NCLEX-RN Basic Care and Comfort Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   A 74-year-old client at a primary care clinic has a cerumen impaction in the right ear, and the health care provider prescribes ear irrigation. Which finding in the client's history requires the nurse to hold the irrigation and consult the health care provider?

   1. AA. Use of a hearing aid in the right ear
   2. BB. A past perforation of the right eardrum
   3. CC. Mild hearing loss in the right ear
   4. DD. A feeling of fullness in the right ear
   Show answer to question 1

   Answer: B. A past perforation of the right eardrum

   Irrigation is contraindicated with a known or suspected tympanic membrane perforation, because fluid can enter the middle ear and cause infection, pain, and vertigo.

   Why the other options are wrong

   • AThe hearing aid is removed before irrigation; wearing one does not prevent the procedure.
   • CMild hearing loss is an expected effect of cerumen blocking the ear canal.
   • DA feeling of fullness is a typical symptom of cerumen impaction.

2. Question 2 of 25Easy

   A client with end-stage chronic obstructive pulmonary disease who transitioned to comfort-focused hospice care reports severe dyspnea and air hunger. The oxygen saturation is 90% on room air. Which prescribed intervention should the nurse administer first?

   1. AA. Sublingual or oral low-dose morphine
   2. BB. Inhaled short-acting beta-2 agonist bronchodilator
   3. CC. Intravenous high-dose loop diuretic
   4. DD. High-flow oxygen via a non-rebreather mask
   Show answer to question 2

   Answer: A. Sublingual or oral low-dose morphine

   Low-dose opioids such as morphine are the first-line pharmacologic treatment for refractory dyspnea in palliative and end-of-life care because they reduce the subjective sensation of air hunger and decrease the work of breathing. Although bronchodilators may help reversible bronchospasm, opioids directly target central respiratory perception and provide rapid relief. High-flow oxygen is not indicated when hypoxemia is mild and may cause mucosal drying and increased discomfort.

3. Question 3 of 25Easy

   A nurse observes an unlicensed assistive personnel (UAP) caring for a client with an indwelling urinary catheter. Which action by the UAP requires immediate intervention by the nurse?

   1. AA. Fastening the drainage tubing to the client's bed frame with an anchor clip.
   2. BB. Hanging the urinary collection bag on the upper side rail of the bed.
   3. CC. Securing the catheter tubing to the client's anterior thigh with a strap.
   4. DD. Emptying the drainage bag when it is approximately two-thirds full of urine.
   Show answer to question 3

   Answer: B. Hanging the urinary collection bag on the upper side rail of the bed.

   The urinary collection bag must always remain below the level of the client's bladder to allow gravity drainage and prevent retrograde flow of contaminated urine. Placing the bag on an upper bed rail elevates it above the bladder level, significantly raising the risk of infection. Securing the tubing properly and emptying the bag before it overfills are correct standard nursing interventions.

4. Question 4 of 25Medium

   A 54-year-old female client reports involuntary urine leakage when laughing, coughing, or lifting heavy boxes at work. The nurse plans teaching on pelvic floor muscle training. Which instruction should the nurse provide to the client?

   1. AA. Hold the breath during each muscle contraction to stabilize the pelvis.
   2. BB. Tighten the pelvic muscles for 10 seconds, then relax for 10 seconds.
   3. CC. Practice stopping the stream of urine repeatedly during every void.
   4. DD. Bear down forcefully while contracting the abdominal and gluteal muscles.
   Show answer to question 4

   Answer: B. Tighten the pelvic muscles for 10 seconds, then relax for 10 seconds.

   Pelvic floor muscle training for stress incontinence involves contracting the pubococcygeus muscle for up to 10 seconds followed by a 10-second rest period, performed in sets multiple times daily. Contracting the abdomen and gluteals increases intra-abdominal pressure, which can worsen stress leakage. Stopping the urinary stream mid-void is used only as an initial assessment technique to locate the correct muscles; performing it regularly during voiding can cause incomplete bladder emptying and urinary tract infection.

5. Question 5 of 25Easy

   A client with an established gastrostomy tube reports sudden abdominal cramping and nausea halfway through an intermittent bolus feeding. The nurse observes that the formula was administered immediately after removal from the refrigerator. Which action should the nurse take?

   1. AA. Use a syringe plunger to rapidly push the remaining cold feeding into the tube.
   2. BB. Allow the remaining formula to reach room temperature before resuming.
   3. CC. Warm the formula container in a microwave to 105 degrees Fahrenheit.
   4. DD. Dilute the refrigerated formula with an equal volume of cold water.
   Show answer to question 5

   Answer: B. Allow the remaining formula to reach room temperature before resuming.

   Administering cold enteral formula causes gastric spasms, abdominal cramping, and nausea. Bringing the formula to room temperature prior to administration promotes gastric comfort and tolerance. Heating formula in a microwave creates uneven thermal pockets that can burn mucosa, while rapidly infusing formula or diluting it with cold water worsens gastrointestinal distress.

6. Question 6 of 25Hard

   A 45-year-old male is on bed rest after a lumbar spinal fusion 12 hours ago. He reports numbness and tingling in his left foot. His vital signs are BP 128/76, HR 80, RR 16, temperature 37.0°C. Which nursing intervention is most appropriate?

   1. AA. Apply a warm blanket to the left foot for comfort
   2. BB. Perform passive range of motion to both lower extremities
   3. CC. Notify the surgeon immediately of the neurological change
   4. DD. Reposition the client to the right side and reassess
   Show answer to question 6

   Answer: C. Notify the surgeon immediately of the neurological change

   New numbness and tingling in a foot after lumbar fusion can signal nerve root compression from swelling, a hematoma or a displaced graft. A new neurological deficit needs prompt surgical evaluation, so the nurse notifies the surgeon immediately.

   Why the other options are wrong

   • AWarming the foot does not address a neurological cause and delays reporting the change.
   • BRange of motion does not address possible nerve compression from surgery.
   • DRepositioning and waiting delays the evaluation that a new neurological change requires.

7. Question 7 of 25Medium

   A nurse is caring for an older adult client who wears an acrylic ocular prosthesis and requires routine cleaning of the device. Which action by the nurse demonstrates proper care?

   1. AA. Store the prosthesis completely dry in an open container at the bedside.
   2. BB. Wash the prosthesis with mild soap and warm water, rinsing thoroughly.
   3. CC. Soak the prosthesis in a concentrated rubbing alcohol solution overnight.
   4. DD. Scrape protein deposits from the acrylic surface using a metal nail file.
   Show answer to question 7

   Answer: B. Wash the prosthesis with mild soap and warm water, rinsing thoroughly.

   An ocular prosthesis should be cleaned using mild soap and warm water or sterile saline and rinsed thoroughly before reinsertion to avoid chemical irritation to the socket. Alcohol and abrasive metal tools can permanently scratch or craze the acrylic surface, creating harbors for bacteria and damaging delicate tissues.

8. Question 8 of 25Easy

   The nurse provides morning care to an immobile, bedbound client. While cleansing the sacral area, the nurse observes nonblanchable erythema over the coccyx. Which action should the nurse take?

   1. AA. Cleanse the reddened site with isopropyl alcohol to prevent infection.
   2. BB. Apply a hot water bottle over the area to enhance microvascular circulation.
   3. CC. Gently cleanse the skin and avoid massaging the reddened area.
   4. DD. Firmly massage the reddened area using circular strokes to restore blood flow.
   Show answer to question 8

   Answer: C. Gently cleanse the skin and avoid massaging the reddened area.

   Nonblanchable erythema indicates localized tissue ischemia consistent with a Stage 1 pressure injury; gentle cleansing and skin protection without pressure are required. Vigorously massaging reddened bony prominences damages compromised deep capillaries and accelerates tissue necrosis. Alcohol is drying and cytotoxic, and heat application increases cellular metabolic demand in an already ischemic area.

9. Question 9 of 25Easy

   A nurse in a long-term care facility is assisting an older adult resident with morning dressing. Which action by the nurse best promotes the resident's dignity and autonomy?

   1. AA. Offering the resident a choice between two preferred, weather-appropriate outfits
   2. BB. Choosing the resident's outfit based on what other residents on the unit are wearing
   3. CC. Dressing the resident completely in a hospital gown to streamline incontinence checks
   4. DD. Selecting the clothing items that are easiest for nursing staff to fasten and put on
   Show answer to question 9

   Answer: A. Offering the resident a choice between two preferred, weather-appropriate outfits

   Offering a structured choice between two appropriate outfits empowers the resident to make personal decisions about appearance, which directly supports autonomy and dignity. Dressing residents in hospital gowns for staff convenience strips away individuality and devalues the resident. Choosing clothing solely based on ease of fastening or unit trends disregards personal preferences and identity.

10. Question 10 of 25Hard

    A 66-year-old client is 4 hours post-operative following a right total hip arthroplasty via a posterior approach. The nurse finds the client lying on the right side with the operative hip flexed to 90 degrees. Which action should the nurse take first?

    1. AA. Apply a trochanteric brace and assist the client to a semi-Fowler's position.
    2. BB. Administer the prescribed analgesic and reassess the client's comfort in 30 minutes.
    3. CC. Document the position and remind the client to avoid crossing legs.
    4. DD. Place an abduction pillow between the client's legs and reposition to supine.
    Show answer to question 10

    Answer: D. Place an abduction pillow between the client's legs and reposition to supine.

    After a posterior-approach hip replacement, hip flexion past 90 degrees, adduction and internal rotation can dislocate the prosthesis. Returning the client to supine with an abduction pillow between the legs corrects the unsafe position immediately.

    Why the other options are wrong

    • ASemi-Fowler's adds hip flexion, and a brace does not correct the adduction risk.
    • BPain medication can follow, but the dangerous position must be corrected first.
    • CDocumenting without repositioning leaves the client at immediate risk of dislocation.

11. Question 11 of 25Medium

    A nurse is teaching a client who has a non-weight-bearing left leg cast how to ascend stairs using axillary crutches. Which instruction should the nurse include?

    1. AA. Advance the crutches and the left leg up to the step first, then step up with your right leg.
    2. BB. Move the crutches onto the step first, then hop up simultaneously with both legs.
    3. CC. Step up first with your right leg, then bring the crutches and left leg up to the step.
    4. DD. Push down on the crutches while swinging both legs up to the step at the same time.
    Show answer to question 11

    Answer: C. Step up first with your right leg, then bring the crutches and left leg up to the step.

    When ascending stairs with crutches, the client should follow the guideline of 'up with the good': the unaffected leg steps up first, and then the crutches and affected extremity are brought up to the same step. Advancing the crutches or the injured extremity up first places undue strain on the client and increases the risk of tipping backward. Hopping or swinging both extremities simultaneously destabilizes balance and presents a severe fall risk.

12. Question 12 of 25Hard

    A 72-year-old client in a long-term care facility receives continuous nasogastric tube feeding at 50 mL/hr through an open system and has had four liquid stools since morning. The nurse notes the head of the bed at 35 degrees, water flushes of 30 mL every 4 hours, and formula that was poured into the feeding bag 14 hours ago. Which finding most likely contributes to the diarrhea?

    1. AA. Head of the bed elevated to 35 degrees
    2. BB. Water flushes of 30 mL every 4 hours
    3. CC. Formula that has hung for 14 hours
    4. DD. Continuous infusion rate of 50 mL/hr
    Show answer to question 12

    Answer: C. Formula that has hung for 14 hours

    Formula in an open system should hang no longer than about 8 hours, because bacteria multiply at room temperature. Contaminated formula is a common, preventable cause of diarrhea, so the bag and formula should be replaced.

    Why the other options are wrong

    • AElevating the head of the bed 30 degrees or more prevents aspiration and does not cause diarrhea.
    • BRoutine water flushes keep the tube patent and support hydration; they do not cause liquid stools.
    • DA steady continuous rate is usually better tolerated than bolus feeding and is unlikely to cause diarrhea.

13. Question 13 of 25Easy

    A nurse is preparing to perform a heel stick on a 2-day-old full-term newborn for routine metabolic screening. Which nonpharmacologic intervention is most effective for minimizing procedural pain during this blood collection?

    1. AA. Providing oral sucrose solution two minutes prior to the heel puncture
    2. BB. Placing the newborn under a radiant warmer for the duration of the blood draw
    3. CC. Applying a cold compress to the newborn's heel immediately before the puncture
    4. DD. Swaddling the infant loosely in a blanket with both lower extremities extended
    Show answer to question 13

    Answer: A. Providing oral sucrose solution two minutes prior to the heel puncture

    Administration of a small volume of oral sucrose solution combined with non-nutritive sucking stimulates endogenous opioid pathways and significantly reduces pain during minor procedural interventions in neonates. Applying cold to the heel produces vasoconstriction, which impairs capillary blood collection and increases procedural pain. Swaddling should be snug with limbs flexed rather than loose with extended legs to promote containment and neuromotor regulation.

14. Question 14 of 25Easy

    A client in the active stage of dying has become comatose with cool extremities and mottled skin. The family asks the nurse if they should continue speaking to the client. Which instruction should the nurse provide?

    1. AA. Speak gently near your loved one because hearing is often the last sense to be lost.
    2. BB. Avoid speaking aloud because auditory stimulation can cause uncomfortable agitation.
    3. CC. Rely only on touch because processing spoken words is no longer biologically possible.
    4. DD. Wait to talk until your loved one awakens so that your messages can be understood.
    Show answer to question 14

    Answer: A. Speak gently near your loved one because hearing is often the last sense to be lost.

    Hearing is widely recognized as the last sense retained during the dying process, so families are encouraged to speak words of comfort, reassurance, and love to their dying relative. Avoiding conversation deprives both the client and family of closure and connection. Waiting for full alertness is unrealistic during active dying, and communication should incorporate both touch and spoken words.

15. Question 15 of 25Hard

    A 49-year-old client dies 10 hours after admission to a medical unit despite resuscitation efforts, and the death is being referred to the medical examiner. The family asks to see the client. What should the nurse do while preparing the body?

    1. AA. Remove the endotracheal tube and intravenous lines before the family enters
    2. BB. Tell the family they cannot see the client until the examination is done
    3. CC. Bathe the body completely and discard the client's soiled gown and linens
    4. DD. Leave all tubes and lines in place and allow the family to view the body
    Show answer to question 15

    Answer: D. Leave all tubes and lines in place and allow the family to view the body

    When a death is referred to the medical examiner, all tubes, lines, and devices stay in place because they may be part of the investigation. Families can usually still view the body and say goodbye.

    Why the other options are wrong

    • ARemoving devices can destroy evidence the medical examiner needs to determine the cause of death.
    • BViewing is usually allowed and supports grieving; it does not have to wait for the examination.
    • CBathing the body and discarding items can remove evidence; the nurse follows medical examiner policy instead.

16. Question 16 of 25Hard

    A client with left-sided hemispatial neglect following a right hemispheric stroke leaves half of the food uneaten on the left side of the meal tray. Which action should the nurse implement first?

    1. AA. Remind the client to actively scan and turn the head toward the left side of the tray.
    2. BB. Rotate the meal tray 180 degrees without drawing attention to the deficit.
    3. CC. Feed the remaining food to the client to ensure nutritional requirements are met.
    4. DD. Transfer all remaining food onto a single smaller dish positioned on the right side.
    Show answer to question 16

    Answer: A. Remind the client to actively scan and turn the head toward the left side of the tray.

    Clients with hemispatial neglect fail to attend to stimuli on the affected side; cueing them to consciously scan to that side is the primary rehabilitative nursing strategy to retrain visual awareness and promote independence. While rotating the tray or moving items to the intact visual field compensates for intake in severe impairment, retraining scanning should be attempted first. Feeding the client should be reserved for those unable to safely manipulate food after cueing.

17. Question 17 of 25Hard

    A nurse is caring for a critically ill client with severe diarrhea who is being evaluated for the placement of an indwelling fecal management system. Which assessment finding is a contraindication to the use of this device?

    1. AA. Impaired mobility secondary to continuous sedation
    2. BB. Liquid stool output exceeding 800 mL over 12 hours
    3. CC. Incontinence-associated dermatitis on the perianal skin
    4. DD. Active bleeding from the distal rectal mucosa
    Show answer to question 17

    Answer: D. Active bleeding from the distal rectal mucosa

    Active rectal bleeding, recent rectal surgery, or severe rectal mucosal ulceration contraindicates the placement of an indwelling rectal catheter due to the high risk of mucosal necrosis and mechanical perforation. Severe liquid stool output and perineal skin breakdown are primary clinical indications for the device to protect skin integrity. Sedation and immobility frequently accompany the clinical need for containment but do not contraindicate it.

18. Question 18 of 25Medium

    A nurse is providing discharge instructions to a client with severe thrombocytopenia following chemotherapy. Which instruction should the nurse include regarding oral hygiene?

    1. AA. Scrape the tongue firmly with a plastic tongue cleaner every morning
    2. BB. Clean the teeth with a soft-bristle toothbrush or foam swab
    3. CC. Use an alcohol-based mouthwash twice daily to eradicate oral bacteria
    4. DD. Floss teeth vigorously after each meal to remove food particles
    Show answer to question 18

    Answer: B. Clean the teeth with a soft-bristle toothbrush or foam swab

    Clients with thrombocytopenia have a high risk of bleeding, so gentle cleaning with a soft-bristle toothbrush or foam swab minimizes gingival trauma. Vigorous flossing and firm tongue scraping are contraindicated due to the likelihood of inducing mucosal hemorrhage. Commercial alcohol-based rinses irritate fragile oral mucosa and exacerbate dry mouth.

19. Question 19 of 25Medium

    A nurse is providing perineal care to a client who has an indwelling urinary catheter. Which action should the nurse take when cleansing around the catheter?

    1. AA. Apply an alcohol-based antiseptic ointment around the meatus following routine washing.
    2. BB. Wipe the catheter tubing in an upward motion toward the urethral insertion site.
    3. CC. Advance the catheter 2 inches into the urethra to clean the portion resting inside the meatus.
    4. DD. Cleanse the catheter tubing starting at the urethral meatus and moving downward away from the body.
    Show answer to question 19

    Answer: D. Cleanse the catheter tubing starting at the urethral meatus and moving downward away from the body.

    Catheter hygiene involves stabilizing the catheter to prevent traction on the bladder neck and cleansing downward along the tubing away from the urethral meatus for at least 4 inches (10 cm). This directional movement prevents introducing bacteria from the tubing into the urinary tract. Moving toward the meatus increases the risk of contamination, advancing the catheter introduces external pathogens into the sterile bladder, and antiseptic ointments are not recommended because they can cause tissue irritation and do not decrease infection rates.

20. Question 20 of 25Medium

    A nurse is monitoring the fluid intake and output of a client following a transurethral resection of the prostate who has continuous bladder irrigation. Over an 8-hour shift, 3,000 mL of irrigant solution was infused, and 3,850 mL of total fluid was emptied from the drainage bag. What is the client's actual urine output for the shift?

    1. AA. 3,000 mL
    2. BB. 6,850 mL
    3. CC. 3,850 mL
    4. DD. 850 mL
    Show answer to question 20

    Answer: D. 850 mL

    To calculate true urine output during continuous bladder irrigation, the nurse subtracts the total volume of irrigant solution infused from the total fluid volume emptied from the collection bag (3,850 mL - 3,000 mL = 850 mL). Recording the total drainage bag volume of 3,850 mL fails to deduct the instilled irrigation fluid and gives a falsely elevated urine output. Adding the two volumes together to get 6,850 mL is a calculation error that combines input and output.

21. Question 21 of 25Medium

    A client with left-sided hemiparesis following an ischemic stroke is learning to ambulate with a quad cane. Which technique should the nurse reinforce during gait training?

    1. AA. Advance the right leg first, followed simultaneously by the cane and left leg
    2. BB. Hold the cane in the left hand and step forward with the right leg first
    3. CC. Hold the cane in the right hand and advance the cane with the left leg
    4. DD. Place the cane two full footsteps ahead of the body before moving either leg
    Show answer to question 21

    Answer: C. Hold the cane in the right hand and advance the cane with the left leg

    A cane is held on the stronger or unaffected side, which is the right hand for a client with left-sided hemiparesis. The client advances the cane simultaneously with, or immediately prior to, the weaker left leg to provide a wide base of support and relieve weight from the impaired limb. Holding the cane on the affected left side places the assistive device on the weaker extremity, compromising balance and stability.

22. Question 22 of 25Medium

    A nurse is repositioning a bedridden client to reduce the risk of pressure injury formation. Which side-lying position is most appropriate?

    1. AA. Thirty-degree lateral tilt position supported by pillows behind the back
    2. BB. Semi-Fowler position with the knee gatch elevated to 45 degrees
    3. CC. Full 90-degree lateral position with the bottom arm extended forward
    4. DD. Prone position with a firm sandbag placed beneath the lower abdomen
    Show answer to question 22

    Answer: A. Thirty-degree lateral tilt position supported by pillows behind the back

    The 30-degree lateral tilt position redistributes body weight across the hips and buttocks while avoiding direct pressure on the greater trochanter and sacrum. A full 90-degree lateral position places intense, concentrated pressure directly over the greater trochanter and lateral malleolus, significantly increasing the risk of tissue ischemia. Elevating the head and knees creates sustained shear and pressure over the sacrum.

23. Question 23 of 25Medium

    A hospice client with end-stage lung cancer exhibits noisy, moist breathing caused by retained pharyngeal secretions. The family expresses severe distress over the sound. Which comfort measure should the nurse carry out first?

    1. AA. Place the client in a fully supine position to promote chest drainage
    2. BB. Administer an intravenous crystalloid fluid bolus to thin the secretions
    3. CC. Perform deep endotracheal suctioning using a high-pressure catheter
    4. DD. Reposition the client into a side-lying posture with the head of the bed slightly elevated
    Show answer to question 23

    Answer: D. Reposition the client into a side-lying posture with the head of the bed slightly elevated

    Repositioning the client onto the side with the head slightly elevated allows gravity to clear or pool secretions in the buccal cavity where they can be gently swabbed, reducing the audible rattle without causing agitation. Deep endotracheal suctioning is distressing, invasive, and typically induces coughing, gagging, or mucosal trauma in dying clients. Intravenous fluid boluses increase pulmonary congestion and aggravate terminal secretions.

24. Question 24 of 25Medium

    A home health nurse evaluates the daily routine of a client with multiple sclerosis who reports severe mid-day fatigue. Which modification should the nurse suggest to balance activity and rest?

    1. AA. Eliminate all physical exercise to prevent depletion of energy stores.
    2. BB. Consolidate all physical errands into a single continuous outing.
    3. CC. Incorporate brief, scheduled rest breaks between household tasks.
    4. DD. Take a warm or hot bath immediately before beginning morning housework.
    Show answer to question 24

    Answer: C. Incorporate brief, scheduled rest breaks between household tasks.

    Pacing activities and inserting planned, short rest periods throughout the day helps prevent exhaustion and preserves energy reserves in clients with multiple sclerosis. Exposure to heat, such as warm baths, can trigger Uhthoff phenomenon and temporarily worsen neurological symptoms and fatigue. Eliminating exercise entirely is counterproductive, as regular moderate exercise improves endurance and mood.

25. Question 25 of 25Hard

    A nurse is developing a passive range-of-motion care plan for a client with acute flaccid hemiplegia following an ischemic stroke. Which action is essential to prevent injury to the client's flaccid shoulder during exercises?

    1. AA. Avoid elevating the shoulder beyond 90 degrees without scapular movement.
    2. BB. Apply gentle traction by pulling on the client's wrist to elevate the shoulder.
    3. CC. Perform rapid, repetitive movements to stimulate dormant muscle stretch reflexes.
    4. DD. Maintain the fingers in a clenched fist while hyperextending the wrist joint.
    Show answer to question 25

    Answer: A. Avoid elevating the shoulder beyond 90 degrees without scapular movement.

    In a flaccid extremity, the rotator cuff muscles lack the tone needed to stabilize the humeral head within the glenoid fossa, placing the joint at high risk for subluxation and impingement. Shoulder elevation beyond 90 degrees should only occur if the scapula is mobilized into upward rotation and the humerus is externally rotated. Pulling on the flaccid arm or moving the joint rapidly can directly cause joint subluxation and neuropathic pain.

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