NCLEX Basic Care and Comfort Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Nutrition and Oral Hydration | Therapeutic diets, dysphagia and enteral feeding | 5 |
| Mobility and Immobility | Positioning, transfers and the hazards of bed rest | 4 |
| Elimination | Bowel and bladder care, ostomies and catheters | 3 |
| Hygiene and Skin Integrity | Pressure injury prevention and wound care | 3 |
| Non-Pharmacological Comfort | Heat, cold, positioning and complementary measures | 2 |
| Rest and Sleep | Sleep hygiene and non-pharmacological support | 1 |
Item formats in this test: Multiple choice, Fill in the blank, Select all that apply. This is test 8 of 9 — there is one for every client-need category.
The 18 questions
A client with left-sided weakness is learning to use a cane. Which instruction is correct?
Show answer and rationale
Correct answer: B. "Hold the cane in your right hand and move it forward with your left leg."
The cane goes in the hand opposite the weak side and advances together with the weak leg. This widens the base of support and shifts weight away from the affected limb.
Why the other options are wrong
- A. Placing the cane on the weak side gives no support to that limb.
- C. Cane placement is determined by biomechanics, not preference.
- D. Cane and weak leg on the same side provides no offloading.
Which stoma assessment finding should the nurse report immediately?
Show answer and rationale
Correct answer: C. Dark purple, dry appearance
A dark purple, dusky or dry stoma indicates compromised blood supply and possible necrosis. It requires immediate reporting because the stoma may need surgical revision.
Why the other options are wrong
- A. Pink and moist is the expected healthy appearance.
- B. A stoma is highly vascular, so slight bleeding with cleaning is normal.
- D. Some oedema is expected in the early post-operative period and settles over weeks.
A client sustained an ankle sprain two hours ago. Which comfort measure is most appropriate?
Show answer and rationale
Correct answer: B. Apply a cold pack with a cloth barrier for 15 to 20 minutes
Cold causes vasoconstriction, which limits swelling and numbs pain in the first 24 to 48 hours after injury. A barrier prevents tissue damage and 15 to 20 minutes is the safe application time.
Why the other options are wrong
- A. Heat causes vasodilation and increases swelling in an acute injury.
- C. Direct prolonged cold contact can cause frostbite and tissue injury.
- D. Rapid alternation has no therapeutic basis in acute injury.
An older adult on a medical unit reports difficulty sleeping. Which nursing action should be tried first?
Show answer and rationale
Correct answer: B. Offer a warm drink, dim the lights and cluster overnight care
Non-pharmacological measures are tried first, especially in older adults where sedatives increase falls and confusion. Reducing light and noise and grouping care to protect sleep periods addresses the most common hospital causes of insomnia.
Why the other options are wrong
- A. Sedative hypnotics are a last resort in older adults because of fall and delirium risk.
- C. Long daytime naps worsen night-time insomnia.
- D. Screen light and stimulation delay sleep onset.
During an 8-hour shift a client consumed 240 millilitres of juice, 180 millilitres of tea, 120 millilitres of soup and received 500 millilitres of intravenous fluid. What is the total intake in millilitres? Record your answer as a whole number.
Show answer and rationale
Answer: 1040
240 plus 180 plus 120 plus 500 equals 1,040 millilitres. Intake includes oral fluids, foods that are liquid at room temperature, and all intravenous fluids.
A client with chronic low back pain asks whether relaxation techniques can replace their analgesia. Which response by the nurse is most appropriate?
Show answer and rationale
Correct answer: B. "Relaxation works alongside your medication and can reduce how much you need. Let us discuss it with your provider."
Non-pharmacological measures are effective adjuncts that can reduce analgesic requirements, but they supplement rather than replace prescribed therapy. Changing the regimen involves the provider.
Why the other options are wrong
- A. Overstating the effect sets the client up for uncontrolled pain.
- C. Dismissing relaxation is inaccurate; the evidence supports it as an adjunct.
- D. Advising a client to stop prescribed analgesia is outside the nurse’s scope.
A client suddenly develops dyspnoea, chest pain and hypotension while a central line is being changed. Air embolism is suspected. Which position should the nurse use?
Show answer and rationale
Correct answer: B. Left side-lying with the head lowered
Placing the client left side down with the head lowered traps air in the right atrium and away from the pulmonary outflow tract, buying time for the air to be absorbed or aspirated.
Why the other options are wrong
- A. Sitting upright encourages air to move into the pulmonary circulation.
- C. Prone positioning has no role and impairs assessment.
- D. Right side down and head elevated encourages air toward the outflow tract.
A nurse finds an area over the sacrum with intact skin and persistent redness that does not blanch with pressure. How should the nurse document this?
Show answer and rationale
Correct answer: A. Stage 1 pressure injury
Stage 1 is intact skin with non-blanchable erythema over a bony prominence. The tissue is damaged but the epidermis is unbroken, and immediate offloading can still reverse it.
Why the other options are wrong
- B. Stage 2 involves partial thickness loss with a shallow open area or an intact or ruptured blister.
- C. Stage 3 involves full thickness loss extending into subcutaneous fat.
- D. Unstageable means the base is obscured by slough or eschar, which requires a break in the skin.
Which interventions help prevent pressure injuries in an immobile client? Select all that apply.
- AReposition at least every two hours
- BMassage reddened bony prominences to improve circulation
- CKeep skin clean and dry and manage incontinence promptly
- DUse a lift sheet rather than dragging the client up the bed
- EPlace a ring-shaped cushion under the sacrum
Show answer and rationale
Correct answers: A. Reposition at least every two hours; C. Keep skin clean and dry and manage incontinence promptly; D. Use a lift sheet rather than dragging the client up the bed
Regular repositioning relieves capillary pressure, moisture control prevents maceration, and lift sheets prevent shear injury during repositioning.
Why the other options are wrong
- B. Massaging reddened areas damages already compromised capillaries and is contraindicated.
- E. Ring or donut cushions concentrate pressure around the ring and reduce circulation to the centre.
A client with dysphagia after a stroke is about to eat lunch. Which nursing action is most important?
Show answer and rationale
Correct answer: A. Position the client upright at 90 degrees with the chin tucked
Sitting fully upright with the chin tucked narrows the airway entrance and directs food toward the oesophagus, which is the single most effective positional measure against aspiration.
Why the other options are wrong
- B. Straws deliver a fast uncontrolled bolus to the back of the throat and are avoided in dysphagia.
- C. Rushing increases aspiration risk. Small bites at a slow pace are safer.
- D. Thin liquids are the hardest to control and are usually thickened for clients with dysphagia.
During a continuous nasogastric tube feeding, the client begins coughing and the oxygen saturation drops to 88 percent. Which action should the nurse take first?
Show answer and rationale
Correct answer: A. Stop the feeding
Coughing with desaturation during a feed suggests aspiration. Stopping the feed immediately prevents further material entering the airway and is the first action, followed by suctioning, oxygen and assessment.
Why the other options are wrong
- B. Checking residual is useful for assessing tolerance but does not stop ongoing aspiration.
- C. Lowering the head increases reflux and aspiration risk.
- D. Flushing pushes more fluid down a tube that may be misplaced.
A client who had surgery six hours ago has not voided and reports lower abdominal discomfort. The bladder is palpable above the symphysis pubis. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Assist the client to an upright position and provide privacy and running water
Non-invasive measures are attempted first because they often succeed and avoid the infection risk of catheterisation. Upright positioning, privacy, running water and warm perineal water all promote voiding.
Why the other options are wrong
- A. Catheterisation is appropriate if non-invasive measures fail, but it carries an infection risk that should be avoided when possible.
- C. More fluid into an already distended bladder increases discomfort without helping the client void.
- D. A diuretic produces more urine the client still cannot pass.
A client is prescribed a low-sodium diet. Which menu choice indicates the teaching was effective?
Show answer and rationale
Correct answer: B. Grilled chicken with fresh steamed vegetables and rice
Fresh unprocessed protein, fresh vegetables and plain rice are naturally low in sodium. Sodium in the diet comes overwhelmingly from processing rather than from the salt shaker.
Why the other options are wrong
- A. Canned soup is among the highest-sodium foods available.
- C. Cured ham and pickles are both preserved in salt.
- D. Cheese and bacon are both high in sodium.
Which instructions should the nurse give a client after a total hip replacement with a posterior approach? Select all that apply.
- ADo not cross your legs
- BDo not bend the hip more than 90 degrees
- CUse a raised toilet seat
- DSit in low soft chairs to rest the joint
- EPlace a pillow between your legs when turning
Show answer and rationale
Correct answers: A. Do not cross your legs; B. Do not bend the hip more than 90 degrees; C. Use a raised toilet seat; E. Place a pillow between your legs when turning
Posterior hip precautions prevent dislocation by avoiding adduction, flexion beyond 90 degrees and internal rotation. Raised seats and an abduction pillow keep the joint within safe limits.
Why the other options are wrong
- D. Low soft chairs force the hip past 90 degrees of flexion and are precisely what must be avoided.
A client who has not passed formed stool for five days now has frequent small liquid stools. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Assess for a faecal impaction
Liquid stool leaking around a hardened mass is overflow diarrhoea and is a classic presentation of impaction. Assessment, usually including a digital rectal examination, confirms it.
Why the other options are wrong
- A. An antidiarrhoeal worsens the impaction by further slowing the bowel.
- C. Fluids help soften stool and are encouraged, not restricted.
- D. This is not improvement; it is a complication of constipation.
Which complications is an immobile client at increased risk of developing? Select all that apply.
- ADeep vein thrombosis
- BAtelectasis
- CConstipation
- DIncreased bone density
- EOrthostatic hypotension
Show answer and rationale
Correct answers: A. Deep vein thrombosis; B. Atelectasis; C. Constipation; E. Orthostatic hypotension
Immobility causes venous stasis, reduced lung expansion and secretion clearance, slowed peristalsis, and loss of the cardiovascular reflexes that maintain blood pressure on standing.
Why the other options are wrong
- D. Immobility causes bone demineralisation and loss of density, not an increase, because bone requires weight bearing to maintain mass.
A nurse is cleaning a surgical incision with a drain. Which technique is correct?
Show answer and rationale
Correct answer: B. Clean the incision first, then the drain site, moving from clean to contaminated
Cleaning moves from the least contaminated to the most contaminated area, so the incision is cleaned before the drain site. A new swab is used for each stroke.
Why the other options are wrong
- A. The drain site is more contaminated, so cleaning it first would carry organisms to the incision.
- C. Reusing a swab transfers organisms between areas.
- D. Moving inward carries organisms from the periphery toward the wound.
A client on haemodialysis asks about fluid intake between sessions. Which response by the nurse is most accurate?
Show answer and rationale
Correct answer: B. "Your fluid allowance is set by your team and weight gain between sessions is the guide."
Interdialytic weight gain is the practical measure of fluid retention and drives the individualised allowance. Excessive gain causes hypertension, pulmonary oedema and difficult dialysis sessions.
Why the other options are wrong
- A. Excess fluid between sessions causes overload and cardiovascular strain.
- C. Complete avoidance is unnecessary and unrealistic, and risks hypotension during dialysis.
- D. All liquids and foods that are liquid at room temperature count.
What to do with your score
A single 18-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
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