1Question
A nurse is observing a newly hired nurse suction a client's tracheostomy using the open technique. Which actions by the new nurse are correct?
Select all that apply.
- Gives extra oxygen to the client before passing the catheter.
- Applies suction while advancing the catheter into the tube.
- Applies suction only while withdrawing the catheter and limits each pass to about 10 seconds.
- Instills sterile saline into the tube before every pass to loosen secretions.
- Lets the client recover and gives oxygen again before a second pass.
Show the answers and explanation
Answers: A, C and E.
- A – Gives extra oxygen to the client before passing the catheter.
- C – Applies suction only while withdrawing the catheter and limits each pass to about 10 seconds.
- E – Lets the client recover and gives oxygen again before a second pass.
Topic: tracheostomy suctioning technique
Suctioning removes oxygen along with secretions, so the client is oxygenated before and between passes, suction is applied only on withdrawal and each pass is kept short. These steps limit hypoxemia, mucosal injury and vagal slowing of the heart.
Why the others are wrong
- B – Suction during insertion removes oxygen for longer and damages the tracheal lining; the catheter is advanced without suction.
- D – Routine saline instillation is not recommended; it can wash organisms into the lower airway and worsen oxygenation. Humidification and hydration are used to thin secretions.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client with a large right pleural effusion is to have a thoracentesis at the bedside. The client is able to sit up. How should the nurse position the client for the procedure?
- Lying flat on the back with the right arm at the side.
- Lying on the right side with the knees drawn up to the chest.
- Sitting on the edge of the bed, leaning forward with the arms resting on an overbed table.
- Lying face down with a pillow under the abdomen.
Show the answer and explanation
Answer: C. Sitting on the edge of the bed, leaning forward with the arms resting on an overbed table.
Topic: positioning for thoracentesis
Sitting upright and leaning forward over a table widens the spaces between the ribs and lets the fluid collect at the base of the pleural space, where the needle can reach it safely from the back. The supported arms also help the client stay still.
Why the others are wrong
- A – Lying flat spreads the fluid along the back of the chest and does not open the rib spaces for a posterior approach.
- B – Lying on the affected side hides the insertion site; if a client cannot sit, the unaffected side is used with the head of the bed raised.
- D – The prone position restricts breathing and does not collect the fluid at an accessible site.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client is receiving peritoneal dialysis. Two liters of dialysate were instilled, and after the dwell time the drain has returned only 900 mL and then stopped. The client is comfortable, the returned fluid is clear and pale yellow, and vital signs are unchanged. Which action does the nurse take first?
- Notify the provider that the catheter is blocked.
- Instill the next exchange and add the retained volume to the fluid balance.
- Raise the drainage bag to the level of the abdomen.
- Check the tubing for kinks and closed clamps and turn the client from side to side.
Show the answer and explanation
Answer: D. Check the tubing for kinks and closed clamps and turn the client from side to side.
Topic: peritoneal dialysis outflow problem
Slow or incomplete outflow is most often mechanical: a kinked or clamped line, a catheter tip lying against bowel or omentum, or a bowel full of stool. The nurse checks the system and repositions the client, which often restores drainage by gravity. If the problem continues, the provider is told and constipation is assessed.
Why the others are wrong
- A – The provider is told if simple measures fail; the nurse first checks for the common mechanical causes.
- B – Instilling more fluid on top of retained dialysate overfills the abdomen and can impair breathing.
- C – Outflow depends on gravity; the bag must be below the abdomen, so raising it stops drainage.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A nurse is preparing a client for electroconvulsive therapy (ECT) for severe depression. Which statements should the nurse include in the teaching?
Select all that apply.
- The client will not eat or drink for several hours before the treatment
- Dentures, hairpins and jewelry are removed and the bladder is emptied beforehand
- The client may drive home as soon as fully awake
- Brief confusion and some memory gaps around the treatment can occur
- A seizure is allowed to happen without any medication to relax the muscles
- A responsible adult should accompany the client home after an outpatient treatment
Show the answers and explanation
Answers: A, B, D and F.
- A – The client will not eat or drink for several hours before the treatment
- B – Dentures, hairpins and jewelry are removed and the bladder is emptied beforehand
- D – Brief confusion and some memory gaps around the treatment can occur
- F – A responsible adult should accompany the client home after an outpatient treatment
Topic: ECT preparation teaching
ECT is given under brief anesthesia with a muscle relaxant so that the seizure is modified and safe. The client is kept NPO, and dentures, jewelry and hairpins are removed and the bladder emptied. Temporary confusion and memory gaps are common, so an adult escorts outpatients home and driving is not allowed that day.
Why the others are wrong
- C – Confusion and drowsiness after the anesthetic make driving unsafe.
- E – A muscle relaxant and anesthesia are given so that the seizure does not cause injury.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A client has a nasogastric tube attached to low intermittent suction after surgery for a bowel obstruction. The client reports nausea, the abdomen is more distended, and nothing has drained into the canister for 2 hours. Which action should the nurse take first?
- Give the prescribed antiemetic and reassess in one hour
- Check the tube and suction for kinks, connections, settings and position
- Advance the tube 5 cm (2 in) and tape it again
- Clamp the tube and offer the client ice chips
Show the answer and explanation
Answer: B. Check the tube and suction for kinks, connections, settings and position
Topic: nasogastric suction not draining
Nausea and increasing distention with no drainage suggest that the tube is no longer decompressing the stomach. The nurse first assesses the system from the client to the wall: placement mark at the nostril, kinks, loose connections, a blocked air vent and suction that is off or set incorrectly; the tube is then irrigated as prescribed if it is blocked.
Why the others are wrong
- A – An antiemetic treats the symptom while the stomach continues to fill, with a risk of vomiting and aspiration.
- C – The nurse does not advance a tube without first assessing it and without a prescription, particularly after gastrointestinal surgery.
- D – Clamping stops decompression completely and ice chips add fluid to a stomach that is not being emptied.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A client has a Jackson-Pratt drain after a mastectomy. The nurse finds the bulb fully expanded and half full of serosanguineous fluid. Which action should the nurse take?
- Empty and measure the drainage, then squeeze the bulb flat and replace the plug while it is compressed
- Leave the bulb until it is completely full so that the output measurement is accurate
- Connect the drain tubing to low wall suction
- Flush the drain tubing with sterile normal saline to keep it open
Show the answer and explanation
Answer: A. Empty and measure the drainage, then squeeze the bulb flat and replace the plug while it is compressed
Topic: closed-suction wound drain
A bulb drain works by the gentle negative pressure created when the compressed bulb tries to re-expand. An expanded bulb has lost its suction, so the nurse empties it, records the amount and character of the drainage and re-establishes suction by compressing the bulb before closing the plug.
Why the others are wrong
- B – A full or expanded bulb does not drain the wound; fluid then collects under the incision.
- C – The bulb itself supplies the suction; wall suction is not attached without a specific prescription and may damage tissue.
- D – Flushing a surgical drain is not routine nursing care and can carry organisms into the wound.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A client with a hip fracture is in Buck's skin traction while awaiting surgery. Which actions by the nurse are correct?
Select all that apply.
- Make sure the weights hang freely and do not touch the bed or the floor
- Lift the weights while the client is being moved up in bed
- Check the skin, the pulses and the sensation of the affected leg at regular intervals
- Keep the client in the center of the bed with the body in line with the pull of the traction
- Rest the weights on the bed frame while the client eats meals
Show the answers and explanation
Answers: A, C and D.
- A – Make sure the weights hang freely and do not touch the bed or the floor
- C – Check the skin, the pulses and the sensation of the affected leg at regular intervals
- D – Keep the client in the center of the bed with the body in line with the pull of the traction
Topic: skin traction care
Traction works only when the pull is continuous and in line with the limb: weights hang freely, ropes run unobstructed and the body stays aligned. Skin traction can press on skin and nerves, so skin integrity and neurovascular status of the limb are checked regularly.
Why the others are wrong
- B – Lifting the weights releases the traction and can cause muscle spasm and pain; the client is moved with the traction maintained.
- E – Resting the weights on the bed frame removes the pull; the weights are not removed or supported without a prescription.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A client with schizophrenia who still hears voices despite taking medication is referred for cognitive behavioral therapy and asks the nurse what it involves. Which explanation by the nurse is best?
- The therapy will make the voices stop by exposing you to them again and again until they fade
- You will explore childhood memories to find out why the voices began
- The therapy is meant to replace your medication over the next several months
- You will practice linking your thoughts about the voices to your mood and actions
Show the answer and explanation
Answer: D. You will practice linking your thoughts about the voices to your mood and actions
Topic: cognitive behavioral therapy in schizophrenia
Cognitive behavioral therapy for psychosis helps the client examine how thoughts about experiences such as voices affect emotions and behavior, and practice coping and different responses. It is used alongside medication, not instead of it, and it does not aim to uncover childhood causes.
Why the others are wrong
- A – The therapy cannot promise the voices will stop; the focus is on changing the response to them.
- B – Exploring childhood origins is the work of psychodynamic therapy, not cognitive behavioral therapy.
- C – It is added to medication treatment and does not replace it; stopping medication risks relapse.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A client who has been offered psychodynamic therapy once a week asks the nurse how it differs from classical psychoanalysis. Which explanation is most accurate?
- Psychoanalysis is more intensive, with several sessions a week over years; psychodynamic therapy is less frequent and shorter
- Psychodynamic therapy does not deal with unconscious processes at all, while psychoanalysis is built entirely around them
- Psychoanalysis is carried out together with medication, and psychodynamic therapy is never combined with it
- Psychodynamic therapy aims to change observable habits by reinforcing desired behavior
Show the answer and explanation
Answer: A. Psychoanalysis is more intensive, with several sessions a week over years; psychodynamic therapy is less frequent and shorter
Topic: psychoanalysis versus psychodynamic therapy
Both approaches explore unconscious conflict and early experience, but classical psychoanalysis is typically far more intensive, with multiple sessions per week over a period of years. Psychodynamic therapy draws on the same ideas in a less frequent and often shorter format.
Why the others are wrong
- B – Psychodynamic therapy also works with unconscious processes; the difference is not whether it does.
- C – Neither approach is defined by medication use.
- D – Reinforcing desired behavior describes behavioral therapy, not psychodynamic therapy.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A client with borderline personality disorder asks why the unit's therapy group practices breathing exercises and non-judgmental observation of feelings. Which explanation by the nurse is most accurate?
- Dialectical behavior therapy teaches mindfulness, drawn from contemplative traditions, to balance acceptance with change
- Cognitive restructuring requires clients to eliminate every distressing emotion before they can move forward in therapy and daily life
- Exposure therapy depends on sitting with trauma memories until the client falls asleep
- Interpersonal therapy focuses on the therapist's analysis of the client's dreams
Show the answer and explanation
Answer: A. Dialectical behavior therapy teaches mindfulness, drawn from contemplative traditions, to balance acceptance with change
Topic: DBT and mindfulness skills
Dialectical behavior therapy combines acceptance and change strategies. Its skills modules, including mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, draw on contemplative practice and help clients tolerate strong emotions without acting on them.
Why the others are wrong
- B – Cognitive restructuring challenges thoughts; it does not aim to eliminate all emotions.
- C – Exposure therapy involves planned, graded confrontation of feared cues, not sleeping through memories.
- D – Dream analysis belongs to psychoanalytic approaches; interpersonal therapy addresses current relationships.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
A client with a severe fear of elevators is about to begin exposure therapy. Which statement by the nurse best describes this treatment?
- You will learn better ways to avoid elevators so you feel calmer day to day
- You will take a medication before every ride so that anxiety never appears
- You will think positive thoughts until the fear disappears without going near elevators
- You will gradually face situations involving elevators, starting with less frightening steps, with your therapist guiding you
Show the answer and explanation
Answer: D. You will gradually face situations involving elevators, starting with less frightening steps, with your therapist guiding you
Topic: exposure therapy explained to the client
Exposure therapy involves planned, graded and repeated contact with the feared stimulus while the therapist provides support, which allows fear to fade and teaches the client that the feared outcome does not occur. Avoidance maintains anxiety.
Why the others are wrong
- A – Avoidance reinforces fear and is what exposure is designed to reduce.
- B – Medication before every ride is not part of exposure and prevents learning that the situation is safe.
- C – Avoiding the feared object while thinking positively does not provide exposure.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A client with schizophrenia has well-controlled hallucinations, but repeatedly loses jobs because of problems with attention, memory and planning. Which referral would best address the cause of this client's disability?
- Cognitive remediation with supported employment services
- A higher antipsychotic dose to remove all remaining symptoms
- Admission to treat acute positive symptoms
- Electroconvulsive therapy consultation
Show the answer and explanation
Answer: A. Cognitive remediation with supported employment services
Topic: cognitive symptoms and functional disability
Cognitive symptoms such as impaired attention, memory and executive function are a major source of functional disability in schizophrenia and respond poorly to antipsychotics alone. Cognitive remediation and supported employment target these deficits directly.
Why the others are wrong
- B – Raising the dose adds side effects and does not reliably improve cognition.
- C – The positive symptoms are controlled, so admission for them is not indicated.
- D – ECT is not a treatment for cognitive deficits in schizophrenia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A client with PTSD asks what trauma-focused cognitive behavioral therapy will involve. Which explanation by the nurse is accurate?
- You will follow a finger with your eyes while recalling images, without discussing any thoughts
- You will rebuild your life story year by year before anyone asks about your feelings
- You will take medication while the therapist interprets childhood conflicts
- You and the therapist will look at how your thoughts about the event shape your feelings and actions and practice new responses
Show the answer and explanation
Answer: D. You and the therapist will look at how your thoughts about the event shape your feelings and actions and practice new responses
Topic: trauma-focused CBT
Trauma-focused cognitive behavioral therapy helps clients identify and change unhelpful thoughts about the trauma, understand the links among thoughts, feelings and behavior, and practice coping and gradual approach to avoided reminders.
Why the others are wrong
- A – Finger tracking while recalling images describes eye movement desensitization and reprocessing.
- B – A chronological life narrative is a different, narrative-focused technique.
- C – Interpreting childhood conflicts describes psychodynamic therapy and not cognitive behavioral therapy.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
During his first exposure session for a fear of flying, a client's anxiety rises sharply. The nurse reinforces what the therapist told him. Which expected outcome should the nurse describe if he stays in the situation?
- Anxiety will increase with every exposure until he cannot tolerate it
- Anxiety will gradually decline with prolonged and repeated exposure
- Anxiety will stay the same unless he leaves early
- Anxiety will vanish completely within the first minute
Show the answer and explanation
Answer: B. Anxiety will gradually decline with prolonged and repeated exposure
Topic: habituation during exposure
Habituation is the decline of the anxiety response with continued or repeated contact with a feared stimulus. Staying in the situation until anxiety falls, and repeating exposures, teaches the client that the feared outcome does not occur.
Why the others are wrong
- A – Repeated exposure does not progressively increase anxiety; that would make the therapy harmful.
- C – Anxiety changes with staying in the situation, whereas leaving early reinforces avoidance.
- D – Relief is gradual; it does not vanish within a minute.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
A client with borderline personality disorder and repeated self-injury asks which psychotherapy has the strongest research support for her condition. Which response by the nurse is best?
- Exposure and response prevention, which targets compulsive rituals
- Hypnotherapy, which relaxes the client until impulses fade
- Open-ended psychoanalysis, which has been shown to outperform every skills-based treatment in every trial published so far
- Dialectical behavior therapy, which combines skills training, individual sessions and coaching between sessions
Show the answer and explanation
Answer: D. Dialectical behavior therapy, which combines skills training, individual sessions and coaching between sessions
Topic: DBT for borderline personality disorder
Dialectical behavior therapy was developed for borderline personality disorder and has the most consistent research support for reducing self-harm and suicidal behavior. It combines individual therapy, group skills training, and between-session coaching.
Why the others are wrong
- A – Exposure and response prevention treats obsessive-compulsive disorder.
- B – Hypnotherapy has no strong evidence for this disorder.
- C – Psychoanalysis has not been shown to outperform skills-based treatment for borderline personality disorder.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A client who has been socially withdrawn says, 'No one wants to be around me.' Which statement by the nurse is an example of cognitive restructuring?
- Try not to think about that
- Tell me more about your childhood
- Everyone feels that way sometimes, so do not worry
- Let us list the times friends contacted you and the times you turned them down, and see what the evidence shows
Show the answer and explanation
Answer: D. Let us list the times friends contacted you and the times you turned them down, and see what the evidence shows
Topic: cognitive restructuring
Cognitive restructuring teaches the client to test an automatic thought against evidence and develop a more balanced thought. Thought suppression, reassurance and exploring childhood are different approaches.
Why the others are wrong
- A – Telling the client to suppress thoughts does not evaluate them and often increases them.
- B – Exploring childhood is a psychodynamic approach.
- C – Generalized reassurance dismisses the thought without testing it.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
17Question
A client with bipolar I disorder is learning to keep regular times for sleeping, meals and social activity and to recognize early warning signs of mood episodes. Which psychotherapy is the client most likely receiving?
- Hypnotherapy
- Interpersonal and social rhythm therapy
- Psychoanalysis
- Exposure and response prevention for obsessive-compulsive rituals
Show the answer and explanation
Answer: B. Interpersonal and social rhythm therapy
Topic: interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy stabilizes daily routines and sleep-wake cycles, which helps prevent mood episodes in bipolar disorder, while also addressing interpersonal problems. It is used alongside medication.
Why the others are wrong
- A – Hypnotherapy does not target routine and mood stability.
- C – Psychoanalysis explores unconscious conflict and does not stabilize daily rhythms.
- D – Exposure and response prevention treats obsessive-compulsive disorder.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
18Question
A client who is starting mindfulness-based therapy says, 'The goal is to empty my head so I never feel bad again.' Which nurse response is most accurate?
- Yes, the goal is to remove every unpleasant thought
- The practice focuses on finding childhood causes of your distress
- The therapist will give you steady reassurance until symptoms stop
- The practice helps you notice difficult thoughts and feelings without judging or fighting them, which changes how you relate to them
Show the answer and explanation
Answer: D. The practice helps you notice difficult thoughts and feelings without judging or fighting them, which changes how you relate to them
Topic: mindfulness-based therapy
Mindfulness-based therapies teach non-judgmental awareness of present experience. Instead of eliminating distressing thoughts or feelings, the client learns to observe them and respond differently, which reduces their power over behavior.
Why the others are wrong
- A – Eliminating thoughts is not the aim and is not possible.
- B – Childhood causes are explored in psychodynamic therapy.
- C – Constant reassurance is a supportive technique and not the mechanism of mindfulness.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
19Question
An adolescent with depression says, 'I will call my friends when I feel better.' Using behavioral activation, which nurse response is best?
- Wait until your energy returns before planning anything
- Let us look for evidence that your friends do not want to hear from you
- Let us schedule one short, manageable outing this week, since taking action can lift mood before motivation returns
- Do not worry; your friends will contact you when they are ready
Show the answer and explanation
Answer: C. Let us schedule one short, manageable outing this week, since taking action can lift mood before motivation returns
Topic: behavioral activation
Behavioral activation is based on the idea that depression reduces activity and rewarding experiences, which worsens mood. Scheduling small, achievable activities, even when motivation is low, helps restore positive reinforcement and improves mood.
Why the others are wrong
- A – Waiting for energy maintains withdrawal and worsens mood.
- B – Examining evidence for thoughts is a cognitive technique, not behavioral activation.
- D – Passive reassurance leaves the client inactive and does not teach a skill.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
20Question
A therapist plans for a client with a severe fear of dogs to walk progressively closer to a calm dog in a park. Which type of exposure is this?
- In vivo exposure
- Imaginal exposure
- Interoceptive exposure
- Relaxation training
Show the answer and explanation
Answer: A. In vivo exposure
Topic: in vivo exposure
In vivo exposure is real-life, graded contact with the feared object or situation. Imaginal exposure uses vivid mental recall, and interoceptive exposure deliberately provokes feared body sensations.
Why the others are wrong
- B – Imaginal exposure uses mental images, not real contact.
- C – Interoceptive exposure produces feared body sensations such as a racing heart.
- D – Relaxation training teaches calming skills and does not involve facing the feared object.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
NCLEX-RN is a registered trademark of the National Council of State Boards of Nursing, Inc. (NCSBN). This site is not affiliated with, sponsored by or endorsed by the owner of that mark.
Nursing