NCLEX-RN Practice Test

The National Council Licensure Examination for Registered Nurses is better known as the NCLEX-RN. This licensure exam measures the basic competencies needed to perform effectively and safely as a newly licensed, entry-level nurse. To prepare for this exam you should practice with as many NCLEX-RN questions as possible. Start your review here with our free NCLEX-RN practice test.


NCLEX-RN Questions

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Question 1
After determining that a client has a ruptured appendix, the physician ordered an emergency appendectomy. After assessing the client and finding that he is exhibiting signs and symptoms of shock, the nurse should

A
place the client in Semi-fowler's position.
B
immediately notify the physician.
C
increase the flow rate of the oxygen at 5-6 liters per minute.
D
obtain an order for a blood transfusion.
Question 1 Explanation: 
The correct answer is (B). The physician must be notified immediately as peritonitis and shock are potentially life-threatening complications after an abdominal surgery; immediate treatment is needed during this time. Answer (A) is incorrect because the head of the bed should be flat to increase tissue perfusion and oxygenation to the vital organs. Answer (C) is incorrect because the client is already getting oxygen and the problem still exists. Answer (D) is incorrect because the problem is not necessarily a loss of blood; fluid would be required to expand and sustain the circulating blood volume.
Question 2
A 55 year-old woman who is to have a total abdominal hysterectomy for a non-invasive endometrial cancer may have difficulty in emotionally adjusting to this type of surgery. The nurse recognizes that the reason for this may be anxiety about her

A
diminished sexual desire.
B
loss of femininity.
C
slow recovery because of age.
D
body image changes.
Question 2 Explanation: 
The correct answer is (B). Removal of the uterus may produce changes in how some women view themselves sexually because it is a reproductive organ. Answer (A) is incorrect because the libido of a postmenopausal woman probably would not be altered unless there are concerns about sexuality. Answer (C) is incorrect because a client who is an otherwise healthy woman should have an uneventful recovery. Answer (D) is incorrect because it is more likely to occur with surgery that has obvious external changes.
Question 3
Upon admission, a female client is to receive a 2-gram sodium diet. Her husband asks whether he can bring some food from home. The nurse suggests that he bring foods low in sodium such as

A
celery sticks.
B
peanut butter.
C
ice cream.
D
fresh oranges.
Question 3 Explanation: 
The correct answer is (D). Oranges contain only trace amounts of sodium. Other options contain larger amount of sodium compared to oranges.
Question 4
A 7-year-old client is to have a nasogastric tube placed. Organize the following steps in chronological order for this procedure:

  1. Measure the tube for the approximate placement length.
  2. Insert the tube along the base of the nose.
  3. Place the client supine in a sniffing position.
  4. Check the position of the tube placement and secure the tube.
  5. Lubricate the tube.
  6. Advance the tube straight back toward the occiput.
A
3, 1, 5, 2, 6, 4
B
3, 5, 1, 2, 5, 4
C
1, 3, 5, 2, 6, 4
D
3, 1, 4, 5, 2, 6
Question 4 Explanation: 
The correct answer is (A). The child is placed in a supine position with the head in sniffing position. Next, the tube is measured for approximate insertion length. The tube is lubricated. It is passed first through the nose and then straight back. If the child can swallow, he or she should be asked to assist with the insertion. Once the tube is in place, confirm its correct placement and secure the tube.
Question 5
One gram of aminophylline is added to 500 mL normal saline. The physician orders aminophylline to be infused over 10 hours. How much aminophylline per hour will the client receive?

A
50 mg
B
60 mg
C
75 mg
D
100 mg
Question 5 Explanation: 
The correct answer is (D). Solve as shown here:
500 mL/10 h = 50 mL/h
1,000 mg/500 mL = x mg/50 mL
x = 100mg/50 ml
Question 6
What is the most effective method for the nurse to assess a client's response to ongoing serum albumin therapy for biliary cirrhosis?

A
Monitor the client's weight daily.
B
Monitor the client's vital signs frequently.
C
Monitor the client's urine output every half-hour.
D
Monitor the client's urine albumin level every shift.
Question 6 Explanation: 
The correct answer is (A). The increased osmotic effect of therapy increases the intravascular volume and urinary output; weight loss reflects fluid loss. Vital signs will not change drastically. The urine output is measured hourly. Serum albumin, not urine albumin levels, would be significant.
Question 7
The nurse is planning care for a client who is an alcoholic. The nurse must understand that the most serious, life-threatening symptoms from alcohol withdrawal usually occur how many hours after the last drink?

A
4 to 8 hours.
B
8 to 12 hours.
C
16 to 24 hours.
D
24 to 72 hours.
Question 7 Explanation: 
The correct answer is (D). Delirium tremens, a life-threatening CNS response to alcohol withdrawal, occurs in 24 to 72 hours when blood alcohol levels drop as alcohol is detoxified and excreted.
Question 8
During a family meeting, a client with a substance abuse disorder accuses his mother of contributing to his substance abuse. The nurse evaluates that the psycho-education the client and family received was ineffective because the client is

A
verbalizing negative feelings toward a family member.
B
creating an environment in which family members cannot learn about his problem.
C
confronting his mother about her lack of support.
D
having difficulty recalling that a change in one person affects the entire family.
Question 8 Explanation: 
The correct answer is (D). The client should understand that any trauma that happens to one family member profoundly affects other family members and will influence their behavior. Answer (A) is incorrect because it is acceptable to appropriately express dissatisfaction and negative feelings to family members as a way to process problems and identify unhealthy behaviors that require change. Answer (B) is incorrect because, during psycho-education, the family did learn about the client’s use of denial, blaming others, and his inability to take responsibility for his actions. Answer (C) is incorrect because a family meeting where the client confronts a family member about lack of knowledge or support is a positive outcome of information learned in a psycho-education group.
Question 9
To provide appropriate instructions for parents caring for an infant with galactosemia, the nurse should include teaching them to

A
keep penicillin on hand for respiratory infections.
B
eliminate milk from the diet.
C
avoid soybean-based formulas.
D
substitute cheese for meat in the diet.
Question 9 Explanation: 
The correct answer is (B). Milk and dairy products have high lactose content and should be avoided. Penicillin may contain lactose as filler; antibiotics should be prescribed and not stored in home. Soybean -based formulas are acceptable because they do not contain lactose.
Question 10
A client is taught how to change the dressing and how to care for a recently inserted nephrostomy tube. On the day of discharge, the client states, "I hope I can handle all this at home. It's a lot to remember." The best response by the nurse is

A
"I'm sure you can do it.”
B
"You seem to be nervous about going home."
C
"Perhaps you can stay in the hospital another day."
D
"A family member can do it for you."
Question 10 Explanation: 
The correct answer is (B). Reflection conveys acceptance and encourages further communication. Answer (A) is incorrect because it is a false reassurance which does not help reduce anxiety. Answer (C) is incorrect because it is unrealistic, and it is too late to suggest this. Answer (D) is incorrect because it provides false reassurance and it removes the focus from the client's needs.
Question 11
A female adult client diagnosed with hyperthyroidism decided to undergo the surgical procedure after refusing ablation therapy. While awaiting the surgical date, the nurse should plan to instruct the client to

A
consciously attempt to calm down.
B
refrain from drinking tea, cola and coffee.
C
plan all activities during the day to overcome lethargy.
D
maintain the warmth of the home and use an extra blanket during bedtime.
Question 11 Explanation: 
The correct answer is (B). These beverages contain caffeine, which may increase thyroid activity. Consciously attempting to calm down is a good idea, but this is a physiological problem and needs a physiological solution. This patient will not be experiencing lethargy or chills and instead may have too much energy and be hot.
Question 12
After pharmacologic treatment for hyperthyroidism, a client has the thyroid ablated with ¹³¹I. While at the clinic, the client shows signs and symptoms of thyroid storm. The nurse understands that this is often associated with

A
iodine insufficiency.
B
decreased serum calcium.
C
increased sodium retention.
D
excessive thyroid replacement.
Question 12 Explanation: 
The correct answer is (D). Thyroid storm is the body's response to excessive circulating thyroid hormones. Iodine insufficiency would create a goiter, where the thyroid becomes enlarged. Calcium has to do with the parathyroid, not the thyroid. Sodium retention has no relationship with thyroid hormone.
Question 13
A 22 year-old customer service representative has been feeling increasingly tired and seeks medical attention. Type 1 diabetes is diagnosed. The nurse explains that the increased fatigue is the result of

A
decreased glucose secretion into the renal tubules.
B
decreased production of insulin by the pancreas.
C
increased metabolism at the cellular level.
D
increased glucose absorption from the intestine.
Question 13 Explanation: 
The correct answer is (B). Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is normal, glucose does not spill into the urine. In diabetes, there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells.
Question 14
Six hours after surgery, the blood glucose level of a client who has type 1 diabetes is highly elevated. The nurse should expect to

A
give supplemental doses of regular insulin.
B
start urine glucose monitoring.
C
decrease the rate of the IV fluid.
D
administer oral hypoglycemic agent.
Question 14 Explanation: 
The correct answer is (A). The blood glucose level needs to be reduced; regular insulin begins to act in 30 to 60 minutes. An increase in the client's insulin requirements could indicate sepsis, but this is not expected. Insulin requirements would remain elevated rather than decrease. Fluctuating insulin requirements are usually associated with noncompliance, not surgery.
Question 15
Benita, a retired teacher, is diagnosed with occluded left femoral artery and is scheduled for an arteriogram. Prior to the procedure, the most significant assessment finding would be which of the following?

A
Absent left femoral pulse.
B
Mottled left leg.
C
Thickened toenails on the left foot.
D
Unexplained coolness of the left foot.
Question 15 Explanation: 
The correct answer is (A). This is indicative of inadequate circulatory status of the left lower extremity. Answer (B) may indicate poor circulation but observation of both extremities for comparison would be necessary. Answer (C) is not significant as the pulse. Answer (D) is a less significant indication of arterial occlusive disease.
Question 16
A patient being discharged after a myocardial infarction asks the nurse when he is allowed to resume sexual activity. Which of the following answers by the nurse is CORRECT?

A
“Unfortunately, there may never be a time when you can safely resume sexual activity.”
B
“When you are able to dress yourself without getting out of breath, we can ask the doctor.”
C
“It is safe to resume sexual activity once you are able to walk three blocks without getting out of breath.”
D
“Masturbation is the only sexual expression your heart can handle from now on.”
Question 16 Explanation: 
The correct answer is (C). Once a patient has had a myocardial infarction, he or she must allow some healing time for cardiovascular strength to return. Most physicians recommend waiting until the patient can climb a flight of stairs or walk three blocks without getting out of breath. Once they have achieved this, they are considered generally cleared for sexual activity unless they begin to have symptoms.
Question 17
When using therapeutic communication with pediatric patients, what is the most important factor that the nurse should take into consideration?

A
Nonverbal cues
B
Parental involvement
C
Physiological age
D
Developmental age
Question 17 Explanation: 
The correct answer is (D). The developmental age of the child is key to good communication. Physiological age may not always match the child’s mental development. Nonverbal cues are good clues, but are not the most important. Parental involvement may or may not be a factor.
Question 18
A child arrives at the post-anaesthesia unit after undergoing a tonsillectomy. Which of the following positions is most appropriate for his recovery?

A
Semi-reclined
B
Side-lying
C
Supine
D
High Fowlers
Question 18 Explanation: 
The correct answer is (B). Side-lying position will allow oral secretions to drain out the side of the mouth, rather than be swallowed, which is important to assess for excess bleeding. High Fowler’s, supine, and semi-reclined do not accomplish this goal.
Question 19
A client’s labs return and indicate that her platelet level is 60,000. Which of the following precautions would be most important for this client?

A
Fall precautions
B
Seizure precautions
C
Neutropenic precautions
D
Elopement precautions
Question 19 Explanation: 
The correct answer is (A). With a platelet count of only 60,000, this patient should be watched to ensure she does not fall or it is likely she would bleed heavily if injured. Low platelets reduce the ability to clot. None of the other precautions apply.
Question 20
What is the priority nursing assessment after a subtotal thyroidectomy?

A
Airway
B
Blood pressure
C
Bleeding
D
Pain level
Question 20 Explanation: 
The correct answer is (A). After a surgery so close to the throat/nose, the most important assessment is for presence of a patent airway.
Question 21
What client has the highest risk for an air embolism?

A
A client who is returning from a cardiac catheterization.
B
A client who has a central line with TPN running.
C
A client who has a peripheral IV that is not actively running at the moment.
D
A client who has a history of a myocardial infarction three months ago.
Question 21 Explanation: 
The correct answer is (B). The central line is the most likely place to accidentally intake enough air for an air embolism. A cardiac cath or history of MI might place the patient at risk for a blood clot, but not an air embolism. The peripheral IV is unlikely to place the patient at risk for an air embolism.
Question 22
A client with a cast on his right arm complains to the nurse that he has not been able to straighten the fingers on his right hand “since this morning.” Which of the following actions should the nurse take next?

A
Perform a neurovascular assessment.
B
Call the physician.
C
Inspect the tightness of the cast.
D
Cut the cast off.
Question 22 Explanation: 
The correct answer is (A). Performing a neurovascular assessment is most important to gather more information initially. After the assessment, an action such as calling the physician or cutting the cast off may be necessary.
Question 23
A nurse is performing teaching regarding stroke prevention. Which of the following teaching points is most important to include as a factor in reducing strokes?

A
Active lifestyle
B
Hypertension
C
Alcohol use
D
Drug use
Question 23 Explanation: 
The correct answer is (B). The single most important factor in reducing stroke risk is to reduce hypertension, which puts the patient at risk for hemorrhagic stroke.
Question 24
A patient is taking the medication Plavix. Which of the following symptoms would be a manifestation of a drug-specific complication?

A
Jaundice
B
Itchy skin
C
Upset stomach
D
Black stool
Question 24 Explanation: 
The correct answer is (D). Plavix is an anticoagulant and could cause black stool to occur, indicating bleeding. The other symptoms are not specific to Plavix.
Question 25
Which of the following lab values in a patient with hyperparathyroidism would you expect to remain normal?

A
Parathyroid hormone
B
Calcium
C
Magnesium
D
Phosphorous
Question 25 Explanation: 
The correct answer is (C). The magnesium level should remain normal because it is unrelated to hyperparathyroidism. The other levels are related, however, and may become abnormal.
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NCLEX-RN Exam

The NCLEX-RN exam is administered to candidates using computerized adaptive testing (CAT). With CAT, each test that is given is completely unique. There are a large pool of questions in the computer that are organized by category and difficulty level. After each answer the computer calculates an ability estimate of the test taker, and chooses the next question that will best measure this ability. The computer will continue to present new questions in this manner until a pass or fail decision is made.

You will be required to answer at least 75 questions and at most 265 questions. There is a maximum time limit of 6 hours, which includes the tutorial, the sample questions, and all of your breaks. It is a challenging test, so be sure to do plenty studying. Work through as many practice questions as possible, starting with our free NCLEX-RN practice exam.