NCLEX NURSING ASSESSMENT AND INTERVENTION EXAM UPDATED 2025-2026
170 VERIFIED QUESTIONS AND 100% CORRECT ANSWERS.
Section 1: Nursing Assessment and Clinical Judgment (Questions 1-30)
1. A nurse is performing a comprehensive health assessment on a new client.
Which action best demonstrates the purpose of nursing assessment?
A. Collecting data to formulate nursing diagnoses and plan care
B. Documenting the client's insurance information
C. Completing admission paperwork
D. Introducing the client to other staff members
Answer: A
Rationale: The purpose of nursing assessment is to collect comprehensive data to
identify health problems, formulate nursing diagnoses, and develop an
individualized plan of care. Assessment is the first step of the nursing process and
provides the foundation for all subsequent nursing actions .
2. An older adult client had hip replacement surgery 2 days ago. The nurse enters
the client's room and encourages the client to use the incentive spirometer ten
,times every hour. This action is an example of which phase of the nursing
process?
A. Nursing assessment
B. Nursing diagnosis
C. Nursing intervention
D. Nursing evaluation
Answer: C
Rationale: Nursing interventions are actions taken to monitor health status,
prevent or resolve problems, assist with activities of daily living, or promote
optimum health and independence. Encouraging incentive spirometer use is an
intervention to prevent postoperative pulmonary complications .
3. The nurse is taking a health history on a new patient. The patient informs the
nurse that her mother has type 1 diabetes. What is the significance of this
information to the health history?
A. The patient will definitely develop diabetes
B. The patient may be at risk for developing diabetes
C. This information is not relevant
,D. The patient should be tested immediately
Answer: B
Rationale: Nurses incorporate a genetics focus into health assessments to
evaluate family history for genetics-related risk factors. This information helps
determine if the patient may be predisposed to diseases that are genetic in origin
.
4. A nurse is assessing a client with regard to nutritional habits, use of substances,
education, and work and stress levels. The nurse recognizes this as what type of
information?
A. History of present health concerns
B. Personal health history
C. Lifestyle and health practices profile
D. Family health history
Answer: C
Rationale: By assessing the client's nutritional habits, substance use, education,
and work/stress levels, the nurse is obtaining a lifestyle and health practices
, profile. This information helps identify health risks and areas for health promotion
.
5. Which observation would cause the nurse to suspect an abusive situation?
(Select all that apply)
A. A child is persistent in trying to please a parent
B. A caregiver of a cognitively intact older adult dominates the interview
C. A pre-schooler rubs her perineum and complains of it hurting
D. A parent firmly but gently corrects a child's behavior
Answers: A, B, C
Rationale: Indicators of potential abuse include: a child who is overly eager to
please (often due to fear), a caregiver who dominates the interview and speaks
for the client (controlling behavior), and a child who complains of perineal pain
(possible sexual abuse). Firm but gentle discipline does not indicate abuse .
6. A nurse draws a genogram to help organize and illustrate a client's family
history. Which shape is the standard format for representing a deceased female
relative?
170 VERIFIED QUESTIONS AND 100% CORRECT ANSWERS.
Section 1: Nursing Assessment and Clinical Judgment (Questions 1-30)
1. A nurse is performing a comprehensive health assessment on a new client.
Which action best demonstrates the purpose of nursing assessment?
A. Collecting data to formulate nursing diagnoses and plan care
B. Documenting the client's insurance information
C. Completing admission paperwork
D. Introducing the client to other staff members
Answer: A
Rationale: The purpose of nursing assessment is to collect comprehensive data to
identify health problems, formulate nursing diagnoses, and develop an
individualized plan of care. Assessment is the first step of the nursing process and
provides the foundation for all subsequent nursing actions .
2. An older adult client had hip replacement surgery 2 days ago. The nurse enters
the client's room and encourages the client to use the incentive spirometer ten
,times every hour. This action is an example of which phase of the nursing
process?
A. Nursing assessment
B. Nursing diagnosis
C. Nursing intervention
D. Nursing evaluation
Answer: C
Rationale: Nursing interventions are actions taken to monitor health status,
prevent or resolve problems, assist with activities of daily living, or promote
optimum health and independence. Encouraging incentive spirometer use is an
intervention to prevent postoperative pulmonary complications .
3. The nurse is taking a health history on a new patient. The patient informs the
nurse that her mother has type 1 diabetes. What is the significance of this
information to the health history?
A. The patient will definitely develop diabetes
B. The patient may be at risk for developing diabetes
C. This information is not relevant
,D. The patient should be tested immediately
Answer: B
Rationale: Nurses incorporate a genetics focus into health assessments to
evaluate family history for genetics-related risk factors. This information helps
determine if the patient may be predisposed to diseases that are genetic in origin
.
4. A nurse is assessing a client with regard to nutritional habits, use of substances,
education, and work and stress levels. The nurse recognizes this as what type of
information?
A. History of present health concerns
B. Personal health history
C. Lifestyle and health practices profile
D. Family health history
Answer: C
Rationale: By assessing the client's nutritional habits, substance use, education,
and work/stress levels, the nurse is obtaining a lifestyle and health practices
, profile. This information helps identify health risks and areas for health promotion
.
5. Which observation would cause the nurse to suspect an abusive situation?
(Select all that apply)
A. A child is persistent in trying to please a parent
B. A caregiver of a cognitively intact older adult dominates the interview
C. A pre-schooler rubs her perineum and complains of it hurting
D. A parent firmly but gently corrects a child's behavior
Answers: A, B, C
Rationale: Indicators of potential abuse include: a child who is overly eager to
please (often due to fear), a caregiver who dominates the interview and speaks
for the client (controlling behavior), and a child who complains of perineal pain
(possible sexual abuse). Firm but gentle discipline does not indicate abuse .
6. A nurse draws a genogram to help organize and illustrate a client's family
history. Which shape is the standard format for representing a deceased female
relative?
