Here are some free comprehensive nclex questions for you to practice with. Questions are ideal for both NCLEX-RN and NCLEX-PN

An elderly patient is found lying on the floor of his hospital room.  The patient was on fall precautions.  Which of the following actions is most appropriate for the nurse to take first in this situation?

  1. Assess the patient for any injuries
  2. Notify the patient’s physician
  3. Ask another staff member to assist you to get the patient back into bed
  4. Ask the patient why he tried to get up without assistance

Correct Answer:  1

Using the nursing process, the first action the nurse should carry out is to completely assess the patient for injuries and any other changes in their condition in order to provide any nursing interventions that may be needed, such as applying pressure to bleeding, immobilizing a possible broken joint, etc.  The nurse should definitely notify the patient’s physician, however it is not the first action that should be taken.  The nurse should also seek assistance for help in getting the patient back into bed for the safety of both the patient and staff, but this is not the first action that should be taken either.  Finally, it is always important to determine why the patient got out of bed without assistance in order to implement new interventions that may help to prevent future falls, but it is not the initial action the nurse should take.

A staff registered nurse (RN) is preparing to insert an IV for patient that has been ordered to have morphine 10mg IVP.  Using time management skills, which of the following actions should the RN take first?

  1. Enter the room and perform hand hygiene
  2. Explain the procedure to the patient
  3. Mentally go over the procedure when collecting supplies before entering the room
  4. Eject excess medication from the prefilled syringe

Correct Answer:  3

The initial action the RN should take is to mentally think over the procedure to ensure that she has all of the supplies that are going to be needed, this way she will be able to avoid wasting time by having to make more trips to get supplies.  Hand hygiene should be performed upon entrance to the room; this should not be the very first action.  The RN should explain the procedure to the patient immediately prior to performing the task and inserting the IV, this should not be the first action.  Once the IV is inserted and patent, the RN should eject/waste any excess medication from the prefilled syringe if needed, so the patient receives the correct amount, so this would also not be the first action.

An RN on a medical-surgical unit is in charge of making nurse-patient assignments at the beginning of the shift.  Which task should the nurse delegate to the licensed practical nurse (LPN)?

  1. Instructing a patient on how to perform wound care
  2. Obtaining vital signs on a patient who is 2 hours post-operative after a cardiac catheterization
  3. Administration of 1 unit of fresh frozen plasma (FFP)
  4. Developing a care plan for a newly admitted patient

Correct Answer: 2

It is within the scope of practice of the LPN to monitor a patient who is 2 hours post-op after a cardiac catheterization, so she can get their vital signs and record them.  The RN is responsible for any patient education, whereas an LPN can only reinforce patient education.  The RN is responsible for administering blood components; it is not within the scope of the LPN.  The RN is the one responsible for developing a care plan for a new admission to the unit, whereas it is within the scope of practice for an LPN to only suggest additions to the care plans.

As a nurse, you are preparing to transfer an adult patient who is 72 hours postoperative from surgery, back to a long-term care facility.  Which of the following should you include in the transfer report?  (Select all that apply).

  1. Patient’s vital signs on the day of admission
  2. Patient’s medical diagnosis
  3. Type of anesthesia that was used
  4. Patient’s advance directive status
  5. Any needs for special equipment

Correct Answer: 2, 4, 5

The nurse giving transfer report should only include information that is pertinent and that the following nurse at the next facility will need in order to provide the best care.  Vital signs on the day of admission are not pertinent, rather the most recent vital signs would be.  The type of anesthesia that was used is not pertinent for the transfer report at this point either, unless there were complications.  What the patient has been diagnosed with is pertinent in order to adjust care, along with the code status of the patient, and if there is any special equipment that the long-term facility will need in order to provide the best care.

An RN is attending an interprofessional conference for a patient who has sustained a recent C6 spinal cord injury.  The patient was a construction worker.  Which of the following members of the healthcare team should also participate in planning care for this patient?  (Select all that apply).

  1. Psychologist
  2. Vocational counselor
  3. Speech therapist
  4. Physical therapist
  5. Occupational therapist

Correct Answer:  1, 2, 4, 5 

The patient will need the assistance of a psychologist in order to adapt to any psychological impacts the injury has caused due to being so active immediately prior to the accident and all that being taken away so quickly.  The patient will also need assistance from a vocational counselor in order to explore any options for reemployment in the future.  A speech therapist will not be needed because speech and/or swallowing problems will not be anticipated for this patient.  A physical therapist will need to attend the conference because they will be the ones to assist the patient with mobility skills and help to maintain muscle strength.  Finally, an occupational therapist will also be needed so the patient can learn how to perform their activities of daily living again with possible deficits.

The RN has taken over care for a patient and their condition is declining.  Upon reviewing their medical records, the nurse notices that the patient’s do not resuscitate (DNR) order has expired.  Which of the following actions should the nurse take in this situation?

  1. Anticipate that CPR will be initiated should the patient go into cardiac arrest
  2. Call the physician to determine whether the order should be reinstated immediately
  3. Assume that the patient does not want to be resuscitated and take no action should cardiac arrest occur
  4. Write a note on the front of the physician order sheet asking for the DNR to be reordered

Correct Answer: 2

The nurse should immediately call the physician in order to determine whether or not the order should be reinstated, which is the action that should be taken to ensure the patient’s wishes are carried out.  Without a current DNR order, the nurse must initiate emergency resuscitation, which most likely would not be consistent with the patient’s wishes.  In addition, without a current DNR order, writing a note on the physician order sheet will likely delay resolving the problem at hand.

A newly licensed nurse is preparing to start an IV.  Which of the following sources should the nurse use in order to best review the procedure and the standard at which it should be performed?

  1. A more experienced nurse
  2. Web site explaining the task
  3. State nurse practice act
  4. Institutional policy and procedure manual

Correct Answer:  4

The policy and procedure manual will provide instructions on how to perform the procedure that is consistent with established standards; therefore the nurse should use this resource first.  A more experienced nurse on the unit may not perform the task according to the policy and procedure.  A web site may not provide consistent information in order to correctly do the task.  The nurse practice act identifies a scope of practice and other aspects of the law, but it does not set standards for performing a task.

A nurse observes a nursing assistant reprimanding a patient for not using the urinal properly.  The nursing assistant threatens to put a brief on the patient if he does not use the urinal more carefully next time.  Which tort is the nursing assistant committing?

  1. Assault
  2. Battery
  3. Invasion of privacy
  4. False imprisonment

Correct Answer:  1

Assault is conduct that makes a person fear that he or she will be harmed.  Battery is the actual physical contact without a person’s consent that could possibly cause harm.  Invasion of privacy is the unauthorized release of a patient’s private information.  False imprisonment is when a patient is restrained against their will, including use of both physical and chemical restraints, and refusing to allow a patient to leave a facility.

A nursing assistant reports that the blood sugar of a patient was 58 mg/dL a half hour before lunch.  The patient’s morning blood sugar was 285 mg/dL.  The patient is observed to be asymptomatic at this time despite their low blood sugar result, plus the next dose of insulin is scheduled to be administered at this time.  Which of the following actions should the nurse take first?

  1. Phone the laboratory in order to obtain a STAT serum glucose level
  2. Recalibrate the glucometer and recheck the blood sugar
  3. Inform the nursing assistant to go ahead and give the patient 120 mL of orange juice
  4. Administer the insulin as ordered

Correct Answer:  2

Due to the blood sugar being 285 mg/dL just a few hours prior to this reading, it is unlikely that it has dropped to 58 mg/dL at this time.  Therefore, the first thing the nurse should do herself should be to recalibrate the glucometer and obtain another reading before taking any other actions.  Calling the laboratory to obtain a STAT serum glucose level may be unnecessary right at this moment and could even add cost to the patient’s care.  The nurse should refrain from allowing the nursing assistant to give the patient orange juice because it is unlikely that the blood glucose is low enough at this time.  Also, before administering insulin, an accurate blood sugar reading needs to be obtained.

A nurse finds out that a patient was administered an antihypertensive medication in error.  Arrange the following actions in the appropriate order that the nurse should follow in this situation.

  1. Complete an incident report
  2. Notify the risk manager
  3. Monitor the vital signs
  4. Call the patient’s physician
  5. Instruct the patient to remain in bed until further notice

Correct Answer: 3, 5, 4, 1, 2

In this situation the nurse should first monitor the patient’s vital signs to see how the medication has affected the blood pressure.  Then, the nurse should educate the patient to remain in bed in order to prevent falls should they get up and experience any dizziness.  Next, the nurse should phone the physician and explain the situation with the most recent blood pressure value.  Once the physician is notified, the nurse and complete an incident report that is very thorough and accurate.  Finally, the incident should be reported to the risk manager.

A community is experiencing an outbreak of meningitis, and hospital beds are in urgent need.  Which of the following patient should the charge nurse recommend for discharge?

  1. 70 year old admitted 24 hours prior with pneumonia and dehydration
  2. 65 year old female who sustained a fall with a hip fracture, who is schedule for hip replacement the next day
  3. 50 year old with type 2 diabetes admitted for rotator cuff surgery
  4. 58 year old male admitted 12 hours ago with angina and a history of CABG 1 year ago

Correct Answer:  3

This patient is stable and can be safely discharged at this time.  The 70 year old patient is unstable and at risk for complications such as fluid volume deficit and cannot be safely discharged.  The 65 year old patient is also unstable, and discharge would place her more at risk for causing further damage to her hip.  Finally, the 58 year old is at risk for a cardiac event, discharging him would not be safe at this time.

A nurse is educating a patient who is taking iron supplements about what other foods aid in its absorption into the body.  Which of the following food choices made by the patient would indicate that they understood the teaching?

  1. Green beans
  2. Orange juice
  3. Milk
  4. Baked potato

Correct Answer: 2

Vitamin C aids in the absorption of iron, and orange juice is a great source of vitamin C.  Green beans, milk and baked potatoes do not aid in iron absorption.

A nurse is caring for a patient who routinely takes warfarin (Coumadin).  Which of the following food choices should the nurse advise the patient to limit in their diet?

  1. Ice cream
  2. Broccoli
  3. Orange juice
  4. Chicken

Correct Answer:  2

Broccoli is a green leafy vegetable and is a good source of vitamin K.  The patient should avoid excess consumption of vitamin K because in excess it has a negative response to the effects of warfarin.  Ice cream, orange juice and chick do not effect coagulation.

A nurse is teaching a nutritional class on minerals and electrolytes.  Which of the following food sources would provide the best amounts of magnesium when consumed?

  1. Canned soup
  2. Yogurt
  3. Nuts
  4. Tomatoes

Correct Answer:  3

Of the foods listed, nuts are the best source of magnesium and should be included in the diet if needed.  Canned soup contains sodium, yogurt would be a good source of calcium, and tomatoes are a good source of potassium.

Which of the following clinical findings are associated with hypothyroidism?

  1. Diarrhea
  2. Increased heart rate
  3. Decreased metabolic demand
  4. Weight loss

Correct Answer:  3

Hypothyroidism will most likely decrease the metabolic demand of your body, making all the processes slower than normal.  Diarrhea, increased heart rate and weight loss would most likely be signs of hyperthyroidism.

Which of the following medications should the nurse be aware of that decreases the body’s rate of metabolism?

  1. amitriptyline 
  2. prednisone 
  3. somatropin 
  4. levothyroxine 

Correct Answer:  1

Amitriptyline is a tricyclic antidepressant used for treating depression and decreases that body’s rate of metabolism.  Prednisone is a glucocorticoid that is used for suppressing the immune system and inflammation; therefore it increases the metabolic rate.  Somatropin is used as a growth hormone and increases the metabolic rate.  Levothyroxine is used for the treatment of hypothyroidism and increases the metabolic rate.

A nurse is calculating BMI for a number of patients.  Which of the following BMI results indicates an overweight patient?

  1. 27
  2. 30
  3. 24
  4. 32

Correct Answer:  1

Overweight is defined as an increased body weight in relation to height, indicated by a BMI of 25 to 29.9.  Obesity is an excess amount of body fat indicated by a BMI greater than or equal to 30.  Normal/healthy weight is indicated by a BMI of 18.5 to 24.9.

A nurse is teaching a nutritional class to a group of females.  Which of the following should the nurse include as risk factors for developing osteoporosis?  (Select all that apply).

  1. Obesity
  2. Cigarette smoking
  3. Family history
  4. Inactivity
  5. Hyperlipidemia

Correct Answer:  2, 3, 4

Cigarette smoking may increase the risk of osteoporosis.  Also, osteoporosis tends to run in families and tends to occur more in those who are inactive.  Weight-bearing exercises should be discussed as primary prevention measures to decrease their risk.  Weight loss, instead of obesity, can lead to a decreased intake of dietary calcium and vitamin D leading to development of osteoporosis.  Hyperlipidemia is not a risk factor.

You are caring for a patient who has a urinary tract infection (UTI).  The patient reports pain and a sensation of burning upon urination, along with cloudy urine with an odor.  Which of the following would be your priority intervention as the nurse?

  1. Offer a warm sitz bath
  2. Administer an antibiotic
  3. Encourage increased fluids
  4. Recommend to the patient they should drink cranberry juice

Correct Answer:  2

The greatest risk to the patient at this time is injury to their renal system from the UTI.  Therefore, the most important intervention would be to give an antibiotic ASAP.  Offering a warm sitz bath and encouraging increased fluids will provide only temporary relief.  In addition, drinking cranberry juice may help to prevent a UTI in the future.

You are admitting a patient with a kidney stone.  Which of the following findings would you expect to note in your assessment?

  1. Bradycardia
  2. Nocturia
  3. Bradypnea
  4. Diaphoresis

Correct Answer:  4

Diaphoresis is a manifestation that is noted with a patient with a kidney stone.  Other symptoms you will see would be the opposite of the other choices and would include: tachycardia, oliguria, and tachypnea.

During your completion of discharge instructions with a patient who has passed a calcium oxalate stone, which of the following food choices should you instruct them to avoid in the future?  Select all that apply.

  1. Red meat
  2. Black tea
  3. Cheese
  4. Whole grains
  5. Spinach

Correct Answer:  2, 5

Both black tea and spinach contain calcium oxalate and should be avoided for prevention of this type of kidney stone.  Red meat, cheese, and whole grains contain magnesium ammonium phosphate and do not need to be avoided in this situation.

You are providing instructions to your patient prior to a mammogram.  Which of the following should you instruct your patient to avoid prior to their procedure?

  1. Deodorant
  2. Multivitamin
  3. Sexual intercourse
  4. Exercise

Correct Answer:  1

Application of deodorant or powder can cause a shadow to appear when the mammogram is done.  Taking a multivitamin, having sexual intercourse, and exercising does not alter accuracy of a mammogram.

You are reviewing the medical record of your patient with premenstrual syndrome (PMS).   Which of the following medications are used to treat PMS?  (Select all that apply).

  1. fluoxetine 
  2. spironolactone 
  3. ethinyl estradiol/drospirenone
  4. ferrous sulfate
  5. methylergonovine

Correct Answer:  1, 2, 3

Fluoxetine is an SSRI that is used to treat the emotional symptoms of PMS (irritability & mood swings), plus it can also treat physical symptoms.  Spironolactone is a diuretic that can reduce bloating and weight gain that accompanies PMS.  Oral contraceptives that contain drospirenone help to reduce symptoms of PMS.  Oral iron supplements are only used to treat anemia related to dysfunctional bleeding and methylergonovine is used to treat postpartum hemorrhage.

It is up to you to provide support to your patient who has a recent diagnosis of endometriosis.  You should reinforce to your patient that which of the following conditions is a complication of endometriosis?

  1. Insulin resistance
  2. Pelvic inflammatory disease (PID)
  3. Infertility
  4. Vaginitis

Correct Answer:  3 

Infertility is a complication because overgrowth of endometrial tissue can block the fallopian tubes.  Insulin resistance is a complication of polycystic ovary syndrome, vaginitis is usually caused by an infection, and PID is caused by an infection of the pelvic organs.

The nurse is assessing a patient who has a cast on his arm due to a compound fracture.  Which of the following findings is an early indication of neurovascular compromise?

  1. Pallor
  2. Paralysis
  3. Paresthesia
  4. Pulselessness

Correct Answer:  3

Paresthesia is an early sign of neurovascular compromise that may even suggest compartment syndrome.  Pulselessness, paralysis and pallor are late signs, all of which suggest compartment syndrome.

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