Verified NCLEX‑Style Questions with Answers | Nursing
Fundamentals Exam Study Guide | Graded A+ | 100%
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1. A nurse is preparing to administer a first dose of an oral antibiotic to a client with a
known penicillin allergy. The nurse notes that the medication order is for amoxicillin.
Which action should the nurse take first?
A. Administer the medication because the allergy is older than 10 years.
B. Hold the medication and verify the medication order with the provider.
C. Ask the client if they have ever tolerated amoxicillin before.
D. Delegate the administration to the unlicensed assistive personnel.
Answer: B
2. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with stable hypertension who reports a headache rated 4 on a 0–10 scale.
B. A client with diabetes who has a blood glucose of 52 mg/dL and is diaphoretic.
C. A client with a urinary tract infection who needs a scheduled oral antibiotic.
D. A client with mild constipation who requests a stool softener.
Answer: B
3. A nurse is teaching a client how to use an incentive spirometer. Which statement by the
client indicates understanding?
A. I should use this only when I feel short of breath.
B. I will take a slow, deep breath in and hold it for a few seconds.
C. I can stop if I feel dizzy or light‑headed.
D. I will use this every hour while awake.
Answer: B
4. A client is scheduled for a chest x‑ray. The nurse discovers the client has not signed the
consent form. What should the nurse do first?
A. Send the client to radiology and have the technologist obtain consent.
B. Ask another nurse to witness the client’s signature.
C. Notify the radiology department that the exam will be delayed.
D. Explain the procedure and ask the client to sign the consent form.
Answer: D
5. A nurse is caring for a client who is suspected of having a urinary tract infection. Which
finding should the nurse report to the provider immediately?
A. Temperature of 37.5°C (99.5°F).
B. Complaint of burning with urination.
C. Cloudy, foul‑smelling urine.
, D. Flank pain and a temperature of 39.2°C (102.6°F).
Answer: D
6. A nurse is caring for a client who is at high risk for falls. Which intervention should the
nurse prioritize first?
A. Place the bed in the lowest position with all side rails up.
B. Keep the client’s call light within reach and check on the client frequently.
C. Use a bed alarm and keep the bathroom light on at night.
D. Ask the client to use the call light before trying to get out of bed.
Answer: B
7. A nurse administers an incorrect dose of oral pain medication. Which action should the
nurse take first?
A. Document the error in the client’s chart as soon as possible.
B. Assess the client for any adverse effects or changes in condition.
C. Notify the manager and file an incident report.
D. Ask the pharmacy to bring the correct dose as soon as possible.
Answer: B
8. A client reports sudden onset of chest pain radiating to the left arm. The nurse checks
the client’s vital signs and notes a heart rate of 124 beats per minute and blood pressure
of 88/50 mm Hg. Which action should the nurse prioritize first?
A. Administer the scheduled morning dose of aspirin.
B. Notify the provider immediately and prepare for possible cardiac protocols.
C. Offer the client a sip of water.
D. Reassure the client that the pain will pass.
Answer: B
9. A nurse is caring for a client with an IV infusion of normal saline at 100 mL per hour. The
nurse notes that the IV site is red, warm, and tender with slight swelling. Which action
should the nurse prioritize?
A. Stop the infusion and remove the IV catheter.
B. Slow the infusion rate to 50 mL per hour.
C. Elevate the client’s arm and apply a warm compress.
D. Notify the provider and request an order for an alternate site.
Answer: A
10.A nurse is teaching a client about hand hygiene. Which statement by the client reflects
understanding?
A. I should wash my hands whenever they look dirty.
B. I should use hand sanitizer after touching contaminated surfaces.
C. I should wash my hands before and after contact with each client.
D. I should rinse under hot water only.
Answer: C
11.A nurse is caring for a client who is receiving oxygen at 2 L per minute via nasal cannula.
The oxygen saturation is 92% on room air but rises to 98% with oxygen. Which finding
should the nurse monitor most closely?
A. Respiratory rate.
B. Skin turgor.
, C. Bowel sounds.
D. Blood glucose level.
Answer: A
12.A client reports shortness of breath when lying flat. Which nursing intervention should
the nurse implement first?
A. Place the client in a high‑Fowler position.
B. Administer oxygen at 2 L per minute.
C. Offer the client a glass of water.
D. Ask the client to take slow, deep breaths.
Answer: A
13.A nurse is preparing to transfer a client from bed to a wheelchair. Which action should
the nurse prioritize to ensure safety?
A. Ask another nurse to hold the client’s hand during transfer.
B. Use a transfer belt and have the client’s legs dangling over the bed for a minute.
C. Instruct the client to stand up quickly to avoid dizziness.
D. Have the client grab the wheelchair arm for support.
Answer: B
14.A nurse is caring for a client with a history of diabetes. The client’s blood pressure is
168/94 mm Hg. Which action should the nurse prioritize?
A. Offer the client a low‑sodium snack.
B. Notify the provider and monitor for signs of end‑organ damage.
C. Administer the scheduled dose of antihypertensive medication.
D. Instruct the client to lie down immediately.
Answer: B
15.A client reports severe abdominal pain after receiving a dose of oral laxative. Which
assessment finding should the nurse report to the provider immediately?
A. Soft, non‑distended abdomen.
B. Absent bowel sounds and rigid, board‑like abdomen.
C. Mild cramping after several hours.
D. Flatulence and passing gas.
Answer: B
16.A nurse is delegating tasks to an unlicensed assistive personnel. Which task is
appropriate for the UAP to perform?
A. Assess a client who reports new chest pain.
B. Assist a stable client with ambulation in the hallway.
C. Evaluate the effectiveness of a new pain medication.
D. Reassess the client’s IV site for infiltration.
Answer: B
17.A nurse is teaching a client about discharge instructions for a wound dressing change.
Which statement by the client indicates understanding?
A. I can skip the dressing change if the wound looks dry.
B. I will clean the wound with tap water and cover it with a fresh dressing.
C. I will keep the area exposed to the air so it can heal faster.