NCLEX RN
NCLEX RN Exam– Practice Questions With Answers
Build your test-taking confidence with Ulosca’s NCLEX RN Exam review. This guide is designed for nursing students preparing to demonstrate safe, effective, and evidence-based care across diverse patient populations, using the updated Next Generation NCLEX (NGN) format.
Everything you need to answer with confidence:
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Covers all major NCLEX RN test plan categories including Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity.
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Features +5000 practice sets with NGN-style case studies, bowtie items, matrix multiple-response, and priority-based scenario questions modeled after the real NCLEX RN exam.
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Strengthens your ability to apply the nursing process (ADPIE), use clinical judgment, delegate and prioritize care, and interpret patient data across multiple systems.
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Fully aligned with the 2023 NCLEX RN test plan and clinical judgment model.
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Free NCLEX RN Questions
The nurse is reviewing the lab reports on several clients. Which one should be reported to the physician immediately
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A serum creatinine of 5.2 mg/dL in a client with chronic renal failure
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A positive C reactive protein in a client with rheumatic fever
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A hematocrit of 52% in a client with gastroenteritis
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A white cell count of 2,200 cu/mm in a client taking Dilantin (phenytoin)
Explanation
Correct Answer D. A white cell count of 2,200 cu/mm in a client taking Dilantin (phenytoin)
Explanation:
A white blood cell (WBC) count of 2,200 cu/mm indicates severe leukopenia, placing the client at high risk for life-threatening infections. Since the client is taking Dilantin, this may indicate drug-induced bone marrow suppression (agranulocytosis), which requires immediate intervention.
Why the other options are incorrect:
A. A serum creatinine of 5.2 mg/dL in a client with chronic renal failure
Although elevated, this finding is expected in chronic renal failure and would not require immediate reporting unless it represented a sudden change.
B. A positive C reactive protein in a client with rheumatic fever
This is consistent with inflammation in rheumatic fever and is an expected finding. It does not need immediate reporting.
C. A hematocrit of 52% in a client with gastroenteritis
This indicates hemoconcentration from fluid loss, which is important but not immediately life-threatening compared to severe leukopenia.
The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot
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Application of a walking boot
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Stabilization with a cast
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Surgery with Kirschner wire implantation
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Application of spica cast
Explanation
The Correct Answer is B. Stabilization with a cast
Multiple foot fractures usually require immobilization to ensure proper alignment and healing. A cast provides rigid stabilization, prevents further displacement of bone fragments, and allows for adequate healing time. The cast also reduces pain by restricting movement and protecting the injured area.
Why the other options are incorrect:
A. Application of a walking boot
Walking boots are typically used for minor foot fractures or sprains. Multiple fractures need firmer immobilization than a boot provides.
C. Surgery with Kirschner wire implantation
Kirschner wires (K-wires) may be used in severe, displaced, or complex fractures. However, the first-line treatment for most uncomplicated foot fractures is casting, not immediate surgery.
D. Application of spica cast
A spica cast immobilizes the hip or femur, not the foot. It is inappropriate for treating foot fractures.
A client with an abdominal aortic aneurysm is admitted in preparation for surgery. Which finding should be reported to the doctor
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A WBC of 14,000 cu.mm.
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Auscultation of abdominal bruit
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Complaints of lower back pain
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A platelet count of 175,000 cu.mm.
Explanation
Correct Answer C. Complaints of lower back pain
Explanation:
In a client with an abdominal aortic aneurysm, new or worsening back or abdominal pain is a critical finding that may indicate impending rupture. This requires immediate reporting to the physician, as rupture is life-threatening and requires urgent intervention.
Why the other options are incorrect:
A. A WBC of 14,000 cu.mm.
This is slightly elevated and may suggest infection, but it is not as urgent or life-threatening as pain indicating a possible rupture.
B. Auscultation of abdominal bruit
A bruit is an expected finding with an abdominal aortic aneurysm due to turbulent blood flow. It is not an immediate danger sign.
D. A platelet count of 175,000 cu.mm.
This is within the normal range (150,000–400,000) and does not pose an immediate risk.
The nurse is removing a peripherally inserted central catheter (PICC). The nurse should position the patient in which position
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Fowler’s
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Right side lying
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Left side lying
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Trendelenburg
Explanation
Correct Answer D. Trendelenburg
Explanation:
Although PICCs are placed in the arm, they terminate in the central venous system. For safety during removal, the client should be positioned in Trendelenburg (or supine) to increase venous pressure and reduce the risk of air embolism. The nurse should also instruct the patient to perform the Valsalva maneuver (bearing down or holding the breath during removal). This positioning minimizes the chance of air entering the venous system, which could be life-threatening.
Why the other options are incorrect:
A. Fowler’s
An upright position lowers venous pressure, increasing the risk of air embolism during catheter removal.
B. Right side lying
This position does not help with catheter removal and does not reduce embolism risk.
C. Left side lying
This is used only if an air embolism occurs, to trap air in the right atrium, not for routine removal.
A client having an ischemic stroke arrives at the emergency department. The health care provider prescribes TISSUE PLASMINOGEN ACTIVATOR (tPA). Which client statement would be MOST important to clarify before administering tPA
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I can't believe this is happening right after my stomach surgery.
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I had a concussion after a car accident a year ago.
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I started noticing my right arm becoming weak approximately an hour ago.
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I stopped taking my warfarin 4 weeks ago.
Explanation
Correct Answer A. I can't believe this is happening right after my stomach surgery.
Explanation
tPA markedly increases bleeding risk. Recent major surgery—especially abdominal—can leave fresh suture lines and raw tissues that are highly susceptible to hemorrhage when fibrinolysis is induced. Standard inclusion/exclusion guidance for IV alteplase treats recent major surgery (≈ within 14 days; intracranial/intraspinal within 3 months) as a critical contraindication or strong precaution. Therefore, the timing and nature of the “stomach surgery” must be clarified immediately (exact date/time, extent of procedure) because a recent operation may preclude thrombolysis despite an otherwise appropriate treatment window.
Why Other Options Are Wrong
B. I had a concussion after a car accident a year ago.
Remote head trauma (one year ago) is not a typical exclusion. The high-risk period relates to recent severe head trauma (e.g., within 3 months) or any history of intracranial hemorrhage, vascular malformation, or intracranial neoplasm. Absent those, a concussion 12 months prior does not, by itself, bar alteplase. It is appropriate to document the event, but it would not supersede clarifying recent surgery.
C. I started noticing my right arm becoming weak approximately an hour ago.
This actually supports eligibility because it places symptom onset within the therapeutic window (commonly up to 3 hours, and in many protocols up to 4.5 hours for selected patients). You still need to determine the exact last-known-well and confirm persistent disabling deficit, but this statement raises no new bleeding risk. It is important information, yet it does not represent a potential contraindication that must be clarified before giving tPA.
D. I stopped taking my warfarin 4 weeks ago.
Warfarin cessation four weeks prior strongly suggests the INR has normalized (warfarin’s effect wanes within days). Current guidelines focus on the current INR (usually must be ≤1.7 for alteplase). You still check labs before administration, but this history alone does not preclude treatment. Compared with the possibility of very recent abdominal surgery, this is less urgent to clarify.
A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid
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Calcium-rich foods
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Canned or frozen vegetables
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Processed meat
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Raw fruits and vegetables
Explanation
Correct Answer D. Raw fruits and vegetables
Explanation:
Clients with HIV who are immunocompromised and have diarrhea should avoid raw fruits and vegetables because they can harbor bacteria or parasites that may worsen gastrointestinal symptoms and increase infection risk. Cooking or freezing vegetables kills most pathogens, making them safer. Preventing exposure to foodborne illness is a priority in immunocompromised clients.
Why the other options are incorrect:
A. Calcium-rich foods
These do not worsen diarrhea or increase infection risk. In fact, calcium may help maintain bone health in HIV clients on antiretroviral therapy.
B. Canned or frozen vegetables
These are generally safe to eat since processing and freezing destroy most pathogens, unlike raw produce.
C. Processed meat
While not the healthiest food option, processed meat does not directly worsen diarrhea or pose the same infection risk as raw produce in this context.
The nurse recognizes which of the following clients as having the highest risk for pulmonary complications after surgery
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A 24-year-old with open reduction internal fixation of the ulnar
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A 45-year-old with an open cholecystectomy
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A 36-year-old after a hysterectomy
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A 50-year-old after a lumbar laminectomy
Explanation
Correct Answer B. A 45-year-old with an open cholecystectomy
Explanation:
The greatest risk for pulmonary complications after surgery occurs in clients with upper abdominal or thoracic procedures. An open cholecystectomy involves a large upper abdominal incision, which can impair deep breathing, coughing, and effective diaphragmatic movement due to pain. This increases the risk of atelectasis and pneumonia.
Why the other options are incorrect:
A. A 24-year-old with open reduction internal fixation of the ulnar
This is an extremity surgery, not associated with significant pulmonary risk.
C. A 36-year-old after a hysterectomy
Pelvic surgery poses less risk to lung expansion than upper abdominal procedures.
D. A 50-year-old after a lumbar laminectomy
Spinal surgery may limit mobility but does not typically restrict diaphragmatic movement as much as abdominal or thoracic surgery.
The nurse is caring for a client with full thickness burns to the lower half of the torso and lower extremities. During the emergent phase of injury, the primary nursing diagnosis would focus on
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Imbalanced nutrition less than body requirements related to hypermetabolic state
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Risk for infection related to altered skin integrity
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Risk for fluid volume imbalance related to intracompartmental fluid shift
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Acute pain related to burn injury
Explanation
The Correct Answer is C. Risk for fluid volume imbalance related to intracompartmental fluid shift
In the emergent (resuscitative) phase of burn injury, which lasts from the onset of the burn until fluid mobilization and diuresis begin (typically 24–72 hours), the priority concern is hypovolemic shock caused by massive fluid shifts (capillary leak) into the interstitial space. Fluid resuscitation is essential to maintain perfusion to vital organs. Therefore, the primary nursing diagnosis is related to risk for fluid volume imbalance.
Why the other options are incorrect:
A. Imbalanced nutrition less than body requirements related to hypermetabolic state
Nutrition is critical but becomes a priority in the acute/intermediate phase, after fluid balance is restored.
B. Risk for infection related to altered skin integrity
Infection is a major threat but is most significant in the acute and rehabilitative phases, once fluid stabilization is achieved.
D. Acute pain related to burn injury
Pain is always important, but it is not life-threatening in comparison to the immediate danger of hypovolemic shock from fluid loss in the emergent phase.
The nurse in the emergency department assesses a client diagnosed with burns. Which observation most concerns the nurse
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Redness and swelling with fluid-filled vesicles noted on right arm.
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Charred, waxy, white appearance of skin on the left leg.
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Reddened blotchy painful areas noted on the trunk.
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Blistering and blanching of the skin noted on the back.
Explanation
Correct Answer B. Charred, waxy, white appearance of skin on the left leg.
Explanation:
The charred, waxy, white appearance of the skin indicates a full-thickness (third-degree) burn, which destroys the epidermis, dermis, and potentially underlying tissues. This type of burn is the most concerning because it results in loss of protective skin function, high risk for infection, fluid imbalance, and requires surgical intervention such as grafting. Additionally, third-degree burns can be painless due to nerve destruction, making careful monitoring essential.
Why the other options are incorrect:
A. Redness and swelling with fluid-filled vesicles noted on right arm.
This describes a partial-thickness (second-degree) burn. While painful and requiring care, it is less severe than a full-thickness burn and not the most concerning finding.
C. Reddened blotchy painful areas noted on the trunk.
This describes superficial (first-degree) burns, which usually heal without long-term complications. They are painful but not as concerning as deeper burns.
D. Blistering and blanching of the skin noted on the back.
This also indicates partial-thickness burns, which, though painful and needing wound care, do not carry the same immediate risk as full-thickness burns
The physician has prescribed Zyvox (linezolid) for a patient with VRE. The concurrent use of which medication may result in serotonin syndrome
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Nexium (esomeprazole)
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Zoloft (sertraline)
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Lipitor (atorvastatin)
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Zyrtec (cetirizine)
Explanation
Correct Answer B. Zoloft (sertraline)
Explanation:
Linezolid (Zyvox) is an antibiotic with monoamine oxidase inhibitor (MAOI) activity. When used with SSRIs such as sertraline (Zoloft), there is a significant risk for serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, tachycardia, hypertension, hyperthermia, tremor, and seizures.
Why the other options are incorrect:
A. Nexium (esomeprazole)
A proton pump inhibitor used for GERD; it does not interact with linezolid in a way that risks serotonin syndrome.
C. Lipitor (atorvastatin)
A statin for hyperlipidemia; main concern is muscle toxicity, not serotonin syndrome.
D. Zyrtec (cetirizine)
An antihistamine for allergies; it does not interact with linezolid to cause serotonin syndrome.
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NCLEX RN Exam– Comprehensive Practice Questions With Answers
This NCLEX RN exam focuses on critical areas of safe, effective nursing care including legal responsibilities, ethical principles, delegation, prioritization, and clinical judgment. Students will be expected to apply the nursing process, professional standards, and critical thinking to patient scenarios in diverse care settings.
1. Legal and Ethical Responsibilities
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Negligence and malpractice: duty, breach, causation, damages.
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Nurse Practice Act (NPA) and scope of practice.
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Ethical principles: autonomy, beneficence, fidelity, veracity, nonmaleficence, and justice.
2. Medication Safety and Provider Orders
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Nurse accountability in questioning unsafe or toxic medication orders.
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Shared liability between providers and nurses.
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Safe medication administration and independent duty of care.
3. Delegation and Supervision
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Delegating to LPNs and UAPs based on scope of practice.
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RN responsibilities: assessment, evaluation, teaching, and clinical judgment.
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Tasks appropriate for LPNs (reinforcing teaching, wound care) and UAPs (ADLs, ambulation, vital signs).
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Situations where delegation is unsafe (IV medication assessment, complex ostomy care, therapeutic communication).
4. Prioritization of Care
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Use of ABCs (airway, breathing, circulation), Maslow’s hierarchy, and safety principles.
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Prioritizing PACU and unstable clients over teaching and discharge planning.
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Recognizing high-risk postoperative complications and unstable respiratory or hemodynamic status.
5. Patient Rights and Autonomy
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Supporting client decisions to stop treatment or change providers.
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Informed consent and respecting competence in decision-making.
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Balancing nurse’s values with client independence and self-determination.
6. Professional Accountability
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Risk management: incident reports, narcotic counts, reporting unsafe staffing.
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Quality improvement and unit-based audits.
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Identifying true adoption of practice changes (consistent EMR use).
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Maintaining clinical expertise through continuing education.
7. Emergency and Crisis Response
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Delegation during acute respiratory distress (charge nurse paging RT, primary nurse applying O₂).
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Coordination of resources and rapid team response.
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Crisis triage and stabilization before routine tasks.