NCLEX RN Basic Care and Comfort
Exam 2 100 Questions Plus Correct
Answers (Verified Answers) Plus
Rationales 2026 Q & A Instant
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1. A nurse is caring for a client who has been prescribed bed rest. Which
intervention is most appropriate to help prevent complications of
immobility?
A. Limit fluid intake
B. Encourage frequent position changes
C. Keep the client in a supine position
D. Restrict range-of-motion exercises
Answer: Encourage frequent position changes
Rationale: Frequent repositioning helps prevent pressure injuries, venous
stasis, atelectasis, and musculoskeletal complications associated with
immobility.
2. Which position is best for a client experiencing dyspnea?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: High-Fowler's
Rationale: High-Fowler's position promotes maximum lung expansion and
decreases pressure from abdominal organs on the diaphragm.
, 3. A nurse is assisting a client from the bed to a wheelchair. Which action
should the nurse take first?
A. Lock the wheelchair brakes
B. Raise the footrests
C. Ask the client to stand immediately
D. Place the wheelchair several feet from the bed
Answer: Lock the wheelchair brakes
Rationale: Locking the wheelchair prevents movement during transfer and
reduces the risk of falls.
4. A client has weakness of the right leg and uses a cane. Where should the
cane be held?
A. Right hand
B. Left hand
C. Both hands
D. Either hand
Answer: Left hand
Rationale: The cane is held on the stronger side to provide support while the
weaker leg advances.
5. A nurse is helping a client use a walker. Which sequence is correct?
A. Move the weak leg, move the walker, move the strong leg
B. Move the strong leg, move the walker, move the weak leg
C. Move the walker, move the weak leg, move the strong leg
D. Move both legs, then move the walker
Answer: Move the walker, move the weak leg, move the strong leg
Rationale: Advancing the walker first provides a stable base, followed by the
weaker leg and then the stronger leg.
6. Which intervention is most effective for preventing pressure injuries in an
immobile client?
A. Massage reddened areas
B. Reposition the client regularly
, C. Use donut-shaped cushions
D. Keep the head of the bed elevated continuously
Answer: Reposition the client regularly
Rationale: Regular repositioning relieves prolonged pressure and helps
maintain tissue perfusion.
7. A client is incontinent of urine and has fragile skin. Which intervention is
appropriate?
A. Apply talcum powder after every episode
B. Cleanse the skin and apply a moisture barrier
C. Scrub the perineal area vigorously
D. Leave the skin exposed to urine briefly
Answer: Cleanse the skin and apply a moisture barrier
Rationale: Gentle cleansing followed by a moisture barrier protects skin from
irritation and breakdown caused by urine exposure.
8. Which finding is most concerning when assessing a client at risk for a
pressure injury?
A. Warm skin
B. Blanchable redness
C. Nonblanchable erythema
D. Mild dryness
Answer: Nonblanchable erythema
Rationale: Persistent nonblanchable redness is an early sign of a stage 1
pressure injury and requires immediate intervention.
9. Which intervention is appropriate for preventing constipation in a client
who is not fluid restricted?
A. Encourage fluids and fiber
B. Limit physical activity
C. Avoid fruits and vegetables
D. Encourage prolonged bed rest
Answer: Encourage fluids and fiber
Exam 2 100 Questions Plus Correct
Answers (Verified Answers) Plus
Rationales 2026 Q & A Instant
Download Pdf
1. A nurse is caring for a client who has been prescribed bed rest. Which
intervention is most appropriate to help prevent complications of
immobility?
A. Limit fluid intake
B. Encourage frequent position changes
C. Keep the client in a supine position
D. Restrict range-of-motion exercises
Answer: Encourage frequent position changes
Rationale: Frequent repositioning helps prevent pressure injuries, venous
stasis, atelectasis, and musculoskeletal complications associated with
immobility.
2. Which position is best for a client experiencing dyspnea?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: High-Fowler's
Rationale: High-Fowler's position promotes maximum lung expansion and
decreases pressure from abdominal organs on the diaphragm.
, 3. A nurse is assisting a client from the bed to a wheelchair. Which action
should the nurse take first?
A. Lock the wheelchair brakes
B. Raise the footrests
C. Ask the client to stand immediately
D. Place the wheelchair several feet from the bed
Answer: Lock the wheelchair brakes
Rationale: Locking the wheelchair prevents movement during transfer and
reduces the risk of falls.
4. A client has weakness of the right leg and uses a cane. Where should the
cane be held?
A. Right hand
B. Left hand
C. Both hands
D. Either hand
Answer: Left hand
Rationale: The cane is held on the stronger side to provide support while the
weaker leg advances.
5. A nurse is helping a client use a walker. Which sequence is correct?
A. Move the weak leg, move the walker, move the strong leg
B. Move the strong leg, move the walker, move the weak leg
C. Move the walker, move the weak leg, move the strong leg
D. Move both legs, then move the walker
Answer: Move the walker, move the weak leg, move the strong leg
Rationale: Advancing the walker first provides a stable base, followed by the
weaker leg and then the stronger leg.
6. Which intervention is most effective for preventing pressure injuries in an
immobile client?
A. Massage reddened areas
B. Reposition the client regularly
, C. Use donut-shaped cushions
D. Keep the head of the bed elevated continuously
Answer: Reposition the client regularly
Rationale: Regular repositioning relieves prolonged pressure and helps
maintain tissue perfusion.
7. A client is incontinent of urine and has fragile skin. Which intervention is
appropriate?
A. Apply talcum powder after every episode
B. Cleanse the skin and apply a moisture barrier
C. Scrub the perineal area vigorously
D. Leave the skin exposed to urine briefly
Answer: Cleanse the skin and apply a moisture barrier
Rationale: Gentle cleansing followed by a moisture barrier protects skin from
irritation and breakdown caused by urine exposure.
8. Which finding is most concerning when assessing a client at risk for a
pressure injury?
A. Warm skin
B. Blanchable redness
C. Nonblanchable erythema
D. Mild dryness
Answer: Nonblanchable erythema
Rationale: Persistent nonblanchable redness is an early sign of a stage 1
pressure injury and requires immediate intervention.
9. Which intervention is appropriate for preventing constipation in a client
who is not fluid restricted?
A. Encourage fluids and fiber
B. Limit physical activity
C. Avoid fruits and vegetables
D. Encourage prolonged bed rest
Answer: Encourage fluids and fiber
