NCLEX/EXIT EXAM Study Exam 2025–2026
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 answerA. 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 answerD. 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 answerB, 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 answerA, 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 answerA. 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
answerD. 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 answerC; 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 answerA; 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
b. Ask the resident to describe what happened
c. Contact a family member to report the fall
d. Observe for any injury to the head or neck
e. Obtain non-skid socks from the supply room and apply them to the client - correct answerA, E
After completing initial assessment, the nurse can assign the UAP to perform comfort
measures. Non-skid socks may prevent a future fall and this task can be delegated by the RN.
The UAP cannot communicate with the family about injury or assess the client for injury.
Several residents are needing assistance to get to the dining room. Which residents need the
assistance of an LPN rather than a UAP? SATA
a. A legally blind, elderly man with a shuffling gait, who uses the hallway railings to assist in
ambulation
b. An elderly woman, 4 weeks post-hip surgery, who ambulates with a walker but becomes easily
fatigued
c. A client with type I diabetes who reports feeling sweaty and tired
d. An elderly man with diabetes, 2 days after a toe amputation, who requests help transferring to
a wheelchair
e. An elderly woman who has experienced pneumonia and DVT and who has been on bed rest for
2 weeks - correct answerC, E
Option C shows signs of a hypoglycemic reaction which may require emergency intervention by
the LPN. The client in option E is at high risk for orthostatic hypotension and syncope as a result of
, prolonged bed rest and should be assisted by an LPN rather than a UAP. A UAP can assist residents
with a fall risk who have no additional problems requiring a higher degree of expertise.
Which client should be assigned to an LVN rather than an RN?
a. A client with Addison's disease who is experiencing tremors and diaphoresis
b. An afebrile client who is 2 days postoperative with an abdominal incision and a Jackson-Pratt
drain
c. A client who is scheduled to be discharged after receiving instruction about colostomy care
d. A client with diabetes who reports pain 2 days after an above-the-knee amputation - correct
answerB. This afebrile client requires routine postoperative care which can be completed by
the PN.
While making initial rounds, the charge nurse should see which client first?
a. A postoperative client with a tracheostomy who has signs of a tracheoesophageal fistula
b. A postoperative client with CBI that is draining pale pink urine
c. A preoperative client with a history of syncope who is scheduled for a carotid endarterectomy
d. A preoperative client with a prolonged PTT who has receiving anticoagulants - correct answerA
What is the primary action of magnesium sulfate when given in preeclampsia? a.
An antihypertensive
b. A diuretic
c. A CNS depressant
d. A calcium channel blocker - correct answerC; magnesium sulfate depresses the CNS by
interfering with the neuromuscular junction. It is given to prevent or control eclamptic seizures.
While there is some relaxation of blood vessel walls resulting in a slight decrease in the BP,
magnesium sulfate is not an antihypertensive. If a pregnant client needs an antihypertensive,
the drugs of choice are hydralazine or labetalol.
Which tasks can be delegated to a UAP? SATA
a. Enter obtained vital signs in the medical record
b. Ask the client to describe his pain and discomfort
c. Collect the client's psychosocial history
d. Identify potential nursing diagnoses for the plan of care
e. Place a bedside commode in the room - correct answerA, E. The UAP can bring durable medical
equipment into a room and can take vitals.
After receiving report from the night shift charge nurse, which activities should Alex, the day shift
charge nurse anticipate completing during the first hour? a. Distribute breakfast trays as they
arrive on the unit
b. Assign clients to staff nurses according to acuity
c. Identify tasks needed for assignment and delegation
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 answerA. 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 answerD. 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 answerB, 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 answerA, 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 answerA. 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
answerD. 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 answerC; 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 answerA; 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
b. Ask the resident to describe what happened
c. Contact a family member to report the fall
d. Observe for any injury to the head or neck
e. Obtain non-skid socks from the supply room and apply them to the client - correct answerA, E
After completing initial assessment, the nurse can assign the UAP to perform comfort
measures. Non-skid socks may prevent a future fall and this task can be delegated by the RN.
The UAP cannot communicate with the family about injury or assess the client for injury.
Several residents are needing assistance to get to the dining room. Which residents need the
assistance of an LPN rather than a UAP? SATA
a. A legally blind, elderly man with a shuffling gait, who uses the hallway railings to assist in
ambulation
b. An elderly woman, 4 weeks post-hip surgery, who ambulates with a walker but becomes easily
fatigued
c. A client with type I diabetes who reports feeling sweaty and tired
d. An elderly man with diabetes, 2 days after a toe amputation, who requests help transferring to
a wheelchair
e. An elderly woman who has experienced pneumonia and DVT and who has been on bed rest for
2 weeks - correct answerC, E
Option C shows signs of a hypoglycemic reaction which may require emergency intervention by
the LPN. The client in option E is at high risk for orthostatic hypotension and syncope as a result of
, prolonged bed rest and should be assisted by an LPN rather than a UAP. A UAP can assist residents
with a fall risk who have no additional problems requiring a higher degree of expertise.
Which client should be assigned to an LVN rather than an RN?
a. A client with Addison's disease who is experiencing tremors and diaphoresis
b. An afebrile client who is 2 days postoperative with an abdominal incision and a Jackson-Pratt
drain
c. A client who is scheduled to be discharged after receiving instruction about colostomy care
d. A client with diabetes who reports pain 2 days after an above-the-knee amputation - correct
answerB. This afebrile client requires routine postoperative care which can be completed by
the PN.
While making initial rounds, the charge nurse should see which client first?
a. A postoperative client with a tracheostomy who has signs of a tracheoesophageal fistula
b. A postoperative client with CBI that is draining pale pink urine
c. A preoperative client with a history of syncope who is scheduled for a carotid endarterectomy
d. A preoperative client with a prolonged PTT who has receiving anticoagulants - correct answerA
What is the primary action of magnesium sulfate when given in preeclampsia? a.
An antihypertensive
b. A diuretic
c. A CNS depressant
d. A calcium channel blocker - correct answerC; magnesium sulfate depresses the CNS by
interfering with the neuromuscular junction. It is given to prevent or control eclamptic seizures.
While there is some relaxation of blood vessel walls resulting in a slight decrease in the BP,
magnesium sulfate is not an antihypertensive. If a pregnant client needs an antihypertensive,
the drugs of choice are hydralazine or labetalol.
Which tasks can be delegated to a UAP? SATA
a. Enter obtained vital signs in the medical record
b. Ask the client to describe his pain and discomfort
c. Collect the client's psychosocial history
d. Identify potential nursing diagnoses for the plan of care
e. Place a bedside commode in the room - correct answerA, E. The UAP can bring durable medical
equipment into a room and can take vitals.
After receiving report from the night shift charge nurse, which activities should Alex, the day shift
charge nurse anticipate completing during the first hour? a. Distribute breakfast trays as they
arrive on the unit
b. Assign clients to staff nurses according to acuity
c. Identify tasks needed for assignment and delegation
