NCLEX EXIT EXAM LATEST 2026 ACTUAL EXAM
TEST BANK| COMPLETE 350 REAL EXAM
QUESTIONS AND ANSWERS
SECTION 1: Safe and Effective Care Environment (Questions 1-50)
Q1. A nurse is supervising a newly licensed nurse who is inserting an indwelling urinary catheter. Which
action by the new nurse requires immediate intervention?
A. Using sterile gloves and a sterile drape
B. Advancing the catheter without applying lubricant
C. Inflating the balloon after urine return
D. Securing the catheter to the patient's thigh
Answer: B
Rationale: Lubricant must be applied to the catheter tip before insertion to prevent urethral trauma.
The other actions are correct (sterile technique, inflate balloon after urine return, secure catheter).
Q2. A charge nurse is making assignments for a medical-surgical unit. Which client should be assigned to
a float RN from the emergency department?
A. A client with a chest tube for pneumothorax
B. A client with cellulitis requiring IV antibiotics every 8 hours
C. A client receiving continuous IV heparin infusion
D. A client on a patient-controlled analgesia (PCA) pump
Answer: B
Rationale: The ED float RN is competent in IV antibiotic administration. Chest tubes, heparin infusions,
and PCA pumps require specialized med-surg or critical care experience.
Q3. A nurse discovers a client on the floor next to the bed. The client says, "I tried to go to the bathroom
and fell." What should the nurse do first?
A. Complete an incident report
B. Assess the client for injuries
C. Notify the provider
D. Assist the client back to bed
Answer: B
Rationale: The nurse must first assess the client for injuries (fractures, head injury, bleeding). After
assessment, the nurse can assist the client, notify the provider, and complete the incident report.
Q4. A nurse is preparing to delegate vital signs to an unlicensed assistive personnel (UAP). Which client
should the nurse not delegate to the UAP?
A. A client with stable pneumonia
B. A client post-operative day 3 for hip replacement
C. A client with a traumatic brain injury and unstable intracranial pressure
D. A client receiving oral antibiotics for a urinary tract infection
,Answer: C
Rationale: The unstable client with TBI and ICP monitoring requires skilled nursing assessment. Stable,
predictable clients can be delegated for routine vital signs.
Q5. A nurse receives a telephone order from a provider for "furosemide 40 mg IV push." What is the
nurse's priority action?
A. Administer the medication immediately
B. Read back the order to the provider for verification
C. Document the order in the chart
D. Ask another nurse to listen on the extension
Answer: B
Rationale: Telephone orders must be read back to the prescriber to verify accuracy (read-back
verification is a safety standard from The Joint Commission).
Q6. A nurse is caring for a client on fall precautions. Which intervention is most effective in preventing
falls?
A. Keeping all bed rails fully raised at all times
B. Placing the call light within reach and checking frequently
C. Applying a vest restraint at night
D. Keeping the room dark to promote sleep
Answer: B
Rationale: Call light within reach and frequent rounding are evidence-based fall prevention. Full bed
rails can be a restraint. Restraints are last resort. Dark rooms increase fall risk.
Q7. A nurse is preparing to administer a blood transfusion. Which action is essential before starting the
transfusion?
A. Insert a 22-gauge IV catheter
B. Verify the client's identity using two identifiers
C. Pre-medicate with diphenhydramine for all clients
D. Warm the blood to body temperature in a warmer
Answer: B
Rationale: Two-client verification (name, DOB, MRN) prevents fatal ABO incompatibility reactions. Pre-
medication is only for prior reactions. Blood is not routinely warmed.
Q8. A charge nurse is observing a new nurse perform a sterile dressing change. Which action requires
correction?
A. Opening sterile package away from the body
B. Reaching over the sterile field to obtain a dressing
C. Keeping sterile gloves above waist level
D. Discarding a contaminated item immediately
Answer: B
Rationale: Reaching over the sterile field contaminates it. The nurse should walk around or ask for
assistance. Other actions maintain sterility.
Q9. A nurse is caring for a client with a new tracheostomy. Which action by the nurse is correct?
A. Cut a 4x4 gauze to fit around the stoma
B. Use a commercially prepared tracheostomy dressing with a slit
,C. Apply petroleum jelly around the stoma
D. Secure the tracheostomy ties with a square knot
Answer: B
Rationale: Commercial tracheostomy dressings prevent aspiration of gauze fibers. Cutting gauze creates
loose fibers that can be inhaled. Petroleum jelly degrades some trach materials.
Q10. A nurse is preparing to discharge a client with a new colostomy. Which statement by the client
indicates readiness for discharge?
A. "My spouse will change the pouch because I can't look at it."
B. "I can empty the pouch when it is one-third to one-half full."
C. "I will change the entire appliance every day."
D. "I don't need to worry about skin care."
Answer: B
Rationale: Emptying at 1/3 to 1/2 full prevents leakage. Appliances last 3-7 days. Daily changes cause
skin irritation. Skin care is essential.
Q11. A nurse is caring for a client with a nasogastric (NG) tube set to continuous low suction. Which
finding indicates proper tube placement?
A. The tube is taped to the client's chin
B. The client reports no nausea
C. pH of aspirate is 7.5
D. pH of aspirate is 4.0
Answer: D
Rationale: Gastric aspirate pH is 1-5 (acidic). pH >6 suggests intestinal or respiratory placement. The
tube should be taped to the nose, not chin.
Q12. A nurse is preparing to give a subcutaneous injection of heparin. Which site is preferred?
A. Ventrogluteal
B. Deltoid
C. Abdomen (2 inches away from umbilicus)
D. Vastus lateralis
Answer: C
Rationale: Abdomen has consistent subcutaneous tissue and less bruising. Ventrogluteal and vastus
lateralis are IM sites. Deltoid has variable tissue thickness.
Q13. A nurse is caring for a client with a central line. Which finding requires immediate action?
A. Temperature of 100.4°F (38°C)
B. Slight redness at the insertion site
C. Shortness of breath and chest pain after flushing the line
D. Blood return present in all lumens
Answer: C
Rationale: Shortness of breath and chest pain after flushing indicate air embolism. The nurse should
place client in left lateral Trendelenburg position and call for help.
Q14. A nurse is supervising a new nurse who is applying a restraint to a confused client. Which action
requires intervention?
A. Applying a vest restraint and securing it to the side rail
, B. Obtaining a provider order before application
C. Placing two fingers between the restraint and the client
D. Removing the restraint every 2 hours
Answer: A
Rationale: Restraints must be secured to the bed frame, not side rails (side rails move). Two-finger rule
prevents constriction. Orders and q2h removal are correct.
Q15. A nurse is preparing to irrigate a wound. Which solution should the nurse use?
A. Hydrogen peroxide
B. Povidone-iodine
C. Normal saline
D. Acetic acid
Answer: C
Rationale: Normal saline is isotonic and non-cytotoxic to healing tissue. Hydrogen peroxide and
povidone-iodine damage granulation tissue. Acetic acid is for specific infections.
Q16. A nurse is caring for a client receiving IV fluids at 150 mL/hour. The IV pump alarms "occlusion."
What is the first action?
A. Flush the IV line with 10 mL saline
B. Check for kinks in the tubing or closed clamps
C. Discontinue the IV and restart at a new site
D. Increase the infusion rate to clear the line
Answer: B
Rationale: The most common cause of occlusion is a kinked tube or closed clamp. Assess before flushing
or restarting. Increasing rate is unsafe.
Q17. A nurse is preparing to administer a feeding via gastrostomy tube. Which action is correct?
A. Flush with 10 mL water after checking residuals
B. Check residual volume before feeding
C. Lay the client flat during feeding
D. Administer feeding over 5 minutes
Answer: B
Rationale: Check residual before each feeding to assess gastric emptying. Flush with 30 mL. Client
should be semi-Fowler's to prevent aspiration. Feedings are slow (30-60 min).
Q18. A charge nurse is making assignments for a team of RNs and UAPs. Which client should be assigned
to the UAP?
A. A client with unstable angina
B. A client requiring hourly neurological checks
C. A client requesting assistance with a bedpan
D. A client with a new tracheostomy
Answer: C
Rationale: Assisting with elimination is within UAP scope. Unstable angina, neuro checks, and new
tracheostomy require RN assessment.
Q19. A nurse discovers a small electrical fire in a client's room. The client is ambulatory. What is the
priority action?
TEST BANK| COMPLETE 350 REAL EXAM
QUESTIONS AND ANSWERS
SECTION 1: Safe and Effective Care Environment (Questions 1-50)
Q1. A nurse is supervising a newly licensed nurse who is inserting an indwelling urinary catheter. Which
action by the new nurse requires immediate intervention?
A. Using sterile gloves and a sterile drape
B. Advancing the catheter without applying lubricant
C. Inflating the balloon after urine return
D. Securing the catheter to the patient's thigh
Answer: B
Rationale: Lubricant must be applied to the catheter tip before insertion to prevent urethral trauma.
The other actions are correct (sterile technique, inflate balloon after urine return, secure catheter).
Q2. A charge nurse is making assignments for a medical-surgical unit. Which client should be assigned to
a float RN from the emergency department?
A. A client with a chest tube for pneumothorax
B. A client with cellulitis requiring IV antibiotics every 8 hours
C. A client receiving continuous IV heparin infusion
D. A client on a patient-controlled analgesia (PCA) pump
Answer: B
Rationale: The ED float RN is competent in IV antibiotic administration. Chest tubes, heparin infusions,
and PCA pumps require specialized med-surg or critical care experience.
Q3. A nurse discovers a client on the floor next to the bed. The client says, "I tried to go to the bathroom
and fell." What should the nurse do first?
A. Complete an incident report
B. Assess the client for injuries
C. Notify the provider
D. Assist the client back to bed
Answer: B
Rationale: The nurse must first assess the client for injuries (fractures, head injury, bleeding). After
assessment, the nurse can assist the client, notify the provider, and complete the incident report.
Q4. A nurse is preparing to delegate vital signs to an unlicensed assistive personnel (UAP). Which client
should the nurse not delegate to the UAP?
A. A client with stable pneumonia
B. A client post-operative day 3 for hip replacement
C. A client with a traumatic brain injury and unstable intracranial pressure
D. A client receiving oral antibiotics for a urinary tract infection
,Answer: C
Rationale: The unstable client with TBI and ICP monitoring requires skilled nursing assessment. Stable,
predictable clients can be delegated for routine vital signs.
Q5. A nurse receives a telephone order from a provider for "furosemide 40 mg IV push." What is the
nurse's priority action?
A. Administer the medication immediately
B. Read back the order to the provider for verification
C. Document the order in the chart
D. Ask another nurse to listen on the extension
Answer: B
Rationale: Telephone orders must be read back to the prescriber to verify accuracy (read-back
verification is a safety standard from The Joint Commission).
Q6. A nurse is caring for a client on fall precautions. Which intervention is most effective in preventing
falls?
A. Keeping all bed rails fully raised at all times
B. Placing the call light within reach and checking frequently
C. Applying a vest restraint at night
D. Keeping the room dark to promote sleep
Answer: B
Rationale: Call light within reach and frequent rounding are evidence-based fall prevention. Full bed
rails can be a restraint. Restraints are last resort. Dark rooms increase fall risk.
Q7. A nurse is preparing to administer a blood transfusion. Which action is essential before starting the
transfusion?
A. Insert a 22-gauge IV catheter
B. Verify the client's identity using two identifiers
C. Pre-medicate with diphenhydramine for all clients
D. Warm the blood to body temperature in a warmer
Answer: B
Rationale: Two-client verification (name, DOB, MRN) prevents fatal ABO incompatibility reactions. Pre-
medication is only for prior reactions. Blood is not routinely warmed.
Q8. A charge nurse is observing a new nurse perform a sterile dressing change. Which action requires
correction?
A. Opening sterile package away from the body
B. Reaching over the sterile field to obtain a dressing
C. Keeping sterile gloves above waist level
D. Discarding a contaminated item immediately
Answer: B
Rationale: Reaching over the sterile field contaminates it. The nurse should walk around or ask for
assistance. Other actions maintain sterility.
Q9. A nurse is caring for a client with a new tracheostomy. Which action by the nurse is correct?
A. Cut a 4x4 gauze to fit around the stoma
B. Use a commercially prepared tracheostomy dressing with a slit
,C. Apply petroleum jelly around the stoma
D. Secure the tracheostomy ties with a square knot
Answer: B
Rationale: Commercial tracheostomy dressings prevent aspiration of gauze fibers. Cutting gauze creates
loose fibers that can be inhaled. Petroleum jelly degrades some trach materials.
Q10. A nurse is preparing to discharge a client with a new colostomy. Which statement by the client
indicates readiness for discharge?
A. "My spouse will change the pouch because I can't look at it."
B. "I can empty the pouch when it is one-third to one-half full."
C. "I will change the entire appliance every day."
D. "I don't need to worry about skin care."
Answer: B
Rationale: Emptying at 1/3 to 1/2 full prevents leakage. Appliances last 3-7 days. Daily changes cause
skin irritation. Skin care is essential.
Q11. A nurse is caring for a client with a nasogastric (NG) tube set to continuous low suction. Which
finding indicates proper tube placement?
A. The tube is taped to the client's chin
B. The client reports no nausea
C. pH of aspirate is 7.5
D. pH of aspirate is 4.0
Answer: D
Rationale: Gastric aspirate pH is 1-5 (acidic). pH >6 suggests intestinal or respiratory placement. The
tube should be taped to the nose, not chin.
Q12. A nurse is preparing to give a subcutaneous injection of heparin. Which site is preferred?
A. Ventrogluteal
B. Deltoid
C. Abdomen (2 inches away from umbilicus)
D. Vastus lateralis
Answer: C
Rationale: Abdomen has consistent subcutaneous tissue and less bruising. Ventrogluteal and vastus
lateralis are IM sites. Deltoid has variable tissue thickness.
Q13. A nurse is caring for a client with a central line. Which finding requires immediate action?
A. Temperature of 100.4°F (38°C)
B. Slight redness at the insertion site
C. Shortness of breath and chest pain after flushing the line
D. Blood return present in all lumens
Answer: C
Rationale: Shortness of breath and chest pain after flushing indicate air embolism. The nurse should
place client in left lateral Trendelenburg position and call for help.
Q14. A nurse is supervising a new nurse who is applying a restraint to a confused client. Which action
requires intervention?
A. Applying a vest restraint and securing it to the side rail
, B. Obtaining a provider order before application
C. Placing two fingers between the restraint and the client
D. Removing the restraint every 2 hours
Answer: A
Rationale: Restraints must be secured to the bed frame, not side rails (side rails move). Two-finger rule
prevents constriction. Orders and q2h removal are correct.
Q15. A nurse is preparing to irrigate a wound. Which solution should the nurse use?
A. Hydrogen peroxide
B. Povidone-iodine
C. Normal saline
D. Acetic acid
Answer: C
Rationale: Normal saline is isotonic and non-cytotoxic to healing tissue. Hydrogen peroxide and
povidone-iodine damage granulation tissue. Acetic acid is for specific infections.
Q16. A nurse is caring for a client receiving IV fluids at 150 mL/hour. The IV pump alarms "occlusion."
What is the first action?
A. Flush the IV line with 10 mL saline
B. Check for kinks in the tubing or closed clamps
C. Discontinue the IV and restart at a new site
D. Increase the infusion rate to clear the line
Answer: B
Rationale: The most common cause of occlusion is a kinked tube or closed clamp. Assess before flushing
or restarting. Increasing rate is unsafe.
Q17. A nurse is preparing to administer a feeding via gastrostomy tube. Which action is correct?
A. Flush with 10 mL water after checking residuals
B. Check residual volume before feeding
C. Lay the client flat during feeding
D. Administer feeding over 5 minutes
Answer: B
Rationale: Check residual before each feeding to assess gastric emptying. Flush with 30 mL. Client
should be semi-Fowler's to prevent aspiration. Feedings are slow (30-60 min).
Q18. A charge nurse is making assignments for a team of RNs and UAPs. Which client should be assigned
to the UAP?
A. A client with unstable angina
B. A client requiring hourly neurological checks
C. A client requesting assistance with a bedpan
D. A client with a new tracheostomy
Answer: C
Rationale: Assisting with elimination is within UAP scope. Unstable angina, neuro checks, and new
tracheostomy require RN assessment.
Q19. A nurse discovers a small electrical fire in a client's room. The client is ambulatory. What is the
priority action?
