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NCLEX-PN practice questions

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Question 1Safe and Coordinated Care

A nurse is about to care for a client and the nurse's hands are not visibly soiled. Which action is appropriate before touching the client?

  1. Rinse hands with water only
  2. Use alcohol-based hand rub Correct answer.
  3. Apply lotion before gloving
  4. Wear gloves without washing hands

Explanation

Hand hygiene is required before and after every client contact. When hands are not visibly soiled, an alcohol-based rub is an accepted method. Gloves do not replace hand hygiene.

Question 2Safe and Coordinated Care

Which two identifiers should the nurse use to confirm a client's identity before giving a medication?

  1. Room number and bed position
  2. Diagnosis and physician name
  3. Full name and date of birth Correct answer.
  4. ID band color and age

Explanation

Two independent identifiers, such as the client's full name and date of birth, must be used. Room or bed location is not a reliable identifier because clients can be moved.

Question 3Safe and Coordinated Care

A fire starts in a client care area. Which action should the nurse take first?

  1. Activate the fire alarm
  2. Extinguish the fire
  3. Close all doors
  4. Rescue those in danger Correct answer.

Explanation

The RACE sequence begins with rescuing clients in immediate danger. The alarm is activated next, followed by containing the fire and then extinguishing or evacuating.

Question 4Safe and Coordinated Care

A nurse discusses a client's condition with a coworker in a public elevator. Which principle is being violated?

  1. Autonomy
  2. Veracity
  3. Beneficence
  4. Privacy Correct answer.

Explanation

Client health information must be kept confidential and shared only with those who need it for care. Discussing it in a public area violates the client's privacy.

Question 5Safe and Coordinated Care

Which communication tool organizes a handoff report using situation, background, assessment, and recommendation?

  1. PIE
  2. SBIRT
  3. SOAP
  4. SBAR Correct answer.

Explanation

SBAR stands for situation, background, assessment, and recommendation. It provides a structured, concise handoff that reduces omissions.

Question 6Safe and Coordinated Care

Which action demonstrates standard precautions for a nurse caring for all clients?

  1. Using sterile gloves for vital signs
  2. Wearing a gown for every client contact
  3. Placing all clients in private rooms
  4. Hand hygiene before and after contact Correct answer.

Explanation

Standard precautions apply to all clients and include hand hygiene before and after contact. Additional barriers are used based on the expected exposure to blood or body fluids.

Question 7Safe and Coordinated Care

Which instruction should the nurse give a client who uses home oxygen?

  1. Keep oxygen away from open flames Correct answer.
  2. Store oxygen tanks lying flat
  3. Use petroleum jelly on the nostrils
  4. Smoke only when oxygen is off

Explanation

Oxygen supports combustion, so flames, sparks, and smoking must be kept away from the oxygen source. Clients should never smoke while using oxygen.

Question 8Safe and Coordinated Care

A client is at risk for falls. Which nursing action is most appropriate?

  1. Keep the call light within reach Correct answer.
  2. Leave both side rails down
  3. Place personal items out of reach
  4. Keep the bed in the highest position

Explanation

Fall prevention includes keeping the call light and needed items within reach so the client does not attempt unsafe independent movement. The bed should be low and the environment uncluttered.

Question 9Safe and Coordinated Care

A nurse is removing personal protective equipment after contact precautions. Which item should be removed first?

  1. Gloves Correct answer.
  2. Face shield
  3. Gown
  4. Mask

Explanation

Gloves are the most contaminated item and are removed first. The mask is removed last because it covers the airway.

Question 10Safe and Coordinated Care

A client has soft wrist restraints. Which assessment is the priority?

  1. Finger capillary refill Correct answer.
  2. Pupil response
  3. Daily weight
  4. Urine output every 8 hours

Explanation

The priority with restraints is checking circulation, sensation, and skin integrity in the restrained extremity. Capillary refill gives quick information about perfusion.

Question 11Safe and Coordinated Care

A client has a new prescription for seizure precautions. Which action should the nurse include?

  1. Place a tongue blade at the bedside
  2. Restrain the client during a seizure
  3. Keep the bed in the high position
  4. Pad the side rails of the bed Correct answer.

Explanation

Seizure precautions include padding side rails, keeping the bed low, and clearing the environment. Nothing should be placed in the client's mouth during a seizure.

Question 12Safe and Coordinated Care

A nurse is performing medication reconciliation at admission. Which action is correct?

  1. Compare the client's home medication list with new orders Correct answer.
  2. Discontinue all home medications
  3. Verify only prescriptions written by the hospital provider
  4. Ask the client to list medications from memory only

Explanation

Medication reconciliation compares the client's complete home medication list with new orders. This identifies duplications, omissions, and interactions.

Question 13Safe and Coordinated Care

A nurse makes a medication error that reaches the client. Which action should the nurse take first?

  1. Document the error in the chart as a nursing note only
  2. Notify the risk manager
  3. Assess the client for adverse effects Correct answer.
  4. Complete an incident report

Explanation

The client's safety comes first, so the nurse assesses for harm and reports findings to the provider. Incident reports are completed after the client is stable.

Question 14Safe and Coordinated Care

A client scheduled for surgery asks the nurse to explain the procedure. Which response is appropriate?

  1. The nurse explains the risks and benefits
  2. The nurse has the client sign the consent immediately
  3. The nurse tells the client that no explanation is needed
  4. The nurse refers the client to the surgeon Correct answer.

Explanation

Informed consent requires the provider performing the procedure to explain it, including risks and benefits. The nurse witnesses the consent and clarifies the client's understanding.

Question 15Safe and Coordinated Care

A client has active pulmonary tuberculosis. Which precaution should the nurse implement?

  1. Droplet precautions
  2. Contact precautions only
  3. Standard precautions only
  4. Airborne precautions Correct answer.

Explanation

Pulmonary tuberculosis is spread by airborne droplets and requires an airborne infection isolation room and an N95 respirator. Standard precautions are also used.

Question 16Safe and Coordinated Care

A nurse sustains a needlestick injury from a used needle. Which action should the nurse take first?

  1. Wash the site with soap and water Correct answer.
  2. Request HIV testing of the client immediately
  3. Squeeze the site firmly to express blood
  4. Report to employee health after the shift

Explanation

Immediate care is to wash the site with soap and water and flush mucous membranes if exposed. The nurse then reports the exposure and follows post-exposure protocols.

Question 17Safe and Coordinated Care

Before starting a blood transfusion, which action is required?

  1. Obtain vital signs every 4 hours during the transfusion
  2. Start the transfusion at a rapid rate
  3. Verify the blood product with a second licensed nurse Correct answer.
  4. Prime the tubing with dextrose 5% in water

Explanation

Two licensed staff must independently verify the client and blood product before transfusion. Baseline vital signs are obtained and monitored closely, especially during the first 15 minutes.

Question 18Safe and Coordinated Care

A client who speaks limited English needs teaching about a new medication. Which action should the nurse take?

  1. Ask a family member to interpret
  2. Speak louder and use gestures
  3. Use a trained medical interpreter Correct answer.
  4. Provide written materials in English only

Explanation

A trained medical interpreter ensures accurate communication and confidentiality. Family members, especially children, should not be used for medical interpretation.

Question 19Safe and Coordinated Care

A client with a terminal illness has a signed do-not-resuscitate order. The client becomes pulseless. Which action should the nurse take?

  1. Call a code and start rescue breathing
  2. Withhold CPR and notify the provider Correct answer.
  3. Begin chest compressions
  4. Administer epinephrine

Explanation

A valid do-not-resuscitate order directs the team to withhold CPR when the client has no pulse or respirations. The nurse provides comfort care and notifies the provider.

Question 20Safe and Coordinated Care

Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

  1. Assessing pain level
  2. Administering oral medication
  3. Teaching inhaler use
  4. Record intake and output Correct answer.

Explanation

UAP can perform routine, predictable tasks such as measuring and recording intake and output. Teaching, assessment, and medication administration require a licensed nurse.

Question 21Safe and Coordinated Care

In a mass casualty incident, which client should the nurse tag as immediate (red)?

  1. A client with no respirations after airway repositioning
  2. A client with a minor laceration who is walking
  3. A client with a closed femur fracture and stable vital signs
  4. A client with absent radial pulse and delayed capillary refill Correct answer.

Explanation

The red/immediate category is for clients with life-threatening but treatable injuries, such as shock with poor perfusion. Clients with no respirations after airway repositioning are tagged black/expectant.

Question 22Safe and Coordinated Care

A nurse notices a client with dementia attempting to leave the unit through an unsecured door. Which action should the nurse take first?

  1. Apply a wander alert bracelet
  2. Redirect the client to the unit Correct answer.
  3. Document the incident
  4. Call security to restrain the client

Explanation

The immediate priority is to keep the client safe by redirecting the client back to the unit. Documentation and prevention measures follow once the client is safe.

Question 23Safe and Coordinated Care

A nurse is floated from a medical-surgical unit to the intensive care unit. Which action is most appropriate?

  1. Perform ICU tasks beyond the nurse's training to help the team
  2. Accept the assignment without reporting concerns
  3. Refuse the assignment and leave the unit
  4. Inform the charge nurse of the limits of the nurse's competence Correct answer.

Explanation

A nurse must communicate when an assignment exceeds the nurse's competence so that supervision or a different assignment can be arranged. Floating is acceptable when the nurse is oriented and works within scope.

Question 24Safe and Coordinated Care

A client is admitted after a suicide attempt. Which environmental action is most important?

  1. Give privacy by closing the door
  2. Remove harmful items Correct answer.
  3. Keep the room dark and quiet
  4. Allow a razor for grooming

Explanation

Suicide precautions require removing potentially harmful items and maintaining close observation. A safe environment reduces the opportunity for self-harm.

Question 25Safe and Coordinated Care

A nurse is assigned five clients and feels the assignment is unsafe. Which action should the nurse take first?

  1. Wait until the end of the shift to report the concern
  2. Refuse to provide care to any client
  3. Leave the unit to avoid liability
  4. Notify the charge nurse and document the concern Correct answer.

Explanation

The nurse should use the chain of command to report an unsafe assignment so that staffing or assignments can be adjusted. The concern should be documented and escalated promptly.

Question 26Safe and Coordinated Care

A nurse is preparing a client for an invasive procedure. Which action should the nurse take to prevent wrong-site surgery?

  1. Confirm the site during the preoperative telephone call
  2. Ask the client to mark the site on the morning of surgery
  3. Take part in a time-out just before the incision Correct answer.
  4. Verify the site by reviewing the consent alone at the desk

Explanation

The Universal Protocol requires a time-out in the procedure area immediately before the procedure begins, with the whole team confirming client identity, the procedure, the site, and consent together. Site marking is performed by the surgeon or proceduralist with the client involved, and it must be visible and unambiguous.

Question 27Safe and Coordinated Care

During a mass casualty event, a client has a respiratory rate of 36 breaths per minute after the nurse opens the airway. Which triage category should the nurse assign?

  1. Immediate (red), because the breathing rate is over 30 Correct answer.
  2. Delayed (yellow), because the client is breathing on their own
  3. Minor (green), because the client can walk with help
  4. Expectant (black), because the client does not answer questions

Explanation

In START triage, the first assessment is respirations after positioning the airway; a rate greater than 30 breaths per minute automatically places the client in the immediate (red) category regardless of other findings. Red clients need life-saving intervention within minutes and are treated before delayed or minor clients.

Question 28Safe and Coordinated Care

A nurse is assigned four clients. Which client should the nurse assess first?

  1. A client with a new colostomy who will not look at the stoma
  2. A client on IV penicillin who reports throat tightness Correct answer.
  3. A client requesting pain medication for a 6/10 headache
  4. A client whose blood glucose is 180 mg/dL before lunch

Explanation

Airway and breathing threats take priority over all other needs, so a client with new throat tightness while receiving penicillin must be assessed first as a possible anaphylactic reaction. Body-image concerns, mildly elevated glucose, and moderate pain are important but do not threaten airway or circulation.

Question 29Health Promotion and Maintenance

At a well-child visit, the nurse is teaching the parents of a 6-month-old infant about expected development. Which behavior should the nurse include?

  1. Sits briefly with support Correct answer.
  2. Walks while holding furniture
  3. Uses a pincer grasp
  4. Speaks in two-word phrases

Explanation

At 6 months, infants typically sit briefly with support and roll in both directions. More advanced motor and language skills emerge later in infancy.

Question 30Health Promotion and Maintenance

A nurse is reviewing the immunization schedule for a healthy 2-month-old infant. Which vaccine is due at this age?

  1. Measles, mumps, and rubella vaccine
  2. Hepatitis A vaccine
  3. Inactivated poliovirus vaccine Correct answer.
  4. Varicella vaccine

Explanation

Inactivated poliovirus vaccine is part of the routine 2-month immunization set. MMR, varicella, and hepatitis A vaccines are typically given later in infancy or early childhood.

Question 31Health Promotion and Maintenance

A client is planning a pregnancy and asks about folic acid. Which daily amount should the nurse recommend for a client with no known risk factors?

  1. 200 mcg
  2. 400 mcg Correct answer.
  3. 800 mcg
  4. 100 mcg

Explanation

A daily folic acid intake of 400 mcg before conception and in early pregnancy helps prevent neural tube defects. Higher doses are reserved for clients with specific risk factors, such as a prior affected pregnancy.

Question 32Health Promotion and Maintenance

A nurse is teaching a healthy adult about aerobic exercise. How many minutes of moderate-intensity activity should the nurse recommend each week?

  1. 120 minutes
  2. 90 minutes
  3. 60 minutes
  4. 150 minutes Correct answer.

Explanation

Healthy adults should aim for at least 150 minutes of moderate-intensity aerobic activity each week. Activity can be divided into shorter sessions across the week.

Question 33Health Promotion and Maintenance

A nurse is teaching a young adult about preventing sexually transmitted infections. Which action should the nurse recommend?

  1. Rely on birth control pills
  2. Ask each partner about symptoms
  3. Use latex condoms consistently Correct answer.
  4. Wash the genitals after intercourse

Explanation

Consistent and correct use of latex condoms reduces transmission of many sexually transmitted infections. Asking about symptoms and washing after sex do not reliably prevent infection.

Question 34Health Promotion and Maintenance

A parent asks when whole cow's milk can be introduced to an infant. Which response should the nurse give?

  1. At 24 months of age
  2. At 18 months of age
  3. At 6 months of age
  4. At 12 months of age Correct answer.

Explanation

Whole cow's milk is generally introduced at 12 months of age, after the infant has transitioned to iron-fortified formula or breast milk. Early introduction can increase the risk of iron deficiency and gastrointestinal stress.

Question 35Health Promotion and Maintenance

A nurse is teaching a school-age child about bicycle safety. Which instruction should the nurse include?

  1. Ride on the sidewalk at all times
  2. Wear a helmet only on busy roads
  3. Wear a helmet on every ride Correct answer.
  4. Use hand signals only in traffic

Explanation

A properly fitted helmet should be worn on every bicycle ride to reduce the risk of head injury. Helmet use is not limited to busy roads or particular settings.

Question 36Health Promotion and Maintenance

A nurse is teaching a parent about car safety for a toddler. Which instruction should the nurse include?

  1. Place the seat in the front passenger seat
  2. Use a booster with a lap belt only
  3. Rear-face until the seat's limit Correct answer.
  4. Turn forward-facing at 12 months

Explanation

Children should remain rear-facing as long as possible, until they reach the highest weight or height allowed by the car seat. The back seat is the safest location for all children under 13 years.

Question 37Health Promotion and Maintenance

A client who smokes asks about nicotine replacement. Which statement indicates correct understanding of the nicotine patch?

  1. I can use two patches if I crave a cigarette
  2. I should place the patch on my face
  3. I will not smoke while using the patch Correct answer.
  4. I can chew the patch when I feel stressed

Explanation

Smoking while using nicotine replacement increases nicotine exposure and cardiovascular risk. The patch should be applied to clean, hairless skin and should not be chewed or doubled without a prescription.

Question 38Health Promotion and Maintenance

A nurse is teaching a client about sunscreen use. Which instruction should the nurse include?

  1. Choose a product with an SPF of 5
  2. Apply sunscreen only once in the morning
  3. Use sunscreen only on sunny days
  4. Reapply sunscreen every 2 hours Correct answer.

Explanation

Sunscreen should be reapplied at least every 2 hours and after swimming or sweating. Broad-spectrum products with an SPF of 30 or higher are recommended, even on cloudy days.

Question 39Health Promotion and Maintenance

A 50-year-old client at average risk asks when colorectal cancer screening should begin. Which age should the nurse state?

  1. 30 years
  2. 45 years Correct answer.
  3. 55 years
  4. 40 years

Explanation

Average-risk adults should begin colorectal cancer screening at age 45. Earlier or more frequent screening may be indicated for clients with a family history or other risk factors.

Question 40Health Promotion and Maintenance

A client at 32 weeks gestation reports that fetal movement has decreased. Which instruction should the nurse give?

  1. Contact the provider now for evaluation Correct answer.
  2. Drink a glass of water and lie on the back
  3. Count movements for 24 hours before calling
  4. Wait until the next prenatal visit

Explanation

Decreased fetal movement can be a sign of fetal compromise and requires prompt evaluation. The client should contact the provider immediately rather than waiting or delaying assessment.

Question 41Health Promotion and Maintenance

A nurse is teaching new parents how to care for the umbilical cord. Which instruction should the nurse include?

  1. Cover the cord with a tight diaper
  2. Keep the cord clean and dry Correct answer.
  3. Apply alcohol to the cord daily
  4. Bathe the infant in a tub each day

Explanation

The umbilical cord should be kept clean and dry until it falls off. Sponge baths are used during this time, and the diaper is folded below the cord to promote drying.

Question 42Health Promotion and Maintenance

A nurse is teaching a breastfeeding mother about newborn feeding. Which instruction should the nurse include?

  1. Feed the newborn 8 to 12 times per day Correct answer.
  2. Feed the newborn every 4 to 5 hours
  3. Wake the newborn only for daytime feeds
  4. Give water between breastfeeding sessions

Explanation

Breastfed newborns should feed 8 to 12 times per 24 hours, including at night, to support hydration and growth. Supplemental water is not needed and can interfere with milk intake.

Question 43Health Promotion and Maintenance

A postpartum client is being discharged. Which finding should the nurse teach the client to report immediately?

  1. Breast engorgement on the third day
  2. Persistent sadness and no interest Correct answer.
  3. Mild fatigue after each feeding
  4. Occasional afterpains during feeding

Explanation

Persistent sadness and loss of interest may indicate postpartum depression and require prompt evaluation. Mild fatigue, engorgement, and afterpains are common postpartum findings.

Question 44Health Promotion and Maintenance

A nurse is teaching a group of adolescents about sleep. How many hours of sleep should the nurse recommend each night?

  1. 7 to 8 hours
  2. 8 to 10 hours Correct answer.
  3. 4 to 6 hours
  4. 5 to 7 hours

Explanation

Adolescents generally need 8 to 10 hours of sleep per night for healthy growth and development. Inadequate sleep can affect mood, learning, and safety.

Question 45Health Promotion and Maintenance

A client with hypertension asks about dietary changes. Which eating plan should the nurse recommend?

  1. Juice cleanse with no solid foods
  2. DASH diet with fruits and vegetables Correct answer.
  3. Low-carbohydrate diet with added salt
  4. High-protein diet with daily red meat

Explanation

The DASH eating plan emphasizes fruits, vegetables, whole grains, and low-fat dairy and helps lower blood pressure. It also encourages reduced sodium intake.

Question 46Health Promotion and Maintenance

A nurse is teaching a client about increasing dietary fiber. Which food should the nurse recommend?

  1. White bread
  2. Apple juice
  3. Cream of wheat
  4. Lentils Correct answer.

Explanation

Lentils are legumes and are high in dietary fiber. Refined grains and clear juices contain little fiber.

Question 47Health Promotion and Maintenance

A 45-year-old client is overweight and sedentary. Which screening should the nurse discuss with the client?

  1. Monthly breast self-exam
  2. Annual colonoscopy
  3. Yearly chest x-ray for lung cancer
  4. Blood glucose screening for diabetes Correct answer.

Explanation

Overweight adults should be screened for prediabetes and type 2 diabetes as part of routine preventive care. This client's age and weight place them in a group for which glucose screening is recommended.

Question 48Health Promotion and Maintenance

A client at 10 weeks gestation reports nausea. Which instruction should the nurse give?

  1. Eat small, frequent meals Correct answer.
  2. Lie down after every meal
  3. Drink fluids only with meals
  4. Eat three large meals each day

Explanation

Small, frequent meals can help reduce nausea during early pregnancy. Fluids are often better tolerated between meals rather than with meals.

Question 49Health Promotion and Maintenance

A nurse is teaching a parent about lead poisoning prevention. Which action should the nurse recommend for a child living in an older home?

  1. Sand paint in the home without a mask
  2. Use hot tap water for drinking
  3. Let the child play in bare soil
  4. Wash the child's hands before meals Correct answer.

Explanation

Frequent handwashing reduces ingestion of lead-containing dust and soil. Families should also avoid hot tap water for drinking and use safe practices during home renovation.

Question 50Health Promotion and Maintenance

A nurse is reviewing prenatal screening. At which gestational age is screening for gestational diabetes typically performed for a client at average risk?

  1. 8 to 12 weeks
  2. 32 to 36 weeks
  3. 36 to 40 weeks
  4. 24 to 28 weeks Correct answer.

Explanation

Routine screening for gestational diabetes is typically performed between 24 and 28 weeks of gestation. Earlier screening may be done for clients with risk factors.