NCLEX-RN Practice Questions: Nursing Fundamentals
Single-Best-Answer Questions
1) Infection control — contact precautions (Fundamentals:
Infection control)
Vignette / Recognize (cues): A 72-year-old man with profuse
watery diarrhea is diagnosed with Clostridioides difficile
infection. He is febrile and has leukocytosis.
Analyze: Which standard infection-control precautions are most
appropriate to prevent transmission?
A. Airborne precautions (N95, negative-pressure room)
B. Droplet precautions (surgical mask within 3 ft)
C. Contact precautions with gown and gloves; hand hygiene
with soap and water
D. Standard precautions only (alcohol-based hand rub
acceptable)
Decide / Correct answer: C
Act — Rationales:
• A (Airborne): Incorrect. C. difficile is not spread by
airborne droplet nuclei; airborne precautions (N95,
negative pressure) are for organisms like Mycobacterium
tuberculosis and measles. Using airborne precautions
, would not address the organism’s primary transmission
route.
• B (Droplet): Incorrect. Droplet precautions are for
pathogens spread by large respiratory droplets (e.g.,
influenza, pertussis). C. difficile is transmitted via spores on
surfaces/hands — not large respiratory droplets.
• C (Contact with gown/gloves; soap & water): Correct. C.
difficile spores are resistant to alcohol; contact precautions
with gown and gloves plus handwashing with soap and
water (mechanical removal of spores) and environmental
cleaning with sporicidal agents are indicated.
• D (Standard only): Incorrect. Standard precautions alone
are insufficient for C. difficile because alcohol rubs do not
reliably remove spores; contact precautions are required.
Evaluate (expected outcome & monitoring): Decreased
nosocomial transmission; monitor compliance with gown/glove
use, handwashing technique (soap and water), and
environmental cleaning logs.
2) Patient safety — fall risk & prevention (Fundamentals:
Patient safety/prioritization)
Recognize (cues): An 84-year-old woman on the medical floor is
observed getting out of bed unsafely at night. She uses a walker
but appears weak, on opioid analgesics PRN, and has a history
of recent falls.
,Analyze: Which intervention should the RN prioritize to prevent
falls right now?
A. Apply a posey restraint to keep patient in bed
B. Place the bed in the lowest position, ensure call light within
reach, and set hourly rounding with toileting assistance
C. Discontinue opioid analgesics immediately
D. Schedule physical therapy evaluation for tomorrow
Decide / Correct answer: B
Act — Rationales:
• A (Restraints): Incorrect. Physical restraints are last-resort,
require an order, and increase risk of harm (e.g., agitation,
injury). They are not the first priority for fall prevention.
• B (Lower bed, call light, hourly rounding/toileting):
Correct. Immediate, evidence-based fall reduction actions
include environmental adjustments, ensuring call light
access, scheduled rounding for toileting/assistance, and
ambulation help — all least restrictive and immediately
implementable.
• C (Discontinue opioids immediately): Incorrect. Opioids
may contribute to sedation/falls, but medication changes
require prescriber collaboration and assessing pain control;
abrupt discontinuation could cause uncontrolled pain or
withdrawal. It’s not an immediate single action to prevent
current fall risk.
, • D (PT tomorrow): Incorrect. PT assessment is important
but delayed; it does not address immediate risk.
Evaluate: Reduced attempts to get up unsafely, fewer fall
incidents; reassess fall-risk scale and review analgesic dosing
with prescriber within 24 hours.
3) Documentation — timely & accurate charting
(Fundamentals: Documentation/communication)
Recognize (cues): An RN finds that the morning shift
documented a Foley catheter removal at 0700, but the catheter
is physically still in the patient at 1200.
Analyze: What is the best immediate nursing action?
A. Ignore the discrepancy; chart that you removed the catheter
at 1200 to match reality
B. Notify the morning nurse by email and document the
discrepancy in the chart later
C. Verify the current catheter status, notify the charge nurse
and the morning nurse verbally, correct the record per facility
policy and document the correction with reason and time
D. Remove the catheter immediately and then create a new
note stating it was removed earlier to avoid confusion
Decide / Correct answer: C
Act — Rationales:
Single-Best-Answer Questions
1) Infection control — contact precautions (Fundamentals:
Infection control)
Vignette / Recognize (cues): A 72-year-old man with profuse
watery diarrhea is diagnosed with Clostridioides difficile
infection. He is febrile and has leukocytosis.
Analyze: Which standard infection-control precautions are most
appropriate to prevent transmission?
A. Airborne precautions (N95, negative-pressure room)
B. Droplet precautions (surgical mask within 3 ft)
C. Contact precautions with gown and gloves; hand hygiene
with soap and water
D. Standard precautions only (alcohol-based hand rub
acceptable)
Decide / Correct answer: C
Act — Rationales:
• A (Airborne): Incorrect. C. difficile is not spread by
airborne droplet nuclei; airborne precautions (N95,
negative pressure) are for organisms like Mycobacterium
tuberculosis and measles. Using airborne precautions
, would not address the organism’s primary transmission
route.
• B (Droplet): Incorrect. Droplet precautions are for
pathogens spread by large respiratory droplets (e.g.,
influenza, pertussis). C. difficile is transmitted via spores on
surfaces/hands — not large respiratory droplets.
• C (Contact with gown/gloves; soap & water): Correct. C.
difficile spores are resistant to alcohol; contact precautions
with gown and gloves plus handwashing with soap and
water (mechanical removal of spores) and environmental
cleaning with sporicidal agents are indicated.
• D (Standard only): Incorrect. Standard precautions alone
are insufficient for C. difficile because alcohol rubs do not
reliably remove spores; contact precautions are required.
Evaluate (expected outcome & monitoring): Decreased
nosocomial transmission; monitor compliance with gown/glove
use, handwashing technique (soap and water), and
environmental cleaning logs.
2) Patient safety — fall risk & prevention (Fundamentals:
Patient safety/prioritization)
Recognize (cues): An 84-year-old woman on the medical floor is
observed getting out of bed unsafely at night. She uses a walker
but appears weak, on opioid analgesics PRN, and has a history
of recent falls.
,Analyze: Which intervention should the RN prioritize to prevent
falls right now?
A. Apply a posey restraint to keep patient in bed
B. Place the bed in the lowest position, ensure call light within
reach, and set hourly rounding with toileting assistance
C. Discontinue opioid analgesics immediately
D. Schedule physical therapy evaluation for tomorrow
Decide / Correct answer: B
Act — Rationales:
• A (Restraints): Incorrect. Physical restraints are last-resort,
require an order, and increase risk of harm (e.g., agitation,
injury). They are not the first priority for fall prevention.
• B (Lower bed, call light, hourly rounding/toileting):
Correct. Immediate, evidence-based fall reduction actions
include environmental adjustments, ensuring call light
access, scheduled rounding for toileting/assistance, and
ambulation help — all least restrictive and immediately
implementable.
• C (Discontinue opioids immediately): Incorrect. Opioids
may contribute to sedation/falls, but medication changes
require prescriber collaboration and assessing pain control;
abrupt discontinuation could cause uncontrolled pain or
withdrawal. It’s not an immediate single action to prevent
current fall risk.
, • D (PT tomorrow): Incorrect. PT assessment is important
but delayed; it does not address immediate risk.
Evaluate: Reduced attempts to get up unsafely, fewer fall
incidents; reassess fall-risk scale and review analgesic dosing
with prescriber within 24 hours.
3) Documentation — timely & accurate charting
(Fundamentals: Documentation/communication)
Recognize (cues): An RN finds that the morning shift
documented a Foley catheter removal at 0700, but the catheter
is physically still in the patient at 1200.
Analyze: What is the best immediate nursing action?
A. Ignore the discrepancy; chart that you removed the catheter
at 1200 to match reality
B. Notify the morning nurse by email and document the
discrepancy in the chart later
C. Verify the current catheter status, notify the charge nurse
and the morning nurse verbally, correct the record per facility
policy and document the correction with reason and time
D. Remove the catheter immediately and then create a new
note stating it was removed earlier to avoid confusion
Decide / Correct answer: C
Act — Rationales:
