NCLEX practice questions are most useful when they make you choose the safest next action, not merely recall a definition. The NCLEX-RN uses computerised adaptive testing and may include multiple-choice and other item types. Its questions test application and clinical judgement, including prioritisation, delegation, medication safety and recognition of deterioration.
For each item below, select the single best answer. The explanation follows immediately so you can examine the cue you used, the risk you prioritised and the action you chose.
The first item below is a MySummaries-style question focused on airway risk after surgery.
A client is 4 hours post-thyroidectomy. The client develops restlessness, noisy inspiration, and increasing neck swelling. The oxygen saturation is 91% on room air. Which action should the nurse take first?
The correct answer is to place the client in a high-Fowler position and apply oxygen. Noisy inspiration and neck swelling suggest airway compression, so immediate airway and breathing support comes before routine notification or analgesia. The strongest distractor is notifying the surgeon: escalation is necessary, but the nurse must begin emergency supportive care rather than wait.
The key cue is stridor or noisy inspiration with swelling: this is an airway threat. In a real emergency, the nurse would also activate the appropriate emergency response and remain with the client. Do not let a post-operative pain complaint distract from a potentially obstructed airway.
Question 2: delegation
This tests whether the task is appropriate for an unlicensed assistive personnel member and whether the client is stable.
The registered nurse is caring for four clients. Which task is appropriate to delegate to an experienced unlicensed assistive personnel member?
The routine weight of a stable client is within an unlicensed assistive personnel member's role when the person has been trained and the nurse provides appropriate supervision. Teaching, assessment and evaluation remain nursing responsibilities. The strongest distractor is the antihypertensive task: obtaining observations may be delegated, but evaluating a medication response requires nursing judgement.
A reliable delegation check is: is the client stable, is the task predictable, and does it require assessment, teaching or evaluation? If the answer involves a change in condition or clinical judgement, keep it with the registered nurse.
Question 3: hypoglycaemia
This tests immediate treatment of a conscious client who can swallow safely.
A client with diabetes is awake, able to swallow, diaphoretic and shaky. The blood glucose is fifty-four milligrams per decilitre (3.0 mmol/L). Which intervention should the nurse perform first?
A conscious client who can swallow should receive about 15 g of rapid-acting carbohydrate, followed by reassessment according to local protocol. Insulin would worsen the hypoglycaemia. The strongest distractor is a protein meal: protein is not the fastest correction for an acute low glucose level.
The sequence matters: recognise the low glucose, confirm the client can protect the airway, give fast carbohydrate, reassess and provide longer-acting food if indicated. If the client cannot swallow or is unconscious, oral carbohydrate is unsafe and the emergency hypoglycaemia protocol is different.
Question 4: deterioration and sepsis risk
This tests prioritisation when several findings point to acute deterioration.
Which client should the nurse assess first?
New confusion, tachypnoea and hypotension indicate possible sepsis and poor perfusion. This client is unstable and needs immediate assessment and escalation. The urinary symptoms may require review, but the client described is not showing the same immediate threat to airway, breathing or circulation. The strongest distractor is the catheter-associated complaint because it may indicate infection, but the unstable client comes first.
Prioritisation is not based on which diagnosis sounds most serious. Compare the current cues, identify instability and act before harm progresses. Assessment should include immediate observations and escalation through the facility's emergency or sepsis pathway.
Question 5: airborne precautions
This tests infection-control action for suspected pulmonary tuberculosis.
A client is admitted with suspected infectious pulmonary tuberculosis. Which nursing action is correct?
Suspected infectious pulmonary tuberculosis requires airborne precautions, including a negative-pressure room when available and appropriate respiratory protection such as a fit-tested N95 respirator. A surgical mask may be used for the client during transport, but it does not replace the staff respirator. The strongest distractor is the positive-pressure room, which is used to protect certain immunocompromised clients, not to contain airborne infection.
The question is testing the route of transmission rather than a tuberculosis drug regimen. Match the isolation measure to the organism and route, then follow the organisation's infection-control policy.
Question 6: transfusion reaction
This tests the first response to a potentially life-threatening medication and blood-product reaction.
Fifteen minutes after a packed red blood cell transfusion begins, the client reports chills and low back pain. Which action should the nurse take first?
Stop the transfusion immediately and maintain venous access with normal saline using new tubing, while following the transfusion-reaction protocol and notifying the appropriate clinicians. Continuing or slowing the transfusion exposes the client to more of the suspected cause. The strongest distractor is an antipyretic: it may mask symptoms and does not remove the source of the reaction.
The first action removes the suspected harmful exposure. Subsequent actions usually include checking vital signs, notifying the provider and blood bank, verifying identification and preparing the product and required specimens according to policy.
Question 7: chest pain
This tests whether the nurse selects an immediate diagnostic action rather than giving an intervention without assessing the client.
A client reports sudden crushing substernal chest pain with nausea and diaphoresis. Which action should the nurse take first?
Vital signs and an immediate 12-lead ECG help identify a time-critical cardiac problem and guide treatment. The nurse should also escalate according to the emergency chest-pain pathway. The strongest distractor is oxygen for every client: oxygen is not automatically required when saturation is adequate, whereas rapid assessment is essential.
The phrase “first” does not always mean “perform a treatment”. When the client is not in respiratory arrest, collect the critical cues that determine the next safe intervention. Avoid delaying assessment with comfort measures or unnecessary activity.
Question 8: postpartum haemorrhage
This tests recognition of poor uterine tone and an immediate bedside action.
One hour after a vaginal birth, a client has heavy vaginal bleeding and a soft, boggy uterus. Which action should the nurse take first?
A boggy uterus suggests uterine atony, a common cause of postpartum haemorrhage. Fundal massage is an immediate nursing action to promote uterine contraction, followed by urgent assessment and escalation according to protocol. The strongest distractor is a cold perineal pack: it may help local discomfort but does not address the bleeding source.
Here the physical finding changes the priority. Heavy bleeding with a boggy fundus requires prompt action, quantification of blood loss, vital-sign assessment and escalation; it is not a documentation-and-wait situation.
Question 9: lithium toxicity
This tests medication monitoring and recognition of toxicity rather than routine administration.
A client taking lithium reports worsening diarrhoea, coarse tremors and unsteady gait. Which action should the nurse take?
Diarrhoea, coarse tremor and ataxia can indicate lithium toxicity. Hold the dose and notify the provider promptly for assessment and possible serum testing, while maintaining safety precautions. The strongest distractor is giving lithium with food: food may reduce mild nausea, but it is not an appropriate response to neurological signs suggesting toxicity.
Medication questions often turn on a change from an expected effect to a dangerous one. Link the symptom pattern to the drug, hold a potentially harmful dose when appropriate, and escalate rather than reassuring the client without assessment.
Question 10: supervision after delegation
This tests the registered nurse's continuing responsibility after assigning a task.
The nurse delegates ambulation to an experienced unlicensed assistive personnel member for a stable client who is recovering from pneumonia. The assistant reports that the client became short of breath and needed to sit down. What should the nurse do first?
A new symptom after activity is a change in condition, so the nurse must assess the client immediately and determine whether escalation is needed. Delegation transfers a task, not accountability for assessment and follow-up. The strongest distractor is asking for documentation first: documentation matters, but it must follow immediate assessment and safety actions.
The most useful question to ask after delegation is not only “Was the task completed?” but “Did the client tolerate it, and has the condition changed?” Any new shortness of breath, chest pain, confusion or instability brings the registered nurse back to direct assessment.
Review the misses, not just the score
A percentage alone is not the main measure of readiness for a computerised adaptive exam. Review each choice by asking:
- Which cue indicated immediate risk?
- Did I assess before intervening when appropriate?
- Did I put an unstable client before a stable one?
- Was the task inside the delegatee's scope?
- Did I recognise a contraindication, adverse effect or treatment failure?
- What would I monitor after the first action?
A review screen can group your errors by the decision that caused them:
Study the lowest section first, but do not simply reread it. Turn each error into a short rule tied to a cue: “new stridor after neck surgery means airway support first” or “a delegated client who becomes short of breath needs direct nursing assessment”. Then answer a new question testing the same decision in a different clinical setting.
A repeated error should become a small remediation prompt rather than another full chapter to review:
You lost this mark twice: a client becomes newly confused, tachypnoeic and hypotensive. What makes this client higher priority than a stable client reporting a less urgent symptom?
How MySummaries helps
MySummaries can turn your own nursing notes into a revision board, then generate question practice, spaced-repetition cards, marked written work and audio explanations. For this task, use it to separate prioritisation, delegation, medication safety and deterioration, then revisit the topics attached to repeated errors.