💓 Savvy NurseOpen the app

🩺 20 questions · answers and rationales · free

NCLEX fundamentals practice questions

20 free NCLEX-style fundamentals questions: assessment, mobility, nutrition, elimination, comfort, skin integrity and health promotion, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A client with heart failure who is limited to 2,000 mg of sodium a day shows the nurse a can of soup labeled 'Reduced Sodium' on the front. The Nutrition Facts list a serving size of 1 cup, 2 servings per container, and 480 mg of sodium (21% Daily Value) per serving. The client plans to eat the whole can at lunch. Which response by the nurse is accurate?

  1. 'Eating the whole can gives you 480 mg, about a quarter of your limit.'
  2. 'At 21% of the Daily Value, this soup falls in the moderate range.'
  3. 'Eating the whole can gives you 960 mg, nearly half of your daily limit.'
  4. 'A reduced-sodium soup counts as low sodium, so the whole can fits.'
Show the answer and rationale

Answer: C

Label amounts are per serving, and the can holds 2 servings, so the whole can provides 2 × 480 = 960 mg, almost half of a 2,000-mg limit in one dish. Reading 480 mg as the amount in the whole can is the runner-up and the most common label error, because it ignores servings per container. By FDA guidance, 5% Daily Value or less per serving is low and 20% or more is high, so 21% is a high-sodium food, not a moderate one. 'Reduced sodium' means only at least 25% less than the regular product, while 'low sodium' means 140 mg or less per serving.

📚 Learn it: The Diet Orders You Must Not Mix Up

Question 2 of 20

A client who had a stroke receives continuous feedings at 65 mL/hr through a small-bore nasogastric tube. A new prescription reads phenytoin oral suspension 125 mg/5 mL, 125 mg through the tube three times a day. Which action should the nurse take?

  1. Stop the feeding for a set time before and after each dose
  2. Mix each dose into the formula bag so it infuses along with the feeding
  3. Watch for nystagmus and ataxia, because formula raises phenytoin levels
  4. Give each dose with the feeding running, then flush with 30 mL of water
Show the answer and rationale

Answer: A

The phenytoin label warns that clients receiving enteral feedings have lower than expected phenytoin levels and advises against giving the drug at the same time as a feeding, so the feeding is paused for the interval the facility or pharmacist sets before and after each dose, and serum levels are checked more often. Giving the dose with the feeding running and then flushing is the runner-up, because that is the routine for most tube medications, but the formula still lowers absorption and leaves the client underprotected against seizures. Mixing the drug into the bag adds the same problem and delays the dose, and formula lowers phenytoin levels rather than raising them toward toxicity.

📚 Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 3 of 20

A nurse plans to move a client from the bed to a chair. The client weighs 190 lb (86 kg), cannot bear weight on either leg, and cannot follow instructions reliably because of advanced dementia. Which method should the nurse use?

  1. A two-person pivot transfer using a gait belt
  2. A sliding board transfer with the bed level with the chair
  3. A full-body mechanical lift with a sling
  4. A stand-assist lift with the client gripping the handle
Show the answer and rationale

Answer: C

A client who cannot bear weight and cannot reliably cooperate is fully dependent, and safe handling guidance calls for a full-body mechanical lift; the recommended limit for lifting a person by hand is about 35 lb (16 kg), far below what this transfer would demand. A stand-assist lift is the runner-up because it is also mechanical, but it works only for a client who can bear some weight, hold on, and follow directions. A two-person pivot with a gait belt still lifts most of the client's weight by hand, and a sliding board needs sitting balance, arm strength, and cooperation the client does not have.

📚 Learn it: Canes, Crutches and Walkers: Which Side, Which Leg, Which Step

Question 4 of 20

A nurse and two assistive personnel (AP) are repositioning a client who had a lumbar spinal fusion yesterday. Which action by an AP requires the nurse to intervene?

  1. Having the client grab the side rail and pull himself over
  2. Placing a pillow between the client's knees before the turn
  3. Lowering the head of the bed flat before the turn
  4. Having the client cross the arms on his chest and keep his body stiff
Show the answer and rationale

Answer: A

After spinal surgery the spine is kept in straight alignment, so the client is logrolled: a pillow goes between the knees, a draw sheet is used, and on a signal the team turns the shoulders, hips and legs together as one unit while the client keeps the arms crossed on the chest. Grabbing the rail and pulling himself over twists the trunk and strains the fusion, so the nurse stops it and shows the client how to stay rigid and let the team do the turning. Lowering the bed flat can seem uncomfortable the day after surgery, but the head of the bed stays flat during the turn so the spine does not flex. Crossing the arms and keeping the body stiff is what the client should do.

📚 Learn it: Positions That Protect: Hips, Spines, Lungs and Enemas

Question 5 of 20

A client with peripheral artery disease who has been bedbound for 3 weeks has a pressure injury on the right heel covered completely by dry, black, firmly attached eschar. The surrounding skin has no redness, swelling, or drainage, and the area is not soft or fluctuant. Which action should the nurse include in the plan of care?

  1. Leave the eschar intact and float the heel off the bed
  2. Request an enzymatic debriding ointment to soften the eschar
  3. Cover the heel with a hydrocolloid dressing to keep it moist
  4. Document the injury as stage 4, because the eschar is black
Show the answer and rationale

Answer: A

Dry, adherent, intact heel eschar with no redness, fluctuance, or drainage is stable and acts as the body's natural cover; on a heel, especially one with poor arterial flow, it is not softened or removed, because opening it exposes a wound that may not heal and invites infection. The heel is floated and checked at each assessment for redness, drainage, or softening that would mean the eschar is no longer stable. An enzymatic debriding agent is the runner-up because it is a standard way to clear eschar from other wounds so they can be staged, but it is not used on stable heel eschar. A moist hydrocolloid softens eschar the same way, and an injury hidden by eschar is documented as unstageable, not stage 4.

📚 Learn it: Pressure Injuries: Stage It, Turn Them, Feed Them

Question 6 of 20 · Select all that apply

A client with Crohn disease who has a narrowed segment of the small intestine is prescribed a low-residue (low-fiber) diet to reduce the risk of a blockage. Which foods are appropriate for the client? Select all that apply.

  1. Popcorn as an afternoon snack
  2. Baked chicken with white pasta
  3. Brown rice with steamed green peas
  4. Smooth peanut butter on white crackers
  5. Canned peaches packed in juice
  6. Oatmeal topped with raisins
Show the answer and rationale

Answer: B, D, E

A low-residue diet limits fiber and other food that leaves bulk in the bowel, which could lodge at a narrowed segment. Refined white grains such as white crackers and pasta, tender cooked meat, canned fruit without skins or seeds, and smooth peanut butter are allowed; smooth peanut butter sounds like a nut food, but only crunchy peanut butter and whole nuts are avoided. Popcorn, oats, dried fruit such as raisins, brown rice, and peas are all high in fiber and are avoided, even though oatmeal and brown rice seem soft and gentle on the bowel.

📚 Learn it: The Diet Orders You Must Not Mix Up

Question 7 of 20

A nurse is supervising assistive personnel (AP) giving perineal care to an uncircumcised male client who has an indwelling urinary catheter. Which action by the AP requires the nurse to intervene?

  1. Washes the catheter from the meatus outward about 4 inches
  2. Uses plain soap and water rather than antiseptic at the meatus
  3. Gently retracts the foreskin before washing the glans
  4. Leaves the foreskin pulled back so the skin can air dry
Show the answer and rationale

Answer: D

After cleansing, the foreskin must be returned over the glans, because a foreskin left retracted can swell and constrict the penis (paraphimosis), an emergency that can cut off blood flow. Plain soap and water can look like a shortcut, but routine hygiene is what the CDC recommends; antiseptic cleaning of the meatus does not lower infection rates. Retracting the foreskin is the correct first step, the glans is cleaned in circles from the meatus outward, and the catheter is cleaned from the meatus out about 4 inches (10 cm) with a clean part of the washcloth for each stroke, moving organisms away from the urethral opening and lowering the risk of a catheter-associated infection.

📚 Learn it: Catheters, Ostomies and the Stoma Color Chart

Question 8 of 20

During preseason football practice on a hot August afternoon, a high school athlete collapses and is confused and combative, with hot, sweaty skin, a heart rate of 142 beats/min, and a rectal temperature of 106.2°F (41.2°C). An ice-water tub is set up on the field. Which action should the nurse take first?

  1. Start an IV and infuse a liter of normal saline for dehydration
  2. Immerse the athlete in the ice-water tub up to the neck
  3. Give acetaminophen and arrange rapid transport to the hospital
  4. Apply ice packs to the neck, armpits and groin until EMS arrives
Show the answer and rationale

Answer: B

A core temperature above 104°F (40°C) with confusion after exertion is exertional heat stroke, and survival depends on how quickly the temperature comes down, so the athlete is immersed in cold water up to the neck right away, following the rule 'cool first, transport second,' while the rectal temperature is monitored. Ice packs to the neck, armpits and groin are a familiar first-aid step, but they cool far more slowly than whole-body immersion, which is already available. Antipyretics such as acetaminophen do not work, because the high temperature is not caused by a raised set point in the hypothalamus, and transport before cooling loses critical time. IV fluids may help but must never delay cooling.

📚 Learn it: The Numbers That Should Live in Your Spine

Question 9 of 20

A nurse observes assistive personnel (AP) applying a prescribed aquathermia (warm water flow) pad to the lower back of a client with muscle spasms. Which action by the AP requires the nurse to intervene?

  1. Has the client lie on the pad so it stays in place
  2. Checks the skin under the pad every 5 minutes
  3. Slips a flannel cover over the pad before applying it
  4. Uses the key to set the temperature at 105°F (40.5°C)
Show the answer and rationale

Answer: A

Lying on a heating pad traps the heat and presses the skin against the warm surface, which cuts blood flow and the skin's ability to carry heat away, so burns can occur even at a safe setting; the pad goes over the area, never under the client or a body part. Checking the skin every 5 minutes is the runner-up because it sounds excessive, but it is the standard for heat applications, since redness, blistering, or pain can develop quickly. A flannel cover insulates the pad, and 105°F (40.5°C) set with a key is the usual temperature, so the client cannot turn it higher.

📚 Learn it: Pain Is What the Client Says It Is

Question 10 of 20

A charge nurse is reviewing documentation practices on a unit that uses charting by exception. Which action by a staff nurse requires the charge nurse to intervene?

  1. Documenting the 1000 dressing change at 0930 so she can stay with a new admission
  2. Entering an 1100 assessment at 1500, labeled as a late entry
  3. Charting only the assessment findings that differ from the unit's written normal standards
  4. Quoting a client who said, 'I don't want that shot, so stop asking me'
Show the answer and rationale

Answer: A

Documenting care before it is given falsifies the record, because the care may be delayed or never done and anyone reading the chart would believe the dressing was changed; care is charted only after it is done. Charting only findings that differ from the written standards sounds incomplete, but that is how charting by exception works, with the unit's standards defining what each normal entry means. Quoting a client's exact words is accurate, objective documentation of a refusal, and a late entry labeled with the time it was written and the time of the assessment is the correct way to add information after the fact.

📚 Learn it: Charting That Protects Your License

Practice 10 more Fundamentals questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A client receiving oxycodone after hip surgery has the expected outcome 'The client will have a soft, formed bowel movement by postoperative day 3.' The plan included 2,000 mL of fluid a day, high-fiber foods, and walking in the hall twice daily. On day 3, the client has not had a bowel movement. Which action should the nurse take first?

  1. Ask the provider for a prescription for a stimulant laxative
  2. Assess the abdomen and review how much of the plan the client carried out
  3. Change the target date to postoperative day 5 and continue the plan
  4. Revise the outcome to 'The client will pass flatus by postoperative day 3'
Show the answer and rationale

Answer: B

When an outcome is not met, the nurse first reassesses to find out why: assessing the abdomen and bowel sounds and checking whether the client actually drank the fluids, ate the fiber, and walked as planned shows whether the plan failed or was never carried out, and that answer guides the revision. A laxative is often needed with opioids, but asking for one before assessing skips the step that can reveal a problem such as an ileus and leaves the nurse unable to tell the provider what has been tried. Moving the target date or rewriting the outcome to something easier changes the goal without finding out why it was missed.

📚 Learn it: ADPIE: Nursing Diagnoses Are Not Medical Diagnoses

Question 12 of 20

A client with pneumonia has been receiving oxygen at 6 L/min by nasal cannula, without a humidifier, for 2 days. The SpO2 is 94%. The client reports a dry, burning nose and has had a small nosebleed. Which action should the nurse take?

  1. Switch to a simple face mask at 6 L/min to rest the nose
  2. Lower the flow to 4 L/min, the highest rate that needs no humidifier
  3. Apply a thin layer of petroleum jelly inside each nostril
  4. Attach a humidifier to the flowmeter and offer a water-soluble lubricant
Show the answer and rationale

Answer: D

Wall oxygen is completely dry, and at flows above about 4 L/min it dries and irritates the nasal mucosa, so a humidifier is added to the flowmeter and a water-soluble lubricant soothes the nares while the prescribed flow keeps the saturation at 94%. Lowering the flow to avoid humidification looks tidy, but it changes the prescribed oxygen dose for a client who needs 6 L/min and risks hypoxemia. Petroleum-based products are not used in the nares of a client on oxygen, and switching to a simple mask changes the device without a prescription and still delivers dry gas.

📚 Learn it: Oxygen Devices in One Table

Question 13 of 20

A 12-month-old is at the clinic for the measles, mumps and rubella (MMR) vaccine. The parent reports that the child developed hives and vomited after eating scrambled eggs last month, and an allergist has confirmed an egg allergy. Which action should the nurse take?

  1. Hold the vaccine until an allergist does a skin test with it
  2. Give the vaccine in two divided doses 30 minutes apart
  3. Postpone the vaccine until the child outgrows the egg allergy
  4. Give the MMR vaccine today and observe as for any vaccine
Show the answer and rationale

Answer: D

The measles and mumps vaccine viruses are grown in chick embryo cell cultures that contain almost no egg protein, so severe reactions to MMR in children with egg allergy are extremely rare, and the vaccine is given on schedule without skin testing or special precautions, with the routine observation and readiness to treat anaphylaxis that apply to every vaccine. Skin testing with the vaccine is the runner-up because it was once advised, but it does not predict reactions and only delays protection. Divided doses and waiting for the allergy to resolve leave the child exposed to measles; rare severe reactions to MMR are more often linked to the gelatin it contains.

📚 Learn it: The Vaccine Schedule and the Live-Vaccine Rule

Question 14 of 20 · Select all that apply

A 76-year-old client will be on bed rest for at least 2 weeks after a pelvic fracture that is being managed without surgery. Which interventions should the nurse include in the plan of care to prevent complications of immobility? Select all that apply.

  1. Place a pillow under the knees to keep the legs relaxed
  2. Massage the calves when the client reports leg cramping
  3. Teach the client to do ankle pumps and foot circles every hour while awake
  4. Have the client use the incentive spirometer every hour while awake
  5. Encourage a generous fluid intake unless fluids are restricted
  6. Keep the head of the bed at 60 degrees most of the day to ease breathing
Show the answer and rationale

Answer: C, D, E

Ankle pumps and foot circles keep blood moving through the leg veins and help prevent deep vein thrombosis, hourly incentive spirometry while awake keeps alveoli open against atelectasis and pneumonia, and a generous fluid intake keeps urine dilute against the calcium released from unused bone, softens stool and thins secretions. A pillow under the knees promotes knee flexion contractures and presses on the popliteal vessels, and massaging a cramping calf can dislodge a clot if a DVT is the cause. A head of the bed kept at 60 degrees adds shear and sacral pressure and keeps the hips flexed for hours.

📚 Learn it: Positions That Protect: Hips, Spines, Lungs and Enemas

Question 15 of 20

At a well-child visit, an 8-year-old client's body mass index plots at the 96th percentile for age and sex. Which action by the nurse is most appropriate?

  1. Give the parents healthy-eating handouts and recheck the BMI at next year's visit
  2. Enroll the child in a school activity program and set a weight-loss goal, rechecking BMI in 6 months
  3. Refer the child to a pediatric endocrinologist for evaluation for weight-loss medication
  4. Discuss referral to a family-based program on nutrition, activity and behavior
Show the answer and rationale

Answer: D

A BMI at or above the 95th percentile for age and sex indicates obesity in a child, and the USPSTF recommends offering or referring children 6 years and older at that level to intensive, family-based behavioral programs addressing nutrition, activity and behavior; the AAP advises against watchful waiting. The runner-up is a school activity program with a weight-loss goal and a recheck in 6 months: it adds activity, but it is not intensive or family-based and it delays comprehensive treatment. Handouts with a recheck in a year are watchful waiting, and excess weight in childhood often persists into adulthood. Weight-loss medications are not first-line treatment for an 8-year-old, so endocrinology referral for medication evaluation skips the recommended behavioral program.

📚 Learn it: Who Gets Screened for What, and When

Question 16 of 20

A nurse reviews the fundal assessments documented at four clients' prenatal visits. Which finding should the nurse report to the provider?

  1. At 34 weeks, fundal height of 28 cm measured from the symphysis pubis
  2. At 28 weeks, fundal height of 27 cm measured from the symphysis pubis
  3. At 22 weeks, fundal height of 20 cm measured from the symphysis pubis
  4. At 36 weeks, fundal height of 38 cm measured from the symphysis pubis
Show the answer and rationale

Answer: A

From about 20 to 36 weeks, fundal height in centimeters should match gestational age within about 2 cm, so 28 cm at 34 weeks lags by 6 cm and should be reported for ultrasound evaluation of growth restriction, low fluid, or dating error. The runner-up is 20 cm at 22 weeks, because it looks 2 cm behind but remains within the expected tolerance. A height of 38 cm at 36 weeks is likewise 2 cm above the week count and within tolerance, and 27 cm at 28 weeks differs by only 1 cm.

📚 Learn it: Prenatal Basics: Due Dates, Visits and Danger Signs

Question 17 of 20

A 70-year-old client reports taking more than an hour to fall asleep most nights. Which statement by the client indicates understanding of the nurse's sleep hygiene teaching?

  1. 'If I can't fall asleep, I'll lie still in bed with my eyes closed.'
  2. 'I'll get up at the same time every day, even on weekends.'
  3. 'I'll go to bed an hour earlier to get more sleep.'
  4. 'I'll take an over-the-counter sleep aid like diphenhydramine.'
Show the answer and rationale

Answer: B

A consistent wake-up time anchors the body's sleep-wake rhythm and is one of the most effective sleep hygiene measures. Lying still with eyes closed sounds restful, but lying awake in bed teaches the brain to link the bed with wakefulness; a client who cannot fall asleep within about 20 minutes should get up and do something quiet in dim light until drowsy. Going to bed earlier adds time awake in bed, and diphenhydramine is an anticholinergic the Beers Criteria advise older adults to avoid because it causes confusion, urinary retention, and falls.

📚 Learn it: Normal Aging Versus the Thing You Must Not Call Normal

Question 18 of 20

A client with Parkinson disease has a resting tremor and spills much of the food before it reaches the mouth, so meals take more than an hour. Which intervention should the nurse implement?

  1. Provide weighted utensils and a plate with a raised rim
  2. Feed the client each meal at a set time to shorten meals and conserve energy
  3. Replace solid meals with liquid supplements sipped slowly through a straw
  4. Serve all foods pureed to a smooth consistency so they are easier to spoon up
Show the answer and rationale

Answer: A

Weighted utensils dampen the tremor and a plate with a raised rim keeps food from being pushed off, so the client keeps eating independently, protecting nutrition and dignity. Serving all foods pureed to a smooth consistency is the runner-up because puree seems easier to spoon up, but food texture is changed only after a swallowing assessment and puree does not stop tremor-related spills. Feeding the client each meal to shorten mealtime removes function the client still has, and replacing meals with liquid supplements through a straw gives the client a fluid that is harder to control and is not indicated here.

📚 Learn it: The Diet Orders You Must Not Mix Up

Question 19 of 20

A nurse is checking a continuous tube feeding that runs from an open-system bag filled with ready-to-use formula poured from cans. Which finding requires the nurse to take action?

  1. The formula in the bag is at room temperature
  2. The tube was flushed with 30 mL of water 3 hours ago
  3. The formula in the bag was poured 10 hours ago
  4. The bag and tubing were last replaced 20 hours ago
Show the answer and rationale

Answer: C

Formula in an open system is exposed to air and bacteria, so ready-to-use formula hangs no more than 8 hours, and the bag and tubing are replaced every 24 hours; formula poured 10 hours ago is discarded. A bag and tubing changed 20 hours ago are still within their 24-hour limit, which makes that finding easy to confuse with the 8-hour rule for the formula. Formula is given at room temperature, since cold formula can cause cramping, and a regular water flush is correct.

📚 Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 20 of 20

A nurse is evaluating how an older adult client uses a standard pickup walker after surgery for a hip fracture. Which action by the client indicates a need for further teaching?

  1. Pulls up on the walker's handgrips to rise from the chair
  2. Pushes up from the chair's armrests and then grips the walker
  3. Keeps all four walker legs flat on the floor before shifting weight onto the handgrips
  4. Advances the walker a short distance, then steps in with the operated leg first
Show the answer and rationale

Answer: A

Pulling up on the handgrips can tip the walker backward and cause a fall, so this action needs correction. Pushing up from the chair armrests and then gripping the walker is the runner-up because it also involves rising from a chair, but it uses a stable support and is correct technique. Advancing the walker a short distance and then stepping in with the operated leg protects the healing hip, and keeping all four legs flat before shifting weight onto the handgrips prevents the frame from rocking or sliding.

📚 Learn it: Canes, Crutches and Walkers: Which Side, Which Leg, Which Step

Practice 10 more Fundamentals questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

📚 Learn it first

📝 More NCLEX practice questions