Are you embarking on your NCLEX journey or facing a retake? Then this episode is 100% a must-listen for you!
Take a deep breath and get ready to conquer those challenges with us, one question at a time.
In this episode, I’ll be sharing with you 28 difficult NCLEX questions and their answers so you can pass the exam with flying colors.
This isn’t just another practice session; it’s a strategic deep dive into 28 tricky questions you’ll encounter, complete with detailed answers and insights.
So, whether you’re a first-timer or looking to overcome a hurdle, this is your stepping stone to success.
Are you ready to learn more?
Let’s dive in!
NCLEX Question #1:
You are the charge nurse on a medical-surgical unit, and you must assign a patient to the newly graduated RN who is on the second week of orientation. Which patient should be assigned to the new graduate?
- A 27-year-old male newly admitted with periorbital cellulitis.
- A 30-year-old female waiting for discharge instructions after receiving skin grafts for burn injuries.
- A 40-year-old male who needs further education prior to receiving skin grafts for burn injuries.
- A 35-year-old female who is waiting for a dressing change for a pressure ulcer.
Answer: A 35-years-old female who is waiting for a dressing change for a pressure ulcer.
Rationale: The other three choices require an experienced RN. Choice D is a stable patient that a new RN is permitted to provide care for.
NCLEX Question #2:
The nurse understands that the following medication should be double-checked with another RN before administering to the patient with burn injuries:
- Acetaminophen 650 mg
- Silver sulfadiazine (Silvadene)
- Midazolam (Versed)
- Ranitidine (Zantac)
Answer: Midazolam (Versed).
Rationale: Midazolam is a benzodiazepine which requires two nurses to check prior to administration. The other three choices can be given without another nurse double-checking.
NCLEX Question #3:
The nurse understands that the following diagnostic test will provide a definitive diagnosis of cirrhosis:
- Sodium levels
- Albumin levels
- Liver enzyme levels
- Liver biopsy
Answer: Liver biopsy.
Rationale: A liver biopsy can reveal the exact cause of an enlarged liver, which is known as hepatomegaly. Elevated liver enzymes can be caused by multiple conditions, not just cirrhosis. Albumin and sodium levels do not provide a definitive diagnosis of cirrhosis.
NCLEX Question #4:
The nurse is speaking with a patient who is using words that are made up with no common meaning. This is identified as which of the following?
- Word salad
- Imaginative play
- Echolalia
- Neologism
Answer: Neologism.
Rationale: Neologism means a newly-coined word that does not currently exist. Word salad is placing words together that do not connect. Imaginative play is role-play usually acted out by children. Echolalia is repeated speech.
NCLEX Question #5:
A mother is asking the nurse if hypospadias can be repaired and when it can be taken care of. Which of the following is the correct response?
- “Hypospadias is congenital and cannot be cured.”
- “Hypospadias is congenital and is fixed by hypospadias repair, which is done between 6 to18 months of age.”
- “Hypospadias is congenital and is fixed by hypospadias repair, which is done immediately after birth.”
- “Hypospadias is congenital and is fixed by hypospadias repair, which is done during teenage years.”
Answer: “Hypospadias is congenital and is fixed by hypospadias repair, which is done between 6 to 18 months of age.”
Rationale: Hypospadias is when the abnormal urethral opening is under the penis (closer to the testicles), which is congenital. There is a higher risk of infection. This can be fixed with hypospadias repair, which is done between 6 to 18 months of age. Catheter or stent care education is provided due to the high risk of infection. The nurse must observe for bleeding and impaired circulation after surgery and report to the physician for abnormal findings.
NCLEX Question #6:
A 31-year-old patient is currently 28-weeks pregnant with a miscarriage at 9-weeks gestation two years ago. She currently has a 4-year-old child who was born at 38 weeks. What is her GTPAL?
- G – 4 , T – 1, P – 1, A – 1, L – 4
- G – 2 , T – 2, P – 1, A – 1, L – 3
- G – 3 , T – 2, P – 0, A – 0, L – 1
- G – 3, T – 1, P – 0, A – 1, L – 1
Answer: G – 3, T – 1, P – 0, A – 1, L – 1
Rationale: The patient was pregnant three times. Her 4-year-old child was born after 37-weeks gestation at term. She did not deliver an infant at preterm. Her miscarriage occurred at 9-weeks gestation, categorizing the baby under abortion. Do not count her current pregnancy or the miscarriage. Only count her 4-year-old child under living children.
NCLEX Question #7:
The nurse is providing care for a client who has returned from surgery. The nurse looked at the results and noticed that which of the following should be reported to the physician as soon as possible?
- Sodium 144 mEq/L
- Sodium 129 mEq/L
- Potassium 3.5 mEq/L
- Potassium 5 mEq/L
Answer: Sodium 129 mEq/L
Rationale: The normal range of sodium is 135 to 145 mEq/L. The client’s sodium level falls below the normal range and should be reported to the physician. The normal range of potassium is 3.5 to 5 mEq/L.
NCLEX Question #8:
The nurse suspects signs of an aneurysm. What should she look out for indicating an abdominal aneurysm?
- Edema and shortness of breath
- Cramps
- Night sweats, fever, and chills
- Vascular sound or bruit over the abdominal aorta
Answer: Vascular sound or bruit over the abdominal aorta.
Rationale: Signs of an abdominal aortic aneurysm is vascular sound or bruit over the abdominal aorta. Edema and shortness of breath can be seen with kidney failure. Cramps can be seen as a dialysis side effect from too much fluid removal. Night sweats, fever, and chills are signs of tuberculosis.
NCLEX Question #9:
The nurse is reviewing Yalom’s Curative Factors of Group Therapy. Which of the following is unselfish thinking about others before self?
- Universality
- Instillation of hope
- Altruism
- Corrective recapitulation
Answer: Altruism.
Rationale: Altruism is unselfish thinking about others before self. Universality is sharing common experiences and responses to feel that one is not alone. Providing optimism is an installation of hope. Corrective recapitulation is re-experiencing family situations to correct unresolved conflicts.
NCLEX Question #10:
Nurse Jojo is providing care for a newborn with myelomeningocele. The newborn is about to go through a sal closure procedure. Which of the following demonstrates Nurse Jojo’s need for further education?
- Newborn must be placed in side-lying position post-operation
- Newborn must be placed in supine position post-operation
- Sac closure procedure is done first 24-48 hours after birth
- Myelomeningocele is the most serious form of spina bifida
Answer: Newborn must be placed in supine position post-operation.
Rationale: The newborn must avoid supine position and be placed in a side-lying position after the sac closure procedure, which is done during the first 24 to 48 hours after birth. Myelomeningocele is the most serious form of spina bifida.
NCLEX Question #11:
Calculate using Naegele’s rule to estimate the date of delivery of Justine, whose last menstrual period was May 1st, 2020.
- February 1st, 2021
- February 8th, 2021
- February 1st, 2020
- March 8th, 2021
Answer: February 8th, 2021.
Rationale: February will always have 28 days, no matter what. Each month has a different number of days, so keep that in mind! April, June, September, and November have 30 days. Calculation is done assuming that the woman has a menstrual cycle of 28 days. The NCLEX is aware that this does not apply to everyone, but with Naegele’s rule, we’re going to assume. Add 7 days to the first day of the last menstrual period. Subtract 3 months. Add 1 year.
NCLEX Question #12:
The nursing student is learning about white blood cells. Which of the following is not one of the five types of white blood cells?
- Neutrophils
- Lymphocytes
- Eosinophils
- Erythrocytes
Answer: Erythrocytes.
Rationale: The five white blood cells are neutrophils, lymphocytes, eosinophils, monocytes, and basophils. Erythrocyte is a red blood cell and is not one of the five white blood cells.
NCLEX Question #13:
Patient verbalized understanding when she stated that blood transfusion can cause reactions, such as (select all that applies):
- Hemolytic reaction
- Febrile reaction
- Septic reaction
- Shocking reaction
Answer: Hemolytic reaction, febrile reaction, and pyogenic reaction.
Rationale: Patient verbalized understanding when she stated that blood transfusion can cause reactions such as hemolytic reaction, febrile reaction, and pyogenic reaction. It does not cause a shocking reaction.
NCLEX Question #14:
The nurse is assessing the patient’s abdomen and notices a pulsating abdominal mass. The patient does not report any pain at this time. What should the nurse do next?
- Report to the physician
- Put the patient on NPO
- Assess the femoral pulse
- Treat for hypovolemic shock
Answer: Assess the femoral pulse.
Rationale: The nurse suspects an abdominal aorta due to the pulsating abdominal mass. Assessing the femoral pulse (in the thigh) can assist the nurse in deciding whether or not there is circulatory compromise. Signs of hypovolemic shock occur with a ruptured abdominal aorta. The patient has not shown signs of a ruptured abdominal aorta or hypovolemic shock, so the nurse should observe for signs and not start treating right away. Assessing is important prior to reporting to the physician. Holding the patient from drinking or eating is pointless at this time.
NCLEX Question #15:
Which of the following is false about depersonalization disorder?
- There is a cure
- There is no cure
- Client reports feeling like an outsider observing the moment
- Client feels detached from self and describes the event as a dream
Answer: There is a cure.
Rationale: There is no cure for depersonalization disorder at this time. Medication can be prescribed to treat the symptoms but not the disorder itself. Client reports feeling like an outsider observing the moment or feels detached from self. The client may describe the event as a dream.
NCLEX Question #16:
The mother is asking the nurse about the strawberry hemangioma that is on her infant’s back. What is the appropriate response by the nurse?
- “Retinoid is applied to get rid of the lesion.”
- “Unfortunately, it will never go away.”
- “It will keep growing until the child becomes a teenager.”
- “It usually goes away by age 10.”
Answer: “It usually goes away by age 10.”
Rationale: Strawberry hemangioma is a condition in which vascular lesions grow at a rapid rate until age 1. It usually goes away by the age of 10. In some cases, it may remain. It can appear anywhere on the body but is most commonly found on the back, face, or chest.
NCLEX Question #17:
Which is the proper delegation to assign to the nursing assistant from the registered nurse?
- “Check on the client in room 502 and tell me how he’s doing.”
- “Please let me know if the client’s pain is alleviated in room 501.”
- “Take the client’s blood pressure every hour in room 500.”
- “Get the client up today in room 503.”
Answer: “Take the client’s blood pressure every hour in room 500.”
Rationale: Telling the nursing assistant to take the blood pressure every hour is a specific task that is under the appropriate scope of practice for the nursing assistant to perform. The other choices involve judgment calls that the nurse should make. Telling the client to get up in room 503 is too vague of an instruction.
NCLEX Question #18:
A client with iron deficiency anemia is taking ferrous gluconate. Which of the following is true about ferrous gluconate?
- Take ferrous gluconate with milk and cereal in the morning
- Take ferrous gluconate after meal on a full stomach
- Take ferrous gluconate on an empty stomach
- Take ferrous gluconate at 3 A.M.
Answer: Take ferrous gluconate on an empty stomach.
Rationale: Ferrous gluconate is taken on an empty stomach. Do not take ferrous gluconate with antacids, milk, or whole-grain cereals. Ferrous gluconate does not need to be taken at 3 A.M. and should not be taken on a full stomach.
NCLEX Question #19:
The nurse is providing care for a client who has dialysis treatment three times a week at an outpatient clinic. Which of the following should be assessed prior to starting treatment?
- Positive bruits and thrills
- Negative bruits and thrills
- Cramps
- Hyperphosphatemia
Answer: Positive bruits and thrills.
Rationale: The nurse should expect positive bruits and thrills in the client’s fistula or graft. If the bruits or thrills are absent, the client would not be able to get dialyzed. Further intervention would be needed to ensure a patient’s access in order to receive adequate dialysis.
NCLEX Question #20:
A 78-year-old male client has signs and symptoms of vascular dementia. Which of the following is true about vascular dementia? Select all that applies:
- Caused by delirium
- Affects level of consciousness
- Does not affect level of consciousness
- Occurs due to a stroke
Answer: Does not affect level of consciousness and occurs due to a stroke.
Rationale: Vascular dementia does not affect level of consciousness and occurs due to a stroke. It is not caused by delirium. Personality, memory, and cognitive functioning are affected.
NCLEX Question #21:
Which of the following is false about lumbar puncture?
- Needle is placed in the spinal cord for diagnostic testings
- Cerebrospinal fluid is collected
- Place the child on the side with curved back for good needle placement
- Place the child on the stomach for good needle placement
Answer: Place the child on the stomach for good needle placement.
Rationale: The child should be placed on the side with a curved back for good needle placement during a lumbar puncture. Cerebrospinal fluid is collected. The needle is placed in the spinal cord for diagnostic testing.
NCLEX Question #22:
Which of the following demonstrates that the nursing student has an understanding of Rhₒ(D) immune globulin?
- Rhₒ(D) immune globulin is given to the Rh-negative mother within 72 hours postpartum
- Rhₒ(D) immune globulin is given to the Rh-positive mother within 72 hours postpartum
- Rhₒ(D) immune globulin is given to the Rh-negative mother within 24 hours postpartum
- Rhₒ(D) immune globulin is given to the newborn within 72 hours postpartum
Answer: Rhₒ(D) immune globulin is given to the Rh-negative mother within 72 hours postpartum.
Rationale: Rhₒ(D) immune globulin is given to the Rh-negative mother within 72 hours postpartum to prevent antibodies from forming. The antibodies can destroy fetal blood cells during the next pregnancy. It is not given to the newborn.
NCLEX Question #23:
Which of the following is the correct order of the chain of infection?
- Reservoir, Infectious agent, exit route, mode of transmission, portal of entry, and susceptible host
- Infectious agent, portal of entry, reservoir, exit route, mode of transmission, and susceptible host
- Susceptible host, reservoir, exit route, mode of transmission, portal of entry, and infectious agent
- Infectious agent, reservoir, exit route, mode of transmission, portal of entry, and susceptible host
Answer: Infectious agent, reservoir, exit route, mode of transmission, portal of entry, and susceptible host.
Rationale: The correct order is infectious agent, reservoir, exit route, mode of transmission, portal of entry, and susceptible host. Infectious agent is the organism that caused the infection. Reservoir is where the infectious agent grows. Exit route is the route the infectious agent leaves (droplets or excretions). Mode of transmission is how the infectious agent spreads from one location to another. Portal of entry is where the infectious agent enters. Susceptible host is the person that is at risk for becoming infected.
NCLEX Question #26:
HMG-CoA Reductase Inhibitors interrupts cholesterol generating enzymes in the liver. The nurse understands that examples of HMG-CoA Reductase Inhibitors include (select all that applies):
- Lovastatin
- Pravastatin
- Alprazolam
- Clorazepate
Answer: Lovastatin and Pravastatin.
Rationale: Examples of HMG-CoA Reductase Inhibitors are lovastatin and pravastatin. Alprazolam and clorazepate are anti-anxiety medications.
NCLEX Question #25:
The client is about to start hemodialysis treatment for the first time. The nurse should inform the client that which of the following side effects is not common on hemodialysis?
- Cramping
- Dizziness
- Hypotension
- Hematuria
Answer: Hematuria.
Rationale: Cramping, dizziness, and hypotension are side effects that can occur when the client is receiving hemodialysis treatment. Hematuria is not a common finding and should be reported to the physician immediately.
NCLEX Question #26:
A 42-year-old male with a history of alcohol abuse reports nervousness, diaphoresis, and nausea. The nurse suspects that these are signs and symptoms of which of the following?
- Early signs of alcohol withdrawal
- Late signs of alcohol withdrawal
- Benzodiazepines withdrawal
- None of the above
Answer: Early signs of alcohol withdrawal.
Rationale: Nervousness, diaphoresis, and nausea are all early signs of alcohol withdrawal. Hallucinations and seizures are late signs of alcohol withdrawal. Anxiety or seizures for months are signs of benzodiazepine withdrawal.
NCLEX Question #27:
The nurse is providing care for a child diagnosed with diabetes mellitus. The child is found vomiting and reported lack of appetite. Which of the following should the nurse expect the physician to order?
- Lowered NPH insulin dosage by 25-30%
- Lowered NPH insulin dosage by 10%
- Increased NPH insulin dosage by 25-30%
- NPH insulin dosage to be withheld
Answer: Lowered NPH insulin dosage by 25-30%.
Rationale: If the child is vomiting or has a lack of appetite, the NPH insulin dosage should be lowered by 25-30% to prevent hypoglycemia from occurring. Blood glucose test is taken prior to administering insulin.
NCLEX Question #28:
Which of the following should the nurse keep in mind in regards to providing care for a pregnant client with diabetes? Select all that applies:
- Client is not at risk for hypoglycemia after giving birth
- Never ever give insulin
- Severe hypoglycemia can occur postpartum
- Take blood glucose levels and observe for signs and symptoms
Answer: Severe hypoglycemia can occur postpartum and take blood glucose levels and observe for signs and symptoms.Rationale: Severe hypoglycemia can occur postpartum. Take blood glucose levels and observe for signs and symptoms. Insulin can be given with the physician’s order at a safe dosage.
