Are you preparing for the NCLEX exam? The National Council Licensure Examination (NCLEX) is a crucial step in your nursing career, testing your knowledge and skills to ensure you are ready to provide safe and effective patient care. To help you prepare, we have compiled a list of 27 challenging NCLEX questions along with detailed answers to help you understand the concepts and rationale behind each question.
Practice Questions
Question 1:
A client with a history of heart failure is admitted to the hospital with shortness of breath and edema. Which medication should the nurse expect to be prescribed?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
Answer and Rationale
The correct answer is B. Furosemide.
Furosemide is a loop diuretic that is commonly prescribed for patients with heart failure to reduce fluid overload and improve symptoms such as shortness of breath and edema. Metoprolol is a beta-blocker, lisinopril is an ACE inhibitor, and digoxin is an inotropic agent, all of which may be used in the treatment of heart failure but are not the most appropriate initial treatment for fluid overload.
Question 2:
A client with type 2 diabetes mellitus is scheduled to undergo a colonoscopy. Which instruction should the nurse provide to the client?
A. "You may eat a light breakfast on the day of the procedure."
B. "You will need to follow a clear liquid diet for 24 hours before the procedure."
C. "You should take your oral diabetes medication as prescribed on the day of the procedure."
D. "You will need to adjust your insulin dosage on the day of the procedure."
Answer and Rationale
The correct answer is B. "You will need to follow a clear liquid diet for 24 hours before the procedure."
Before a colonoscopy, patients are typically instructed to follow a clear liquid diet for 24 hours to ensure the bowel is adequately prepared for the procedure. Patients should not eat solid food on the day of the procedure, and oral diabetes medications and insulin dosages may need to be adjusted to prevent hypoglycemia.
Question 3:
A client with a history of schizophrenia is admitted to the hospital with auditory hallucinations and paranoid delusions. Which medication should the nurse expect to be prescribed?
A. Haloperidol
B. Lorazepam
C. Fluoxetine
D. Lithium
Answer and Rationale
The correct answer is A. Haloperidol.
Haloperidol is a typical antipsychotic medication that is commonly prescribed for the treatment of schizophrenia, particularly for patients experiencing acute psychotic symptoms such as auditory hallucinations and paranoid delusions. Lorazepam is an anxiolytic, fluoxetine is an antidepressant, and lithium is a mood stabilizer, none of which are the most appropriate initial treatment for acute psychotic symptoms in schizophrenia.
Question 4:
A client with a history of asthma is admitted to the hospital with acute respiratory distress. Which medication should the nurse expect to be prescribed?
A. Albuterol
B. Ipratropium
C. Methylprednisolone
D. Theophylline
Answer and Rationale
The correct answer is A. Albuterol.
Albuterol is a short-acting beta-2 agonist that is commonly prescribed for the treatment of acute asthma exacerbations to relieve bronchospasm and improve respiratory function. Ipratropium is an anticholinergic medication that may be used in combination with albuterol, methylprednisolone is a corticosteroid that may be used for severe exacerbations or persistent symptoms, and theophylline is a methylxanthine that is less commonly used in the acute setting due to potential toxicity and interactions.
Question 5:
A client with a history of hypertension is admitted to the hospital with chest pain and shortness of breath. Which diagnostic test should the nurse prioritize?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Complete blood count (CBC)
D. Urinalysis
Answer and Rationale
The correct answer is B. Electrocardiogram (ECG).
In a patient with a history of hypertension presenting with chest pain and shortness of breath, an ECG should be prioritized to evaluate for potential cardiac ischemia or arrhythmias. A chest X-ray may be helpful to assess for pulmonary edema or other lung pathology, but would not provide as much information about the patient's cardiac status. A CBC and urinalysis may be useful for a comprehensive workup but are not the highest priority in this scenario.
Question 6:
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital with increased sputum production and shortness of breath. Which nursing intervention should be prioritized?
A. Encourage coughing and deep breathing
B. Administer oxygen therapy
C. Monitor blood glucose levels
D. Provide oral care
Answer and Rationale
The correct answer is A. Encourage coughing and deep breathing.
In a patient with COPD exacerbation, encouraging coughing and deep breathing techniques can help mobilize secretions and improve ventilation. Oxygen therapy may be necessary for hypoxemia, but should be used cautiously in COPD patients due to the risk of hypercapnia. Monitoring blood glucose levels and providing oral care are important nursing interventions but are not the highest priority in this scenario.
Question 7:
A client with a history of epilepsy is admitted to the hospital following a grand mal seizure. Which medication should the nurse expect to be prescribed for seizure prophylaxis?
A. Phenytoin
B. Levetiracetam
C. Carbamazepine
D. Valproic acid
Answer and Rationale
The correct answer is A. Phenytoin.
Phenytoin is a commonly prescribed antiepileptic medication for the prophylaxis of generalized tonic-clonic (grand mal) seizures. Levetiracetam, carbamazepine, and valproic acid are also antiepileptic medications that may be used for seizure prophylaxis, but phenytoin is often the preferred agent for the acute management of seizures in the hospital setting.
Question 8:
A client with a history of hypothyroidism is admitted to the hospital with fatigue and cold intolerance. Which medication should the nurse expect to be prescribed?
A. Levothyroxine
B. Methimazole
C. Propylthiouracil
D. Potassium iodide
Answer and Rationale
The correct answer is A. Levothyroxine.
Levothyroxine is a synthetic form of thyroid hormone that is commonly prescribed for the treatment of hypothyroidism to replace the deficient hormone and alleviate symptoms such as fatigue and cold intolerance. Methimazole and propylthiouracil are antithyroid medications used to treat hyperthyroidism, and potassium iodide is used to prevent thyroid uptake of radioactive iodine in certain medical situations.
Question 9:
A client with a history of atrial fibrillation is admitted to the hospital with palpitations and shortness of breath. Which medication should the nurse expect to be prescribed for rate control?
A. Metoprolol
B. Diltiazem
C. Digoxin
D. Amiodarone
Answer and Rationale
The correct answer is B. Diltiazem.
Diltiazem is a calcium channel blocker that is commonly prescribed for rate control in patients with atrial fibrillation. Metoprolol is a beta-blocker that may also be used for rate control, but calcium channel blockers are often preferred in the acute setting. Digoxin is an inotropic agent that may be used for rate control in certain situations, and amiodarone is an antiarrhythmic medication used for rhythm control rather than rate control.
Question 10:
A client with a history of heart failure is admitted to the hospital with shortness of breath and decreased urine output. Which nursing intervention should be prioritized?
A. Administer intravenous furosemide
B. Encourage fluid intake
C. Monitor blood pressure
D. Provide oxygen therapy
Answer and Rationale
The correct answer is A. Administer intravenous furosemide. In a patient with heart failure exacerbation and evidence of fluid overload (shortness of breath, decreased urine output), administering intravenous furosemide (a loop diuretic) should be prioritized to promote diuresis and alleviate symptoms. Encouraging fluid intake would be contraindicated in this scenario, as it could worsen fluid overload. Monitoring blood pressure and providing oxygen therapy are important interventions but are not the highest priority in this scenario.
Question 11:
A client with a history of chronic kidney disease is admitted to the hospital with nausea and vomiting. Which electrolyte imbalance should the nurse monitor for?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypernatremia
Answer and Rationale
The correct answer is B. Hyperkalemia.
In patients with chronic kidney disease, hyperkalemia is a common electrolyte imbalance due to decreased renal excretion of potassium. Nausea and vomiting can further exacerbate this imbalance by causing metabolic alkalosis and shifting potassium out of cells. Hypokalemia, hyponatremia, and hypernatremia are less likely in this scenario.
Question 12:
A client with a history of depression is admitted to the hospital with suicidal ideation. Which nursing intervention should be prioritized?
A. Administer antidepressant medication
B. Provide a quiet, calming environment
C. Assess for access to lethal means
D. Encourage social interaction
Answer and Rationale
The correct answer is C. Assess for access to lethal means.
In a patient with suicidal ideation, the highest priority nursing intervention is to ensure patient safety by assessing for access to lethal means (e.g. weapons, medications) and removing any potential hazards from the environment. Administering antidepressant medication, providing a quiet environment, and encouraging social interaction are important interventions but are not the most critical in ensuring immediate patient safety.
Question 13:
A client with a history of diabetes mellitus is admitted to the hospital with hyperglycemia and diabetic ketoacidosis (DKA). Which medication should the nurse expect to be prescribed?
A. Insulin
B. Metformin
C. Glipizide
D. Pioglitazone
Answer and Rationale
The correct answer is A. Insulin.
In a patient with DKA, the primary treatment is insulin therapy to lower blood glucose levels and suppress ketogenesis. Metformin, glipizide, and pioglitazone are oral antihyperglycemic medications that are not appropriate for the acute management of DKA.
Question 14:
A client with a history of Parkinson's disease is admitted to the hospital with worsening tremors and rigidity. Which medication should the nurse expect to be prescribed?
A. Levodopa
B. Haloperidol
C. Risperidone
D. Benztropine
Answer and Rationale
The correct answer is A. Levodopa.
Levodopa is a dopamine precursor that is commonly prescribed for the treatment of Parkinson's disease to alleviate symptoms such as tremors and rigidity. Haloperidol and risperidone are antipsychotic medications that can worsen Parkinson's symptoms and should be avoided. Benztropine is an anticholinergic medication that may be used to treat extrapyramidal side effects of antipsychotics but is not a primary treatment for Parkinson's disease.
Question 15:
A client with a history of osteoporosis is admitted to the hospital following a hip fracture. Which medication should the nurse expect to be prescribed for osteoporosis treatment?
A. Calcium supplements
B. Vitamin D supplements
C. Bisphosphonates
D. Calcitonin
Answer and Rationale
The correct answer is C. Bisphosphonates.
Bisphosphonates (e.g. alendronate, risedronate) are a class of medications commonly prescribed for the treatment of osteoporosis to increase bone density and reduce the risk of fractures. Calcium and vitamin D supplements are important for bone health but are not sufficient as a primary treatment for osteoporosis. Calcitonin is a hormone that may be used to treat osteoporosis but is less commonly prescribed than bisphosphonates.
Question 16:
A client with a history of peptic ulcer disease is admitted to the hospital with acute abdominal pain and hematemesis. Which medication should the nurse expect to be prescribed?
A. Proton pump inhibitor (PPI)
B. H2 receptor antagonist
C. Antacid
D. Sucralfate
Answer and Rationale
The correct answer is A. Proton pump inhibitor (PPI).
PPIs (e.g. omeprazole, pantoprazole) are the most effective medications for the treatment of peptic ulcer disease, particularly in cases of acute bleeding. They work by inhibiting gastric acid secretion and promoting ulcer healing. H2 receptor antagonists (e.g. famotidine) and antacids may also be used for symptom relief but are not as effective as PPIs for acute bleeding. Sucralfate is a mucosal protective agent that may be used for ulcer prophylaxis but is not a primary treatment for acute bleeding.
Question 17:
A client with a history of deep vein thrombosis (DVT) is admitted to the hospital with unilateral leg swelling and pain. Which medication should the nurse expect to be prescribed for anticoagulation?
A. Heparin
B. Warfarin
C. Aspirin
D. Clopidogrel
Answer and Rationale
The correct answer is A. Heparin.
In a patient with suspected acute DVT, initial anticoagulation with heparin (either unfractionated or low molecular weight) is recommended to prevent thrombus extension and embolization. Warfarin is an oral anticoagulant that may be started concurrently with heparin but requires several days to reach therapeutic effect. Aspirin and clopidogrel are antiplatelet agents that are not sufficient for the treatment of acute DVT.
Question 18:
A client with a history of alcohol use disorder is admitted to the hospital with acute alcohol withdrawal. Which medication should the nurse expect to be prescribed?
A. Benzodiazepines
B. Antipsychotics
C. Beta-blockers
D. Calcium channel blockers
Answer and Rationale
The correct answer is A. Benzodiazepines.
Benzodiazepines (e.g. lorazepam, diazepam) are the first-line treatment for acute alcohol withdrawal to prevent seizures and delirium tremens. They work by enhancing GABA activity in the brain, which is disrupted during alcohol withdrawal. Antipsychotics may be used for agitation or hallucinations but are not the primary treatment for withdrawal. Beta-blockers and calcium channel blockers may be used for symptomatic treatment of tachycardia and hypertension but do not address the underlying pathophysiology of withdrawal.
Question 19:
A client with a history of sickle cell disease is admitted to the hospital with acute chest syndrome. Which nursing intervention should be prioritized?
A. Administer oxygen therapy
B. Encourage fluid intake
C. Administer pain medication
D. Transfuse packed red blood cells
Answer and Rationale
The correct answer is A. Administer oxygen therapy.
In a patient with acute chest syndrome (a vaso-occlusive crisis affecting the lungs), administering supplemental oxygen should be prioritized to prevent hypoxemia and maintain adequate oxygenation of tissues. Encouraging fluid intake and administering pain medication are also important interventions but are not as critical as ensuring adequate oxygenation. Transfusion of packed red blood cells may be necessary in severe cases but is not the first-line intervention for all patients with acute chest syndrome.
Question 20:
A client with a history of systemic lupus erythematosus (SLE) is admitted to the hospital with a malar rash and joint pain. Which medication should the nurse expect to be prescribed?
A. Corticosteroids
B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
C. Hydroxychloroquine
D. Methotrexate
Answer and Rationale
The correct answer is A. Corticosteroids.
In a patient with SLE presenting with acute symptoms such as malar rash and joint pain, corticosteroids (e.g. prednisone) are the first-line treatment to reduce inflammation and suppress immune activity. NSAIDs may be used for mild symptoms but are not sufficient for acute flares. Hydroxychloroquine is an antimalarial medication that is commonly used for long-term management of SLE but is not the primary treatment for acute flares. Methotrexate is an immunosuppressant that may be used for resistant cases but is not a first-line agent.
Question 21:
A client with a history of chronic pain is admitted to the hospital with acute exacerbation of pain. Which medication should the nurse expect to be prescribed for pain management?
A. Opioids
B. Acetaminophen
C. Gabapentin
D. Tricyclic antidepressants
Answer and Rationale
The correct answer is A. Opioids.
In a patient with acute exacerbation of chronic pain, opioid analgesics (e.g. morphine, oxycodone) are often necessary for adequate pain control. Acetaminophen is a mild analgesic that may be used for mild to moderate pain but is not sufficient for severe pain. Gabapentin is an anticonvulsant that may be used for neuropathic pain but is not a first-line agent for acute pain. Tricyclic antidepressants are often used for chronic pain management but are not appropriate for acute pain exacerbations.
Question 22:
A client with a history of inflammatory bowel disease (IBD) is admitted to the hospital with abdominal pain and diarrhea. Which medication should the nurse expect to be prescribed?
A. Corticosteroids
B. Aminosalicylates
C. Immunomodulators
D. Antibiotics
Answer and Rationale
The correct answer is A. Corticosteroids.
In a patient with IBD (Crohn's disease or ulcerative colitis) presenting with acute symptoms such as abdominal pain and diarrhea, corticosteroids (e.g. prednisone) are often the first-line treatment to reduce inflammation and induce remission. Aminosalicylates (e.g. mesalamine) may be used for mild to moderate symptoms but are not sufficient for acute flares. Immunomodulators (e.g. azathioprine) and antibiotics may be used for certain indications but are not the primary treatment for acute exacerbations.
Question 23:
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital with increased sputum production and shortness of breath. Which diagnostic test should the nurse anticipate?
A. Chest X-ray
B. Pulmonary function tests
C. Arterial blood gas (ABG)
D. Sputum culture
Answer and Rationale
The correct answer is A. Chest X-ray.
In a patient with COPD exacerbation, a chest X-ray is often the initial diagnostic test to evaluate for potential complications such as pneumonia, pneumothorax, or heart failure. Pulmonary function tests are important for long-term management of COPD but are not typically performed during an acute exacerbation. ABG may be helpful to assess for respiratory failure but is not necessary in all cases. Sputum culture may be ordered if there is concern for bacterial infection but is not a routine test for all COPD exacerbations.
Question 24:
A client with a history of hypertension is admitted to the hospital with severe headache and blurred vision. Which complication should the nurse monitor for?
A. Hypertensive emergency
B. Myocardial infarction
C. Stroke
D. Renal failure
Answer and Rationale
The correct answer is A. Hypertensive emergency.
In a patient with severe hypertension presenting with symptoms such as severe headache and blurred vision, the nurse should monitor for signs of hypertensive emergency, which can lead to end-organ damage if not promptly treated. Myocardial infarction, stroke, and renal failure are potential complications of chronic hypertension but are less likely to present with the acute symptoms described in this scenario.
Question 25:
A client with a history of anxiety disorder is admitted to the hospital with chest pain and palpitations. Which nursing intervention should be prioritized?
A. Administer anti-anxiety medication
B. Perform a 12-lead ECG
C. Assess for suicidal ideation
D. Encourage deep breathing exercises
Answer and Rationale
The correct answer is B. Perform a 12-lead ECG.
In a patient with chest pain and palpitations, the priority nursing intervention should be to assess for potential cardiac causes by performing a 12-lead ECG. While anxiety can cause chest pain and palpitations, it is important to rule out life-threatening conditions such as myocardial infarction or arrhythmia first. Administering anti-anxiety medication, assessing for suicidal ideation, and encouraging deep breathing exercises are important interventions for managing anxiety but are not the highest priority in this scenario.
Question 26:
A client with a history of bipolar disorder is admitted to the hospital with manic symptoms, including grandiose delusions and decreased need for sleep. Which medication should the nurse expect to be prescribed?
A. Lithium
B. Valproic acid
C. Quetiapine
D. Sertraline
Answer and Rationale
The correct answer is A. Lithium.
Lithium is a mood stabilizer that is commonly prescribed for the treatment of acute mania in bipolar disorder. It works by reducing neuronal excitability and has been shown to be effective in controlling manic symptoms. Valproic acid is another mood stabilizer that may be used for bipolar disorder but is not as well-studied for acute mania. Quetiapine is an atypical antipsychotic that may be used for psychotic symptoms in bipolar disorder but is not a first-line treatment for mania. Sertraline is an antidepressant that is not indicated for the treatment of acute mania.
Question 27:
A client with a history of schizophrenia is admitted to the hospital with auditory hallucinations and paranoid delusions. Which nursing intervention should be prioritized?
A. Administer antipsychotic medication
B. Assess for suicidal ideation
C. Provide a quiet, calming environment
D. Encourage social interaction
Answer and Rationale
The correct answer is A. Administer antipsychotic medication.
In a patient with schizophrenia presenting with acute psychotic symptoms such as auditory hallucinations and paranoid delusions, the priority nursing intervention should be to administer prescribed antipsychotic medication to reduce the severity of symptoms. Assessing for suicidal ideation is important given the increased risk of suicide in schizophrenia but is not the most urgent intervention in this scenario. Providing a quiet environment and encouraging social interaction may be helpful for long-term management but are not sufficient to control acute psychotic symptoms.
Conclusion
Preparing for the NCLEX exam requires a comprehensive study approach that includes practicing with challenging questions and reviewing the rationales for the correct answers. By understanding the key concepts and principles underlying each question, you can improve your critical thinking skills and increase your confidence on test day. Remember to always prioritize patient safety and use evidence-based practice guidelines when answering questions. Good luck on your NCLEX exam!
