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Fundamentals and Assessment NCLEX practice questions
Fundamentals and health assessment are the base everything else builds on, and they show up on first-semester exams and the NCLEX alike. Practice core nursing care, head-to-toe findings and cranial nerves.
Question 1 · Physiological Adaptation
A nurse is assessing a client who arrives at the emergency department with sudden onset right-sided facial drooping, arm weakness, and slurred speech. The nurse asks the client to smile and raise the eyebrows. Which cranial nerve is the nurse specifically assessing with this action?
Show answer and rationale
Answer: D. Asking a client to smile and raise the eyebrows tests the muscles of facial expression, which are controlled by CN VII (facial); asymmetry or drooping is a critical cue in stroke recognition. CN V controls facial sensation and chewing, not expression. CN IX relates to taste and swallowing on the posterior tongue. CN XII controls tongue movement, which is assessed by asking the client to stick out the tongue, not smile.
Checked against: OpenStax Clinical Nursing Skills, 26.2
Question 2 · Reduction of Risk Potential
Which cranial nerves are classified as purely motor? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, C, D, E. CN III, CN IV, CN VI, and CN XI are purely motor nerves controlling eye movement and shoulder/neck movement. CN V (trigeminal) is a 'both' nerve, providing facial sensation as well as motor control of chewing. CN X (vagus) is also a 'both' nerve, controlling gag/swallow/phonation motor function while also carrying parasympathetic sensory and autonomic fibers to organs. Therefore CN V and CN X are incorrect choices for 'purely motor.'
Checked against: OpenStax Fundamentals of Nursing, 23.1; OpenStax Clinical Nursing Skills, 26.1
Question 3 · Physiological Adaptation
The nurse is reviewing kidney function with a new graduate. Which statement about the nephron is accurate?
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Answer: A. The nephron is the functional unit of the kidney responsible for filtering blood and forming urine, and each kidney contains approximately 1 million nephrons. The renal pelvis is a separate structure that collects already-formed urine before it travels to the ureter, not the nephron itself. While the kidney does produce erythropoietin, this is not the primary function of the nephron, which is filtration and urine formation. The number of nephrons per kidney is about 1 million, not just a few hundred.
Checked against: OpenStax Nutrition for Nurses, 15.1; OpenStax Pharmacology for Nurses, 33.1
Question 4 · Reduction of Risk Potential
A client with chronic alcohol use disorder is found to have a low serum magnesium level. Which finding would the nurse expect to observe?
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Answer: D. Low magnesium (hypomagnesemia) increases neuromuscular and cardiac excitability, so the nurse expects tremors and cardiac arrhythmias, and both need close monitoring. Absent deep tendon reflexes point to hypermagnesemia (high magnesium); low magnesium tends to cause hyperactive reflexes and tetany instead. Bradycardia and hypotension are also signs of magnesium excess, not deficiency. Severe constipation is not a classic finding of hypomagnesemia and is more often linked to hypercalcemia. Clients with alcohol use disorder often have low magnesium from poor intake and absorption, and it frequently occurs together with low potassium and calcium.
Checked against: merckmanuals.com; OpenStax Clinical Nursing Skills, 19.1
Question 5 · Management of Care
A client has a DNR order on file. The client's heart rate drops and they go into cardiac arrest. What is the appropriate nursing action?
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Answer: A. A DNR order means no CPR should be performed if the client's heart or breathing stops, but comfort care continues; the nurse should verify the order is signed and valid, then withhold CPR accordingly. Initiating CPR against a verified DNR order violates the client's documented wishes. Calling a rapid response and starting compressions contradicts the purpose of a DNR order. Family verbal permission does not override a valid, signed DNR order already in the chart.
Checked against: openstax.org
Question 6 · Safety and Infection Control
Using the mnemonic "My Chicken Hez TB," which client requires airborne precautions with an N95 respirator and a negative-pressure room?
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Answer: D. The mnemonic "My Chicken Hez TB" stands for Measles, Chickenpox (varicella), Herpes zoster and TB, the infections that call for airborne precautions with an N95 respirator and a negative-pressure room, so the client with active chickenpox needs them. Zoster needs airborne plus contact precautions only when it is disseminated, or in an immunocompromised client until dissemination is ruled out; localized zoster in a client with a normal immune system needs only standard precautions with the lesions covered. MRSA and C. diff require contact precautions, not airborne. Seasonal influenza requires droplet precautions with a surgical mask.
Checked against: OpenStax Fundamentals of Nursing, 10.4; OpenStax Clinical Nursing Skills, 6.4
Question 7 · Reduction of Risk Potential
The nurse asks a client to say "ah" and observes that the uvula and soft palate rise symmetrically at midline. This finding demonstrates intact function of which cranial nerves?
Show answer and rationale
Answer: A. CN IX (glossopharyngeal) and CN X (vagus) are tested together by observing symmetric midline elevation of the uvula and soft palate during phonation, along with the gag reflex. CN VII and VIII relate to facial expression/taste and hearing/balance, respectively. CN XI and XII control shoulder/neck movement and tongue movement. CN III and IV control eye movement and pupil function, unrelated to the palate.
Checked against: OpenStax Clinical Nursing Skills, 26.2
Question 8 · Physiological Adaptation
A client's urine output has been 20 mL/hr for the past 2 hours. What does this finding most likely indicate?
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Answer: D. Urine output under 30 mL/hr signals poor perfusion and requires prompt evaluation, as it may reflect hypovolemia, decreased cardiac output, or renal impairment. This is not a normal or expected finding, and it does not indicate adequate fluid balance. Even after a fluid bolus, a sustained output this low is concerning and warrants further assessment rather than being dismissed as expected.
Checked against: OpenStax Clinical Nursing Skills, 19.1
Question 9 · Management of Care
The nurse is caring for four patients at the start of the shift. Which patient should the nurse assess first?
Show answer and rationale
Answer: D. Per Maslow's hierarchy and the ABC priority framework, physiologic needs such as airway and breathing take priority over other concerns, so the patient with new dyspnea and a low oxygen saturation needs immediate assessment. Bladder fullness is a physiologic concern but is not immediately life-threatening compared to compromised oxygenation. A headache rated 4/10 and preoperative anxiety, while important, are lower priority than a potential respiratory emergency.
Checked against: OpenStax Fundamentals of Nursing, 43.3
Question 10 · Reduction of Risk Potential
When assessing cranial nerve III (oculomotor), which components should the nurse evaluate? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C. CN III (oculomotor) assessment includes checking pupillary constriction and reactivity to light (part of PERRLA), extraocular movement through the six cardinal gazes, and eyelid elevation, since ptosis can indicate CN III dysfunction. Facial symmetry is a CN VII finding, hearing acuity is a CN VIII finding, and taste on the anterior two-thirds of the tongue is also a CN VII function, so none of these belong to a CN III assessment.
Checked against: OpenStax Clinical Nursing Skills, 26.1; OpenStax Clinical Nursing Skills, 26.2
Question 11 · Physiological Adaptation
The nurse is teaching a class about the autonomic nervous system. Which of the following are effects of sympathetic nervous system stimulation? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, E. Sympathetic nervous system stimulation, the fight-or-flight response, increases heart rate and blood pressure and causes pupil dilation to prepare the body for immediate action. It also slows digestion rather than increasing it, since blood flow is diverted away from the digestive tract during a stress response. Increased digestive activity and stimulated digestion are actually parasympathetic (rest-and-digest) effects, and slowed heart rate is also a parasympathetic effect, making these three options incorrect for sympathetic stimulation.
Checked against: OpenStax Fundamentals of Nursing, 23.1; OpenStax Clinical Nursing Skills, 26.1
Question 12 · Safety and Infection Control
A client is scheduled for surgery in the morning. The nurse notes an NPO order. What is the correct interpretation of this order?
Show answer and rationale
Answer: C. NPO means 'nothing by mouth,' indicating the client should have no food or fluids, typically to reduce aspiration risk before surgery or certain tests. Clear liquids are not permitted under a strict NPO order unless otherwise specified by the provider. Eating a light breakfast directly violates the purpose of the order. Drinking extra fluids is not part of an NPO order; when fasting starts, and whether clear liquids are allowed until 2 hours before surgery, follows the anesthesia provider's instructions.
Checked against: OpenStax Fundamentals of Nursing, 31.2
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Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.