Free NCLEX-RN practice questions

Answer: B

• A. Without an earlier conversation the agent has to guess, which makes substituted judgment difficult and adds stress for the agent and family.
• B. Correct. The best agent knows the client’s values and will carry them out, and discussing wishes in advance prepares the agent to decide as the client would.
• C. Many people name a spouse or child, but the client may choose any adult he trusts; state rules on who may serve vary, and next of kin is not required.
• D. The agent’s authority begins only when the client can no longer make or communicate decisions; until then the client decides for himself.

A durable power of attorney for health care names an agent (also called a proxy or surrogate) who makes decisions only when the client lacks capacity, with the same authority to accept or refuse treatment that the client would have. Because no document can foresee every situation, the agent is expected to decide as the client would, so best practice is to choose someone who knows and will honor the client’s values and to discuss those wishes well before an emergency. Copies go to the agent, the provider and the record.

Bottom line: Choose a health care agent who will honor your values, and discuss your wishes with that person well before an emergency, because the agent decides as you would.

Sources: StatPearls (NCBI Bookshelf); Potter & Perry Fundamentals, 12th ed.

Answer: A

• A. Correct. Her comprehension is preserved, so she can take part in the decision when questions are framed for her expressive deficit.
• B. Sharing the plan is courteous, but it informs her after the decision is made instead of letting her shape it.
• C. The therapist can suggest communication aids, but the client is already following the discussion, and delaying her inclusion is not needed.
• D. Being unable to speak fluently is not the same as being unable to decide; the daughter supports her but does not replace her voice.

In expressive (Broca) aphasia, damage to the inferior frontal language area impairs speech production while comprehension is usually preserved. Clients with this deficit can often express a clear choice through yes-or-no questions, gestures, writing or picture boards, and decision-making capacity is judged by understanding, choice, appreciation and reasoning, not by fluent speech. Talking only to a relative silences the client. Advocating for the client’s rights, as the ANA Code describes, means making sure she takes part in decisions about her own care.

Bottom line: Aphasia impairs speech but often not comprehension, so advocate by including the client in decisions using yes-or-no questions, gestures or picture boards rather than speaking only to family.

Sources: StatPearls (NCBI Bookshelf); ANA Code of Ethics for Nurses (2025)

Answer: C

• A. Truth-telling is not the deciding principle.
• B. The client did not make the choice.
• C. Correct. Distributive justice requires fair allocation of resources based on clinical need rather than social status or ability to pay.
• D. No promise was involved.

Justice in health care means treating clients equitably and allocating scarce resources (beds, organs, staff time, vaccines in a shortage) by objective criteria such as acuity and likelihood of benefit. Influence, wealth and status are not criteria. Institutional policies and ethics committees support nurses facing such decisions.

Bottom line: Justice means allocating scarce resources by objective clinical criteria such as acuity, not by social status, influence or ability to pay.

Sources: ANA Code of Ethics for Nurses (2025); Potter & Perry Fundamentals, 12th ed.

Answer: A

• A. Correct. A distraction-free zone or period for preparation and administration reduces interruptions, which are linked to procedural failures and clinical errors.
• B. Independent double checks are reserved for selected high-alert drugs; applying them to every oral dose adds more interruptions and is not sustainable.
• C. Preparing early to avoid later interruptions separates preparation from bedside verification and leaves unlabeled doses that can be mixed up.
• D. Staying at the cart seems efficient, but answering calls mid-preparation is the very interruption that causes errors.

Interruptions during medication preparation and administration are associated with procedural failures, clinical errors and compromised client safety. Distraction-free periods and zones, and visible do-not-interrupt cues, reduce them: in one study non-medication interruptions fell from 50 to 34 per 100 administrations. Pre-pouring breaks the link between preparing a dose and verifying it at the bedside with two identifiers and bar-code scanning, so it adds risk rather than removing it. Independent double checks are kept for high-alert drugs such as insulin and heparin, where they are worth the time.

Bottom line: Reduce medication errors by preparing doses in a distraction-free zone with do-not-interrupt cues, and never pre-pour, which breaks bedside verification and scanning.

Sources: StatPearls (NCBI Bookshelf); Potter & Perry Fundamentals, 12th ed.

Answer: C

• A. Potency loss is invisible.
• B. Freezing destroys many vaccines.
• C. Correct. Exposed vaccines are labeled “do not use,” kept refrigerated and quarantined until the manufacturer or immunization program determines viability.
• D. Some vaccines may remain viable; guidance determines disposal.

Vaccine cold chain: refrigerator at 2 to 8 °C and freezer at −50 to −15 °C, continuous data loggers with twice-daily checks, no storage in doors, water bottles for thermal stability, a written management plan, and reporting of excursions. Clients given compromised vaccines may need revaccination.

Bottom line: Vaccines exposed to temperatures outside 2 to 8 °C are labeled do not use, kept refrigerated, and quarantined until the manufacturer or immunization program determines viability.

Sources: Wong's Care of Infants & Children, 12th ed.

Answer: B

• A. Tempting because he asks for it and already knows the drug, but PrEP protects against future exposures. After a 3-week gap he was unprotected 40 hours ago, and CDC advises offering PEP to people with an exposure while nonadherent to PrEP; he can move back to PrEP after the PEP course with no gap.
• B. Correct. Condomless receptive anal sex 40 hours ago while off PrEP is a recent exposure inside the 72-hour window. Because the partner's status is unknown, the decision is made case by case, so he needs a prescriber's assessment today and the first dose as soon as possible.
• C. A visit later in the week would fall outside the 72-hour window, after which CDC finds the evidence insufficient to start PEP; the urgent problem is the exposure that has already happened.
• D. An HIV test is drawn before starting, but CDC says the first PEP dose should not be delayed while waiting for laboratory results, and every hour counts toward the 72-hour limit.

CDC's 2025 nPEP guideline recommends starting postexposure prophylaxis as soon as possible, ideally within 24 hours and no later than 72 hours, after an exposure that carries substantial HIV risk. Receptive anal sex carries the highest per-act risk of any sexual exposure. When the source's status is unknown, as here, the prescriber decides case by case, so the nurse arranges same-day evaluation. CDC treats PrEP use outside the recommended schedule as nonadherent and advises offering PEP after an exposure during that time. An HIV test is drawn, but the first dose does not wait for laboratory results. The course lasts 28 days, and because his risk is ongoing he moves straight back to PrEP afterward with no gap.

Bottom line: After a high-risk HIV exposure, arrange same-day evaluation for postexposure prophylaxis, ideally within 24 hours and no later than 72 hours, rather than simply restarting PrEP.

Sources: CDC nPEP Guidelines (2025)

Answer: C

• A. Dismissive advice is harmful.
• B. Medication without assessment misses the underlying problem.
• C. Correct. Loss, isolation and vegetative symptoms in an older adult require screening for depression and suicide risk and a connection to bereavement support.
• D. Encouragement alone misses screening for depression and suicide risk in a bereaved older adult.

Late-life depression is under-recognized and often presents as physical complaints, withdrawal and cognitive changes. Older adults, especially men after loss, have high suicide rates. Screening (Geriatric Depression Scale, PHQ-9), asking directly about suicide, treating depression and reducing isolation are essential.

Bottom line: Withdrawal, poor appetite and poor sleep after loss in an older adult warrant depression and suicide screening, since late-life depression is under-recognized.

Sources: Varcarolis' Psychiatric Nursing, 10th ed.

Answer: C

• A. Leaving severe pain untreated for 10 hours causes needless suffering; the breakthrough dose exists for exactly this flare.
• B. Halving a prescribed dose on the nurse's own judgment undertreats the pain and reinforces the spouse's fear.
• C. Correct. The prescribed immediate-release dose treats the flare, and a prompt follow-up call lets the nurse reassess the pain and adjust the plan with the team.
• D. Hospice manages pain crises at home; a trip to the emergency department adds distress for pain the home regimen already covers.

Breakthrough pain is a temporary flare of pain in someone whose pain is otherwise controlled on a scheduled opioid. It is treated with an immediate-release opioid prescribed alongside the long-acting dose. Fear of respiratory depression and addiction is common among clients and families, but respiratory depression rarely occurs when opioids are used and titrated properly. The nurse explains this, coaches the spouse to give the prescribed dose now, and follows up to reassess the pain. If breakthrough doses are needed often, the nurse reports it so the hospice team can increase the scheduled dose.

Bottom line: For a breakthrough pain flare at home, coach the caregiver to give the prescribed immediate-release opioid now and follow up to reassess the pain.

Sources: NCI PDQ: Cancer Pain (2025)

Answer: B

• A. Calcium and phosphate are not affected by these drugs.
• B. Correct. Both drugs raise potassium; together they can cause dangerous hyperkalemia.
• C. Neither drug affects hemoglobin.
• D. Sodium and chloride changes are less specific to this combination.

Spironolactone is a potassium-sparing diuretic; ACE inhibitors and angiotensin receptor blockers also retain potassium. The combination improves survival in heart failure but requires potassium and creatinine monitoring, avoidance of potassium supplements and salt substitutes, and teaching to report weakness or palpitations.

Bottom line: Spironolactone combined with an ACE inhibitor or ARB can cause dangerous hyperkalemia, so serum potassium is monitored closely.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; AHA/ACC/HFSA Heart Failure Guideline (2022); Lehne's Pharmacology for Nursing, 12th ed.

Answer: D

• A. Lung injury can bring fever and hypotension, but its defining features are hypoxemia and noncardiogenic pulmonary edema; this client has clear lungs and an SpO2 of 97%.
• B. Hemolysis also causes fever and hypotension, but it usually starts within the first 15 minutes with flank pain and red or brown urine; this urine is pale yellow.
• C. The history makes this tempting, but a febrile reaction is a diagnosis of exclusion, leukoreduction makes it less likely, and a 3 °C rise with shock and vomiting goes well beyond it.
• D. Correct. High fever, rigors, flushing, profound hypotension, abdominal cramps and vomiting during the transfusion or up to 2 hours after it are the picture of bacterial contamination.

A septic transfusion reaction comes from bacteria or endotoxin in the unit, introduced by poor donor-arm disinfection, donor bacteremia or handling after collection. It begins during the transfusion or within about 2 hours with high fever, flushing, hypotension, back pain, abdominal cramping, vomiting and diarrhea, so a picture of shock without hemoglobinuria or hypoxemia points to it. The nurse stops the transfusion, removes the unit and tubing, keeps the vein open with 0.9% sodium chloride, notifies the provider and blood bank, and expects blood cultures, a Gram stain and culture of the bag, fluids and broad-spectrum antibiotics. Each unit is finished within 4 hours because bacteria multiply in blood left out longer.

Bottom line: High fever, flushing, tachycardia and pale urine during a transfusion, without wheezing or hives, suggest a septic reaction from bacteria in the unit.

Sources: Open RN Nursing Advanced Skills (2023)

Answer: A

• A. Correct. Adherence for the full course and interaction screening determine cure rates.
• B. Cure rates exceed 95%.
• C. Alcohol is avoided with liver disease.
• D. Courses are typically 8 to 12 weeks.

Direct-acting antivirals for hepatitis C: high cure rates, short courses, minimal side effects, but important interactions (acid suppressants, amiodarone, statins, antiepileptics) and hepatitis B reactivation risk. Sustained virologic response is checked 12 weeks after completion.

Bottom line: Hepatitis C cure with direct-acting antivirals depends on completing every dose and screening all other medications for interactions.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Lehne's Pharmacology for Nursing, 12th ed.

Answer: B

• A. Red and purple liquids are avoided because they look like blood in the colon.
• B. Correct. A clear-liquid diet the day before, the full prep and clear effluent are the goals.
• C. The whole prep is taken to clear the colon completely.
• D. Nothing but clear liquids is allowed after the prep, and nothing by mouth for several hours before the test.

Colonoscopy preparation: clear liquids (no red or purple) the day before, the complete bowel-cleansing solution as directed, nothing by mouth for the hours before the procedure, and a driver home because of sedation. The nurse reviews anticoagulants and diabetes medications with the provider beforehand.

Bottom line: Colonoscopy preparation means clear liquids without red or purple the day before and completing the bowel prep until the stool runs clear.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Lewis's Medical-Surgical Nursing, 13th ed.

Answer: A

• A. Correct. Rectal temperatures can injure mucosa and introduce bacteria in immunocompromised clients.
• B. Oral is acceptable when the client can hold the probe.
• C. Axillary is acceptable though less accurate.
• D. Temporal is acceptable.

Temperature measurement: oral (avoid after hot or cold drinks, with oxygen masks or in confused clients), rectal (most accurate but contraindicated in neutropenia and after rectal surgery; newborns are screened by axillary reading, and rectal is preferred to confirm fever in infants under 3 months), tympanic, temporal and axillary. Consistent sites allow trend comparison.

Bottom line: Rectal temperatures are contraindicated in neutropenic clients because they can injure the mucosa and introduce bacteria.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Potter & Perry Fundamentals, 12th ed.

Answer: B

• A. Hyperkalemia comes from cell destruction and does not reflect fluid status.
• B. Correct. Hourly urine output at or above 0.5 mL/kg/h is the best bedside measure of perfusion during burn resuscitation.
• C. A high hematocrit reflects hemoconcentration from inadequate fluid.
• D. Tachycardia suggests continuing hypovolemia.

Burn resuscitation (Parkland formula: 4 mL × kg × % burned of lactated Ringer’s over 24 hours, half in the first 8) is titrated to urine output of 0.5 mL/kg/h in adults (about 30 to 50 mL/h). Early complications include hypovolemic shock, hyperkalemia and airway edema in inhalation injury.

Bottom line: Burn fluid resuscitation is titrated to hourly urine output, with 0.5 mL/kg/h in adults indicating adequate perfusion.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; ABA Burn Shock Resuscitation Guideline (2024)

Answer: C

• A. Sedatives worsen respiratory depression.
• B. Rapid rewarming causes vasodilation and cardiovascular collapse; passive rewarming is used.
• C. Correct. Myxedema coma threatens the airway and ventilation, so the nurse watches closely for hypoventilation; thyroid hormone is replaced intravenously.
• D. Oral absorption is unreliable in myxedema coma.

Myxedema coma: hypothermia, bradycardia, hypotension, hypoventilation, hyponatremia and decreased consciousness in a client with untreated hypothyroidism. Care is airway support, IV levothyroxine, hydrocortisone until adrenal insufficiency is excluded, passive rewarming, and treating the precipitant, often infection.

Bottom line: Myxedema coma threatens airway and ventilation, so the priority is airway support and monitoring for hypoventilation while IV levothyroxine is prepared.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Lewis's Medical-Surgical Nursing, 13th ed.