1
2023 NCLEX-RN Actual Exam (Updated
for 2025) – Actual Questions with 100%
Verified Answers & Rationales | A+
Grade Guaranteed
Safe and Effective Care Environment (38 Questions: 34
Scored, 4 Unscored)
1. A nurse is preparing to administer a medication. Which action ensures client safety?
a. Administer the dose immediately
b. Verify the client’s identity
c. Document the medication before administration
d. Use a single identifier for verification
Rationale: Verifying identity with two identifiers ensures the right client, per 2025
NCSBN safety guidelines. Scored
2. A client is on contact precautions for MRSA. Which PPE is required?
a. Surgical mask only
b. Gown and gloves
c. Face shield only
d. No PPE needed
Rationale: Gown and gloves prevent MRSA transmission, per 2025 CDC guidelines.
Scored
3. A nurse discovers a medication error. What is the first action?
a. Document the error
b. Assess the client for adverse effects
c. Notify the pharmacy
d. Administer a corrective dose
Rationale: Assessing the client ensures safety, per 2025 NCSBN safety standards.
Scored
4. NGN Select All That Apply: A nurse is implementing infection control for a client with
C. difficile. Which actions are appropriate?
a. Use a bleach-based cleaner
b. Wear gloves and gown
c. Use alcohol-based hand sanitizer
d. Place in a private room
e. Allow shared equipment
Correct Answers: a, b, d
Rationale: Bleach kills C. difficile spores, gloves and gown prevent contact, and a
private room reduces spread. Alcohol is ineffective, per 2025 CDC guidelines. Scored
, 2
5. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is
appropriate?
a. Administer oral medications
b. Assist with ambulation
c. Perform a sterile dressing change
d. Assess pain levels
Rationale: Assisting with ambulation is within UAP scope, per 2025 NCSBN delegation
guidelines. Scored
6. A client refuses a procedure. What is the nurse’s best action?
a. Proceed with the procedure
b. Document the refusal
c. Convince the client to consent
d. Ignore the refusal
Rationale: Documenting refusal respects autonomy, per 2025 NCSBN ethical standards.
Scored
7. A nurse is using a Hoyer lift. Which action ensures safety?
a. Use one staff member
b. Check the lift’s weight capacity
c. Position the client off-center
d. Raise the lift to maximum height
Rationale: Checking capacity prevents equipment failure, per 2025 NCSBN safety
guidelines. Scored
8. NGN Case Study: A client with a fall risk is found attempting to get out of bed.
Question: What is the nurse’s first action? (Fill-in-the-blank)
Correct Answer: Assist the client to a safe position
Rationale: Ensuring immediate safety prevents falls, per 2025 NCSBN safety guidelines.
Scored
9. A client with a history of seizures is admitted. Which precaution is priority?
a. Keep the bed in high position
b. Pad the side rails
c. Restrain the client during sleep
d. Remove all bedside equipment
Rationale: Padded rails prevent injury during seizures, per 2025 NCSBN safety
standards. Scored
10. A nurse is preparing a sterile field. Which action contaminates the field?
a. Open packages away from the body
b. Reach over the sterile field
c. Use sterile gloves
d. Keep items above waist level
Rationale: Reaching over introduces contaminants, per 2025 NCSBN infection control
guidelines. Scored
11. A nurse is responding to a fire alarm. What is the first step in the RACE protocol?
a. Activate the alarm
b. Rescue clients in immediate danger
c. Extinguish the fire
d. Contain the fire
, 3
Rationale: Rescuing clients is the priority, per 2025 NCSBN fire safety guidelines.
Scored
12. A client is receiving oxygen via nasal cannula. Which safety precaution is critical?
a. Increase flow to 6 L/min
b. Avoid open flames
c. Remove the cannula during meals
d. Tape the cannula to the face
Rationale: Oxygen is flammable, requiring fire precautions, per 2025 NCSBN safety
standards. Scored
13. A nurse is disposing of a used needle. Which action is appropriate?
a. Recap the needle
b. Place in a sharps container
c. Dispose in regular trash
d. Break the needle first
Rationale: A sharps container prevents needlestick injuries, per 2025 OSHA guidelines.
Scored
14. A nurse is lifting a heavy object. Which technique prevents injury?
a. Bend at the waist
b. Use leg muscles to lift
c. Twist while lifting
d. Lift with arms extended
Rationale: Using leg muscles reduces back strain, per 2025 NCSBN body mechanics
guidelines. Scored
15. NGN Hot Spot: A nurse is assessing a client’s peripheral pulse. Where should the nurse
palpate the posterior tibial pulse? (Select the area on a diagram.)
Correct Answer: Behind the medial malleolus
Rationale: The posterior tibial pulse is located behind the medial malleolus, per 2025
NCSBN assessment guidelines. Scored
16. A client with dementia is wandering. Which intervention is best?
a. Lock the client’s door
b. Use a bed alarm
c. Restrain the client at all times
d. Allow unsupervised exits
Rationale: A bed alarm alerts staff to movement, per 2025 NCSBN safety guidelines.
Scored
17. A nurse is assisting a client with a cane. Where should the cane be positioned?
a. On the weaker side
b. On the stronger side
c. With both hands
d. Behind the client
Rationale: The cane on the stronger side provides support, per 2025 NCSBN mobility
guidelines. Scored
18. A nurse is preparing to insert a urinary catheter. Which action ensures sterility?
a. Use clean gloves
b. Maintain a sterile field
c. Cleanse the site with alcohol
2023 NCLEX-RN Actual Exam (Updated
for 2025) – Actual Questions with 100%
Verified Answers & Rationales | A+
Grade Guaranteed
Safe and Effective Care Environment (38 Questions: 34
Scored, 4 Unscored)
1. A nurse is preparing to administer a medication. Which action ensures client safety?
a. Administer the dose immediately
b. Verify the client’s identity
c. Document the medication before administration
d. Use a single identifier for verification
Rationale: Verifying identity with two identifiers ensures the right client, per 2025
NCSBN safety guidelines. Scored
2. A client is on contact precautions for MRSA. Which PPE is required?
a. Surgical mask only
b. Gown and gloves
c. Face shield only
d. No PPE needed
Rationale: Gown and gloves prevent MRSA transmission, per 2025 CDC guidelines.
Scored
3. A nurse discovers a medication error. What is the first action?
a. Document the error
b. Assess the client for adverse effects
c. Notify the pharmacy
d. Administer a corrective dose
Rationale: Assessing the client ensures safety, per 2025 NCSBN safety standards.
Scored
4. NGN Select All That Apply: A nurse is implementing infection control for a client with
C. difficile. Which actions are appropriate?
a. Use a bleach-based cleaner
b. Wear gloves and gown
c. Use alcohol-based hand sanitizer
d. Place in a private room
e. Allow shared equipment
Correct Answers: a, b, d
Rationale: Bleach kills C. difficile spores, gloves and gown prevent contact, and a
private room reduces spread. Alcohol is ineffective, per 2025 CDC guidelines. Scored
, 2
5. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is
appropriate?
a. Administer oral medications
b. Assist with ambulation
c. Perform a sterile dressing change
d. Assess pain levels
Rationale: Assisting with ambulation is within UAP scope, per 2025 NCSBN delegation
guidelines. Scored
6. A client refuses a procedure. What is the nurse’s best action?
a. Proceed with the procedure
b. Document the refusal
c. Convince the client to consent
d. Ignore the refusal
Rationale: Documenting refusal respects autonomy, per 2025 NCSBN ethical standards.
Scored
7. A nurse is using a Hoyer lift. Which action ensures safety?
a. Use one staff member
b. Check the lift’s weight capacity
c. Position the client off-center
d. Raise the lift to maximum height
Rationale: Checking capacity prevents equipment failure, per 2025 NCSBN safety
guidelines. Scored
8. NGN Case Study: A client with a fall risk is found attempting to get out of bed.
Question: What is the nurse’s first action? (Fill-in-the-blank)
Correct Answer: Assist the client to a safe position
Rationale: Ensuring immediate safety prevents falls, per 2025 NCSBN safety guidelines.
Scored
9. A client with a history of seizures is admitted. Which precaution is priority?
a. Keep the bed in high position
b. Pad the side rails
c. Restrain the client during sleep
d. Remove all bedside equipment
Rationale: Padded rails prevent injury during seizures, per 2025 NCSBN safety
standards. Scored
10. A nurse is preparing a sterile field. Which action contaminates the field?
a. Open packages away from the body
b. Reach over the sterile field
c. Use sterile gloves
d. Keep items above waist level
Rationale: Reaching over introduces contaminants, per 2025 NCSBN infection control
guidelines. Scored
11. A nurse is responding to a fire alarm. What is the first step in the RACE protocol?
a. Activate the alarm
b. Rescue clients in immediate danger
c. Extinguish the fire
d. Contain the fire
, 3
Rationale: Rescuing clients is the priority, per 2025 NCSBN fire safety guidelines.
Scored
12. A client is receiving oxygen via nasal cannula. Which safety precaution is critical?
a. Increase flow to 6 L/min
b. Avoid open flames
c. Remove the cannula during meals
d. Tape the cannula to the face
Rationale: Oxygen is flammable, requiring fire precautions, per 2025 NCSBN safety
standards. Scored
13. A nurse is disposing of a used needle. Which action is appropriate?
a. Recap the needle
b. Place in a sharps container
c. Dispose in regular trash
d. Break the needle first
Rationale: A sharps container prevents needlestick injuries, per 2025 OSHA guidelines.
Scored
14. A nurse is lifting a heavy object. Which technique prevents injury?
a. Bend at the waist
b. Use leg muscles to lift
c. Twist while lifting
d. Lift with arms extended
Rationale: Using leg muscles reduces back strain, per 2025 NCSBN body mechanics
guidelines. Scored
15. NGN Hot Spot: A nurse is assessing a client’s peripheral pulse. Where should the nurse
palpate the posterior tibial pulse? (Select the area on a diagram.)
Correct Answer: Behind the medial malleolus
Rationale: The posterior tibial pulse is located behind the medial malleolus, per 2025
NCSBN assessment guidelines. Scored
16. A client with dementia is wandering. Which intervention is best?
a. Lock the client’s door
b. Use a bed alarm
c. Restrain the client at all times
d. Allow unsupervised exits
Rationale: A bed alarm alerts staff to movement, per 2025 NCSBN safety guidelines.
Scored
17. A nurse is assisting a client with a cane. Where should the cane be positioned?
a. On the weaker side
b. On the stronger side
c. With both hands
d. Behind the client
Rationale: The cane on the stronger side provides support, per 2025 NCSBN mobility
guidelines. Scored
18. A nurse is preparing to insert a urinary catheter. Which action ensures sterility?
a. Use clean gloves
b. Maintain a sterile field
c. Cleanse the site with alcohol
