The 10 Hardest NCLEX Questions
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How to Confidently Answer
The NCLEX is one of the most challenging exams for nursing students—not just because of the vast range of topics but also due to its adaptive format, which tests critical thinking and the ability to apply knowledge in real-life scenarios. Some questions are designed to be especially tricky, assessing high-level competencies. Here, we break down the 10 most difficult types of NCLEX questions and give you expert strategies to tackle them with confidence.
1. Infection Control Questions
Example: "What is the best way to prevent hospital-acquired infections?"
A common mistake is choosing responses that seem correct but are too broad. The best answer is always proper hand hygiene, as endorsed by all major health organizations. If options like wearing gloves or changing bed linens appear, remember that nothing is as effective as washing hands.
🧠 Strategy:
Prioritize universal precautions and evidence-based guidelines. If a question asks for the best method, choose the most scientifically supported answer.
2. Select All That Apply (SATA) Questions
Example: "Which of these factors increase the risk of hospital-acquired infections?"
SATA questions do not award partial credit, so you must select all correct options. Many students try to choose a set number of answers, which is a common mistake.
🧠 Strategy:
- Treat each option as True or False and evaluate them individually.
- There’s no fixed number of correct answers—choose only those that apply.
- Watch for absolute words like “always” or “never”, as these often indicate incorrect choices.
- Practice regularly to identify patterns in SATA questions.
3. Patient Prioritization Questions
Example: "Which patient should you assess first?"
These questions test your ability to manage critical situations. The best approach is to use the ABC rule (Airway, Breathing, Circulation)—a patient with breathing difficulties takes priority over someone with pain or minor complaints.
🧠 Strategy:
- Follow the hierarchy of emergencies: ABC > sudden neurological changes > safety concerns > pain and comfort.
- Use clinical reasoning: A patient with dyspnea is more critical than a patient with mild fever.
- Don’t be distracted by irrelevant details like age or medical history unless they impact the urgency of care.
4. Delegation & Assignment Questions
Example: "Which task can you delegate to an LPN or a nursing assistant?"
A common mistake is delegating tasks that require clinical judgment.
🧠 Strategy:
- Remember: “Never delegate what you can E.A.T.” (Evaluate, Assess, Teach).
- RNs are always responsible for assessments and clinical decisions.
- Only stable patients should be assigned to LPNs or UAPs.
If the question asks what NOT to delegate, look for tasks involving assessment, teaching, or clinical judgment.
5. Medication Dosage Calculation Questions
Example: "The doctor orders 0.25 g of amoxicillin. You have 125 mg tablets. How many do you give?"
Errors often occur due to incorrect unit conversions.
🧠 Strategy:
- Memorize common conversions (1 g = 1000 mg, 1 kg = 2.2 lb).
- Use the Desired/Available formula: (250 mg / 125 mg) = 2 tablets.
- Double-check the plausibility of your answer—if it seems off, recalculate.
Practicing with NCLEX-style dosage questions is essential for improving accuracy and speed.
6. Therapeutic Communication Questions
Example: A patient says, “I can’t stop thinking about death.” What’s the best response?
A common mistake is choosing answers that minimize the issue ("Try not to think about it") or provide false reassurance ("Everything will be fine").
🧠 Strategy:
- Choose responses that encourage emotional expression, like "Would you like to talk about it?"
- Avoid responses that shut down conversation, such as "Don’t worry about it."
- Never give personal advice—instead, guide the patient in processing their feelings.
7. SATA Questions with Negative Wording
Example: "Which of these conditions are NOT associated with anxiety?"
Negative-worded questions are tricky because our brains instinctively look for answers that confirm rather than exclude.
🧠 Strategy:
- Underline key words like “NOT” or “EXCEPT” before reading the choices.
- Divide answers into two groups: likely vs. unlikely.
- Review common associations between conditions and symptoms to choose correctly.
8. Diagnostic & Assessment Questions
Example: "Which question provides the most useful information for identifying a thyroid disorder?"
Many students choose vague or less relevant questions.
🧠 Strategy:
- Pick the question that leads to the best clinical insight (e.g., “Has your weight changed recently?” for thyroid issues).
- Eliminate vague options that don’t directly lead to a diagnosis.
9. Pediatric Risk Factor Questions
Example: "Which child is at the highest risk for cognitive impairment?"
Correct answers are usually linked to clear environmental factors, such as lead exposure in older homes.
🧠 Strategy:
- Prioritize known environmental risks, like lead poisoning or malnutrition.
- Eliminate options that describe normal developmental variations.
10. Long-Term Therapy Questions
Example: "Which patient statement shows correct understanding of immunosuppressive therapy after a transplant?"
Students often select incorrect answers based on misconceptions, such as believing immunosuppressive drugs can be stopped after a few years.
🧠 Strategy:
- Choose the response that aligns with clinical reality (e.g., “I must take immunosuppressive drugs for life to prevent rejection.”).
- Eliminate absolute statements that oversimplify treatment plans.
Conclusion: Conquer the NCLEX with Confidence
Passing the NCLEX requires more than just memorization—you need to think like a nurse. Practicing with NCLEX-style questions, recognizing tricky phrasing, and applying critical thinking strategies will help you tackle even the most challenging questions.
If you’re looking for realistic NCLEX practice questions with detailed explanations, our NCLEX Practice Questions resource is a must-have. With the right preparation, you can walk into the exam room with confidence and pass on your first try!