NCLEX-RN Basic Care and Comfort Practice Questions

Comfort, nutrition, mobility, hygiene, and the activities of daily living. It sits under Physiological Integrity on the NCLEX-RN test plan and carries an approximate weight of 9% of the exam.

Below are 12 practice questions for this domain — 7 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN 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. Constipation prevention — client teaching

A nurse provides dietary and lifestyle teaching to a client who reports infrequent, hard stools that are difficult to pass. The client takes no medications that affect the bowel.

Which client statement indicates understanding of the teaching?

  1. I will drink more fluids, add fiber to my meals gradually, and walk most days of the week.
  2. I will take a stimulant laxative every night so I never miss a bowel movement.
  3. I will hold the urge to have a bowel movement until I get home.
  4. I will cut back on fluids in the evening so my body absorbs more from my food.
Show the answer and rationales

Correct answer: A

  • A. Correct . Adequate fluid intake, dietary fiber increased gradually to limit bloating and gas, and regular physical activity are the first-line, evidence-based measures for preventing constipation.
  • B. Incorrect . Routine nightly stimulant laxative use can lead to dependence and is not first-line management. Lifestyle measures come first, with laxatives used only as directed.
  • C. Incorrect . Ignoring the urge lets stool remain in the colon, where more water is absorbed and the stool becomes harder. Responding to the urge promptly helps maintain a regular pattern.
  • D. Incorrect . Restricting fluids worsens constipation. Fluids keep stool soft and are needed for fiber to work effectively.

Reference: MedlinePlus (constipation self-care); National Institute on Aging (concerned about constipation)

Easy Multiple choice

2. Continuous tube feeding — head of bed flat

A nurse enters the room of a client receiving a continuous enteral feeding through a nasogastric tube and finds the head of the bed flat. Assistive personnel had lowered the bed to change the linens and were called away. The feeding pump is still infusing.

Which action should the nurse take first?

  1. Raise the head of the bed to at least 30 degrees.
  2. Stop the infusion and notify the provider.
  3. Check the gastric residual volume.
  4. Auscultate the client's lung sounds.
Show the answer and rationales

Correct answer: A

  • A. Correct . A flat position during a running feeding allows gastric contents to reflux into the esophagus and be aspirated. Elevating the head of the bed 30 to 45 degrees immediately removes the risk and takes only seconds, so it comes before any other step.
  • B. Incorrect . Raising the head of the bed corrects the unsafe position right away. The feeding does not need to be interrupted, and there is nothing that requires provider notification once the position is restored.
  • C. Incorrect . Measuring residual volume does not address the immediate aspiration risk created by the flat position. Correcting the position comes first.
  • D. Incorrect . Assessing the lungs is a reasonable follow-up to evaluate for possible aspiration, but the first action is to eliminate the ongoing risk by elevating the head of the bed.

Reference: AACN practice alert on prevention of aspiration in adults (head-of-bed elevation 30 to 45 degrees)

Medium Multiple choice

3. Coughing after abdominal surgery — splinting

One day after abdominal surgery, a client refuses to cough and deep breathe, saying it pulls at the incision and hurts too much. The client rated the pain 3 of 10 thirty minutes after a scheduled analgesic dose.

Which instruction by the nurse is most appropriate?

  1. Hold a pillow firmly against the incision while coughing and deep breathing.
  2. Avoid coughing until the incision has fully healed.
  3. Take rapid, shallow breaths to keep the incision still.
  4. Use the incentive spirometer instead of the coughing exercises.
Show the answer and rationales

Correct answer: A

  • A. Correct . Splinting supports the incision, reduces the pulling pain, and lets the client cough effectively. This keeps secretions moving and the alveoli expanded, preventing atelectasis and pneumonia without skipping the exercises.
  • B. Incorrect . Avoiding coughing and deep breathing allows secretions to pool and alveoli to collapse, leading to atelectasis and pneumonia. With the incision splinted, coughing is safe and necessary.
  • C. Incorrect . Shallow breathing promotes alveolar collapse — exactly the complication that coughing and deep breathing are meant to prevent.
  • D. Incorrect . Incentive spirometry encourages deep inhalation but does not clear secretions the way coughing does. Both are needed, and splinting makes the coughing tolerable.

Reference: American Nurse (preventing postoperative pulmonary complications); postoperative nursing fundamentals

Medium Multiple choice

4. Dry skin in an older adult — bathing teaching

A home health nurse teaches an 80-year-old client with dry, itchy skin on the lower legs about bathing and skin care.

Which client statement indicates a need for further teaching?

  1. A long, hot shower every day is the best way to stop my skin from itching.
  2. I will pat my skin dry and apply a fragrance-free moisturizer right after bathing.
  3. I will wash with a mild, gentle cleanser instead of a strong deodorant soap.
  4. I will keep my showers short, around 5 to 10 minutes, with warm water.
Show the answer and rationales

Correct answer: A

  • A. Correct . Hot water and prolonged daily bathing strip the skin's natural oils and worsen the dryness and itching of aging skin. Short warm-water bathing is recommended instead, so this statement shows a need for further teaching.
  • B. Incorrect . Patting rather than rubbing protects fragile skin, and applying moisturizer within a few minutes of bathing traps water in the skin — this statement reflects correct technique.
  • C. Incorrect . Harsh and deodorant soaps remove protective oils and irritate dry skin. Choosing a mild cleanser preserves the skin barrier, so this statement is correct.
  • D. Incorrect . A short shower or bath in warm (not hot) water adds moisture to the skin without stripping its oils — this statement reflects the teaching accurately.

Reference: American Academy of Dermatology (relieving dry skin); National Institute on Aging (skin care and aging)

Medium Select all that apply

5. Dysphagia after stroke — safe feeding

A client recovering from a stroke has dysphagia. The speech-language pathologist recommends a soft diet with nectar-thick liquids and a chin-tuck swallowing technique. The nurse is supervising the client during lunch.

Which actions by the nurse are appropriate? Select all that apply.

  1. Position the client sitting fully upright at 90 degrees for the meal.
  2. Remind the client to tuck the chin toward the chest when swallowing.
  3. Provide liquids thickened to nectar consistency as recommended.
  4. Keep the client sitting upright for at least 30 minutes after the meal.
  5. Offer thin liquids through a straw so the client can drink more quickly.
  6. Tilt the client's head back to help food pass to the back of the throat.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . An upright position aligns the swallowing structures and uses gravity to direct food toward the esophagus rather than the airway, reducing the risk of aspiration.
  • B. Correct . The chin-tuck position narrows the airway entrance and helps protect the trachea during the swallow. Reinforcing the speech-language pathologist's technique is part of safe feeding supervision.
  • C. Correct . Thin liquids move too quickly for an impaired swallow to control. Thickened liquids travel more slowly and are less likely to be aspirated, which is why the consistency was prescribed.
  • D. Correct . Remaining upright after eating reduces reflux and aspiration of food that may be retained in the mouth, pharynx, or stomach.
  • E. Incorrect . Thin liquids contradict the prescribed consistency, and straws deliver liquid rapidly to the back of the mouth, overwhelming an impaired swallow and increasing aspiration risk.
  • F. Incorrect . Hyperextending the neck opens the airway and directs food toward the trachea — the opposite of the protective chin-tuck position. It markedly increases the risk of aspiration.

Reference: Hartford Institute for Geriatric Nursing (preventing aspiration in older adults with dysphagia); speech-language pathology dysphagia practice guidance

Medium Multiple choice

6. First ambulation after surgery — orthostatic safety

A client who had abdominal surgery the previous day is prescribed ambulation for the first time since the operation. The client has been on bed rest since leaving the recovery area and reports feeling weak. The nurse prepares to assist the client out of bed.

Which action should the nurse take first?

  1. Assist the client to sit on the side of the bed with the legs dangling for several minutes.
  2. Apply a gait belt and walk the client directly into the hallway.
  3. Ask assistive personnel to walk the client to the bathroom.
  4. Encourage leg exercises in bed and postpone ambulation until the next day.
Show the answer and rationales

Correct answer: A

  • A. Correct . After bed rest, blood pools in the legs and the blood pressure can drop suddenly on standing (orthostatic hypotension). Sitting on the edge of the bed with the legs dangling lets the circulation adjust and lets the nurse check for dizziness or lightheadedness before the client stands, reducing the risk of a fall.
  • B. Incorrect . A gait belt is appropriate equipment, but standing and walking immediately after bed rest skips the gradual position change needed to detect orthostatic hypotension and places the client at risk for syncope and a fall.
  • C. Incorrect . The first postoperative ambulation requires the nurse to assess the client's tolerance of activity, including dizziness and blood pressure response. It should not be delegated before the nurse has evaluated how the client responds.
  • D. Incorrect . Postponing delays the benefits of early ambulation, which prevents deep vein thrombosis, pneumonia, and constipation. Feeling weak after surgery is expected and is managed with a gradual, assisted approach, not by avoiding activity.

Reference: Nursing Fundamentals, NCBI Bookshelf (mobility and orthostatic hypotension); postoperative orthostatic assessment evidence for fall prevention

Medium Select all that apply

7. New fever — nursing interventions

An adult client on a medical unit develops a temperature of 38.9°C (102°F) with chills, a heart rate of 104/min, and dry mucous membranes. The provider prescribes acetaminophen 650 mg orally, blood cultures from two sites, and an IV antibiotic.

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

  1. Administer the prescribed acetaminophen.
  2. Obtain the blood cultures before the first dose of the antibiotic is given.
  3. Encourage the client to drink fluids.
  4. Sponge the client's skin with isopropyl alcohol to speed evaporative cooling.
  5. Pack ice around the axillae and groin until the temperature normalizes.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . An antipyretic lowers the temperature set point, reducing fever and the associated aches and chills, which improves comfort and decreases metabolic demand.
  • B. Correct . Antibiotics started before cultures are drawn can suppress organism growth and obscure identification of the causative pathogen. Cultures are collected first whenever this does not significantly delay treatment.
  • C. Correct . Fever increases insensible fluid loss and metabolic demand, and the client's dry mucous membranes already suggest a fluid deficit. Oral fluids support heat loss and prevent dehydration.
  • D. Incorrect . Alcohol baths are contraindicated. The rapid surface cooling triggers vasoconstriction and shivering, which raises core temperature, and the alcohol can be absorbed through the skin or inhaled.
  • E. Incorrect . Aggressive ice application for a routine fever causes shivering, which generates heat and drives the core temperature up. Antipyretics, light covers, and fluids are the appropriate measures here.

Reference: MedlinePlus (fever); Mayo Clinic fever treatment guidance

Medium Select all that apply

8. Pressure injury prevention — immobile client

A nurse is planning care for a client on bed rest following a stroke. The client cannot reposition independently, and the Braden Scale score is 14, indicating moderate risk for pressure injury. During the bath the nurse notes a reddened area over the sacrum that blanches with light pressure.

Which interventions should the nurse include in the plan of care? Select all that apply.

  1. Reposition the client at least every 2 hours using a written turning schedule.
  2. Use foam wedges and heel-elevation devices to offload bony prominences.
  3. Keep the client's skin clean and dry, especially after any episode of moisture.
  4. Keep the head of the bed at or below 30 degrees unless contraindicated.
  5. Massage the reddened area over the sacrum at each turn to stimulate circulation.
  6. Place a ring-shaped (donut) cushion under the sacrum when the client sits up.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Scheduled, documented repositioning relieves pressure over bony prominences before tissue damage occurs and is the cornerstone of prevention for clients who cannot turn themselves.
  • B. Correct . Offloading devices such as foam wedges and heel protectors redistribute pressure away from high-risk areas like the sacrum and heels, consistent with pressure injury prevention guidelines.
  • C. Correct . Moisture macerates the skin and makes it far more vulnerable to breakdown from pressure, friction, and shear, so prompt cleansing and drying protect skin integrity.
  • D. Correct . Higher elevations cause the client to slide down in bed, creating shear forces over the sacrum. The lowest elevation consistent with the client's condition limits shear injury.
  • E. Incorrect . Massaging reddened skin over a bony prominence does not prevent pressure injury and can cause additional deep tissue trauma. It is contraindicated in pressure injury prevention guidelines.
  • F. Incorrect . Ring or donut devices concentrate pressure around the rim and reduce blood flow to the tissue inside the ring. Guidelines advise against them in favor of pressure-redistributing surfaces.

Reference: NPIAP/EPUAP pressure injury prevention guideline; AHRQ pressure injury prevention toolkit

Medium Select all that apply

9. Promoting sleep — hospitalized older adult

A 78-year-old client on a medical unit reports being unable to sleep since admission, saying staff come into the room all night long. The client is clinically stable, and vital signs have been within normal limits for 48 hours.

Which interventions should the nurse include in the plan of care? Select all that apply.

  1. Cluster assessments and care activities to allow uninterrupted periods of sleep.
  2. Dim the lights and reduce noise near the client's room at night.
  3. Help the client follow the usual bedtime routine from home.
  4. Offer a back massage in the evening to promote relaxation.
  5. Request a nightly PRN prescription of diphenhydramine for sleep.
  6. Encourage a long nap in the late afternoon so the client is less exhausted at night.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Grouping nighttime tasks lets the client complete full sleep cycles instead of being repeatedly awakened, which is the core strategy for restoring sleep in the hospital.
  • B. Correct . A dark, quiet environment supports the natural circadian rhythm and removes the most common hospital barriers to falling and staying asleep.
  • C. Correct . A consistent, familiar routine cues the body for sleep and is a first-line nonpharmacologic intervention.
  • D. Correct . An evening back massage is a traditional, evidence-supported nonpharmacologic comfort measure that promotes relaxation and sleep.
  • E. Incorrect . Diphenhydramine is a highly anticholinergic first-generation antihistamine that the AGS Beers Criteria recommend avoiding in older adults — it causes confusion, urinary retention, and falls, and tolerance develops when it is used as a hypnotic.
  • F. Incorrect . Long, late-day naps reduce the drive to sleep at night and further fragment the sleep-wake cycle, worsening the problem.

Reference: AGS Beers Criteria 2023 (diphenhydramine in older adults); nursing fundamentals sleep promotion guidance

Medium Multiple choice

10. Tube feeding — high gastric residual

A nurse prepares to administer an intermittent enteral feeding through a gastrostomy tube. Before the feeding, the nurse aspirates 320 mL of gastric contents. The facility protocol directs the nurse to hold feedings and notify the provider for a gastric residual volume greater than 250 mL.

Which action should the nurse take?

  1. Return the aspirate to the stomach, hold the feeding, and notify the provider.
  2. Discard the aspirate and administer the feeding at half the prescribed rate.
  3. Administer the feeding as prescribed and recheck the residual in 1 hour.
  4. Flush the tube with 30 mL of water and position the client flat to promote gastric emptying.
Show the answer and rationales

Correct answer: A

  • A. Correct . Returning the aspirate prevents loss of fluid, electrolytes, and digestive enzymes. Because 320 mL exceeds the protocol threshold, the feeding is held and the provider is notified so the plan can be adjusted.
  • B. Incorrect . Discarding the aspirate causes fluid and electrolyte loss, and the nurse cannot independently change a prescribed feeding rate. The protocol requires holding the feeding, not slowing it.
  • C. Incorrect . The residual already exceeds the hold threshold in the protocol. Adding feeding on top of a high residual increases the risk of vomiting and aspiration.
  • D. Incorrect . Lying flat does not promote gastric emptying and increases aspiration risk. The head of the bed stays elevated, and the protocol-directed hold still applies.

Reference: ASPEN/SCCM enteral nutrition guidance on gastric residual volume; facility enteral feeding protocol practice

Hard Select all that apply

11. Comfort-focused care at the end of life

A client with end-stage heart failure has chosen comfort-focused palliative care, and a do-not-resuscitate order is in place. The client is drowsy, takes only sips of fluid, has a dry mouth, and becomes short of breath with any movement. Prescriptions include morphine oral concentrate 5 mg sublingually every 2 hours as needed for pain or shortness of breath.

Which actions by the nurse are appropriate? Select all that apply.

  1. Provide mouth care with moist oral swabs and apply lip moisturizer frequently.
  2. Administer the prescribed morphine when the client shows signs of dyspnea or pain.
  3. Reposition the client gently for comfort, using pillows for support.
  4. Allow family members to remain at the bedside as the client wishes.
  5. Encourage the client to eat full meals to maintain strength.
  6. Obtain a full set of vital signs every 2 hours throughout the night.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . A dry mouth is one of the most distressing symptoms near the end of life, especially as oral intake declines. Frequent oral care with moist swabs and lip moisturizer is a core comfort measure.
  • B. Correct . Low-dose morphine relieves air hunger and pain at the end of life. In a drowsy client the nurse uses nonverbal cues — grimacing, restlessness, labored breathing — to identify distress and treat it.
  • C. Correct . Gentle, supported position changes relieve pressure discomfort and ease breathing. In comfort-focused care, the client's comfort guides the timing and extent of repositioning.
  • D. Correct . The presence of loved ones is central to psychosocial and spiritual comfort at the end of life, and facilitating it is part of palliative nursing care.
  • E. Incorrect . Declining intake is an expected part of the dying process. Pressuring the client to eat causes distress and raises the risk of aspiration — food and fluids are offered for pleasure, never forced.
  • F. Incorrect . Frequent routine vital signs disturb rest and do not change comfort-focused management. Assessments are limited to those that promote the client's comfort.

Reference: National Institute on Aging (providing care and comfort at the end of life); AAFP end-of-life symptom management review

Hard Multiple choice

12. Wound evisceration — next action

Five days after abdominal surgery, a client coughs forcefully during a dressing change and states that something gave way at the incision. The nurse observes the incision edges separated, with a loop of bowel protruding through the open wound. The nurse remains with the client and calls for help.

Which action should the nurse take next?

  1. Cover the protruding bowel with sterile dressings moistened with sterile normal saline.
  2. Gently guide the protruding bowel back through the incision.
  3. Place the client in high Fowler's position with the legs extended.
  4. Apply an abdominal binder snugly over the open wound.
Show the answer and rationales

Correct answer: A

  • A. Correct . Evisceration is a surgical emergency. Exposed viscera must be kept moist and protected — dry tissue quickly becomes ischemic — so sterile saline-moistened dressings are applied while the provider is notified and the client is prepared for surgery.
  • B. Incorrect . Eviscerated organs are never pushed back into the abdomen — doing so risks tissue trauma, contamination, and perforation. The bowel is reduced surgically in the operating room.
  • C. Incorrect . Sitting fully upright with straight legs increases tension on the abdominal wall and can worsen the protrusion. The correct position is low Fowler's with the knees flexed to reduce strain on the wound.
  • D. Incorrect . A binder placed over exposed bowel would compress and traumatize the viscera. Binders may support an intact incision before dehiscence, but they are contraindicated once evisceration has occurred.

Reference: StatPearls (wound dehiscence); medical-surgical nursing perioperative standards

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