Free NCLEX-RN practice questions with answers

Question 3

A young adult from a family with a strongly hierarchical decision-making structure is scheduled for a procedure. During assessment, the client speaks only briefly about the procedure whenever a parent is in the room, and later tells the RN privately that they feel unable to express their own opinion about the treatment plan. This client is most at risk for which condition?

• Ineffective Health Maintenance
• Impaired emancipated Decision-MakingCorrect
• Noncompliance
• Chronic Sorrow

Why: Impaired emancipated Decision-Making is defined as choosing a health care option without personal knowledge or consideration of one's own views, often occurring in a traditional hierarchical family or health care system; limited verbalization of opinions in others' presence is a defining characteristic. Ineffective Health Maintenance concerns inability to manage health behaviors generally, Noncompliance describes failure to follow an agreed plan, and Chronic Sorrow concerns recurring grief, none of which match this presentation. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Impaired emancipated Decision-Making, p. 309.

Question 4

An RN is helping a client with newly diagnosed heart failure set goals for managing the treatment plan at home. Per the recommended nursing intervention for this situation, what should the RN clarify with the client early in the discussion?

• That the client must follow the provider's instructions exactly as written
• The respective roles of the health care provider and the client in managing the regimenCorrect
• That the client will be discharged only after demonstrating perfect adherence
• That family members will make all treatment-related decisions

Why: The suggested nursing intervention for supporting a client's health management is mutual goal setting, which includes helping the client and significant others develop realistic role expectations and clarifying the respective roles of the provider and the client. This collaborative approach differs from simply demanding adherence, imposing a perfection standard for discharge, or removing the client from decision-making altogether. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Readiness for Enhanced Health Management, p. 452.

Question 5

A client with type 2 diabetes tells the RN, "I know I should be checking my blood sugar and taking my medication the way we planned, but between work and my other health problems, it just isn't happening." The client wants help but has not been able to follow the plan both agreed upon. Which nursing diagnosis and approach best fits this situation?

• Noncompliance; document the client's failure to adhere and notify the provider
• Ineffective Health Management; partner with the client to identify barriers and adjust the plan collaborativelyCorrect
• Risk-Prone Health Behavior; refer immediately for a psychiatric evaluation
• Deficient Knowledge; provide a single teaching session and reassess in one month

Why: Ineffective Health Management describes a client who wants to meet health goals but whose pattern of integrating the regimen into daily living is unsatisfactory; the diagnosis is made together with the client and interventions emphasize a collaborative partnership to identify barriers, not the client's compliance with orders. Labeling this Noncompliance is discouraged because it is judgmental, an immediate psychiatric referral is not indicated by a barriers-to-adherence presentation, and a single teaching session does not address a complex regimen difficulty. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Ineffective Health Management, p. 444.

Question 6

During a care-planning meeting, a nurse manager explains to staff why the unit avoids the nursing diagnosis label "Noncompliance" for clients struggling with complex regimens. What is the stated rationale?

• The label is outdated and no longer recognized by any classification system
• The label is judgmental and places blame on the client for factors that may be outside the client's controlCorrect
• The label requires physician co-signature before it can be used
• The label can only be applied to pediatric clients

Why: The source text notes explicitly that Noncompliance is judgmental and places blame on the client for things the client may have no control over, and recommends the diagnosis Ineffective Health Management in its place. The label remains a recognized NANDA-I diagnosis, does not require a co-signature, and is not restricted to pediatric clients. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Noncompliance, p. 609.

Question 7

An RN is caring for a client recovering from a sensitive surgical procedure in a shared room. Which of the following nurse actions or situational factors would place this client at risk for compromised human dignity? Select all that apply.

• A staff member discusses the client's diagnosis with a coworker where other clients can overhearCorrect
• The client's body is left exposed longer than necessary during a dressing changeCorrect
• The nurse knocks and waits for a response before entering the client's room
• A staff member reviews the client's chart only with other members of the care team
• The nurse discusses the client's test results with a visitor without the client's permissionCorrect

Why: Risk factors for compromised human dignity include disclosure of confidential information, exposure of the body, and invasion of privacy — all of which occur when protected health information is shared without permission (with a coworker in earshot of other clients, or with a visitor without consent) or when the body is exposed longer than necessary. Knocking before entry and restricting chart access to the care team are dignity-preserving practices, not risk factors. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Risk for Compromised Human Dignity, p. 471.

Question 8

A client is admitted for an elective surgical procedure. As part of admission processing, the RN ensures the client receives written information about the right to accept or refuse medical treatment and the option to complete an advance directive. This nursing action fulfills a requirement of which federal law?

• Health Insurance Portability and Accountability Act (HIPAA)
• Emergency Medical Treatment and Labor Act (EMTALA)
• Patient Self-Determination ActCorrect
• Americans with Disabilities Act

Why: The Patient Self-Determination Act, effective in 1991, requires that all individuals receiving medical care receive written information about their right to accept or refuse medical or surgical treatment and their right to initiate advance directives. HIPAA governs privacy of health information, EMTALA governs emergency screening and stabilization obligations, and the ADA addresses disability discrimination — none of which specifically mandate this admission disclosure. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Risk for Compromised Human Dignity, p. 472.

Question 9

An older client with mild dementia becomes confused and calls out repeatedly during a hospital stay. Which nursing action best preserves the client's dignity as described for this population?

• Refer to the client using an affectionate nickname like "sweetie" so the client feels cared for
• Ask how the client prefers to be addressed and use that name consistently, approaching gently and with respectCorrect
• Limit interactions with the confused client to essential tasks only to avoid overstimulation
• Have unlicensed staff manage all interactions with the confused client so the RN can focus on other clients

Why: The care plan for this diagnosis specifically instructs nurses to always ask how a client wants to be addressed and to avoid demeaning terms such as "sweetie" or "honey," and to treat confused clients with respect and dignity even when delirium or dementia is present. Using nicknames, minimizing interaction, or removing the RN entirely from care of a vulnerable client does not reflect this guidance. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Risk for Compromised Human Dignity, p. 472.

Question 10

A client who lives alone has been hospitalized twice this year for exacerbations related to an unsafe, cluttered home with no working smoke detector. As discharge is being planned, which nursing action addresses the underlying problem most directly?

• Provide a pamphlet on home safety and discharge the client as scheduled
• Refer for a predischarge home assessment to evaluate the need for accessibility and safety-related environmental changesCorrect
• Recommend the client be discharged to a homeless shelter instead of home
• Restrict the discussion to medication teaching since housing is outside the nursing scope

Why: For a client with Impaired Home Maintenance, the recommended intervention is to consider a predischarge home assessment referral to determine the need for accessibility and safety-related environmental changes; controlled trials show this reduces falls and fall-related injuries. A pamphlet alone does not address an identified unsafe environment, shelter placement is not indicated without further assessment, and home safety is within the RN's care-coordination role, not outside it. Primary reference: Ackley, Ladwig, & Makic, Nursing Diagnosis Handbook (Elsevier, 11th Edition), Impaired Home Maintenance, p. 460.