NCLEX/EXIT EXAM Study Exam 2026–2027
Exam Questions and Verified Correct
Answers
A nurse manager in a pediatric facility is approached by a staff RN regarding
several telephone messages from clients. Which situation requires the most
immediate follow-up by the nurse?
a. A mother expressing concern that her baby refuses to take formula, stating
the infant's "soft spot" seems more sunken
b. A grandmother asking for immunization information, stating her 5-year-old
grandchild has
never been immunized.
c. A parent calling to ask if it is necessary to keep her child with a sore throat
home from school
d. A mother stating that she sent her child to school but is concerned about
his eye, which is pink
and painful - CORRECT ANSWER A. This situation indicates the infant is
probably dehydrated, and dehydration can lead to a rapid loss of
physiologic integrity in an infant. The nurse needs to respond to this first.
Which child requires the most immediate follow-up by a nurse?
a. A 10-month-old with yellow nasal mucous and a fever of 101, who is fussy
and crying loudly
b. A 5-year-old who has started wetting the bed and constantly requests
extra snacks and drinks
c. A 13-year-old who was injured while playing football the previous day and
now cannot bear weight on his foot due to severe pain
d. A 9-year-old who got hit on the head with a baseball bat and has a bruise
behind his ear and clear nasal discharge - CORRECT ANSWER D. Bruising
behind the ear following a head injury is referred to as a Battle sign, which
, is an indication of a basilar skull fracture. Because the clear nasal drainage
may be CSF, this child needs the most immediate assessment to determine
severity of the head
injury.
A nurse manager is planning care for a teen with a possible fracture of the
foot. Which tasks can be assigned to the UAP assisting the nurse? SATA a.
Palpate for presence of pedal pulses b. Apply a cold pack to the teenager's
foot
c. Explain to the client the difference between a fracture and a sprain
d. Use a numeric pain scale to assess the teen's pain level
e. Take the teen's vital signs - CORRECT ANSWER B, E
Applying a cold pack may be delegated to the UAP with sufficient instruction
and supervision. Taking VS is a common task delegated to a UAP as long as a
life-threatening complication has not occurred. Client teaching and
assessment is done by the nurse.
Which tasks should be assigned to an LPN, rather than a UAP? SATA a.
Check residual on a tube feeding for a child with a PEG tube
b. Transport an infant with rotavirus to the treatment room for IV insertion
c. Perform a straight catheterization for urine specimen collection
d. Take the tympanic temperature of an infant
e. Distribute a snack to a child with diabetes - CORRECT ANSWER A, C
The UAP is not usually trained to perform an invasive procedure such as
checking residual or sterile procedures such as catheterization. The UAP can
safely be assigned to transport clients, take vital signs, and can distribute
snacks BUT the UAP should not be assigned of selecting the snack.
Which client should be assigned to a staff RN, rather than a staff LPN? a.
A 2-year-old with diabetes who has been vomiting all night
b. A 4-year-old with a rash creating a slapped appearance on the face
,c. An infant boy with a fever of 101 who has been pulling on his ear
d. A 2-month-old with a pulse of 140 who needs routine immunizations -
CORRECT ANSWER A. This child, who may be hyperglycemia and
dehydrated, requires the highest of nursing expertise for assessment and
care. Option B is probably fifth disease, and does not require RN expertise
as much as option A. Option C is most likely an ear infection, and is not as
immediate as another option. Option D shows a normal pulse rate and
does not require expertise of the RN.
A pediatric clinic has only one pulse oximeter available for continuous
monitoring of oxygen saturation. Which client should it be used on?
a. A 6-month-old with a hemoglobin of 10 who is receiving an iron
supplement
b. An 8-month-old who is vomiting and passing stools with a currant jelly
appearance
c. A 2-year-old who has a fever and enlarged tonsils covered with purulent
discharge
d. A 3-year-old with a sore throat who is drooling and sitting in a tripod
position - CORRECT ANSWER D. This child is manifesting signs of
epiglottitis, an acute condition that can rapidly lead to severe respiratory
distress. This child needs the pulse oximeter. The other options do not
require continuous pulse oximetry.
Which situation requires the most immediate action at a skilled care unit?
a. A resident with a colostomy tells the nurse manager that his
colostomy bag is very full and is about to pop
b. A resident who is hard of hearing turns her head away when the nurse
manager inquires about how she is feeling
c. A resident with incontinence has urinated on the floor while
ambulating from his room toward the dining room
, d. A resident sitting in a wheelchair outside the shower room is wrapped
in a blanket and
states she is cold - CORRECT ANSWER C; this situation is a safety hazard and
requires immediate intervention because it increases the risk of falls. Persons
who are hard of hearing often turn their head in an effort to hear better. The
nurse should determine if that is the situation or if the resident has a
problem, but it is not priority.
Which situation requires the most immediate intervention by a nurse
manager?
a. A UAP is demonstrating verbally abusive behaviors toward a resident with
dementia who is
confused and disoriented
b. A newly hired UAP asks for assistance to correctly measure and document
the fluid intake of a resident with dysphagia
c. A resident with Parkinson's disease is drooling excessively and refuses to
allow the staff to feed
him
d. A resident with Alzheimer's disease is agitated and demands to be released
from his geriatric
chair - CORRECT ANSWER A; abusive behavior toward any resident places
the resident at risk for further abuse that could potentially escalate to
assault. The nurse manager has an ethical responsibility to advocate for
those residents unable to defend themselves. Drooling is common in
Parkinson's disease and is not a risk to the resident; since the client in
option D is secured in the chair, this does not pose an immediate risk.
A client fell while attempting to transfer to the bedside commode without
calling for assistance. In responding to the situation, which tasks can be
delegated to the UAP? SATA a. Place covers around the resident for warmth
if needed
Exam Questions and Verified Correct
Answers
A nurse manager in a pediatric facility is approached by a staff RN regarding
several telephone messages from clients. Which situation requires the most
immediate follow-up by the nurse?
a. A mother expressing concern that her baby refuses to take formula, stating
the infant's "soft spot" seems more sunken
b. A grandmother asking for immunization information, stating her 5-year-old
grandchild has
never been immunized.
c. A parent calling to ask if it is necessary to keep her child with a sore throat
home from school
d. A mother stating that she sent her child to school but is concerned about
his eye, which is pink
and painful - CORRECT ANSWER A. This situation indicates the infant is
probably dehydrated, and dehydration can lead to a rapid loss of
physiologic integrity in an infant. The nurse needs to respond to this first.
Which child requires the most immediate follow-up by a nurse?
a. A 10-month-old with yellow nasal mucous and a fever of 101, who is fussy
and crying loudly
b. A 5-year-old who has started wetting the bed and constantly requests
extra snacks and drinks
c. A 13-year-old who was injured while playing football the previous day and
now cannot bear weight on his foot due to severe pain
d. A 9-year-old who got hit on the head with a baseball bat and has a bruise
behind his ear and clear nasal discharge - CORRECT ANSWER D. Bruising
behind the ear following a head injury is referred to as a Battle sign, which
, is an indication of a basilar skull fracture. Because the clear nasal drainage
may be CSF, this child needs the most immediate assessment to determine
severity of the head
injury.
A nurse manager is planning care for a teen with a possible fracture of the
foot. Which tasks can be assigned to the UAP assisting the nurse? SATA a.
Palpate for presence of pedal pulses b. Apply a cold pack to the teenager's
foot
c. Explain to the client the difference between a fracture and a sprain
d. Use a numeric pain scale to assess the teen's pain level
e. Take the teen's vital signs - CORRECT ANSWER B, E
Applying a cold pack may be delegated to the UAP with sufficient instruction
and supervision. Taking VS is a common task delegated to a UAP as long as a
life-threatening complication has not occurred. Client teaching and
assessment is done by the nurse.
Which tasks should be assigned to an LPN, rather than a UAP? SATA a.
Check residual on a tube feeding for a child with a PEG tube
b. Transport an infant with rotavirus to the treatment room for IV insertion
c. Perform a straight catheterization for urine specimen collection
d. Take the tympanic temperature of an infant
e. Distribute a snack to a child with diabetes - CORRECT ANSWER A, C
The UAP is not usually trained to perform an invasive procedure such as
checking residual or sterile procedures such as catheterization. The UAP can
safely be assigned to transport clients, take vital signs, and can distribute
snacks BUT the UAP should not be assigned of selecting the snack.
Which client should be assigned to a staff RN, rather than a staff LPN? a.
A 2-year-old with diabetes who has been vomiting all night
b. A 4-year-old with a rash creating a slapped appearance on the face
,c. An infant boy with a fever of 101 who has been pulling on his ear
d. A 2-month-old with a pulse of 140 who needs routine immunizations -
CORRECT ANSWER A. This child, who may be hyperglycemia and
dehydrated, requires the highest of nursing expertise for assessment and
care. Option B is probably fifth disease, and does not require RN expertise
as much as option A. Option C is most likely an ear infection, and is not as
immediate as another option. Option D shows a normal pulse rate and
does not require expertise of the RN.
A pediatric clinic has only one pulse oximeter available for continuous
monitoring of oxygen saturation. Which client should it be used on?
a. A 6-month-old with a hemoglobin of 10 who is receiving an iron
supplement
b. An 8-month-old who is vomiting and passing stools with a currant jelly
appearance
c. A 2-year-old who has a fever and enlarged tonsils covered with purulent
discharge
d. A 3-year-old with a sore throat who is drooling and sitting in a tripod
position - CORRECT ANSWER D. This child is manifesting signs of
epiglottitis, an acute condition that can rapidly lead to severe respiratory
distress. This child needs the pulse oximeter. The other options do not
require continuous pulse oximetry.
Which situation requires the most immediate action at a skilled care unit?
a. A resident with a colostomy tells the nurse manager that his
colostomy bag is very full and is about to pop
b. A resident who is hard of hearing turns her head away when the nurse
manager inquires about how she is feeling
c. A resident with incontinence has urinated on the floor while
ambulating from his room toward the dining room
, d. A resident sitting in a wheelchair outside the shower room is wrapped
in a blanket and
states she is cold - CORRECT ANSWER C; this situation is a safety hazard and
requires immediate intervention because it increases the risk of falls. Persons
who are hard of hearing often turn their head in an effort to hear better. The
nurse should determine if that is the situation or if the resident has a
problem, but it is not priority.
Which situation requires the most immediate intervention by a nurse
manager?
a. A UAP is demonstrating verbally abusive behaviors toward a resident with
dementia who is
confused and disoriented
b. A newly hired UAP asks for assistance to correctly measure and document
the fluid intake of a resident with dysphagia
c. A resident with Parkinson's disease is drooling excessively and refuses to
allow the staff to feed
him
d. A resident with Alzheimer's disease is agitated and demands to be released
from his geriatric
chair - CORRECT ANSWER A; abusive behavior toward any resident places
the resident at risk for further abuse that could potentially escalate to
assault. The nurse manager has an ethical responsibility to advocate for
those residents unable to defend themselves. Drooling is common in
Parkinson's disease and is not a risk to the resident; since the client in
option D is secured in the chair, this does not pose an immediate risk.
A client fell while attempting to transfer to the bedside commode without
calling for assistance. In responding to the situation, which tasks can be
delegated to the UAP? SATA a. Place covers around the resident for warmth
if needed
