Free NCLEX-RN Questions and Answers — Questions and Answers

Question 1: Which person has the highest chance of having hypertension?

40-year-old Caucasian nurse
55-year-old Hispanic teacher
45-year-old African-American attorney (Correct answer)
60-year-old Asian-American shop owner

Correct answer: 45-year-old African-American attorney

African Americans have a significantly higher prevalence and severity of hypertension compared to other racial and ethnic groups, often developing it earlier in life. While age is a risk factor, the combination of African-American ethnicity and being in the mid-40s places this individual at the highest risk among the given options. This demographic group experiences a disproportionate burden of hypertension.

Question 2: A 18-year-old female is transported to the emergency room after taking 15 maximum dosage acetaminophen tablets 45 minutes earlier. Which directive should the nurse follow first?

Administer acetylcysteine (mucomyst) orally
Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open
Have the patient drink activated charcoal mixed with water
Gastric lavage (Correct answer)

Correct answer: Gastric lavage

For an acetaminophen overdose within 1 hour of ingestion, gastric lavage (stomach pumping) is often the preferred initial intervention to remove unabsorbed medication from the stomach. This procedure aims to quickly reduce the amount of drug absorbed into the bloodstream. Activated charcoal can also be used, but lavage is more effective for large ingestions within a very short timeframe before significant absorption occurs.

Question 3: In the first 24 hours following the procedure, which cardiac catheterization complication should the nurse be on the lookout for?

Thrombus formation (Correct answer)
Dizziness
Falling blood pressure
Angina at rest

Correct answer: Thrombus formation

After a cardiac catheterization, the insertion site (often the femoral artery) is at risk for complications. Thrombus formation, leading to arterial occlusion, is a significant concern in the first 24 hours due to vessel trauma and the presence of a foreign body (catheter). Nurses must diligently monitor for signs of decreased circulation, pain, pallor, and pulselessness in the affected extremity to detect this serious complication early.

Question 4: A patient with renal calculi is brought into the emergency room complaining of nausea and moderate to severe flank discomfort. The patient is currently 100.8 degrees Fahrenheit hot. For this client, the top nursing objective is:

Prevent urinary tract infection
Manage pain (Correct answer)
Maintain fluid and electrolyte balance
Control nausea

Correct answer: Manage pain

Renal calculi (kidney stones) often cause excruciating flank pain, which is typically the most distressing symptom for the patient. While preventing infection (indicated by fever), maintaining fluid balance, and controlling nausea are important, addressing the severe pain is the immediate priority to provide comfort and allow the patient to cooperate with further diagnostic and treatment measures. Effective pain management improves patient well-being and facilitates care.

Question 5: What would a nurse look for when evaluating a child's progress over the school years?

Yearly weight gain of about 5.5 pounds per year (Correct answer)
Progressive height increase of 4 inches each year
Decreasing amounts of body fat and muscle mass
Little change in body appearance from year to year

Correct answer: Yearly weight gain of about 5.5 pounds per year

School-aged children (6-12 years) typically experience a steady, moderate growth rate. A weight gain of approximately 5.5 pounds (2.5 kg) per year is considered a normal and healthy indicator of progress during these years. This consistent growth reflects adequate nutrition and development, unlike the other options which describe abnormal or inconsistent growth patterns.

Question 6: A 64-year-old client's blood pressure is 160/96 mmHg at a neighborhood health fair. The patient says, "My blood pressure is usually much lower." The nurse should instruct the patient to:

See the healthcare provider immediately
Visit the health care provider within one (1) week for a BP check
Go get a blood pressure check within the next 15 minutes (Correct answer)
Check blood pressure again in two (2) months

Correct answer: Go get a blood pressure check within the next 15 minutes

A single elevated blood pressure reading, especially if the client states it's usually lower, could be due to temporary factors like stress, anxiety, or recent activity. The immediate priority is to recheck the blood pressure after a short rest period (10-15 minutes) to ensure accuracy and rule out transient elevation. This allows for a more reliable assessment of the client's true blood pressure status before escalating to a healthcare provider visit.

Question 7: A 24-year-old man who has recently been diagnosed with hypothyroidism will take 50 mcg of levothyroxine (Synthroid) orally each day. The nurse stresses in the lesson plan that this medication:

Should be taken in the morning (Correct answer)
May decrease the client’s energy level
Must be stored in a dark container
Will decrease the client’s heart rate

Correct answer: Should be taken in the morning

Levothyroxine (Synthroid) is best absorbed on an empty stomach and should be taken in the morning, typically 30-60 minutes before breakfast. Taking it at this time helps ensure consistent absorption and prevents interactions with food or other medications. This timing also mimics the body's natural diurnal rhythm of thyroid hormone release, optimizing its effectiveness and reducing the risk of insomnia if taken later in the day.

Question 8: The nursing diagnostic of Impaired Physical Mobility associated with Neuromuscular Impairment is given to patients with Parkinson's disease. All of these tasks are being performed by a nursing assistant, as you can see. What need do you have to step in?

The NA reminds the patient not to look at his feet when he is walking.
The NA sets up the patient’s tray and encourages the patient to feed himself.
The NA assists the patient to ambulate to the bathroom and back to bed.
The NA performs the patient’s complete bath and oral care. (Correct answer)

Correct answer: The NA performs the patient’s complete bath and oral care.

For a patient with Parkinson's disease and 'Impaired Physical Mobility,' the goal is to promote independence and maintain function as much as possible. While NAs can assist with personal care, performing a *complete* bath and oral care for a patient who might be able to do some tasks themselves goes against the principle of encouraging self-care. The nurse should intervene to ensure the patient is encouraged to participate in their care to the fullest extent possible, which helps maintain their physical and cognitive abilities.

Question 9: The nurse is giving the leukemia patient discharge instruction. The customer should be warned not to:

Flossing between the teeth (Correct answer)
Using oil- or cream-based soaps
Using an electric razor
The intake of salt

Correct answer: Flossing between the teeth

Patients with leukemia are often at high risk for thrombocytopenia (low platelet count) due to bone marrow suppression from the disease or treatment. Thrombocytopenia increases the risk of bleeding. Flossing can cause trauma to the gums and lead to bleeding, which can be difficult to control in a thrombocytopenic patient, making it an activity to avoid.

Question 10: The client with a tracheostomy is having his or her ties changed by the nurse. The following actions are the safest ways to adjust tracheostomy ties:

Hold the tracheostomy with the nondominant hand while removing the old tie.
Apply the new tie before removing the old one. (Correct answer)
Ask the doctor to suture the tracheostomy in place.
Have a helper present.

Correct answer: Apply the new tie before removing the old one.

When changing tracheostomy ties, it is crucial to apply the new ties *before* removing the old ones. This prevents accidental dislodgement of the tracheostomy tube, which could lead to airway obstruction or loss of the airway, a life-threatening emergency. Maintaining securement of the tube at all times is paramount for patient safety.

Question 11: Following a lung resection, the nurse is keeping an eye on the patient. The chest tube produced 300mL per hour. Priority should be given to:

Slowing the intravenous infusion
Turning the client to the left side
Notifying the physician (Correct answer)
Milking the tube to ensure patency

Correct answer: Notifying the physician

Following a lung resection, chest tube drainage of 300 mL per hour is excessive and indicates significant bleeding or hemorrhage. Normal drainage is typically less than 100 mL/hour. This amount of drainage is a medical emergency requiring immediate physician notification for further assessment and intervention, as it could lead to hypovolemic shock.

Question 12: Tetralogy of Fallot is the reason for the infant's admission to the unit. Which medication would the nurse expect to receive a request for?

Epinephrine
Aminophylline
Atropine
Digoxin (Correct answer)

Correct answer: Digoxin

Tetralogy of Fallot is a congenital heart defect that often leads to right-to-left shunting and decreased pulmonary blood flow, causing cyanosis. While surgical repair is definitive, medications like digoxin may be used to improve cardiac output and manage heart failure symptoms in infants awaiting surgery or to support cardiac function. Digoxin strengthens myocardial contraction, which can be beneficial in managing the heart's workload.

Question 13: The toddler has a heart abnormality and is hospitalized. The newborn with a ventricular septal defect will, according to the nurse:

Grow normally
Be more susceptible to viral infections
Tire easily (Correct answer)
Need more calories

Correct answer: Tire easily

A ventricular septal defect (VSD) allows oxygenated blood from the left ventricle to shunt into the right ventricle and then to the pulmonary artery, increasing blood flow to the lungs. This increased workload on the heart and lungs can lead to symptoms like fatigue, shortness of breath, and poor feeding in infants. Therefore, a toddler with a VSD would likely tire easily due to the increased cardiac effort.

Question 14: An individual with a history of stillbirths is being watched by the nurse. The doctor can request a non-stress test for this patient to:

Show the effect of contractions on fetal heart rate
Determine lung maturity
Measure the wellbeing of the fetus
Measure the fetal activity (Correct answer)

Correct answer: Measure the fetal activity

A non-stress test (NST) is a common prenatal test used to assess fetal well-being by monitoring the fetal heart rate in response to fetal movement. The test measures accelerations in the fetal heart rate, which indicate a healthy and reactive nervous system. It primarily evaluates fetal activity and heart rate patterns without the stress of contractions.

Question 15: After being released, a patient with clotting disease must continue receiving Lovenox (enoxaparin) injections. The client should learn from the nurse that injections of Lovenox should:

Be injected into the abdomen (Correct answer)
Be injected into the deltoid muscle
Clear the air from the syringe before injections
Aspirate after the injection

Correct answer: Be injected into the abdomen

Enoxaparin (Lovenox) is a low molecular weight heparin administered via subcutaneous injection. The recommended site for subcutaneous injection of enoxaparin is the anterolateral or posterolateral abdominal wall, at least two inches from the navel. This site allows for consistent absorption and minimizes the risk of muscle damage or nerve injury compared to other sites.

Question 16: The nurse is authorized to provide phenergan (Promethazine) 25mg and valium (Diazepam) 10mg prior to surgery. The appropriate way to give these drugs is to:

Administer the Valium, wait 5 minutes, and then inject the Phenergan
Question the order because they cannot be given at the same time
Administer the medication separately (Correct answer)
Administer the medications together in one syringe

Correct answer: Administer the medication separately

Phenergan (promethazine) and Valium (diazepam) are incompatible when mixed in the same syringe and can cause precipitation. Administering them separately ensures that each medication maintains its integrity and effectiveness, preventing adverse reactions or reduced therapeutic effect. Always check compatibility before mixing medications to ensure patient safety.

Free NCLEX-RN Questions and Answers

Which person has the highest chance of having hypertension?