Poorly Written NCLEX-style Questions (with examples)

Don’t think that just because you got the question wrong that it had to be you! There are poorly written NCLEX-style questions out there! If you think you are right and that the rationale seems a bit of a stretch, you are probably right. Don’t let some of these bad questions ruin your confidence.

No matter what resource you use to practice questions there will be questions and rationales that make NO sense or go against what you were taught. Of course there will be times that you get the question wrong because you didn’t know the content well enough or that you didn’t use the strategy or analyzing skill in the right way. But don’t think it’s always something you did wrong.

Stupid Test Questions (because the answers are just totally wrong)

When I really started getting into tutoring (in 2014), I started practicing tons of NCLEX questions to be a better tutor. I came across so many questions that didn’t seem right that I googled, “poorly written NCLEX questions” and found this article. It was from a frustrated student that thought the questions were “stupid”. She found some research articles to back up her thoughts that many NCLEX-style test questions are poorly written. She was right.

I have been known to say, “that’s just a stupid test question”. I remember my nursing professors doing some major mental back flips to justify the answer. It took some real restraint to not throw the nursing textbook across their office! These days I’m not afraid to admit to a student that they are probably right and that it was just a stupid NCLEX-style question.

Here are some REAL NCLEX-style questions I’ve come across that are POORLY written. I’ll even provide where I got the question so that you can see many resources out there are guilty of it. Hey, even I’ve had some stupid questions in my sets that I’ve done with students!

Poorly Written NCLEX-style Question Example 1: Wrong Answers

From Davis Q&A Review for NCLEX-RN, 2017 edition , p 81, #129

The unlicensed NA is providing care to multiple clients, under the supervision of the RN. Which activities are appropriate for the RN to delegate to the NA? Select all that apply.

1. Ask the client if the antiemetic given a half hour ago relieved the client’s nausea, and report the finding to the RN.
2. Observe for and report muscle weakness for the client with a serum potassium level of 3.2 mEq/L.
3. Inject air and withdraw medication from a vial after being shown by the RN while the RN administers the client’s first prepared medication.
4. Cleanse and redress the client’s surgical and wound drain dressing on the client’s second postoperative day.
5. Shave the facial hair with an electric razor for the client who needs to lie flat in bed after spinal surgery.

What answers did you choose? I only choose answer 5. But the rationale says 1, 2 & 5. But there’s no way it’s 1 and 2 because those are both assessments or “collecting” data and only the nurse can do that! Delegation questions are probably the most confusing questions because every resource has a different opinion on what’s appropriate.

Poorly Written NCLEX-style Question Example 2: Wrong Answer

LaCharity: Prioritization, Delegation & Assignment, 2014 edition, pg 29 #19

You are administering vancomycin 500 mg IV to a client with a MRSA wound infection when you notice that the client’s neck and face are becoming flushed. What action should you take next?

1. Discontinue the vancomycin infusion.
2. Slow the rate of the vancomycin infusion.
3. Obtain an order for an antihistamine.
4. Check the client’s temperature.

What answer did you choose? I chose 1 because this dude is getting Red Man Syndrome, an anaphylactoid reaction! it’s not anaphylaxis yet, but it’s bad. However, the book says 2! Are they crazy?! You need to discontinue it or stop the infusion so that he doesn’t get an even worse reaction. #2 is just a dumb answer and should not be what a new nurse does.

Poorly Written NCLEX-style Question Example 3: Obscure Content

Kaplan, NCLEX-RN Prep Plus, 2018 Edition, pg 237 #12

A client with known heparin-induce thrombocytopenia (HIT) is undergoing chemotherapy and is having a central venous access device placed. Which of the following types of central venous access device does the nurse know BEST minimizes the risk of HIT-related complications?

1. Hickman
2. Broviac
3. Groshong
4. Port

How the heck is anyone supposed to know this?! The first three are all brand names, which it’s very unlikely you’ll see brand names on the test. The bottom line is that no one knows this and it shouldn’t be a question.

Poorly Written NCLEX-style Question Example 4: Bad Rationale

Saunders Comprehensive Review for the NCLEX-RN Exam, 2020 edition, pg 1070 #906

Even my beloved ❤️ Saunders has a dumb question.

The nurse is caring for an older adult who has been placed in Buck’s extension traction after a hip fracture. On assessment of the client, the nurse notes that the client is disoriented. What is the best nursing action based on this information?

1. Apply restraints to the client
2. Ask the family to stay with the client
3. Place a clock and calendar in the client’s room
4. Ask the laboratory to perform electrolyte studies

It clearly seems like this person is having a complication because they shouldn’t be disoriented. I choose 4. According to Saunders it says the answer is 3. Seriously!? That seems like I’m totally ignoring that this patient has serious problem. The rationale says you don’t have the order for 4, so you can’t choose it. Even though getting some labs done is clearly MORE important to see what could be causing the problem. Anytime you see a rationale that says, “you don’t have the order”, that’s a dumb question because you can assume you have the order and that every answer is within your scope of practice. That’s a stupid question my beloved Saunders ❤️.

Poorly Written NCLEX-style Question Example 5: Totally Wrong

The Princeton Review, Cracking the NCLEX-RN, 2013 edition, pg 80 #3

A client who is admitted with Addison’s disease has hyponatremia. Sign and symptoms that the nurse would asses for include:

1. thirst and dry skin.
2. weakness and weight gain.
3. restlessness and abdominal cramps.
4. tachycardia and headaches.

The only reasonable answer is 4 because addison’s gets dehydration and I can see if their sodium is too high they might have some neuro problems. But the book says the answer is 2. What?! Weakness and weight gain?! Addison’s doesn’t get weight gain so that’s just a dumb answer that has nothing to with the disease.

Poorly Written NCLEX-style Question Example 6: Out-of-Date Answer

Nursing.com, Comprehensive NCLEX Review, 2020 edition, pg 92 #7

A client with a paralytic ileus has an order to insert an NG tube and set to low intermittent suction. Which of the following steps would be included as part of inserting an NG tube? Select all that apply.

1. A. Inspect the client’s nares for polyps.
2. B. Test the gag reflex by asking the client to swallow two cups of water
3. C. Measure the tube from the tip of the nose to the xiphoid process.
4. D. Insert air into the NG tube with a syringe and auscultate with a stethoscope to verify placement.
5. E. Check the client’s coagulation studies prior to insertion.

Well, I choose 1 and 5. But according to the rationale, the answers are 1, 4, and 5. I KNOW it’s not 4 because that’s an old intervention that is not supposed to be done anymore. That’s not the way to confirm NG tube placement because you can still hear a “whoosh” even if the tube migrated into the lungs. I even found on nursing.com’s website that it’s no longer a valid intervention. Why is it in the book then? Not sure, but things slip past.

Should I Even Be Practicing NCLEX-style Questions?

Yes, absolutely! No matter what resource you use, there will be some poorly-written questions in the batch. I’ve been guilty of using or writing some dumb questions too. However, if your content is strong and you know how to answer questions, you still should be getting the majority of the questions correct.

The actual NCLEX questions go through a rigorous process to become valid questions on the test. All the practice questions out there DO NOT go through a rigorous process. It’s a wild west of question banks! There’s no rules and anyone can sell you their NCLEX-style practice question banks.

So be aware that it’s not always you, it could possibly be a stupid question. And you are smarter than that!