Practice with NCLEX-Style Sample Questions
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The Best NCLEX-Style Practice Questions
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Free NCLEX-Style Sample Practice Questions
The best way to become more familiar with NCLEX-style questions is by practicing them. You’ve been through nursing school, so you have the knowledge. Now you just need to apply it. Choose your exam below to answer a few exam style questions …
The questions on the NCLEX-RN are designed to test your critical thinking skills and ability to apply knowledge in real-world scenarios. Don’t waste time practicing low-level questions! Challenge yourself with our NCLEX-RN sample questions.
The nurse is caring for a client at 39 weeks gestation who is receiving an IV oxytocin infusion for induction of labor. The nurse notes recurrent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply.
| 1. Administer an IV fluid bolus | ||
| 2. Apply abdominal vibroacoustic stimulation | ||
| 3. Discontinue the IV oxytocin infusion | ||
| 4. Prepare the client for an amnioinfusion | ||
| 5. Reposition the client laterally |
Explanation:
A late deceleration is a gradual decrease in fetal heart rate (FHR) with a uterine contraction that reaches its lowest point (ie, nadir) after the contraction’s peak with a slow return to baseline. Late decelerations occur as a reflexive chemoreceptor response to temporary fetal hypoxemia or fetal metabolic acidemia (in severe cases). Uteroplacental insufficiency, uterine tachysystole, and maternal supine hypotension are common causes because they compromise perfusion and oxygen availability to the fetus.
Intrauterine resuscitation interventions to improve fetal perfusion and oxygenation include:
- Administering an IV fluid bolus to increase maternal blood volume (Option 1)
- Discontinuing the IV oxytocin infusion to reduce uterine stimulation and decrease contraction frequency because relaxation of the uterus increases uteroplacental blood flow and fetal oxygenation (Option 3)
- Repositioning the client laterally to relieve compression of the maternal inferior vena cava, which can be occluded by the weight of the gravid uterus when supine (Option 5)
The mnemonic VEAL CHOP helps recall of causes of FHR changes on monitor tracings.
(Option 2) Vibroacoustic stimulation is used during nonreactive nonstress tests (ie, no accelerations) to provoke fetal movement, which helps determine whether the absence of expected accelerations is physiologic (eg, fetal sleep cycle) or pathophysiologic (ie, fetal acidemia). It is never performed during FHR decelerations or fetal bradycardia.
(Option 4) An amnioinfusion is indicated to relieve persistent, recurrent variable decelerations caused by umbilical cord compression. It is not indicated for late FHR decelerations or uterine tachysystole.
Educational objective:
Late decelerations of fetal
heart rate indicate
compromised fetal oxygenation and perfusion. Intrauterine resuscitation interventions include
administering an IV fluid bolus, discontinuing the IV oxytocin infusion, and repositioning the
client laterally.
The nurse is delegating client care tasks to a licensed practical nurse (LPN) and unlicensed assistive personnel. Which of the following assignments are most appropriate to assign to the LPN? Select all that apply.
| 1. Administer a client’s daily dose of subcutaneous insulin glargine | ||
| 2. Administer a scheduled oral analgesic to a 2 days postoperative client | ||
| 3. Complete an admission nursing interview for a client admitted for elective hysterectomy | ||
| 4. Reinforce teaching on self-administration of insulin to a client with diabetes mellitus | ||
| 5. Tally the shift’s intake and outputs for the entire unit |
Explanation:
| Scope of practice | ||
|---|---|---|
| RN | LPN/LVN | UAP |
|
|
|
|
*Limited assessments (eg, lung sounds, bowel sounds, neurovascular checks). LPN = licensed practical nurse; LVN = licensed vocational nurse; RN = registered nurse; UAP = unlicensed assistive personnel. |
||
Nurses preparing to delegate client care to a licensed practical nurse (LPN) and/or unlicensed assistive personnel (UAP) should consider the 5 rights of delegation. The LPN can monitor and care for stable clients who have been initially evaluated by a registered nurse (RN). Interventions LPNs may perform include:
- Administering oral and parenteral medications, but excluding administering IV medications, which vary by state legislation (Options 1 and 2)
- Reinforcing teaching and skills that have been initially taught by the RN (Option 4)
- Focused assessments (eg, bowel sounds) after the RN’s initial assessment
(Option 3) Performing admission or initial assessments is outside the scope of the LPN and UAP. The RN must perform initial assessments in order to analyze the findings and formulate the client’s plan of care before delegating tasks.
(Option 5)The LPN is capable of performing routine care (eg, calculating daily intake and output, toileting). However, the UAP may also perform these tasks, which frees the LPN to perform more complex duties. Therefore, the most appropriate staff member to assign the task of calculating intake and output to is the UAP.
Educational objective:
Nurses preparing to delegate
client care should consider
the 5 rights of delegation. Appropriate tasks to delegate to a licensed practical nurse include
administration of oral and parenteral medications, excluding IV route, and reinforcement of teaching
previously provided by the registered nurse.
The nurse cares for a client with aortic stenosis who was admitted due to syncope on exertion and dyspnea. Identify the area where the nurse would best auscultate the client’s heart murmur.
Think of a location on the image which you deem right and click on ‘Show Correct Regions’ link to see if your selection is correct.
Explanation:
Aortic stenosis (AS) is a type of valvular heart disease characterized by narrowing of the aortic valve opening, which limits the left ventricle’s ability to eject blood into the aorta. AS may occur from hardening (ie, calcification) of the valves, congenital heart disorders, or inflammation. If left untreated, AS may result in heart failure and pulmonary hypertension as compensatory mechanisms fail.
When assessing a client with AS, the nurse should auscultate in the aortic area (ie, second intercostal space at the right sternal border) for a loud, systolic ejection murmur heard following the first heart sound. The aortic area, rather than directly over the heart valve, is the preferred location for auscultation as the heart sounds travel in the direction the blood flows. Additional clinical manifestations of aortic stenosis include chest pain, shortness of breath, and/or syncope that are worsened by exertion.
Educational objective:
Aortic stenosis is a type of
valvular heart disease
causing narrowing of the valve between the left ventricle and aorta, impairing ejection of blood
from the heart. Nurses attempting to auscultate heart murmurs associated with aortic stenosis should
listen at the right sternal border, second intercostal space (ie, aortic area).
A health care provider prescribes cefuroxime 30 mg/kg/day PO divided in equal doses every 12 hours for a child with a urinary tract infection. The child weighs 34 lb. Based on the available concentration of cefuroxime, how many mL would the nurse administer per dose? Click the exhibit button for additional information. Record your answer using one decimal place.
| Answer: (mL) |
Correct Answer: 4.6 mL
Explanation:
Using dimensional analysis, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:
-
Identify the prescribed, available, and required medication information
Prescribed: 30 mg cefuroxime / kg / day Available: 250 mg cefuroxime / 5 mL Required: mL / dose
-
Convert the prescription to the volume needed for administration using dimensional analysis
Prescription × available data = mL per dose
OR
( mg cefuroxime / kg / day ) ( kg / lb ) ( lb / )( day / dose ) ( mL / mg cefuroxime ) = mL cefuroxime / dose
OR
( 30 mg cefuroxime / kg / day ) ( kg / 2.2 lb ) ( 34 lb / )( day / 2 doses ) ( 5 mL / 250 mg cefuroxime ) = 4.6363 mL cefuroxime / dose
-
Round to the first decimal place
4.6363 mL / dose = 4.6 mL / dose
Educational objective:
To calculate the volume of cefuroxime in milliliters per
dose, the nurse should first identify the prescribed dose (eg, 30 mg/kg/day) and available
medication (eg, 250 mg/5 mL) and then convert to volume in milliliters per dose (eg, 4.6 mL).
Alternative Method:
The formula method is an alternate way to calculate medication dosages. However, this method may increase the occurrence of miscalculation and medication errors. If you choose to use this method, do not round calculations until the final step.
Using the formula method, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:
-
Convert pounds to kilograms
( kg / 2.2 lb ) ( 34 lb / ) = 15.4545 kg
-
Calculate the prescribed dose in milligrams
( 30 mg cefuroxime / kg / day ) ( 15.4545 kg / ) ( day / 2 doses ) = 231.8181 mg cefuroxime / dose
-
Convert the prescription to administration volume
Prescribed dose / available dose x available volume = dose in ML
OR
231.8181 mg cefuroxime / 250 mg cefuroxime x 5 mL = 4.6363 mL cefuroxime / dose
-
Round to the first decimal place
4.6363 mL / dose = 4.6 mL / dose
The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescription should the nurse implement first?
| 1. Administer 0.25 mg hydromorphone IV push for pain | ||
| 2. Draw blood for complete blood count and electrolyte levels. | ||
| 3. Initiate IV access and infuse normal saline 100 mL/hr | ||
| 4. Obtain urine specimen for urinalysis |
Explanation:
Appendicitis is inflammation of the appendix and often results from obstruction by fecal matter. Appendiceal obstruction traps fluid and mucus typically secreted into the colon, causing increased intraluminal pressure and inflammation. As appendiceal intraluminal pressure and inflammation increase, blood circulation to the appendix is impaired, resulting in swelling and ischemia. These factors increase the risk for appendiceal perforation, a medical emergency, which may lead to peritonitis and sepsis.
When prioritizing care of the client with appendicitis, the nurse should utilize the ABCs (ie, airway, breathing, circulation). Fluid resuscitation with IV crystalloids (eg, normal saline, lactated Ringer solution) is an important intervention aimed at preventing circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status (Option 3).
(Option 1) Pain medications may be administered to promote comfort, but should be administered via IV route to maintain NPO status in case of emergency surgery. However, circulation takes priority over pain medication.
(Options 2 and 4) Blood and urine samples often are prescribed to assist with treatment and care decisions. However, the nurse should prioritize circulatory status over obtaining laboratory specimens.
Educational objective:
Nurses caring for clients with
appendicitis should
prioritize client care according to the ABCs (ie, airway, breathing, circulation). Initiating IV
crystalloids (eg, normal saline) is a priority action that prevents circulatory collapse resulting
from fluid losses (eg, vomiting, diarrhea) and NPO status.
NCLEX-style practice questions can help you identify areas where you may need additional study or review. Every question in our NCLEX-PN QBank includes detailed rationales for the correct and incorrect answers, so you learn as you practice.
The nurse auscultates the heart sounds of a 77-year-old client with chronic heart failure. Which heart sound should the nurse document? Listen to the audio clip. (Headphones are required for best audio quality.)
| 1. Pericardial friction rub | ||
| 2. S1, S2, no adventitious sounds | ||
| 3. S3 extra heart sound | ||
| 4. Systolic murmur |
Explanation:
S1 and S2 are the normal “lub-dub” heart sounds that result from closure of valves. Systole occurs between S1 and S2, with S1 indicating closure of the atrioventricular (tricuspid, mitral) valves and S2 indicating closure of the pulmonic and aortic valves.
S3 is an adventitious (extra) heart sound heard as “DUB” immediately following S2 (Option 3). S3 occurs during early diastole as a result of rapid ventricular filling and is a normal finding in children and young adults. In older adults, S3 is an abnormal finding that often indicates heart failure because the sound results from decreased ventricular compliance.
S3 can be difficult to distinguish from S4. S4 is a “LUB” sound that occurs immediately before S1, during late diastole, and indicates ventricular hypertrophy.
(Option 1) A pericardial friction rub is a creaky, grating sound heard throughout systole and diastole. Friction rub occurs with pericarditis and is due to friction between inflamed layers of pericardium.
(Option 2) S1 and S2 are the normal heart sounds heard during cardiac auscultation.
(Option 4) A murmur is a swooshing, blowing, or rumbling sound caused by turbulent blood flow (eg, from valve regurgitation or stenosis).
Educational objective:
S3, the third heart sound, is a “DUB” sound that
immediately follows S2. It is a normal finding in children and young adults. S3, an abnormal finding
in older adults, often indicates heart failure.
A client with a hip fracture is placed in Buck traction. Which activities are appropriate for the nurse to include in the client’s plan of care? Select all that apply.
| 1. Assess for skin breakdown of the limb in traction | ||
| 2. Ensure adequate pain relief | ||
| 3. Keep the limb in a neutral position | ||
| 4. Perform frequent neurovascular checks on the limb in traction | ||
| 5. Reposition the client and use a wedge pillow for the entire unit |
Explanation:
Buck traction is a type of skin traction used to immobilize hip fractures and reduce pain and spasm until the client can undergo surgical repair of the fracture. A traction boot is applied to the leg, below the fracture site. A weight gently and continuously pulls on the leg and hip, helping maintain alignment of the limb. The nurse should ensure that the traction boot is fitted properly and that the limb remains straight in a neutral position (Option 3).
Skin traction exerts pressure on nerves, blood vessels, and soft tissue. The nurse should frequently assess neurovascular status (eg, pulse, capillary refill, color, temperature, sensation, movement) and skin integrity in the limb to which the boot is applied (Options 1 and 4). Overall pain level and efficacy of administered pain medications should be monitored closely, as increasing pain in the limb in traction may indicate neurovascular compromise (Option 2).
(Option 5) Side-to-side repositioning of the client in Buck traction can cause injury. Side-to-side position changes cause the affected leg to be adducted or abducted, which, when paired with the force of traction, can increase spasm and pain and contribute to neurovascular and orthopedic compromise.
Educational objective:
Buck traction is used to immobilize hip fractures and
reduce pain and spasm until the fracture can be repaired surgically. The nurse caring for a client
in Buck traction should frequently assess the neurovascular status and skin integrity of the
affected limb and maintain it in a straight, neutral position.
The nurse is assigned to care for four clients. Which client should the nurse see first?.
| 1. Female client who had an arthroscopic rotator cuff repair with sling immobilization and reports moderate swelling and tingling of the hand and fingers | ||
| 2. Female client who had an open reduction and internal fixation of the tibia and reports severe pain and pressure under the cast and inability to move the toes | ||
| 3. Male client who has two new prosthetic legs applied after traumatic, bilateral, below-the-knee amputation and reports crushing pain in the amputated areas | ||
| 4. Male client who has a hematocrit of 37% and hemoglobin of 12.5 g/dL and is prescribed enoxaparin 1 day after a total hip arthroplasty |
Explanation:
| Clinical manifestations of compartment syndrome (7 Ps) | |
|---|---|
|
Paresthesia (early sign) |
Tingling, numbness, burning |
| Pain |
Out of proportion to injury, unrelieved by medication |
| Pressure |
Taut skin, cast fits too tightly |
| Pallor |
Pale skin tone, decreased color, white, gray |
|
Pulselessness (uncommon) |
Possibly weakened or lost |
| Poikilothermy |
Cool skin temperature, matches room temperature |
|
Paralysis (late sign) |
Weakness, loss of motor activity |
Compartment syndrome occurs when swelling in a tissue compartment causes compression of arteries and nerves, typically after a direct injury (eg, fracture, dislocation) or medical device placement (eg, cast, splint). Tissue perfusion and nerve function distal to the swelling become impaired, causing signs of neurovascular compromise (eg, severe, unrelenting pain; paralysis) due to tissue ischemia. Without relieving compartment pressure (ie, cast removal, fasciotomy), ischemia leads to permanent nerve and tissue damage and/or loss of limb (Option 2).
(Option 1) Edema and numbness or tingling (paresthesia) of the hands and fingers commonly occur from inappropriate sling application. Numbness and tingling also are early signs of compartment syndrome. However, the client with late signs of compartment syndrome (eg, paralysis) should be seen first.
(Option 3)Clients with amputations may experience phantom limb pain that is severe and described as burning or crushing and requires pain management. However, limb-threatening emergencies should be managed first.
(Option 4)Slightly decreased hematocrit and hemoglobin levels (normal male: 39%-50%, 13.2-17.3 g/dL, respectively) are expected after hip arthroplasty due to intra- and postoperative blood loss.
Educational objective:
Compartment syndrome is a condition of impaired
circulation due to increased tissue pressure, often from edema or medical devices. Clients with
signs of compartment syndrome (eg, severe, unrelenting pain; paralysis) require immediate assessment
and intervention to prevent permanent tissue damage or loss of limb.
The nurse is reinforcing teaching about constipation prevention to a client. Which of the following client statements indicate appropriate understanding of the teaching? Select all that apply.
| 1. “Drinking more caffeinated drinks such as tea and soda helps to stimulate the bowel.” | ||
| 2. “Having a routine for bowel movements is important, but I should not wait if I feel the urge.” | ||
| 3. “I can use an over-the-counter laxative every other day if needed.” | ||
| 4. “I should try to eat more fruits and vegetables every day.” on the limb in traction | ||
| 5. “Increasing my daily exercise level may help keep my bowel movements regular.” pillow for the entire unit |
Explanation:
Constipation is a symptom of many disease processes (eg, Parkinson disease, diabetic neuropathy, depression), procedures (eg, abdominal surgery, bowel manipulation), and medications (eg, anticholinergics, diuretics, opioids). Immobility, low-fiber diets, decreased fluid intake, and irregular bowel habits increase the likelihood of constipation. Educate clients to prevent constipation by:
- Encouraging a healthy bowel regimen (eg, avoid delaying defecation if the urge is felt, defecate at the same time daily when possible, track bowel movements to identify changes in patterns) (Option 2)
- Increasing consumption of fruits and vegetables to reach a daily fiber intake of at least 20 g (unless contraindicated) because fiber softens and increases the bulk of stool, which promotes defecation (Option 4)
- Increasing daily exercise because activity stimulates peristalsis and promotes defecation (Option 5)
- Drinking 2-3 L of noncaffeinated fluids daily (unless contraindicated), which prevents drying and hardening of stool in the colon
(Option 1) Clients should avoid caffeinated beverages, which promote diuresis and dehydration and may lead to constipation.
(Option 3) Clients should avoid using laxatives and enemas unless prescribed by a health care provider because overuse can result in physical and psychological dependency.
Educational objective:
Constipation is a symptom of many disease processes, procedures, and medications. To prevent
constipation, educate the client to increase daily fiber intake, drink 2-3 L of fluids daily,
increase daily activity levels, and initiate a bowel regimen (eg, avoiding delay of defecation,
defecating at the same time each day).
The nurse is assigning client care tasks to unlicensed assistive personnel. Which statement by the nurse is appropriate?
| 1. “I need you to take vital signs on all clients in rooms 1 through 10 this morning.” | ||
| 2. “Mrs. Jones fell out of bed during the night while walking to the commode. Please monitor her closely.” | ||
| 3. “Please ensure that Mr. Garcia in room 8 ambulates several times.” | ||
| 4. “Please take Mr. Wu’s vital signs in 10 minutes and let me know if his systolic blood pressure is < 100." |
Explanation:
| Five rights of delegation | |
|---|---|
| Right task |
|
| Right circumstances |
|
| Right person |
|
|
Right direction/ communication |
|
|
Right supervision/ evaluation |
|
When assigning client care, the nurse must consider the five rights of delegation. Right direction/communication involves clear and precise instructions about assigned tasks, including any specific information necessary for completion. Necessary information includes the specific tasks (eg, take vital signs), the time frame (eg, in 10 minutes), and when to report back to the nurse (eg, if systolic blood pressure is < 100) (Option 4).
(Option 1)
Assigning unlicensed assistive personnel (UAP) to measure
vital signs “this morning” does not provide a clear time frame (eg, in 1 hour) for
completion. In addition, there is no communication about what the nurse expects in terms of
follow-up.
(Option 2)
Instructing the UAP to monitor the client closely is an
unclear direction because it does not provide specific actions to perform (eg, “Set the bed
alarm.”), time intervals for performance (eg, “Check on the patient every hour.”), or
criteria to report to the nurse (eg, “Notify me if the client attempts to exit the bed
unassisted.”).
(Option 3)
Instructing the UAP to assist with ambulation “several times”
does not give a specific time frame or distance for the client to ambulate. The nurse should
also communicate the conditions or aids needed to accomplish the task (eg, walks with
assistance or rolling walker).
Educational objective:
Nurses assigning client care to unlicensed
assistive personnel must consider the five rights of delegation. Right
direction/communication involves providing clear instructions about the assigned tasks,
specific information needed for task completion, the time frame, and when to report back to
the nurse.
NGN Question Types & Scoring
The Next Generation NCLEX was launched on April 1, 2023 and the updated exam now contains new item types designed to better measure candidates’ clinical judgment. NCSBN also introduced a new partial credit NGN scoring model. Depending on the item type used, the 0/1 scoring rule, +/- scoring rule, or rationales scoring rule may be applied.
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Practice NCLEX-Style Questions Anytime, Anywhere
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NGN Sample Questions
The future of nursing education is here. We’ve included examples below of the new NGN question types to prepare you for what’s to come.
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