NCLEX-RN Practice Exam #2 (40 Questions)

Another set of 40-item NCLEX exam. These questions can help you sharpen your critical thinking skills and prepare you for the big exam day!

If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.
–Martin Luther King, Jr.

Topics

Questions on this exam are in random and taken from various nursing core concepts.

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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NCLEX Practice Exam 2 (40 Items)

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NCLEX Practice Exam 2 (40 Items)

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1. A nurse is reviewing a patient’s medication during shift change. Which of the following medications would be contraindicated if the patient were pregnant? Select all that apply:

A. Warfarin (Coumadin)
B. Finasteride (Propecia, Proscar)
C. Celecoxib (Celebrex)
D. Clonidine (Catapres)
E. Transdermal nicotine (Habitrol)
F. Clofazimine(Lamprene)

2. A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has photosensitive reactions to medications. Which of the following drugs is associated with photosensitive reactions? Select all that apply: 

A. Ciprofloxacin (Cipro)
B. Sulfonamide
C. Norfloxacin (Noroxin)
D. Sulfamethoxazole and Trimethoprim (Bactrim)
E. Isotretinoin (Accutane)
F. Nitro-Dur patch

3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration?

A. Sulfasalazine
B. Levodopa
C. Phenolphthalein
D. Aspirin

4. You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drug, if found inside the fridge, should be removed? 

A. Nadolol (Corgard)
B. Opened (in-use) Humulin N injection
C. Urokinase (Kinlytic)
D. Epoetin alfa IV (Epogen)

5. A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

A. IgA
B. IgD
C. IgE
D. IgG

6. A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that nursing student should take?

A. Immediately see a social worker.
B. Start prophylactic AZT treatment.
C. Start prophylactic Pentamidine treatment.
D. Seek counseling.

7. A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

A. Atherosclerosis
B. Diabetic nephropathy
C. Autonomic neuropathy
D. Somatic neuropathy

8. You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?

A. Multiple sclerosis
B. Anorexia nervosa
C. Bulimia nervosa
D. Systemic sclerosis

9. A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect?

A. Diverticulosis
B. Hypercalcemia
C. Hypocalcemia
D. Irritable bowel syndrome

10. Rhogam is most often used to treat____ mothers that have a ____ infant.

A. RH positive, RH positive
B. RH positive, RH negative
C. RH negative, RH positive
D. RH negative, RH negative

11. A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU?

A. A Guthrie test can check the necessary lab values.
B. The urine has a high concentration of phenylpyruvic acid
C. Mental deficits are often present with PKU.
D. The effects of PKU are reversible.

12. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient?

A. Onset of pulmonary edema
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Parkinson’s disease type symptoms

13. A 50-year-old blind and deaf patient have been admitted to your floor. As the charge nurse, your primary responsibility for this patient is?

A. Let others know about the patient’s deficits.
B. Communicate with your supervisor your patient safety concerns.
C. Continuously update the patient on the social environment.
D. Provide a secure environment for the patient.

14. A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient?

A. Deep breathing techniques to increase oxygen levels.
B. Cough regularly and deeply to clear airway passages.
C. Cough following bronchodilator utilization.
D. Decrease CO2 levels by increased oxygen take output during meals.

15. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present?

A. Slow pulse rate
B. Weight gain
C. Decreased systolic pressure
D. Irregular WBC lab values

16. A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome?

A. Simian crease
B. Brachycephaly
C. Oily skin
D. Hypotonicity

17. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following?

A. Observe for neurological changes.
B. Monitor for any signs of renal failure.
C. Check the food diary.
D. Observe for signs of bleeding.

18. A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?”

A. Green vegetables and liver
B. Yellow vegetables and red meat
C. Carrots
D. Milk

19. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans?

A. S. pneumoniae
B. H. influenzae
C. N. meningitidis
D. Cl. difficile

20. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC’s last in my body? The correct response is.

A. The life span of RBC is 45 days.
B. The life span of RBC is 60 days.
C. The life span of RBC is 90 days.
D. The life span of RBC is 120 days.

21. A 65-year-old man has been admitted to the hospital for spinal stenosis surgery. When should the discharge training and planning begin for this patient?

A. Following surgery
B. Upon admit
C. Within 48 hours of discharge
D. Preoperative discussion

22. A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s psychosocial development stages, the child is in which stage?

A. Trust vs. mistrust
B. Initiative vs. guilt
C. Autonomy vs. shame and doubt
D. Intimacy vs. isolation

23. A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in?

A. Trust vs. mistrust
B. Initiative vs. guilt
C. Autonomy vs. shame and doubt
D. Intimacy vs. isolation

24. A young adult is 20 years old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the adult in?

A. Trust vs. mistrust
B. Initiative vs. guilt
C. Autonomy vs. shame
D. Intimacy vs. isolation

25. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal?

A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg
B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg
C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg
D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg

26. When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking?

A. Amitriptyline (Elavil)
B. Calcitonin
C. Pergolide mesylate (Permax)
D. Verapamil (Calan)

27. Which of the following conditions would a nurse not administer erythromycin?

A. Campylobacteriosis infection
B. Legionnaire’s disease
C. Pneumonia
D. Multiple Sclerosis

28. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute?

A. Decreased HR
B. Paresthesias
C. Muscle weakness of the extremities
D. Migraines

29. A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?

A. Vomiting
B. Extreme Thirst
C. Weight gain
D. Acetone breath smell

30. A patient’s chart indicates a history of meningitis. Which of the following would you not expect to see with this patient if this condition were acute?

A. Increased appetite
B. Vomiting
C. Fever
D. Poor tolerance of light

31. A nurse if reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which of the following microorganisms is related to this condition?

A. Yersinia pestis
B. Helicobacter pylori
C. Vibrio cholerae
D. Haemophilus aegyptius

32. A nurse if reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition?

A. Borrelia burgdorferi
B. Streptococcus pyogenes
C. Bacillus anthracis
D. Enterococcus faecalis

33. A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?

A. FBC (full blood count)
B. ECG (electrocardiogram)
C. Thyroid function tests
D. CT scan

34. An 84-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

A. FBC (full blood count)
B. ECG (electrocardiogram)
C. Thyroid function tests
D. CT scan

35. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

A. Blood sugar check
B. CT scan
C. Blood cultures
D. Arterial blood gases

36. A 28-year-old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?

A. Blood sugar check
B. CT scan
C. Blood cultures
D. Arterial blood gases

37. A mother is inquiring about her child’s ability to potty train. Which of the following factors is the most important aspect of toilet training?

A. The age of the child
B. The child’s ability to understand instruction.
C. The overall mental and physical abilities of the child.
D. Frequent attempts with positive reinforcement.

38. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20 minutes. Which of the following is the most important instruction the nurse can give the parent?

A. This too shall pass.
B. Take the child immediately to the ER
C. Contact the Poison Control Center quickly
D. Give the child syrup of ipecac

39. A nurse is administering a shot of Vitamin K to a 30 day-old infant. Which of the following target areas is the most appropriate?

A. Gluteus maximus
B. Gluteus minimus
C. Vastus lateralis
D. Vastus medialis

40. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4-year-old boy who is non-verbal. This child does not have on any identification. What should the nurse do?

A. Contact the provider
B. Ask the child to write their name on paper.
C. Ask a coworker about the identification of the child.
D. Ask the father who is in the room the child’s name.

Answers and Rationale


1. Answers: A, and B. 

  • Option A: Warfarin (Coumadin). Has a pregnancy category X and associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when given anytime during pregnancy and a fetal warfarin syndrome when given during the first trimester.
  • Option B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of causing permanent damage to the fetus.
  • Option C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; not known if the effect on people is the same.
  • Option D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed.
  • Option E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to pregnancy category C (nicotine gum) and category D (transdermal patches, inhalers, and spray nicotine products).
  • Option F: Clofazimine (Lamprene). Clofazimine has been assigned to pregnancy category C.

2. Answers: A, B, C, D, and E. 

Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Antiinfectives are the most common cause of this type of reaction.

3. Answer: D. Aspirin

 Aspirin is not known to cause discoloration of the urine.

  • Option A: Sulfasalazine may discolor the urine or skin to an orange-yellow color.
  • Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color.
  • Option C: Phenolphthalein can discolor the urine to a red color.

4. Answer: A. Corgard

Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store in the bathroom and keep bottle tightly closed.

  • Option B: Humulin N injection if unopened (not in use) is stored in the fridge and is used until the expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen.
  • Option C: Urokinase (Kinlytic) is refrigerated at 2–8°C.
  • Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light.

5. Answer: D. IgG

IgG is the only immunoglobulin that can cross the placental barrier.

  • Option A: IgA antibodies protect body surfaces that are exposed to outside foreign substances.
  • Option B: IgD antibodies are found in small amounts in the tissues that line the belly or chest.
  • Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander.

6. Answer: B. Start prophylactic AZT treatment

Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus.

  • Options A and D: Other interventions mentioned are to be done later.
  • Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia

7. Answer: C. Autonomic neuropathy

Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy.

  • Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood).
  • Option B: Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality.
  • Option D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and possible amputation.

8. Answer: B. Anorexia nervosa

All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse.

  • Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged.
  • Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives or diuretics.
  • Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue.

9. Answer: B. Hypercalcemia

Hypercalcemia can cause polyuria, severe abdominal pain, and confusion.

  • Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms.
  • Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia.
  • Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection.

10. Answer: C. RH negative, RH positive

Rhogam prevents the production of anti-RH antibodies in the mother that has a Rh-positive fetus.

11. Answer: D. The effects of PKU are reversible.

Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with classic PKU appear normal until they are a few months old. Without treatment, these children develop a permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than unaffected family members and are also likely to have skin disorders such as eczema. The effects of PKU stay with the infant throughout their life (via Genetic Home Reference).

12. Answer: A. Onset of pulmonary edema

  • Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
  • Early symptoms of aspirin poisoning also include tinnitus, hyperventilation, vomiting, dehydration, and fever. Late signs include drowsiness, bizarre behavior, unsteady walking, and coma. Abnormal breathing caused by aspirin poisoning is usually rapid and deep.
  • Pulmonary edema may be related to an increase in permeability within the capillaries of the lung leading to “protein leakage” and transudation of fluid in both renal and pulmonary tissues. The alteration in renal tubule permeability may lead to a change in colloid osmotic pressure and thus facilitate pulmonary edema (via Medscape).

13. Answer: D. Provide a secure environment for the patient.

This patient’s safety is your primary concern.

14. Answer: C. Cough following bronchodilator utilization

The bronchodilator will allow a more productive cough.

15. Answer: B. Weight gain

Weight gain due to fluid accumulation is associated with heart failure and congenital heart defects.

16. Answer: C. Oily skin

The skin would be dry and not oily.

17. Answer: D. Observe for signs of bleeding.

Bleeding is the priority concern for a client taking thrombolytic medication.

  • Options A and B: Are monitored but are not the primary concern.
  • Option C: is not related to the use of medication.

18. Answer: A. Green vegetables and liver

Green vegetables and liver are a great source of folic acid.

19. Answer: D. Cl. difficile

Cl. difficile has not been linked to meningitis.

20. Answer: D. The life span of RBC is 120 days.

Red blood cells have a lifespan of 120 in the body.

21. Answer: B. Upon admit

Discharge education begins upon admission.

22. Answer: B. Initiative vs. guilt

Initiative vs. guilt- 3-6 years old

23. Answer: C. Autonomy vs. shame

Autonomy vs Shame and doubt is at 12-18 months old

24. Answer: D. Intimacy vs. isolation

Intimacy vs. isolation- 18-35 years old

25. Answer:  B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg

HR and Respirations are slightly increased. BP is down.

26. Answer: A. Elavil

Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression.

  • Option B: Calcitonin is used to treat osteoporosis in women who have been in menopause.
  • Option C: Pergolide mesylate (Permax) is used in the treatment of Parkinson’s disease.
  • Option D: Verapamil (Calan) is a calcium channel blocker.

27. Answer: D. Multiple Sclerosis

Erythromycin is used to treat conditions A-C.

28. Answer: D. Migraines

Answer choices A-C were symptoms of acute hyperkalemia.

29. Answer: C. Weight gain

Weight loss would be expected.

30. Answer: A. Increased appetite

Loss of appetite would be expected.

31. Answer: D. Haemophilus aegyptius

  • Option A: is linked to Plague
  • Option B: is linked to peptic ulcers
  • Option C: is linked to Cholera.

32. Answer: A. Borrelia burgdorferi

  • Option B: is linked to Rheumatic fever
  • Option C: is linked to Anthrax
  • Option D: is linked to Endocarditis.

33. Answer: D. CT scan

A CT scan would be performed for further investigation of the hemiparesis.

34. Answer: C. Thyroid function tests

Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function.

35. Answer: C. Blood cultures

Blood cultures would be performed to investigate the fever and rash symptoms.

36. Answer: A. Blood sugar check

With a history of diabetes, the first response should be to check blood sugar levels.

37. Answer: C. The overall mental and physical abilities of the child.

Age is not the greatest factor in potty training. The overall mental and physical abilities of the child are the most important factor.

38. Answer: C. Contact the Poison Control Center quickly

The poison control center will have an exact plan of action for this child.

39. Answer: C. Vastus lateralis

Vastus lateralis is the most appropriate location.

40. Answer: D. Ask the father who is in the room the child’s name.

In this case, you can determine the name of the child by the father’s statement. You should not withhold the medication from the child after identification.

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Recommended Books and Resources


Selected NCLEX-RN review books: 

  1.  MUST HAVE:  Saunders Comprehensive Review for the NCLEX-RN® Examination, 7th Edition – A must have book if you're taking the NCLEX-RN. You need to have this.
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