NCLEX Practice Exam/Test: Fundamentals of Nursing Concepts Practice Test (1-10)

1. Which of the following is an appropriate nursing action when implementing standard precautions?

A. Consider all body substances potentially infectious
B. wear gloves whenever in contact with patient
C wear gown and gloves when caring for a client in droplet precaution
D. place a body substance isolation sign on the client's door

2. Which of the following clients would qualify for hospice care?

A. a client with metastatic cancer
B. a client with left-side after a stroke
C. a client who had coronary artery bypass surgery 1 week ago
D. a client who is undergoing treatment for heroin addiction

3. For a hospitalized client, which statement reflects appropriate documentation in the client's medical record?

A. "client had a good day"
B. "seems to be mad at the physician"
C. "small pressure ulcer noted at the lower back"
D. "skin moist and cool"

4. The nurse will administer the client's 9 A.M. medications. The client is away from his room for ultrasound of the liver. Which nursing action is appropriate ?

A. have the client skip that dose of medication
B. ask the client's relatives to keep the medications for the client until he returns
C. lock the medications in the medicine preparation area until the client returns
D. leave the medications on the drawer of the client's bedside table

5. The nurse is caring for a client receiving patient-controlled analgesia (PCA) for pain management. Which statement about PCA is true?

A. the PCA pump cant' infuse opioids continuously
B. pain relief is initiated by the client as needed
C. no complications related to opioid delivery by the pump exist
D. the nurse prescribes the dosage of opioid for delivery

6. Which assessment sequence should the nurse follow when examining abdomen?

A. Inspection, percussion, auscultation, palpation
B. auscultation, inspection, percussion, palpation
C. inspection, auscultation, percussion, palpation
D. auscultation, inspection, palpation, percussion

7. Which of the following instructions given to an elderly client who had undergone total hip replacement would prevent post-operative constipation?

A. "take metamucil regularly"
B. "walk 50 feet daily"
C. "eat a soft diet"
D. "drink 6 to 8 glasses of water a day"

8. Which action by the nurse is essential when cleaning the area around a Jackson Pratt wound drain?

A. clean from the center, out in a circular motion
B. remove the drain before cleaning the skin
C. clean briskly around the site with alcohol
D. wear sterile gloves and mask

9. An obese client comes to the physician's office for a routine physical examination. The nurse chooses a standard blood pressure cuff to auscultate the client's blood pressure. If the blood pressure cuff is too small for the client, blood pressure reading taken with such cuff may do which of the following?

A. fail to show changes in blood pressure
B. produce a false-high measurement
C. cause sciatic nerve damage
D. produce false-low measurement

10. Before administering a medication through a nasogastric tube (NGT), which action should the nurse take first?

A. instruct the client to cough
B. give the client a sip of water through a straw
C. observe and test the pH of the aspirate
D. inject 10ml of water into the NGT


1) A- standard precautions are based on the concepts that all body substances are potentially infectious. The nurse should wear gloves when contact with body substances is potential, not when in contact with intact skin. Mask should be used as a barrier to prevent transmission of droplet infections. Signs on door are unnecessary for standard precaution.

2) A
hospices provide supportive, palliative care to terminally ill clients and their families

3) D
- documentation should be factual and accurate, what are heard, seen, smelled, or felt. Documentation of ulcer should include exact size and location. Interpretations, conclusions, opinions should not be documented.

4) C
the nurse must put the medicines in the secured area. She should not leave the medications at the bedside. The nurse should not omit doses of medications without physician's order

5) B
- the client pushes a button to self-administer narcotic analgesic. The PCA pump also allows for continuous infusions of the medication. The client may still experience complications of the medication. It is the physician who prescribes the medication order

6) C
- the sequence of inspection, auscultation, percussion and palpation ensures that bowel sounds are not altered or stimulated by percussion and palpation (IAPP)

7) D
- Water is needed to promote peristalsis. Regular use of laxative may create dependence and cause dehydration. A high fiber diet, not soft diet prevents constipation. Walking 50 feet a day may not be enough to increase motility

8) A
- cleaning from the center, out in a circular motion around a wound drain prevents contamination of wound. The skin near the drain is more contaminated. Alcohol is never used to clean around the drain because it is irritating. The nurse should wear sterile gloves to prevent contamination but a mask in not necessary

9) B
- using too small blood pressure cuff produces a false-high measurement because the cuff can't measure brachial artery pressure unless it's excessively inflated

10) C
- NGT placement must be verified before administering a medication to prevent introducing the medication into the airway. Placement may be checked by assessing the pH of gastric contents. The pH should be less than 5.

[---------------------] NEXT -> FUNDAMENTALS  11-20 --&gt

Related Topics:

NCLEX Practice Exam/Test - Leadership and Management Practice Test

CHEAP BUY ! ! !        
NCLEX E-Book with FREE Saunders and KAPLAN ($4)

1. A registered nurse is planning for the client assignment for the day. Which of the following is the most appropriate assignment for a nursing assistant?

A. a client requires tap water enemas
B. a client requiring colostomy irrigation
C. a client requiring continuous tube feeding
D. a client with difficulty swallowing food and fluid

2. A registered nurse employed in long-term care facility is planning assignments for the clients on a nursing unit. The RN needs to assign four clients and has a licensed practical (vocational) nurse and three nursing assistants on a nursing team. Which of the following clients would the nurse most appropriately assign to LPN

A. a client who requires a 24-hour urine collection
B. an elderly client requiring assistance with bed bad and frequent ambulation
C. a client who requires a fleet and an oil retention enema
D. a client with an abdominal wound that requires irrigation and dressing changes every 3 hours

3. A registered nurse has received the assignment for the day shift. After making initial rounds and checking all the assigned clients, which will the RN plan to care for first?

A. a client who is ambulatory
B. a client who has fever and who is diaphoretic and restless
C. a client scheduled for physical therapy at 1:00 pm
D. a post-operative client who has received pain medications

4. A nurse is assigned to care for four clients. In planning client rounds, which client would the nurse assess first?

A. a client receiving oxygen via nasal cannula who had difficulty breathing the previous shift
B. a post-operative client for discharge
C. a client scheduled for x-ray
D. a client requiring daily dressing changes


1) A
- The nursing assistant can perform enema. Option B, C, and D will be done by the LVN/LPN

2) D
- the LVN can perform more complicated procedures like wound care. Option A, B, and C tasks done by nursing assistants

3) B
- patients with unstable condition should be given highest priority by the nurse. The client who has fever, and who is diaphoretic and restless is with unstable condition

4) A
- the client with problem with airways and whose condition is unstable should be given first priority by the nurse. "ABC" is a priority.

Related Topics:

NCLEX Practice Exam/Test - Ethical and Legal Issues Practice Test

CHEAP BUY ! ! !        
NCLEX E-Book with FREE Saunders and KAPLAN ($4)

1. A nurse calls a physician in regard to a new medication order because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the physician and the medication is due to be administered. Which of the following actions would the nurse take?

A. hold the medication until the physician can be contacted
B. administer the dosage prescribed
C. administer the recommended dose until the physician can be located
D. contact the nurse supervisor

2. A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action?

A. refuse to float in the ICU
B. call the hospital lawyer
C. call the nursing supervisor
D. report to the ICU and identify tasks that can be safely performed

3. An 87 year-old female is brought to the emergency room for treatment of a fractured arm. On physical assessment, a nurse notes old and new ecchymotic areas on the client's chest and legs. The nurse asks the client how the bruises were sustained. The client although reluctant, tells the nurse in confidence that her son frequently hit her if supper is not ready on time when he arrives home from work. Which of the following is the most appropriate nursing response?

A. "Oh really, I will discuss the situation with your son."
B. "Do you have any friends who can help you out until you resolve these important issues with your son?"
C. "Lets talk about the ways you can manage your time to prevent this from happening."
D. "This is a legal issue, and I need to let you know that I will need to report."

4. A client is brought to the emergency room by the EMS after being hit by a car. The name of the client is not known. The client has sustained severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. In regard to informed consent for the surgical procedures, which of the following is the best initial nursing action?

A. call the police to identify the client and locate the family
B. obtain court order for the surgical procedure
C. ask the EMS team to sign the informed consent
D. transport the victim to the OR surgery

5. A nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. The most appropriate initial action by the nurse is which of the following?

A. call the police
B. call security
C. lock the co-worker in the medication room until help is obtained
D. call the nursing supervisor

6. A nurse hears a client calling for help. The nurse hurries down the hallway to the client's room and found a client lying on the floor. The nurse performs a thorough assessment and assists the client back to bed. The nurse notifies the physician of the incident and completes an incident report. Which of the following would the nurse document on the incident report?

A. the client was found on the floor
B. the client climbed of the side rails
C. the client fell out of bed
D. the client became restless and tried to get out of bed


1) D
- when a physician's order is inappropriate, the nurse should question/verify the order. When the nurse is unable to contact the physician, he/she should seek the help of the nursing supervisor. This action enables the nurse to perform her other tasks

2) D 
- floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.

3) D 
- the presence of old and new signs of injury indicates abuse. This is one of the reporting responsibilities of the nurse. The other choices do not address the issue of abuse

4) D 
- in case of emergency, to save the life of a client, written consent may be waived. Two physicians will signed the consent and the nature of the emergency situation need to be documented.

5) D 
- the nurse should report the situation to the nursing supervisor. Proper channel of communication should be used to deal with legal matters.

6) A 
- documentation should be factual and objective. Avoid opinion, interpretations, and legally-implicating statements.

Related Topics:

NCLEX Practice Exam/Test - Cultural Diversity Practice Test

CHEAP BUY ! ! !        
NCLEX E-Book with FREE Saunders and KAPLAN ($4)

1. A nurse in an ambulatory care clinic is performing an admission assessment for an African-American client scheduled for a cataract removal with intraocular lens implant. Which of the following questions would be inappropriate for the nurse to ask on initial assessment?

A. Do you have any difficulty breathing?
B. Do you have a close family relationship?
C. Do you ever experience chest pain?
D. Do you frequently have episodes of headache?

2. A nurse is preparing to deliver a food tray to client whose religion is Jewish. The nurse checks the food on the tray and notes that the client has received roast beef dinner with whole milk as beverage. Which action will the nurse take?

A. deliver the food tray to the client
B. call the dietary department and ask for new meal tray
C. replace the whole milk with fat-free milk
D. ask the dietary department to replace the roast beef with pork

3. A nurse is providing discharge instructions to a Chinese client regarding prescribed dietary modifications. During the teaching sessions, the client continuously turns away from the nurse. Which nursing action is most appropriate?

A. continue with the instructions, verifying client's understanding
B. tell the client about the importance of the instruction for maintenance of health care
C. walk around the client so that the nurse continuously faces the client
D. give the client a dietary booklet and return later to continue with the instructions.

4. A clinic is preparing to examine a Hispanic child who was brought to the clinic by the mother. During assessment of the child, the nurse would avoid which of the following?

A. Asking the mother questions about the child
B. admiring the child
C. taking the child's temperature
D. obtaining an interpreter as necessary


1) B
- among African-Americans, avoid asking personal questions during initial encounter. It is considered as intrusive.

2) B
- the diet for Jewish people is Kosher diet. Meat and milk combination, pork, and scavenger fishes are prohibited. The appropriate nursing action is to call the dietary department to change the meal tray of the patient

3)  A
- Asian- Americans like Chinese, avoid eye contact with authorities to show respect. The appropriate action by the nurse is to continue giving health teachings and verify client's understanding every now and then

4) B
- Among Hispanic_Americans, admiring a child during initial encounter with a stranger should be avoided because this may afflict the child with the "evil eye" ( the child will get sick)

Related Topics: