1,039 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.
For breakthrough pain, the standard equianalgesic recommendation is to administer a rescue dose equal to approximately 10-20% of the total daily opioid dose (or 1/6 of the total daily dose). This can be given every 1-2 hours as needed. The rescue medication should be available on an as-needed basis, not scheduled at fixed intervals.
The first priority when catheter-related bloodstream infection is suspected is to obtain blood cultures from both the catheter hub and a peripheral site to confirm the diagnosis and identify the causative organism. This guides antibiotic therapy. Catheter removal may be necessary but should be done after cultures are obtained.
The correct answer is retracting the foreskin fully and cleaning under it with soap and water daily. Proper hygiene includes gently retracting the foreskin to clean the glans penis, preventing smegma buildup and infection. However, if phimosis (inability to retract) is present, forceful retraction should be avoided; in such cases, clean only what is accessible. Alcohol-based cleaners are too harsh and can cause irritation, and powder should be avoided as it can promote infection.
Prealbumin is a more sensitive indicator of acute protein status than albumin (which has a long half-life). A prealbumin of 8 mg/dL is severely low (normal: 15-40 mg/dL), indicating acute protein deficiency and increased pressure injury risk. The albumin is also low (normal: 3.5-5.0 g/dL). Both indicate malnutrition requiring nutritional intervention. Prealbumin reflects more recent nutritional intake and changes more rapidly.
For an adult receiving an enema, the rectal tube should be inserted 2-4 inches (5-10 cm). For children, the insertion depth is 1-2 inches. Inserting too far can cause trauma or perforation. The Fleet enema is a small-volume saline enema.
Sitting the client straight up (high Fowler's position) comes first. Autonomic dysreflexia is a dangerous surge in blood pressure set off by a stimulus below the level of the spinal cord injury. Raising the head lets gravity pool blood in the legs and brings the pressure down within seconds, which lowers the immediate risk of stroke or seizure. Next, the nurse looks for and removes the trigger. The most common one is a full bladder, so checking the bladder and catheter is the second step, followed by the bowel and the skin. Antihypertensive medication is reserved for blood pressure that stays high after the trigger has been removed. A cold compress does nothing about the cause and can itself become a new trigger below the injury.
The answer: C (Placing patients with MRSA in a private room) Think of it this way: Standard Precautions are the baseline habits used for EVERY patient, EVERY time, regardless of their diagnosis — like hand hygiene and gloves. Additional, diagnosis-specific precautions (like room placement for certain organisms) are layered ON TOP of Standard Precautions only when needed. Why C is right: placing a patient with MRSA (a bacteria spread by contact) in a private room is part of Contact Precautions — an additional precaution applied specifically because of the MRSA diagnosis, not something done for every patient. Why the others are wrong: - A: Hand hygiene before and after touching any patient is a core part of Standard Precautions, used universally. - B: Wearing gloves whenever contact with body fluids is possible is also core Standard Precautions, applied to all patients. - D: Wearing a mask during procedures that could generate splashes or sprays (like suctioning) is part of Standard Precautions, protecting the nurse regardless of the patient's diagnosis. Remember: Standard Precautions = for everyone, every time. Additional precautions (contact, droplet, airborne) = added on top, based on a specific diagnosis. Technical note: Contact Precautions for organisms like MRSA typically include a private room (or cohorting with another patient with the same organism), gown and gloves for patient contact, and dedicated or disinfected equipment — these are added to, not part of, Standard Precautions.
The answer: C (Refer the patient to a podiatrist for nail care) Think of it this way: Diabetes can reduce blood flow and nerve sensation in the feet, so even a small nick from nail cutting can turn into a serious wound that's slow to heal and prone to infection. Why C is right: Referring to a podiatrist (a foot care specialist) ensures nail care is done safely by someone trained to manage the higher injury risk in diabetic patients. Why the others are wrong: - A: Cutting nails straight across with rounded edges is generally good technique for the general population, but for a diabetic patient, the act of cutting itself still carries unacceptable injury risk - referral is preferred. - B: Using clippers and filing into a curved shape carries the same cutting-related injury risk and is not recommended for diabetic patients. - D: Soaking the feet softens the skin and nails, but it doesn't remove the underlying risk of injury from cutting, and soaking can also macerate fragile diabetic skin if not done carefully. Remember: Diabetic feet plus nail care = call the podiatrist, don't cut. Technical note: Diabetic foot care education also includes daily foot inspections (looking for cuts, redness, or sores), wearing properly fitted shoes, avoiding walking barefoot, and prompt reporting of any foot wounds - all aimed at preventing diabetic foot ulcers and their complications.
The answer: A (14 mL/hr) Think of it this way: this is a two-step unit conversion — first figure out how many units per hour the client needs based on their weight, then figure out how many mL deliver that many units based on the bag's concentration. Why A is right: first, 18 units/kg/hr × 80 kg = 1,440 units/hr. Next, the concentration is 25,000 units in 250 mL, which simplifies to 100 units per mL. Finally, 1,440 units/hr ÷ 100 units/mL = 14.4 mL/hr, which rounds to 14 mL/hr. Why the others are wrong: - B: 8 mL/hr would deliver only 800 units/hr — too low for the ordered dose. - C: 20 mL/hr would deliver 2,000 units/hr — too high for the ordered dose. - D: 6 mL/hr would deliver only 600 units/hr — far too low. Remember: for weight-based drip calculations — (dose per kg per hr × weight in kg) ÷ concentration (units per mL) = mL/hr. Technical note: heparin (an anticoagulant, a medication that reduces blood clotting) drips are titrated based on regular coagulation lab tests (such as aPTT, activated partial thromboplastin time) — the rate is adjusted up or down according to a weight-based protocol to keep the client in a safe therapeutic range, balancing clot prevention against bleeding risk.
