These 25 free NCLEX practice questions cover every client needs category on the NCLEX-RN test plan: management of care, safety, health promotion, psychosocial integrity, basic care, pharmacology, reduction of risk, and physiological adaptation. Click an answer to see right away if you got it, plus a rationale for every option. Your score shows at the end.
The questions mix categories the way the real exam does and get harder as you go. Many ask what the nurse should do first, which finding to report, or which statement shows the client needs more teaching.
Question 1 of 25 Safety and Infection Control
The nurse is teaching a family how to prevent carbon monoxide poisoning at home. Which statement by a family member indicates a need for further teaching?
- “We will put a carbon monoxide alarm outside each sleeping area.”. Incorrect. Carbon monoxide alarms near sleeping areas can wake the family if levels rise at night, so this statement is correct.
- “We will have the furnace and water heater checked every fall.”. Incorrect. Yearly inspection of fuel-burning appliances helps find leaks and blocked vents, so this statement is correct.
- “I can warm up the car in our attached garage if the door is open.”. Correct. A running car in an attached garage can fill the home with carbon monoxide even when the garage door is open. Vehicles should never be left running inside a garage, so this family member needs more teaching.
- “We will never use the charcoal grill inside the house or garage.”. Incorrect. Burning charcoal indoors or in a garage releases large amounts of carbon monoxide, so this statement shows understanding.
Question 2 of 25 Pharmacological and Parenteral Therapies
A client with asthma has a new prescription for montelukast. Which statement by the client indicates understanding of the teaching?
- “I will report any new mood changes, nightmares, or thoughts of self-harm.”. Correct. Montelukast carries a warning for neuropsychiatric effects such as agitation, sleep disturbances, depression, and suicidal thoughts. The client should report any new mood or behavior changes to the provider right away.
- “I will take this tablet to stop an asthma attack once it has started.”. Incorrect. Montelukast is a long-term controller and does not relieve acute bronchospasm. A short-acting bronchodilator such as albuterol is used for an attack.
- “I can stop using my inhaled steroid now that I have this tablet.”. Incorrect. Montelukast is often added to, not used in place of, an inhaled corticosteroid. Controller drugs should not be stopped without the provider’s direction.
- “I only need to take this tablet on the days when I am wheezing or short of breath.”. Incorrect. Montelukast must be taken every day, even when the client has no symptoms, to prevent attacks.
Question 3 of 25 Basic Care and Comfort
A client who had a stroke has weakness of the right arm and leg. The nurse observes an unlicensed assistive personnel (UAP) helping the client get dressed. Which action by the UAP requires the nurse to intervene?
- Has the client sit in a chair with both feet flat on the floor.. Incorrect. Sitting with feet flat on the floor gives a stable base and reduces fall risk during dressing.
- Offers the client a loose shirt that closes in the front.. Incorrect. Loose clothing with front closures is easier to manage with one weak arm and promotes independence.
- Allows the client extra time to do as much as possible alone.. Incorrect. Encouraging self-care at the client’s own pace supports rehabilitation and dignity.
- Guides the client’s left arm into the shirt sleeve first.. Correct. The client should dress the weak (affected) side first and undress it last. Here the right side is weak, so starting with the left arm makes it harder to get the right arm into the sleeve, and the nurse should redirect the UAP.
Question 4 of 25 Management of Care
After receiving change-of-shift report, which client should the nurse assess first?
- A client with COPD whose oxygen saturation is 90% on 2 L/min by nasal cannula. Incorrect. An oxygen saturation near 90% is often the target for a client with COPD, so this is an expected finding.
- A client with heart failure who is newly restless and has crackles in both lungs. Correct. New restlessness and crackles throughout both lungs suggest worsening pulmonary edema with hypoxia. This is a change in condition that affects breathing, so this client is the priority.
- A client with cellulitis of the leg who is due for an IV antibiotic in 30 minutes. Incorrect. The antibiotic should be given on time, but there is still time to give it after the unstable client is assessed.
- A client 2 days after an appendectomy who rates incision pain 4 on a 0-10 scale. Incorrect. Mild to moderate incision pain 2 days after surgery is expected and is not an immediate threat.
Question 5 of 25 Health Promotion and Maintenance
The nurse is assessing a client 24 hours after an uncomplicated vaginal birth. Which finding is expected?
- Firm fundus at the level of the umbilicus. Correct. About 24 hours after birth the fundus is normally firm, midline, and at or near the level of the umbilicus. It then descends about 1 fingerbreadth per day.
- Pinkish-brown lochia serosa on the perineal pad. Incorrect. Lochia rubra (dark red) is expected for the first few days. Lochia serosa usually appears around days 4 to 10.
- Oral temperature of 38.6°C (101.5°F). Incorrect. A slight rise up to 38°C (100.4°F) can occur in the first 24 hours from dehydration, but this temperature is higher than expected. It may signal infection and should be reported.
- Soft fundus displaced to the right of midline. Incorrect. A boggy fundus displaced to one side usually means a full bladder, which raises the risk of hemorrhage. The client should void and the fundus should be massaged.
Question 6 of 25 Physiological Adaptation
The nurse is caring for a client with acute pancreatitis. Which finding should the nurse report to the provider?
- Epigastric pain that radiates to the back. Incorrect. Severe epigastric pain radiating to the back is a classic, expected finding in acute pancreatitis.
- Serum lipase level above the normal range. Incorrect. An elevated lipase is how pancreatitis is diagnosed, so it is an expected finding.
- Carpal spasm when a blood pressure cuff is inflated. Correct. Carpal spasm with an inflated blood pressure cuff is a positive Trousseau sign, which indicates hypocalcemia. Calcium binds to areas of fat necrosis in pancreatitis, and low calcium can cause tetany, laryngospasm, and dysrhythmias, so it must be reported.
- Nausea and vomiting on the day of admission. Incorrect. Nausea and vomiting are common with acute pancreatitis and are expected. They are treated with antiemetics and IV fluids.
Question 7 of 25 Reduction of Risk Potential
The nurse is giving discharge teaching to a client after an outpatient cystoscopy. Which statement by the client indicates understanding of the teaching?
- “I should expect blood clots in my urine for about a week.”. Incorrect. Pink-tinged urine for a day or two is common, but blood clots or bright red urine are not expected and should be reported.
- “I will call if I have a fever or chills or cannot urinate.”. Correct. Fever or chills can signal a urinary tract infection, and inability to void can mean retention from swelling or clots. These are the key problems to report after a cystoscopy.
- “I will limit how much I drink so I do not have to urinate as often.”. Incorrect. The client should increase fluid intake, unless restricted, to flush the bladder and reduce burning and infection risk.
- “Any burning when I urinate means I must go to the ER.”. Incorrect. Mild burning with urination for a day or two is expected after a cystoscopy. It is not an emergency by itself.
Question 8 of 25 Pharmacological and Parenteral Therapies
A client with depression is starting phenelzine. Which statement by the client indicates a need for further teaching?
- “I will avoid tap beer and red wine while I take this drug.”. Incorrect. Tap beer and some wines are high in tyramine and should be avoided, so this statement is correct.
- “I will check with my provider before taking any cold medicine.”. Incorrect. Many cold remedies contain decongestants or dextromethorphan that can interact dangerously with this drug, so checking first is correct.
- “I will get up slowly because this drug can make me dizzy.”. Incorrect. Orthostatic hypotension is a common side effect, so rising slowly is correct.
- “I can still have aged cheddar and pepperoni pizza on weekends.”. Correct. Phenelzine is a monoamine oxidase inhibitor (MAOI). Aged cheeses and cured meats such as pepperoni are high in tyramine, which can cause a hypertensive crisis in a client taking an MAOI, so this client needs more teaching.
Question 9 of 25 Psychosocial Integrity
A client who just learned that a biopsy shows cancer says to the nurse, “I don’t know how I am going to tell my kids.” Which response by the nurse is most therapeutic?
- “Tell me what worries you most about talking with them.”. Correct. This open-ended response invites the client to explore and express the specific fears behind the statement. It keeps the focus on the client’s feelings and opens the door to planning and support.
- “Your children will probably handle it better than you think.”. Incorrect. This is false reassurance. It dismisses the client’s concern and discourages further talk.
- “Why are you worried about that right now?”. Incorrect. “Why” questions can sound judgmental and put the client on the defensive.
- “You should focus on your treatment plan for now.”. Incorrect. This gives advice and changes the subject, which blocks the client from sharing feelings.
Question 10 of 25 Safety and Infection Control
The nurse discovers a fire in the wastebasket of a client’s room. The client is in bed next to the burning wastebasket. Which action should the nurse take first?
- Pull the nearest fire alarm.. Incorrect. Activating the alarm is the second step. The client in immediate danger must be moved first.
- Spray the fire with an extinguisher.. Incorrect. Extinguishing the fire comes after the client is rescued, the alarm is activated, and the fire is contained.
- Move the client out of the room.. Correct. Using the RACE sequence (rescue, alarm, contain, extinguish), the nurse first rescues any client in immediate danger. This client is next to the fire, so moving the client to safety comes before all other steps.
- Close the door and windows of the room.. Incorrect. Closing doors contains the fire and smoke, but it is done after the client is removed and the alarm is activated.
Question 11 of 25 Management of Care
The RN is making assignments on a medical-surgical unit. Which client is most appropriate to assign to the licensed practical nurse (LPN)?
- A client admitted 1 hour ago with chest pain and new ECG changes. Incorrect. A new admission with possible acute coronary syndrome is unstable and needs RN assessment and judgment.
- A client with stable type 2 diabetes who needs a scheduled insulin injection. Correct. This client is stable with a predictable outcome, and giving a scheduled subcutaneous insulin injection is within the LPN scope of practice. The RN remains responsible for supervising the care.
- A client receiving the first unit of packed red blood cells. Incorrect. The start of a blood transfusion carries the highest risk of reaction. Starting the transfusion and monitoring the first 15 minutes require RN assessment.
- A client who needs discharge teaching about a new colostomy. Incorrect. Initial and discharge teaching require RN assessment and evaluation. The LPN can reinforce teaching but should not provide it alone.
Question 12 of 25 Pharmacological and Parenteral Therapies
A client is prescribed IV ondansetron for nausea after surgery. Which finding should the nurse report to the provider before giving the medication?
- A markedly prolonged QTc interval on today’s ECG. Correct. Ondansetron can prolong the QT interval. A markedly prolonged QTc raises the risk of a life-threatening dysrhythmia called torsades de pointes, so the nurse should hold the dose and report the finding.
- Nausea rated 6 on a 0-10 scale after sips of water. Incorrect. Nausea is the reason the drug was prescribed, so this finding supports giving it.
- Hypoactive bowel sounds on the first day after surgery. Incorrect. Slow return of bowel sounds is common on the first day after surgery and is not a reason to hold ondansetron.
- Blood pressure of 118/74 mm Hg and heart rate of 82/min. Incorrect. These vital signs are within normal limits and do not affect the safety of the dose.
Question 13 of 25 Physiological Adaptation
The nurse is monitoring a client who was admitted 4 hours ago after a closed head injury. Which finding should the nurse report immediately?
- Glasgow Coma Scale score of 15. Incorrect. A score of 15 is the highest possible and shows normal level of consciousness.
- Headache rated 3 on a 0-10 scale. Incorrect. A mild headache is common after a head injury. It should be monitored but is not urgent by itself.
- Pupils equal and briskly reactive to light. Incorrect. Equal, briskly reactive pupils are a normal finding.
- BP 176/58 mm Hg, pulse 50/min, irregular breathing. Correct. Rising systolic pressure with a widening pulse pressure, bradycardia, and irregular respirations make up Cushing triad. This is a late sign of increased intracranial pressure and possible brain herniation, so it needs immediate action.
Question 14 of 25 Basic Care and Comfort
A client is receiving a continuous enteral feeding through a nasogastric tube. The client suddenly begins coughing and has difficulty breathing. Which action should the nurse take first?
- Check the gastric residual volume.. Incorrect. Checking residual volume takes time and does not stop formula from entering the airway.
- Flush the tube with 30 mL of water.. Incorrect. Flushing the tube adds more fluid and could worsen aspiration if the tube is out of place.
- Stop the tube feeding.. Correct. Sudden coughing and dyspnea during a feeding suggest aspiration or a displaced tube. Stopping the feeding first prevents more formula from entering the lungs. The nurse then keeps the head of the bed up, suctions as needed, assesses the client, and notifies the provider.
- Lower the head of the bed.. Incorrect. Lowering the head of the bed increases the risk of aspiration. The head of the bed should stay elevated.
Question 15 of 25 Reduction of Risk Potential
A client is 2 hours after an esophagogastroduodenoscopy (EGD) performed with moderate sedation. Which finding should the nurse report to the provider immediately?
- Mild sore throat when swallowing saliva. Incorrect. A mild sore throat from the scope passing through the throat is expected and usually resolves in a day or two.
- Sharp neck and chest pain with crackling under the skin. Correct. New sharp chest or neck pain with crackling under the skin (subcutaneous emphysema) suggests perforation of the esophagus. This is a rare but life-threatening complication that requires immediate evaluation.
- Bloating relieved by passing gas. Incorrect. Air is put into the stomach during the procedure, so bloating and passing gas are expected.
- Drowsiness that improves each time the client is spoken to. Incorrect. Mild drowsiness that improves with stimulation is expected as moderate sedation wears off.
Question 16 of 25 Health Promotion and Maintenance
The nurse is teaching the parent of a 2-year-old about home safety. Which statement by the parent indicates understanding?
- “I keep all medicines in a locked cabinet up high.”. Correct. Toddlers are curious, climb well, and put things in their mouths, so poisoning is a major risk. Keeping medicines locked and out of reach is a key prevention measure.
- “I let her sit in the front seat if the trip is short.”. Incorrect. Young children should ride in an appropriate car seat in the back seat on every trip. The front seat and air bags pose serious risk.
- “I give her whole grapes and hot dog slices for snacks.”. Incorrect. Whole grapes and round slices of hot dog are a common cause of choking in toddlers. These foods should be cut lengthwise into small pieces.
- “I let her play in the tub alone if the water is shallow.”. Incorrect. A toddler can drown in a few inches of water in seconds. An adult must stay within arm’s reach for the entire bath.
Question 17 of 25 Pharmacological and Parenteral Therapies
A client has been taking simvastatin for 3 months. Which finding requires the nurse to take immediate action?
- Mild headache that is relieved by acetaminophen. Incorrect. Headache is a minor side effect and is not a sign of serious harm.
- Occasional mild nausea after taking the dose. Incorrect. Mild stomach upset is a common, minor side effect of statins.
- LDL cholesterol that has dropped since last visit. Incorrect. A falling LDL cholesterol is the desired effect of the drug.
- Diffuse muscle pain with weakness and dark urine. Correct. Unexplained muscle pain and weakness with dark (cola-colored) urine suggest rhabdomyolysis, a rare but serious adverse effect of statins that can cause acute kidney injury. The client should stop the drug and the nurse should notify the provider, who will likely check a creatine kinase level.
Question 18 of 25 Management of Care
The nurse receives a handwritten prescription that reads “MS 4 mg IV every 4 hours as needed for pain.” Which action should the nurse take?
- Give morphine sulfate because the dose fits a pain prescription.. Incorrect. “MS” is an error-prone abbreviation that can mean morphine sulfate or magnesium sulfate. The nurse cannot assume which drug was intended.
- Ask the pharmacist to decide which drug the provider meant.. Incorrect. The pharmacist may help identify the problem, but only the prescriber can clarify what was intended.
- Contact the provider to clarify which drug is intended.. Correct. “MS” is on The Joint Commission’s “Do Not Use” list because it can be read as morphine sulfate or magnesium sulfate. The nurse must contact the prescriber to clarify before giving any medication.
- Hold the drug and document that the prescription was unclear.. Incorrect. Holding the drug without contacting the provider delays pain relief and does not fix the unclear prescription.
Question 19 of 25 Physiological Adaptation
A client is brought to the emergency department after being trapped in a burning house. The client has burns to the face and neck, singed nasal hairs, a hoarse voice, and sputum with black specks. Which action is the priority?
- Monitor for stridor and prepare for early intubation.. Correct. Singed nasal hairs, hoarseness, and soot in the sputum point to an inhalation injury. Airway swelling can progress rapidly and close the airway, so early intubation is often needed before obstruction occurs. Airway comes before all other burn care.
- Calculate fluid needs using the burn resuscitation formula.. Incorrect. Fluid resuscitation is essential, but airway protection comes first when an inhalation injury is suspected.
- Apply a topical antimicrobial cream to the facial burns.. Incorrect. Wound care is important later but does not address the threat to the airway.
- Insert an indwelling urinary catheter to track output.. Incorrect. Hourly urine output guides fluid resuscitation, but this is not the priority over the airway.
Question 20 of 25 Psychosocial Integrity
A client with obsessive-compulsive disorder spends 45 minutes washing the hands each morning and has missed breakfast for 3 days. Which action should the nurse take?
- Stop the client after 10 minutes of handwashing each morning.. Incorrect. Abruptly stopping a ritual in the early phase of treatment greatly increases anxiety and may worsen the behavior.
- Wake the client earlier so the ritual ends before breakfast.. Correct. Rituals reduce the client’s anxiety, so early in treatment the nurse allows time for them and plans the schedule around them. Limits are added gradually as the client learns other ways to cope.
- Lock the bathroom door until breakfast is over each day.. Incorrect. Blocking access to the ritual causes severe anxiety and is a punitive approach.
- Point out that the client’s hands are already clean enough.. Incorrect. Logical arguments do not relieve obsessive thoughts. The client usually knows the behavior is excessive but feels unable to stop.
Question 21 of 25 Safety and Infection Control
The nurse is observing an unlicensed assistive personnel (UAP) moving clients. Which action by the UAP requires the nurse to intervene?
- Raises the bed to waist height before giving a bed bath. Incorrect. Working at waist height keeps the back straight and reduces strain, so this action is correct.
- Uses a friction-reducing sheet with a coworker to move a client up in bed. Incorrect. Friction-reducing devices and a second person lower the risk of injury to both the client and staff.
- Stands with feet apart to widen the base of support during a transfer. Incorrect. A wide base of support improves balance and stability during a transfer.
- Twists at the waist while turning a client from the bed to a chair. Correct. Twisting the trunk while bearing a load places high stress on the spine and is a common cause of back injury. The UAP should pivot with the feet and keep the body facing the client, so the nurse should intervene.
Question 22 of 25 Reduction of Risk Potential
A client returned from interventional radiology 4 hours ago with a new right nephrostomy tube. Which finding should the nurse report to the provider immediately?
- No drainage from the tube for 1 hour with new right flank pain. Correct. A sudden stop in drainage with new flank pain suggests the tube is blocked, kinked, or dislodged. Urine can back up into the kidney and cause damage or infection, so the provider must be notified right away. The nurse should not irrigate the tube unless it is prescribed.
- Pink-tinged urine draining from the nephrostomy tube. Incorrect. Light pink or blood-tinged urine is expected for the first day or two after placement.
- Mild discomfort at the insertion site rated 2 on a 0-10 scale. Incorrect. Mild discomfort at the insertion site is expected and can be managed with prescribed analgesics.
- Client voids clear yellow urine through the urethra. Incorrect. Urine from the other kidney still drains into the bladder, so voiding clear urine through the urethra is expected.
Question 23 of 25 Pharmacological and Parenteral Therapies
A client with type 2 diabetes takes semaglutide by subcutaneous injection once a week. The client calls the clinic with a new symptom. Which report requires the nurse to take immediate action?
- Mild nausea for a day or two after each weekly injection. Incorrect. Mild nausea is the most common side effect of GLP-1 receptor agonists and often improves over time.
- Less appetite and a steady weight loss over the past month. Incorrect. Reduced appetite and gradual weight loss are expected effects of semaglutide.
- Severe upper abdominal pain spreading to the back, with vomiting. Correct. Severe, persistent upper abdominal pain that may radiate to the back, with or without vomiting, suggests acute pancreatitis, a serious adverse effect of GLP-1 receptor agonists. The client should hold the drug and be evaluated right away.
- A small, faint red area at the injection site that fades quickly. Incorrect. A minor, short-lived skin reaction at the injection site is common and not urgent.
Question 24 of 25 Management of Care
The intensive care unit charge nurse needs a bed for a client arriving from surgery. Which client is most appropriate to transfer to the medical-surgical unit?
- A client receiving mechanical ventilation with 60% oxygen. Incorrect. A client who needs a ventilator and high oxygen levels requires intensive care monitoring.
- A client 3 days after a myocardial infarction who is pain-free with stable vital signs. Correct. This client is stable, without chest pain, and has a predictable course. Care can be safely provided on a medical-surgical unit, which frees the intensive care bed for a client with greater needs.
- A client with diabetic ketoacidosis who is receiving an IV insulin infusion. Incorrect. An insulin infusion for diabetic ketoacidosis requires hourly glucose checks and close electrolyte monitoring that most medical-surgical units cannot provide.
- A client receiving norepinephrine titrated to keep blood pressure stable. Incorrect. A vasoactive infusion being titrated to blood pressure requires continuous intensive care monitoring.
Question 25 of 25 Physiological Adaptation
A client with a history of hypertension suddenly reports “the worst headache of my life” and vomits. The client has a stiff neck and is drowsy but follows commands. The nurse notifies the provider. Which intervention should the nurse anticipate first?
- Aspirin 325 mg by mouth. Incorrect. Aspirin is contraindicated when bleeding in the brain is suspected because it can worsen the hemorrhage.
- Acetaminophen by mouth and dim the lights in the room. Incorrect. Comfort measures matter, but treating the pain does not identify the cause. The client is drowsy, so oral intake also raises the risk of aspiration.
- Place the client flat in bed with no pillow. Incorrect. Lying flat can raise intracranial pressure and increases aspiration risk in a vomiting, drowsy client. The head of the bed is usually raised.
- Prepare for an emergency noncontrast CT of the head. Correct. A sudden, severe headache with vomiting, neck stiffness, and drowsiness suggests subarachnoid hemorrhage. An emergency noncontrast CT scan is needed right away to confirm bleeding and guide treatment.
Your score
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What is on the NCLEX-RN?
Since April 2023, the NCLEX-RN uses the Next Generation NCLEX format. It is a computer adaptive test: the exam picks each question based on how you answered the ones before. You will get between 85 and 150 questions and have up to 5 hours, including clinical judgment case studies built around a single client.
Questions are organized by client needs:
- Safe and effective care environment: management of care, and safety and infection control.
- Health promotion and maintenance: growth and development, prevention, and screening.
- Psychosocial integrity: mental health, coping, and therapeutic communication.
- Physiological integrity: basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and physiological adaptation.
Tips for NCLEX priority questions
- Airway, breathing, and circulation come first, unless the question is about something else entirely, like safety or a client in pain who is otherwise stable.
- An acute, unexpected change beats a chronic or expected finding.
- Assess before you act, unless the client is in immediate danger.
- For delegation, the RN keeps assessment, teaching, evaluation, and unstable clients.
- Read every rationale, including the ones for answers you got right. That is where the learning happens.
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