Evidence-Based Practice Nursing Exam 2026 |
120 Practice Questions + Detailed Rationales |
NCLEX Ready
1. The main goal of treatment for acute glomerulonephritis is to:
A. Encourage activity
B. Encourage high protein intake
C. Maintain fluid balance
D. Teach intermittent urinary catheterization
Correct Answer: C. Maintain fluid balance
Rationale:
Acute glomerulonephritis results in impaired kidney filtration, causing fluid retention and
potential hypertension. The priority treatment goal is maintaining proper fluid and
electrolyte balance to prevent overload and complications such as pulmonary edema. High
protein intake is avoided because it increases renal workload. Activity and catheterization are
not primary treatment goals.
2. Nursing diagnoses mostly differ from medical diagnoses in that they are:
A. Dependent upon medical diagnoses for direction of interventions
B. Primarily concerned with caring, while medical diagnoses focus on curing
C. Primarily concerned with human response, while medical diagnoses focus on pathology
D. Primarily concerned with psychosocial parameters, while medical diagnoses focus on
physiologic parameters
Correct Answer: C. Primarily concerned with human response, while medical diagnoses
focus on pathology
Rationale:
Nursing diagnoses address patient responses to health conditions, such as pain, anxiety, or
impaired mobility. Medical diagnoses identify diseases or pathologic conditions. This
distinction allows nurses to plan care interventions independent of medical diagnosis. Both
physiologic and psychosocial responses fall within nursing diagnosis scope.
3. A patient received spinal anesthesia 4 hours ago. Now reports severe
incisional pain, BP 170/90, HR 108, RR 30. Skin pale, dressing dry. Most
appropriate intervention?
,A. Medicate the patient for pain
B. Place in high Fowler and administer oxygen
C. Place in reverse Trendelenburg and open IV line
D. Report findings to provider
Correct Answer: A. Medicate the patient for pain
Rationale:
The patient exhibits physiologic signs of acute pain (hypertension, tachycardia, tachypnea).
The surgical site is intact, ruling out hemorrhage. Post-spinal anesthesia pain commonly
returns several hours later and requires prompt analgesic treatment. Treating pain will
stabilize vital signs and promote recovery.
4. To prevent a common adverse effect of prolonged phenytoin (Dilantin) use,
patients should:
A. Avoid crowds and obtain flu vaccination
B. Drink at least 2 L of fluids daily
C. Eat a potassium-rich low-sodium diet
D. Practice good dental hygiene and report gum swelling
Correct Answer: D. Practice good dental hygiene and report gum swelling
Rationale:
Phenytoin commonly causes gingival hyperplasia. Good oral hygiene and early reporting of
gum changes prevent severe complications. The other interventions do not address
phenytoin’s most common chronic adverse effect. Dental monitoring is essential for long-
term therapy.
5. The most common preventable complication of abdominal surgery is:
A. Atelectasis
B. Fluid and electrolyte imbalance
C. Thrombophlebitis
D. Urinary retention
Correct Answer: A. Atelectasis
Rationale:
Postoperative atelectasis occurs due to shallow breathing from pain and anesthesia effects.
It is highly preventable through early ambulation, incentive spirometry, and deep breathing
exercises. While other complications occur, atelectasis is the most common and most
preventable respiratory complication after surgery.
6. A 78-year-old patient with heart disease is transitioning home. Spouse has
COPD. Best discharge planning approach?
,A. Arrange nursing home placement
B. Consult spouse’s provider about ability to care
C. Contact children to confirm commitment
D. Discuss community resources and offer referrals
Correct Answer: D. Discuss community resources and offer referrals
Rationale:
Discharge planning must promote autonomy while ensuring support. Discussing home care
services, community nursing, and support resources empowers the family without assuming
inability to care. Automatically arranging placement removes patient choice. Collaboration
and resource connection reflect patient-centered discharge planning.
7. A head-injury patient develops slurred speech and disorientation 24 hours
after injury. Nurse’s initial action?
A. Continue hourly assessments
B. Inform the neurosurgeon
C. Prepare for emergency surgery
D. Recheck neuro status in 15 minutes
Correct Answer: B. Inform the neurosurgeon
Rationale:
New neurologic deterioration after head injury suggests rising intracranial pressure or
bleeding. This is a medical emergency requiring immediate provider notification. Delaying
reassessment risks permanent damage. Early intervention improves outcomes.
8. For evaluation feedback to be effective, the nurse manager:
A. Conducts weekly meetings
B. Considers staff abilities when delegating
C. Informs staff regularly of job performance
D. Provides goals for staff to meet
Correct Answer: C. Informs staff regularly of job performance
Rationale:
Effective evaluation requires continuous feedback so staff know strengths and improvement
areas. Regular performance communication promotes professional growth. Meetings and
delegation are management functions but not evaluation feedback itself. Clear feedback
improves job satisfaction and patient care quality.
9. An 80-year-old in isolation for MRSA now has hallucinations and confusion.
Cause is likely:
,A. Fluid and electrolyte imbalance
B. Stimulating environment
C. Sensory deprivation
D. Sundowning
Correct Answer: C. Sensory deprivation
Rationale:
Isolation reduces sensory input and social interaction, increasing risk of delirium in older
adults. Visual hallucinations and confusion often result from sensory deprivation. Providing
stimulation and frequent orientation reduces symptoms. Sundowning typically occurs in
dementia during evening hours.
10. After giving IV sedation for bronchoscopy, the nurse instructs the LPN to:
A. Educate patient about procedure
B. Give small sips of water
C. Measure blood pressure and heart rate
D. Take patient to bathroom
Correct Answer: C. Measure blood pressure and heart rate
Rationale:
After sedation, monitoring vital signs is essential to detect respiratory or cardiovascular
depression. LPNs can safely monitor and report vital signs. Education and hydration are
delayed until recovery. Safety monitoring is the priority.
11. Which physiologic response is associated with surgery-related stress?
A. Bronchial constriction
B. Decreased cortisol
C. Peripheral vasodilation
D. Sodium and water retention
Correct Answer: D. Sodium and water retention
Rationale:
Surgical stress triggers release of aldosterone and antidiuretic hormone, causing fluid and
sodium retention. This helps maintain blood pressure during stress but increases risk of fluid
overload. Cortisol actually increases rather than decreases. Bronchoconstriction and
vasodilation are not typical stress responses.
12. A family assumes they know the patient’s end-of-life wishes. This reflects:
A. Justice
B. Paternalism
, C. Pragmatism
D. Veracity
Correct Answer: B. Paternalism
Rationale:
Paternalism occurs when others make decisions on behalf of a patient without confirmed
consent, assuming they know what is best. This violates patient autonomy. Justice refers to
fairness, veracity to truth-telling, and pragmatism to practical action. Advance directives
prevent paternalistic decisions.
13. Which statement indicates understanding of insulin glargine (Lantus)?
A. Causes weight loss
B. Used only at night
C. Duration is six hours
D. There is no peak time
Correct Answer: D. There is no peak time
Rationale:
Insulin glargine is a long-acting basal insulin with no pronounced peak. It maintains steady
glucose control for approximately 24 hours. It does not cause weight loss and can be
administered any consistent time daily. Recognizing its peakless action prevents
hypoglycemia risk.
NEXT: QUESTIONS 14–40
(Generated Advanced Nursing Evidence-Based Practice Items)
14. In evidence-based practice, the strongest level of research evidence is:
A. Expert opinion
B. Case-control study
C. Randomized controlled trial
D. Systematic review and meta-analysis
Correct Answer: D. Systematic review and meta-analysis
Rationale:
Systematic reviews and meta-analyses synthesize results from multiple high-quality studies,
providing the strongest evidence for clinical decision-making. They reduce bias and increase
reliability. Randomized controlled trials are strong but single-study evidence. Expert opinion
is the weakest level.
120 Practice Questions + Detailed Rationales |
NCLEX Ready
1. The main goal of treatment for acute glomerulonephritis is to:
A. Encourage activity
B. Encourage high protein intake
C. Maintain fluid balance
D. Teach intermittent urinary catheterization
Correct Answer: C. Maintain fluid balance
Rationale:
Acute glomerulonephritis results in impaired kidney filtration, causing fluid retention and
potential hypertension. The priority treatment goal is maintaining proper fluid and
electrolyte balance to prevent overload and complications such as pulmonary edema. High
protein intake is avoided because it increases renal workload. Activity and catheterization are
not primary treatment goals.
2. Nursing diagnoses mostly differ from medical diagnoses in that they are:
A. Dependent upon medical diagnoses for direction of interventions
B. Primarily concerned with caring, while medical diagnoses focus on curing
C. Primarily concerned with human response, while medical diagnoses focus on pathology
D. Primarily concerned with psychosocial parameters, while medical diagnoses focus on
physiologic parameters
Correct Answer: C. Primarily concerned with human response, while medical diagnoses
focus on pathology
Rationale:
Nursing diagnoses address patient responses to health conditions, such as pain, anxiety, or
impaired mobility. Medical diagnoses identify diseases or pathologic conditions. This
distinction allows nurses to plan care interventions independent of medical diagnosis. Both
physiologic and psychosocial responses fall within nursing diagnosis scope.
3. A patient received spinal anesthesia 4 hours ago. Now reports severe
incisional pain, BP 170/90, HR 108, RR 30. Skin pale, dressing dry. Most
appropriate intervention?
,A. Medicate the patient for pain
B. Place in high Fowler and administer oxygen
C. Place in reverse Trendelenburg and open IV line
D. Report findings to provider
Correct Answer: A. Medicate the patient for pain
Rationale:
The patient exhibits physiologic signs of acute pain (hypertension, tachycardia, tachypnea).
The surgical site is intact, ruling out hemorrhage. Post-spinal anesthesia pain commonly
returns several hours later and requires prompt analgesic treatment. Treating pain will
stabilize vital signs and promote recovery.
4. To prevent a common adverse effect of prolonged phenytoin (Dilantin) use,
patients should:
A. Avoid crowds and obtain flu vaccination
B. Drink at least 2 L of fluids daily
C. Eat a potassium-rich low-sodium diet
D. Practice good dental hygiene and report gum swelling
Correct Answer: D. Practice good dental hygiene and report gum swelling
Rationale:
Phenytoin commonly causes gingival hyperplasia. Good oral hygiene and early reporting of
gum changes prevent severe complications. The other interventions do not address
phenytoin’s most common chronic adverse effect. Dental monitoring is essential for long-
term therapy.
5. The most common preventable complication of abdominal surgery is:
A. Atelectasis
B. Fluid and electrolyte imbalance
C. Thrombophlebitis
D. Urinary retention
Correct Answer: A. Atelectasis
Rationale:
Postoperative atelectasis occurs due to shallow breathing from pain and anesthesia effects.
It is highly preventable through early ambulation, incentive spirometry, and deep breathing
exercises. While other complications occur, atelectasis is the most common and most
preventable respiratory complication after surgery.
6. A 78-year-old patient with heart disease is transitioning home. Spouse has
COPD. Best discharge planning approach?
,A. Arrange nursing home placement
B. Consult spouse’s provider about ability to care
C. Contact children to confirm commitment
D. Discuss community resources and offer referrals
Correct Answer: D. Discuss community resources and offer referrals
Rationale:
Discharge planning must promote autonomy while ensuring support. Discussing home care
services, community nursing, and support resources empowers the family without assuming
inability to care. Automatically arranging placement removes patient choice. Collaboration
and resource connection reflect patient-centered discharge planning.
7. A head-injury patient develops slurred speech and disorientation 24 hours
after injury. Nurse’s initial action?
A. Continue hourly assessments
B. Inform the neurosurgeon
C. Prepare for emergency surgery
D. Recheck neuro status in 15 minutes
Correct Answer: B. Inform the neurosurgeon
Rationale:
New neurologic deterioration after head injury suggests rising intracranial pressure or
bleeding. This is a medical emergency requiring immediate provider notification. Delaying
reassessment risks permanent damage. Early intervention improves outcomes.
8. For evaluation feedback to be effective, the nurse manager:
A. Conducts weekly meetings
B. Considers staff abilities when delegating
C. Informs staff regularly of job performance
D. Provides goals for staff to meet
Correct Answer: C. Informs staff regularly of job performance
Rationale:
Effective evaluation requires continuous feedback so staff know strengths and improvement
areas. Regular performance communication promotes professional growth. Meetings and
delegation are management functions but not evaluation feedback itself. Clear feedback
improves job satisfaction and patient care quality.
9. An 80-year-old in isolation for MRSA now has hallucinations and confusion.
Cause is likely:
,A. Fluid and electrolyte imbalance
B. Stimulating environment
C. Sensory deprivation
D. Sundowning
Correct Answer: C. Sensory deprivation
Rationale:
Isolation reduces sensory input and social interaction, increasing risk of delirium in older
adults. Visual hallucinations and confusion often result from sensory deprivation. Providing
stimulation and frequent orientation reduces symptoms. Sundowning typically occurs in
dementia during evening hours.
10. After giving IV sedation for bronchoscopy, the nurse instructs the LPN to:
A. Educate patient about procedure
B. Give small sips of water
C. Measure blood pressure and heart rate
D. Take patient to bathroom
Correct Answer: C. Measure blood pressure and heart rate
Rationale:
After sedation, monitoring vital signs is essential to detect respiratory or cardiovascular
depression. LPNs can safely monitor and report vital signs. Education and hydration are
delayed until recovery. Safety monitoring is the priority.
11. Which physiologic response is associated with surgery-related stress?
A. Bronchial constriction
B. Decreased cortisol
C. Peripheral vasodilation
D. Sodium and water retention
Correct Answer: D. Sodium and water retention
Rationale:
Surgical stress triggers release of aldosterone and antidiuretic hormone, causing fluid and
sodium retention. This helps maintain blood pressure during stress but increases risk of fluid
overload. Cortisol actually increases rather than decreases. Bronchoconstriction and
vasodilation are not typical stress responses.
12. A family assumes they know the patient’s end-of-life wishes. This reflects:
A. Justice
B. Paternalism
, C. Pragmatism
D. Veracity
Correct Answer: B. Paternalism
Rationale:
Paternalism occurs when others make decisions on behalf of a patient without confirmed
consent, assuming they know what is best. This violates patient autonomy. Justice refers to
fairness, veracity to truth-telling, and pragmatism to practical action. Advance directives
prevent paternalistic decisions.
13. Which statement indicates understanding of insulin glargine (Lantus)?
A. Causes weight loss
B. Used only at night
C. Duration is six hours
D. There is no peak time
Correct Answer: D. There is no peak time
Rationale:
Insulin glargine is a long-acting basal insulin with no pronounced peak. It maintains steady
glucose control for approximately 24 hours. It does not cause weight loss and can be
administered any consistent time daily. Recognizing its peakless action prevents
hypoglycemia risk.
NEXT: QUESTIONS 14–40
(Generated Advanced Nursing Evidence-Based Practice Items)
14. In evidence-based practice, the strongest level of research evidence is:
A. Expert opinion
B. Case-control study
C. Randomized controlled trial
D. Systematic review and meta-analysis
Correct Answer: D. Systematic review and meta-analysis
Rationale:
Systematic reviews and meta-analyses synthesize results from multiple high-quality studies,
providing the strongest evidence for clinical decision-making. They reduce bias and increase
reliability. Randomized controlled trials are strong but single-study evidence. Expert opinion
is the weakest level.
