NCLEX EXAM vc
Exam Solution vc
NCLEX RN Fundamentals 2026 A+ GRADE ASSURED CO vc vc vc vc vc vc vc
MPLETE SOLUTIONS AND VERIFIED ANSWERS (A5356) vc vc vc vc vc
QUESTION 1 vc
The nurse encourages a patient with a history of heart failure to reduce energy expendit
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ure by alternating activity and rest. Which nursing process phase is this?
vc vc vc vc vc vc vc vc vc vc vc
a. Diagnosis
vc
b. Planning
vc
c. Implementation
vc
d. Evaluation
vc
ANSWER
C. Implementation Teaching a patient about alternating activity and rest is a component of patient educ
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ation, which falls into the implementation phase. This is an example of putting an individualized plan int
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
o action. Other components of implementation include assisting with hygienic care, promoting physical
vc vc vc vc vc vc vc vc vc vc vc vc vc
comfort, supporting respiratory and elimination functions, facilitating ingestion of food/fluids, managing
vc vc vc vc vc vc vc vc vc vc
the patient's surroundings, promoting a therapeutic relationship, and carrying out other therapeutic nu
vc vc vc vc vc vc vc vc vc vc vc vc vc
rsing activities. vc
QUESTION 2 vc
New nurses in orientation are learning about completion of incident reports. Which of th
vc vc vc vc vc vc vc vc vc vc vc vc vc
e following incidents would require an incident report be filed?
vc vc vc vc vc vc vc vc vc
a. Medication given 30 minutes before scheduled time
vc vc vc vc vc vc vc
b. Patient belongings lost when transferred to their hospital room
vc vc vc vc vc vc vc vc vc
c. Frayed electrical cord on an IV pump
vc vc vc vc vc vc vc
d. Medication order
vc vc
ANSWER
b. Patient belongings lost when transferred to their hospital room Any time a patient's belongings are lo
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
st an incident report must be filed. This can help identify people and departments involved, ways to pre
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
vent the occurrence in the future, and even help in locating belongings.
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 3 vc
,A patient is in the clinic with complaints of "not feeling well." The nurse knows the patie
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nt's primary defense against infection is:
vc vc vc vc vc
a. Fever
vc
b. Intact skin
vc vc
c. Inflammation
vc
d. Lethargy
vc
ANSWER
b. Intact skin The primary defense from infection is intact skin. Breaks in the skin allow a route for infec
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tion to invade. A is incorrect because fever is a secondary defense against infection. Fever is significant
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
when above 100.4℉ or 38℃. C is incorrect because inflammation is a secondary defense against infectio
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
n. Inflammation produces redness, pain, swelling, and warmth as a result of infection, irritation, or injur
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
y. The body heals during the inflammatory process as leukocytes and proteins migrate to the area in or
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
der to fight infection and repair damage. D is incorrect because lethargy is not a defense against infectio
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
n. Lethargy can be a symptom of infection.
vc vc vc vc vc vc vc
QUESTION 4 vc
A patient is recovering from a total abdominal hysterectomy. When assessed by the nurs
vc vc vc vc vc vc vc vc vc vc vc vc vc
e eight hours after the procedure, which of the following would the nurse identify as an e
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
arly sign of shock?
vc vc vc
a. Restlessness
vc
b. Warm, dry skin that is pale
vc vc vc vc vc vc
c. Heart rate of 115 bpm
vc vc vc vc vc
d. Urine output 50 mL/hr
vc vc vc vc
ANSWER
a. Restlessness Early signs of shock include restlessness, anxiousness, nervousness, and irritability. This
vc vc vc vc vc vc vc vc vc vc vc vc vc
is due to the sympathetic nervous system release of epinephrine, which also decreases perfusion to the
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
skin causing pallor, coolness, and clamminess. Other signs of shock include hypotension and confusion.
vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 5 vc
A patient is admitted to the emergency room complaining of shortness of breath. The nu
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
rse knows the patient will be evaluated for hypoxia and anticipates the healthcare provi
vc vc vc vc vc vc vc vc vc vc vc vc vc
der ordering which test?
vc vc vc
a. Complete blood cell count (CBC)
vc vc vc vc vc
b. Sputum culture
vc vc
c. Hemoglobin (Hgb)
vc vc
d. Arterial blood gas (ABG)
vc vc vc vc
ANSWER
d. Arterial blood gas (ABG) An ABG evaluates gas exchange in the lungs, which will provide the needed i
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nformation regarding oxygenation status. An arterial blood gas reveals pH, carbon dioxide and oxygen p
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
artial pressures, bicarbonate level (HCO3-), and pH.
vc vc vc vc vc vc
, QUESTION 6 vc
Emergency medical services brings an unconscious adult in to the emergency room. Whe
vc vc vc vc vc vc vc vc vc vc vc vc
n the nurse performs a rapid assessment, the location to check the pulse is:
vc vc vc vc vc vc vc vc vc vc vc vc vc
a. Radialvc
b. Brachial
vc
c. Femoral
vc
d. Carotidvc
ANSWER
d. Carotid Rapid assessment of an unconscious adult patient begins with checking circulation, which is c
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hecked at the carotid artery. If a patient is hypotensive (decreased blood pressure), the most likely plac
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e to be able to feel a pulse is the carotid artery.
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 7 vc
A patient is admitted to the medical-surgical unit with methicillin-
vc vc vc vc vc vc vc vc vc
resistant staphylococcus aureus (MRSA) of a wound. The nurse initiates contact precauti
vc vc vc vc vc vc vc vc vc vc vc
ons, which includes use of which of the following?
vc vc vc vc vc vc vc vc
a. Clean gown and gloves
vc vc vc vc
b. N-95 respirator
vc vc
c. Biohazard bin placed in the room
vc vc vc vc vc vc
d. Negative airflow room
vc vc vc
ANSWER
a. Clean gown and gloves Contact isolation requires all people entering the room to follow standard prec
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
autions in addition to wearing a clean (not sterile) gown and gloves. Other diseases that require contact
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v
precautions include the following: norovirus, rotavirus, and Clostridium difficile. Additionally, patients
c vc vc vc vc vc vc vc vc vc vc vc
with draining wounds, uncontrolled secretions, pressure ulcers, generalized rash, and ostomy bags/tube
vc vc vc vc vc vc vc vc vc vc vc
s also warrant contact precautions. C is incorrect because linen and trash for this patient are not consid
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ered biohazardous. vc
QUESTION 8 vc
A patient in the medical-
vc vc vc vc
surgical unit tells the nurse they haven't had a bowel movement in two days. What is the
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
first intervention the nurse should implement?
vc vc vc vc vc
a. Review the patient's medical record to determine normal bowel pattern
vc vc vc vc vc vc vc vc vc vc
b. Offer prune juice with every meal
vc vc vc vc vc vc
c. Call the healthcare provider to request an order for stool softener
vc vc vc vc vc vc vc vc vc vc vc
d. Increase the patient's oral fluid intake
vc vc vc vc vc vc
ANSWER
a. Review the patient's medical record to determine normal bowel pattern Bowel patterns can vary grea
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tly in adults: three BMs weekly up to three BMs daily is considered within normal range. Several factors
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v
Exam Solution vc
NCLEX RN Fundamentals 2026 A+ GRADE ASSURED CO vc vc vc vc vc vc vc
MPLETE SOLUTIONS AND VERIFIED ANSWERS (A5356) vc vc vc vc vc
QUESTION 1 vc
The nurse encourages a patient with a history of heart failure to reduce energy expendit
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ure by alternating activity and rest. Which nursing process phase is this?
vc vc vc vc vc vc vc vc vc vc vc
a. Diagnosis
vc
b. Planning
vc
c. Implementation
vc
d. Evaluation
vc
ANSWER
C. Implementation Teaching a patient about alternating activity and rest is a component of patient educ
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ation, which falls into the implementation phase. This is an example of putting an individualized plan int
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
o action. Other components of implementation include assisting with hygienic care, promoting physical
vc vc vc vc vc vc vc vc vc vc vc vc vc
comfort, supporting respiratory and elimination functions, facilitating ingestion of food/fluids, managing
vc vc vc vc vc vc vc vc vc vc
the patient's surroundings, promoting a therapeutic relationship, and carrying out other therapeutic nu
vc vc vc vc vc vc vc vc vc vc vc vc vc
rsing activities. vc
QUESTION 2 vc
New nurses in orientation are learning about completion of incident reports. Which of th
vc vc vc vc vc vc vc vc vc vc vc vc vc
e following incidents would require an incident report be filed?
vc vc vc vc vc vc vc vc vc
a. Medication given 30 minutes before scheduled time
vc vc vc vc vc vc vc
b. Patient belongings lost when transferred to their hospital room
vc vc vc vc vc vc vc vc vc
c. Frayed electrical cord on an IV pump
vc vc vc vc vc vc vc
d. Medication order
vc vc
ANSWER
b. Patient belongings lost when transferred to their hospital room Any time a patient's belongings are lo
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
st an incident report must be filed. This can help identify people and departments involved, ways to pre
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
vent the occurrence in the future, and even help in locating belongings.
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 3 vc
,A patient is in the clinic with complaints of "not feeling well." The nurse knows the patie
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nt's primary defense against infection is:
vc vc vc vc vc
a. Fever
vc
b. Intact skin
vc vc
c. Inflammation
vc
d. Lethargy
vc
ANSWER
b. Intact skin The primary defense from infection is intact skin. Breaks in the skin allow a route for infec
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tion to invade. A is incorrect because fever is a secondary defense against infection. Fever is significant
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
when above 100.4℉ or 38℃. C is incorrect because inflammation is a secondary defense against infectio
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
n. Inflammation produces redness, pain, swelling, and warmth as a result of infection, irritation, or injur
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
y. The body heals during the inflammatory process as leukocytes and proteins migrate to the area in or
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
der to fight infection and repair damage. D is incorrect because lethargy is not a defense against infectio
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
n. Lethargy can be a symptom of infection.
vc vc vc vc vc vc vc
QUESTION 4 vc
A patient is recovering from a total abdominal hysterectomy. When assessed by the nurs
vc vc vc vc vc vc vc vc vc vc vc vc vc
e eight hours after the procedure, which of the following would the nurse identify as an e
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
arly sign of shock?
vc vc vc
a. Restlessness
vc
b. Warm, dry skin that is pale
vc vc vc vc vc vc
c. Heart rate of 115 bpm
vc vc vc vc vc
d. Urine output 50 mL/hr
vc vc vc vc
ANSWER
a. Restlessness Early signs of shock include restlessness, anxiousness, nervousness, and irritability. This
vc vc vc vc vc vc vc vc vc vc vc vc vc
is due to the sympathetic nervous system release of epinephrine, which also decreases perfusion to the
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
skin causing pallor, coolness, and clamminess. Other signs of shock include hypotension and confusion.
vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 5 vc
A patient is admitted to the emergency room complaining of shortness of breath. The nu
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
rse knows the patient will be evaluated for hypoxia and anticipates the healthcare provi
vc vc vc vc vc vc vc vc vc vc vc vc vc
der ordering which test?
vc vc vc
a. Complete blood cell count (CBC)
vc vc vc vc vc
b. Sputum culture
vc vc
c. Hemoglobin (Hgb)
vc vc
d. Arterial blood gas (ABG)
vc vc vc vc
ANSWER
d. Arterial blood gas (ABG) An ABG evaluates gas exchange in the lungs, which will provide the needed i
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nformation regarding oxygenation status. An arterial blood gas reveals pH, carbon dioxide and oxygen p
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
artial pressures, bicarbonate level (HCO3-), and pH.
vc vc vc vc vc vc
, QUESTION 6 vc
Emergency medical services brings an unconscious adult in to the emergency room. Whe
vc vc vc vc vc vc vc vc vc vc vc vc
n the nurse performs a rapid assessment, the location to check the pulse is:
vc vc vc vc vc vc vc vc vc vc vc vc vc
a. Radialvc
b. Brachial
vc
c. Femoral
vc
d. Carotidvc
ANSWER
d. Carotid Rapid assessment of an unconscious adult patient begins with checking circulation, which is c
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hecked at the carotid artery. If a patient is hypotensive (decreased blood pressure), the most likely plac
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e to be able to feel a pulse is the carotid artery.
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 7 vc
A patient is admitted to the medical-surgical unit with methicillin-
vc vc vc vc vc vc vc vc vc
resistant staphylococcus aureus (MRSA) of a wound. The nurse initiates contact precauti
vc vc vc vc vc vc vc vc vc vc vc
ons, which includes use of which of the following?
vc vc vc vc vc vc vc vc
a. Clean gown and gloves
vc vc vc vc
b. N-95 respirator
vc vc
c. Biohazard bin placed in the room
vc vc vc vc vc vc
d. Negative airflow room
vc vc vc
ANSWER
a. Clean gown and gloves Contact isolation requires all people entering the room to follow standard prec
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
autions in addition to wearing a clean (not sterile) gown and gloves. Other diseases that require contact
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v
precautions include the following: norovirus, rotavirus, and Clostridium difficile. Additionally, patients
c vc vc vc vc vc vc vc vc vc vc vc
with draining wounds, uncontrolled secretions, pressure ulcers, generalized rash, and ostomy bags/tube
vc vc vc vc vc vc vc vc vc vc vc
s also warrant contact precautions. C is incorrect because linen and trash for this patient are not consid
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ered biohazardous. vc
QUESTION 8 vc
A patient in the medical-
vc vc vc vc
surgical unit tells the nurse they haven't had a bowel movement in two days. What is the
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
first intervention the nurse should implement?
vc vc vc vc vc
a. Review the patient's medical record to determine normal bowel pattern
vc vc vc vc vc vc vc vc vc vc
b. Offer prune juice with every meal
vc vc vc vc vc vc
c. Call the healthcare provider to request an order for stool softener
vc vc vc vc vc vc vc vc vc vc vc
d. Increase the patient's oral fluid intake
vc vc vc vc vc vc
ANSWER
a. Review the patient's medical record to determine normal bowel pattern Bowel patterns can vary grea
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tly in adults: three BMs weekly up to three BMs daily is considered within normal range. Several factors
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc v
