Free NCLEX-PN Practice Test: 70 Questions With Rationales
This free NCLEX-PN practice test has 70 original, unofficial questions for U.S. LPN/VN candidates: 52 content-area questions and three six-question clinical-judgment cases based on the 2026 test plan. Answer first, then reveal each explanation; this is fixed practice, not a full-length adaptive exam or a pass predictor.
Question 1 · Choose one
The nurse in a long-term care facility is making assignments for the day shift. Which task is most appropriate to assign to a trained, competent assistive personnel (AP) member?
- A. Reinforce teaching with a resident who just received a new prescription for an inhaled corticosteroid
- B. Walk with a resident who has long-standing, stable Parkinson disease to the dining room using the resident’s usual walker
- C. Decide whether a resident who became newly confused an hour ago needs to be seen by the provider
- D. Feed lunch to a resident who began coughing and choking on liquids at breakfast today
Show answer and explanation
Correct answer: B. Walk with a resident who has long-standing, stable Parkinson disease to the dining room using the resident’s usual walker
Why: Walking with a familiar device is routine care, and this resident’s condition is stable and predictable. That is the “right circumstance” for handing a task to AP.
Why not the others:
- A: Reinforcing medication teaching is a licensed-nurse responsibility in the PN test plan. It isn’t a routine AP task.
- C: Deciding whether a client needs the provider is clinical judgment, and judgment can’t be delegated. A new change in mental status also makes the situation unstable.
- D: New coughing and choking with liquids suggests a new swallowing problem and possible aspiration risk. The nurse needs to collect data and report it before anyone feeds this resident.
Takeaway: Give AP routine tasks for clients who are stable and predictable. Teaching, interpretation, and anything involving a new change stay with the nurse.
Scoring: 1 point · PN action: Assign
Source: NCSBN & ANA, National Guidelines for Nursing Delegation (2019), pp. 3–4 (judgment can’t be delegated; Five Rights) and p. 7 (stability and predictability); NCSBN, 2026 NCLEX-PN Test Plan, Coordinated Care, pp. 7 and 20; ASHA, Adult Dysphagia, Signs and Symptoms; Screening: new coughing/choking during intake warrants assessment; a symptom alone does not confirm aspiration
Part A: 52 content-area questions. Questions 1–11 cover Coordinated Care. “The nurse” is the licensed practical or vocational nurse (LPN/VN). Assignment and medication actions assume authorization under the applicable law, facility policy, and the stated orders or protocol. Unless stated otherwise, the client is an adult. These scenarios are fictional.
Use this page: Record a choice before opening its answer. Matrix circles and blank-choice lists are readable practice prompts, not clickable inputs; select an answer mentally or on paper. All questions and explanations are on this page.
Jump to: Coordinated Care (11) · Safety and Infection Prevention and Control (7) · Health Promotion and Maintenance (5) · Psychosocial Integrity (6) · Basic Care and Comfort (5) · Pharmacological Therapies (7) · Reduction of Risk Potential (6) · Physiological Adaptation (5) · Case studies (18) · Your results
Question 2 · Choose one
In a long-term care facility, the nurse assigned an AP to walk a resident with stable heart failure in the hallway after lunch, as the resident does every day. Halfway down the hall, the AP calls out that the resident suddenly feels dizzy. What should the nurse do first?
- A. Tell the AP to finish the walk slowly because it’s part of the care plan
- B. Tell the AP to help the resident sit down right away, then go to the resident to collect data
- C. Ask the AP to take the resident’s vital signs and report them at the end of the shift
- D. Document the dizziness and move the walk to the evening shift
Show answer and explanation
Correct answer: B. Tell the AP to help the resident sit down right away, then go to the resident to collect data
Why: The resident’s condition changed during a delegated task. The AP’s job is to report the change; the nurse’s job is to reassess the resident and decide whether the task is still appropriate.
Why not the others:
- A: A care plan doesn’t override a new symptom. Continuing the walk puts the resident at risk of a fall.
- C: Vital signs may be part of the picture, but waiting until the end of the shift delays the nurse’s reassessment of a new change.
- D: Documentation matters, but it doesn’t address a resident who is dizzy right now.
Takeaway: When a client’s condition changes during an assigned task, the task stops being routine. The nurse reassesses.
Scoring: 1 point · PN action: Monitor AP / reassess
Source: NCSBN & ANA, National Guidelines for Nursing Delegation (2019), p. 4, “Right circumstance”: if the condition changes, the licensed nurse must reassess; NCSBN, 2026 NCLEX-PN Test Plan, Coordinated Care, “Monitor activities of assistive personnel,” p. 7
Question 3 · Choose one
The charge nurse asks the nurse to check a client for urinary retention using the unit’s new bladder scanner. The nurse has never been trained on a bladder scanner. What is the best response?
- A. Use the scanner by following the quick-start card attached to it
- B. Ask an AP who has seen the scanner used to perform the scan
- C. Tell the charge nurse about the lack of training and ask for help or training before doing the scan
- D. Palpate the bladder instead and document that a bladder scan was done
Show answer and explanation
Correct answer: C. Tell the charge nurse about the lack of training and ask for help or training before doing the scan
Why: A nurse accepts only the tasks they are trained and competent to perform. Saying so, and asking for help or training, protects the client.
Why not the others:
- A: A quick-start card isn’t training or validated competence.
- B: Handing the task to someone else doesn’t solve the training gap, and the nurse can’t supervise a task they don’t know how to do.
- D: Documenting a bladder scan that wasn’t done is falsifying the record; palpation is not the requested scan.
Takeaway: Recognize your limits and ask for help. Competence comes before convenience.
Scoring: 1 point · PN action: Recognize self-limitations
Source: NCSBN & ANA, National Guidelines for Nursing Delegation (2019), pp. 8–9, delegatee responsibilities (accept only what you are trained to perform; tell leadership if training is inadequate); NCSBN, 2026 NCLEX-PN Test Plan, Coordinated Care, “Recognize self-limitations and seek assistance,” p. 7; CDC, CAUTI Guideline: Summary of Recommendations, II.H.1: portable bladder-ultrasound use requires clear indications and staff training
Question 4 · Choose one
The nurse assigned an AP to weigh a resident at 1500. At 1445 the AP says, “I’m swamped, so I asked the dietary aide to weigh him when she drops off his snack.” What should the nurse do?
- A. Accept the plan because the dietary aide is also a staff member
- B. Tell the AP that only the nurse can reassign the task, then decide who will get the weight
- C. Leave the plan in place and check the weight at the end of the shift
- D. Ask the dietary aide to enter the weight in the chart
Show answer and explanation
Correct answer: B. Tell the AP that only the nurse can reassign the task, then decide who will get the weight
Why: The person given a task can’t pass it to someone else. If the AP can’t complete it, the AP tells the nurse, and only the nurse decides who does it next.
Why not the others:
- A: Being a staff member doesn’t mean the dietary aide was assigned, trained, or directed for this task.
- C: This lets an improper handoff stand and delays finding out whether it was done correctly.
- D: This formalizes the improper handoff instead of correcting it.
Takeaway: Tasks move only through the nurse. The delegatee reports back; the nurse reassigns.
Scoring: 1 point · PN action: Assign / supervise
Source: NCSBN & ANA, National Guidelines for Nursing Delegation (2019), p. 9, delegatee responsibility 4 (the delegatee cannot delegate to another individual)
Question 5 · Choose one
The nurse has reinforced discharge instructions using the client’s reconciled medication list, including each medicine’s name, dose, and time, and a pill organizer. Which question best checks the client’s understanding?
- A. “Do you understand when to take each pill?”
- B. “I want to be sure I explained this clearly. Can you tell me, in your own words, how and when you’ll take each medicine on this list?”
- C. “Your pharmacist will go over this again, right?”
- D. “Please sign here to show we reviewed your medicines.”
Show answer and explanation
Correct answer: B. “I want to be sure I explained this clearly. Can you tell me, in your own words, how and when you’ll take each medicine on this list?”
Why: Teach-back asks the client to explain the plan in their own words. The nurse can then clarify anything that came out wrong and check again.
Why not the others:
- A: A yes/no question invites a polite “yes” and doesn’t show what the client actually understood.
- C: This hands the job to someone else and checks nothing.
- D: A signature shows the instructions were given, not that they were understood.
Takeaway: Ask clients to say it back in their own words. “Do you understand?” isn’t a check.
Scoring: 1 point · PN action: Reinforce teaching
Source: AHRQ, Use the Teach-Back Method: Tool 5, Overview and Actions; AHRQ, MATCH Toolkit, Chapter 3, Discharge medication reconciliation and communication of the reconciled medication list
Question 6 · Drop-down
The nurse is calling the RN about a client whose blood pressure dropped after surgery. Complete the sentence about where two parts of the report belong in SBAR (Situation, Background, Assessment, Recommendation or request).
“The client had a hip replacement yesterday and takes warfarin at home” belongs in [Blank 1]. “Please come and assess the client now” belongs in [Blank 2].
Blank 1 choices: Situation · Background · Assessment · Recommendation or request
Blank 2 choices: Situation · Background · Assessment · Recommendation or request
Show answer and explanation
Correct answers: 1: Background; 2: Recommendation or request
Why: Background is the context the listener needs: history, recent procedures, relevant medicines. Recommendation (or request) is what you are asking the listener to do and by when.
Why not the others:
- Situation: Situation is the current problem in one line, such as “the client’s blood pressure is 88/50 mmHg.”
- Assessment: Assessment is what you think is going on, based on your data.
Takeaway: S = what’s happening now; B = context; A = what you think; R = what you need and by when.
Scoring: up to 2 points: 1 for each correct drop-down · PN action: Provide and receive report
Source: AHRQ TeamSTEPPS, SBAR, SBAR component definitions
Question 7 · Choose one
A nurse working on the surgical unit hears that a neighbor was admitted to the medical unit down the hall. The nurse is not involved in the neighbor’s care. Which action is appropriate?
- A. Open the neighbor’s chart to see how she’s doing, without making any entries
- B. Ask a coworker on the medical unit what the neighbor’s diagnosis is
- C. Don’t look at or ask about the neighbor’s health information, because the nurse has no job-related reason to see it
- D. Open the chart only to find the room number for a get-well card
Show answer and explanation
Correct answer: C. Don’t look at or ask about the neighbor’s health information, because the nurse has no job-related reason to see it
Why: Access to health information is limited to what a person needs for their role. Curiosity, even friendly curiosity, isn’t a job-related need.
Why not the others:
- A: Viewing without editing is still access, and it still requires a job-related reason.
- B: Asking a coworker to share the information is an improper disclosure by a different route.
- D: A kind reason doesn’t create a job-related need to open the record.
Takeaway: No job-related need, no chart access. That applies to reading, not just writing.
Scoring: 1 point · PN action: Maintain confidentiality
Source: HHS, Minimum Necessary Requirement, How the Rule Works; uses of and requests for PHI
Question 8 · Choose one
In a hospital, an alert adult client who is able to make her own decisions declines a scheduled, nonemergency physical therapy session after the therapist explained why it helps. What should the nurse do?
- A. Tell the client the session is required because it’s in her care plan
- B. Respect her decision, ask what concerns she has, and communicate the refusal to the RN and the therapist
- C. Ask her family to persuade her to go
- D. Take her to therapy anyway because it was ordered
Show answer and explanation
Correct answer: B. Respect her decision, ask what concerns she has, and communicate the refusal to the RN and the therapist
Why: A client who can make her own decisions has the right to refuse care. The nurse’s job is to respect that, explore her reasons, and make sure the team knows.
Why not the others:
- A: An order or care plan doesn’t remove the right to refuse.
- C: Recruiting family to pressure her undermines her choice.
- D: Taking her against her wishes ignores a valid refusal.
Takeaway: Respect, explore, communicate, document. Refusal is information the team needs.
Scoring: 1 point · PN action: Advocate for client rights
Source: eCFR, 42 CFR 482.13 Patient’s Rights, § 482.13(b)(2), right to make informed decisions, including to refuse treatment; NCSBN, 2026 NCLEX-PN Test Plan, Coordinated Care, “Recognize client right to refuse treatment/procedure,” p. 20
Question 9 · Choose one
During admission medication reconciliation, the client’s pharmacy list shows metoprolol 25 mg twice daily. The client’s own list and the transfer form both say 50 mg twice daily. No reconciled order resolves the difference. What should the nurse do before the next dose?
- A. Give 50 mg because two documents agree
- B. Give 25 mg because the lower dose is safer
- C. Report the discrepancy to the prescriber or the RN responsible for reconciliation and get the dose clarified before giving it
- D. Hold metoprolol until discharge
Show answer and explanation
Correct answer: C. Report the discrepancy to the prescriber or the RN responsible for reconciliation and get the dose clarified before giving it
Why: An unexplained difference between medication lists has to be clarified with the appropriate clinician before the disputed dose is given.
Why not the others:
- A: Two matching lists can still be wrong. Counting votes isn’t reconciliation.
- B: Choosing a dose yourself is prescribing, and the lower dose isn’t automatically safer.
- D: Holding a medication indefinitely is also a decision that needs the prescriber.
Takeaway: Discrepancy → clarify before giving. Don’t pick a list.
Scoring: 1 point · PN action: Verify orders / reconcile medications
Source: AHRQ, MATCH Toolkit, Chapter 3, Medication reconciliation process; clarifying discrepancies; NCSBN, 2026 NCLEX-PN Test Plan, Pharmacological Therapies, “Reconcile and maintain medication list,” p. 12
Question 10 · Choose one
At the start of the shift on a medical unit, the nurse gets report on four clients. Which client should the nurse see first?
- A. A client whose face began drooping on the left 20 minutes ago, with new left arm weakness and slurred speech
- B. A client with type 2 diabetes asking when breakfast will arrive; fasting glucose 132 mg/dL (reference 70–99 mg/dL)
- C. A client 2 days after knee surgery whose scheduled pain medicine is due in 30 minutes; pain 4/10
- D. A client being discharged today who wants to review home instructions
Show answer and explanation
Correct answer: A. A client whose face began drooping on the left 20 minutes ago, with new left arm weakness and slurred speech
Why: Sudden face drooping, arm weakness, and speech trouble are stroke warning signs. The nurse activates the facility’s stroke or emergency response now and notes when the symptoms started.
Why not the others:
- B: The glucose is above the reference range but isn’t an emergency, and the client is asking about breakfast.
- C: This client is stable, and the medicine isn’t due yet.
- D: Discharge teaching matters, but it can wait for a possible stroke.
Takeaway: A sudden new neurologic change beats every stable, scheduled need.
Scoring: 1 point · PN action: Prioritize / recognize and report change
Source: CDC, Signs and Symptoms of Stroke, Signs and symptoms; F.A.S.T.
Question 11 · Choose one
An adult client asks, “What’s the difference between a living will and a durable power of attorney for health care?” Which response by the nurse is accurate?
- A. “A living will describes the treatments you do or don’t want if you can’t make decisions yourself. A durable power of attorney for health care names someone to make health decisions for you if you can’t.”
- B. “They’re the same document with two names.”
- C. “A durable power of attorney for health care lets someone manage your bank accounts.”
- D. “A living will takes over as soon as you sign it, even while you can still decide for yourself.”
Show answer and explanation
Correct answer: A. “A living will describes the treatments you do or don’t want if you can’t make decisions yourself. A durable power of attorney for health care names someone to make health decisions for you if you can’t.”
Why: These are the two most common advance directives. One records treatment wishes; the other names a decision-maker (also called a health care proxy or agent). Names and forms vary by state, so the client should use their own state’s form.
Why not the others:
- B: They do different jobs, and many people complete both.
- C: A health care power of attorney covers health decisions. Financial authority is a separate document.
- D: A living will guides care only when the person can’t make their own decisions.
Takeaway: Living will = what I want. Health care power of attorney = who decides.
Scoring: 1 point · PN action: Provide information about advance directives
Source: American Cancer Society, Types of Advance Directives, The living will; durable power of attorney for health care; NCI Dictionary, durable power of attorney for health care, Definition (also called health care proxy); NCSBN, 2026 NCLEX-PN Test Plan, Coordinated Care, “Provide information about advance directives,” p. 7
Safety and Infection Prevention and Control (7 questions)
Question 12 · Choose one
After removing gloves following wound care, the nurse notices a smear of blood on the back of one hand. The skin is intact and there was no needlestick. What should the nurse do next?
- A. Rub alcohol-based hand sanitizer over the area
- B. Wash the hands with soap and water
- C. Put on a fresh pair of gloves and continue care
- D. Wipe the area with a dry paper towel
Show answer and explanation
Correct answer: B. Wash the hands with soap and water
Why: Visible soiling is the deciding detail. When hands are visibly soiled, wash with soap and water.
Why not the others:
- A: Sanitizer is right for many clinical moments, but not for visibly soiled hands.
- C: Gloves would cover the contamination, not remove it.
- D: Wiping isn’t hand hygiene.
Takeaway: Visible soil → soap and water. Removing gloves never replaces hand hygiene.
Scoring: 1 point · PN action: Apply infection control
Source: CDC, Clinical Safety: Hand Hygiene for Healthcare Workers, Soap and water vs. alcohol-based hand sanitizer; glove use
Question 13 · Choose one
A coworker short on supplies says she’ll use the same syringe for a second client’s injection after putting on a new needle. What should the nurse do?
- A. Agree, because the needle was changed
- B. Agree, if the syringe barrel is wiped with alcohol first
- C. Stop her: each client needs a new sterile needle and a new sterile syringe
- D. Agree, if both clients are getting the same medicine
Show answer and explanation
Correct answer: C. Stop her: each client needs a new sterile needle and a new sterile syringe
Why: A syringe is contaminated once it has been used for a client, even if the needle is replaced.
Why not the others:
- A: Changing the needle doesn’t make the syringe safe for another client.
- B: Wiping the outside doesn’t decontaminate the inside of a used syringe.
- D: Same medicine, same risk. The syringe is still contaminated.
Takeaway: One needle, one syringe, one client, one time.
Scoring: 1 point · PN action: Apply infection control
Source: CDC, Safe Injection Practices (clinical guidance), Recommendation IV.H.2 (don’t reuse a syringe even if the needle is changed)
Question 14 · Select all that apply
A client has an indwelling urinary catheter. Which actions keep the drainage system working safely? Select all that apply.
- A. Keep the drainage bag below the level of the bladder
- B. Keep the drainage bag off the floor
- C. Keep the tubing free of kinks
- D. Keep the catheter connected to the drainage tubing so the system stays closed
- E. Disconnect the catheter from the tubing to measure urine for intake and output
- F. Hang the bag on the bed rail above bladder level during a transfer
Show answer and explanation
Correct answers: A, B, C, D
Why: A closed, unobstructed system with the bag below the bladder and off the floor lets urine drain and lowers infection risk.
Why not the others:
- E: Breaking the closed system invites infection. Measure urine from the bag’s drainage spout instead.
- F: A bag above the bladder lets urine flow backward.
Takeaway: Closed, unkinked, below the bladder, off the floor.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Maintain urinary catheter
Source: CDC, CAUTI Guideline: Summary of Recommendations, Recommendations III.A and III.B
Question 15 · Matrix
For each task, choose the protective equipment standard precautions call for. No client has a known infection that requires transmission-based precautions. Hand hygiene is required for every task. Choose the PPE for the exposures described; no additional splash or clothing exposure is expected unless stated.
| Finding or action | Gloves only | Gloves and gown | Gloves, gown, and face protection | No PPE |
|---|---|---|---|---|
| Checking a fingerstick blood glucose | ○ | ○ | ○ | ○ |
| Changing bed linens soaked with wound drainage | ○ | ○ | ○ | ○ |
| Irrigating a wound where splashing is likely | ○ | ○ | ○ | ○ |
| Handing a meal tray to an alert client | ○ | ○ | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Checking a fingerstick blood glucose | Gloves only |
| Changing bed linens soaked with wound drainage | Gloves and gown |
| Irrigating a wound where splashing is likely | Gloves, gown, and face protection |
| Handing a meal tray to an alert client | No PPE |
Why: Standard precautions match the equipment to the exposure you expect: gloves for hand contact with blood or body fluids, a gown when clothing or skin could be soiled, and mask plus eye protection when a splash to the face is likely.
Takeaway: Choose PPE by what could touch you, not by the client’s label.
Scoring: up to 4 points: 1 for each correct row · PN action: Apply infection control
Source: CDC, Standard Precautions for All Patient Care, Risk assessment and PPE; CDC, Isolation Precautions: Recommendations, IV.B.2–IV.B.4: gloves, gowns, and face protection based on anticipated exposure
Question 16 · Select all that apply
During a home visit, the nurse reviews fall risks with an older adult who lives alone. Which changes should the nurse reinforce? Select all that apply.
- A. Remove throw rugs from the hallway
- B. Add brighter lighting on the stairs
- C. Install grab bars next to the toilet and in the tub or shower
- D. Make sure there are secure handrails on the stairs
- E. Run an extension cord across the walkway so the bedside lamp reaches
- F. Store everyday items on high shelves so the counters stay clear
Show answer and explanation
Correct answers: A, B, C, D
Why: Removing trip hazards, improving lighting, and adding grab bars and handrails are core home fall-prevention changes.
Why not the others:
- E: A cord across a walkway is a new trip hazard.
- F: High shelves push an older adult to reach or climb for things they use every day.
Takeaway: Fewer trip hazards, more light, more things to hold on to.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Reinforce home safety
Source: CDC, Preventing Falls, Make your home safer; CDC STEADI, Check for Safety, 2017 brochure, p. 2: Stairs and Steps, Floors, Kitchen, Bedrooms, Bathrooms; frequently used items on lower shelves; page image checked
Question 17 · Matrix
For each client in an acute care hospital, choose any transmission-based precautions needed in addition to standard precautions, or choose standard precautions only.
| Finding or action | Contact precautions | Airborne precautions | Standard precautions only |
|---|---|---|---|
| Suspected pulmonary tuberculosis | ○ | ○ | ○ |
| New diarrhea with suspected C. difficile infection | ○ | ○ | ○ |
| Measles | ○ | ○ | ○ |
| Hip fracture, no signs or history of infection | ○ | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Suspected pulmonary tuberculosis | Airborne precautions |
| New diarrhea with suspected C. difficile infection | Contact precautions |
| Measles | Airborne precautions |
| Hip fracture, no signs or history of infection | Standard precautions only |
Why: CDC lists tuberculosis and measles as airborne-route infections. CDC’s C. diff guidance calls for contact precautions for suspected or confirmed infection. Standard precautions apply to every client. No additional transmission-based precautions are indicated for the hip-fracture client described.
Takeaway: Match the precaution to the route: air, contact, or none beyond standard.
Scoring: up to 4 points: 1 for each correct row · PN action: Apply isolation precautions
Source: CDC, Transmission-Based Precautions, Airborne Precautions (TB, measles); CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Isolate and initiate contact precautions for suspected or confirmed CDI; CDC, Standard Precautions for All Patient Care, Standard precautions for all patient care
Question 18 · Choose one
A client on airborne precautions for suspected pulmonary tuberculosis needs to go to radiology. What should the nurse do?
- A. Place a surgical mask on the client for the trip
- B. Have the client wear a fit-tested N95 respirator for the trip
- C. Cancel the test, because clients on airborne precautions can never leave the room
- D. Send the client without a mask, because radiology staff wear respirators
Show answer and explanation
Correct answer: A. Place a surgical mask on the client for the trip
Why: Transport is limited to medically necessary trips. When it happens, the client wears a surgical mask if possible, which is source control.
Why not the others:
- B: CDC recommends a surgical mask for the transported client. Health care personnel use the appropriate fitted respirator for airborne precautions.
- C: Transport is limited, not forbidden, when it’s medically necessary.
- D: Masking the client protects everyone along the route, not just radiology staff.
Takeaway: Airborne precautions on the move: the client wears a surgical mask.
Scoring: 1 point · PN action: Apply isolation precautions
Source: CDC, Transmission-Based Precautions, Airborne Precautions: limit transport; patient wears a surgical mask
Health Promotion and Maintenance (5 questions)
Question 19 · Select all that apply
The parent of a 2-week-old asks how to set up the baby’s sleep space. Which arrangements should the nurse reinforce? Select all that apply.
- A. Place the baby on his back for every sleep, including naps
- B. Use a firm, flat, level surface, such as a safety-approved crib mattress with a fitted sheet
- C. Keep pillows, blankets, bumpers, and toys out of the sleep space
- D. Have the baby sleep in the parents’ room on his own separate sleep surface
- E. Lay a soft folded blanket under the baby for comfort
- F. Let the baby sleep between the parents in the adult bed
Show answer and explanation
Correct answers: A, B, C, D
Why: Back sleeping on a firm, flat, empty surface of the baby’s own, ideally in the parents’ room, is the core of safe infant sleep.
Why not the others:
- E: Soft bedding under or around the baby is a suffocation risk.
- F: Room-sharing is recommended; sharing an adult bed is not.
Takeaway: Back, flat, firm, empty, and separate.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Reinforce teaching (newborn care)
Source: NICHD Safe to Sleep, Reduce the Risk, Back to sleep and risk-reduction actions; NICHD Safe to Sleep, Safe Sleep Environment, Safe sleep space
Question 20 · Choose one
A client who is 34 weeks pregnant calls the clinic. She has had a headache since this morning that won’t go away, and her vision has been blurry. What should the nurse do?
- A. Advise rest and acetaminophen, and ask her to call back tomorrow if it isn’t better
- B. Tell her she needs medical care right away and notify the provider now
- C. Move her next routine appointment up by a week
- D. Reassure her that headaches are common late in pregnancy
Show answer and explanation
Correct answer: B. Tell her she needs medical care right away and notify the provider now
Why: A headache that won’t go away and changes in vision during pregnancy are urgent maternal warning signs that need medical care right away.
Why not the others:
- A: Waiting until tomorrow delays care for a warning sign.
- C: A sooner routine visit is still too late for an urgent warning sign.
- D: Reassurance here could miss a serious complication.
Takeaway: Pregnancy plus a persistent headache or vision change means urgent evaluation, not a routine visit.
Scoring: 1 point · PN action: Identify potential prenatal complications
Source: CDC Hear Her, Urgent Maternal Warning Signs, Urgent maternal warning signs (headache that won’t go away; changes in vision)
Question 21 · Choose one
A grandparent who takes several daily medicines will be caring for toddler grandchildren. Which plan is safest?
- A. Keep the pill bottles in a purse so they’re always nearby
- B. Keep the medicines on the kitchen counter as a reminder to take them
- C. Store medicines up high and out of the children’s sight, and relock safety caps after every use
- D. Put the pills in an unlabeled plastic bag to save space
Show answer and explanation
Correct answer: C. Store medicines up high and out of the children’s sight, and relock safety caps after every use
Why: Medicines belong up and away, out of children’s reach and sight, with safety caps relocked. Many containers aren’t fully child-resistant.
Why not the others:
- A: Purses and bags are among the easiest places for toddlers to find medicine.
- B: A counter is within a curious toddler’s reach.
- D: Unlabeled bags remove the label and the child-resistant cap.
Takeaway: Up, away, out of sight, cap relocked.
Scoring: 1 point · PN action: Reinforce teaching (home safety)
Source: CDC, About Medication Safety, Children and medication safety; medicine storage; MedlinePlus, Lithium, Storage and disposal (keep out of sight and reach; always lock safety caps)
Question 22 · Choose one
At a senior health screening, an 82-year-old with no fluid restriction tells the nurse, “I only drink when I’m thirsty.” Which response is most accurate?
- A. “That’s the best guide at any age.”
- B. “Some people feel less thirsty as they get older, so waiting for thirst may not be enough. Let’s talk about a fluid plan with your provider.”
- C. “Older adults need much less fluid, so thirst doesn’t matter.”
- D. “Drink as much as you possibly can every day.”
Show answer and explanation
Correct answer: B. “Some people feel less thirsty as they get older, so waiting for thirst may not be enough. Let’s talk about a fluid plan with your provider.”
Why: Some people lose their sense of thirst as they age, which puts older adults at higher risk of dehydration.
Why not the others:
- A: Thirst can be a late or missing signal in older adults.
- C: There’s no basis for dismissing fluids in older adults.
- D: A “drink as much as possible” rule ignores the person’s health conditions and provider’s plan.
Takeaway: In older adults, thirst may not be a reliable alarm.
Scoring: 1 point · PN action: Reinforce teaching (aging process)
Source: MedlinePlus, Dehydration, Who is more likely to develop dehydration? (older adults)
Question 23 · Select all that apply
At a 12-month well-child visit, a parent asks what most children can do by age 1. Which statements match CDC’s 1-year milestones? Select all that apply.
- A. Waves “bye-bye”
- B. Pulls up to stand
- C. Picks things up between the thumb and pointer finger
- D. Walks while holding on to furniture
- E. Tries to say three or more words besides “mama” or “dada”
- F. Follows a one-step direction with no gestures, like handing over a toy when you say “give it to me”
Show answer and explanation
Correct answers: A, B, C, D
Why: All four appear on CDC’s list of what most children can do by 1 year.
Why not the others:
- E: This appears on CDC’s 18-month list.
- F: This also appears on CDC’s 18-month list.
Takeaway: Know the current CDC lists. Use the age-specific checklist, not an older memory aid.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Compare client to developmental milestones
Source: CDC, Milestones in Action: By 1 Year, Language/communication, cognitive, and movement milestones by 1 year; CDC, Milestones by 18 Months, Language/Communication Milestones: tries three or more words; follows a one-step direction without gestures
Psychosocial Integrity (6 questions)
Question 24 · Choose one
On a medical unit, a client tells the nurse, “I’ve been thinking about killing myself. I’m thinking about it right now.” What should the nurse do first?
- A. Tell the client that things will look better tomorrow
- B. Stay with the client, keep the client safe, and immediately notify the RN or provider to start the unit’s suicide safety protocol
- C. Document the statement and continue the medication pass
- D. Ask a family member to check in on the client later
Show answer and explanation
Correct answer: B. Stay with the client, keep the client safe, and immediately notify the RN or provider to start the unit’s suicide safety protocol
Why: Current suicidal thoughts need immediate safety measures and an urgent evaluation. The client shouldn’t be left alone.
Why not the others:
- A: False reassurance dismisses a statement that needs action.
- C: Documenting and moving on leaves the client unsafe.
- D: Later isn’t soon enough, and it shifts the nurse’s responsibility to family.
Takeaway: Thoughts of suicide right now: stay, keep safe, escalate immediately.
Scoring: 1 point · PN action: Collect data on risk to self; report
Source: NIMH, Adult Inpatient Brief Suicide Safety Assessment Guide, Current suicidal thoughts: urgent evaluation; do not leave the patient alone
Question 25 · Choose one
A resident in the middle stage of Alzheimer’s disease is trying to tell the nurse something but keeps losing her words. Which approach is best?
- A. Ask several quick questions to narrow down what she means
- B. Move to a quiet spot, ask one simple question at a time, and give her time to respond
- C. Finish her sentences so she doesn’t get frustrated
- D. Correct each word she gets wrong
Show answer and explanation
Correct answer: B. Move to a quiet spot, ask one simple question at a time, and give her time to respond
Why: Quiet surroundings, one question at a time, and time to answer make communication easier in the middle stage.
Why not the others:
- A: Rapid questions overload someone who is already searching for words.
- C: Finishing her sentences takes over and may put the wrong words in her mouth.
- D: Correcting her is discouraging and doesn’t help her get the message across.
Takeaway: Slow down, simplify, and wait.
Scoring: 1 point · PN action: Assist with care of the cognitively impaired client
Source: Alzheimer’s Association, Communication, Communication in the middle stage
Question 26 · Choose one
A resident with Alzheimer’s disease becomes upset and pushes the washcloth away during a scheduled morning shower. There’s no urgent need to bathe right now. What should the nurse do?
- A. Finish the shower quickly while gently holding his arms
- B. Stop, keep him covered and warm, and offer a simple choice or try again later
- C. Tell him the shower is on the schedule and has to happen now
- D. Skip bathing for the rest of the week
Show answer and explanation
Correct answer: B. Stop, keep him covered and warm, and offer a simple choice or try again later
Why: Pausing, protecting his dignity and warmth, and offering a manageable choice or a later time respects him and lowers distress.
Why not the others:
- A: Holding his arms turns routine hygiene into forced care.
- C: A schedule isn’t a reason to push through distress when nothing is urgent.
- D: Hygiene still matters. The fix is a better approach, not no bathing.
Takeaway: Distress during routine care: pause, preserve dignity, retry.
Scoring: 1 point · PN action: Use behavioral management techniques
Source: Alzheimer’s Association, Bathing, Help the person feel in control; resistance and comfort
Question 27 · Choose one
Three weeks after her husband died of cancer, a woman tells the nurse, “Some days I’m fine, and then I fall apart in the grocery store.” Which response is most helpful?
- A. “You should be moving into acceptance by now.”
- B. “Tell me more about what the hard days are like for you.”
- C. “That sounds like depression, and you need medication.”
- D. “Try to stay busy so you don’t think about it.”
Show answer and explanation
Correct answer: B. “Tell me more about what the hard days are like for you.”
Why: Grief doesn’t follow a fixed schedule, and ups and downs are common. An open invitation lets her describe her experience and what support she needs.
Why not the others:
- A: There’s no required sequence or deadline for grief.
- C: One statement doesn’t support a diagnosis, and diagnosing isn’t the nurse’s role here.
- D: This gives advice instead of listening.
Takeaway: Grief varies. Invite, listen, support.
Scoring: 1 point · PN action: Therapeutic communication / grief support
Source: NCI, Grief, Bereavement, and Coping With Loss (PDQ), Normal or common grief; factors affecting grief
Question 28 · Choose one
A client with advanced cancer says, “I’d like to talk with someone from my church.” What should the nurse do?
- A. Offer to pray with the client using the nurse’s own faith
- B. Ask how the team can help, and arrange contact with her faith community or the chaplain as she wishes
- C. Explain that visitors will tire her out
- D. Suggest she focus on her medical treatment instead
Show answer and explanation
Correct answer: B. Ask how the team can help, and arrange contact with her faith community or the chaplain as she wishes
Why: Spiritual care follows the client’s stated wishes. The nurse helps connect her with the support she asked for.
Why not the others:
- A: This doesn’t answer her request for support from her own faith community.
- C: This dismisses a clear request.
- D: Spiritual needs are part of care, not a distraction from it.
Takeaway: Follow the client’s lead on spiritual support.
Scoring: 1 point · PN action: Plan care considering spiritual beliefs
Source: NCI, Spirituality in Cancer Care (PDQ), Meeting patients’ spiritual and religious needs
Question 29 · Select all that apply
A client admitted with pneumonia usually drinks heavily every day. The last drink was 18 hours ago. Which findings are consistent with alcohol withdrawal? Select all that apply.
- A. Tremor of the hands
- B. Sweating, clammy skin
- C. Rapid heart rate
- D. Anxiety or jumpiness
- E. Very small (pinpoint) pupils
- F. Slow heart rate
Show answer and explanation
Correct answers: A, B, C, D
Why: Withdrawal symptoms usually start within 8 hours of the last drink and peak around 24 to 72 hours. Tremor, sweating, a fast heart rate, and anxiety are typical. Report them: withdrawal can progress to confusion, hallucinations, fever, and seizures.
Why not the others:
- E: Dilated rather than pinpoint pupils are a typical withdrawal finding.
- F: A fast, not slow, heart rate is typical.
Takeaway: Alcohol withdrawal revs the body up: shaky, sweaty, fast, anxious.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Identify signs of substance withdrawal
Source: MedlinePlus, Alcohol withdrawal, Symptoms; delirium tremens
Basic Care and Comfort (5 questions)
Question 30 · Select all that apply
A client has uncomplicated constipation. There is no abdominal pain, vomiting, or fluid restriction. Which self-care measures should the nurse reinforce? Select all that apply.
- A. Eat more fiber-containing foods, such as fruits, vegetables, and whole grains
- B. Drink enough water and other fluids
- C. Be physically active as much as you’re able
- D. Take a stimulant laxative every day for the next month
- E. Avoid fruits and vegetables because they cause gas
Show answer and explanation
Correct answers: A, B, C
Why: Fiber, fluids, and physical activity are the first-line self-care changes for uncomplicated constipation.
Why not the others:
- D: A month of daily stimulant laxatives isn’t a self-care plan the nurse can reinforce without the provider.
- E: Cutting fruits and vegetables removes fiber, which works against the goal.
Takeaway: Fiber, fluids, and movement first.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Provide care for bowel management
Source: NIDDK, Treatment for Constipation, Diet and drink changes; physical activity
Question 31 · Select all that apply
A resident who is bedbound after a stroke is at high risk for pressure injuries. Which actions should the nurse include? Select all that apply.
- A. Reposition the resident on the individualized schedule in the care plan
- B. Relieve pressure on bony areas such as the heels and sacrum
- C. Use a lift sheet or transfer aid to reposition instead of dragging
- D. Stop repositioning because a pressure-redistribution mattress is in place
- E. Pull the resident up in bed by the arms
Show answer and explanation
Correct answers: A, B, C
Why: Individualized repositioning, offloading vulnerable areas, and moving without dragging reduce pressure, friction, and shear.
Why not the others:
- D: A special mattress supports repositioning; it doesn’t replace it.
- E: Pulling by the arms creates friction and shear and can injure the shoulders.
Takeaway: Turn on plan, offload bony points, lift, don’t drag.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Maintain skin integrity
Source: NPIAP/EPUAP/PPPIA International Guideline, Repositioning, R1–R5: support surfaces do not replace repositioning; pressure offloading, friction/shear reduction with suitable equipment, and individualized schedules; MedlinePlus, Pulling a patient up in bed, Avoiding Injury: pulling by the arms can injure shoulders; friction can damage skin; reviewed October 19, 2025
Question 32 · Choose one
A client in hospice care with advanced cancer is in the last days of life and has comfort-focused goals. Her mouth is dry, but she tells the nurse she doesn’t want anything to drink. What should the nurse do?
- A. Encourage her to finish a glass of water every hour
- B. Give mouth care, such as moistening the mouth and applying lip balm, in line with her wishes and the care plan
- C. Tell her IV fluids need to be started
- D. Skip mouth care because she refused fluids
Show answer and explanation
Correct answer: B. Give mouth care, such as moistening the mouth and applying lip balm, in line with her wishes and the care plan
Why: With comfort-focused goals and a clear preference, gentle mouth and lip care relieves dryness without forcing fluids she doesn’t want.
Why not the others:
- A: Pushing fluids overrides her wishes and her comfort goals.
- C: Dry mouth alone doesn’t establish a need for IV fluids. Any hydration treatment must be discussed with the client and care team.
- D: Refusing a drink isn’t refusing comfort care.
Takeaway: At end of life, comfort measures can meet the need when drinking isn’t wanted.
Scoring: 1 point · PN action: Provide palliative/comfort care
Source: NCI, Last Days of Life (PDQ), Health Professional Version, Care During the Final Hours of Life: moistening mouth and lips; avoid forcing food or fluids; Artificial Hydration: individualized decisions; NCI, End-of-Life Care for People Who Have Cancer, Appetite changes: patient choice, lip balm, and gentle mouth care; updated June 28, 2021
Question 33 · Choose one
A client’s right leg is weak after a knee injury, and physical therapy has fitted him with a single-point cane. Which statement shows correct understanding?
- A. “I’ll hold the cane in my left hand.”
- B. “I’ll hold the cane in my right hand, next to my weak leg.”
- C. “Either hand is fine, as long as it feels comfortable.”
- D. “I’ll carry the cane and use it only on stairs.”
Show answer and explanation
Correct answer: A. “I’ll hold the cane in my left hand.”
Why: The cane goes in the hand on the side opposite the weak leg.
Why not the others:
- B: The cane belongs on the strong side.
- C: The side matters for support.
- D: The cane was fitted for walking, not just stairs.
Takeaway: Cane in the hand opposite the weak leg.
Scoring: 1 point · PN action: Reinforce teaching (assistive devices)
Source: MedlinePlus, Using a cane, Cane basics (use the cane on the side opposite the weak leg)
Question 34 · Matrix · Stand-alone clinical judgment (trend)
An 87-year-old long-term care resident with a recent cold has no fluid restriction. Review the 3-day trend. For each Day 3 finding, decide whether it needs follow-up or is stable.
| Finding | Day 1 | Day 2 | Day 3 |
|---|---|---|---|
| Oral fluid intake, 24-hour total | 1,500 mL | 1,000 mL | 600 mL |
| Urine output, 24-hour total | 1,200 mL, pale yellow | 800 mL | 450 mL, dark amber |
| Heart rate (beats/min) | 76 | 84 | 98 |
| Mouth | Moist | Dry lips | Dry mouth; says “I’m not thirsty” |
| Blood pressure (mmHg) | 132/78 | 128/76 | 126/74 |
| Temperature | 36.8 °C | 37.0 °C | 36.9 °C |
| Finding or action | Needs follow-up | Stable |
|---|---|---|
| Falling fluid intake | ○ | ○ |
| Less urine that is darker | ○ | ○ |
| Heart rate rising from 76 to 98 | ○ | ○ |
| Dry mouth without thirst | ○ | ○ |
| Blood pressure 126/74 | ○ | ○ |
| Temperature 36.9 °C | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Falling fluid intake | Needs follow-up |
| Less urine that is darker | Needs follow-up |
| Heart rate rising from 76 to 98 | Needs follow-up |
| Dry mouth without thirst | Needs follow-up |
| Blood pressure 126/74 | Stable |
| Temperature 36.9 °C | Stable |
Why: Less intake, less and darker urine, a dry mouth, and a climbing heart rate together point toward dehydration. Older adults may not feel thirsty, so “I’m not thirsty” doesn’t rule it out. The nurse reports the trend. Blood pressure and temperature are essentially unchanged.
Takeaway: Read the direction, not just today’s numbers.
Scoring: up to 6 points: 1 for each correct row · PN action: Monitor intake and output; report change
Source: MedlinePlus, Dehydration, Symptoms of dehydration in adults; older adults and thirst
Pharmacological Therapies (7 questions)
Question 35 · Calculation
The prescriber orders 300 mg of an oral suspension. The bottle contains 100 mg per 5 mL. How many mL should the nurse give? Record a whole number.
Your answer: ______ mL
Show answer and explanation
Correct answer: 15 mL
Why: 300 mg × (5 mL ÷ 100 mg) = 15 mL. The mg units cancel, leaving mL.
Why not the others:
- 1.5: 1.5 mL contains 30 mg, one-tenth of the ordered dose.
- 150: 150 mL contains 3,000 mg, ten times the ordered dose.
- 3: This counts 100-mg portions (3) and forgets that each is 5 mL.
Takeaway: Desired ÷ have × volume. Check that the units cancel.
Scoring: 1 point · PN action: Perform calculations for medication administration
Source: NCSBN, 2026 NCLEX-PN Test Plan, Pharmacological Therapies, “Perform calculations needed for medication administration,” p. 12; NCLEX, Frequently Asked Questions, Calculation items: record as instructed; round at the end
Question 36 · Calculation
1,000 mL of IV fluid is to infuse over 8 hours by gravity. The tubing drop factor is 15 gtt/mL. How many drops per minute should the nurse set? Round to the nearest whole number.
Your answer: ______ gtt/min
Show answer and explanation
Correct answer: 31 gtt/min
Why: 8 hours = 480 minutes. 1,000 mL ÷ 480 min × 15 gtt/mL = 31.25, which rounds to 31 gtt/min. Round only at the end.
Why not the others:
- 125: This is the hourly rate in mL/h, not drops per minute.
- 32: This rounds up instead of to the nearest whole number.
- 2: This is mL per minute (about 2.08), not drops.
Takeaway: gtt/min = volume (mL) × drop factor ÷ time (minutes).
Scoring: 1 point · PN action: Calculate and monitor IV flow rate
Source: NCSBN, 2026 NCLEX-PN Test Plan, Pharmacological Therapies, “Calculate and monitor intravenous flow rate,” p. 12; NCLEX, Frequently Asked Questions, Round at the end of the calculation
Question 37 · Choose one
The nurse is reinforcing teaching with a client starting warfarin who eats a lot of salads. Which statement shows correct understanding?
- A. “I’ll stop eating green vegetables completely.”
- B. “I’ll keep the amount of vitamin K–rich foods about the same from week to week and check with my provider before big diet changes.”
- C. “I’ll eat extra spinach on any day I forget a dose.”
- D. “What I eat doesn’t matter as long as I take the pill on time.”
Show answer and explanation
Correct answer: B. “I’ll keep the amount of vitamin K–rich foods about the same from week to week and check with my provider before big diet changes.”
Why: Vitamin K affects how warfarin works. The goal is a consistent amount week to week, not avoidance, and diet changes go through the provider.
Why not the others:
- A: Cutting out greens isn’t required and is its own big diet change.
- C: Food doesn’t replace a missed dose, and sudden extra vitamin K changes warfarin’s effect.
- D: Diet does affect warfarin.
Takeaway: Warfarin and vitamin K: consistent, not zero.
Scoring: 1 point · PN action: Reinforce education regarding medications
Source: MedlinePlus, Warfarin, Special dietary instructions
Question 38 · Choose one
A client taking an over-the-counter cold medicine whose label lists acetaminophen 325 mg per tablet wants to also take a pain reliever whose label lists acetaminophen 500 mg. What should the nurse reinforce?
- A. “They’re different brands, so taking both is fine.”
- B. “Both contain acetaminophen, so taking them together could add up to too much. Check the labels and ask your pharmacist or provider before combining them.”
- C. “Take them together with food to protect your stomach.”
- D. “Skip the pain reliever and double the cold medicine instead.”
Show answer and explanation
Correct answer: B. “Both contain acetaminophen, so taking them together could add up to too much. Check the labels and ask your pharmacist or provider before combining them.”
Why: Different products can share an active ingredient. Taking both doubles up on it, so the labels and a pharmacist or provider decide.
Why not the others:
- A: Brand names don’t tell you the ingredients.
- C: Food doesn’t fix a duplicated ingredient.
- D: Doubling a product still delivers more of the same ingredient.
Takeaway: Read active ingredients, not brand names.
Scoring: 1 point · PN action: Reinforce education regarding medications
Source: FDA, Acetaminophen, Read labels; do not take more than one acetaminophen-containing product at a time; overdose risk
Question 39 · Choose one
The nurse draws up one dose from a vial labeled “single-dose vial.” Medicine is left in the vial. What should the nurse do with the rest?
- A. Save it in the medication refrigerator for the same client’s next dose
- B. Use it for another client later today
- C. Discard it according to facility policy
- D. Combine it with what’s left in another single-dose vial
Show answer and explanation
Correct answer: C. Discard it according to facility policy
Why: A single-dose vial is for one client for a single case, procedure, or injection. Leftover medicine isn’t saved for later, even for the same client.
Why not the others:
- A: Saving it for the same client still breaks single-dose rules.
- B: Using it for another client is an infection risk.
- D: Pooling leftovers is unsafe.
Takeaway: Single-dose means single use.
Scoring: 1 point · PN action: Maintain medication safety practices
Source: CDC, Preventing Unsafe Injection Practices, Key points for single-dose vials
Question 40 · Choose one
A postoperative client’s PRN oxycodone is due for pain rated 6/10. The client is hard to keep awake and falls asleep mid-sentence. Respirations are 9 per minute and shallow; earlier they were 16. What should the nurse do?
- A. Give the dose because the client rated the pain 6/10
- B. Give half the dose to balance pain and sleepiness
- C. Withhold the dose, stay with the client, and activate the facility’s emergency response for the breathing and sedation changes
- D. Give the dose and recheck in an hour
Show answer and explanation
Correct answer: C. Withhold the dose, stay with the client, and activate the facility’s emergency response for the breathing and sedation changes
Why: The client’s slowed, shallow breathing and difficulty staying awake suggest opioid-related respiratory depression. Withhold oxycodone, get emergency help, and support the airway and breathing according to the emergency protocol.
Why not the others:
- A: The pain score doesn’t outweigh signs of opioid-related breathing problems.
- B: Changing the dose isn’t the nurse’s call, and any added opioid is unsafe here.
- D: An hour is too long to wait with slowed breathing.
Takeaway: Too sleepy + slow, shallow breathing: withhold the opioid, get emergency help, and support breathing.
Scoring: 1 point · PN action: Collect data before medication administration
Source: MedlinePlus, Oxycodone, Important warning: slowed breathing; sedation; American Heart Association, 2025 Adult BLS Algorithm for Health Care Professionals, Pulse present with abnormal breathing: activate emergency response, provide breaths, and use naloxone when opioid overdose is suspected; p. 1
Question 41 · Bow-tie · Stand-alone clinical judgment
An hour after an oral oxycodone dose, a hospitalized client is very hard to arouse. Respirations are 6 per minute and SpO₂ is 86%. Fingerstick glucose is 104 mg/dL (hypoglycemia: below 70 mg/dL). The facility’s protocol authorizes nurses to give naloxone for suspected opioid overdose. Complete the bow-tie: choose the condition, 2 actions to take, and 2 parameters to monitor. A pulse is present. A second nurse is supporting the airway and providing assisted breaths.
Condition most likely — choose 1:
- Opioid-induced respiratory depression
- Alcohol withdrawal
- Low blood glucose
- Anxiety attack
Actions to take — choose 2:
- Call for emergency help using the facility’s rapid response process
- Give naloxone as the protocol authorizes
- Give the next scheduled opioid dose early
- Let the client sleep and recheck in an hour
- Offer sips of water
Parameters to monitor — choose 2:
- Breathing rate, depth, and oxygen saturation
- Level of responsiveness
- Bowel sounds
- Urine color
Show answer and explanation
Correct answers:
- Condition most likely: Opioid-induced respiratory depression
- Actions to take: Call for emergency help using the facility’s rapid response process; Give naloxone as the protocol authorizes
- Parameters to monitor: Breathing rate, depth, and oxygen saturation; Level of responsiveness
Why: Very slow breathing and difficulty waking after an opioid point to opioid-induced respiratory depression; the glucose is above the hypoglycemia threshold. Get emergency help and give naloxone as authorized. Keep watching breathing and responsiveness: naloxone’s effect is temporary, and symptoms can return.
Why not the others:
- Alcohol withdrawal: Withdrawal speeds things up; this client is slowed down.
- Low blood glucose: 104 mg/dL is not below the 70 mg/dL hypoglycemia threshold.
- Give the next scheduled opioid dose early: More opioid would deepen the problem.
- Let the client sleep and recheck in an hour: This is an emergency, not sleep.
- Anxiety attack: Anxiety does not best explain profound slowing of breathing and reduced alertness after oxycodone.
- Offer sips of water: Reduced alertness makes oral fluids unsafe; the immediate need is breathing support.
- Bowel sounds and urine color: These do not show whether the immediate respiratory and alertness problems are reversing.
Takeaway: Slow breathing + hard to wake after an opioid: help, naloxone, then keep watching.
Scoring: up to 5 points: 1 for each correct box · PN action: Respond to a life-threatening situation
Source: MedlinePlus, Oxycodone, Important warning: life-threatening breathing problems; FDA, Access to Naloxone Can Save a Life During an Opioid Overdose, Recognizing and responding to an overdose; naloxone effects are temporary; American Heart Association, 2025 Adult BLS Algorithm for Health Care Professionals, Adult pulse-present respiratory arrest pathway and opioid antagonist; p. 1; CDC, Low Blood Sugar (Hypoglycemia), Blood glucose below 70 mg/dL is low
Reduction of Risk Potential (6 questions)
Question 42 · Choose one
A client with an indwelling urinary catheter has an order for a urine culture. How should the nurse collect the specimen?
- A. Pour urine from the drainage bag into a sterile cup
- B. Disconnect the catheter from the tubing and let urine drip into a sterile cup
- C. Clean the needleless sampling port and aspirate a fresh sample with a sterile syringe or adapter
- D. Remove the catheter and send the tip to the lab
Show answer and explanation
Correct answer: C. Clean the needleless sampling port and aspirate a fresh sample with a sterile syringe or adapter
Why: A culture needs a small, fresh sample taken aseptically from the disinfected sampling port, without opening the closed system.
Why not the others:
- A: Urine sitting in the bag isn’t fresh and isn’t appropriate for a culture.
- B: Disconnecting breaks the closed system.
- D: There is no removal order or protocol in this scenario, and a catheter tip is not the requested urine specimen.
Takeaway: Culture from a catheter: sampling port, aseptic, fresh.
Scoring: 1 point · PN action: Collect specimen for diagnostic testing
Source: CDC, CAUTI Guideline: Summary of Recommendations, Recommendation III.U (obtaining urine samples)
Question 43 · Matrix
The nurse is screening four clients for orthostatic hypotension. Each rested lying down for 5 minutes, then stood for measurements at 1 and 3 minutes. The screen is abnormal if systolic pressure drops by 20 mm Hg or more, diastolic drops by 10 mm Hg or more, or the client has lightheadedness or dizziness on standing. Mark each client.
| Client | Lying (mmHg) | Standing 1 min (mmHg) | Standing 3 min (mmHg) | Symptoms on standing |
|---|---|---|---|---|
| A | 130/80 | 108/76 | 112/76 | None |
| B | 128/78 | 126/72 | 122/66 | None |
| C | 126/76 | 122/74 | 120/72 | None |
| D | 130/80 | 126/78 | 124/76 | Dizziness |
| Finding or action | Abnormal screen | Normal screen |
|---|---|---|
| Client A | ○ | ○ |
| Client B | ○ | ○ |
| Client C | ○ | ○ |
| Client D | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Client A | Abnormal screen |
| Client B | Abnormal screen |
| Client C | Normal screen |
| Client D | Abnormal screen |
Why: A: systolic drops 22 at 1 minute. B: diastolic drops 12 at 3 minutes. C: largest drops are 6 systolic and 4 diastolic, with no symptoms. D: pressures barely change, but dizziness on standing makes the screen abnormal.
Takeaway: Check both numbers at both times, and don’t forget symptoms.
Scoring: up to 4 points: 1 for each correct row · PN action: Monitor vital signs
Source: CDC STEADI, Measuring Orthostatic Blood Pressure, Measuring orthostatic blood pressure: procedure and abnormal criteria
Question 44 · Choose one
Two days after hip surgery, which finding should the nurse report to the provider promptly?
- A. Pain of 3/10 at the incision after physical therapy
- B. New swelling, warmth, and tenderness in the left calf
- C. Incision edges together with no drainage
- D. Asking for help to walk to the bathroom
Show answer and explanation
Correct answer: B. New swelling, warmth, and tenderness in the left calf
Why: Swelling, pain or tenderness, warmth, and redness in one leg are signs of a deep vein thrombosis (blood clot), which needs prompt medical attention.
Why not the others:
- A: Mild incision pain after therapy is expected after hip surgery.
- C: This is a healing incision.
- D: Asking for help is safe behavior after hip surgery.
Takeaway: One leg, new swelling, warmth, tenderness: think clot and report.
Scoring: 1 point · PN action: Notify provider of signs of potential complications
Source: CDC, Blood Clots: Know the Risks, Signs and Symptoms, DVT symptoms; American Heart Association, Symptoms and Diagnosis of VTE, DVT warning signs
Question 45 · Choose one
A client taking warfarin asks why she needs regular blood tests. Which response is accurate?
- A. “The PT/INR test shows how your blood is responding to warfarin.”
- B. “The test checks whether warfarin is harming your kidneys.”
- C. “It measures your blood sugar, because warfarin raises it.”
- D. “Once your first result is normal, you won’t need any more tests.”
Show answer and explanation
Correct answer: A. “The PT/INR test shows how your blood is responding to warfarin.”
Why: The PT, reported as an INR, is checked regularly to see how the body is responding to warfarin.
Why not the others:
- B: That isn’t what the PT/INR measures.
- C: PT/INR isn’t a glucose test.
- D: Testing is regular and ongoing while taking warfarin.
Takeaway: Warfarin → regular PT/INR checks.
Scoring: 1 point · PN action: Reinforce teaching on purposes of laboratory tests
Source: MedlinePlus, Warfarin, Important warning: PT/INR blood test
Question 46 · Select all that apply
Which findings should a client taking warfarin report to the provider right away? Select all that apply.
- A. Black, tarry stools
- B. Pink, red, or dark brown urine
- C. Bleeding that doesn’t stop
- D. Mild muscle soreness after gardening that has resolved, with no swelling or bruising
- E. Feeling full after a large meal
Show answer and explanation
Correct answers: A, B, C
Why: Warfarin can cause serious bleeding. Black tarry stools, discolored urine, and bleeding that won’t stop are warning signs to report right away.
Why not the others:
- D: The resolved soreness described does not suggest active bleeding. New, severe, unexplained pain or swelling still needs attention.
- E: Fullness after a large meal is expected.
Takeaway: On warfarin, blood where it shouldn’t be, or bleeding that won’t stop, gets reported now.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Reinforce teaching on possible effects of medications
Source: MedlinePlus, Warfarin, Important warning: bleeding warning signs
Question 47 · Choose one
The nurse is reinforcing teaching about daily weights with a client with heart failure. Which plan is correct?
- A. “I’ll weigh myself every morning after I use the bathroom and before breakfast, on the same scale, in similar clothes.”
- B. “I’ll weigh at different times of day to get an average.”
- C. “I’ll weigh once a week, since daily changes don’t matter.”
- D. “I’ll weigh after dinner with my shoes on.”
Show answer and explanation
Correct answer: A. “I’ll weigh myself every morning after I use the bathroom and before breakfast, on the same scale, in similar clothes.”
Why: Same time, same scale, similar clothing, after voiding and before eating makes day-to-day changes meaningful. Sudden gains can mean fluid is building up.
Why not the others:
- B: Changing the time adds noise from meals and fluids.
- C: Daily weights are the point; a gain over 2 to 3 pounds in a day matters.
- D: Food and shoes distort the reading.
Takeaway: Weigh the same way every morning so a real change stands out.
Scoring: 1 point · PN action: Reinforce teaching to prevent complications
Source: MedlinePlus, Heart failure: home monitoring, Checking your weight
Physiological Adaptation (5 questions)
Question 48 · Bow-tie · Stand-alone clinical judgment
In the dining room of a long-term care facility, a resident with a seizure disorder suddenly loses awareness, falls to the floor, and has rhythmic jerking of both arms and legs that continues for 90 seconds without regaining awareness. The nurse has already called for help. Complete the bow-tie: choose the condition, 2 actions to take, and 2 parameters to monitor.
Condition most likely — choose 1:
- Convulsive (generalized) seizure
- Fainting from low blood pressure
- Choking
- Panic attack
Actions to take — choose 2:
- Protect the head with something soft and move hard objects away
- Gently turn the resident onto one side
- Put something in the mouth to protect the teeth
- Hold the arms and legs still
- Give sips of water
Parameters to monitor — choose 2:
- How long the seizure lasts
- Breathing during and after the seizure
- Bowel sounds
- Hand-grip strength
Show answer and explanation
Correct answers:
- Condition most likely: Convulsive (generalized) seizure
- Actions to take: Protect the head with something soft and move hard objects away; Gently turn the resident onto one side
- Parameters to monitor: How long the seizure lasts; Breathing during and after the seizure
Why: Sudden loss of awareness with jerking of both arms and legs is most consistent with a convulsive seizure in this scenario. Protect the head, clear the area, and turn the person on their side to help breathing. Time the seizure and watch breathing and recovery.
Why not the others:
- Put something in the mouth to protect the teeth: Never put anything in the mouth during a seizure.
- Hold the arms and legs still: Don’t restrain the movements.
- Give sips of water: Nothing by mouth until the person is fully alert.
- Fainting from low blood pressure: The ongoing rhythmic convulsions and seizure history favor a convulsive seizure rather than a brief faint.
- Choking: The described event is loss of awareness with bilateral jerking, not the usual airway-obstruction presentation.
- Panic attack: A panic attack does not best explain this loss of awareness with bilateral jerking.
- Bowel sounds and hand-grip strength: Neither is the immediate monitoring priority during an active convulsion; duration and breathing guide urgent help.
Takeaway: Protect, position, time it, watch the breathing.
Scoring: up to 5 points: 1 for each correct box · PN action: Respond to a life-threatening situation
Source: CDC, First Aid for Seizures, During a seizure; what not to do; when to call for emergency help
Question 49 · Choose one
During a home visit, a 64-year-old client says he has had pressure in the center of his chest for 15 minutes. He is sweating and short of breath. What should the nurse do first?
- A. Drive him to the emergency department
- B. Call 911
- C. Have him rest for 30 minutes and recheck
- D. Call his primary care office for an appointment
Show answer and explanation
Correct answer: B. Call 911
Why: Chest pressure with sweating and shortness of breath are heart attack warning signs. In the community, the right move is to call 911 now.
Why not the others:
- A: Driving delays treatment that emergency responders can start on the way.
- C: Waiting loses time that matters.
- D: An appointment is far too slow.
Takeaway: Possible heart attack at home: call 911.
Scoring: 1 point · PN action: Respond to a life-threatening situation
Source: CDC, About Heart Attack, Symptoms; call 911
Question 50 · Choose one
A hospitalized client being treated for pneumonia was alert this morning. She is now confused, breathing faster, and says she feels “the worst I’ve ever felt.” What should the nurse do first?
- A. Recheck her in an hour
- B. Report now and start the facility’s rapid response or sepsis process
- C. Encourage fluids and rest
- D. Give PRN acetaminophen and document
Show answer and explanation
Correct answer: B. Report now and start the facility’s rapid response or sepsis process
Why: An infection plus new confusion, fast breathing, and feeling extremely unwell can signal sepsis, which is a medical emergency needing urgent evaluation.
Why not the others:
- A: An hour is too long when deterioration is happening now.
- C: Comfort measures don’t address a possible emergency.
- D: Treating one symptom and documenting delays escalation.
Takeaway: Infection + sudden deterioration = escalate now.
Scoring: 1 point · PN action: Recognize and report change in condition
Source: CDC, About Sepsis, Signs and symptoms; emergency evaluation
Question 51 · Matrix · Stand-alone clinical judgment (trend)
A home health client has heart failure. Review the 3-day record. For each Day 3 finding, decide whether it suggests worsening fluid buildup to report or does not.
| Finding | Day 1 | Day 2 | Day 3 |
|---|---|---|---|
| Morning weight | 172.0 lb | 172.6 lb | 175.4 lb |
| Ankles | No swelling | Slight swelling | Swollen; shoes feel tight |
| Breathing | Normal with activity | Normal with activity | More short of breath walking to the mailbox |
| Sleep | 1 pillow | 1 pillow | Slept sitting up; woke short of breath |
| Blood pressure (mmHg) | 128/76 | 126/74 | 126/74 |
| Temperature | 36.8 °C | 36.9 °C | 36.8 °C |
| Finding or action | Suggests worsening; report | Does not suggest worsening |
|---|---|---|
| Weight up 2.8 lb since yesterday | ○ | ○ |
| Swollen ankles and tight shoes | ○ | ○ |
| More short of breath with activity | ○ | ○ |
| Short of breath lying down at night | ○ | ○ |
| Blood pressure 126/74 mmHg | ○ | ○ |
| Temperature 36.8 °C | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Weight up 2.8 lb since yesterday | Suggests worsening; report |
| Swollen ankles and tight shoes | Suggests worsening; report |
| More short of breath with activity | Suggests worsening; report |
| Short of breath lying down at night | Suggests worsening; report |
| Blood pressure 126/74 mmHg | Does not suggest worsening |
| Temperature 36.8 °C | Does not suggest worsening |
Why: The 2.8-lb gain in 24 hours, together with new swelling and breathlessness, needs prompt reporting. Use the client’s individualized weight-action threshold when provided. Blood pressure and temperature haven’t changed.
Takeaway: Heart failure trend: weight up + swelling + breathlessness = report.
Scoring: up to 6 points: 1 for each correct row · PN action: Recognize and report change in condition
Source: MedlinePlus, Heart failure: home monitoring, Warning signs of fluid buildup; checking your weight
Question 52 · Select all that apply · Stand-alone clinical judgment (trend)
The nurse checks a client hourly after abdominal surgery. Which trends are consistent with fluid or blood loss and need to be reported immediately? Select all that apply.
| Time | Heart rate (beats/min) | Blood pressure (mmHg) | Urine output | Skin and behavior | Temperature | Pain |
|---|---|---|---|---|---|---|
| 1300 | 88 | 124/76 | 60 mL/h | Warm, dry; calm | 37.0 °C | 4/10 |
| 1400 | 102 | 112/70 | 35 mL/h | Restless | 37.0 °C | 4/10 |
| 1500 | 118 | 96/60 | 15 mL/h | Cool, clammy; anxious | 37.0 °C | 4/10 |
- A. Rising heart rate
- B. Falling blood pressure
- C. Falling urine output
- D. Cool, clammy skin with new anxiety
- E. Temperature holding at 37.0 °C
- F. Pain holding at 4/10
Show answer and explanation
Correct answers: A, B, C, D
Why: A faster pulse, lower blood pressure, less urine, and cool, clammy skin with anxiety are signs of hypovolemia and possible shock. Activate urgent help according to the facility’s emergency protocol and report the changes immediately.
Why not the others:
- E: A steady, normal temperature doesn’t point to fluid loss.
- F: Unchanged pain isn’t part of this pattern.
Takeaway: Pulse up, pressure down, urine down, skin cool: report now.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0 · PN action: Recognize and report change in condition
Source: MedlinePlus, Hypovolemic shock, Symptoms; exam findings (low blood pressure, rapid weak pulse)
Score Part A
Add up your points in each area. Count only questions you answered before opening the explanation.
| Content area | Questions | Points if all answered | Your points |
|---|---|---|---|
| Coordinated Care | 11 | 12 | |
| Safety and Infection Prevention and Control | 7 | 19 | |
| Health Promotion and Maintenance | 5 | 11 | |
| Psychosocial Integrity | 6 | 9 | |
| Basic Care and Comfort | 5 | 14 | |
| Pharmacological Therapies | 7 | 11 | |
| Reduction of Risk Potential | 6 | 11 | |
| Physiological Adaptation | 5 | 17 | |
| Part A total | 52 | 104 |
The displayed totals assume every question was answered before its explanation was opened. For a partial attempt, subtract the maximum points for unanswered or peeked questions before calculating a percentage.
Part B: Three clinical-judgment case studies
Each case unfolds over six questions that follow NCSBN’s six clinical-judgment steps: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Chart updates appear with the question they belong to. These are Next Generation NCLEX (NGN)-style practice cases, not official NCLEX items.
Case study 1: A client’s low blood glucose on a medical unit
Setting: Medical unit, hospital
Nurses’ note, 0800. 58-year-old client with insulin-treated diabetes, admitted for a foot wound. Alert, oriented, swallowing safely; no nothing-by-mouth (NPO) order. Scheduled mealtime insulin was given at 0730. The breakfast tray has been delayed. Client says, “I feel shaky and sweaty, and I’m really hungry.”
| Vital signs and labs, 0800 | Result |
|---|---|
| Fingerstick glucose (fasting) | 58 mg/dL (reference 70–99 mg/dL) |
| Blood pressure | 128/78 mmHg |
| Heart rate | 92 beats/min |
| Temperature | 37.0 °C |
| Orientation | Person, place, time |
Unit protocol (authorized): For a client who is alert and can swallow, with glucose below 70 mg/dL: give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if still below 70 mg/dL. Notify the RN and provider per protocol and document.
Question 53 · Recognize cues · Select all that apply
Which findings require follow-up? Select all that apply.
- A. Glucose 58 mg/dL
- B. Shakiness
- C. Sweating
- D. Mealtime insulin given at 0730 with breakfast not yet delivered
- E. Blood pressure 128/78 mmHg
- F. Oriented to person, place, and time
Show answer and explanation
Correct answers: A, B, C, D
Why: The glucose is below the reference range, the client has classic low blood sugar symptoms, and insulin was given without the meal it was timed for.
Why not the others:
- E: Blood pressure is within an expected range.
- F: Orientation is reassuring; the chart also explicitly says the client can swallow safely.
Takeaway: Cues cluster: the number, the symptoms, and the cause.
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0
Source: CDC, Low Blood Sugar (Hypoglycemia), Symptoms and causes of low blood sugar; MedlinePlus, Blood sugar test, Normal fasting reference (70–99 mg/dL)
Question 54 · Analyze cues · Matrix
For each finding, decide whether it supports or does not support low blood glucose as the explanation.
| Finding or action | Supports low blood glucose | Does not support |
|---|---|---|
| Insulin given, breakfast delayed | ○ | ○ |
| Shakiness and sweating | ○ | ○ |
| Strong hunger | ○ | ○ |
| Temperature 37.0 °C | ○ | ○ |
| Blood pressure 128/78 | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Insulin given, breakfast delayed | Supports low blood glucose |
| Shakiness and sweating | Supports low blood glucose |
| Strong hunger | Supports low blood glucose |
| Temperature 37.0 °C | Does not support |
| Blood pressure 128/78 | Does not support |
Why: Insulin without food, shakiness, sweating, and hunger all fit low blood glucose. A normal temperature and blood pressure don’t add to that explanation.
Takeaway: Link each cue to the problem it explains.
Scoring: up to 5 points: 1 for each correct row
Source: CDC, Low Blood Sugar (Hypoglycemia), Symptoms; insulin and food mismatch
Question 55 · Prioritize hypotheses · Choose one
Which problem is the nurse’s priority right now?
- A. Low blood glucose
- B. Delayed wound healing
- C. Need for diabetes diet teaching
- D. Risk for high blood pressure
Show answer and explanation
Correct answer: A. Low blood glucose
Why: Low blood glucose is happening now and can worsen quickly. The other options do not address the immediate problem.
Why not the others:
- B: Wound healing matters but isn’t the immediate threat.
- C: Teaching comes after the client is safe.
- D: Blood pressure is within an expected range.
Takeaway: Treat what’s dangerous now first.
Scoring: 1 point
Source: CDC, Treatment of Low Blood Sugar (Hypoglycemia), Treat low blood sugar immediately
Question 56 · Generate solutions · Select all that apply
Which actions belong in the plan under the unit protocol? Select all that apply.
- A. Give 15 g of fast-acting carbohydrate, such as 4 ounces (½ cup) of juice
- B. Recheck glucose in 15 minutes
- C. Notify the RN and provider per protocol
- D. Give a diet soda
- E. Skip the client’s next insulin dose without an order
Show answer and explanation
Correct answers: A, B, C
Why: The 15-15 approach is 15 g of carbohydrate, a recheck in 15 minutes, and repeat if still low. The protocol also calls for notifying the team.
Why not the others:
- D: Diet soda has no sugar, so it won’t raise glucose.
- E: Changing insulin is a prescriber decision, not part of this protocol.
Takeaway: 15 grams, 15 minutes, repeat if needed, and tell the team.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0
Source: CDC, Treatment of Low Blood Sugar (Hypoglycemia), The 15-15 rule; foods to treat low blood sugar
Question 57 · Take action · Drop-down
Update, 0815. The nurse gave 15 g of fast-acting carbohydrate at 0800. Glucose is now 66 mg/dL. Still shaky. Alert; swallowing safely. Breakfast still not delivered.
At 0815 the recheck shows glucose 66 mg/dL. The client is still alert and swallowing safely. Complete the next step.
The nurse should [Blank 1] and recheck glucose in [Blank 2].
Blank 1 choices: repeat 15 g of fast-acting carbohydrate · wait for the breakfast tray · give only a protein snack · give glucagon
Blank 2 choices: 15 minutes · 30 minutes · 1 hour · at lunch
Show answer and explanation
Correct answers: 1: repeat 15 g of fast-acting carbohydrate; 2: 15 minutes
Why: The glucose is still below 70 mg/dL, so the protocol says repeat the carbohydrate and recheck in another 15 minutes.
Why not the others:
- wait for the breakfast tray: Waiting leaves the low untreated.
- give only a protein snack: Fast-acting carbohydrate treats the low; the balanced snack or meal comes after.
- give glucagon: Glucagon isn’t the step for an alert client who can swallow under this protocol.
- 30 minutes, 1 hour, or at lunch: Each delays the 15-minute recheck specified by this protocol.
Takeaway: Still under 70? Repeat and recheck.
Scoring: up to 2 points: 1 for each correct drop-down
Source: CDC, Treatment of Low Blood Sugar (Hypoglycemia), The 15-15 rule: repeat if still below 70 mg/dL
Question 58 · Evaluate outcomes · Choose one
Update, 0830. The nurse repeated 15 g of fast-acting carbohydrate at 0815. Glucose is now 94 mg/dL. No shakiness or sweating. Breakfast tray delivered.
At 0830 glucose is 94 mg/dL, the shakiness and sweating are gone, and breakfast has arrived. Which statement best evaluates the outcome?
- A. The treatment worked; the client should eat the meal, and monitoring continues per the plan
- B. The problem is solved for good, so no more glucose checks are needed
- C. The treatment failed because the value is not higher
- D. Give another 15 g of carbohydrate now
Show answer and explanation
Correct answer: A. The treatment worked; the client should eat the meal, and monitoring continues per the plan
Why: Glucose is back above 70 and symptoms have resolved, so treatment worked. After treating a low, the client eats a balanced meal or snack, and ongoing monitoring continues.
Why not the others:
- B: One good value doesn’t end monitoring.
- C: 94 mg/dL is a successful response.
- D: The glucose is no longer low.
Takeaway: Improved number + resolved symptoms = response. Then feed and keep monitoring.
Scoring: 1 point
Source: CDC, Treatment of Low Blood Sugar (Hypoglycemia), After treating, eat a balanced snack or meal
Case study 2: New diarrhea on an acute care unit
Setting: Acute care unit, hospital
Nurses’ note, 1000. 72-year-old client on day 5 of IV antibiotics for pneumonia. Three loose, unformed stools since 0600. No laxatives in the past 48 hours. Client says her mouth is dry and she hasn’t urinated as much as usual; last urine was darker than usual. Alert and oriented. Temperature 37.2 °C, BP 124/76 mmHg, HR 88 beats/min.
Unit protocol and orders: The unit uses a nurse-driven protocol to place clients with new diarrhea on contact precautions while the cause is evaluated. Orders: stool specimen for C. difficile testing; strict intake and output; notify the provider of changes.
Question 59 · Recognize cues · Select all that apply
Which findings require follow-up? Select all that apply.
- A. Three loose stools since 0600
- B. Dry mouth
- C. Less urine than usual, darker in color
- D. Blood pressure 124/76
- E. Alert and oriented
- F. Temperature 37.2 °C
Show answer and explanation
Correct answers: A, B, C
Why: New diarrhea in a client on antibiotics needs evaluation, and a dry mouth with less, darker urine suggests fluid loss.
Why not the others:
- D: Blood pressure is within an expected range.
- E: Normal mental status is reassuring.
- F: This temperature isn’t a new concern.
Takeaway: New stools plus signs of fluid loss need follow-up.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0
Source: MedlinePlus, Dehydration, Symptoms of dehydration in adults; CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Patients with diarrhea are evaluated for cause
Question 60 · Analyze cues · Matrix
For each finding, decide whether it specifically supports fluid loss (dehydration).
| Finding or action | Supports fluid loss | Does not specifically support fluid loss |
|---|---|---|
| Dry mouth | ○ | ○ |
| Urinating less than usual | ○ | ○ |
| Darker urine | ○ | ○ |
| Alert and oriented | ○ | ○ |
| Temperature 37.2 °C | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Dry mouth | Supports fluid loss |
| Urinating less than usual | Supports fluid loss |
| Darker urine | Supports fluid loss |
| Alert and oriented | Does not specifically support fluid loss |
| Temperature 37.2 °C | Does not specifically support fluid loss |
Why: Dry mouth, urinating less, and dark urine are adult dehydration symptoms. Being alert and having a temperature of 37.2 °C do not specifically support fluid loss, but they do not rule it out.
Takeaway: Match each finding to what it actually supports.
Scoring: up to 5 points: 1 for each correct row
Source: MedlinePlus, Dehydration, Symptoms of dehydration in adults
Question 61 · Prioritize hypotheses · Choose one
What is the most likely explanation for the client’s dry mouth and reduced urine?
- A. Fluid loss from the diarrhea
- B. Confirmed C. difficile infection
- C. Normal aging
- D. Worsening pneumonia
Show answer and explanation
Correct answer: A. Fluid loss from the diarrhea
Why: Several loose stools plus dry mouth and less urine point to fluid loss. The cause of the diarrhea is still being evaluated.
Why not the others:
- B: C. diff is suspected, not confirmed; symptoms alone don’t confirm it.
- C: These are new changes, not a baseline.
- D: Nothing in the data points to a lung change.
Takeaway: Explain the new findings with what the data supports, not a diagnosis you don’t have yet.
Scoring: 1 point
Source: MedlinePlus, Dehydration, Symptoms and causes of dehydration (vomiting or diarrhea)
Question 62 · Generate solutions · Select all that apply
Which actions should the nurse plan now? Select all that apply.
- A. Place the client on contact precautions now, while the cause is evaluated
- B. Use dedicated equipment, such as a blood pressure cuff and stethoscope
- C. Monitor intake and output as ordered
- D. Wait for a positive C. diff test before starting precautions
- E. Give an over-the-counter antidiarrheal without an order
Show answer and explanation
Correct answers: A, B, C
Why: CDC guidance supports isolating clients with diarrhea while the cause is evaluated and using dedicated equipment. Intake and output is ordered to track fluid status.
Why not the others:
- D: Waiting for results allows spread during the testing window.
- E: Medicating without an order isn’t within the plan.
Takeaway: Suspected C. diff: precautions now, not after the result.
Scoring: up to 3 points: +1 for each correct choice, −1 for each incorrect choice, never below 0
Source: CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Isolate and initiate contact precautions; dedicated equipment
Question 63 · Take action · Drop-down
Update, day 6. C. difficile infection confirmed; treatment ordered. Transfer to the hospital’s inpatient rehabilitation unit today.
The test confirms C. difficile infection. The client is being transferred to the hospital’s inpatient rehabilitation unit. Complete the handoff statement.
In the handoff, the nurse should [Blank 1] so that [Blank 2].
Blank 1 choices: tell the receiving unit the client’s C. diff status · leave the diagnosis out to protect privacy · tell the receiving unit only about the pneumonia
Blank 2 choices: contact precautions continue on the new unit · the client can stop precautions on arrival · the rehab unit can repeat the test
Show answer and explanation
Correct answers: 1: tell the receiving unit the client’s C. diff status; 2: contact precautions continue on the new unit
Why: CDC guidance says to notify the receiving unit of a client’s C. diff status so contact precautions continue at the new location. This pair is scored together: both parts must be right.
Why not the others:
- leave the diagnosis out to protect privacy: Sharing information needed for treatment and safety is part of care.
- the client can stop precautions on arrival: A transfer doesn’t end precautions.
- tell the receiving unit only about the pneumonia: This omits the infection-control information the receiving unit needs.
- the rehab unit can repeat the test: Repeat testing is not the reason for this handoff; the receiving unit needs to continue the indicated precautions. CDC advises against testing to document cure.
Takeaway: Precautions travel with the client, and the handoff is how.
Scoring: 1 point, only if both drop-downs are correct
Source: CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, When transferring patients, notify receiving units of CDI status
Question 64 · Evaluate outcomes · Choose one
Update, day 8. No loose stools for 24 hours. One formed stool. Mouth moist. Urine output back to baseline.
Two days later, the client has had no loose stools for 24 hours, her mouth is moist, and urine output is back to her usual amount. Which statement is correct?
- A. Stools and hydration are improving; keep contact precautions until the protocol’s criteria are met, at least 48 hours after diarrhea resolves
- B. Remove precautions now, because the diarrhea has stopped
- C. There’s no improvement; she is still dehydrated
- D. Stop monitoring intake and output now
Show answer and explanation
Correct answer: A. Stools and hydration are improving; keep contact precautions until the protocol’s criteria are met, at least 48 hours after diarrhea resolves
Why: The findings show improvement. For confirmed C. diff in acute care hospitals, CDC guidance keeps contact precautions for at least 48 hours after diarrhea resolves, or longer.
Why not the others:
- B: 24 hours without diarrhea doesn’t meet the 48-hour minimum.
- C: The data show improvement.
- D: Stopping monitoring is a provider or protocol decision, not an automatic step.
Takeaway: Improvement is real, but precautions follow the clock, not the first good day.
Scoring: 1 point
Source: CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Maintain contact precautions at least 48 hours after diarrhea has resolved
Case study 3: A client taking lithium on a behavioral health unit
Setting: Inpatient behavioral health unit
Nurses’ note, 0800. 45-year-old client with bipolar disorder, taking lithium for 3 years, admitted yesterday. His sister reports he started over-the-counter ibuprofen 5 days ago for back pain and has had vomiting and diarrhea for 2 days. This morning he is drowsy, his hands are shaking in a way he can’t control, he walks unsteadily, and his speech is slurred. He reports mild thirst. Next lithium dose is due at 0900.
| Vital signs and labs, 0800 | Result |
|---|---|
| Serum lithium | 2.1 mEq/L (laboratory reference range 0.6–1.2 mEq/L) |
| Blood pressure | 124/80 mmHg |
| Heart rate | 84 beats/min |
| Temperature | 36.9 °C |
Question 65 · Recognize cues · Select all that apply
Which findings require follow-up? Select all that apply.
- A. Drowsiness
- B. Hand shaking he can’t control
- C. Unsteady walking
- D. Slurred speech
- E. Blood pressure 124/80 mmHg
- F. Temperature 36.9 °C
Show answer and explanation
Correct answers: A, B, C, D
Why: Drowsiness, uncontrollable shaking, loss of coordination, and slurred speech are all on the list of symptoms that mean lithium should be stopped and the prescriber called immediately.
Why not the others:
- E: Blood pressure is within an expected range.
- F: A temperature of 36.9 °C does not explain the new neurologic changes.
Takeaway: Know which lithium symptoms are “tell your provider” and which are “stop and call now.”
Scoring: up to 4 points: +1 for each correct choice, −1 for each incorrect choice, never below 0
Source: MedlinePlus, Lithium, Side effects: symptoms that require stopping lithium and calling the doctor immediately; DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Question 66 · Analyze cues · Matrix
For each factor, decide whether it is linked to a higher risk of lithium side effects or toxicity.
| Finding or action | Linked to higher risk | Not linked |
|---|---|---|
| Started ibuprofen 5 days ago | ○ | ○ |
| Two days of vomiting and diarrhea | ○ | ○ |
| Takes lithium at the same times every day | ○ | ○ |
| Wears glasses for reading | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Started ibuprofen 5 days ago | Linked to higher risk |
| Two days of vomiting and diarrhea | Linked to higher risk |
| Takes lithium at the same times every day | Not linked |
| Wears glasses for reading | Not linked |
Why: NSAIDs such as ibuprofen interact with lithium. Severe diarrhea is a flag to tell the prescriber about, and vomiting and diarrhea are also on the stop-and-call list. Taking lithium on schedule is correct use.
Takeaway: Look for what changed: new medicines and fluid losses.
Scoring: up to 4 points: 1 for each correct row
Source: MedlinePlus, Lithium, Special precautions (NSAIDs such as ibuprofen; severe diarrhea); DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Question 67 · Prioritize hypotheses · Drop-down
Complete the statement.
The client’s findings are most consistent with [Blank 1], as shown by [Blank 2].
Blank 1 choices: lithium toxicity · alcohol withdrawal · a manic episode
Blank 2 choices: neurologic changes plus a lithium level above the reference range · normal vital signs · mild thirst
Show answer and explanation
Correct answers: 1: lithium toxicity; 2: neurologic changes plus a lithium level above the reference range
Why: The neurologic symptoms match the lithium warning list, and the level is well above the laboratory’s range. This pair is scored together: both parts must be right.
Why not the others:
- alcohol withdrawal: Nothing in the history points to alcohol, and the level explains the picture.
- a manic episode: Mania is a frenzied, abnormally excited mood. Drowsiness and slurred speech don’t fit that picture.
- normal vital signs: These do not explain the neurologic changes and do not exclude lithium toxicity.
- mild thirst: Thirst is less specific than the new neurologic changes and elevated lithium level; it does not establish the priority problem by itself.
Takeaway: Match the pattern to the level, and to what changed.
Scoring: 1 point, only if both drop-downs are correct
Source: MedlinePlus, Lithium, Symptoms requiring immediate action; lab monitoring; DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Question 68 · Generate solutions · Matrix
For each proposed action, decide whether it is indicated or not indicated.
| Finding or action | Indicated | Not indicated |
|---|---|---|
| Hold the 0900 lithium dose and notify the provider immediately | ○ | ○ |
| Put fall precautions in place | ○ | ○ |
| Give ibuprofen for back pain | ○ | ○ |
| Cut back the client’s salt intake without an order | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Hold the 0900 lithium dose and notify the provider immediately | Indicated |
| Put fall precautions in place | Indicated |
| Give ibuprofen for back pain | Not indicated |
| Cut back the client’s salt intake without an order | Not indicated |
Why: These symptoms call for stopping lithium and calling the prescriber immediately, and unsteady walking calls for fall precautions. Ibuprofen can raise lithium concentrations. Lithium diets need the right amounts of fluid and salt as the provider directs, so the nurse doesn’t change salt on their own.
Takeaway: Stop the risk, protect from injury, and don’t add a new one.
Scoring: up to 4 points: 1 for each correct row
Source: MedlinePlus, Lithium, Symptoms requiring stopping lithium; special dietary instructions; NSAID interaction; NCSBN, 2026 NCLEX-PN Test Plan, Pharmacological Therapies, “Withhold medication dose if client experiences adverse effect,” p. 39; DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Question 69 · Take action · Choose the number shown
Which 2 actions should the nurse take first?
- A. Withhold the 0900 lithium dose
- B. Report the findings and the lithium level to the provider immediately
- C. Give the ibuprofen for back pain
- D. Encourage him to walk the hallway alone to improve his balance
- E. Give a double dose tonight to make up for the missed dose
Show answer and explanation
Correct answers: A, B
Why: Withhold the dose and report immediately. Both come straight from the lithium warning instructions.
Why not the others:
- C: This adds an interacting drug.
- D: Walking alone with poor coordination risks a fall.
- E: Do not double a lithium dose to make up for a missed dose; here it would add to an already dangerous exposure.
Takeaway: Withhold the dose and get help now.
Scoring: up to 2 points: 1 for each correct choice
Source: MedlinePlus, Lithium, Symptoms requiring stopping lithium; missed-dose instructions (never double); DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Question 70 · Evaluate outcomes · Matrix
Update, next day, 0800. Speech clear. Walking steadily. No vomiting or diarrhea since yesterday afternoon. Hand tremor is now fine rather than uncontrollable. Serum lithium 1.4 mEq/L (reference 0.6–1.2 mEq/L).
The next day, after the provider’s treatment, the nurse reviews the client. Compare each finding with the initial 0800 assessment.
| Finding or action | Improved | No change | Worsened |
|---|---|---|---|
| Speech | ○ | ○ | ○ |
| Walking | ○ | ○ | ○ |
| Vomiting and diarrhea | ○ | ○ | ○ |
| Hand tremor | ○ | ○ | ○ |
| Lithium level (2.1 → 1.4 mEq/L) | ○ | ○ | ○ |
Show answer and explanation
Correct answers:
| Finding or action | Answer |
|---|---|
| Speech | Improved |
| Walking | Improved |
| Vomiting and diarrhea | Improved |
| Hand tremor | Improved |
| Lithium level (2.1 → 1.4 mEq/L) | Improved |
Why: Speech, gait, and GI symptoms have improved, and the level has come down, although it is still above the reference range. The hand tremor is less pronounced than at the initial assessment.
Takeaway: Compare with the baseline and the last value. Improving isn’t the same as back in range.
Scoring: up to 5 points: 1 for each correct row
Source: MedlinePlus, Lithium, Side effects: fine tremor versus more concerning neurologic symptoms; interpret alongside the current label; DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark), Label August 2025: Warnings—Lithium Toxicity; Drug Interactions—NSAIDs; Adverse Reactions; long-term serum range 0.6–1.2 mEq/L
Score Part B
Each clinical-judgment step appears once in each case, so each row below covers three questions.
| Clinical-judgment step | Questions | Points if all answered | Your points |
|---|---|---|---|
| Recognize cues | 53, 59, 65 | 11 | |
| Analyze cues | 54, 60, 66 | 14 | |
| Prioritize hypotheses | 55, 61, 67 | 3 | |
| Generate solutions | 56, 62, 68 | 10 | |
| Take action | 57, 63, 69 | 5 | |
| Evaluate outcomes | 58, 64, 70 | 7 | |
| Part B total | 18 | 50 |
The displayed totals assume every question was answered before its explanation was opened. For a partial attempt, subtract the maximum points for unanswered or peeked questions before calculating a percentage.
Your results and what to study first
The whole test is worth 154 points: 104 in Part A and 50 in Part B. For each content area and each clinical-judgment step, divide points earned by the possible points only for the items you answered before revealing their answers. Exclude unanswered and peeked items from both totals. No attempted items means “not attempted,” not 0%.
Count only the questions you answered before opening the explanation. If you peeked first, that question is a review, not a score, and that’s fine. Reviewing is the point.
Choose what to review next by looking for a repeated missed concept, a missed safety cue, or an error in reading the format. Revisit those explanations and sources, then explain the right action in your own words. A few items in one area cannot reliably rank your strengths or weaknesses.
This is practice feedback on 70 fixed questions. It isn’t an NCLEX score and doesn’t predict a result. Areas with 5 to 11 questions swing a lot with one or two answers.
How this practice test matches the 2026 NCLEX-PN
The 52 content-area questions follow the 2026 PN midpoints, and the 18 case-study questions follow the three six-step case studies NCSBN describes. That’s the same 52 + 18 split as the scored part of a minimum-length NCLEX-PN. What a fixed set can’t copy is the adaptive part.
| Content area | Official range | Official midpoint | Questions here | Share here |
|---|---|---|---|---|
| Coordinated Care | 18–24% | 21% | 11 | 21.2% |
| Safety and Infection Prevention and Control | 10–16% | 13% | 7 | 13.5% |
| Health Promotion and Maintenance | 6–12% | 9% | 5 | 9.6% |
| Psychosocial Integrity | 9–15% | 12% | 6 | 11.5% |
| Basic Care and Comfort | 7–13% | 10% | 5 | 9.6% |
| Pharmacological Therapies | 10–16% | 13% | 7 | 13.5% |
| Reduction of Risk Potential | 9–15% | 12% | 6 | 11.5% |
| Physiological Adaptation | 7–13% | 10% | 5 | 9.6% |
| Total | 100% | 52 | 100% |
Ranges and midpoints: 2026 NCLEX-PN Test Plan, “Distribution of Content,” p. 5 (effective April 1, 2026, through March 31, 2029, per the NCLEX Test Plans page). Question counts are Castleport arithmetic: 52 × each midpoint, rounded by largest remainder so the total stays 52. Five of the 52 are stand-alone clinical-judgment items (two bow-ties, three trend items), echoing the plan’s “approximately 10%.” That count is our design choice, not an NCSBN number. The percentages describe item counts, not the share of practice points: multi-part questions carry different point totals. The cases and topics are a limited selection, not exhaustive blueprint coverage.
What a fixed test can’t do. The real exam runs 85 to 150 items in five hours, including breaks, and adds 15 unscored pretest items you can’t identify. A computer picks each item based on your previous answers, and by the end you usually receive items you have about a 50% chance of answering fully correctly, so the real exam is supposed to feel hard. You pass by showing ability at or above NCSBN’s passing standard of −0.18 logits, not by reaching a percentage. No score on this page converts to that standard.
Sources: 2026 NCLEX-PN Test Plan, “Examination Length” and “Scoring the NCLEX,” pp. 15–17; NCLEX FAQs, “How the NCLEX Works”; NCLEX passing standard.
How we scored multi-answer questions. NCSBN gives partial credit on items with more than one correct answer, using three methods: plus/minus (points for correct choices, points taken away for incorrect ones, never below zero), zero/one (a point for each correct response), and rationale (credit depends on correctly linking related responses). This page uses the same three methods. Which method we apply to each format is our practice choice:
| Format on this page | Method we use |
|---|---|
| Choose one, calculation | 1 point or 0 |
| Select all that apply | Plus/minus |
| Matrix, drop-down, select the specified number, bow-tie | Zero/one for each correct row, blank, or selected response |
| Linked drop-down pair (Questions 63 and 67) | 1 point only when both blanks are correct |
Source: NCLEX FAQs, “How are items scored?”
How to review what you missed
For each miss, name the cause before you reread the explanation. Most misses fall into one of four buckets:
- You didn’t know it. The fact or principle was new. Study the source linked under the question.
- You missed a cue. The answer was in the stem or chart and you skimmed past it. Reread the stem and find the detail that decides it.
- You chose an action outside the PN role. Look at the PN action the question tests: assign, reinforce teaching, collect data, report, withhold, monitor. If you picked a diagnosis, a prescription change, or an independent decision the plan doesn’t give the LPN/VN, that’s this bucket.
- You misread the format. Select-all questions can have several correct answers, and bow-ties ask for exactly one condition, two actions, and two parameters.
For cue, role, or format mistakes, identify the detail that changed the answer before attempting a new question on that topic.
More free practice from NCSBN
NCSBN’s Prepare page offers a free Sample Pack that includes two PN case studies, an Exam Preview, and the Pearson candidate tutorial for the exam software. The 2026 NCLEX-PN Test Plan also includes one official sample question for each of the eight content areas in Appendix A. Use the tutorial to get comfortable with the official screens and the sample questions to study the reasoning and formats. These resources do not provide a validated readiness score.
Questions about this practice test
What score on this test means I’m ready?
None. You pass the NCLEX-PN by performing at or above an ability standard of −0.18 logits, which NCSBN has set through March 31, 2029. It isn’t a percentage, and no practice percentage converts to it. Use the specific concepts and cues you missed to decide what to study next. (NCLEX passing standard)
Are these real NCLEX questions?
No. Castleport wrote every question. Do not seek or use recalled exam content. NCSBN’s candidate rules prohibit disclosing or reconstructing exam items. (2026 NCLEX Candidate Bulletin, “Candidate Rules,” p. 16)
Can I practice with NCLEX-RN questions?
For shared nursing knowledge, yes, but RN material is weighted differently and some RN items expect actions outside the PN role. Use the official RN and PN test plans to check the role and content differences.
Does NCSBN recommend any practice test or review course?
No. NCSBN says it doesn’t recommend or endorse any review courses or study materials, including this one. (NCLEX FAQs)
Sources and verification
Exam facts (test-plan dates, content distribution, exam length and structure, scoring methods, passing standard) come from NCSBN:
- NCSBN, 2026 NCLEX-PN Test Plan
- NCLEX, Test Plans page
- NCLEX, Frequently Asked Questions
- NCLEX, Passing Standard
- NCLEX, Prepare page
- NCLEX, 2026 Candidate Bulletin
Clinical and practice sources. Each explanation links to the source for its principle. The full list:
- AHRQ TeamSTEPPS, SBAR
- AHRQ, MATCH Toolkit, Chapter 3
- AHRQ, Use the Teach-Back Method: Tool 5
- ASHA, Adult Dysphagia
- Alzheimer’s Association, Bathing
- Alzheimer’s Association, Communication
- American Cancer Society, Types of Advance Directives
- American Heart Association, 2025 Adult BLS Algorithm for Health Care Professionals
- American Heart Association, Symptoms and Diagnosis of VTE
- CDC Hear Her, Urgent Maternal Warning Signs
- CDC STEADI, Check for Safety
- CDC STEADI, Measuring Orthostatic Blood Pressure
- CDC, About Heart Attack
- CDC, About Medication Safety
- CDC, About Sepsis
- CDC, Blood Clots: Know the Risks, Signs and Symptoms
- CDC, CAUTI Guideline: Summary of Recommendations
- CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities
- CDC, Clinical Safety: Hand Hygiene for Healthcare Workers
- CDC, First Aid for Seizures
- CDC, Isolation Precautions: Recommendations
- CDC, Low Blood Sugar (Hypoglycemia)
- CDC, Milestones by 18 Months
- CDC, Milestones in Action: By 1 Year
- CDC, Preventing Falls
- CDC, Preventing Unsafe Injection Practices
- CDC, Safe Injection Practices (clinical guidance)
- CDC, Signs and Symptoms of Stroke
- CDC, Standard Precautions for All Patient Care
- CDC, Transmission-Based Precautions
- CDC, Treatment of Low Blood Sugar (Hypoglycemia)
- DailyMed, Lithium Carbonate Extended-Release Tablets (Glenmark)
- FDA, Access to Naloxone Can Save a Life During an Opioid Overdose
- FDA, Acetaminophen
- HHS, Minimum Necessary Requirement
- MedlinePlus, Alcohol withdrawal
- MedlinePlus, Blood sugar test
- MedlinePlus, Dehydration
- MedlinePlus, Heart failure: home monitoring
- MedlinePlus, Hypovolemic shock
- MedlinePlus, Lithium
- MedlinePlus, Oxycodone
- MedlinePlus, Pulling a patient up in bed
- MedlinePlus, Using a cane
- MedlinePlus, Warfarin
- NCI Dictionary, durable power of attorney for health care
- NCI, End-of-Life Care for People Who Have Cancer
- NCI, Grief, Bereavement, and Coping With Loss (PDQ)
- NCI, Last Days of Life (PDQ), Health Professional Version
- NCI, Spirituality in Cancer Care (PDQ)
- NCSBN & ANA, National Guidelines for Nursing Delegation (2019)
- NICHD Safe to Sleep, Reduce the Risk
- NICHD Safe to Sleep, Safe Sleep Environment
- NIDDK, Treatment for Constipation
- NIMH, Adult Inpatient Brief Suicide Safety Assessment Guide
- NPIAP/EPUAP/PPPIA International Guideline, Repositioning
- eCFR, 42 CFR 482.13 Patient’s Rights
Last verified: September 21, 2026. Exam facts and the supporting passages linked in each explanation were checked on that date. The content-area allocation, question counts, and practice-point calculations were recalculated.
How this resource was prepared: AI tools assisted with drafting and source checking. Source checking is not professional clinical review. Use the questions for study, not as instructions for treating an actual patient.
Written by the Castleport Test Prep Editorial Team · Methodology · Editorial standards · Independence · Corrections
Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by the National Council of State Boards of Nursing (NCSBN), Pearson, or any nursing regulatory body. Exam and credential names identify their subjects; trademarks belong to their respective owners. These are original, unofficial practice questions, not NCLEX items. Nothing on this page guarantees a passing result or licensure.