1
Updated 2025 NCLEX Test Bank – With
Expert-Verified Answers With Explanations
Why Choose This Document?
📌 NCLEX-RN focused – Aligned with high-yield topics and tested
concepts
📌 Answer Key Included – With bolded answers and expert clarity
📌 100-Word Explanations – Digestible and exam-ready content
📌 Perfect for Study Groups, Last-Minute Revision, & Nursing School
Exams
, 2
Updated 2025 NCLEX Test Bank – With Expert-Verified Answers With
Explanations
1. A patient with rheumatoid arthritis is prescribed methotrexate. What is the most
important instruction the nurse should give the patient?
A. Take with high-fat meals
B. Avoid folic acid supplements
C. Avoid alcohol and report any signs of infection
D. Take it only when joints are painful
The answer is: C. Avoid alcohol and report any signs of infection
Explanation
Methotrexate is an immunosuppressive disease-modifying antirheumatic drug (DMARD) used
in rheumatoid arthritis. It increases the risk of infection and hepatotoxicity, so patients must
avoid alcohol and report signs like fever, sore throat, or cough. Unlike NSAIDs, methotrexate is
taken consistently once a week, regardless of pain. Folic acid supplementation is encouraged to
reduce side effects. Methotrexate can also cause bone marrow suppression, so regular lab
monitoring is essential. Patient education is critical to prevent complications and ensure
adherence. Nurses must emphasize that methotrexate takes weeks to show effects and is not a
pain reliever but a disease controller.
2. Which of the following findings is most concerning in a client with a cast on the lower
leg?
A. Slight swelling and warmth
B. Reports of itching inside the cast
C. Pain increasing despite medication
D. Mild tingling relieved by elevation
The answer is: C. Pain increasing despite medication
Explanation
Pain that worsens despite medication in a patient with a cast can indicate compartment
syndrome, a serious condition caused by increased pressure within the muscle compartments. It
compromises circulation and nerve function, leading to ischemia and possible limb loss. This is a
medical emergency. While mild swelling and itching are expected, unrelieved pain is not. Other
symptoms include pallor, paresthesia, pulselessness, and paralysis—known as the 6 P’s. Nurses
must immediately report such findings. Delays can lead to permanent damage, requiring
fasciotomy or even amputation. Frequent neurovascular checks are vital for early detection.
, 3
3. What is the best position for a client recovering from a right total hip arthroplasty?
A. Supine with legs crossed
B. Semi-Fowler’s with a pillow between the knees
C. High-Fowler’s with the right leg elevated
D. Side-lying on the right side
The answer is: B. Semi-Fowler’s with a pillow between the knees
Explanation
After total hip arthroplasty (hip replacement), the priority is to prevent dislocation of the
prosthesis. The hip should remain in an abducted position (knees apart), supported by a pillow
between the knees. Semi-Fowler’s (a reclined position) reduces hip flexion, avoiding angles
greater than 90°, which could lead to dislocation. Crossing legs or placing the client on the
surgical side increases risk. Nurses should educate patients not to bend forward, twist at the hips,
or sleep on the operative side. Proper positioning ensures healing and long-term joint function,
especially in the early postoperative phase.
4. A client with osteoporosis is prescribed alendronate. Which instruction should the nurse
emphasize?
A. Take with meals to avoid nausea
B. Lie down immediately after taking the medication
C. Take with a full glass of water and remain upright for 30 minutes
D. Take before bedtime with milk
The answer is: C. Take with a full glass of water and remain upright for 30 minutes
Explanation
Alendronate is a bisphosphonate used to treat osteoporosis. It must be taken first thing in the
morning on an empty stomach, with a full glass of plain water. Remaining upright for at least
30 minutes prevents esophageal irritation or ulceration, a serious side effect. The drug should
not be taken with food, milk, or other medications as these impair absorption. The nurse must
educate the client on adherence to these specific instructions. Long-term therapy may include
monitoring of bone density and calcium levels. Fall prevention strategies are also essential in
managing osteoporosis effectively.
5. What complication should the nurse monitor for in a patient with a long bone fracture
who suddenly becomes restless and tachypneic?
A. Pulmonary edema
B. Fat embolism
, 4
C. Acute asthma attack
D. Myocardial infarction
The answer is: B. Fat embolism
Explanation
A sudden onset of restlessness, tachypnea, hypoxia, and petechiae in a client with a recent
long bone fracture (e.g., femur) suggests fat embolism syndrome (FES). Fat globules released
from the bone marrow enter circulation and lodge in pulmonary capillaries. It typically occurs
12–72 hours post-injury. Symptoms include respiratory distress, confusion, and petechiae on the
chest or neck. Unlike thrombotic pulmonary embolism, FES often presents with neurological
symptoms and rash. The nurse should administer oxygen immediately, notify the provider, and
support the patient. Prompt recognition and intervention can be life-saving in FES.
6. Which laboratory value should the nurse monitor in a patient receiving long-term
corticosteroid therapy for rheumatoid arthritis?
A. Hematocrit
B. Serum calcium
C. Blood glucose
D. Serum magnesium
The answer is: C. Blood glucose
Explanation
Long-term corticosteroid therapy, such as prednisone for rheumatoid arthritis, increases the risk
of hyperglycemia due to enhanced gluconeogenesis and insulin resistance. Blood glucose levels
must be routinely monitored, especially in diabetic or pre-diabetic patients. Corticosteroids can
also cause fluid retention, osteoporosis, immunosuppression, and delayed wound healing. Serum
calcium may decrease over time, but glucose monitoring is more critical for immediate safety.
Nurses must educate patients on signs of hyperglycemia and reinforce the importance of diet and
possibly medication adjustments during steroid use. Frequent lab monitoring and provider
communication help manage long-term complications.
7. A nurse is caring for a client who just had a left below-the-knee amputation. What is a
priority nursing action in the first 24 hours?
A. Elevate the residual limb continuously
B. Keep the limb flat on the bed
C. Apply heat packs to reduce pain
D. Place the patient in a prone position for 12 hours
The answer is: A. Elevate the residual limb continuously
Explanation
Updated 2025 NCLEX Test Bank – With
Expert-Verified Answers With Explanations
Why Choose This Document?
📌 NCLEX-RN focused – Aligned with high-yield topics and tested
concepts
📌 Answer Key Included – With bolded answers and expert clarity
📌 100-Word Explanations – Digestible and exam-ready content
📌 Perfect for Study Groups, Last-Minute Revision, & Nursing School
Exams
, 2
Updated 2025 NCLEX Test Bank – With Expert-Verified Answers With
Explanations
1. A patient with rheumatoid arthritis is prescribed methotrexate. What is the most
important instruction the nurse should give the patient?
A. Take with high-fat meals
B. Avoid folic acid supplements
C. Avoid alcohol and report any signs of infection
D. Take it only when joints are painful
The answer is: C. Avoid alcohol and report any signs of infection
Explanation
Methotrexate is an immunosuppressive disease-modifying antirheumatic drug (DMARD) used
in rheumatoid arthritis. It increases the risk of infection and hepatotoxicity, so patients must
avoid alcohol and report signs like fever, sore throat, or cough. Unlike NSAIDs, methotrexate is
taken consistently once a week, regardless of pain. Folic acid supplementation is encouraged to
reduce side effects. Methotrexate can also cause bone marrow suppression, so regular lab
monitoring is essential. Patient education is critical to prevent complications and ensure
adherence. Nurses must emphasize that methotrexate takes weeks to show effects and is not a
pain reliever but a disease controller.
2. Which of the following findings is most concerning in a client with a cast on the lower
leg?
A. Slight swelling and warmth
B. Reports of itching inside the cast
C. Pain increasing despite medication
D. Mild tingling relieved by elevation
The answer is: C. Pain increasing despite medication
Explanation
Pain that worsens despite medication in a patient with a cast can indicate compartment
syndrome, a serious condition caused by increased pressure within the muscle compartments. It
compromises circulation and nerve function, leading to ischemia and possible limb loss. This is a
medical emergency. While mild swelling and itching are expected, unrelieved pain is not. Other
symptoms include pallor, paresthesia, pulselessness, and paralysis—known as the 6 P’s. Nurses
must immediately report such findings. Delays can lead to permanent damage, requiring
fasciotomy or even amputation. Frequent neurovascular checks are vital for early detection.
, 3
3. What is the best position for a client recovering from a right total hip arthroplasty?
A. Supine with legs crossed
B. Semi-Fowler’s with a pillow between the knees
C. High-Fowler’s with the right leg elevated
D. Side-lying on the right side
The answer is: B. Semi-Fowler’s with a pillow between the knees
Explanation
After total hip arthroplasty (hip replacement), the priority is to prevent dislocation of the
prosthesis. The hip should remain in an abducted position (knees apart), supported by a pillow
between the knees. Semi-Fowler’s (a reclined position) reduces hip flexion, avoiding angles
greater than 90°, which could lead to dislocation. Crossing legs or placing the client on the
surgical side increases risk. Nurses should educate patients not to bend forward, twist at the hips,
or sleep on the operative side. Proper positioning ensures healing and long-term joint function,
especially in the early postoperative phase.
4. A client with osteoporosis is prescribed alendronate. Which instruction should the nurse
emphasize?
A. Take with meals to avoid nausea
B. Lie down immediately after taking the medication
C. Take with a full glass of water and remain upright for 30 minutes
D. Take before bedtime with milk
The answer is: C. Take with a full glass of water and remain upright for 30 minutes
Explanation
Alendronate is a bisphosphonate used to treat osteoporosis. It must be taken first thing in the
morning on an empty stomach, with a full glass of plain water. Remaining upright for at least
30 minutes prevents esophageal irritation or ulceration, a serious side effect. The drug should
not be taken with food, milk, or other medications as these impair absorption. The nurse must
educate the client on adherence to these specific instructions. Long-term therapy may include
monitoring of bone density and calcium levels. Fall prevention strategies are also essential in
managing osteoporosis effectively.
5. What complication should the nurse monitor for in a patient with a long bone fracture
who suddenly becomes restless and tachypneic?
A. Pulmonary edema
B. Fat embolism
, 4
C. Acute asthma attack
D. Myocardial infarction
The answer is: B. Fat embolism
Explanation
A sudden onset of restlessness, tachypnea, hypoxia, and petechiae in a client with a recent
long bone fracture (e.g., femur) suggests fat embolism syndrome (FES). Fat globules released
from the bone marrow enter circulation and lodge in pulmonary capillaries. It typically occurs
12–72 hours post-injury. Symptoms include respiratory distress, confusion, and petechiae on the
chest or neck. Unlike thrombotic pulmonary embolism, FES often presents with neurological
symptoms and rash. The nurse should administer oxygen immediately, notify the provider, and
support the patient. Prompt recognition and intervention can be life-saving in FES.
6. Which laboratory value should the nurse monitor in a patient receiving long-term
corticosteroid therapy for rheumatoid arthritis?
A. Hematocrit
B. Serum calcium
C. Blood glucose
D. Serum magnesium
The answer is: C. Blood glucose
Explanation
Long-term corticosteroid therapy, such as prednisone for rheumatoid arthritis, increases the risk
of hyperglycemia due to enhanced gluconeogenesis and insulin resistance. Blood glucose levels
must be routinely monitored, especially in diabetic or pre-diabetic patients. Corticosteroids can
also cause fluid retention, osteoporosis, immunosuppression, and delayed wound healing. Serum
calcium may decrease over time, but glucose monitoring is more critical for immediate safety.
Nurses must educate patients on signs of hyperglycemia and reinforce the importance of diet and
possibly medication adjustments during steroid use. Frequent lab monitoring and provider
communication help manage long-term complications.
7. A nurse is caring for a client who just had a left below-the-knee amputation. What is a
priority nursing action in the first 24 hours?
A. Elevate the residual limb continuously
B. Keep the limb flat on the bed
C. Apply heat packs to reduce pain
D. Place the patient in a prone position for 12 hours
The answer is: A. Elevate the residual limb continuously
Explanation
