Fundamentals of Nursing: NCLEX Practice Questions

We prepared a quiz of practice test questions on the fundamentals of nursing, similar to the ones you’ll find in the NCLEX exam. This test bank of 25 multiple choice questions will challenge your knowledge of nursing fundamentals in several categories, including Physiological Adaptation, Pharmacology, Basic Care & Comfort and Safety & Infections.

1. Question

The nurse is attending to a client who was diagnosed with heart failure. During the examination, the nurse observes that the client is dyspneic with crackles upon auscultation. Which symptoms would manifest for a client with excess fluid volume?

  • A. Decreased central venous pressure
  • B. Flat neck and hand veins
  • C. Hypertension
  • D. Weight loss
Show Rationale


C. Hypertension is a sign of fluid volume excess or fluid overload. The increase in fluid volume causes an increase in blood pressure in the vessels.


A., B., D. Decreased central venous pressure, flat neck and hand veins, and weight loss are all signs of fluid volume deficit.

2. Question

During the client’s medical records review, what condition can put the client at risk for developing hypokalemia?

  • A. Has a history of Addison’s disease
  • B. Nasogastric suction
  • C. Burn
  • D. Uric acid level of 10.2 mg/dL (59.48 µmol/L)
Show Rationale


B. The client is at risk for hypokalemia due to losing potassium-rich gastrointestinal fluids during nasogastric suction.


A., C., D. Clients with tissue damage (such as from severe burns), hyperuricemia, and Addison’s disease are at risk for developing hyperkalemia. The normal uric acid level ranges from 2.7 to 8.5 mg/dL (160 to 501 µmol/L).

3. Question

The nurse analyzes the electrolyte test results for a client and notes that the potassium level is 2.2 mEq/L (2.2 mmol/L). Based on the laboratory result, which ECG pattern is not expected?

  • A. Absent P waves
  • B. Depressed ST segment
  • C. Inverted T waves
  • D. Presence of U waves
Show Rationale


A. A serum potassium level of 3.5 – 5.0 mEq/L (3.5-5.0 mmol/L) is considered normal. Hypokalemia is a serum potassium level below 3.5 mEq/L (3.5 mmol/L). Absent P waves are not a sign of hypokalemia. However, it can be seen in a patient with ventricular rhythms, junctional rhythms, or atrial fibrillation.


B., C., D. Shallow, flat, or inverted T waves, ST segment depression, and the presence of U waves are electrocardiographic alterations in hypokalemia.

4. Question

An intravenous dose of potassium chloride is prescribed for a client with hypokalemia. Which action of the nurse indicates a need for further teaching in the preparation and administration of potassium?

  • A. Administer potassium through IV bolus.
  • B. Check if the label of the bag indicates the volume of the potassium in the solution.
  • C. Infuse potassium through an intravenous (IV) infusion pump.
  • D. Monitor urine output during infusion.
Show Rationale


A. Never administer potassium chloride through bolus (IV push). Cardiac arrest may occur when potassium chloride is injected intravenously as a bolus. The nurse needs to ensure that the potassium is diluted in the correct fluid or diluent.


B. The amount of potassium chloride in the IV bag is always noted on the label.
C. Potassium chloride must always be diluted with IV fluid and infused using an infusion pump before being delivered intravenously.
D. During administration, the nurse closely monitors the urinary output and reports to the healthcare provider if it decreases below 30 mL/hr.

5. Question

A client with hypoparathyroidism is suspected of having hypocalcemia. Upon assessment, the nurse notes which clinical symptom would indicate hypocalcemia.

  • A. Diminished deep tendon reflexes
  • B. Hypoactive bowel sounds
  • C. Negative Trousseau’s sign
  • D. Twitching
Show Rationale


D. Low parathyroid levels in hypoparathyroidism cause hypocalcemia by disrupting the calcium balance.The normal serum calcium is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). It is known as hypocalcemia when the serum calcium level is less than 9 mg/dL (2.25 mmol/L). Twitching is a sign of neuromuscular excitability in hypocalcemia.


A., B., and C. Hyperactive deep tendon reflexes,and a positive Trousseau’s or Chvostek’s sign indicate hypocalcemia. Increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety are symptoms of hypocalcemia.

6. Question

A client diagnosed with Crohn’s disease has a calcium level of 7 mg/dL (1.75 mmol/L). Which ECG patterns would the nurse monitor?

  • A. Peaked T wave
  • B. Prolonged QT interval
  • C. Prominent U wave
  • D. Widened T wave
Show Rationale


B. A Crohn’s disease patient is susceptible to hypocalcemia.The normal serum calcium is 9–10.5 mg/dL (2.25–2.75 mmol/L). Hypocalcemia manifests by a blood calcium level of less than 9 mg/dL (2.25 mmol/L). A prolonged QT interval and a prolonged ST segment are electrocardiographic alterations in clients with hypocalcemia.


A. Myocardial infarction results in peaked T waves.
C. Hypokalemia results in ST depression and prominent U waves.
D. Hypercalcemia causes a narrowed ST segment and a widened T wave.

7. Question

A client diagnosed with Cushing’s disease has a potassium level of 2.3 mEq/L (2.3 mmol/L). Based on the result, which pattern would the nurse be monitoring for on the cardiac monitor?

  • A. Prolonged ST segment
  • B. Prominent U wave
  • C. ST elevation
  • D. Tall peaked T waves
Show Rationale


B. A potassium level of 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is considered normal. Hypokalemia is indicated by a blood potassium level of less than 3.5 mEq/L (3.5.0 mmol/L). In Cushing’s syndrome, the increase in cortisol causes hypokalemia.


A. Hypocalcemia causes the prolonged ST segment.
C. In hypokalemia, there is ST depression and NOT elevation.
D. Hyperkalemia causes tall peaked T waves, enlarged QRS complexes, longer PR intervals, and flat P waves.

8. Question

Which client will most likely experience a serum sodium concentration of 127 mEq/L (127 mmol/L)?

  • A. A client who has Cushing’s syndrome
  • B. A client who has hyperaldosteronism
  • C. A client who is taking thiazide diuretics
  • D. A client who uses corticosteroids
Show Rationale


C. A serum sodium level of 135 to 145 mEq/L (or 135 to 145 mmol/L) is considered normal. Hyponatremia is indicated by a serum sodium level of 127 mEq/L (127 mmol/L). The client who is taking diuretics may experience hyponatremia.


A., B., and D. Risk factors for hypernatremia include using corticosteroids, having hyperaldosteronism, or having Cushing’s syndrome.

9. Question

The client was diagnosed with heart failure and is currently taking high doses of diuretics. During the assessment, the nurse noted generalized weakness, flat neck veins, and diminished deep tendon reflexes. Which of the following symptoms would indicate that the client has hyponatremia?

  • A. Decreased urinary output
  • B. Hyperactive bowel sounds
  • C. Increased urine specific gravity
  • D. Tremors
Show Rationale


B. A serum sodium level of 135 to 145 mEq/L (or 135 to 145 mmol/L) is considered normal. A serum sodium level of less than 135 mEq/L (135 mmol/L) indicates hyponatremia. Hyperactive bowel movements indicate hyponatremia.


A., C., and D. Hypernatremia symptoms include decreased urine output, increased urine specific gravity, and tremors.

10. Question

After the nurse reviewed the client’s lab results, the client’s serum phosphorus (phosphate) level was found to be at 1.8 mg/dL (0.58 mmol/L) level. What condition is most likely to cause the serum phosphorus level?

  • A. Hypoparathyroidism
  • B. Kidney failure
  • C. Malnutrition
  • D. Tumor lysis syndrome
Show Rationale


C. The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). There is hypophosphatemia in the client. Malnutrition and using antacids with aluminum hydroxide or magnesium base are contributing factors.


A., B., and D. The three leading causes of hyperphosphatemia are renal insufficiency, hypoparathyroidism, and tumor lysis syndrome.

11. Question

After reading the doctor’s progress reports, the nurse plans to monitor the client, which states that the patient has “insensible fluid loss of approximately 800 mL daily.” The nurse is aware that one way insensible fluid loss happens is through which form of excretion?

  • A. Gastrointestinal tract
  • B. Sweat
  • C. Urinary output
  • D. Wound drainage
Show Rationale


B. Insensible fluid losses are fluid losses that are not easily measured and include fluids from the respiratory system, skin, and water in the excreted stool.


A., C., and D. Sensible losses can be measured by the nurse, including those caused by urination, wound drainage, and gastrointestinal losses.

12. Question

The nurse reviewed the medical records of the four clients assigned to her. Which client has the highest risk for a fluid volume deficit?

  • A. A client with an ileostomy
  • B. A client with heart failure
  • C. A client on long-term corticosteroid therapy
  • D. A client with SIADH
Show Rationale


A. Vomiting, diarrhea, conditions that increase respiration or urine output, inadequate intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy are among the factors that cause fluid volume deficit.


B., C., and D. The most vulnerable patients to fluid volume excess are those with heart failure, those taking long-term corticosteroid therapy, and those with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

13. Question

A client diagnosed with heart failure has been receiving intravenous (IV) diuretics. Which finding would the nurse expect to assess from this client suspected of experiencing fluid volume deficit?

  • A. Decreased hematocrit
  • B. Increased blood pressure
  • C. Lung congestion
  • D. Poor skin turgor
Show Rationale


D. Poor skin turgor is when the skin is pulled up and does not return to its original state within a few seconds. If there is a wrinkle in the skin for more than 20 seconds, the patient has poor skin turgor. This is a late sign of dehydration or fluid volume deficit.


A., B., and C. Excessive fluid intake includes elevated blood pressure, decreased hematocrit, and congested lungs.

14. Question

Which client is at risk for fluid volume excess?

  • A. The client with intermittent gastrointestinal suctioning
  • B. The client who is on diuretics and has skin tenting
  • C. The client with an ileostomy from a recent abdominal surgery
  • D. The client with kidney disease developed as a complication of diabetes mellitus
Show Rationale


D. Reduced renal function is one of the leading causes of excess fluid volume. Diabetes mellitus is complicated by renal disease, which affects the body’s ability to eliminate fluid and causes the patient to retain fluid.


A, B, and C. Clients who use diuretics, have ileostomies, or need suctioning of their gastrointestinal tract are at risk for fluid volume deficit.

15. Question

Which client is most likely to develop a potassium level of 6.2 mEq/L (6.2 mmol/L)?

  • A. The client who abuses laxatives
  • B. The client who had a traumatic burn
  • C. The client with colitis
  • D. The client with Cushing’s syndrome
Show Rationale


B. A potassium level of 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is considered normal. Indicative of hyperkalemia is a blood potassium level of more than 5.0 mEq/L (5.0 mmol/L). Clients who encounter cellular shifting of potassium during the initial phases of extensive cell death, such as trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia.


A., C., and D. Hypokalemia is dangerous for clients with colitis, Cushing’s syndrome, or who have abused laxatives.

16. Question

Immunosuppression is noted in the client. Which WBC value would cause the nurse to consider using neutropenic precautions?

  • A. 2000 mm3 (2.0 × 109/L)
  • B. 5800 mm3 (5.8 × 109/L)
  • C. 8400 mm3 (8.4 × 109/L)
  • D. 9,500 mm3 (9.5 × 109/L)
Show Rationale


A. Normal WBC counts range from 5000 to 10,000 mm3 (5 -10 x 109/L). A decrease in the quantity of WBCs in circulation is called immunosuppression. The nurse takes neutropenic precautions when the client’s levels fall significantly below the usual range. The policy of the healthcare institution typically determines the specific value for using neutropenic precautions.


B., C., and D. All values are within the normal range. No intervention (such as implementing neutropenic precautions) is needed.

17. Question

The client’s blood has a platelet count of 300,000 mm3 (300 x 109/L). What should the nurse do when she receives this laboratory result?

  • A. Advise the primary healthcare provider about the unusually increased value.
  • B. Document the report as normal in the client’s medical file.
  • C. Notify the primary healthcare provider about the unusually decreased value.
  • D. Put the client on platelet boosting medication.
Show Rationale


B. A normal range for platelet count is 150,000 to 400,000 mm3 (150 to 400 x 109/L). A 300,000 mm3 (300 x 109/L) platelet count is within the normal range. The nurse needs to enter the report with the normal laboratory value in the client’s medical file.


A., C., and D. These interventions are unnecessary since the platelet count falls within the normal range. Precautions against bleeding are not necessary because the count is not low.

18. Question

After undergoing abdominal perineal excision for a colon tumor, a 55-year-old male patient is admitted for colostomy placement. The nurse will evaluate the newly inserted colostomy. Which of the following assessments indicates a functional colostomy?

  • A. Absent bowel sounds upon auscultation
  • B. Bloody drainage coming out of the colostomy drainage
  • C. Presence of flatus
  • D. Client’s food tolerance
Show Rationale


C. The colostomy should begin working within 72 hours of surgery, but it could take up to 5 days. Bowel sounds and flatus should be present to confirm that the peristalsis has returned.


A. Absent bowel sounds indicate that peristalsis has not yet returned.
B. A colostomy is expected not to produce bloody drainage.
D. The client would be kept on NPO (nothing by mouth) until peristalsis has returned.

19. Question

The nurse observes the stoma to be red and edematous. Based on this finding, what should the nurse do?

  • A. Immediately apply ice.
  • B. Record the findings.
  • C. Elevate the client’s buttocks.
  • D. Notify the primary healthcare provider.
Show Rationale


B. A new colostomy stoma will initially look red and edematous. However, this will eventually subside. After some time, the colostomy site turns pink and should not manifest abnormal drainage, edema, or skin collapse. The nurse should record the assessment findings since this is an expected finding, and there is no need for interventions.


A., C., and D. These interventions are not necessary to be implemented.

20. Question

The client started passing foul-smelling flatus from the colostomy stoma after two days of the insertion. What is the correct interpretation for the nurse?

  • A. It is a sign of ischemic bowel disease.
  • B. The client’s nasogastric tube should stay inserted with the client.
  • C. It is an expected outcome.
  • D. The intestinal preparation before surgery is not adequate.
Show Rationale


C. After a colostomy, the client is expected to pass foul-smelling flatus as peristalsis starts returning. Foul-smelling flatus is a normal finding indicating that gastrointestinal function has returned. The patient should pass feces through the colostomy within 72 hours of surgery.


A, B, and D. These are incorrect interpretations for passing foul-smelling flatus after the colostomy insertion.

21. Question

Which of the following findings must be immediately reported to the primary healthcare provider?

  • A. Beefy red and shiny stoma.
  • B. Excoriation of the skin around the stoma
  • C. A semi-formed stool in the ostomy.
  • D. The stoma is purple in appearance.
Show Rationale


D. The stoma manifests a dark, bluish, or purple appearance when it is ischemic or lacks oxygenated blood supply.


A. A stoma that is beefy red, and shiny is normal and expected.
B. Skin excoriation must be addressed and treated, but it does not need the same level of attention as purple stoma discoloration.
C. A semi-formed stool is expected.

22. Question

A nosocomial infection of Methicillin-resistant Staphylococcus aureus was detected in the client, who has been put on contact precautions as a result (MRSA). What protective equipment should a nurse prepare before providing colostomy care?

  • A. Gloves and gown
  • B. Gloves and goggles
  • C. Gloves, gown, and shoe protectors
  • D. Gloves, gown, goggles, and a mask or face shield
Show Rationale


D. Splashes of bodily secretions are possible when doing colostomy care. Goggles, a mask, or a face shield are worn to protect the face and eye mucous membranes during procedures that could cause splashes of blood, body fluids, secretions, or excretions. Additionally, gloves are necessary for contact precautions, and a gown should be worn for direct client contact.


A. Goggles and a mask or face shield should be worn to protect the face and mucous membranes of the eyes.
B. Colostomy care necessitates wearing a gown and a mask/ face shield.
C. Shoe protectors are not required.

23. Question

The responsibility of taking a 47-year-old female client’s vital signs who was diagnosed with right breast cancer post-mastectomy has been assigned to the newly graduated nurse. Which of the following vital sign procedures should be considered?

  • A. Attaching pulse oximeter on the left index finger.
  • B. Attaching pulse oximeter on the right index finger.
  • C. Taking BP on the left arm.
  • D. Taking BP on the right arm.
Show Rationale


C. Regardless of the type or timing of the surgery, most facilities will impose limb restrictions on anyone who has undergone breast cancer surgery. These limb restrictions are applied to clients who need to have their blood pressure taken or have a venipuncture performed in the ipsilateral or the same side of the affected arm.


A. and B. There are no known contraindications for pulse oximetry. A pulse oximeter comprises a microprocessor unit and a peripheral probe. It is safe to use in all client monitoring.
D. Taking BP on the same arm where the surgical site is not recommended for this client. BP should be done on the opposite arm.

24. Question

The nurse is preparing to give a bed bath to a client diagnosed with tuberculosis. Which equipment should the nurse include when administering this procedure?

  • A. Particulate respirator and protective eyewear
  • B. Particulate respirator, gown, and gloves
  • C. Surgical mask and gloves
  • D. Surgical mask, gown, and protective eyewear
Show Rationale


B. If a nurse encounters a client with tuberculosis, they should wear a fitted particulate respirator. The nurse would also put on gloves as part of standard precautions. The nurse should also wear a gown when giving a bed bath since there is a possibility that the clothing will become contaminated.


A., C., and D. A particulate respirator, gown, and gloves should be worn.

25. Question

The client is getting ready for a thoracentesis. Which position should the client be placed in for the procedure?

  • A. Lie on the affected side
  • B. Lay on the unaffected side.
  • C. Prone with the head turned to the side with a pillow supporting the head
  • D. Sims’ position with the head flat on the bed
Show Rationale


B. If they are able to sit, the client should be seated at the edge of the bed. They are instructed to lean over the bedside table with their feet on a stool. The client can also be placed on the unaffected side with the head elevated 30 to 45 degrees to enable fluid drainage from the chest.


A. The client should be placed on the unaffected side.
C. Prone position is not recommended for thoracentesis.
D. Sim’s position is not recommended for thoracentesis.

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