NCLEX Exam NCLEX-PN Actual Exams Questions
and Answers, 100% Verified
2026/2027 Version
1. A 68-year-old client arrives at the emergency department reporting sudden crushing
substernal chest pain that radiates to the left arm and jaw. The client is pale,
diaphoretic, and nauseated. Vital signs reveal hypotension and tachycardia. What is the
nurse’s priority action?
The priority action is to activate the emergency cardiac protocol and administer oxygen
while preparing for a 12-lead ECG and possible administration of aspirin and nitroglycerin as
prescribed. The symptoms strongly indicate an acute myocardial infarction, which is life-
threatening and requires immediate intervention to restore perfusion and limit cardiac muscle
damage. Rapid recognition and treatment reduce mortality and preserve heart function.
2. A client with type 1 diabetes becomes shaky, diaphoretic, and confused while waiting
for lunch. A finger-stick blood glucose reveals 48 mg/dL. The client is conscious and
able to swallow. What is the nurse’s immediate intervention?
The nurse should administer 15 grams of a fast-acting carbohydrate such as glucose tablets or
juice. This follows the “15-15 rule,” where blood glucose is rechecked after 15 minutes and
retreated if necessary. Prompt treatment prevents progression to seizures, unconsciousness,
or coma caused by severe hypoglycemia.
3. A postoperative client 24 hours after hip surgery reports sudden shortness of breath
and sharp chest pain that worsens with inspiration. Oxygen saturation drops to 88% on
room air. What complication should the nurse suspect and address immediately?
The nurse should suspect a pulmonary embolism and notify the provider while administering
oxygen. A pulmonary embolism occurs when a clot dislodges, often from the leg, and travels
to the lungs. Rapid treatment is critical because the condition can quickly become fatal if
circulation and oxygenation are not restored.
4. A 4-year-old child presents with a barking cough, inspiratory stridor, and hoarseness
that worsens at night. The child is anxious but maintains adequate oxygen saturation.
What is the most likely condition and appropriate nursing focus?
The condition is most consistent with croup, a viral upper airway infection causing
inflammation. Nursing care focuses on maintaining airway patency, providing humidified
air, and keeping the child calm to reduce airway obstruction. Monitoring for worsening
stridor at rest is essential because it signals increasing airway compromise.
,5. A client with chronic obstructive pulmonary disease becomes drowsy and confused
while receiving oxygen at 6 L/min via nasal cannula. What is the nurse’s priority
consideration?
The nurse should recognize possible carbon dioxide retention due to excessive oxygen
administration. Clients with COPD may rely on hypoxic drive for breathing, and high
oxygen levels can suppress respiratory effort. Oxygen should be titrated carefully, typically
between 1–3 L/min, while monitoring arterial blood gases.
6. A postpartum client saturates a perineal pad within 10 minutes and reports feeling
lightheaded. The uterus is boggy upon palpation. What is the nurse’s immediate
action?
The nurse should perform fundal massage to stimulate uterine contraction. A boggy uterus
indicates uterine atony, the leading cause of postpartum hemorrhage. Prompt massage helps
the uterus contract and reduces bleeding, preventing hypovolemic shock.
7. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and ECG
changes including peaked T waves. What intervention is most urgent?
The nurse should anticipate administration of IV calcium gluconate to stabilize the cardiac
membrane. Severe hyperkalemia can cause life-threatening arrhythmias, and immediate
treatment is required to prevent cardiac arrest. Additional treatments may include insulin
with glucose or dialysis.
8. A client diagnosed with bacterial meningitis reports severe headache, neck stiffness,
and photophobia. What isolation precautions are required?
Droplet precautions must be initiated immediately. Bacterial meningitis spreads through
respiratory droplets, making early isolation critical to prevent transmission. Staff must wear
surgical masks and ensure appropriate hand hygiene to protect themselves and others.
9. A client taking warfarin reports bleeding gums and easy bruising. The INR is 5.5.
What is the appropriate nursing action?
The nurse should hold the medication and notify the provider. An INR of 5.5 indicates
excessive anticoagulation and increased risk of bleeding. Vitamin K may be administered to
reverse the effects and reduce hemorrhage risk.
10. A client with major depressive disorder states, “I don’t want to live anymore.” The
client appears withdrawn and tearful. What is the nurse’s priority response?
The nurse must directly assess for suicidal intent by asking if the client has a plan. Direct
questioning does not increase suicide risk and ensures safety planning. Protecting the client
from self-harm is the highest priority.
11. A toddler ingests an unknown household cleaning product and is crying but
breathing adequately. What is the nurse’s first action?
The nurse should assess airway patency and contact poison control immediately. Inducing
vomiting is contraindicated with caustic substances. Early intervention minimizes chemical
injury to the gastrointestinal tract.
, 12. A client with heart failure gains 3 pounds in 24 hours and has bilateral crackles.
What is the priority nursing intervention?
The nurse should assess for fluid overload and anticipate diuretic administration. Rapid
weight gain reflects fluid retention, which can progress to pulmonary edema. Monitoring
intake, output, and lung sounds guides treatment effectiveness.
13. A client with Addison’s disease presents with hypotension, weakness, and confusion.
What life-threatening condition should the nurse suspect?
The nurse should suspect an Addisonian crisis. This acute adrenal insufficiency requires
immediate IV fluids and corticosteroids to prevent shock. Rapid treatment restores
circulating volume and hormonal balance.
14. A client receiving a blood transfusion develops fever, chills, and lower back pain
within 15 minutes. What is the nurse’s immediate action?
The transfusion must be stopped immediately while maintaining IV access with normal
saline. These symptoms indicate a possible hemolytic reaction. Rapid discontinuation
prevents further hemolysis and kidney damage.
15. A client with a spinal cord injury at T6 reports severe headache and blurred vision.
Blood pressure is 210/110 mm Hg. What complication is occurring?
The nurse should recognize autonomic dysreflexia, a medical emergency. Immediate
interventions include elevating the head of the bed and identifying triggers such as bladder
distention. Prompt action reduces the risk of stroke.
16. A client with diabetic ketoacidosis presents with fruity breath and deep rapid
respirations. Blood glucose is 480 mg/dL. What is the priority treatment?
The priority treatment is IV insulin and fluid replacement. DKA results from insulin
deficiency leading to acidosis and dehydration. Rapid correction of glucose and hydration
prevents organ failure.
17. A client with pancreatitis reports severe epigastric pain radiating to the back. What
dietary instruction is appropriate during recovery?
The client should consume a low-fat diet. Fat stimulates pancreatic enzyme secretion,
worsening inflammation and pain. Gradual reintroduction of bland foods supports healing.
18. A client with hyperthyroidism develops fever, tachycardia, and agitation. What life-
threatening complication may be present?
The nurse should suspect thyroid storm. This severe hypermetabolic state requires immediate
treatment with antithyroid medications and supportive care. Early recognition prevents
cardiovascular collapse.
19. A client with a head injury becomes increasingly drowsy with unequal pupils. What
is the nurse’s priority action?
The nurse must notify the provider immediately and prepare for possible emergency
and Answers, 100% Verified
2026/2027 Version
1. A 68-year-old client arrives at the emergency department reporting sudden crushing
substernal chest pain that radiates to the left arm and jaw. The client is pale,
diaphoretic, and nauseated. Vital signs reveal hypotension and tachycardia. What is the
nurse’s priority action?
The priority action is to activate the emergency cardiac protocol and administer oxygen
while preparing for a 12-lead ECG and possible administration of aspirin and nitroglycerin as
prescribed. The symptoms strongly indicate an acute myocardial infarction, which is life-
threatening and requires immediate intervention to restore perfusion and limit cardiac muscle
damage. Rapid recognition and treatment reduce mortality and preserve heart function.
2. A client with type 1 diabetes becomes shaky, diaphoretic, and confused while waiting
for lunch. A finger-stick blood glucose reveals 48 mg/dL. The client is conscious and
able to swallow. What is the nurse’s immediate intervention?
The nurse should administer 15 grams of a fast-acting carbohydrate such as glucose tablets or
juice. This follows the “15-15 rule,” where blood glucose is rechecked after 15 minutes and
retreated if necessary. Prompt treatment prevents progression to seizures, unconsciousness,
or coma caused by severe hypoglycemia.
3. A postoperative client 24 hours after hip surgery reports sudden shortness of breath
and sharp chest pain that worsens with inspiration. Oxygen saturation drops to 88% on
room air. What complication should the nurse suspect and address immediately?
The nurse should suspect a pulmonary embolism and notify the provider while administering
oxygen. A pulmonary embolism occurs when a clot dislodges, often from the leg, and travels
to the lungs. Rapid treatment is critical because the condition can quickly become fatal if
circulation and oxygenation are not restored.
4. A 4-year-old child presents with a barking cough, inspiratory stridor, and hoarseness
that worsens at night. The child is anxious but maintains adequate oxygen saturation.
What is the most likely condition and appropriate nursing focus?
The condition is most consistent with croup, a viral upper airway infection causing
inflammation. Nursing care focuses on maintaining airway patency, providing humidified
air, and keeping the child calm to reduce airway obstruction. Monitoring for worsening
stridor at rest is essential because it signals increasing airway compromise.
,5. A client with chronic obstructive pulmonary disease becomes drowsy and confused
while receiving oxygen at 6 L/min via nasal cannula. What is the nurse’s priority
consideration?
The nurse should recognize possible carbon dioxide retention due to excessive oxygen
administration. Clients with COPD may rely on hypoxic drive for breathing, and high
oxygen levels can suppress respiratory effort. Oxygen should be titrated carefully, typically
between 1–3 L/min, while monitoring arterial blood gases.
6. A postpartum client saturates a perineal pad within 10 minutes and reports feeling
lightheaded. The uterus is boggy upon palpation. What is the nurse’s immediate
action?
The nurse should perform fundal massage to stimulate uterine contraction. A boggy uterus
indicates uterine atony, the leading cause of postpartum hemorrhage. Prompt massage helps
the uterus contract and reduces bleeding, preventing hypovolemic shock.
7. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and ECG
changes including peaked T waves. What intervention is most urgent?
The nurse should anticipate administration of IV calcium gluconate to stabilize the cardiac
membrane. Severe hyperkalemia can cause life-threatening arrhythmias, and immediate
treatment is required to prevent cardiac arrest. Additional treatments may include insulin
with glucose or dialysis.
8. A client diagnosed with bacterial meningitis reports severe headache, neck stiffness,
and photophobia. What isolation precautions are required?
Droplet precautions must be initiated immediately. Bacterial meningitis spreads through
respiratory droplets, making early isolation critical to prevent transmission. Staff must wear
surgical masks and ensure appropriate hand hygiene to protect themselves and others.
9. A client taking warfarin reports bleeding gums and easy bruising. The INR is 5.5.
What is the appropriate nursing action?
The nurse should hold the medication and notify the provider. An INR of 5.5 indicates
excessive anticoagulation and increased risk of bleeding. Vitamin K may be administered to
reverse the effects and reduce hemorrhage risk.
10. A client with major depressive disorder states, “I don’t want to live anymore.” The
client appears withdrawn and tearful. What is the nurse’s priority response?
The nurse must directly assess for suicidal intent by asking if the client has a plan. Direct
questioning does not increase suicide risk and ensures safety planning. Protecting the client
from self-harm is the highest priority.
11. A toddler ingests an unknown household cleaning product and is crying but
breathing adequately. What is the nurse’s first action?
The nurse should assess airway patency and contact poison control immediately. Inducing
vomiting is contraindicated with caustic substances. Early intervention minimizes chemical
injury to the gastrointestinal tract.
, 12. A client with heart failure gains 3 pounds in 24 hours and has bilateral crackles.
What is the priority nursing intervention?
The nurse should assess for fluid overload and anticipate diuretic administration. Rapid
weight gain reflects fluid retention, which can progress to pulmonary edema. Monitoring
intake, output, and lung sounds guides treatment effectiveness.
13. A client with Addison’s disease presents with hypotension, weakness, and confusion.
What life-threatening condition should the nurse suspect?
The nurse should suspect an Addisonian crisis. This acute adrenal insufficiency requires
immediate IV fluids and corticosteroids to prevent shock. Rapid treatment restores
circulating volume and hormonal balance.
14. A client receiving a blood transfusion develops fever, chills, and lower back pain
within 15 minutes. What is the nurse’s immediate action?
The transfusion must be stopped immediately while maintaining IV access with normal
saline. These symptoms indicate a possible hemolytic reaction. Rapid discontinuation
prevents further hemolysis and kidney damage.
15. A client with a spinal cord injury at T6 reports severe headache and blurred vision.
Blood pressure is 210/110 mm Hg. What complication is occurring?
The nurse should recognize autonomic dysreflexia, a medical emergency. Immediate
interventions include elevating the head of the bed and identifying triggers such as bladder
distention. Prompt action reduces the risk of stroke.
16. A client with diabetic ketoacidosis presents with fruity breath and deep rapid
respirations. Blood glucose is 480 mg/dL. What is the priority treatment?
The priority treatment is IV insulin and fluid replacement. DKA results from insulin
deficiency leading to acidosis and dehydration. Rapid correction of glucose and hydration
prevents organ failure.
17. A client with pancreatitis reports severe epigastric pain radiating to the back. What
dietary instruction is appropriate during recovery?
The client should consume a low-fat diet. Fat stimulates pancreatic enzyme secretion,
worsening inflammation and pain. Gradual reintroduction of bland foods supports healing.
18. A client with hyperthyroidism develops fever, tachycardia, and agitation. What life-
threatening complication may be present?
The nurse should suspect thyroid storm. This severe hypermetabolic state requires immediate
treatment with antithyroid medications and supportive care. Early recognition prevents
cardiovascular collapse.
19. A client with a head injury becomes increasingly drowsy with unequal pupils. What
is the nurse’s priority action?
The nurse must notify the provider immediately and prepare for possible emergency
