NCLEX Fundamentals of Nursing MCQs (Part 3: 101–150)
101. Which technique is best to prevent infection during wound dressing changes?
A) Use of sterile gloves only
B) Strict hand hygiene before and after procedure
C) Wearing a mask only
D) Applying antiseptic solution after completion
Correct Answer: B) Strict hand hygiene before and after procedure
Explanation: While sterile gloves and masks are important, hand hygiene is the single most effective method to prevent infection transmission in nursing practice.
102. Which electrolyte imbalance is most associated with cardiac arrhythmias?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
Correct Answer: B) Hyperkalemia
Explanation: Increased potassium levels alter cardiac conduction and can cause life-threatening arrhythmias. Continuous ECG monitoring is essential.
103. Which is the safest injection site for intramuscular administration in adults?
A) Deltoid muscle
B) Vastus lateralis
C) Dorsogluteal muscle
D) Ventrogluteal muscle
Correct Answer: D) Ventrogluteal muscle
Explanation: The ventrogluteal site avoids major nerves and blood vessels, making it the safest for IM injections in adults.
104. Which nursing intervention is most appropriate for a patient with dyspnea?
A) Place patient in Trendelenburg position
B) Encourage supine lying
C) Place patient in Fowler’s or semi-Fowler’s position
D) Restrict oxygen therapy
Correct Answer: C) Place patient in Fowler’s or semi-Fowler’s position
Explanation: Upright positioning expands lung capacity and improves oxygen exchange in patients with breathing difficulty.
105. Which is the primary purpose of nursing documentation?
A) To protect the nurse legally
B) To serve as proof of workload
C) To ensure continuity of patient care
D) To provide research data
Correct Answer: C) To ensure continuity of patient care
Explanation: Nursing documentation serves as a communication tool among healthcare providers, ensuring safe and continuous patient care.
106. A nurse should check the radial pulse before administering which medication?
A) Digoxin
B) Aspirin
C) Furosemide
D) Atorvastatin
Correct Answer: A) Digoxin
Explanation: Digoxin slows heart rate; checking the apical pulse (not radial) is recommended, and the drug is withheld if HR <60 bpm.
107. Which nursing diagnosis is most appropriate for a patient on prolonged bed rest?
A) Acute confusion
B) Risk for impaired skin integrity
C) Risk for deficient fluid volume
D) Ineffective breathing pattern
Correct Answer: B) Risk for impaired skin integrity
Explanation: Prolonged immobility increases risk of pressure ulcers, making skin integrity the most relevant concern.
108. Which vital sign is assessed first in a patient suspected of shock?
A) Temperature
B) Blood pressure
C) Respiratory rate
D) Pulse
Correct Answer: B) Blood pressure
Explanation: Hypotension is the hallmark of shock and is assessed immediately to evaluate tissue perfusion.
109. Which is the most important step when administering blood transfusion?
A) Checking patient’s hemoglobin level
B) Ensuring IV line is patent
C) Verifying blood product with another nurse
D) Monitoring urine output
Correct Answer: C) Verifying blood product with another nurse
Explanation: Double-checking ensures correct patient, blood type, and unit, preventing fatal transfusion reactions.
110. Which nursing action is essential in preventing falls in elderly patients?
A) Keep side rails always raised
B) Encourage walking without assistance
C) Ensure proper lighting and remove obstacles
D) Restrict patient to bed
Correct Answer: C) Ensure proper lighting and remove obstacles
Explanation: Fall prevention includes maintaining a safe environment with clear pathways and adequate lighting.
111. Which type of isolation is required for a patient with tuberculosis (TB)?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Standard precautions only
Correct Answer: C) Airborne precautions
Explanation: TB spreads via tiny airborne particles; N95 respirators, negative-pressure rooms, and airborne isolation are required.
112. The first nursing action when a patient is having a seizure is:
A) Insert an oral airway
B) Restrain the patient
C) Protect the patient from injury
D) Administer antiseizure medication immediately
Correct Answer: C) Protect the patient from injury
Explanation: Safety is priority. Do not restrain or insert anything in the mouth. Administering meds comes after ensuring protection.
113. Which pulse site is checked during CPR to assess circulation in adults?
A) Radial
B) Brachial
C) Femoral
D) Carotid
Correct Answer: D) Carotid
Explanation: The carotid pulse is used because it is central and reliable during cardiac arrest.
114. Which oxygen delivery device provides the most precise concentration of oxygen?
A) Nasal cannula
B) Simple face mask
C) Venturi mask
D) Non-rebreather mask
Correct Answer: C) Venturi mask
Explanation: The Venturi mask delivers accurate and controlled FiO₂, especially useful for COPD patients.
115. Which assessment finding suggests fluid overload?
A) Dry skin
B) Sunken eyes
C) Crackles in lungs
D) Hypotension
Correct Answer: C) Crackles in lungs
Explanation: Excess fluid accumulates in lungs, causing pulmonary crackles, edema, and hypertension.
116. Which method is best to confirm nasogastric (NG) tube placement before feeding?
A) Checking residual volume
B) Aspirating gastric contents and checking pH
C) Blowing air and auscultating
D) Asking patient to swallow water
Correct Answer: B) Aspirating gastric contents and checking pH
Explanation: Gastric aspirate with acidic pH (≤5) is the safest bedside method; X-ray is gold standard.
117. What is the normal range of urine output per hour in adults?
A) 10–15 mL
B) 20–30 mL
C) 30–50 mL
D) 60–80 mL
Correct Answer: C) 30–50 mL
Explanation: Minimum 30 mL/hr indicates adequate renal perfusion. Less suggests oliguria.
118. Which position should the patient be placed in during lumbar puncture?
A) High Fowler’s position
B) Prone with head turned
C) Side-lying with knees flexed to chest
D) Supine with arms stretched
Correct Answer: C) Side-lying with knees flexed to chest
Explanation: This fetal position widens intervertebral spaces, allowing easier needle insertion.
119. The first step in the nursing process is:
A) Planning
B) Assessment
C) Implementation
D) Diagnosis
Correct Answer: B) Assessment
Explanation: Nursing process begins with data collection and patient assessment before diagnosis or planning.
120. Which is a correct nursing responsibility for a patient on IV potassium chloride (KCl) infusion?
A) Administer KCl via IV bolus for rapid action
B) Dilute KCl and give via slow infusion
C) Mix KCl with antibiotics
D) Store KCl in freezer before administration
Correct Answer: B) Dilute KCl and give via slow infusion
Explanation: Never give KCl as IV bolus; it causes cardiac arrest. It must always be diluted and infused slowly.
121. Which type of pain is described as sharp, localized, and short-term?
A) Visceral pain
B) Neuropathic pain
C) Somatic pain
D) Chronic pain
Correct Answer: C) Somatic pain
Explanation: Somatic pain arises from skin, muscles, joints, and bones; it is well-localized and sharp.
122. Which of the following is a priority nursing action for a patient on opioid analgesics?
A) Monitor blood pressure
B) Monitor heart rate
C) Monitor respiratory rate
D) Monitor urine output
Correct Answer: C) Monitor respiratory rate
Explanation: Respiratory depression is the most dangerous side effect of opioids.
123. Which scale is most commonly used to assess a patient’s level of consciousness?
A) Morse Fall Scale
B) Braden Scale
C) Glasgow Coma Scale
D) Apgar Score
Correct Answer: C) Glasgow Coma Scale
Explanation: GCS evaluates eye, verbal, and motor responses to assess neurological status.
124. Which infection control practice helps reduce catheter-associated UTIs?
A) Frequent irrigation of the catheter
B) Keeping catheter bag above bladder
C) Maintaining closed drainage system
D) Routine daily replacement of catheter
Correct Answer: C) Maintaining closed drainage system
Explanation: A closed system prevents bacterial entry; the bag should always be below bladder level.
125. Which is the first action in case of a fire in the hospital?
A) Activate fire alarm
B) Rescue patients in immediate danger
C) Extinguish the fire
D) Close all doors and windows
Correct Answer: B) Rescue patients in immediate danger
Explanation: Follow RACE protocol (Rescue, Alarm, Confine, Extinguish). First step is rescuing patients.
126. Which laboratory test best evaluates long-term blood glucose control?
A) Fasting blood glucose
B) Random blood glucose
C) HbA1c
D) Oral glucose tolerance test
Correct Answer: C) HbA1c
Explanation: HbA1c reflects average blood sugar levels over 2–3 months, useful for diabetes management.
127. Which is an early sign of hypoxia?
A) Cyanosis
B) Restlessness
C) Bradycardia
D) Confusion
Correct Answer: B) Restlessness
Explanation: Restlessness, anxiety, and tachypnea appear first. Cyanosis is a late sign of hypoxia.
128. Which type of precaution is required for patients with MRSA infection?
A) Airborne
B) Droplet
C) Contact
D) Standard only
Correct Answer: C) Contact
Explanation: MRSA spreads via direct or indirect contact, requiring gowns, gloves, and dedicated equipment.
129. Which electrolyte imbalance is most common in patients using loop diuretics?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hyperkalemia
Correct Answer: B) Hypokalemia
Explanation: Loop diuretics increase potassium excretion, leading to muscle weakness and arrhythmias.
130. A nurse caring for a dying patient should prioritize which intervention?
A) Provide curative treatment
B) Ensure patient comfort and dignity
C) Encourage frequent visitors
D) Focus on nutritional intake
Correct Answer: B) Ensure patient comfort and dignity
Explanation: The focus of palliative care is symptom relief, comfort, and dignity in end-of-life care.
131. Which laboratory test is most important to monitor for a patient on warfarin therapy?
A) aPTT
B) PT/INR
C) Platelet count
D) D-dimer
Correct Answer: B) PT/INR
Explanation: Warfarin therapy is guided by INR (therapeutic 2–3). aPTT monitors heparin, not warfarin.
132. Which position is recommended for a patient with hypotension?
A) Supine with head elevated
B) Trendelenburg position
C) Side-lying
D) Prone position
Correct Answer: B) Trendelenburg position
Explanation: Head down, legs up increases venous return and improves perfusion in shock/hypotension.
133. What is the primary action when administering blood transfusion?
A) Start IV antibiotics first
B) Verify patient ID and blood compatibility with another nurse
C) Warm the blood before transfusion
D) Infuse rapidly within 30 minutes
Correct Answer: B) Verify patient ID and blood compatibility with another nurse
Explanation: The double-check process prevents fatal transfusion reactions.
134. Which nursing action is best for preventing pressure ulcers?
A) Massage bony prominences
B) Keep patient in high Fowler’s
C) Reposition patient every 2 hours
D) Increase fluid restriction
Correct Answer: C) Reposition patient every 2 hours
Explanation: Frequent repositioning and skin care prevent pressure injury. Massaging bony areas is harmful.
135. A patient with COPD should receive oxygen at which rate?
A) 1–2 L/min via nasal cannula
B) 4–6 L/min via nasal cannula
C) 8–10 L/min via mask
D) 15 L/min via non-rebreather mask
Correct Answer: A) 1–2 L/min via nasal cannula
Explanation: High oxygen can suppress hypoxic drive in COPD. Low-flow O₂ is safe.
136. Which finding is most critical to report in a post-operative patient?
A) Pain score of 6/10
B) Urine output 35 mL/hr
C) Respiratory rate 8/min
D) Temperature 100.2°F (37.9°C)
Correct Answer: C) Respiratory rate 8/min
Explanation: Severe respiratory depression is life-threatening, requiring immediate action.
137. Which nursing intervention is most important for preventing aspiration in a patient with dysphagia?
A) Provide thin liquids
B) Feed in semi-Fowler’s
C) Keep patient upright during and after meals
D) Place food at the back of throat
Correct Answer: C) Keep patient upright during and after meals
Explanation: Upright position reduces risk of choking and aspiration pneumonia.
138. Which vitamin deficiency causes rickets in children?
A) Vitamin A
B) Vitamin B12
C) Vitamin C
D) Vitamin D
Correct Answer: D) Vitamin D
Explanation: Lack of vitamin D causes soft bones, bow legs, and rickets.
139. What is the recommended site for intramuscular injection in infants under 12 months?
A) Deltoid
B) Vastus lateralis
C) Dorsogluteal
D) Ventrogluteal
Correct Answer: B) Vastus lateralis
Explanation: Vastus lateralis (thigh) is safest in infants due to good muscle mass.
140. Which electrolyte imbalance increases the risk of cardiac arrest?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
Correct Answer: B) Hyperkalemia
Explanation: Excess potassium disrupts cardiac conduction, leading to fatal arrhythmias.
141. Which nursing action is correct when administering ear drops to an adult?
A) Pull the pinna down and back
B) Pull the pinna up and back
C) Insert drops directly onto the eardrum
D) Place cotton tightly after drops
Correct Answer: B) Pull the pinna up and back
Explanation: This straightens the ear canal in adults; in children under 3, pull down and back.
142. Which patient is at highest risk for developing pneumonia?
A) A young adult with mild fever
B) A post-surgical patient with immobility
C) A child with a sore throat
D) A pregnant woman with morning sickness
Correct Answer: B) A post-surgical patient with immobility
Explanation: Immobility, anesthesia, and shallow breathing increase pneumonia risk post-surgery.
143. Which is the normal range for adult respiratory rate?
A) 8–12 breaths/min
B) 12–20 breaths/min
C) 20–28 breaths/min
D) 28–36 breaths/min
Correct Answer: B) 12–20 breaths/min
Explanation: Normal adult respiratory rate is 12–20 per minute.
144. Which assessment is priority before administering digoxin?
A) Blood pressure
B) Apical pulse
C) Respiratory rate
D) Oxygen saturation
Correct Answer: B) Apical pulse
Explanation: Hold digoxin if apical pulse <60 bpm to prevent toxicity.
145. Which complication is most associated with immobility?
A) Hypertension
B) Pressure ulcers
C) Polycythemia
D) Hyperglycemia
Correct Answer: B) Pressure ulcers
Explanation: Prolonged immobility leads to skin breakdown and ulcers.
146. Which dietary instruction is important for patients on iron supplements?
A) Take with milk for better absorption
B) Take with vitamin C-rich foods
C) Avoid citrus fruits
D) Always take on empty stomach only
Correct Answer: B) Take with vitamin C-rich foods
Explanation: Vitamin C enhances iron absorption; milk reduces absorption.
147. Which nursing intervention prevents deep vein thrombosis (DVT) in immobile patients?
A) Keep legs crossed in bed
B) Apply anti-embolic stockings
C) Encourage complete bed rest
D) Restrict fluid intake
Correct Answer: B) Apply anti-embolic stockings
Explanation: Stockings and mobility improve circulation and prevent clot formation.
148. Which condition requires strict neutropenic precautions?
A) Burns
B) Leukemia with chemotherapy
C) Asthma
D) Chronic kidney disease
Correct Answer: B) Leukemia with chemotherapy
Explanation: Low WBC counts increase infection risk; protective isolation is necessary.
149. Which finding suggests infiltration at an IV site?
A) Redness and warmth
B) Coolness, swelling, and pain
C) Presence of pus
D) Hard, cord-like vein
Correct Answer: B) Coolness, swelling, and pain
Explanation: IV fluid leakage into tissues causes cool, swollen, and painful site.
150. Which is the correct sequence for donning personal protective equipment (PPE)?
A) Gloves → Gown → Mask → Goggles
B) Gown → Mask → Goggles → Gloves
C) Mask → Gloves → Gown → Goggles
D) Goggles → Mask → Gown → Gloves
Correct Answer: B) Gown → Mask → Goggles → Gloves
Explanation: Correct order is Gown → Mask/Respirator → Goggles/Face shield → Gloves.
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