NCLEX-RN Nursing — All Questions

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 nurse at a women's health clinic is counseling a 24-year-old client who plans to conceive within the next year. Which statement by the client indicates that the teaching about folic acid was effective?

• a.I should begin folic acid only if a prior baby had a birth defect.
• b.I should begin folic acid at the start of my second trimester.
• c.I should begin folic acid once a home pregnancy test is positive.
• d.I should take 400 micrograms of folic acid every day before I conceive.✓

CDC advises that all women capable of becoming pregnant take 400 mcg of folic acid daily, starting at least a month before conception, because the neural tube closes in the earliest weeks of pregnancy. Waiting for a positive pregnancy test is the most tempting error, but by then most of the window for preventing neural tube defects has already passed.

A client at 28 weeks' gestation received Tdap during a pregnancy two years ago and asks the nurse whether she needs the vaccine again. Which response by the nurse is correct?

• a.Tdap is given in the first trimester so antibodies have time to build.
• b.Tdap is given in every pregnancy, ideally between 27 and 36 weeks.✓
• c.Tdap is given after delivery, before you go home from the hospital.
• d.Tdap is given once every ten years, so you are not due for it now.

CDC recommends a Tdap dose during each pregnancy at 27 through 36 weeks' gestation, preferably early in that window, regardless of when the client last received Tdap or Td, because maternal antibodies cross the placenta and protect the infant before the infant's own pertussis series begins. The ten-year interval applies to tetanus boosters outside pregnancy and does not replace the dose given in each pregnancy.

A nurse is triaging telephone calls from clients in the third trimester. Which report requires the most immediate follow-up?

• a.Swelling of both ankles at the end of a long day on her feet
• b.Irregular tightening of the abdomen that stops when she walks
• c.A headache for two days that is worsening, with spots in her vision✓
• d.Heartburn after evening meals that eases when she sits upright

A persistent headache that is getting worse, together with visual changes, is an urgent maternal warning sign for preeclampsia and needs same-day evaluation. Dependent ankle edema, positional heartburn, and irregular tightening that resolves with activity are common third-trimester discomforts rather than emergencies.

A nurse palpates a laboring client's contractions. One contraction begins at 0800 and ends at 0800:45; the next begins at 0804 and ends at 0805. How should the nurse document the frequency of these contractions?

• a.Every 5 minutes
• b.Every 4 minutes✓
• c.Every 3 minutes
• d.Every 45 seconds

Frequency is timed from the beginning of one contraction to the beginning of the next, so 0800 to 0804 is a frequency of every 4 minutes. Timing from the end of the first contraction to the start of the next (0800:45 to 0804, about 3 minutes) measures the resting interval, and 45 seconds is the duration of the first contraction, not its frequency.

Four hours after a vaginal birth, a nurse palpates the client's fundus two fingerbreadths above the umbilicus and displaced to the right. The fundus is firm, lochia rubra is moderate, and the oxytocin infusion is running at the ordered rate. Which action should the nurse take first?

• a.Increase the oxytocin infusion rate per the standing order
• b.Assist the client to the bathroom to empty her bladder✓
• c.Massage the uterine fundus with a cupped hand for 15 seconds
• d.Notify the provider of the fundal height and position now

A fundus that is firm but sits high and off midline points to a distended bladder displacing the uterus, and having the client void is the intervention the nurse can carry out independently; an overdistended bladder inhibits involution and raises the risk of postpartum hemorrhage. Fundal massage and more oxytocin treat uterine atony, which is not the problem here because the fundus is already firm, and calling the provider before the client voids delays the action that fixes the finding.

A nurse is completing discharge teaching with a client on postpartum day 2. Which statement by the client indicates that the teaching about when to call the provider was effective?

• a.I will call if I feel cramping while my newborn is breastfeeding.
• b.I will call if I soak through a pad in an hour or less.✓
• c.I will call if my discharge turns pinkish-brown later this week.
• d.I will call if my breasts feel full and firm on the third day.

Soaking one or more pads in an hour is an urgent maternal warning sign for postpartum hemorrhage and warrants immediate contact with the provider. The change to pinkish-brown lochia serosa around days 4 to 10, afterpains during breastfeeding, and breast fullness on about the third day are all expected postpartum findings.

On the first day after an uncomplicated birth, a client repeatedly retells the story of her labor and asks the nurse to bathe the newborn for her. The nurse plans newborn care teaching. Which action is most appropriate?

• a.Document that the client is showing impaired bonding with her newborn
• b.Have the client perform the bath now so she practices before discharge
• c.Give the client written bath instructions and ask her to read them today
• d.Meet the client's own comfort needs now and demonstrate the bath tomorrow✓

During Rubin's taking-in phase in the first one to three days, the client is focused on her own recovery and on processing the birth, so she is not yet ready to learn; readiness returns in the taking-hold phase around days 4 to 10, when clients actively seek newborn care instruction. Dependent behavior this early is expected and by itself is not evidence of impaired bonding.

At 1 minute of life a term newborn has a heart rate of 128, a weak irregular cry with slow respirations, some flexion of the extremities, a grimace when the nares are suctioned, and a pink trunk with blue hands and feet. What Apgar score should the nurse assign?

• a.5
• b.7
• c.8
• d.6✓

Scoring 2 for a heart rate above 100, 1 for slow and weak respiratory effort, 1 for some flexion, 1 for a grimace, and 1 for acrocyanosis totals 6. Awarding 2 for color is the common error: a pink body with blue hands and feet scores 1, and only a completely pink newborn scores 2.

A nurse is evaluating a new parent's understanding of safe infant sleep. Which statement indicates that the teaching was effective?

• a.My baby will sleep in our bed so I can reach him during the night.
• b.My baby will sleep in his crib with a thin bumper pad around it.
• c.My baby will sleep on his side with a rolled blanket at his back.
• d.My baby will sleep on his back in his own crib in our bedroom.✓

Back sleeping on a firm, flat surface in the infant's own crib or bassinet kept in the parents' room is the recommended arrangement, and room sharing without bed sharing substantially lowers the risk of sleep-related infant death. Side positioning is not protective because infants roll to the stomach, and rolled blankets, bumper pads, and the adult bed all add suffocation and entrapment hazards.

A newborn is delivered to a client whose prenatal laboratory results show a positive hepatitis B surface antigen. Which intervention should the nurse anticipate for this newborn?

• a.Hepatitis B vaccine alone, with the immune globulin held until 2 months of age
• b.Hepatitis B testing of the newborn's cord blood before any product is given
• c.Hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth✓
• d.Hepatitis B immune globulin alone, with the vaccine series begun at 2 months

An infant born to a client who is hepatitis B surface antigen positive needs both active and passive protection, hepatitis B vaccine plus hepatitis B immune globulin, within 12 hours of birth. Giving only one of the two agents, or waiting on cord blood testing, leaves the newborn unprotected during the hours when perinatal transmission is prevented.

A nurse performs developmental screening at a 9-month well-child visit. Which finding should the nurse report to the provider for further evaluation?

• a.The infant cries when a stranger holds her.
• b.The infant cannot sit without support.✓
• c.The infant is not yet walking across the room.
• d.The infant has not said a clear first word yet.

Sitting without support is a CDC movement milestone for 9 months, so an infant who cannot do it needs further evaluation. Being shy or fearful with strangers is an expected 9-month social milestone, and walking independently and saying a first special name are milestones for later ages, so their absence at 9 months is not a red flag.

A nurse is counseling the parent of a 7-month-old who has started eating solid foods. Which statement by the parent requires correction by the nurse?

• a.I give him soft cooked vegetables cut into small pieces.
• b.I keep offering breast milk along with his new solid foods.
• c.I offer him iron-fortified cereal thinned with breast milk.
• d.I dip his pacifier in honey when he is fussy about teething.✓

Honey, including honey placed on a pacifier, can contain Clostridium botulinum spores and must not be given to a child younger than 1 year because of the risk of infant botulism. Iron-fortified cereal, soft cooked vegetables in small pieces, and continued breast milk alongside complementary foods are all appropriate at 7 months.

The parent of a healthy 4-year-old who weighs 40 pounds tells the nurse she plans to move the child from a forward-facing car seat to a booster seat this week. Which response by the nurse is correct?

• a.Move her to a booster now, because 4 years is the age for a booster seat
• b.Keep her in the harnessed seat until she outgrows its height or weight limit✓
• c.Move her to a booster in the front seat so the shoulder belt fits her
• d.Move her back to a rear-facing seat until she turns 5 years of age

CDC guidance is to keep a child in a forward-facing seat with a harness and top tether until the child reaches the manufacturer's maximum height or weight limit, which for most children is well past age 4, so age alone does not trigger the move to a booster. Children stay buckled in the back seat until age 13, so moving her to the front seat is not an option.

The parent of a healthy 2-year-old tells the nurse she worries her son is behind the other children at his daycare. Which behavior should the nurse identify as an expected milestone for his age?

• a.He names several colors when shown a set of blocks
• b.He puts two words together, such as saying 'more milk'✓
• c.He tells a stranger his own first name when asked
• d.He draws a person with three or more body parts

Saying at least two words together, such as 'more milk,' is a CDC language milestone for 2 years, so this child is on track. Giving one's own first name on request belongs to the 3-year list, and naming colors and drawing a person with three or more body parts are 4-year milestones, so their absence at 2 years is expected.

An 8-year-old is hospitalized for two weeks in traction after a femur fracture. Which nursing action best supports this child's psychosocial development?

• a.Limit visits from classmates so that he can rest and recover faster
• b.Encourage his parents to make his daily care choices for him for now
• c.Arrange schoolwork and let him finish projects he can show others✓
• d.Offer a choice of two pajama colors to give him a sense of control

A school-age child is in Erikson's industry versus inferiority stage, so chances to complete tasks and be recognized for accomplishments protect self-esteem during a long admission. Simple either-or choices are what a toddler working on autonomy needs, and removing peer contact and decision making both deepen a sense of inferiority.

A school nurse is planning a health education session for parents of fifth graders. Which physical activity recommendation should the nurse present for children this age?

• a.150 minutes of moderate activity spread across the whole week
• b.20 minutes of vigorous activity on three or four days each week
• c.30 minutes of moderate activity on at least five days each week
• d.60 minutes or more of moderate-to-vigorous activity every day✓

CDC guidance for ages 6 through 17 is at least 60 minutes of moderate-to-vigorous physical activity daily, including vigorous, muscle-strengthening, and bone-strengthening activity on at least 3 of those days. The 150-minutes-per-week figure is the adult aerobic target and understates what school-age children need.

A 38-year-old client already walks briskly for 30 minutes on five days each week. Which addition should the nurse recommend so the client meets the physical activity guidelines for adults?

• a.Muscle-strengthening activity on at least two days each week✓
• b.Balance training on at least three days of each week
• c.An additional 150 minutes of brisk walking spread over the week
• d.Static stretching before and after each walking session

CDC guidance for adults is 150 minutes of moderate-intensity aerobic activity per week plus muscle-strengthening activity on 2 or more days a week; this client already meets the aerobic target and is missing only the strengthening component. Balance training is emphasized for older adults at risk of falling, and stretching does not count toward either requirement.

During a routine visit, a 34-year-old client screens positive for risky drinking on a validated alcohol screening tool and has no signs of alcohol dependence. Which action should the nurse take?

• a.Refer the client directly to an inpatient medical detoxification unit
• b.Reassure the client that a daily drink carries no health risk
• c.Provide a brief behavioral counseling intervention about drinking✓
• d.Repeat the screening tool at the client's visit in twelve months

USPSTF recommends screening adults 18 and older for unhealthy alcohol use and providing brief behavioral counseling to those who screen positive for risky or hazardous drinking, which is exactly this client's result. Inpatient detoxification is aimed at withdrawal risk in dependence, and postponing the conversation for a year forgoes the intervention the screening was done to trigger.

A nurse is planning care for a 74-year-old who lives alone and has fallen twice in the past year. Which intervention has the strongest preventive evidence for this client?

• a.Set up a bed alarm in the client's home each night
• b.Advise the client to limit walking outside the home
• c.Enroll the client in a supervised exercise program✓
• d.Arrange a weekly telephone check from clinic staff

USPSTF gives exercise interventions a B recommendation to prevent falls in community-dwelling adults 65 years or older who are at increased risk, and two falls in the past year establishes that risk. Restricting walking is counterproductive because deconditioning raises fall risk, while alarms and telephone checks may detect a fall but do nothing to prevent one.

A home health nurse visits an 80-year-old who walks with a rolling walker and reports poor night vision. Which finding in the home should the nurse address first?

• a.A pill organizer refilled by a neighbor each Sunday
• b.Expired canned goods stored in a kitchen cupboard
• c.Loose throw rugs along the hallway to the bathroom✓
• d.A cordless telephone kept in the living room only

Loose rugs in the path a walker must cross are the immediate fall hazard for a client with an assistive device and poor night vision, and removing them is a first-line home modification alongside better lighting and clutter reduction. The other findings deserve follow-up, but none of them is likely to put this client on the floor tonight.

A 41-year-old client with no personal or family history of breast cancer asks when she should begin screening mammograms. Which response by the nurse reflects current USPSTF guidance?

• a.Begin now and repeat the mammogram every two years through age 74✓
• b.Begin at age 50 and repeat the mammogram every two years to 74
• c.Begin at age 45 and repeat the mammogram every year until age 54
• d.Begin screening now and repeat the mammogram every year to age 74

USPSTF recommends biennial screening mammography for women aged 40 to 74 years, so an average-risk 41-year-old should start now and be screened every other year. Annual screening and a start age of 50 reflect other organizations' guidance or the superseded 2016 USPSTF statement rather than the current recommendation.

A nurse is reviewing preventive services for a 4-year-old at a well-child visit. Which screening does USPSTF recommend for a child of this age?

• a.Vision screening to detect amblyopia and its risk factors✓
• b.Depression screening with a standardized adolescent tool
• c.Scoliosis screening of the spine in a forward bend position
• d.Hearing screening repeated at every visit from age 3 to 5

USPSTF recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors, and concludes evidence is insufficient for children younger than 3. Depression screening is the tempting choice, but its B recommendation begins at age 12, and neither repeated preschool hearing screening nor scoliosis screening at this age is a USPSTF recommendation.

A nurse is setting up preventive services at a school-based health center. For which group does USPSTF recommend routine screening for major depressive disorder?

• a.Students of any age each school year
• b.Children 8 to 11 years of age
• c.Adolescents with a prior diagnosis only
• d.Adolescents 12 to 18 years of age✓

USPSTF gives a B recommendation to screening adolescents 12 to 18 years for major depressive disorder and an I statement for children 11 years and younger, where the evidence is insufficient. Screening is intended for students without a recognized diagnosis, so limiting it to those already diagnosed would defeat its purpose.

A client at her first prenatal visit reports regular 28-day cycles and states that her last menstrual period began on August 1, 2026 and that the flow lasted five days. Using Naegele's rule, which estimated date of delivery should the nurse record?

• a.May 1, 2027
• b.May 8, 2027✓
• c.May 12, 2027
• d.April 24, 2027

Naegele's rule is applied to the first day of the last menstrual period: August 1, 2026 plus 1 year and 7 days, minus 3 months, gives May 8, 2027, which is also the 280th day after that date. Counting from the last day of the flow rather than the first day, subtracting the 7 days instead of adding them, or leaving the 7 days out altogether are the three errors that produce the other dates.

A community health nurse visits a family whose 2-year-old lives in a house built in 1955 that is being repainted. Which teaching addresses this child's greatest environmental risk?

• a.Keep the child away from paint chips and dust during the work✓
• b.Wash the child's hands after outdoor play in the fenced yard
• c.Give the child a calcium supplement during the renovation work
• d.Keep the child's bedroom window open while the work is done

Paint in a home built before 1978 should be assumed to contain lead, and lead-contaminated paint chips and dust generated during renovation are the major source of childhood lead exposure, so keeping a child younger than 6 out of the work area is the priority teaching. Opening a window does not control settled dust, and no supplement substitutes for removing the exposure itself.