deficit can cause cardiac and respiratory failure. High-risk clients have phosphorus checked before feeding and about every 12 hours for the first three days, while bilirubin, uric acid, and amylase do not track this risk.

During a screening on a medical unit, a client states a plan to overdose on the bottle of sleeping pills in the bag at the bedside. Which action should the nurse take first?

• a.Place the client on hourly safety checks.
• b.Schedule a psychiatric consult for morning.
• c.Ask the client to sign a no-harm contract.
• d.Stay with the client and secure the pills.✓

A client with a specific plan and the means within reach cannot be left alone; continuous observation combined with removing the means is the immediate intervention, and the urgent mental health evaluation follows. Hourly checks leave unwatched intervals, a morning consult delays an evaluation needed now, and no-harm contracts have not been shown to keep clients safe.

A client assessed as high risk for suicide is admitted to a medical unit that is not ligature resistant and is awaiting transfer to a behavioral health facility. Which action best reduces the environmental risk?

• a.Remove cords, belts, and glass items from the room.✓
• b.Let the family keep personal belongings at the bedside.
• c.Close the door so the client has a quiet space to rest.
• d.Assign the room farthest from the nurses' station.

In a setting that is not ligature resistant the expectation is an environmental risk assessment, removal of objects that could be used for self-harm, and continuous monitoring in a safe location while the client waits for transfer. A distant room and a closed door both reduce observation, and leaving belongings at the bedside leaves the means available.

A nurse meets with a client in the emergency department two hours after the client's home and belongings were destroyed by a fire. The client is tearful and says she does not know what to do next. Which nursing action reflects crisis intervention?

• a.Explore how losses in her childhood shaped this reaction
• b.Help her decide where she will sleep for two nights✓
• c.Begin insight-oriented therapy to change her personality
• d.Postpone planning until she meets a therapist next week

Crisis intervention is short-term work that steadies the client and returns her toward her baseline, so helping her settle a concrete, immediate problem such as where she will sleep tonight is the action that fits. Exploring childhood losses is insight-oriented work belonging to longer-term therapy and does nothing about the practical problem she faces in the next few hours.

A nurse is planning care for a client who has told the admitting nurse that a religious observance important to the client falls during this hospital stay. Which action best incorporates the client's beliefs into the plan of care?

• a.Ask the client which practices to include this week.✓
• b.Ask a relative what the client's community usually does.
• c.Consult a reference describing that faith's dietary rules.
• d.Follow the unit's standard plan for clients of that faith.

People differ within any religious or cultural group in which practices they keep and how strictly, so the client is the only reliable source and asking directly is what individualizes the plan. A standard plan for a faith, a relative's account, and a reference book each substitute an assumption about the group for this client's stated preference.

The adult children of a dying client sit silently at the bedside because their father no longer responds to them. Which instruction should the nurse give the family?

• a.Wait for the chaplain before you say your goodbyes.
• b.Step out until he shows a response to your voices.
• c.Talk to your father as though he can still hear you.✓
• d.Discuss his care in the hallway where he cannot hear.

Families are encouraged to speak to a dying person as if the person can hear them, because awareness of others may persist after responsiveness is lost, and voice, touch, and presence are the comfort measures still available. Leaving the room or waiting for someone else removes the family at the point their presence matters most.

A hospice client who is close to death has loud, wet-sounding respirations. The spouse asks whether the client is drowning. Which nursing action is most appropriate?

• a.Suction the oropharynx deeply whenever the sound returns.
• b.Reposition the client and explain that the sound is expected.✓
• c.Seat the spouse in the hallway until the sound settles.
• d.Increase the intravenous fluid rate to thin the secretions.

Secretions pooling in the airway near death do not appear to distress the client but are frightening to the family, so repositioning plus a plain explanation is the intervention; drug trials for this symptom have been negative. Deep suctioning is traumatic and the sound returns, and extra intravenous fluid in the final days increases the secretions.

Three weeks after her husband's death, a client tells the nurse she cries in waves that pass after about half an hour and that her sleep is broken. She is eating normally and has returned to work. Which action is appropriate?

• a.Tell her the crying should have stopped by now.
• b.Request an antidepressant prescription for the client.
• c.Acknowledge these as usual features of early grief.✓
• d.Refer her for prolonged grief disorder treatment.

Waves of intense sadness lasting twenty to thirty minutes, disturbed sleep, and yearning are ordinary in the first weeks of bereavement and generally ease over the following months, so the nurse normalizes and supports. Prolonged grief disorder is diagnosed when impairing grief persists roughly a year after the death, and antidepressants alone have little effect on grief intensity.

A client on a behavioral health unit is pacing the day room, clenching both fists, and speaking loudly at another client. Which action should the nurse take first?

• a.Move quickly to the client's side and take hold of his arm.
• b.Approach calmly, stay two arm lengths back, and keep the exit clear.✓
• c.Ask several staff to surround the client and speak at once.
• d.Call for restraints before attempting to speak with him.

Noncoercive verbal de-escalation is the first-line response to escalating agitation, delivered by one person in a calm voice while keeping one to two arm lengths of space and unobstructed access to the door. Grabbing the client, crowding him with several voices, or going straight to restraints escalates the situation and skips the intervention that usually works.

A client with moderate dementia is being discharged home to a spouse who provides all of the care alone. Which assessment is most important before discharge teaching begins?

• a.Which relatives the couple sees during winter holidays.
• b.How many years the couple has lived in that house.
• c.How much help and relief time the spouse actually gets.✓
• d.Whether the spouse can name each of the client's medicines.

The plan of care depends on who is genuinely available to help and whether the sole caregiver gets any respite, because a caregiver with no support is the usual reason a discharge plan collapses. Naming medicines is a teaching outcome measured after teaching, and holiday visitors or length of residence do not describe day-to-day support.

A client who lost a job and health insurance six weeks ago returns to the clinic. Which statement indicates the client is coping adaptively?

• a.I decided not to think about the bills until they pile up.
• b.I called the clinic about a sliding-scale fee.✓
• c.I stopped answering calls because nobody understands this.
• d.I have a beer or two in the evening so I stop worrying.

Calling about a sliding-scale fee is problem-focused coping, which acts directly on the stressor and is associated with better outcomes and better treatment adherence. Drinking to stop worrying, withdrawing from contact, and putting the bills out of mind are avoidance and disengagement, the patterns linked to poorer mental health.

A nurse is writing the plan of care for a 32-year-old client with schizophrenia who has taken an antipsychotic for two years. Which observation should the nurse record as a negative symptom of the illness?

• a.He says a neighbor sends him coded messages through the radio
• b.He shows little facial expression and starts no activities✓
• c.He hears a voice that comments on what he is doing
• d.He shifts between unrelated topics in the middle of a sentence

Negative symptoms are the loss or reduction of normal function, such as diminished emotional expression and avolition, which is what reduced facial expression together with no self-started activity describes. Delusions, hallucinations, and disorganized speech are positive symptoms, added experiences rather than absent ones, and they usually respond better to antipsychotic medication than the negative symptoms do.

An 80-year-old client with age-related hearing loss is being taught to use a new inhaler in a room where a television is playing. Which nursing action best supports the teaching?

• a.Turn the television off and face the client while speaking.✓
• b.Raise your voice and repeat the same words more loudly.
• c.Hand over printed instructions and cut the explanation short.
• d.Stand behind the client to demonstrate over the shoulder.

Turning off background noise and letting the client see the speaker's face are the recommended adjustments for age-related hearing loss, since facial movement and expression carry part of the message. Shouting distorts speech sounds rather than clarifying them, and standing out of view or substituting a leaflet removes the visual cues and the chance to check understanding.

A client on an inpatient unit repeatedly leaves group therapy early and argues with staff about the posted unit schedule. Which approach reflects sound behavioral management?

• a.Extend the group by ten minutes whenever the client walks out.
• b.Let the client keep a personal schedule apart from the unit's.
• c.Raise the client's behavior with peers during the next group.
• d.State the rule consistently and praise each full session attended.✓

Behavior modification pairs a consistent limit on the unwanted behavior with reinforcement of the behavior you want, so a steady rule plus praise for full attendance is the technique. Lengthening the group punishes the whole group, an individual schedule removes the limit entirely, and raising the behavior with peers shames the client rather than shaping the behavior.