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NCLEX RN Practice Exam Questions

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Question 1 of 5

The nurse is performing a neurological assessment on a client admitted with TIAs. Assessment findings reveal an absence of the gag reflex. The nurse suspects injury to:

Correct Answer: B

Rationale: The vagus nerve (X) innervates the pharynx and is responsible for the gag reflex, so its injury would cause an absent gag reflex.

Question 2 of 5

A nurse has delegated care of a client in wrist restraints to a nursing assistant. The nursing assistant should check the skin circulation under the restraints at least

Correct Answer: C

Rationale: Restraints require circulation checks every 1-2 hours to prevent skin breakdown or neurovascular injury. Hourly checks (
C) balance safety and practicality.

Question 3 of 5

Which of the following are controlled substances (Schedules I through V) regulated by the Drug Enforcement Agency (DEA)? Select all that apply.

Correct Answer: A,D

Rationale: Codeine (
A) and hydrocodone (
D) are DEA-controlled substances (Schedules II-V). Ibuprofen (
B) and diphenhydramine (
C) are not controlled.

Question 4 of 5

The toddler is admitted with a cardiac anomaly. The nurse is aware that the infant with a ventricular septal defect will:

Correct Answer: A

Rationale: A ventricular septal defect causes increased pulmonary blood flow, leading to easy tiring due to cardiac workload.

Question 5 of 5

A client admitted for treatment of a deep venous thrombosis of the calf complains of dyspnea and chest pain. What is the best response by the nurse?

Correct Answer: C

Rationale: Dyspnea and chest pain suggest a possible pulmonary embolism, a complication of DVT, requiring immediate preparation for diagnostic tests to confirm and treat.

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