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NCLEX-RNFree Registered Nurses Licensure Examination practice test
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A 6-year-old child who had a tonsillectomy 3 hours ago is complaining of throat pain. The next scheduled analgesic dose is still an hour away. Which comfort measure can the nurse safely offer at this time?
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Q1. A 6-year-old child who had a tonsillectomy 3 hours ago is complaining of throat pain. The next scheduled analgesic dose is still an hour away. Which comfort measure can the nurse safely offer at this time?
Correct answer: B. Offer ice chips
Ice chips are appropriate once the child is alert and awake following tonsillectomy. The cold temperature promotes local vasoconstriction and a numbing effect that reduces pain and swelling while also limiting the risk of postoperative bleeding — a safe, nonpharmacologic comfort intervention during the immediate recovery period. Warm liquids such as soup or warm milk promote vasodilation at the surgical site, which can increase the risk of postoperative bleeding. Milk-based beverages may increase mucus production and are not recommended in the first hours after tonsillectomy. Oropharyngeal suctioning should be avoided unless clinically necessary because the mechanical trauma may disrupt the surgical site and trigger bleeding.
Q2. An elderly client with a long-standing diagnosis of chronic obstructive pulmonary disease develops worsening shortness of breath. Which position should the nurse encourage to best ease the client's breathing?
Correct answer: D. Sitting upright with the body leaning slightly forward
The tripod position — sitting upright and leaning slightly forward — maximizes chest expansion, recruits accessory muscles, and facilitates diaphragmatic descent. Clients with COPD frequently adopt this posture instinctively during dyspneic episodes because it reduces the effort of breathing more effectively than other positions. Lateral positioning with minimal head elevation does not sufficiently optimize pulmonary expansion and may intensify dyspnea. Semi-Fowler's position is superior to lying flat but does not provide the same respiratory benefit as leaning forward in an upright posture during acute shortness of breath. Lying flat increases diaphragmatic resistance and can significantly worsen respiratory difficulty in clients with chronic lung disease.
Q3. A child has been diagnosed with lactose intolerance. Which nutritional deficiencies is this child most at risk for developing? Select all that apply.
Correct answer: B. Vitamin D
Vitamin D deficiency is a significant risk because dairy products are a primary dietary source of this nutrient. When dairy is restricted or eliminated to prevent gastrointestinal symptoms, inadequate vitamin D intake can occur unless fortified alternatives or supplements are used. Vitamin D is critical for calcium absorption and healthy bone development in children. Calcium deficiency is also a concern because milk and dairy products supply the majority of dietary calcium for most children. Without adequate substitution, reduced dairy intake can impair bone mineralization and increase the risk of growth delays. Vitamin C is primarily obtained from fruits and vegetables, which are generally well tolerated by children with lactose intolerance and are not restricted in this condition. Folate is sourced mainly from leafy greens, legumes, and fortified grains rather than dairy foods, so lactose intolerance does not significantly affect folate status. Vitamin A is available through a variety of fruits, vegetables, and fortified non-dairy foods, so its intake is not substantially compromised by avoiding dairy.
Q4. A client with renal calculi is receiving discharge nutrition teaching. Which food items should the nurse advise the client to limit or avoid? Select all that apply.
Correct answer: B. Sardines and herring
Sardines and herring are high in purines, which are metabolized to uric acid. Elevated uric acid levels contribute to uric acid kidney stone formation, making these foods problematic for clients with renal calculi. Spinach and asparagus are rich in oxalates. When oxalates bind with urinary calcium, calcium oxalate stones can form, which is the most common type of kidney stone. Milk and cheese are high-calcium foods. In susceptible individuals, excessive calcium intake can elevate urinary calcium excretion and promote calcium-based stone formation. Grapes, melon, and bananas are low in oxalates and purines and are generally encouraged in a stone-prevention diet. Cucumbers and cauliflower are low in both oxalates and purines and represent safe dietary choices for clients managing renal calculi.
Q5. A client has a wound over the coccyx measuring 2 cm × 2 cm. The wound contains yellow slough and areas of granulation tissue. Subcutaneous adipose tissue is visible, but bone and muscle remain covered. The wound depth is 4 cm, and tunneling is noted at the 2 o'clock position. Which pressure injury stage does this wound represent?
Correct answer: B. Stage III
Stage III pressure injuries involve full-thickness skin loss with damage extending into subcutaneous tissue. Adipose tissue may be visible, slough is common, and tunneling or undermining can be present. Exposed bone, tendon, or muscle is absent. Depth varies by anatomical site, and wounds over the coccyx may appear quite deep due to limited tissue layers. Stage II involves partial-thickness skin loss exposing the dermis and does not include slough, tunneling, or visible subcutaneous fat. Stage I is marked by nonblanchable erythema of intact skin with no open tissue loss. Stage IV involves full-thickness tissue loss with exposed bone, tendon, or muscle — findings not present in this wound.
Q6. A client with a severe ankle sprain is being discharged. The client asks what can be done at home to relieve pain. Which recommendation is appropriate for managing a sprain or strain?
Correct answer: A. Place ice over the injured area for 10 to 15 minutes, three to four times each day
Cold therapy is a standard initial intervention for sprains and strains. Brief, repeated ice applications induce vasoconstriction, limit swelling and inflammation, and provide analgesia. This measure can be safely performed at home and supports recovery during the acute injury phase. Dependent positioning of the injured limb promotes edema accumulation and worsens pain; the ankle should be elevated above heart level to facilitate venous return and reduce swelling. Brisk walking places excessive stress on damaged ligamentous tissue. Rest is essential during the acute phase to prevent further injury and control pain and swelling. While ibuprofen is appropriate for analgesia, 800 mg taken four times daily exceeds standard over-the-counter dosing and increases the risk of adverse gastrointestinal and renal effects. Clients should be advised to follow prescribed or labeled dosing instructions.
Q7. A client has been newly diagnosed with iron deficiency anemia. During dietary teaching, which foods should the nurse instruct the client to include for their iron content? Select all that apply.
Correct answer: A. Legumes
Dark green leafy vegetables such as spinach and kale are nonheme iron sources that support hemoglobin synthesis. Pairing them with vitamin C–rich foods enhances nonheme iron absorption. Dried fruits including raisins and apricots contain nonheme iron and are a convenient option for increasing daily iron intake. Legumes such as beans and lentils provide substantial nonheme iron and are appropriate for clients following plant-based or mixed dietary patterns. Fortified or enriched breads and cereals are common dietary iron sources that can meaningfully boost daily iron consumption. Dairy products are not significant sources of dietary iron, and their calcium content may actually inhibit iron absorption. Egg whites contain negligible iron; the iron in eggs is concentrated in the yolk, so egg whites are an ineffective choice for boosting iron intake.
Q8. A client has been newly diagnosed with pancreatitis. The nurse is advising on appropriate meal choices. Which options are suitable for this client? Select all that apply.
Correct answer: A. Baked chicken with rice
Clients with pancreatitis require a low-fat diet to minimize pancreatic stimulation. Baked chicken provides lean protein and rice offers easily digestible carbohydrates, making this combination appropriate during pancreatitis recovery. Egg whites are a low-fat protein source, and fresh fruit provides carbohydrates and vitamins without triggering significant pancreatic enzyme secretion, making this a suitable meal choice. Bacon and avocado are both high in fat. Fat intake increases pancreatic enzyme output, which can worsen inflammation and trigger pain in clients with pancreatitis. Fried eggs and whole milk contain substantial amounts of fat, which stimulate pancreatic enzyme secretion and can exacerbate symptoms, making this meal inappropriate for a client with pancreatitis.
Q9. A client has been seated on the toilet for 30 minutes and is unable to expel stool despite straining. Hard stool is visible at the rectal opening. What is the nurse's most appropriate immediate action?
Correct answer: C. Perform manual disimpaction using gloves and a water-soluble lubricant
Visible hardened stool at the rectum combined with prolonged straining indicates fecal impaction. Manual disimpaction provides the most immediate relief when stool is already obstructing the rectum. The nurse should apply adequate lubrication, use gloves, monitor for a vagal response, and follow institutional policy regarding any required orders for this procedure. An oral laxative is not appropriate as the initial intervention because it takes hours to work and cannot move stool that is already lodged in the rectum; it may worsen distension and discomfort. A rectal suppository is unlikely to be effective because impacted stool blocks contact between the suppository and the rectal mucosa. A sodium phosphate enema may be contraindicated when firm stool is already present at the rectal outlet and should not be attempted until the obstruction is cleared.
Q10. A client with infectious diarrhea has been started on antibiotics and asks what to eat until the diarrhea resolves. Which reply by the nurse is most appropriate?
Correct answer: B. "Choose bland foods such as toast, applesauce, rice, and bananas."
Low-residue, bland foods are less irritating to the gastrointestinal tract and easier to digest during episodes of diarrhea. Foods such as toast, applesauce, rice, and bananas help reduce stool frequency, support fluid and electrolyte balance, and allow intestinal mucosa to recover — reflecting safe, evidence-based nutritional guidance. Spicy foods irritate the gastrointestinal lining and can worsen diarrhea; they have no antimicrobial effect. Caffeine stimulates intestinal motility, increasing stool frequency and accelerating fluid loss, which elevates the risk of dehydration. High-fiber foods increase bowel transit speed and stool bulk; they are contraindicated during acute diarrhea and may aggravate symptoms.
Exam facts and objectives sourced from the official NCSBN certification page. Last reviewed June 2026.
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