Top NCLEX Practice Questions You Should Study

Priority Practice Questions

#1 

What is the most important nursing intervention for the prevention and treatment of pressure ulcers in an older, immobilized client?

1. Use lift sheets to facilitate client movement.

2. Massage pressure areas with lotion.

3. Reposition the client frequently.

4. Use pressure-reducing devices. 

Answer: C 

1. Use of lift sheets, or any other devices, directly on the skin can cause friction and new pressure ulcers to develop or cause further damage to current pressure ulcers.

2. Massage is contraindicated when there is acute inflammation and where there is a possibility of damaged blood vessels or fragile skin. Lotion should not be used as the area should remain dry at all times. 

3. Clients will have individualized needs based on their risk factors, overall condition, and other supportive measures being used. But, repositioning is the most important intervention for the prevention and treatment of pressure ulcers. Repositioning improves and maintains circulation and relieves pressure on injured areas.

4. Pressure-reducing devices may benefit the client with healing, but may also cause skin breakdown depending on individual circumstances.

#2 

A nurse is working in the pediatric emergency department. Which of the following clients should the nurse see first?

1. A 1-day post tubal myringotomy client with tympanic drainage that is purulent

2. A 8-day-old client with a patent ductus arteriosus (PDA) who has a murmur

3. A 6-year-old client with epiglottitis who is drooling and has a severe sore throat 

4. An 11-year-old client whose mom reported seizures when the child had a fever of 104 

Answer: C 

1. A tubal myringotomy is a procedure that allows trapped fluid to drain out. Drainage of this purulent fluid would show that the procedure has been effective. 

2. A murmur is an expected finding in a client with a PDA. 

3. Airway is the priority (think ABCs). This client has epiglottitis which is inflammation in the airway. Signs are indicating a life-threatening airway obstruction. This client should be seen first!

4. This is called a febrile seizure and can occur when a child has a high temperature. Though this is concerning, febrile seizures are associated with a high fever and are not related to intracranial pressure or neurological issues. 

#3 

You are caring for a client who is admitted after a thermal burn injury. The client's vital signs are the following: blood pressure: 72/48. Heart rate: 152 beats/min. Respiratory rate: 26/min. He is pale in color and you are unable to feel his pedal pulses. Which action will the nurse take first?

1.  Begin intravenous fluids

2.  Check the pulses with a doppler device

3.  Insert a foley catheter to monitor urinary output  

4.  Obtain an electrocardiogram (ECG)

Answer: A 

1. This client is in the emergent phase of a burn, so the chances of hypovolemic shock are very high. This is a common cause of death in the emergent phase. Administration of fluids can begin the process of treating hypovolemic shock! 

2. Checking pulses would indicate perfusion to the periphery but this is not an immediate nursing action. Reversing and preventing further hypovolemic shock is a priority.

3. The nurse should insert a foley catheter to monitor urinary output but reversing and preventing further hypovolemic shock is priority!  

4. An ECG will be taken to assess if a cardiac or bleeding problem is causing these vital signs. However, these are not actions that the nurse would take immediately; reversing and preventing further hypovolemic shock is priority.

#4 

Genetic testing for familial adenomatous polyposis is positive for a 23 year old client who has a family history of colon cancer. Which action is most important for the nurse to teach the client?

1. Annual colonoscopy.

2. Modified dietary intake.

3. Encourage adoption to avoid further genetic deficits.

4. Seek further medical testing with a genetic specialist.

Answer: A 

1. Annual colonoscopies evaluate for polyp growth or development. 

2. Dietary changes will not directly affect the development of polyps.

3. Genetic predisposition places individuals at risk for developing the same disease process but is not guaranteed. 

4. Genetic testing is considered exploratory and experimental. The information already discovered is adequate to implement precautionary measures.

Multiple Choice Practice Questions

#1 

A nurse is assigned a client who has tested positive for Clostridium difficile (C. diff) after weeks on oral antibiotics. The nurse knows to:

Use airborne precautions and prohibit visitors.

1. Use a face mask while interacting with the client.

2. Use alcohol to clean all surfaces.

3. Use contact precautions and wash hands frequently.

Answer: D

1. AIRBORNE precautions are used for clients with infections that spread through aerosolized particles– tuberculosis for example! These clients require different PPE, as their disease spreads differently than C. diff.

2. A face mask is not typically needed for clients with C. diff, as the stool itself is infected. If you feel you will have close contact with the infected stool, apply a face shield or mask if needed.

3. Alcohol does NOT kill C. diff. For this reason, a diluted bleach solution or bleach wipes would be used for cleansing surfaces!

4. CONTACT precautions are implemented for clients with C. diff, as this spreads through CONTACT with infected stool or contaminated surfaces. Gowns and gloves are required for the care of these clients.

#2 

Which client finding requires further assessment and could possibly indicate bleeding? (Select all that apply)

1. Coffee ground emesis

2. Hemoptysis

3. Hemoglobin 14 g/dL

4. Dark, tarry stools

5. Pink skin color

Answer: A, B, & D 

1. Indicates there was bleeding previously; dark coloring is old blood from within the intestinal tract.

2. Coughing up dark colored blood indicates a past bleed as the dark coloring is “old” blood. Bright red blood indicates an active bleed.

3. This hemoglobin is within normal parameters.

4. Dark, tarry stools indicate blood from the intestinal tract.

5. Pink skin is a normal finding.

#3 

After a nursing assessment of a patient diagnosed with pneumonia, which finding demonstrates the need for the nursing diagnosis of impaired gas exchange?

1. Crackles to bilateral lower bases.

2. Oxygen saturation of 85%.

3. Temperature of 101.9°F (38.8°C).

4. Presence of yellow colored sputum.

Answer: B

1. Crackles are an expected finding for a client with pneumonia, but does not relate to impaired gas exchange.

2. The client’s decreased oxygen saturation level indicates hypoxemia and impaired gas exchange. A normal oxygen saturation is 95 - 100%. 

3. An elevated temperature is an expected finding for a client with pneumonia, but does not relate to impaired gas exchange.

4. The presence of green or yellow sputum is an expected finding for a client with pneumonia, but does not relate to impaired gas exchange.

Select All That Apply (SATA) Practice Questions

#1 

The nurse on the med-surg floor is performing discharge teaching for a client with peripheral artery disease. Which of the following statements made by the client indicates the need for further education? (Select all that apply)

1. I will use a heating pad to promote circulation

2. I will elevate my legs while watching TV

3. I will perform daily skin care and apply moisturizing lotion

4. I will dangle my legs off the bed while sitting

5. I will join a gym and walk on the treadmill

Answer: A, B

1.  Most clients with PAD have impaired sensation and may burn themselves without feeling it. Heating pads should be avoided. This statement indicates that further education is needed.

2. Remember: elevation is appropriate for vein problems (PVD), not arterial problems (PAD). This statement indicates that further education is needed.

3. Performing skin care prevents skin from becoming dry and damaged. This statement indicates teaching has been effective.

4. For arterial problems, the legs should be placed in a dependent position (legs dangling). This statement indicates teaching has been effective.

5. Moderate exercise promotes circulation and perfusion. This is encouraged and indicates teaching has been effective.

#2 

The nurse is providing dietary instructions to the client with pancreatitis. Which instructions should be given to avoid future attacks? (Select all that apply)

1. Take prescribed enzymes after eating.

2. Avoid nicotine.

3. Monitor stools for steatorrhea.

4. Eat a high fat, high carbohydrate diet.

5. Ingest bland foods.

Answer B, C, & E 

1. Pancreatic enzymes should be taken with meals.

1. Nicotine should be avoided as it stimulates the pancreas.

2. Steatorrhea may indicate worsening of the pancreatic condition.

3. A low fat diet should be ingested.

4. A bland diet should be ingested to decrease stimulation of the pancreas.

#3 

You are caring for a client with gastroesophageal reflux disease (GERD). Which medication is used to decrease gastric acid secretion? (Select all that apply)

1. Omeprazole

2. Misoprostol

3. Ondansetron

4. Famotidine

5. Sucralfate

Answer A, B, & D 

1. Omeprazole decreases gastric acid production.

2. Misopostol decreases gastric acid production.

3. Ondansetron blocks triggers in the CNS reducing nausea.

4. Famotidine decreases gastric acid production.

5. Sucralfate coats the gastrointestinal lining to heal ulcers.

Bow Tie Practice Questions

Question 

Answer 

Pharmacology Practice Questions

#1 

A client recently diagnosed with hypertension is prescribed captopril. The nurse should instruct the client to notify the health care provider immediately if any of the following adverse effects occur when taking this medication:

1. Dizziness

2. Cough

3. Swelling of the tongue

4. Confusion

Answer: C

1. Any medication that treats hypertension and works to lower blood pressure poses a risk for orthostatic hypotension (dizziness). The HCP does not need to be contacted immediately.

2. This is a typical side effect of ACE inhibitors and one they are well known for. The nurse should remind the client that compliance is important. However, the HCP does not need to be contacted immediately.

3. ACE inhibitors may cause angioedema. While rare, it poses a serious risk and can lead to airway obstruction.

4. Confusion is not a side effect of ACE inhibitors.

#2 

The nurse is evaluating a client with bipolar disorder who was prescribed lithium therapy a few months ago. Which statement made by the client would cause the most concern? 

1. “I’ve been napping more than normal this week.”

2. “My mouth has been so dry since being on this medication.”

3. “I’ve gained 4 lbs since being on this medication.”

4. “I’ve had diarrhea for the past couple of days. I think I have the stomach flu.” 

Answer: D 

1. Drowsiness is a common side effect of lithium.

2. Thirst & dry mouth are common side effects of lithium.

3. Weight gain is a common side effect of lithium.

4. Dehydration and sodium loss from vomiting or diarrhea can cause lithium levels to go up in the bloodstream, leading to TOXICITY. This statement should cause the most concern!

#3 

A client has been prescribed rivaroxaban due to a pulmonary embolism (PE). The client reports dark, tarry stools. Which intervention should the nurse implement first? 

1. Transfer the client to the ICU.

2. Assess the client for any other signs of bleeding. 

3. Check the client’s prothrombin time (PT)/international normalized ratio (INR) levels. 

4. Notify the HCP of the dark, tarry stools.

Answer: B

1. The nurse should assess the client before transferring them to the ICU. 

2. The nurse should always assess the client first. The assessment would include taking the client's blood pressure and pulse, assessing for any bruising or hematuria. 

3. Rivaroxaban (Xarelto) is a factor Xa inhibitor and PT/INR would not measure the impact of the medication on the body.

4. The nurse should notify the HCP after the nurse has fully assessed the client’s bleeding. 

#4 

Which instruction should be given to the client regarding the administration of NSAIDs?

1. Take with food.

2. Take with a full glass of milk.

3. Take on an empty stomach.

4. Take one hour after eating.

Answer: A 

1. NSAIDs should be taken with food to decrease GI upset.

2. GI upset from NSAIDs may be reduced by taking them with a full glass of water.

3. Taking NSAIDs on an empty stomach increases the risk of GI upset.

4. NSAIDs should be taken with food, not on an empty stomach, to avoid GI upset.

Maternity Nursing Practice Questions

#1 

A client gives birth within two hours of arriving on your floor. She has a smooth delivery and delivers the placenta five minutes later. As the labor & delivery nurse, you assess the fundus and note that the uterus is midline and boggy. Which action should the nurse take first?

1. Increase IV oxytocin rate.

2. Notify the health care provider.

3. Perform fundal massage.

4. Check for hemorrhage.

Answer: C

1. This is an intervention for uterine atony. However, a fundal massage should be initiated first. If the fundal massage fails to contract the uterus, uterotonics (oxytocin or methergine) may be given to stimulate contractions.

2. There are interventions you as the labor and delivery nurse can perform before contacting the health care provider.

3. Fundal massages stimulate the contraction of the uterine smooth muscle. When the uterus contracts, it causes compression of the arteries, therefore stopping or preventing bleeding.

4. Fundal massages are the primary nursing action because delaying too long can lead to excessive blood loss, which can be life-threatening. Keep in mind, the bleeding may be internal and not visible to the eye.

#2 

A mother with uncontrolled diabetes mellitus just gave birth to a newborn at term gestation. When caring for the newborn, which clinical finding would alarm the nurse?

1. Respiration of 50.

2. APGAR score of 8.

3. Cyanosis of the hands & feet.

4. A baby who appears jittery and tremulous.

Answer: D 

1. Normal newborn respiration is 30 - 60 breaths per minute. This is within normal range and would not alarm the nurse. 

2. An APGAR score of 8 is high. This indicates the newborn is in good condition and would not alarm the nurse.

3. Acrocyanosis (blueness of the extremities at birth) is a normal finding and would not alarm the nurse.

4. A mother with uncontrolled diabetes increases the newborn’s risk for hypoglycemia because the glucose supply is cut off at birth. Common signs of hypoglycemia are jitteriness, hypotonia, lethargy, and irritability. These signs should alarm the nurse of a low glucose level.

#3 

The nurse reviews telephone messages in the pediatric clinic. Which message will the nurse return first?

1. “My 2-day-old child legs extend and return to the previous position when the crib is bumped.”

2. “The circumcision site of my 3-day-old is covered with yellowish oozing.”

3. “My 4-day-old child who is formula fed has had one stool per day for the past 2 days.”

4. “The umbilical cord stump of my 5-day-old is moist at the base and slightly red.”

Answer: D 

1. This is a normal finding in children this age. This is called the Moro reflex (startle reflex). This reflex disappears after 3 to 4 months.

2. Yellow exudate at the site of a circumcision indicates normal healing in a client of this age.

3. Formula-fed infants may pass only one stool per day, while breastfed infants may pass 2 to 5 stools per day.

4. A moist and red umbilical cord stump in a client of this age indicates an infection or other problem with the umbilical stump. The cord should be dry and without redness.

Drag & Drop Cloze 

You will be given 1-5 sentences and you will need to drag the word choices, or "tokens," into their appropriate space within the sentences.

Drag & Drop Rationale 

You will be given one sentence with one cause and 1-2 effects. You will drag one condition and one client finding to complete the statement.

Drop-Down Cloze

You will be given a few sentences in the scenario and there will be one drop-down per sentence.

Drop-Down Rationale 

You will be given one sentence with one cause and 1-2 effect(s).

Drop-Down In Table 

Typically they are 3-4 rows per table. Each drop-down could have 3-5 options, you must choose one option for each row. 

Matrix Multiple Response

Each column can have multiple correct options.

Matrix Multiple Choice

Only one answer per intervention can be correct. (They can’t be both indicated and not indicated.) 

Multiple Response Select-All-That-Apply

This is your standard select-all-that-apply question. Minimum of one correct option, all the way up to all options being correct.

Multiple Response Select N

This is a new type of select-all-that-apply question. The question will tell you the number of items that can be selected. For example, in the question below, you are directed to select 2 findings. 

Multiple Response Grouping Explanations:

Options are presented in a table. There could be 2-5 rows which could each have 2-4 answer options per row. For each “concern” below, click to specify the potential nursing intervention that would be appropriate for the care of this client. Each concern may have more than 1 potential nursing intervention.

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