Nclex 70 questions and answers for Fundamentals of Nursing wit
b b b b b b b b b
h Rationale (-2026)
b b
Ab73-year-
b
oldbpatientbwhobsustainedbabrightbhipbfracturebinbabfallbrequestsbpainbmedicationbfrombthebnurse.bBasedbonbhi
sbinjury,bwhichbtypebofbpainbisbthisbpatientbmostblikelybexperiencing?
1) Phantom
2) Visceral
3) Deepbsomatic
4) Referredb-bANS>>:
3)bDeepbsomatic
Rationale:
Deepbsomaticbpainboriginatesbinbligaments,btendons,bnerves,bbloodbvessels,bandbbones.bTherefore,babhipbfr
acturebcausesbdeepbsomaticbpain.bPhantombpainbisbpainbthatbisbperceivedbtoboriginatebfrombabpartbthatbwas
bremovedbduringbsurgery.bVisceralbpainbisbcausedbbybdeepbinternalbpainbreceptorsbandbcommonlyboccursbi
nbthebabdominalbcavity,bcranium,bandbthorax.bReferredbpainboccursbinbanbareabthatbisbdistantbtobtheboriginalb
site.
Whichbpainbmanagementbtaskbcanbthebnursebsafelybdelegatebtobnursingbassistivebpersonnel?
1) Askingbaboutbpainbduringbvitalbsigns
2) Evaluatingbthebeffectivenessbofbpainbmedication
3) Developingbabplanbofbcarebinvolvingbnonpharmacologicbinterventions
4) Administeringbover-the-counterbpainbmedicationsb-bANS>>:
1)bAskingbaboutbpainbduringbvitalbsigns
Rationale:
Thebnursebcanbdelegatebthebtaskbofbaskingbaboutbpainbwhenbnursingbassistivebpersonnelb(NAP)bobtainbvitalb
signs.bThebNAPbmustbbebinstructedbtobreportbfindingsbtobthebnursebwithoutbdelay.bThebnursebshouldbevalua
tebthebeffectivenessbofbpainbmedicationsbandbdevelopbthebplanbofbcare.bAdministeringbover-the-
counterbandbprescriptionbmedicationsbisbthebresponsibilitybofbthebregisteredbnurseborblicensedbpracticalbn
urse.
,Whichbfactorbinbthebpatient'sbpastbmedicalbhistorybdictatesbthatbthebnursebexercisebcautionbwhenbadminist
eringbacetaminophenb(Tylenol)?
1) HepatitisbB
2) Occasionalbalcoholbuse
3) Allergybtobaspirin
4) Gastricbirritationbwithbbleedingb-bANS>>:
1) HepatitisbB
Rationale:
Evenbinbrecommendedbdoses,bacetaminophenbcanbcausebseverebhepatotoxicitybinbpatientsbwithbliverbdisea
se,bsuchbasbhepatitisbB.bPatientsbwhobconsumebalcoholbregularlybshouldbalsobusebacetaminophenbcautiou
sly.bThoseballergicbtobaspirinborbotherbnonsteroidalbanti-
inflammatorybdrugsb(NSAIDs)bcanbusebacetaminophenbsafely.bAcetaminophenbrarelybcausesbgastrointesti
nalb(GI)bproblems;btherefore,bitbcanbbebusedbforbthosebwithbabhistorybofbgastricbirritationbandbbleeding.
Whichbactionbshouldbthebnursebtakebbeforebadministeringbmorphineb4.0bmgbintravenouslybtobabpatientbcom
plainingbofbincisionalbpain?
1) Assessbthebpatient'sbincision.
2) Clarifybtheborderbwithbthebprescriber.
3) Assessbthebpatient'sbrespiratorybstatus.
4) Monitorbthebpatient'sbheartbrate.b-bANS>>:
3)bAssessbthebpatient'sbrespiratorybstatus.
Rationale:
Beforebadministeringbanbopioidbanalgesic,bsuchbasbmorphine,bthebnursebshouldbassessbthebpatient'sbrespir
atorybstatusbbecausebopioidbanalgesicsbcanbcausebrespiratorybdepression.bItbisbnotbnecessarybtobclarifybth
eborderbwithbthebphysicianbbecausebmorphineb4bmgbIVbisbanbappropriatebdose.bItbisbnotbnecessarybtobmonit
orbthebpatient'sbheartbrate.
Whichbactionbshouldbthebnursebtakebwhenbpreparingbpatient-
controlledbanalgesiabforbabpostoperativebpatient?
1) Cautionbthebpatientbtoblimitbthebnumberbofbtimesbhebpressesbthebdosingbbutton.
2) Askbanotherbnursebtobdouble-checkbthebsetupbbeforebpatientbuse.
3) Instructbthebpatientbtobadministerbabdosebonlybwhenbexperiencingbpain.
4) Providebclear,bsimplebinstructionsbforbdosingbifbthebpatientbisbcognitivelybimpaired.b -bANS>>:
2) Askbanotherbnursebtobdouble-checkbthebsetupbbeforebpatientbuse.
30b/b36
,Rationale:
Asbabsafeguardbtobreducebthebriskbforbdosingberrors,bthebnursebshouldbrequestbanotherbnursebtobdouble-
checkbthebsetupbbeforebpatientbuse.bThebnursebshouldbreassurebthebpatientbthatbthebpumpbhasbablockoutbfe
aturebthatbpreventsbhimbfromboverdosingbevenbifbhebcontinuesbtobpushbthebdosebadministrationbbutton.bTh
ebnursebshouldbalsobinstructbthebpatientbtobadministerbabdosebbeforebpotentiallybpainfulbactivities,bsuchbasb
walking.bPatient-controlledbanalgesiabisbcontraindicatedbforbthosebwhobarebcognitivelybimpaired.
Thebnursebadministersbcodeinebsulfateb30bmgborallybtobabpatientbwhobunderwentbcraniotomyb3bdaysbagobforb
abbrainbtumor.bHowbsoonbafterbadministrationbshouldbthebnursebreassessbthebpatient'sbpain?
1) Immediately
2) Inb10bminutes
3) Inb15bminutes
4) Inb60bminutesb-bANS>>:
4)bInb60bminutes
Rationale:
Codeinebadministeredbbybtheboralbroutebreachesbpeakbconcentrationbinb60bminutes;btherefore,bthebnursebsh
ouldbreassessbthebpatient'sbpainb60bminutesbafterbadministration.bThebnursebshouldbreassessbpainbafter
10bminutesbwhenbadministeringbcodeinebbybthebintramuscularborbsubcutaneousbroutes.bDrugsbadminister
edbbybthebintravenousb(IV)broutebarebeffectivebalmostbimmediately;bhowever,bcodeinebisbnotbrecommendedb
forbIVbadministration.
Whichb nonsteroidalb anti-
inflammatoryb drugb mightb beb administeredb tob inhibitb plateletb aggregationb inb abpatientbatbriskbforbthrombo
phlebitis?
1) Ibuprofenb(Motrin)
2) Celecoxibb(Celebrex)
3) Aspirinb(Ecotrin)
4) Indomethacinb(Indocin)b-bANS>>:
3) Aspirinb(Ecotrin)
Rationale:
AspirinbisbabuniquebNSAIDbthatbinhibitsbplateletbaggregation.bLow-
dosebaspirinbtherapybisbcommonlybadministeredbtobdecreasebthebriskbofbthrombophlebitis,bmyocardialbinfa
rction,bandbstroke.bIbuprofen,bcelecoxib,bandbindomethacinbarebNSAIDs,bbutbtheybdobnotbinhibitbplateletbag
gregation.
31b/b36
, Abclientbwhobisbreceivingbepiduralbanalgesiabcomplainsbofbnauseabandblossbofbmotorbfunctionbinbhisblegs.bT
hebnursebobtainsbhisbbloodbpressurebandbnotesbabdropbinbhisbbloodbpressurebfrombthebpreviousbreading.bW
hichbcomplicationbisbthebpatientbmostblikelybexperiencing?
1) Infectionbatbthebcatheterbinsertionbsite
2) Sidebeffectbofbthebepiduralbanalgesic
3) Epiduralbcatheterbmigration
4) Spinalbcordbdamageb-bANS>>:
3)bEpiduralbcatheterbmigration
Rationale:
Thebpatientbisbexhibitingbsignsbofbepiduralbcatheterbmigration,bwhichbincludebnausea,babdecreasebinbbloodb
pressure,bandblossbofbmotorbfunctionbwithoutbanbidentifiablebcause.bSignsbofbinfectionbatbthebcatheterbsitebi
ncludebredness,bswelling,bandbdrainage.bLossbofbmotorbfunctionbisbnotbabtypicalbsidebeffectbassociatedbwit
hbepiduralbanalgesics.bThesebarebcommonbsignsbofbcatheterbmigration,bnotbspinalbcordbdamage.
Whichbofbthebfollowingbclientsbisbexperiencingbanbabnormalbchangebinbvitalbsigns?bAbclientbwhoseb(selectb
allbthatbapply):
1) Bloodbpressureb(BP)bwasb132/80bmmbHgbsittingbandbisb120/60bmmbHgbuponbstanding
2) Rectalbtemperaturebisb97.9°Fbinbthebmorningbandb99.2°Fbinbthebevening
3) Heartbratebwasb76bbeforebeatingbandbisb60bafterbeating
4) Respiratorybratebwasb14bwhenbstandingbandbisb22bafterbwalkingb-bANS>>:
1) Bloodbpressureb(BP)bwasb132/80bmmbHgbsittingbandbisb120/60bmmbHgbuponbstanding
3)bHeartbratebwasb76bbeforebeatingbandbisb60bafterbeating
Rationale:
ThebBPbchangebisbabnormal;babBPbchangebgreaterbthanb10bmmbHgbmaybindicatebposturalbhypotension.bTheb
changebinbheartbratebisbabnormal;bheartbratebusuallybincreasesbslightlybafterbeatingbratherbthanbdecreasing.b
Thebtemperaturesbarebwithinbnormalbrangebforbthebrectalbroute,bandbtemperaturebincreasesbthroughoutbtheb
day.bItbisbnormalbtobhavebanbincreasedbrespiratorybratebafterbexercise.
Thebnursebassessesbclients'bbreathbsounds.bWhichbonebrequiresbimmediatebmedicalbattention?bAbclientbw
hobhas:
1) Crackles
2) Rhonchi
3) Stridor
4) Wheezesb-bANS>>:
3)bStridor
32b/b36
b b b b b b b b b
h Rationale (-2026)
b b
Ab73-year-
b
oldbpatientbwhobsustainedbabrightbhipbfracturebinbabfallbrequestsbpainbmedicationbfrombthebnurse.bBasedbonbhi
sbinjury,bwhichbtypebofbpainbisbthisbpatientbmostblikelybexperiencing?
1) Phantom
2) Visceral
3) Deepbsomatic
4) Referredb-bANS>>:
3)bDeepbsomatic
Rationale:
Deepbsomaticbpainboriginatesbinbligaments,btendons,bnerves,bbloodbvessels,bandbbones.bTherefore,babhipbfr
acturebcausesbdeepbsomaticbpain.bPhantombpainbisbpainbthatbisbperceivedbtoboriginatebfrombabpartbthatbwas
bremovedbduringbsurgery.bVisceralbpainbisbcausedbbybdeepbinternalbpainbreceptorsbandbcommonlyboccursbi
nbthebabdominalbcavity,bcranium,bandbthorax.bReferredbpainboccursbinbanbareabthatbisbdistantbtobtheboriginalb
site.
Whichbpainbmanagementbtaskbcanbthebnursebsafelybdelegatebtobnursingbassistivebpersonnel?
1) Askingbaboutbpainbduringbvitalbsigns
2) Evaluatingbthebeffectivenessbofbpainbmedication
3) Developingbabplanbofbcarebinvolvingbnonpharmacologicbinterventions
4) Administeringbover-the-counterbpainbmedicationsb-bANS>>:
1)bAskingbaboutbpainbduringbvitalbsigns
Rationale:
Thebnursebcanbdelegatebthebtaskbofbaskingbaboutbpainbwhenbnursingbassistivebpersonnelb(NAP)bobtainbvitalb
signs.bThebNAPbmustbbebinstructedbtobreportbfindingsbtobthebnursebwithoutbdelay.bThebnursebshouldbevalua
tebthebeffectivenessbofbpainbmedicationsbandbdevelopbthebplanbofbcare.bAdministeringbover-the-
counterbandbprescriptionbmedicationsbisbthebresponsibilitybofbthebregisteredbnurseborblicensedbpracticalbn
urse.
,Whichbfactorbinbthebpatient'sbpastbmedicalbhistorybdictatesbthatbthebnursebexercisebcautionbwhenbadminist
eringbacetaminophenb(Tylenol)?
1) HepatitisbB
2) Occasionalbalcoholbuse
3) Allergybtobaspirin
4) Gastricbirritationbwithbbleedingb-bANS>>:
1) HepatitisbB
Rationale:
Evenbinbrecommendedbdoses,bacetaminophenbcanbcausebseverebhepatotoxicitybinbpatientsbwithbliverbdisea
se,bsuchbasbhepatitisbB.bPatientsbwhobconsumebalcoholbregularlybshouldbalsobusebacetaminophenbcautiou
sly.bThoseballergicbtobaspirinborbotherbnonsteroidalbanti-
inflammatorybdrugsb(NSAIDs)bcanbusebacetaminophenbsafely.bAcetaminophenbrarelybcausesbgastrointesti
nalb(GI)bproblems;btherefore,bitbcanbbebusedbforbthosebwithbabhistorybofbgastricbirritationbandbbleeding.
Whichbactionbshouldbthebnursebtakebbeforebadministeringbmorphineb4.0bmgbintravenouslybtobabpatientbcom
plainingbofbincisionalbpain?
1) Assessbthebpatient'sbincision.
2) Clarifybtheborderbwithbthebprescriber.
3) Assessbthebpatient'sbrespiratorybstatus.
4) Monitorbthebpatient'sbheartbrate.b-bANS>>:
3)bAssessbthebpatient'sbrespiratorybstatus.
Rationale:
Beforebadministeringbanbopioidbanalgesic,bsuchbasbmorphine,bthebnursebshouldbassessbthebpatient'sbrespir
atorybstatusbbecausebopioidbanalgesicsbcanbcausebrespiratorybdepression.bItbisbnotbnecessarybtobclarifybth
eborderbwithbthebphysicianbbecausebmorphineb4bmgbIVbisbanbappropriatebdose.bItbisbnotbnecessarybtobmonit
orbthebpatient'sbheartbrate.
Whichbactionbshouldbthebnursebtakebwhenbpreparingbpatient-
controlledbanalgesiabforbabpostoperativebpatient?
1) Cautionbthebpatientbtoblimitbthebnumberbofbtimesbhebpressesbthebdosingbbutton.
2) Askbanotherbnursebtobdouble-checkbthebsetupbbeforebpatientbuse.
3) Instructbthebpatientbtobadministerbabdosebonlybwhenbexperiencingbpain.
4) Providebclear,bsimplebinstructionsbforbdosingbifbthebpatientbisbcognitivelybimpaired.b -bANS>>:
2) Askbanotherbnursebtobdouble-checkbthebsetupbbeforebpatientbuse.
30b/b36
,Rationale:
Asbabsafeguardbtobreducebthebriskbforbdosingberrors,bthebnursebshouldbrequestbanotherbnursebtobdouble-
checkbthebsetupbbeforebpatientbuse.bThebnursebshouldbreassurebthebpatientbthatbthebpumpbhasbablockoutbfe
aturebthatbpreventsbhimbfromboverdosingbevenbifbhebcontinuesbtobpushbthebdosebadministrationbbutton.bTh
ebnursebshouldbalsobinstructbthebpatientbtobadministerbabdosebbeforebpotentiallybpainfulbactivities,bsuchbasb
walking.bPatient-controlledbanalgesiabisbcontraindicatedbforbthosebwhobarebcognitivelybimpaired.
Thebnursebadministersbcodeinebsulfateb30bmgborallybtobabpatientbwhobunderwentbcraniotomyb3bdaysbagobforb
abbrainbtumor.bHowbsoonbafterbadministrationbshouldbthebnursebreassessbthebpatient'sbpain?
1) Immediately
2) Inb10bminutes
3) Inb15bminutes
4) Inb60bminutesb-bANS>>:
4)bInb60bminutes
Rationale:
Codeinebadministeredbbybtheboralbroutebreachesbpeakbconcentrationbinb60bminutes;btherefore,bthebnursebsh
ouldbreassessbthebpatient'sbpainb60bminutesbafterbadministration.bThebnursebshouldbreassessbpainbafter
10bminutesbwhenbadministeringbcodeinebbybthebintramuscularborbsubcutaneousbroutes.bDrugsbadminister
edbbybthebintravenousb(IV)broutebarebeffectivebalmostbimmediately;bhowever,bcodeinebisbnotbrecommendedb
forbIVbadministration.
Whichb nonsteroidalb anti-
inflammatoryb drugb mightb beb administeredb tob inhibitb plateletb aggregationb inb abpatientbatbriskbforbthrombo
phlebitis?
1) Ibuprofenb(Motrin)
2) Celecoxibb(Celebrex)
3) Aspirinb(Ecotrin)
4) Indomethacinb(Indocin)b-bANS>>:
3) Aspirinb(Ecotrin)
Rationale:
AspirinbisbabuniquebNSAIDbthatbinhibitsbplateletbaggregation.bLow-
dosebaspirinbtherapybisbcommonlybadministeredbtobdecreasebthebriskbofbthrombophlebitis,bmyocardialbinfa
rction,bandbstroke.bIbuprofen,bcelecoxib,bandbindomethacinbarebNSAIDs,bbutbtheybdobnotbinhibitbplateletbag
gregation.
31b/b36
, Abclientbwhobisbreceivingbepiduralbanalgesiabcomplainsbofbnauseabandblossbofbmotorbfunctionbinbhisblegs.bT
hebnursebobtainsbhisbbloodbpressurebandbnotesbabdropbinbhisbbloodbpressurebfrombthebpreviousbreading.bW
hichbcomplicationbisbthebpatientbmostblikelybexperiencing?
1) Infectionbatbthebcatheterbinsertionbsite
2) Sidebeffectbofbthebepiduralbanalgesic
3) Epiduralbcatheterbmigration
4) Spinalbcordbdamageb-bANS>>:
3)bEpiduralbcatheterbmigration
Rationale:
Thebpatientbisbexhibitingbsignsbofbepiduralbcatheterbmigration,bwhichbincludebnausea,babdecreasebinbbloodb
pressure,bandblossbofbmotorbfunctionbwithoutbanbidentifiablebcause.bSignsbofbinfectionbatbthebcatheterbsitebi
ncludebredness,bswelling,bandbdrainage.bLossbofbmotorbfunctionbisbnotbabtypicalbsidebeffectbassociatedbwit
hbepiduralbanalgesics.bThesebarebcommonbsignsbofbcatheterbmigration,bnotbspinalbcordbdamage.
Whichbofbthebfollowingbclientsbisbexperiencingbanbabnormalbchangebinbvitalbsigns?bAbclientbwhoseb(selectb
allbthatbapply):
1) Bloodbpressureb(BP)bwasb132/80bmmbHgbsittingbandbisb120/60bmmbHgbuponbstanding
2) Rectalbtemperaturebisb97.9°Fbinbthebmorningbandb99.2°Fbinbthebevening
3) Heartbratebwasb76bbeforebeatingbandbisb60bafterbeating
4) Respiratorybratebwasb14bwhenbstandingbandbisb22bafterbwalkingb-bANS>>:
1) Bloodbpressureb(BP)bwasb132/80bmmbHgbsittingbandbisb120/60bmmbHgbuponbstanding
3)bHeartbratebwasb76bbeforebeatingbandbisb60bafterbeating
Rationale:
ThebBPbchangebisbabnormal;babBPbchangebgreaterbthanb10bmmbHgbmaybindicatebposturalbhypotension.bTheb
changebinbheartbratebisbabnormal;bheartbratebusuallybincreasesbslightlybafterbeatingbratherbthanbdecreasing.b
Thebtemperaturesbarebwithinbnormalbrangebforbthebrectalbroute,bandbtemperaturebincreasesbthroughoutbtheb
day.bItbisbnormalbtobhavebanbincreasedbrespiratorybratebafterbexercise.
Thebnursebassessesbclients'bbreathbsounds.bWhichbonebrequiresbimmediatebmedicalbattention?bAbclientbw
hobhas:
1) Crackles
2) Rhonchi
3) Stridor
4) Wheezesb-bANS>>:
3)bStridor
32b/b36
