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NCLEX Fundamentals Practice Questions

Nursing fundamentals practice questions: safety, infection control, basic care, and communication — the foundation every NCLEX candidate needs.

PharmacologyMed-SurgPediatricsPsychMaternity
Question 1Multiple choiceFundamentals

A client is admitted with influenza. The nurse implements which precautions?

  1. Airborne precautions with an N95 respirator
  2. Droplet precautions: private room and surgical mask within 3 feet
  3. Contact precautions with gown and gloves only
  4. Standard precautions only
Show answer & rationale

Correct: Droplet precautions: private room and surgical mask within 3 feet

Why: Influenza spreads in respiratory droplets (>5 µm particles) that travel about 3 feet, so droplet precautions apply: private room (or cohorting), surgical mask when within 3 feet, plus standard precautions. Airborne precautions (fit-tested N95, negative-pressure room) are reserved for TB, measles, and varicella. Memory aid: droplets travel about 3 feet — 'spit can't fly far'.

📚 Basis: CDC transmission-based precautions: droplet = large-particle droplets within ~3 ft (influenza); airborne = TB, measles, varicella. · CDC transmission-based precautions

Question 2Multiple choiceFundamentals

A client has Clostridioides difficile. The nurse knows hand hygiene must be performed with:

  1. Alcohol-based hand sanitizer
  2. Soap and water
  3. Chlorhexidine wipes only
  4. No hand hygiene needed if gloves were worn
Show answer & rationale

Correct: Soap and water

Why: C. difficile forms spores that alcohol-based sanitizer cannot kill — only soap-and-water handwashing physically removes them. Add contact precautions: gown, gloves, dedicated equipment, and preferably a private room. Gloves never replace hand hygiene. Memory aid: C. diff spores laugh at alcohol gel — only soap and water wash them off.

📚 Basis: C. difficile spores resist alcohol-based sanitizers; soap-and-water handwashing physically removes spores (CDC/IDSA). · CDC/IDSA C. difficile guidance

Question 3Multiple choiceFundamentals

The gold standard for verifying initial nasogastric tube placement is:

  1. Auscultating air insufflation over the epigastrium
  2. Testing aspirate pH
  3. Abdominal X-ray
  4. Observing for respiratory distress
Show answer & rationale

Correct: Abdominal X-ray

Why: Radiography is the only reliable confirmation of initial NG tube position — a tube in the lung can be fatal. The 'whoosh' auscultation test is unreliable and no longer recommended; aspirate pH supports ongoing checks but cannot confirm initial placement. Memory aid: 'X-ray marks the spot' — only radiography confirms initial NG placement.

📚 Basis: X-ray is the gold standard for initial NG tube confirmation; auscultation (whoosh test) unreliable and no longer recommended. · Patient-safety guidance on NG placement (NPSA alerts)

Question 4Multiple choiceFundamentals

The nurse has four clients. Who should be assessed first?

  1. A post-op day 2 client requesting pain medication
  2. A client with a blood glucose of 210 mg/dL
  3. A client with new-onset shortness of breath and oxygen saturation of 88%
  4. A client awaiting discharge teaching
Show answer & rationale

Correct: A client with new-onset shortness of breath and oxygen saturation of 88%

Why: Use ABCs and acute-vs-chronic: new hypoxia (SpO₂ 88%) is an immediate airway/breathing threat. Pain control, a glucose of 210, and discharge teaching matter but are not imminently life-threatening. Memory aid: ABCs win — airway always answers first.

📚 Basis: ABC prioritization: airway/breathing threats first; SpO₂ <90% = hypoxemia requiring urgent action. · Standard ABCs prioritization framework

Question 5Select all that applyFundamentals

A client has a wound infected with MRSA. Which precautions does the nurse implement? Select all that apply.

  1. Gown and gloves on room entry
  2. Dedicated stethoscope and BP cuff kept in the room
  3. Fit-tested N95 respirator
  4. Private room or cohorting with another MRSA client
  5. Negative-pressure room
Show answer & rationale

Correct: Gown and gloves on room entry; Dedicated stethoscope and BP cuff kept in the room; Private room or cohorting with another MRSA client

Why: MRSA wound infection requires contact precautions: gown + gloves, dedicated equipment, private room or cohorting. Fit-tested N95s and negative-pressure rooms are for airborne infections (TB, measles, varicella) — not needed for MRSA. Memory aid: MRSA means contact — 'gown and gloves stop the spread'.

📚 Basis: CDC: contact precautions (gown, gloves, dedicated equipment, private room/cohort) for MRSA colonization/infection. · CDC transmission-based precautions

Question 6Ordered responseFundamentals

The nurse is preparing to enter the room of a client on contact precautions. Place the steps for donning PPE in the correct order, from first to last.

  1. Perform hand hygiene
  2. Put on the gown
  3. Put on the mask or respirator
  4. Put on goggles or face shield
  5. Put on gloves
Show answer & rationale

Correct: Perform hand hygiene → Put on the gown → Put on the mask or respirator → Put on goggles or face shield → Put on gloves

Why: The CDC donning sequence is: hand hygiene → gown → mask/respirator → goggles/face shield → gloves. Gloves go on LAST because they extend over the gown cuffs, sealing the wrists. When removing PPE the logic reverses: gloves come off first, because they are the most contaminated. A common trap is putting gloves on before the mask — never do that, because the bare hands would contaminate the face area while adjusting the mask. Memory aid: gloves seal the deal — they go on last, covering the gown cuffs.

📚 Basis: CDC PPE donning sequence: gown first, then mask or respirator, then goggles or face shield, then gloves; hand hygiene before donning and after doffing. · CDC PPE donning/doffing guidance

Question 7Multiple choiceFundamentals

The RN is caring for a client who is 2 days post-op, stable, afebrile, and requesting help to the bathroom. Which task is appropriate to delegate to the unlicensed assistive personnel (UAP)?

  1. Perform the initial post-op head-to-toe assessment
  2. Teach the client how to use the incentive spirometer
  3. Assist the stable client to the bathroom and record intake/output
  4. Evaluate the client's surgical incision for signs of infection
Show answer & rationale

Correct: Assist the stable client to the bathroom and record intake/output

Why: (1) Principle: The RN may delegate routine, stable, predictable tasks to UAP but never assessment, teaching, evaluation, or nursing judgment (NCSBN delegation). (2) Correct: assisting a stable client to the bathroom and recording I&O is a routine task with a predictable outcome. (3) Wrong: the initial head-to-toe assessment is RN-only; teaching the incentive spirometer is client education (RN/LPN scope, not UAP); evaluating the incision is assessment/evaluation, which cannot be delegated. (4) Memory aid: RN does ATE — Assess, Teach, Evaluate — never delegate those.

📚 Basis: NCSBN: assessment, teaching, evaluation, and nursing judgment cannot be delegated to UAP; only stable, routine tasks with predictable outcomes may be delegated. · NCSBN Delegation Guidelines / NCSBN Test Plan

Question 8Multiple choiceFundamentals

A client is scheduled for a cholecystectomy and asks the nurse, 'Can you explain the risks of this surgery to me?' The consent form is already signed. What is the nurse's best response?

  1. Explain the surgical risks, benefits, and alternatives to the client
  2. Tell the client, 'Your surgeon is required to explain the risks; let me get the surgeon to speak with you'
  3. Have the client's spouse sign a second consent form as a witness
  4. Document that the client understands the risks and proceed with preoperative preparation
Show answer & rationale

Correct: Tell the client, 'Your surgeon is required to explain the risks; let me get the surgeon to speak with you'

Why: (1) Principle: Informed consent requires the provider performing the procedure to disclose risks, benefits, and alternatives; the nurse's role is to verify the consent is signed, ensure the client understands, and witness the signature — not to provide the initial explanation. (2) Correct: the surgeon must explain the risks; the nurse advocates by bringing the surgeon back. (3) Wrong: the nurse explaining risks exceeds the nursing role in informed consent; a spouse cannot re-consent for a competent adult; documenting understanding without verifying it is falsification and unsafe. (4) Memory aid: Provider explains, nurse witnesses — the nurse verifies, never substitutes.

📚 Basis: Informed consent: the practitioner performing the procedure must disclose diagnosis, risks, benefits, and alternatives; the nurse verifies understanding and witnesses the signature. · ANA Code of Ethics; Lewis's Medical-Surgical Nursing

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PharmacologyMed-SurgPediatricsPsychMaternity

NCLEX Drill offers practice questions for study purposes only — not medical advice, and not a substitute for professional judgment or official study materials. Question bank grows daily; last updated 2026-10-09.