NCLEX® Practice Questions

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Master the NCLEX with practice questions written by clinical nurses and experienced educators who know exactly what it takes to pass. With visual, in-depth explanations for every answer choice, you’ll understand the “why” and build the clinical judgment to pass the first time.

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Sample the Best NCLEX Practice Questions

“I swear I saw a UWorld question on the NCLEX!” We hear it constantly, and that’s by design. You won’t see our exact questions on the exam, but with 40+ nurse authors crafting high-fidelity scenarios to strict NCSBN standards, you’ll feel like you did.

Question

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. Reposition the client laterally.
	3. Discontinue the IV oxytocin infusion.
	4. Prepare the client for an amnioinfusion.
	5. Apply abdominal vibroacoustic stimulation.

Explanation

A late deceleration is a decrease in fetal heart rate (FHR) that occurs after the onset of a contraction and continues beyond its end. The lowest point (ie, nadir) occurs near the end of the contraction before the FHR gradually returns to baseline.

Late decelerations occur as a response to temporary fetal hypoxemia. Uteroplacental insufficiency, uterine tachysystole, and maternal supine hypotension are common causes because they compromise perfusion and oxygen availability to the fetus.

Intrauterine resuscitation interventions include:

Administering an IV fluid bolus to increase maternal blood volume (Option 1)
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 2)
Discontinuing the IV oxytocin infusion to reduce uterine stimulation and decrease contraction frequency; relaxation of the uterus increases uteroplacental blood flow and fetal oxygenation (Option 3)

(Option 4) An amnioinfusion (ie, instillation of fluid into the uterine cavity) is indicated to relieve persistent, recurrent variable decelerations caused by umbilical cord compression.

(Option 5) Vibroacoustic stimulation is used during nonreactive nonstress testing (ie, no accelerations) to provoke fetal movement. It is never performed during FHR decelerations or fetal bradycardia.

Educational objective:
Late decelerations of fetal heart rate indicate compromised fetal oxygenation. Intrauterine resuscitation interventions include administering an IV fluid bolus, discontinuing the IV oxytocin infusion, and repositioning the client laterally.

Question

The nurse is assigning client care activities to a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which of the following activities would be appropriate to assign to the LPN? Select all that apply.

	1. Administer the daily dose of subcutaneous insulin glargine to a client.
	2. Administer a scheduled oral analgesic to a client who had surgery 2 days ago.
	3. Reinforce teaching about self-administration of insulin for a client with diabetes mellitus.
	4. Complete an admission assessment for a client admitted for an elective hysterectomy.
	5. Record client intake and output totals during the shift for all clients on the unit.

Explanation

Scope of practice
RN	LPN/LVN	UAP
Clinical assessment Initial client education Discharge education Clinical judgment Initiating blood transfusion	Monitoring RN findings Reinforcing education Routine procedures Most medication administrations Ostomy care Tube patency & enteral feeding Specific assessments*	Activities of daily living Hygiene Linen change Routine, stable vital signs Documenting input/output Positioning
Limited assessments (eg, lung sounds, bowel sounds, neurovascular checks). LPN* = licensed practical nurse; LVN = licensed vocational nurse; RN = registered nurse; UAP = unlicensed assistive personnel.

Scope of practice

LPN/LVN

UAP

Clinical assessment
Initial client education
Discharge education
Clinical judgment
Initiating blood transfusion

Monitoring RN findings
Reinforcing education
Routine procedures
Most medication administrations
Ostomy care
Tube patency & enteral feeding
Specific assessments*

Activities of daily living
Hygiene
Linen change
Routine, stable vital signs
Documenting input/output
Positioning

*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 that LPNs may perform include:

Administering most medications (eg, subcutaneous insulin, oral analgesics) (Options 1 and 2)
Reinforcing teaching and skills that have been initially taught by the RN (Option 3)
Performing focused assessments (eg, bowel sounds) after the RN's initial assessment

(Option 4) Performing admission or initial assessments is outside the scope of the LPN and UAP. The RN must perform initial assessments 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 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 the administration of oral and parenteral medications (excluding those via the IV route) and reinforcement of teaching previously provided by the registered nurse.

Question

The nurse is caring for a client with panic disorder who is reporting palpitations and intense feelings of fear. The client is shaking and hyperventilating. Which of the following actions would be a priority for the nurse to take?

	1. Assess the client for auditory and visual hallucinations.
	2. Administer a benzodiazepine to the client.
	3. Explore possible triggers for the episode with the client.
	4. Remain in the room with the client.

Explanation

Panic disorder involves recurrent, brief (eg, 10- to 30-min) episodes (ie, panic attacks) during which a client experiences sudden, intense fear; anxiety; and physiological discomfort. These attacks often occur unpredictably, without an obvious trigger. Panic disorder may result from an imbalance of neurotransmitters (eg, excess norepinephrine, inadequate serotonin) or an overactivation of the amygdala.

Symptoms of a panic attack resemble many cardiac and respiratory conditions and include a fear of dying, trembling, hyperventilating, palpitations, and shortness of breath. During a panic attack, the nurse should stay with the client to promote safety and offer support (Option 4). In addition, the nurse should remain calm; use simple, clear phrases when providing instruction; and encourage the client to take slow, deep breaths if hyperventilation occurs.

(Option 1) Assessing the client for auditory and visual hallucinations may provide the nurse with information about the severity of the panic attack, but it does not ensure the client's safety.

(Option 2) Benzodiazepines (eg, alprazolam, lorazepam) may help to calm the client, but medication should be considered only if nonpharmacological methods (eg, reducing stimuli) are unsuccessful.

(Option 3) Discussing triggers for the panic attack is not appropriate while the client is symptomatic. Once the client has calmed down, the nurse can discuss possible triggers, evaluate stressors in the client's life, and assist in identifying prevention strategies.

Educational objective:
Panic disorder involves recurrent, brief episodes during which a client experiences sudden, intense anxiety. During a panic attack, the nurse should prioritize staying with the client to promote safety and offer support.

Question

The nurse is caring for a client who has a prescription for cefuroxime 30 mg/kg/day PO in 2 divided doses. The client weighs 35 lb (15.9 kg). The nurse has cefuroxime 250 mg/5 mL available. How many mL should the nurse administer to the client with each dose? Record your answer using 1 decimal place.

mL/dose

Explanation

Correct Answer: 4.8 mL/dose

Using dimensional analysis, perform the following steps to calculate the volume of cefuroxime in milliliters per dose:

Identify the prescribed, available, and required medication information

$Prescribed: \frac{30 mg cefuroxime}{kg | day} Available: \frac{250 mg cefuroxime}{5 mL} Required: \frac{mL}{dose}$
Convert the prescription to the volume needed for administration

$Prescription \times available data = \frac{mL}{dose}$

OR

$(\frac{mg cefuroxime}{kg | day}) (\frac{kg}{}) (\frac{day}{dose}) (\frac{mL}{mg cefuroxime}) = \frac{mL cefuroxime}{dose}$

OR

$(\frac{30 mg cefuroxime}{kg | day}) (\frac{15.9 kg}{}) (\frac{day}{2 doses}) (\frac{5 mL}{250 mg cefuroxime}) = \frac{4.77 mL cefuroxime}{dose}$
Round to 1 decimal place

$\frac{4.77 mL}{dose} \approx \frac{4.8 mL}{dose}$

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 the volume in milliliters per dose (eg, 4.8 mL).

Alternate 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, perform the following steps to calculate the volume of cefuroxime in milliliters per dose:

Calculate the prescribed dose in milligrams

$(\frac{30 mg cefuroxime}{kg | day}) (\frac{15.9 kg}{}) (\frac{day}{2 doses}) = \frac{238.5 mg cefuroxime}{dose}$
Convert the prescription to the volume needed for administration

$\frac{Prescribed dose}{available dose} \times available volume = \frac{mL}{dose}$

OR

$\frac{238.5 mg cefuroxime}{250 mg cefuroxime} \times 5 mL = \frac{4.77 mL cefuroxime}{dose}$
Round to 1 decimal place

$\frac{4.77 mL}{dose} \approx \frac{4.8 mL}{dose}$

Question

The nurse is caring for a client with suspected appendicitis who has vomiting and right lower quadrant pain. It would be a priority for the nurse to

	1. administer oral pain medication
	2. obtain a urine specimen for urinalysis
	3. initiate an IV infusion of 0.9% sodium chloride
	4. obtain a blood specimen for complete blood count and serum electrolyte levels

Explanation

Appendicitis (ie, inflammation of the appendix) often results from obstruction by fecal matter. The obstruction traps fluid and mucus typically secreted into the colon, causing increased intraluminal pressure and inflammation. This impairs blood circulation to the appendix, resulting in swelling and ischemia. These factors increase the risk for perforation, a medical emergency that can 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, 0.9% sodium chloride, 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. In addition, circulation takes priority over pain medication.

(Options 2 and 4) Blood and urine testing often is 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 fluid resuscitation with IV crystalloids (eg, 0.9% sodium chloride) is a priority action that prevents circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status.

Question

The nurse is caring for a client who has a Clostridioides difficile infection. Which of the following infection control precautions should the nurse implement? Select all that apply.

	1. Apply sterile gloves before providing client care.
	2. Request that the client be placed in a private room.
	3. Use an alcohol-based hand sanitizer for hand hygiene.
	4. Wear a single-use, protective gown when providing client care.
	5. Ensure surgical masks are worn by staff members who enter the client's room.

Explanation

Contact precautions
Organisms	MDR organisms (eg, MRSA, VRE) Enteric organisms (eg, Clostridioides difficile) Scabies
Infection-control measures	Hand hygiene (soap & water for C difficile) Nonsterile gloves Gown Private room preferred
MDR = multidrug-resistant; MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant Enterococcus.

Clostridioides difficile is a gram-positive, anaerobic bacterium that causes widespread inflammation of the colon with profuse, watery diarrhea; abdominal pain; fever; and nausea. Antibiotic use can disrupt intestinal flora and increase the risk for C difficile infection. The bacterium is transmitted to susceptible individuals primarily via the fecal-oral route and requires contact precautions to prevent transmission.

The nurse caring for the client with C difficile should wear a single-use, protective gown, use dedicated client care equipment (eg, stethoscope, blood pressure cuff), and request that the client be placed in a private room (Options 2 and 4).

(Option 1) Sterile gloves are not necessary when caring for a client with C difficile. Instead, clean gloves should be used to reduce the transmission of infection to other individuals.

(Option 3) Soap and water should be used to cleanse the hands because C difficile spores have shown resistance to alcohol-based sanitizers.

(Option 5) Surgical masks (ie, face masks) must be worn as personal protective equipment if an organism is spread via droplets. However, masks are not required for preventing the spread of a contact-transmissible infection such as C difficile.

Educational objective:
Clostridioides difficile is transmitted via the fecal-oral route and requires contact precautions to prevent transmission. The nurse should wear a single-use, protective gown, use dedicated client care equipment, and place the client in a private room.

Question

The nurse is preparing to suction a client who has a tracheostomy tube. Which of the following actions should the nurse take? Select all that apply.

	1. Administer 100% oxygen prior to suctioning the client.
	2. Limit suctioning to 20 seconds during each suction pass.
	3. Use sterile gloves and technique throughout the procedure.
	4. Instill sterile normal saline into the tracheostomy tube prior to suctioning.
	5. Apply suction while withdrawing the catheter from the tracheostomy tube.

Explanation

Tracheostomy suctioning is performed to remove pulmonary secretions and maintain airway patency in clients who are unable to clear secretions independently. Tracheostomy suctioning is important for promoting gas exchange and preventing alveolar collapse, but inappropriate technique increases the client's risk for complications (eg, pneumonia, hypoxemia) or tracheal injury.

To reduce the risk of complications and injury during suctioning, the nurse should:

Preoxygenate with 100% oxygen and allow for reoxygenation periods between suction passes (Option 1)
Use strict sterile technique throughout suctioning (Option 3)
Suction only while withdrawing the catheter from the tracheostomy tube (Option 5)
Limit suctioning to 10-15 seconds on each suction pass

(Option 2) Suctioning longer than 10-15 seconds increases the risk for collapse of airway structures (eg, alveoli, bronchioles) and hypoxemia (ie, oxygen saturation <90%).

(Option 4) Instilling sterile normal saline solution or sterile water (ie, lavaging) in the client's tracheostomy tube, a practice no longer supported by evidence, greatly increases the risk for infection by potentially transporting bacteria from the upper airway into the lower airways.

Educational objective:
Tracheostomy suctioning is performed to clear secretions and maintain airway patency. When performing suctioning, the nurse preoxygenates with 100% oxygen, uses sterile technique, applies suction only while withdrawing the catheter, and limits each suction pass to 10-15 seconds.

Question

The nurse is observing continuous cardiac monitoring for assigned clients. Which of the following cardiac rhythms would require immediate follow-up?

	1.
	2.
	3.
	4.

Explanation

Ventricular fibrillation (VF) is a lethal dysrhythmia characterized by disorganized electrical activity in the heart ventricles. Because of this erratic electrical activity, the heart muscles lose the ability to contract, resulting in loss of blood flow and pulse (ie, cardiac arrest). Nurses who identify a client with VF should immediately check the pulse, start CPR, and prepare the client for defibrillation (Option 3).

(Option 1) Atrial fibrillation is a cardiac dysrhythmia characterized by disorganized electrical activity in the atria and an irregular pulse rate. Clients experience this condition chronically or in response to other medical conditions (eg, electrolyte imbalance). However, a client with VF has no pulse and is the priority for care.

(Option 2) Premature ventricular contractions are abnormal electrical impulses in the ventricles that occur spontaneously or in response to heart irritants (eg, stimulant medications, electrolyte alterations, pain). This dysrhythmia is typically not harmful but requires monitoring by the nurse.

(Option 4) Ventricular tachycardia , a potentially lethal dysrhythmia characterized by organized, rapid firing of electrical activity within the ventricles, may impair perfusion and often leads to cardiac arrest and/or VF. However, clients may have a pulse with ventricular tachycardia, making the client with VF the priority.

Educational objective:
Clients with ventricular fibrillation, a lethal cardiac dysrhythmia, require immediate treatment with CPR and defibrillation. A pulse may be present in ventricular tachycardia, so this dysrhythmia should be addressed as soon as possible. Atrial fibrillation and premature ventricular contractions are pulsatile dysrhythmias.

Question

The nurse is talking with a client with macular degeneration. Which of the following statements by the client would be consistent with the condition?

	1. "I have been seeing small flashes of light in one eye."
	2. "I noticed that my peripheral vision is becoming worse."
	3. "I see a blurry spot in the middle of the page when I read."
	4. "I cannot see the newspaper unless I hold it away from me."

Explanation

Age-related macular degeneration (AMD) is a progressive, incurable disease of the eye characterized by deterioration of the macula, the central portion of the retina. AMD has two etiologies (ie, "dry" and "wet"), both of which involve changes to the vasculature of the eye but do not cause increased intraocular pressure. Deterioration from AMD causes visual disturbances (ie, blurred or wavy vision) or loss of the central field of vision, whereas peripheral vision remains intact (Option 3).

(Option 1) Retinal detachment is separation of the retina from the underlying epithelium, which allows fluid to collect in the newly formed space. Clinical manifestations include sudden flashes of light , floaters, and loss of vision.

(Option 2) Glaucoma is a gradual loss of peripheral vision (ie, tunnel vision ) accompanied by an increase in intraocular pressure. Glaucoma should be treated promptly because it can lead to blindness if left untreated.

(Option 4) Age-related loss of near vision (ie, farsightedness) is a sign of presbyopia. This occurs when the lens of the eye becomes less elastic with age and unable to adjust between near and far vision.

Educational objective:
Age-related macular degeneration is a progressive, incurable disease of the eye characterized by deterioration of the macula, the central portion of the retina. Manifestations include visual disturbances and loss of the central field of vision.

Question

The nurse is assessing a client with Bell palsy. Which of the following findings would the nurse expect to observe? Select all that apply.

	1. inability to smile symmetrically
	2. frequent blinking of the affected eye
	3. shock-like pain in the lips and gums
	4. loss of forehead and brow movements
	5. decreased lacrimation on the affected side

Explanation

Bell palsy is peripheral, unilateral facial paralysis characterized by inflammation of the facial nerve (cranial nerve VII) in the absence of a stroke or another causative agent/disease. Paralysis of the motor fibers innervating the facial muscles results in flaccidity on the affected side.

Manifestations of Bell palsy include:

Inability to smile symmetrically (Option 1)
Loss of forehead and brow movements (Option 4)
Decreased lacrimation (ie, tear production) (Option 5)
Inability to close the affected eye completely
Loss of nasolabial folds and drooping of the lower lip

(Options 2 and 3) Frequent blinking of the eye and shock-like pain in the lips and gums are symptoms of trigeminal neuralgia (cranial nerve V). With Bell palsy, the trigeminal nerve may become hypersensitive and cause facial pain, but this is uncommon and typically more indicative of trigeminal neuralgia.

Educational objective:
Bell palsy is unilateral facial paralysis due to inflammation of the facial nerve. Clinical manifestations include the inability to close the affected eye completely, decreased lacrimation, facial droop, loss of forehead and brow movements, and asymmetrical smile or frown.

Question

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

UWorld nclex sample questions - cardiac cycle and heart sounds

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.

Question

The nurse is caring for a client who has a hip fracture and is placed in Buck traction. Which of the following actions should the nurse take? Select all that apply.

	1. Place the client on the affected side.
	2. Monitor the client for skin breakdown.
	3. Perform frequent neurovascular checks.
	4. Keep the affected extremity in a neutral position.
	5. Ensure that the client receives adequate pain relief.

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 extremity. The nurse should ensure that the traction boot is fitted properly and that the extremity remains straight in a neutral position (Option 4).

Skin traction exerts pressure on the nerves, blood vessels, and soft tissue. The nurse should frequently assess the skin integrity and neurovascular status (eg, pulse, capillary refill, color, temperature, sensation, movement) of the affected extremity (Options 2 and 3). Overall pain level and efficacy of administered pain medications should be monitored closely, as increasing pain may indicate neurovascular compromise (Option 5).

(Option 1) Placing a client in Buck traction on the affected side can cause more injury. Side-to-side position changes cause the affected extremity 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. Nursing interventions include frequent assessment of skin integrity and neurovascular status; maintaining the affected extremity in a straight, neutral position; and ensuring adequate pain relief.

Question

Exhibit

The nurse is assigned to care for four clients. Which of the following clients should the nurse see first? Click the exhibit button for additional client information.

	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% (0.37) and hemoglobin of 12.5 g/dL (125 g/L) 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 are also 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 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.

Question

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."
	5. "Increasing my daily exercise level may help keep my bowel movements regular."

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).

Question

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	Within delegatee's scope of practice Routine, frequently recurring task; minimal potential risk Established sequence of steps; requires little to no modification for individual clients Predictable outcome
Right circumstances	Relatively stable client; noncomplex task Adequate staffing, resources & supervision available
Right person	Delegator should assess competency prior to delegating Delegatee must have the appropriate knowledge, skills & abilities
Right direction/ communication	Delegator needs to provide clear instructions; must include specific client concerns & observations to be reported back or recorded Delegatee should verbalize understanding & have the opportunity to ask questions
Right supervision/ evaluation	Monitor, evaluate & intervene as needed Delegator retains ultimate accountability for task

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.

Question

The nurse is caring for a client with deep venous thrombosis of the lower extremity. Which of the following findings would the nurse expect to observe? Select all that apply.

	1. dry, shiny, hairless skin on the affected extremity
	2. warmth and redness of the affected extremity
	3. reports of pain in the affected calf
	4. edema of the affected extremity
	5. cyanosis of the affected toes

Explanation

Deep venous thrombosis (DVT) occurs when a blood clot (ie, thrombus) becomes lodged in a vein and blocks circulation, most often in the deep veins of the lower extremities. Risk for DVT increases with age (>65), immobility, obesity, and oral contraceptive use. Early recognition of DVT is essential because thrombus can quickly dislodge from the vessel and cause life-threatening complications (eg, pulmonary embolism ).

Although clients may not experience symptoms, typical signs and symptoms of DVT include edema, localized pain (eg, calf pain) or tenderness, warmth, and erythema of the affected extremity (Options 2, 3, and 4).

(Option 1) Dry, shiny, hairless skin that feels cool to touch can occur in chronic peripheral arterial disease . These manifestations occur from long-term impairment of blood flow to the extremity.

(Option 5) Cyanotic digits (eg, fingers, toes) with loss of sensation can occur in Raynaud phenomenon as a result of temporary vasospasm. When perfusion returns, the skin becomes red, throbbing, and often painful.

Educational objective:
Deep venous thrombosis occurs when a blood clot becomes lodged in a vein. Clinical manifestations include unilateral edema, localized pain, tenderness to touch, warmth, and erythema.

Question

The nurse is talking with a client recently diagnosed with HIV infection about home and lifestyle alterations. Which of the following statements by the client would require follow-up? Select all that apply.

	1. "I should avoid eating raw or undercooked meats and eggs to prevent infections."
	2. "I need to make sure my family members understand not to borrow my shaving razors."
	3. "I do not need to use barrier methods of protection if my sexual partner is also HIV positive."
	4. "I have started to use lambskin condoms during sexual intercourse because I have a latex allergy."
	5. "I will use a needle exchange program and avoid sharing equipment I use for injecting recreational substances."

Explanation

Client teaching for HIV infection prevention
All clients	Avoid exchanging semen or vaginal fluid Use nonporous condoms (eg, latex) Do not reuse condoms Avoid sharing blood-contaminated items (eg, razors, toothbrushes, sex toys) Consider PrEP if regularly engaging in high-risk behaviors Use needle exchange programs as appropriate
Clients who are HIV positive	Take ART as prescribed to achieve viral suppression Notify all individuals who may have been exposed Avoid having unprotected sex (even if partner is also HIV positive) Do not donate blood, plasma, body organs, or sperm
ART = antiretroviral therapy; PrEP = preexposure prophylaxis.

Unprotected sexual intercourse increases the risk of transmitting HIV and other sexually transmitted infections (STIs). Protection is important even when both sexual partners are HIV positive: HIV has multiple strains, and coinfection results in HIV superinfection, which may hasten disease progression (Option 3).

Clients with HIV infection should use latex or synthetic condoms and/or dental dams during sexual activity involving nonintact skin and mucous membrane exposure (ie, oral, vaginal, anal) to seminal or vaginal secretions. Natural barrier methods (eg, lambskin) do not prevent transmission of STIs due to the presence of small pores (Option 4).

(Option 1) Clients should avoid contact with cat feces and avoid consuming raw/undercooked foods (eg, raw fish, meats, unpasteurized dairy products, eggs) to reduce the risk for infection with Toxoplasma gondii, an opportunistic protozoan that causes toxoplasmic encephalitis.

(Option 2) Sharing personal hygiene devices that may have been exposed to blood (eg, toothbrushes, razors) increases HIV transmission risk and should be avoided.

(Option 5) Cessation of recreational substance use may not be a realistic short-term goal. Needle exchange programs (NEPs) are community-based initiatives that provide resources (eg, sterile needles, syringe disposal) to clients. NEPs have been found to reduce the incidence of blood-borne infection in IV substance users.

Educational objective:
Clients with HIV infection should use latex or synthetic barrier methods of protection during all sexual encounters in which nonintact skin or mucous membranes are exposed to seminal or vaginal secretions. Unprotected sexual intercourse increases the risk of transmitting HIV and other sexually transmitted infections.

Question

The nurse is caring for a client who has acute pericarditis. Which of the following findings would be a priority to follow up?

	1. chest pain that is worse with deep inspiration
	2. muffled heart tones and jugular venous distension
	3. pericardial friction rub auscultated at the left sternal border
	4. temperature of 100.7 F (38.2 C) and a nonproductive cough

Explanation

Pericarditis is inflammation of the pericardium, the double-walled sac that surrounds the heart. Pericardial inflammation can progress to pericardial effusion (ie, fluid buildup between the pericardial layers) followed by cardiac tamponade.

Cardiac tamponade can be life threatening because the heart is compressed by fluid buildup and prevented from pumping effectively (ie, decreased atrioventricular filling and contractility). Clinical manifestations include tachycardia, muffled heart tones, jugular venous distension, and an abnormal decrease in systolic blood pressure (>10 mm Hg) with inspiration (ie, pulsus paradoxus ) (Option 2).

(Option 1) Pericarditis is characterized by pleuritic chest pain that worsens with deep breathing. The pain is typically relieved by sitting up and leaning forward because this position relieves pressure on the inflamed pericardium.

(Option 3) Pericardial friction rub (ie, high-pitched, grating sound) is an expected finding in pericarditis. It is caused by the inflamed surfaces of the heart rubbing against one another.

(Option 4) An elevated temperature and nonproductive cough are expected findings with pericarditis and are not life threatening. Administering an NSAID can reduce both temperature and inflammation.

Educational objective:
Cardiac tamponade is a life-threatening complication of pericarditis that develops when fluid accumulates within the layers of the pericardium. Clinical manifestations include tachycardia, muffled heart tones, jugular venous distension, and pulsus paradoxus.

Question

The nurse is preparing to instill dialysate for a client who is receiving peritoneal dialysis. It would be a priority for the nurse to

	1. place the client in the semi-Fowler position
	2. record the characteristics of the dialysate output
	3. use sterile technique when spiking and attaching the bag of dialysate
	4. ensure that the drainage collection bag is below the level of the abdomen

Explanation

In peritoneal dialysis (PD), the abdominal lining (ie, peritoneum) is used as a semipermeable membrane to dialyze clients with decreased kidney function. A catheter is placed in the peritoneal cavity for infusing and draining dialysis fluid (ie, dialysate). Dialysate is infused and dwells in the abdomen, which allows waste products and electrolytes to cross the peritoneum into the dialysate and be drained after the prescribed dwell time.

When administering PD, it is essential to use sterile technique when spiking and attaching bag of dialysate to the client's PD catheter to prevent contamination and infection (Option 3). Bacterial peritonitis, an infection of the peritoneum, is a potential complication of PD that may lead to sepsis. Signs of peritonitis should be reported to the health care provider.

(Options 1 and 4) Proper positioning of the catheter drainage bag (ie, below the abdomen) and the client (eg, Fowler or semi-Fowler position) promotes effluent (ie, waste and dialysate drained from the peritoneal cavity) outflow but is not a priority over infection prevention.

(Option 2) Cloudy effluent may indicate infection, whereas bloody or brown effluent may indicate bowel perforation. Documenting effluent characteristics is important but not a priority over maintaining asepsis.

Educational objective:
Peritoneal dialysis (PD) uses the peritoneum as a semipermeable membrane to dialyze clients with decreased kidney function. Bacterial peritonitis is a potential complication of PD. Using sterile technique when spiking or changing bags of dialysate is a priority to avoid contamination and reduce the risk for peritonitis.

Question

The nurse is talking with a female client about collecting a clean-catch urine specimen. Which of the following information should the nurse include? Select all that apply.

	1. "Avoid touching the inside of the specimen container."
	2. "Position the specimen container before initiating your stream of urine."
	3. "Cleanse your vulva from front to back with single-use antiseptic towelettes."
	4. "Spread your labia using your nondominant hand before cleansing your perineum and urinating."
	5. "Remove the lid from the specimen container and place it on the counter with the sterile side facing down."

Explanation

A clean-catch (ie, midstream) urine specimen is commonly obtained by clients requiring urinalysis and/or culture and sensitivity. To minimize the risk for specimen contamination, the female client should use the following collection method:

Wash the hands and open the specimen container, making sure not to touch the inner lid or inside of the container (Option 1).
Spread the labia using the index finger and thumb of the nondominant hand (Option 4).
Cleanse the vulva from front to back with single-use antiseptic towelettes, using a new towelette with each wipe (Option 3).
Initiate the urine stream to flush away remaining microorganisms from the urethral meatus before using the dominant hand to pass the container into the stream for specimen collection.
Remove the specimen container from the stream of urine before the urine flow ends.
Replace the sterile cap without touching the inside of the cap.

(Options 2 and 5) To prevent contamination of the specimen, the lid of the specimen container should be placed on the counter with the sterile side facing upward and the urine stream should be initiated before positioning the specimen container to collect the urine.

Educational objective:
A clean-catch urine specimen is obtained by clients requiring urinalysis and/or culture and sensitivity. When collecting the specimen, the client should avoid touching the inside of the specimen container, spread the labia with the nondominant hand, and cleanse the vulva from front to back with single-use antiseptic towelettes before urinating.

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Select 1 or more options for each row or column that apply to the clinical information provided. Square buttons indicate that more than 1 answer can be selected, while radio buttons indicate that only 1 answer can be selected.

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Assess all 6 steps of the Clinical Judgment Measurement Model (CJMM) in a single item. Candidates must read a scenario and then drag and drop 5 answer choices into the correct location in the answer key.

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Analyze patterns over time using data such as vitals, labs, or patient progress. These questions require recognizing trends to determine appropriate clinical actions.

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Analyze patterns over time using data such as vitals, labs, or patient progress. These questions require recognizing trends to determine appropriate clinical actions.

Frequently Asked Questions (FAQs)

What makes UWorld’s NCLEX practice questions unique?

UWorld is the industry leader and the National Student Nurses’ Association (NSNA) preferred choice for NCLEX prep because our NCLEX practice questions are crafted through a rigorous creation process. A dedicated team of over 40 practicing nurses and nurse educators writes, updates, and reviews every item to ensure they meet strict NCSBN standards and match the difficulty of the actual exam.

Expert Visuals: Our clinical team works alongside professional designers with master’s degrees to create a visual language proven to boost retention. We use high-quality medical illustrations to help you visualize difficult concepts, making complex NCLEX-RN practice questions easier to understand.
Clinical Judgment: We don’t just ask you to memorize facts; we teach you how to think like a nurse and build clinical judgment with in-depth explanations for every answer choice.
Realistic Interface: Our platform mimics the actual NCLEX test questions interface, reducing test-day anxiety by ensuring you are familiar with the screen layout and tools.
Active Learning: By using our practice NCLEX questions, you engage in active recall, a scientifically proven strategy that improves long-term retention compared to passive reading.

How many NCLEX practice questions does UWorld’s NCLEX QBank offer?

Between NCLEX-RN and PN, UWorld offers 5,000+ NCLEX practice questions. Our comprehensive QBanks ensure you have everything you need to pass the NCLEX the first time:

NCLEX-RN: Our QBank features up to 3,400+ NCLEX-RN questions, covering all major client needs categories and body systems. This includes 2,800+ QBank questions, and up to 600 self-assessment questions (100 each).
NCLEX-PN: We provide up to 2,050+ NCLEX-PN practice questions specifically tailored to the practical/vocational nursing scope of practice. This includes 1,450+ QBank questions, and up to 600 self-assessment questions (100 each).
Assessment Tests: In addition to the QBank, we offer self-assessment tests comprising unique NCLEX exam questions not found in the regular study bank.

How many questions are on the NCLEX?

The NCLEX uses Computerized Adaptive Testing (CAT), so the exam length varies for each candidate.

Question Count: For both the NCLEX-RN and NCLEX-PN, candidates will answer a minimum of 85 questions and a maximum of 150 questions.
Timing: The maximum time allowed for the exam is 5 hours. Every exam includes Next Gen NCLEX items designed to measure clinical judgment. Our CAT practice tests mirror this variable length and structure to simulate the real testing environment.

What nursing subjects and systems are covered in UWorld's NCLEX practice questions?

Our NCLEX practice questions are comprehensively organized to cover every major subject area and body system outlined in the NCSBN test plan. This allows you to create a personalized study plan by filtering NCLEX exam questions based on your specific needs.

Subjects: We provide extensive coverage of Adult Health (Medical-Surgical), Maternal-Newborn, Pediatric Nursing, Psychiatric-Mental Health, Fundamentals, Leadership & Management, and Pharmacology.
Systems: You can focus your practice NCLEX questions on specific body systems, including Cardiovascular, Respiratory, Neurological, Gastrointestinal, Musculoskeletal, Endocrine, Reproductive, and Immune/Oncology.

Whether you are reviewing NCLEX-RN or NCLEX-PN practice questions, using these subject-specific filters helps you target weak areas and master the content effectively.

Are there separate practice questions available for the NCLEX-RN and NCLEX-PN?

Yes, we offer distinct resources for each exam because the scope of practice differs between registered nurses and licensed practical/vocational nurses.

NCLEX-RN: You can access specific NCLEX-RN practice questions that focus on the management of care and complex clinical judgment expected of RNs.
NCLEX-PN: We provide dedicated NCLEX-PN practice questions that align with the PN test plan, focusing on coordination of care and practical nursing tasks. Ensure you select the correct NCLEX practice quiz for your licensure path to get the most accurate assessment.

Do the practice questions provide detailed rationales for correct and incorrect answers?

Absolutely. The hallmark of UWorld is our industry-leading rationales. Whether you are using our paid QBank or our free NCLEX practice questions, every single question comes with a detailed explanation.

Visual Learning: We use vivid illustrations, charts, and diagrams to explain complex concepts.
Comprehensive Answer Explanations: We explain why the correct answer is right and, just as importantly, why the distractors are incorrect. This approach transforms every NCLEX practice question into a high-yield learning opportunity, helping you master the “why” behind nursing interventions.

Do UWorld’s NCLEX practice questions include every item type?

Yes. Our NCLEX-RN practice questions and NCLEX-PN practice questions are comprehensive and include every item type you will encounter on the official NCLEX exam. To ensure you are fully prepared for the NCLEX, our QBank covers:

Next Gen Item Types: We include all question formats, including Extended Multiple Response, Extended Drag-and-Drop, Cloze (Drop-Down), Enhanced Hot Spot (Highlighting), Matrix/Grid, Bow-tie, and Trend questions.
Case Studies: You will practice with unfolding clinical scenarios that mirror the real exam’s structure to test your clinical judgment.
Traditional Item Types: We continue to feature high-yield Multiple Choice, Select All That Apply (SATA), Ordered Response, and Audio/Graphic NCLEX questions.

Practicing with these varied NCLEX test questions helps build the muscle memory and confidence required for success on test day.

What specific clinical judgment skills are NCLEX practice questions designed to measure?

The NCLEX focuses on the NCSBN Clinical Judgment Measurement Model (NCJMM). Our NCLEX-RN questions and NCLEX-PN questions are built to test the 6 cognitive skills of this model:

Recognize Cues: Identifying relevant data.
Analyze Cues: Connecting data to clinical presentation.
Prioritize Hypotheses: Ranking potential issues.
Generate Solutions: Planning interventions.
Take Action: Implementing the plan.
Evaluate Outcomes: Assessing the patient’s response. Practicing with NCLEX model questions that target these specific skills is essential for passing the NCLEX.

Does UWorld include dosage calculation questions?

Yes, dosage calculation is a critical safety competency for nurses. Our NCLEX practice questions and full NCLEX practice tests include dosage calculation items. These NCLEX practice questions cover various methods (dimensional analysis, ratio-proportion) and require you to calculate distinct dosages, IV drip rates, and fluid intake/output.

Can I sign up for a full free trial to access more than just the sample questions?

Yes, we offer a 7-day free trial that gives you access to exam-style NCLEX-RN practice questions or NCLEX-PN practice questions, along with detailed review videos without any commitment. If you are looking for free NCLEX practice questions to start your prep, this trial allows you to experience our active learning methodology firsthand.

What is the “active learning” approach with practice questions?

Active learning is the core of UWorld’s methodology. Instead of passively reading a textbook, you engage with NCLEX practice questions by solving problems and receiving immediate feedback.

Application: You apply knowledge to clinical scenarios rather than memorizing facts through our comprehensive NCLEX practice questions.
Immediate Remediation: You review detailed rationales immediately after answering each practice question.
Retention: This process of testing and reviewing builds stronger neural connections, leading to better retention and recall during the actual NCLEX exam.

Our NCLEX practice questions are designed to keep you actively engaged, which is proven to be more effective than passive review.

Does UWorld fully prepare me for the Next Generation NCLEX (NGN)?

Yes. UWorld is fully aligned with the Next Generation NCLEX and the NCSBN Clinical Judgment Measurement Model (NCJMM).

We have updated our entire QBank to ensure you are ready for the new exam format. Here is how we prepare you:

All Item Types: Practice with thousands of NCLEX questions, including hundreds of NGN questions.
Real-World Scoring: Our platform uses the exact same partial-credit scoring rules as the actual NGN, giving you a realistic picture of your performance.
Simulated Interface: Our interface mimics the actual NCLEX screen down to the pixel. By the time you sit for the exam, the navigation and layout will feel like second nature.
Clinical Judgment Focus: Our questions don’t just test facts; they challenge you to recognize cues, analyze data, and prioritize care, exactly what the CJMM requires of new nurses.

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Frequently Asked Questions (FAQs)

Frequently Asked Questions