1,040 Fundamentals questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.
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The combination of fever, tachycardia, hypotension, and altered mental status 2 days post-op strongly suggests septic shock from a postoperative infection source.
Heat therapy should be applied with a protective barrier (towel) between the heat source and skin to prevent burns. The temperature should be warm, not hot, and applications should be limited to 20-30 minutes. The nurse should assess the skin frequently for redness, blisters, or discomfort. Prolonged or direct heat application can cause thermal injury.
According to developmental principles, a 4-year-old is in the preschool stage and benefits from familiarization with equipment through play. Allowing the child to handle items like tape or a syringe reduces fear. Medical terminology confuses children, restraint increases distress, and parental presence is comforting.
The correct answer is performing meticulous hand hygiene and using clean technique for all care. Neutropenic patients have severely decreased immune function and are at extremely high risk for infection. Meticulous hand hygiene is critical. Use single-use or patient-specific products to minimize contamination risk. Avoid sharing facilities or using abrasive tools.
For pediatric patients, especially toddlers, the most appropriate fall prevention measure is to use a crib with raised side rails that are locked in the up position. Toddlers are curious and may attempt to climb out of bed, so keeping the side rails up prevents falls. Keeping side rails down (option a) increases fall risk. Toddlers should not walk independently in an unfamiliar environment without supervision (option c). Restraints (option d) are not appropriate for fall prevention in children and require specific orders and monitoring.
The catheter should be advanced further until urine flows freely before inflating the balloon. In female patients, the urethra is approximately 3-5 cm, but the catheter may need to be advanced further to ensure it is fully in the bladder. Discomfort may indicate the catheter is in the urethra but not the bladder.
The answer: B (the patient's name, diagnosis, current condition, recent changes, and pending tests) Think of it this way: handing off a client to another unit is like passing a baton in a relay race — the next runner (the receiving nurse) needs enough information to keep going smoothly without dropping anything, including where things currently stand and what's still "in progress." Why B is right: a complete handoff includes the client's identity, diagnosis, current condition, any recent changes, and pending tests or treatments — this gives the receiving team a full, current picture so they can pick up care without gaps or surprises. Why the others are wrong: - A: diagnosis and room number alone leave out critical information about the client's CURRENT condition, recent changes, and anything still pending — far too little for safe continuity of care. - C: medication and allergy information is important and should be INCLUDED, but limiting the handoff to JUST this leaves out the broader clinical picture (current condition, recent changes, pending items). - D: social history and hobbies, while sometimes helpful for building rapport, aren't the PRIORITY information for a clinical handoff — they don't help the receiving nurse understand the client's current medical status or care needs. Remember: a complete handoff = who the client is, their diagnosis, current condition, recent changes, and anything still pending — often organized using a structured format like SBAR. Technical note: structured handoff tools (like SBAR or I-PASS) are widely promoted by patient safety organizations because unstructured handoffs are a common source of medical errors — missing or unclear information during a handoff can lead to delayed treatments, repeated tests, or missed changes in a client's condition.
The answer: C (A 70-year-old patient with COPD and an indwelling urinary catheter) Think of it this way: think of healthcare-associated infection (HAI) risk as adding up points — each risk factor stacks on top of the others. This patient has three: older age (the immune system isn't as strong), chronic obstructive pulmonary disease, or COPD (the lungs are already compromised), and an indwelling urinary catheter (a tube that gives bacteria a direct path into the bladder). Why C is right: this patient has the most risk factors stacked together — advanced age, a chronic disease that weakens host defenses, and an invasive device that bypasses the body's normal barriers, making a urinary tract infection especially likely. Why the others are wrong: - A: A healthy 25-year-old having a routine appendectomy has no major underlying risk factors and no invasive long-term devices. - B: A 45-year-old with well-controlled diabetes having a planned knee replacement has one risk factor (diabetes), but it's well-controlled, and there's no indwelling device mentioned. - D: A 55-year-old with hypertension admitted for observation has a common chronic condition but no invasive devices and no described immune compromise. Remember: more risk factors stacked together (age + chronic illness + invasive device) = higher HAI risk. Technical note: indwelling urinary catheters are one of the leading causes of HAIs (catheter-associated urinary tract infections, or CAUTIs); risk increases with each day the catheter remains in place, so catheters should be removed as soon as they're no longer clinically necessary.
The answer: A, B, and D - reposition the patient every 2 hours, use mild soap and warm water for bathing, and keep skin clean and dry using moisture barriers as needed - all are correct/appropriate. Think of it this way: Skin breaks down from a combination of pressure, friction, and moisture - so protecting skin means relieving pressure regularly, cleaning gently, and managing moisture. Why these are right: - A: Repositioning every 2 hours relieves sustained pressure on any one area, giving blood flow a chance to return to compressed tissue. - B: Mild soap and warm water clean the skin without stripping its natural protective oils or irritating it with harsh chemicals or extreme temperatures. - D: Keeping skin clean and dry, with moisture barrier products (creams that protect skin from urine, stool, or excess moisture) as needed, prevents maceration (softening and breakdown from prolonged wetness). Why the other is wrong: - C: Vigorous massage of bony prominences (areas where bone is close to the skin, such as the sacrum, hips, or heels) is contraindicated - it can damage fragile tissue and blood vessels under the skin, potentially worsening the risk of pressure injury rather than preventing it. Remember: Reposition, clean gently, keep dry - but never massage the bony spots. Technical note: Pressure injuries develop from a combination of pressure, shear (sliding forces between skin and underlying tissue), friction, and moisture; a thorough skin-integrity program addresses all of these factors along with nutritional support, since adequate protein and hydration are needed for skin to maintain its strength and heal.
The answer: B (12-20 breaths per minute) Think of it this way: think of normal breathing as a steady, relaxed rhythm — not racing, not barely moving. For a resting adult, that steady rhythm falls between 12 and 20 breaths every minute. Why B is right: 12-20 breaths per minute is the accepted normal range for an adult at rest. This is one of the baseline numbers the nurse compares every patient against. Why the others are wrong: - A: 8-12 breaths per minute is too slow — a rate this low (bradypnea, "brady" = slow, "-pnea" = breathing) could signal sedation, opioid overdose, or a neurological problem. - C: 20-28 breaths per minute is faster than normal (tachypnea, "tachy" = fast) and suggests the body is compensating for something, such as anxiety, pain, fever, or low oxygen. - D: 28-36 breaths per minute is significantly elevated and would prompt an urgent assessment for respiratory distress. Remember: 12-20 is normal — below is bradypnea, above is tachypnea. Technical note: respiratory rate should be assessed for one full minute when possible, especially if the rhythm is irregular, since brief counts can miss pauses or irregular patterns.
