NCLEX Fundamentals Questions
Fundamentals questions test the foundational nursing skills that every NCLEX-RN candidate must master.
Fundamentals of nursing forms the bedrock of every NCLEX-RN question. Even when a scenario looks like a cardiac or pediatric question, the answer often depends on a fundamentals principle — fluid balance, infection control, safety, nutrition, or the nursing process. Our free fundamentals question bank drills the core competencies most tested, with rationales that show how fundamentals concepts appear inside complex clinical scenarios.
Fluid, Electrolyte, and Acid-Base Balance
This is the single highest-yield fundamentals topic. Master these ranges and imbalances: Sodium 135–145 — hyponatremia causes confusion and seizures, hypernatremia causes thirst and restlessness. Potassium 3.5–5.0 — hypokalemia causes flat T waves and U waves, muscle weakness; hyperkalemia causes peaked T waves, arrhythmias. Calcium 8.5–10.5 — hypocalcemia causes Trousseau and Chvostek signs; hypercalcemia causes bone pain and kidney stones. Magnesium 1.5–2.5 — deficiency causes tremors and tetany. Fluid types: isotonic (0.9% NS, LR) for volume replacement, hypotonic (0.45% NS) to hydrate cells, hypertonic (3% NS, D5 0.45% NS) to pull fluid into vasculature. Acid-base: ROME — Respiratory Opposite, Metabolic Equal (pH and CO2 move opposite in respiratory, same in metabolic).
Infection Control and Isolation Precautions
Standard precautions apply to every patient. Additional transmission-based precautions: AIRBORNE (tuberculosis, measles, varicella, disseminated zoster) — N95 respirator, negative-pressure room, door closed. DROPLET (influenza, pertussis, meningococcal meningitis, mumps, rubella) — surgical mask within 3–6 feet, private room preferred. CONTACT (C. difficile, MRSA, VRE, RSV, scabies) — gown and gloves for room entry, dedicated equipment. For C. diff specifically, soap and water — NOT alcohol-based sanitizer — because alcohol does not kill spores. Protective (reverse) isolation for immunocompromised patients: private room, no fresh flowers, no raw fruits/vegetables, HEPA filtration when available.
Patient Safety and Fall Prevention
Safety is a major NCLEX-RN client needs category. Universal fall precautions: bed in low position, side rails per policy (two side rails up is not a restraint; four side rails up IS a restraint requiring order), call light within reach, non-slip footwear, adequate lighting. High-fall-risk interventions: bed alarm, gait belt for ambulation, orient to environment, address underlying cause (hypotension, medications, urgency). Restraint use requires physician order (renewed every 24 hours), least restrictive intervention tried first, documented Q2H monitoring of skin, circulation, ROM, toileting, and hydration. Never restrain to a side rail. Never use a knot the patient can reach.
The Nursing Process on the NCLEX-RN
ADPIE — Assessment, Diagnosis, Planning, Implementation, Evaluation. On any 'what do you do first?' question, assessment almost always comes before implementation. Exceptions: cardiac arrest (start CPR), active seizure (protect airway), choking (Heimlich), active bleeding (apply pressure). Assessment must precede: pain medication administration (assess pain first), notification of provider (assess to have information to report), and repositioning (assess skin and pain first). Evaluation is what closes the loop — after every intervention, evaluate the patient's response before proceeding. This assessment-first mindset is what the exam rewards.