NCLEX Basic Care & Health Promotion questions
The PrepScore bank has 109 Basic Care & Health Promotion questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Generate solutions and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Immunization schedules, prenatal/newborn care, pain management, mobility, nutrition, sensory aids, adolescent care, end-of-life comfort.
Three worked questions
Q1. A 68-year-old female is intubated and unconscious in the ICU after a massive intracerebral hemorrhage. She is sedated, ventilated, and has not been responsive to verbal stimuli for 36 hours. The bedside nurse is about to perform routine oral care. Which approach is MOST APPROPRIATE for this patient?
- A. Position the patient in side-lying with HOB at 30°, have suction ready, brush gently with a soft toothbrush plus chlorhexidine swab, and apply lip moisturizer every 2–4 hours
- B. Sit the patient upright at 60° and offer small sips of water to encourage swallowing reflex stimulation during the oral-care procedure
- C. Place the patient supine with HOB flat, scrub all surfaces with a stiff toothbrush, and rinse vigorously with alcohol-based mouthwash to ensure thorough cleansing
- D. Defer all oral care until the patient is extubated and able to participate, since care without consent is inappropriate in an unconscious patient
Show answer and rationale
Answer: Position the patient in side-lying with HOB at 30°, have suction ready, brush gently with a soft toothbrush plus chlorhexidine swab, and apply lip moisturizer every 2–4 hours
Unconscious intubated patients have no airway protection, so oral care must combine aspiration prevention (side-lying + HOB + suction) with VAP prevention (chlorhexidine + gentle mechanical cleaning). Sitting upright with PO fluids, supine with alcohol, and deferring care all increase aspiration or VAP risk.
Q2. A 62-year-old male is intubated and sedated in the ICU on day 3 after a large MCA stroke. His sedation has been weaned from propofol to dexmedetomidine. He cannot self-report. The nurse is preparing for endotracheal suctioning. Which assessment approach BEST evaluates his pain during the procedure?
- A. Use a validated behavioral pain scale (e.g., CPOT or BPS) scoring facial expression, body movement, ventilator compliance, and muscle tension before, during, and after suctioning
- B. Rely on his vital sign trends alone (heart rate and blood pressure) since autonomic changes are the only reliable pain indicators in sedated intubated patients
- C. Wait for the patient to gesture or attempt to verbalize pain during the procedure before administering any analgesic premedication or comfort measures
- D. Use a Wong-Baker FACES self-report scale at rest before suctioning and assume his pain level remains the same during the procedure
Show answer and rationale
Answer: Use a validated behavioral pain scale (e.g., CPOT or BPS) scoring facial expression, body movement, ventilator compliance, and muscle tension before, during, and after suctioning
Intubated sedated patients cannot self-report — the standard of care is a validated behavioral pain scale (CPOT or BPS) assessed at rest AND during procedures, since procedural pain (suctioning, turning) often spikes well above resting baseline. Vital signs alone are insensitive and non-specific.
Q3. Which interventions are part of comprehensive constipation management? Select all that apply.
- A. FIBER intake (soluble + insoluble) — 25-30g/day from food + supplements (psyllium, methylcellulose)
- B. Adequate FLUID intake (≥2L/day if cardiac/renal allows)
- C. PHYSICAL ACTIVITY (ambulation, exercise — stimulates bowel motility)
- D. OPIOID-INDUCED CONSTIPATION — scheduled stimulant + softener, PAMORAs for refractory
- E. Bowel routine + timing (post-meal — gastrocolic reflex; squat position)
- F. Bed rest only
Show answer and rationale
Answer: FIBER intake (soluble + insoluble) — 25-30g/day from food + supplements (psyllium, methylcellulose)Adequate FLUID intake (≥2L/day if cardiac/renal allows)PHYSICAL ACTIVITY (ambulation, exercise — stimulates bowel motility)OPIOID-INDUCED CONSTIPATION — scheduled stimulant + softener, PAMORAs for refractoryBowel routine + timing (post-meal — gastrocolic reflex; squat position)
Comprehensive constipation management — multi-modal: (1) DIETARY — fiber 25-30 g/day soluble + insoluble (psyllium, methylcellulose, polycarbophil) — gradual increase to avoid bloating; FLUID 1.5-2 L/day if no fluid restriction; (2) ACTIVITY — ambulation, exercise stimulates motility; (3) ROUTINE — consistent toileting time (post-meal — gastrocolic reflex peak 15-45 min after eating); squat position (knees above hips — Squatty Potty effective); time + privacy; (4) LAXATIVE STEPWISE — (a) BULK-FORMING (psyllium, methylcellulose) — first-line chronic; (b) OSMOTIC (polyethylene glycol — Miralax, lactulose, magnesium hydroxide / Mg citrate, sorbitol); (c) STIMULANT (senna, bisacodyl) — episodic / OIC, dependence avoided long-term; (d) SOFTENER (docusate) — limited monotherapy effectiveness, adjunct; (e) Lubricants (mineral oil) limited; (f) Suppository / enema (glycerin, bisacodyl, sodium phosphate); (5) OPIOID-INDUCED CONSTIPATION specific — SCHEDULED stimulant + softener FROM DAY 1 of opioid (no tolerance develops); refractory → PAMORAs (peripheral mu-opioid antagonists — methylnaltrexone, naloxegol, naldemedine) restore gut motility without reversing analgesia; lubiprostone, plecanatide; (6) MEDICATION REVIEW — anticholinergics, calcium / iron supplements, opioids, antihypertensives (CCB), antidepressants (TCAs), antacids (Al containing), antiparkinson contribute; (7) RED FLAGS — alarm symptoms (blood, weight loss, fever, severe pain, family hx CRC) → workup for obstruction / mass / IBD; abdominal exam, rectal exam for impaction (manual disimpaction may be needed); imaging if concerning; (8) Chronic / refractory — pelvic floor PT for dyssynergia, secretagogues (linaclotide, lubiprostone, plecanatide), prokinetics (prucalopride); biofeedback.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
At 6 months: DTaP #3, IPV #3, Hib #3, PCV13 #3, RV #3 (RV5 brand), plus first INFLUENZA dose (annual season). HepB #3 by 18 months. MMR + varicella NOT until 12 months. Mild illness without fever is NOT a contraindication. Use motivational interviewing for hesitant parents — never agree-and-skip without informed-decision documentation.
Common pregnancy discomforts (dependent edema, heartburn, round-ligament pain) differ from preeclampsia red flags: SEVERE headache + visual changes + epigastric pain (or RUQ pain) + sudden hand/face swelling + decreased fetal movement. The cluster = severe-features preeclampsia until ruled out. Always BP + UA protein + provider notification.
Standard adolescent visits include time alone with the provider for HEADSS screening. State confidentiality limits up front: 'What we talk about is private, except if you're going to hurt yourself, someone is hurting you, or you're going to hurt someone else.' Never promise total confidentiality; never ask sensitive questions in front of parents.
Patients on chronic opioids have tolerance — acute pain requires higher per-dose opioid PLUS scheduled multimodal (acetaminophen, NSAID if safe, ice, regional, gabapentin per orders). Monitor sedation + RR using the Pasero scale before reaching for more opioid. Goal is functional pain control, not zero pain. Never add benzo for nociceptive pain — synergistic respiratory depression.
Verbal warnings don't reduce fall risk. Prevention bundle: remove/secure throw rugs, install grab bars, brighten lighting, review high-risk meds (benzos on Beers list), verify walker/cane fit, ensure accessible phone or wearable alert. Engage family in home setup. PT/OT consult for home assessment.
Terminal dyspnea = low-dose morphine SC/IV. Death rattle / secretions = anticholinergic (scopolamine patch, glycopyrrolate) + lateral repositioning + gentle oropharyngeal Yankauer at most. AVOID aggressive deep suctioning + IV fluids (worsen secretions/edema). Family presence + teaching that the death rattle is typically not distressing to the patient.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Basic Care & Health Promotion questions does the bank have?
109 multiple-choice items, plus 10 unfolding cases in the Basic Care & Health Promotion pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Generate solutions and Take action, though every step appears.
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