☑️ 20 questions · answers and rationales · free
NCLEX select-all-that-apply (SATA) practice questions
20 free NCLEX-style select-all-that-apply questions from every client-needs area, with full rationales. The Next Generation NCLEX scores SATA plus/minus: a point for each right choice, minus one for each wrong one.
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 · Select all that apply
A nurse is using a portable bladder ultrasound scanner to check a 68-year-old female client for urinary retention after knee surgery. The client had a hysterectomy 10 years ago. Which actions by the nurse are appropriate? Select all that apply.
- Aims the probe up toward the client's umbilicus
- Places the client supine with the abdominal muscles relaxed
- Applies gel midline about 1 inch (3 cm) above the symphysis pubis
- Raises the head of the bed to 45 degrees so urine pools low in the bladder
- Selects the male setting on the scanner
- Records the first reading without repeating the scan
Show the answer and rationale
Answer: B, C, E
The scanner's female setting is meant to account for the uterus, so the manufacturer limits it to women who have not had a hysterectomy, and this client is scanned on the male setting. The client lies supine with the abdominal muscles relaxed, and gel goes midline about 1 inch (3 cm) above the symphysis pubis, with the probe aimed slightly downward toward the coccyx so the beam clears the pubic bone, not up toward the umbilicus. Two or three readings are taken with the bladder centered on the crosshairs, because one off-target scan can miss part of the bladder, and the scan is done with the client flat rather than with the head raised.
Question 2 of 20 · Select all that apply
A 45-year-old client with sputum smear-positive, drug-susceptible pulmonary tuberculosis is in an airborne infection isolation room on day 9 of four-drug therapy. He asks what has to happen before he can come off airborne precautions. Which criteria must be met? Select all that apply.
- A chest x-ray showing that the cavity has closed
- At least 2 weeks of standard multidrug treatment
- Completion of the entire course of treatment
- Clinical improvement, such as less coughing and no fever
- Two negative sputum smears collected on the same morning
- Three negative sputum smears for acid-fast bacilli, collected 8 to 24 hours apart, one in the early morning
Show the answer and rationale
Answer: B, D, F
For confirmed drug-susceptible pulmonary TB, the CDC criteria for ending airborne precautions are three consecutive negative AFB sputum smears collected 8 to 24 hours apart with at least one early-morning specimen, at least 2 weeks of standard multidrug therapy, and clinical improvement, so this client on day 9 must stay in the room. Two smears from one morning are too few and too close together to show that he has stopped shedding bacilli. Healing on a chest x-ray is not one of the criteria, and the client does not need to finish the months-long course before precautions end.
Question 3 of 20 · Select all that apply
An RN on a medical unit has assigned four stable clients to a licensed practical nurse (LPN). Which actions by the RN reflect the RN's continuing accountability for these clients? Select all that apply.
- Leaving outcomes to the LPN, who is now accountable for the clients' care
- Checking in with the LPN at set times to review each client's status
- Waiting until the end of the shift to review the LPN's notes for problems
- Assessing a client herself when the LPN reports new crackles in his lungs
- Recording the LPN's data collection as the RN's own assessment
- Evaluating whether each client is meeting the outcomes in the plan of care
Show the answer and rationale
Answer: B, D, F
Assigning care moves the work, not the accountability: the LPN answers for her own practice, while the RN remains responsible for supervising, assessing and evaluating the clients' outcomes. The RN therefore follows up at planned times, assesses a client whose condition changes, and judges progress against the plan. Data the LPN collects are interpreted and validated by the RN, so recording them as the RN's assessment misstates who assessed the client. The LPN does not take over accountability for outcomes, and an end-of-shift chart review finds problems hours too late to act on them.
📚 Learn it: Delegation Cheat Code: Never Delegate What You EAT
Question 4 of 20 · Select all that apply
A nurse is observing a newly hired nurse measure vital signs on adult clients. Which actions by the new nurse are appropriate? Select all that apply.
- Keeps the fingers on the wrist while counting respirations after the pulse
- Pulls the ear up and back before inserting the tympanic thermometer probe
- Waits 20 minutes after the client finishes a cup of hot coffee before taking an oral temperature
- Places the oral thermometer probe under the front of the tongue, just behind the lower teeth
- Counts an irregular radial pulse for 15 seconds and multiplies by 4
- Takes a rectal temperature on a client whose absolute neutrophil count is 400/mm³
Show the answer and rationale
Answer: A, B, C
A hot drink warms the mouth, so the nurse waits about 15 to 25 minutes or uses another route; pulling the pinna up and back straightens an adult's ear canal so the probe aims at the eardrum; and counting respirations while still appearing to take the pulse keeps the client from changing the breathing pattern. The oral probe belongs in the posterior sublingual pocket at the base of the tongue, where blood flow reflects core temperature, not under the front of the tongue. An irregular pulse is counted for a full 60 seconds, because a short count multiplies the error. Rectal temperatures are avoided in neutropenia because the probe can injure the mucosa and introduce bacteria.
Question 5 of 20 · Select all that apply
A client who had open abdominal surgery yesterday rates incisional pain as 5 out of 10, 1 hour after the prescribed oral opioid. The nurse plans nonpharmacological measures to add to the pain plan. Which measures are appropriate? Select all that apply.
- Teach the client to roll onto the side and push up with the arms to get out of bed
- Coach slow, rhythmic breathing during position changes
- Apply a heating pad over the dressing to relax the abdominal muscles
- Gently massage the skin directly over the incision
- Teach the client to hold a pillow firmly over the incision when coughing
- Delay walking until the pain is 2 out of 10 or lower
Show the answer and rationale
Answer: A, B, E
Splinting the incision with a pillow supports the wound edges during coughing, slow rhythmic breathing relaxes the abdominal muscles and gives the client a sense of control while moving, and rolling to the side before pushing up with the arms keeps the abdominal muscles from pulling on the incision. Heat is not placed over a fresh surgical wound, where it increases blood flow, swelling, and bleeding, and massage directly over an incision disrupts healing tissue. Waiting for pain to fall to 2 out of 10 before walking delays early ambulation, which prevents pneumonia and blood clots; the goal is pain controlled well enough to move, not the absence of pain.
Question 6 of 20 · Select all that apply
A 68-year-old client with heart failure tells the clinic nurse that she has slept poorly for a month. She takes furosemide in the morning and again at bedtime, drinks a glass of wine at bedtime to help her fall asleep, watches television in bed until she dozes off, and naps for about 2 hours most afternoons. Which recommendations should the nurse make? Select all that apply.
- Ask your provider whether the second furosemide dose can be taken earlier in the day
- Drink most of your daily fluids after supper so you do not wake up thirsty
- Shorten the afternoon nap or skip it so you are sleepy at bedtime
- Skip the bedtime furosemide dose on nights when you need a good sleep
- Stop the bedtime wine, since alcohol breaks up sleep later in the night
- Keep watching television in bed until you doze off, since it relaxes you
Show the answer and rationale
Answer: A, C, E
A diuretic taken at bedtime causes nighttime urination, so the client asks the provider about taking the second dose earlier in the day rather than skipping it, which could let fluid build up and worsen her heart failure. Alcohol helps her fall asleep but breaks up sleep later in the night, and a long afternoon nap lowers her drive to sleep at night, so both are cut back. Drinking most fluids in the evening adds to nighttime voiding, and a television in bed keeps her alert with light and sound and trains her to link the bed with being awake.
📚 Learn it: ADPIE: Nursing Diagnoses Are Not Medical Diagnoses
Question 7 of 20 · Select all that apply
A client at 30 weeks of gestation has a negative varicella antibody test and no record of chickenpox or varicella vaccine. She has not received a Tdap vaccine during this pregnancy. Which actions should the nurse anticipate? Select all that apply.
- Wait to give Tdap until after the birth so the fetus is not exposed
- Teach her to call the provider right away if she is exposed to chickenpox
- Give the Tdap vaccine at this visit
- Give the first dose of varicella vaccine at this visit
- Plan the first varicella dose after the birth, before discharge
- Teach her that she must stop breastfeeding after the varicella vaccine
Show the answer and rationale
Answer: B, C, E
Varicella vaccine is live and is not given in pregnancy, so a nonimmune client receives the first dose after the birth, before discharge, and the second 4 to 8 weeks later; it is safe while breastfeeding. Until then she reports any exposure to chickenpox promptly, because varicella zoster immune globulin given soon after an exposure can prevent or soften an infection that is more dangerous in pregnancy. Tdap is an inactivated vaccine recommended in every pregnancy at 27 to 36 weeks, so at 30 weeks it is given now; waiting until after the birth would not pass protective pertussis antibodies to the newborn.
Question 8 of 20 · Select all that apply
At 0700 a nurse is starting a 24-hour urine collection for creatinine clearance for a client who is continent and able to void. Which actions are appropriate? Select all that apply.
- Have the client empty the bladder at 0700 and discard that urine
- Keep the collection container on ice or refrigerated, per laboratory instructions
- Draw the prescribed serum creatinine level during the collection period
- Have the client void at 0700 tomorrow and add that urine to the container
- Measure and record each void, and then discard the urine in the toilet
- Limit the client's fluids so that each specimen is more concentrated
Show the answer and rationale
Answer: A, B, C, D
A 24-hour collection must hold exactly the urine made in 24 hours: the client empties the bladder at the start and that urine is discarded because it was made before the start time, then every void is saved, ending with a final void at the same clock time the next day. Keeping the urine cold, or using the preservative the laboratory supplies, protects the specimen, and creatinine clearance compares urine creatinine with a serum creatinine drawn during the collection. Measuring and then discarding voids is an intake-and-output habit that loses the specimen, and restricting fluids is not needed and can dehydrate the client.
📚 Learn it: Urinalysis, Specific Gravity and Collecting It Right
Question 9 of 20 · Select all that apply
A nurse is teaching a 66-year-old client who has just named her daughter as her health care agent in a durable power of attorney for health care. Which statements by the client indicate understanding? Select all that apply.
- 'If my living will and my daughter disagree, her choice replaces what I wrote.'
- 'My daughter will need a judge to approve each decision she makes for me.'
- 'My daughter should choose what I would want, even if she'd choose differently.'
- 'From now on, my doctors will discuss my care only with my daughter.'
- 'I should tell my daughter now which treatments I would and wouldn't want.'
- 'While I can still make my own decisions, my daughter can't overrule me.'
Show the answer and rationale
Answer: C, E, F
An advance directive never overrides the current wishes of a client who can decide, so the agent acts only when the client cannot. The agent is expected to decide as the client would, using her stated wishes, written ones included, which is why talking with the agent now matters. Once the client loses capacity, the named agent has legal authority without a judge approving each decision. A living will is part of the wishes the agent must carry out, not something the agent replaces, and naming an agent does not shift conversations about her care away from her while she can decide.
📚 Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'
Question 10 of 20 · Select all that apply
A 58-year-old client with amyotrophic lateral sclerosis (ALS) has depended on a ventilator through a tracheostomy for 2 years. He is alert, communicates with an eye-gaze device, and tells the team, 'I've thought about this for months. I want the ventilator stopped.' His wife, who is his health care agent, says, 'I can't let him do this.' Which actions should the nurse take? Select all that apply.
- Notify the provider so the client's decision-making capacity can be confirmed and documented
- Tell the client the ventilator will stay on until his wife agrees
- Explain that a ventilator cannot legally be stopped once it has been started
- Offer his wife support from the chaplain or social worker
- Ask his wife, as his health care agent, to make the final decision
- Ask the palliative care team to plan medications that will keep him comfortable during the withdrawal
Show the answer and rationale
Answer: A, D, F
A client with decision-making capacity may decline any treatment, including one already started, and there is no ethical difference between withholding and withdrawing it, so the nurse makes sure the provider confirms and documents his capacity and informed choice, involves palliative care to plan medications for comfort, and supports his wife in her grief. A health care agent decides only when the client cannot, so his wife does not make the final choice and her agreement is not a condition of honoring his. The idea that a ventilator cannot be stopped once started is a common misconception.
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Question 11 of 20 · Select all that apply
A nurse on a surgical unit has concerns about a coworker. Which observations suggest possible drug diversion and should be reported to the nurse manager? Select all that apply.
- The coworker uses the cabinet override to remove naloxone during a rapid response.
- Clients assigned to the coworker often say their opioid doses 'didn't help at all.'
- The coworker calls the pharmacist to question an opioid dose that seems too high.
- The coworker asks colleagues to co-sign opioid wastes they did not see.
- The coworker records a pain rating before and after each opioid dose she gives.
- The coworker often offers to give pain medication to other nurses' clients.
Show the answer and rationale
Answer: B, D, F
Frequent reports of unrelieved pain after documented doses, offering to medicate other nurses' clients, and asking colleagues to co-sign wastes they did not witness are recognized signs of drug diversion, and the nurse reports them to the nurse manager, who investigates. Questioning a dose that seems too high is safe practice, using an override to get naloxone in an emergency is expected, and pain ratings before and after each dose are required reassessment, so none of these suggests diversion.
📚 Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment
Question 12 of 20 · Select all that apply
At 0700, a nurse receives handoff on a 66-year-old client with type 1 diabetes who was admitted with a foot infection. Which statements by the off-going nurse need clarification before the off-going nurse leaves? Select all that apply.
- 'Her IV site was checked at 0600; no redness or swelling, and it flushes easily.'
- 'I gave her something for pain around 4 o'clock.'
- 'Her blood sugars were fine overnight.'
- 'Her son is her health care agent, and the form is scanned into her record.'
- 'Her temperature was 99.0°F (37.2°C) at 0600, down from 101.2°F (38.4°C) last evening.'
- 'She's a DNR, I think. Her daughter mentioned it last night.'
Show the answer and rationale
Answer: B, C, F
Code status is core handoff content and must come from the provider's order, not a family member's remark, so an uncertain 'I think' is verified now. 'Something for pain around 4' gives no drug, dose, or exact time, so the next dose could be given too early or the wrong drug repeated, and 'fine' blood sugars in a client on insulin gives no values or insulin doses to act on. The temperature trend, the IV site check, and the health care agent with the form on file are specific, dated, and verifiable, which is what a safe handoff sounds like.
📚 Learn it: SBAR, Handoffs and When to Climb the Chain of Command
Question 13 of 20 · Select all that apply
A medical-surgical unit starts a quality improvement project to reduce hospital-acquired pressure injuries. Which data are process measures for this project? Select all that apply.
- Percentage of at-risk clients placed on a pressure-redistribution surface
- Percentage of clients whose pressure injury risk is assessed on admission
- Number of pressure-redistribution mattresses the unit has available
- Number of certified wound care nurses on the hospital's staff
- Number of hospital-acquired pressure injuries per 1,000 occupied bed-days
- Percentage of at-risk clients repositioned on schedule, according to the record
Show the answer and rationale
Answer: A, B, F
Process measures track whether staff carry out the care steps that prevent the outcome, such as assessing risk on admission, repositioning on schedule, and using a pressure-redistribution surface for clients at risk. The rate of hospital-acquired pressure injuries is the outcome measure the project hopes to change. The number of mattresses available and the number of certified wound care nurses are structure measures, which describe the resources in place rather than the care actually given.
📚 Learn it: Incident Reports, Root Causes and Who to Refer To
Question 14 of 20 · Select all that apply
A nurse is teaching a 74-year-old client who will take dabigatran 150 mg twice daily, at 0800 and 2000, for atrial fibrillation. Which statements by the client indicate understanding? Select all that apply.
- 'If the capsules upset my stomach, I'll stop them until my next appointment.'
- 'If I remember my morning dose at 1600, I'll skip it and take my 2000 dose as usual.'
- 'If I miss a dose, I'll take two capsules the next time to catch up.'
- 'I'll keep the capsules in the bottle they came in until it's time to take one.'
- 'I'll throw away any capsules left 4 months after I first opened the bottle.'
- 'I'll fill a weekly pill organizer every Sunday so I don't forget a dose.'
Show the answer and rationale
Answer: B, D, E
Dabigatran capsules must be protected from moisture, so they stay in the original bottle until each dose, and any left 4 months after the bottle is first opened are thrown away. A missed dose is taken only if it can be taken at least 6 hours before the next one, so at 1600, 4 hours before the 2000 dose, it is skipped. A pill organizer sounds like good adherence advice, but the manufacturer says not to put the capsules in one. Stomach upset is common and is handled by taking the capsule with food, not by stopping it, which leaves the client unprotected against stroke, and doses are never doubled.
Question 15 of 20 · Select all that apply
A client in the cardiac care unit with recurrent ventricular tachycardia has just received an amiodarone loading dose of 150 mg over 10 minutes. The nurse is starting the prescribed maintenance infusion of 1 mg/min for 6 hours, then 0.5 mg/min, through a peripheral IV. Which actions should the nurse take? Select all that apply.
- Use an administration set with an in-line filter
- Give any supplemental 150 mg dose by IV push over 1 minute
- Mix the infusion in a standard PVC bag, since the drug does not bind to plastic
- Slow the infusion and notify the provider if the blood pressure falls
- Hang the infusion in a glass or polyolefin container
- Keep the concentration at 2 mg/mL or less while it runs in a peripheral vein
Show the answer and rationale
Answer: A, D, E, F
The amiodarone label calls for an in-line filter, and infusions lasting more than 2 hours must run from glass or polyolefin containers, because the drug adsorbs to PVC and leaches the plasticizer DEHP from it. For infusions longer than an hour, the concentration stays at 2 mg/mL or less unless a central line is used, since stronger solutions cause phlebitis. Hypotension can occur during IV therapy, and the label says to treat it first by slowing the infusion. A standard PVC bag is the opposite of the label's advice, and supplemental 150 mg doses are infused over 10 minutes, not pushed.
📚 Learn it: Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops
Question 16 of 20 · Select all that apply
A nurse is preparing to hang a new bag of a 3-in-1 total nutrient admixture (dextrose, amino acids and lipid emulsion) through the dedicated lumen of a client's PICC. Which actions should the nurse take? Select all that apply.
- Keep the same tubing for 72 hours, as for other continuous infusions
- Compare each component on the bag's label with the PN prescription
- Prime new tubing that has a 1.2-micron in-line filter
- Give the scheduled IV pantoprazole through the PN lumen
- Check the client's capillary glucose every 6 hours as the protocol directs
- Use a 0.2-micron filter so that bacteria are removed as well
Show the answer and rationale
Answer: B, C, E
ASPEN's checklist has the nurse match every component on the label against the prescription and use a 1.2-micron filter, which lets lipid droplets through; a 0.2-micron filter is meant for lipid-free solutions and should not be used with lipid emulsion. Glucose is checked often, commonly every 6 hours at the start, because the dextrose load can cause hyperglycemia. Medications are not co-infused through the PN line, and tubing for a lipid-containing admixture is replaced within 24 hours, with each new bag, not on the 72-hour schedule used for clear fluids.
📚 Learn it: IV Fluids, Potassium Rules and the First 15 Minutes of a Transfusion
Question 17 of 20 · Select all that apply
A nurse is teaching a client with type 2 diabetes who is starting empagliflozin. Which statements by the client indicate understanding? Select all that apply.
- 'My urine tests will show sugar, so I'll keep using my meter to check my glucose.'
- 'I'll call if I have burning when I urinate, a fever or pain in my back.'
- 'I only need to worry about ketones when my blood sugar is higher than 300.'
- 'If I'm vomiting or have belly pain, I'll stop the pill and get seen, even if my sugar isn't high.'
- 'Urinating more often than before means the pill is damaging my kidneys.'
- 'I'll cut back on how much I drink so I don't have to urinate so often.'
Show the answer and rationale
Answer: A, B, D
SGLT2 inhibitors make the kidneys excrete glucose, so urine glucose tests stay positive and glucose is tracked with a meter. They can cause ketoacidosis with a glucose lower than expected, so nausea, vomiting or abdominal pain means stopping the drug and seeking care, and signs of a urinary tract infection are reported promptly because pyelonephritis and urosepsis can occur. More frequent urination is an expected effect, not kidney damage, cutting fluids worsens the volume depletion these drugs can cause, and waiting for a glucose over 300 mg/dL misses the ketoacidosis they cause.
📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each
Question 18 of 20 · Select all that apply
An 86-year-old client arrives 80 minutes after the sudden onset of left arm weakness and slurred speech. The CT shows no hemorrhage, and the stroke team is considering IV thrombolytic therapy. Which findings would exclude the client from receiving it? Select all that apply.
- Blood pressure of 178/104 mm Hg
- Last dose of apixaban taken 10 hours ago
- Ischemic stroke 6 weeks ago
- Platelet count of 84,000/mm³
- Age of 86 years
- Takes aspirin 81 mg daily
Show the answer and rationale
Answer: B, C, D
A platelet count below 100,000/mm³, a direct oral anticoagulant such as apixaban taken within the past 48 hours, and an ischemic stroke within the past 3 months each raise the risk of bleeding into the brain enough to exclude IV thrombolysis. The blood pressure is the tempting wrong choice, but thrombolysis requires a pressure below 185/110 mm Hg, which 178/104 mm Hg meets. There is no upper age limit for treatment, and daily low-dose aspirin, like other single antiplatelet therapy, does not exclude a client.
Question 19 of 20 · Select all that apply
A client with small cell lung cancer has chronic SIADH and is being discharged on a fluid restriction. Which instructions should the nurse include? Select all that apply.
- Count ice chips, soup, and gelatin as part of the daily fluid limit
- Drink a sports drink instead of water to replace sodium
- Stop the fluid limit once your ankles are no longer swollen
- Report a headache, nausea, or new confusion to the provider
- Weigh yourself every morning on the same scale
- Use a salt substitute to help raise your sodium level
Show the answer and rationale
Answer: A, D, E
In SIADH the kidneys keep holding water, so every liquid counts toward the limit, including foods that are liquid at room temperature. Daily weights on the same scale show water retention early, and headache, nausea, or confusion can mean the sodium is falling and the brain is swelling. Salt substitutes are mostly potassium chloride and do not raise sodium. SIADH retains water without visible edema, so swollen ankles were never the marker for the restriction. A sports drink still counts as fluid, and its sodium content is far lower than the blood's, so it does not offset the water.
Question 20 of 20 · Select all that apply
A nurse on a surgical unit receives report on six clients who have new ostomies. Which clients have findings that require prompt follow-up? Select all that apply.
- 5 days after a colostomy: the stoma protrudes much farther from the abdomen than it did this morning
- 4 days after an ileostomy: the stoma is dry and dull, and the client feels dizzy when standing
- 1 day after an ileal conduit (urostomy): urine output of 10 mL/hr for the past 2 hours
- 1 day after an ileal conduit (urostomy): strands of mucus in the urine in the pouch
- 3 days after a colostomy: passing gas into the pouch but no stool yet
- 1 day after an ileostomy: dark green liquid draining into the pouch
Show the answer and rationale
Answer: A, B, C
Urostomy output should stay at 30 mL/hr or more, so 10 mL/hr for 2 hours needs assessment of fluid status and the pouch and a call to the provider. A dry, dull stoma with dizziness on standing points to dehydration, the main risk of a new ileostomy because its output is liquid and continuous, and a stoma that protrudes much farther than before is a prolapse that the provider must evaluate. Mucus strands are normal in urine from a conduit made of bowel, dark green liquid output is expected from a new ileostomy within 24 to 48 hours, and a colostomy usually passes gas by 48 to 72 hours and stool around days 4 to 5.
📚 Learn it: Unstable Beats Stable, Unexpected Beats Expected
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