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

Taking vital signs on a stable postoperative client

Adjusting the flow rate of a continuous IV infusion

Performing the initial assessment of a newly admitted client

Teaching a client how to use an incentive spirometer

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

Setting a quit date and using support resources improves success

Cutting back gradually is impossible, so it is not worth attempting

Nicotine replacement never helps people quit and only prolongs the habit

You must quit all tobacco today or the attempt is not worth making

A nurse prepares to administer an aminoglycoside antibiotic. Which parameters are most important to monitor?

Renal function and drug peak and trough levels

Serum calcium and serum phosphate levels each morning

Thyroid hormone levels and the basal metabolic rate

Blood glucose and hemoglobin A1c measured before each dose

A nurse is admitting a 78-year-old client who lives alone and was hospitalized after a hip fracture. At what point should the nurse begin discharge planning for this client?

At admission, by identifying the client's likely need for post-hospital services

On the day of discharge, after the provider writes the order and names a destination

Once the client can walk the hallway with the walker without assistance

When the client's insurance company approves a post-acute rehabilitation placement

A nurse caring for a 4-year-old notes bruises in several stages of healing across the child’s back, and the parent’s explanation does not match the pattern of injury. Which action should the nurse take?

Report the suspicion to child protective services as a mandated reporter

Ask the parent for written permission to report the injuries to the state

Gather proof of abuse before making a report to an outside agency

Wait for the provider to decide whether the injuries should be reported

A nurse on a postpartum unit sees an unfamiliar woman in scrubs carrying a newborn down the hallway in her arms. What should the nurse do?

Stop the woman at once and call security while checking her badge

Report the observation to the charge nurse at the end of rounds

Follow the woman to the nursery and confirm the infant's identity

Return to the mother's room and confirm the infant was discharged

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?

Six beers within three hours at a Saturday cookout

One beer with dinner on most evenings of the week

Two glasses of wine on Friday and two more on Sunday

Three beers spread across an entire weekend camping trip

A client who takes sertraline for depression tells the clinic nurse about starting St. John's wort bought at a health food store. Which response by the nurse is accurate?

Combining it with sertraline can push serotonin up to a harmful level

It interacts only with warfarin, so sertraline is not a concern here

Combining it with sertraline makes the antidepressant work faster

Herbal products are regulated as drugs, so this pair is safe to use

A postoperative client who received IV midazolam and IV hydromorphone is difficult to arouse with a respiratory rate of 7. Flumazenil is prescribed. Which understanding should guide the nurse's care?

It reverses the midazolam but has no effect on the hydromorphone.

It reverses the hydromorphone and leaves the midazolam fully active.

It reverses both drugs, so no other reversal agent is needed.

It will work only after the hydromorphone has been fully metabolized.

A client has a chest tube connected to a closed drainage system after a lobectomy. Midway through the shift the nurse observes continuous bubbling in the water seal chamber that was not present earlier. How should the nurse interpret this finding?

Air is leaking into the system between the client and the unit.

The client's lung has fully re-expanded and the tube can now be removed.

A clot is obstructing the tubing and blocking fluid from draining.

The prescribed suction level is too low for the size of the pneumothorax.

NCLEX-RN Nursing Practice Test

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A full bank of original NCLEX-RN Nursing practice questions across the official content areas, weighted like the real exam, with explanations. Free, no signup.

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A multiple-choice exam, 300 minutes. Practice by topic here, then take the full timed mock exam to gauge readiness.

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Sample practice questions

A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.

1. Management of Care
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
Answer: b
Explanation: 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.
2. Health Promotion
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
Answer: a
Explanation: Setting a specific quit date combined with behavioral support and, when appropriate, nicotine replacement improves cessation success. Supportive, nonjudgmental counseling promotes readiness to change.
3. Pharmacological Therapies
A nurse prepares to administer an aminoglycoside antibiotic. Which parameters are most important to monitor?
- a.Renal function and drug peak and trough levels
- b.Serum calcium and serum phosphate levels each morning
- c.Thyroid hormone levels and the basal metabolic rate
- d.Blood glucose and hemoglobin A1c measured before each dose
Answer: a
Explanation: Aminoglycosides are nephrotoxic and ototoxic, so renal function and peak and trough serum levels must be monitored to ensure safety and efficacy.
4. Management of Care
A nurse is admitting a 78-year-old client who lives alone and was hospitalized after a hip fracture. At what point should the nurse begin discharge planning for this client?
- a.At admission, by identifying the client's likely need for post-hospital services
- b.On the day of discharge, after the provider writes the order and names a destination
- c.Once the client can walk the hallway with the walker without assistance
- d.When the client's insurance company approves a post-acute rehabilitation placement
Answer: a
Explanation: The federal discharge planning requirement directs hospitals to identify, early in the stay, clients likely to suffer adverse consequences without adequate planning, so needs such as home health or extended care are worked out from admission onward. Waiting for the discharge order compresses planning into a few hours and is a common cause of failed transitions and readmission.
5. Management of Care
A nurse caring for a 4-year-old notes bruises in several stages of healing across the child’s back, and the parent’s explanation does not match the pattern of injury. Which action should the nurse take?
- a.Ask the parent for written permission to report the injuries to the state
- b.Gather proof of abuse before making a report to an outside agency
- c.Report the suspicion to child protective services as a mandated reporter
- d.Wait for the provider to decide whether the injuries should be reported
Answer: c
Explanation: Nurses are mandated reporters and must report a reasonable suspicion of abuse; proof, parental permission, and a provider’s agreement are not prerequisites, and federal privacy rules permit the disclosure to the authority receiving such reports. Waiting to build a case leaves the child in the setting where the injuries occurred.
6. Safety & Infection Control
A nurse on a postpartum unit sees an unfamiliar woman in scrubs carrying a newborn down the hallway in her arms. What should the nurse do?
- a.Stop the woman at once and call security while checking her badge
- b.Report the observation to the charge nurse at the end of rounds
- c.Follow the woman to the nursery and confirm the infant's identity
- d.Return to the mother's room and confirm the infant was discharged
Answer: a
Explanation: The National Center for Missing and Exploited Children lists as an essential guideline that infants are pushed in a bassinet rather than carried in anyone's arms, and that only staff wearing the distinctive infant-transport identification may move an infant, so carrying a newborn down a hallway is itself the warning sign. Because most hospital abductors impersonate staff and leave quickly, the nurse intervenes and summons security in the moment rather than tracking the infant afterward.
7. Psychosocial Integrity
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
Answer: a
Explanation: 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.
8. Basic Care & Comfort
A client who takes sertraline for depression tells the clinic nurse about starting St. John's wort bought at a health food store. Which response by the nurse is accurate?
- a.Combining it with sertraline can push serotonin up to a harmful level
- b.It interacts only with warfarin, so sertraline is not a concern here
- c.Combining it with sertraline makes the antidepressant work faster
- d.Herbal products are regulated as drugs, so this pair is safe to use
Answer: a
Explanation: St. John's wort combined with a serotonergic antidepressant can cause a potentially life-threatening rise in serotonin, so this combination is reported to the prescriber rather than continued. It is not a warfarin-only problem either: the herb also speeds the metabolism of oral contraceptives, cyclosporine, digoxin, indinavir, and irinotecan, weakening all of them.
9. Pharmacological Therapies
A postoperative client who received IV midazolam and IV hydromorphone is difficult to arouse with a respiratory rate of 7. Flumazenil is prescribed. Which understanding should guide the nurse's care?
- a.It reverses the hydromorphone and leaves the midazolam fully active.
- b.It reverses both drugs, so no other reversal agent is needed.
- c.It will work only after the hydromorphone has been fully metabolized.
- d.It reverses the midazolam but has no effect on the hydromorphone.
Answer: d
Explanation: Flumazenil labelling states that it reverses the sedative effects of benzodiazepines and does not reverse the effects of opioids, so opioid-related respiratory depression persists and naloxone may still be required. Labelling also directs monitoring for resedation for up to 120 minutes after flumazenil is given.
10. Physiological Adaptation & Reduction of Risk Potential
A client has a chest tube connected to a closed drainage system after a lobectomy. Midway through the shift the nurse observes continuous bubbling in the water seal chamber that was not present earlier. How should the nurse interpret this finding?
- a.The client's lung has fully re-expanded and the tube can now be removed.
- b.Air is leaking into the system between the client and the unit.
- c.A clot is obstructing the tubing and blocking fluid from draining.
- d.The prescribed suction level is too low for the size of the pneumothorax.
Answer: b
Explanation: Continuous bubbling in the water seal chamber signals an air leak, and the nurse traces the tubing from the chest wall toward the drainage unit to locate it. Full lung re-expansion produces the opposite picture, because bubbling and tidaling stop when the pleural space is no longer venting air.

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