NCLEX-PN Basic Care and Comfort Practice Questions

ADLs, mobility, nutrition, elimination, ostomy and tube-feeding — core PN responsibilities. It sits under Physiological Integrity on the NCLEX-PN test plan and carries an approximate weight of 10% of the exam.

Below are 11 practice questions for this domain — 6 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Multiple choice

1. Indwelling catheter — wheelchair transfer

A nurse is observing assistive personnel transfer a client who has an indwelling urinary catheter from the bed to a wheelchair.

Which action by the assistive personnel requires the nurse to intervene?

  1. Placing the drainage bag on the client's lap during the transfer.
  2. Hanging the drainage bag on the wheelchair frame below the level of the client's bladder.
  3. Checking that the tubing is free of kinks after the client is seated.
  4. Emptying the drainage bag into a clean graduated container before the transfer.
Show the answer and rationales

Correct answer: A

  • A. Correct . On the lap, the bag sits at or above bladder level, allowing urine to flow backward into the bladder and raising the risk of a catheter-associated urinary tract infection. The bag must stay below the bladder at all times, including during transfers.
  • B. Incorrect . This is correct technique — keeping the bag below the bladder (and off the floor) maintains downhill drainage and helps prevent backflow.
  • C. Incorrect . This is correct technique — kinked or compressed tubing obstructs urine flow and promotes stasis, which contributes to infection.
  • D. Incorrect . This is correct technique — emptying the bag before moving the client reduces weight and spill risk, and a separate clean container is used for each client.

Reference: CDC Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009)

Easy Select all that apply

2. Promoting sleep in the hospital

A hospitalized client tells the evening nurse about feeling exhausted after waking up several times every night since admission.

Which actions should the nurse take to promote sleep? Select all that apply.

  1. Cluster nighttime care activities so the client can sleep without interruption.
  2. Dim the lights and reduce hallway noise near the room at night.
  3. Follow the client's usual bedtime routine as closely as possible.
  4. Encourage several long naps during the day to make up for lost sleep.
  5. Offer a cup of regular coffee with the evening snack.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Grouping vital signs, medications, and other care together lets the client complete full sleep cycles instead of being awakened repeatedly.
  • B. Correct . Light and noise are the most common hospital sleep disruptors; a dark, quiet environment supports the body's natural sleep drive.
  • C. Correct . Familiar pre-sleep habits cue the body for sleep, and preserving home routines is a simple, effective comfort measure in the hospital.
  • D. Incorrect . Long or late daytime naps reduce the drive to sleep at night and tend to make nighttime sleep even more fragmented.
  • E. Incorrect . Caffeine is a stimulant whose effects last for hours; caffeinated drinks in the evening directly interfere with falling and staying asleep.

Reference: MedlinePlus (healthy sleep); CDC sleep hygiene guidance

Medium Select all that apply

3. Dysphagia after stroke — mealtime precautions

A nurse is assisting with the noon meal for a client who has dysphagia following a stroke. The speech-language pathologist has recommended honey-thick liquids and a chin-tuck position when swallowing.

Which actions should the nurse take during the meal? Select all that apply.

  1. Position the client fully upright at 90 degrees before offering any food or liquid.
  2. Remind the client to tuck the chin toward the chest when swallowing.
  3. Offer small bites and allow unhurried time between them.
  4. Check the client's mouth for pocketed food during and after the meal.
  5. Offer thin liquids through a straw to make swallowing easier.
  6. Lower the head of the bed so the client can rest as soon as the meal ends.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Sitting fully upright aligns the airway and esophagus for the safest possible swallow and is the standard starting position for any client on aspiration precautions.
  • B. Correct . The chin tuck narrows the airway entrance and slows the bolus, reducing aspiration risk. Reinforcing the strategy the speech-language pathologist taught is within the PN role.
  • C. Correct . Small, slow bites give the client time to complete each swallow before the next bolus arrives — rushing a client with dysphagia is a common cause of aspiration.
  • D. Correct . Facial weakness after a stroke lets food collect in the cheek on the affected side; pocketed food can be aspirated later, so the mouth is checked and cleared.
  • E. Incorrect . Thin liquids violate the prescribed honey-thick consistency, and straws deliver liquid rapidly to the back of the throat — both increase aspiration risk for this client.
  • F. Incorrect . The client should remain upright for at least 30 minutes after eating to prevent reflux and aspiration of residual food or liquid.

Reference: Hartford Institute for Geriatric Nursing aspiration precautions; ASHA dysphagia guidance

Medium Select all that apply

4. Enteral feeding — preparing a bolus feeding

A nurse is preparing to administer an intermittent bolus feeding through a client's established nasogastric tube. The tube placement was confirmed by x-ray after insertion two days ago, and the client has tolerated prior feedings without nausea or distention.

Which actions should the nurse take before starting the feeding? Select all that apply.

  1. Elevate the head of the bed to at least 30 degrees.
  2. Compare the external tube length marking at the nostril with the length documented at insertion.
  3. Check the gastric residual volume according to facility policy.
  4. Flush the tube with about 30 mL of water before the feeding.
  5. Confirm placement by injecting air into the tube while auscultating over the stomach.
  6. Position the client flat on the left side for the duration of the feeding.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Keeping the head of the bed at 30 degrees or higher during and after an enteral feeding reduces the risk of reflux and aspiration.
  • B. Correct . Checking that the exit-site marking has not migrated is an accepted bedside method for confirming the tube has not been displaced since the confirming x-ray.
  • C. Correct . Many facilities still require residual checks before bolus feedings. The nurse follows policy, reports a residual above the facility threshold to the RN, and watches for other signs of intolerance such as distention or nausea.
  • D. Correct . Flushing with water before the feeding confirms tube patency and helps prevent clogging.
  • E. Incorrect . The air bolus auscultation method is unreliable and is no longer an accepted way to verify tube placement — tubes in the lung have produced sounds that falsely suggested gastric placement.
  • F. Incorrect . A flat position during an enteral feeding increases the risk of reflux and aspiration. The head of the bed should stay elevated at least 30 degrees during the feeding and for at least 30 minutes afterward.

Reference: AACN Practice Alert (feeding tube placement verification); ASPEN/SCCM enteral nutrition guidelines

Medium Multiple choice

5. First ambulation — client becomes dizzy

A client who had abdominal surgery yesterday is walking in the hallway with the nurse for the first time since surgery. Midway through the walk, the client stops, becomes pale and diaphoretic, and says the room is spinning.

Which action should the nurse take first?

  1. Assist the client to sit in the nearest chair.
  2. Instruct the client to take slow, deep breaths and continue walking.
  3. Walk the client quickly back to bed.
  4. Leave the client standing and go get a wheelchair.
Show the answer and rationales

Correct answer: A

  • A. Correct . Safety comes first. Seating the client immediately prevents a fall and allows the blood pressure to recover; the nurse can then check vital signs and report the episode to the RN.
  • B. Incorrect . Continuing to walk a pale, dizzy, diaphoretic client risks syncope and a fall. The activity must be stopped before anything else.
  • C. Incorrect . The bed may be too far away. Walking any farther — especially quickly — increases the chance the client will faint and fall before reaching it.
  • D. Incorrect . A dizzy, unsteady client must never be left unattended while standing — this is when falls happen. Get the client seated first, then call for help.

Reference: AHRQ fall prevention guidance; MedlinePlus (orthostatic hypotension)

Medium Multiple choice

6. New colostomy — dusky stoma

Two days after surgery, a nurse removes the pouch of a client with a new sigmoid colostomy to cleanse the peristomal skin and notes that the stoma is dark purple and dry.

Which action should the nurse take?

  1. Report the finding to the registered nurse immediately.
  2. Document the color as an expected finding for a new stoma.
  3. Apply a warm, moist compress to improve circulation to the stoma.
  4. Reapply the pouch and reassess the stoma at the end of the shift.
Show the answer and rationales

Correct answer: A

  • A. Correct . A healthy stoma is pink to red and moist. A dark purple, dry stoma signals ischemia — a surgical emergency that can progress to necrosis — so the PN reports it up the chain of command right away.
  • B. Incorrect . Even a brand-new stoma should be pink to red and moist; some edema is expected, but a purple or dusky color is never normal and indicates compromised blood supply.
  • C. Incorrect . A compress cannot restore blood flow to an ischemic stoma and only delays the urgent evaluation the client needs.
  • D. Incorrect . Waiting hours allows ischemia to progress to full-thickness necrosis. This finding requires immediate escalation, not routine monitoring.

Reference: WOCN Society stoma complications best practice; MedlinePlus (colostomy care)

Medium Multiple choice

7. Opioid constipation — reinforcing teaching

A nurse is reinforcing discharge teaching with a client who will take oxycodone at home for pain after spinal surgery. The provider has also prescribed a daily laxative.

Which client statement indicates an understanding of the teaching?

  1. I will take the laxative every day while I am on the pain medicine, even before constipation starts.
  2. I will start the laxative only after I have gone a week without a bowel movement.
  3. I will stop taking the pain medicine at the first sign of constipation.
  4. Eating extra cheese and white rice with meals will keep my bowels moving.
Show the answer and rationales

Correct answer: A

  • A. Correct . Opioids slow gut motility for as long as they are taken, and tolerance to this effect does not develop. A scheduled laxative started with the opioid — along with fluids and activity — prevents constipation rather than chasing it.
  • B. Incorrect . Waiting a week invites fecal impaction. Opioid-induced constipation is predictable, so the bowel regimen is preventive, not a rescue measure.
  • C. Incorrect . Stopping the analgesic leaves postoperative pain uncontrolled. Constipation is managed with the prescribed bowel regimen, fluids, and activity, and concerns are reported to the provider.
  • D. Incorrect . Cheese and white rice are low-residue, constipating foods. They would worsen the problem, and diet alone does not counteract the opioid's effect on the bowel.

Reference: American Gastroenterological Association guideline on opioid-induced constipation; Palliative Care Network of Wisconsin Fast Facts

Medium Multiple choice

8. Pain report — behavior does not match

A client who is 2 days postoperative rates the incisional pain as 6 on a 0 to 10 scale while sitting up in bed laughing with visitors. Vital signs are unchanged from earlier in the shift. An oral analgesic is prescribed every 4 hours as needed, and the last dose was given 6 hours ago.

Which action should the nurse take?

  1. Administer the prescribed oral analgesic.
  2. Document that the client appears comfortable and reassess in 1 hour.
  3. Encourage the client to continue visiting as a distraction instead of giving the medication.
  4. Ask the registered nurse to verify the pain rating because the behavior does not match the score.
Show the answer and rationales

Correct answer: A

  • A. Correct . The client's self-report is the most reliable indicator of pain, and socializing or laughing is often a coping or distraction strategy that does not rule pain out. The dose is due and giving an oral analgesic is within the PN scope.
  • B. Incorrect . This substitutes the nurse's interpretation of behavior for the client's own report and leaves treatable pain unrelieved for another hour.
  • C. Incorrect . Nonpharmacologic measures complement analgesics — they do not replace a prescribed, due medication when the client reports moderate pain.
  • D. Incorrect . No verification is needed — accepted standards direct nurses to believe the client's report. Stable vital signs and cheerful behavior are common in clients who still have real pain.

Reference: ASPMN position statement on pain assessment; McCaffery standard of pain as self-report

Medium Select all that apply

9. Urinary incontinence — protecting the skin

An older adult client in a long-term care facility has urge urinary incontinence and has had two incontinence episodes this shift. The perineal skin is intact but reddened.

Which actions should the nurse take? Select all that apply.

  1. Toilet the client on a schedule, such as every 2 hours.
  2. Cleanse the perineal skin promptly after each episode and pat it dry.
  3. Apply a moisture-barrier product to the perineal skin.
  4. Limit caffeinated drinks, especially in the evening.
  5. Restrict the client's total daily fluid intake.
  6. Ask the provider to prescribe an indwelling urinary catheter.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Scheduled or prompted toileting empties the bladder before urgency strikes and is more effective than waiting for the client to ask — a cornerstone of incontinence management.
  • B. Correct . Urine left on the skin breaks down its protective barrier and causes incontinence-associated dermatitis; prompt, gentle cleansing protects the already-reddened skin.
  • C. Correct . A barrier cream or ointment shields the skin from urine between episodes and helps reddened skin recover before it breaks down.
  • D. Correct . Caffeine is a bladder irritant and mild diuretic that worsens urgency; reducing it — particularly late in the day — decreases episodes without restricting needed fluids.
  • E. Incorrect . Restricting fluids concentrates the urine, which irritates the bladder and skin further, and places an older adult at risk for dehydration. Adequate fluids are maintained and timed sensibly instead.
  • F. Incorrect . Incontinence alone is not an appropriate indication for an indwelling catheter — catheters placed for convenience are a leading cause of urinary tract infection.

Reference: WOCN guidance on incontinence-associated dermatitis; CDC CAUTI guideline (appropriate catheter indications)

Hard Select all that apply

10. Prolonged bedrest — preventing complications

A nurse is caring for a client on prolonged bedrest after a pelvic fracture. The client is not yet permitted to bear weight on the lower extremities.

Which interventions should the nurse include to prevent complications of immobility? Select all that apply.

  1. Reposition the client at least every 2 hours.
  2. Place a pillow lengthwise under the calves so the heels float off the mattress.
  3. Encourage active range-of-motion exercises of the unaffected limbs.
  4. Remind the client to use the incentive spirometer every hour while awake.
  5. Place a ring-shaped cushion under the sacrum to relieve pressure.
  6. Keep the head of the bed elevated at 90 degrees at all times.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Regular repositioning relieves pressure over bony prominences before tissue damage starts and is the foundation of pressure injury prevention for a client who cannot move independently.
  • B. Correct . The heels are among the highest-risk sites for pressure injury, and completely offloading them with the calves supported is the recommended technique.
  • C. Correct . Active exercise within the prescribed activity restrictions preserves muscle strength and joint motion and promotes venous return, lowering the risk of deep vein thrombosis.
  • D. Correct . Immobility leads to shallow breathing and pooled secretions; hourly incentive spirometry expands the lungs and helps prevent atelectasis and pneumonia.
  • E. Incorrect . Ring or donut cushions concentrate pressure around their rim and impair blood flow to the very tissue they surround — pressure injury guidelines specifically advise against them.
  • F. Incorrect . Constant high-Fowler positioning drives the body's weight onto the sacrum and creates shear as the client slides down. The head of the bed is generally kept at or below 30 degrees unless a condition requires more elevation.

Reference: NPIAP/EPUAP/PPPIA pressure injury prevention guideline; AHRQ preventing pressure ulcers in hospitals toolkit

Hard Multiple choice

11. Sacral redness — repositioning technique

A client on bedrest spends most of the day supine and now has a reddened area over the sacrum that blanches with light fingertip pressure. The nurse prepares to turn the client to the side.

Which repositioning technique is most appropriate?

  1. Place the client in a 30-degree lateral position supported with pillows.
  2. Place the client in a 90-degree side-lying position directly on the hip.
  3. Massage the reddened sacral area briskly before turning the client.
  4. Raise the head of the bed to 60 degrees and keep the client supine.
Show the answer and rationales

Correct answer: A

  • A. Correct . The 30-degree laterally inclined position offloads the sacrum without putting the client's full weight on the trochanter, and pressure injury guidelines recommend it in preference to 90-degree side-lying.
  • B. Incorrect . Full 90-degree side-lying concentrates body weight on the greater trochanter, a high-risk bony prominence, and is discouraged for routine pressure injury prevention.
  • C. Incorrect . Massaging reddened skin over a bony prominence is an outdated practice that can worsen underlying tissue damage and is specifically advised against in current guidelines.
  • D. Incorrect . This leaves the client on the sacrum and adds shear as the body slides downward. The head of the bed is generally kept at or below 30 degrees unless a condition requires more elevation.

Reference: NPIAP/EPUAP/PPPIA pressure injury prevention guideline (repositioning)

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain

Not sure which domain to work on first? Take the NCLEX-PN diagnostic → It samples every domain by its exam weight and hands you a study-first list.