Free NCLEX Practice Questions with NGN & Rationales

Question 1

A client with chronic heart failure calls the clinic and reports gaining 3 lb (1.4 kg) since yesterday. Which additional report requires the nurse to direct the client to emergency care now?

Accepted Answer

C. “I am short of breath sitting still, and I cannot lie flat.”

Question 2

A nurse is caring for four clients at the start of a shift. Which client should the nurse assess first?

Accepted Answer

D. A client with new-onset stridor and difficulty speaking

Question 3

Listen to the five lung-sound clips. Clip 1 corresponds to Sound 1, Clip 2 to Sound 2, and so on. For each row, select the lung sound that best matches what you hear.

Accepted Answer

Sound 1 → Rhonchi · Sound 2 → Wheezing · Sound 3 → Stridor · Sound 4 → Coarse crackles · Sound 5 → Pleural friction rub

Question 4

A client with type 1 diabetes has glucose 512 mg/dL, moderate urine ketones, and deep rapid respirations. Which arterial blood gas result should the nurse expect?

Accepted Answer

B. pH 7.28, PaCO2 26 mm Hg, bicarbonate 12 mEq/L

Question 5

The nurse plans diabetes self-care teaching for a 9-year-old with type 1 diabetes who uses insulin pens. Which tasks are developmentally appropriate for the child to perform? Select all that apply.

Accepted Answer

B. Count the carbohydrates in a simple snack using a food chart · C. Choose and clean a fingertip and operate the lancing device while a parent watches · D. Dial the prescribed dose on the pen after a parent confirms the number · E. Name 3 signs that mean the blood glucose is low

Question 6

A client scheduled for surgery reports that a parent experienced a severe reaction to anesthesia during a past surgery, described as high fever and rigid muscles. Which action should the surgical team take?

Accepted Answer

B. Use alternative anesthetic techniques that avoid known malignant hyperthermia triggers

Question 7

The nurse screens postpartum clients for mood disorders by telephone and at visits. For each finding, indicate whether it is consistent with expected postpartum blues or requires evaluation and referral.

Accepted Answer

Statements that the infant would be better off without her → Requires evaluation and referral · Mood swings that resolved by the end of the second week → Expected postpartum blues · Crying spells and irritability on day 4 in a client who is caring for her infant and sleeping when able → Expected postpartum blues · Persistent sadness, no pleasure in anything, and difficulty caring for the infant at 5 weeks → Requires evaluation and referral · Hearing voices telling her the infant is evil on day 8 → Requires evaluation and referral

Question 8

A client with chronic liver disease says, 'I take several over-the-counter cold products when I have pain and congestion.' Which question is most important for the nurse to ask?

Accepted Answer

D. Do any of the products contain acetaminophen?

Question 9

A 2-year-old is brought to the emergency department at 2 AM after 2 days of a runny nose followed by a barking, seal-like cough and hoarseness. Stridor is heard only when the child cries. The child is calm on the parent's lap with a respiratory rate of 30 breaths per minute. Which treatment should the nurse anticipate?

Accepted Answer

B. A single oral dose of dexamethasone 0.6 mg/kg

Question 10

A client receiving a continuous gastrostomy tube feeding is prescribed a liquid medication. Place the nurse's actions in the order they should be performed.

Accepted Answer

1. Stop the feeding pump and verify tube placement → 2. Flush the tube with 30 mL of water → 3. Instill the liquid medication into the tube → 4. Flush again with 30 mL of water after the dose → 5. Restart the feeding and keep the head of bed at 30 degrees

Question 11

A client in acute mania paces constantly and will not sit down for meals. Which approach to nutrition should the nurse use?

Accepted Answer

B. Offer high-calorie, high-protein finger foods the client can eat on the move

Question 12

The nurse takes a history from a 58-year-old man admitted with acute urinary retention. Which questions should the nurse ask? Select all that apply.

Accepted Answer

B. "Have you taken any cold or allergy medicine recently?" · C. "Do you feel that your bladder does not empty completely?" · E. "Has your urine stream become weaker or harder to start?" · F. "How many times do you get up at night to urinate?"

Question 13

The nurse cares for a newborn whose mother took prescribed methadone throughout pregnancy. Withdrawal signs typically begin [[1]], include [[2]], and are scored with [[3]] to decide whether medication is needed.

Accepted Answer

24 to 72 hours after birth or later · a high-pitched cry, tremors, sneezing, and loose stools · the Finnegan tool or the Eat, Sleep, Console approach

Question 14

A client is brought to the emergency department 2 hours after intentionally taking a large quantity of acetaminophen tablets. Which action should the nurse anticipate?

Accepted Answer

A. Draw a 4-hour acetaminophen level and prepare acetylcysteine per toxicology protocol

Question 15

Highlight the findings in the emergency note that support a diagnosis of bacterial meningitis.

Accepted Answer

“Temperature 39.6°C with severe global headache”, “Unable to touch chin to chest; flexing the neck causes the hips and knees to draw up”, “Increasingly drowsy during the interview and photophobic”

Question 16

An 8-year-old admitted 3 days ago with acute postinfectious glomerulonephritis has been on a low-sodium, fluid-restricted diet with IV furosemide. Which finding best indicates that the treatment regimen has been effective?

Accepted Answer

D. Urine output rose from 320 to 1,250 mL in 24 hours

Question 17

A nurse is checking a client's surgical dressing on postoperative day 1. For each finding, indicate whether it is expected or requires prompt assessment.

Accepted Answer

A dressing saturated with bright red blood → Requires prompt assessment · Sudden increase in drainage with the client reporting new dizziness → Requires prompt assessment · Pink-tinged (serosanguineous) drainage on the dressing → Expected finding · A small amount of dried drainage around the incision edges → Expected finding

Question 18

The nurse explains continuous passive motion (CPM) to a client after knee arthroplasty. Complete the statements. The machine [[1]] in order to [[2]]. The nurse [[3]].

Accepted Answer

moves the knee slowly through flexion and extension · prevent stiffness and improve range of motion · keeps the settings at the prescribed degrees and reports pain beyond the expected level

Question 19

Two days after a 6-hour spinal surgery, the nurse finds a 4 cm area of intact, non-blanchable deep maroon discoloration over the left heel. The area feels boggy and is warmer than the surrounding skin. Which action should the nurse take first?

Accepted Answer

A. Offload the heel and document a deep tissue pressure injury

Question 20

A client in active labor is being monitored with an external ultrasound transducer and a tocodynamometer. The contraction tracing shows contractions every 3 minutes lasting 60 seconds. The client rates them as very strong. How should the nurse assess contraction intensity?

Accepted Answer

A. Palpate the fundus at the peak of a contraction

Question 21

A client takes acetaminophen 500 mg tablets, 2 tablets every 6 hours, and also takes a combination cold medication containing 325 mg of acetaminophen every 6 hours. What is the client's total daily acetaminophen intake in mg? Record your answer as a whole number. ____ mg

Accepted Answer

5300 (accepted 5300–5300)

Question 22

A nurse notices feeling unusually irritated by a client who reminds the nurse of a difficult family member. Which action should the nurse take?

Accepted Answer

C. Reflect privately and seek supervision or peer consultation if needed

Question 23

A nurse leads a community class on advance directives. For each participant statement, indicate whether it indicates understanding or requires further teaching.

Accepted Answer

My health care agent must follow my wishes, not his own opinion → Indicates understanding · Once I sign a directive I am not allowed to change it later → Requires further teaching · I can name an agent and also list treatments I would refuse → Indicates understanding · I need a lawyer and a court filing before a directive counts → Requires further teaching · My living will takes effect only when I cannot speak for myself → Indicates understanding

Question 24

A home health nurse visits an older adult client who lives with an adult grandchild serving as the primary caregiver. Which findings should raise the nurse's suspicion for possible elder neglect or abuse? Select all that apply.

Accepted Answer

A. The client has multiple bruises in various stages of healing on the upper arms in a pattern resembling a grip · B. The client is noted to be significantly underweight with dry mucous membranes and soiled clothing · C. The caregiver answers most questions on the client's behalf and becomes visibly anxious when the nurse asks to speak with the client privately · E. The client has an unexplained delay of several weeks between the onset of a pressure injury and when care was sought

Question 25

A client is 3 weeks after an allogeneic stem cell transplant. The nurse notes a new maculopapular rash on the palms, soles, and trunk, profuse watery diarrhea (2 liters in 24 hours), and a total bilirubin that has risen from 0.8 to 3.4 mg/dL. Select the condition the client is most likely experiencing, the 2 priority actions, and the 2 parameters the nurse should monitor.

Accepted Answer

Actions: Notify the transplant team immediately, Administer prescribed immunosuppressive therapy and maintain fluid/electrolyte replacement · Condition: Acute graft-versus-host disease · Parameters: Stool volume, electrolytes, and skin integrity, Liver function tests and bilirubin

	Expected postpartum blues	Requires evaluation and referral
Statements that the infant would be better off without her
Mood swings that resolved by the end of the second week
Crying spells and irritability on day 4 in a client who is caring for her infant and sleeping when able
Persistent sadness, no pleasure in anything, and difficulty caring for the infant at 5 weeks
Hearing voices telling her the infant is evil on day 8

	Expected finding	Requires prompt assessment
A dressing saturated with bright red blood
Sudden increase in drainage with the client reporting new dizziness
Pink-tinged (serosanguineous) drainage on the dressing
A small amount of dried drainage around the incision edges

	Indicates understanding	Requires further teaching
My health care agent must follow my wishes, not his own opinion
Once I sign a directive I am not allowed to change it later
I can name an agent and also list treatments I would refuse
I need a lawyer and a court filing before a directive counts
My living will takes effect only when I cannot speak for myself