NCLEX-RN Practice Exam Latest Study Guide
For Guaranteed 100% Pass rate | Grade A+|
NEW!!!
Question 1 (Multiple Choice)
Question:
A nurse is caring for a client who was admitted with acute exacerbation of heart failure. The
client’s current vital signs are: BP 158/92 mm Hg, HR 110 bpm, RR 28 breaths/min, SpO₂ 89% on
room air. Lung auscultation reveals coarse crackles bilaterally in the lower lobes. Which
intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Place the client in high-Fowler’s position
C. Apply oxygen at 4 L/min via nasal cannula
D. Notify the provider of the assessment findings
Correct Answer: B. Place the client in high-Fowler’s position
Detailed Rationale:
• Priority framework (ABCs with modification): While oxygenation is critical, positioning
is a rapid, non-invasive intervention that immediately improves ventilation and reduces
preload. High-Fowler’s position (head of bed 90°) uses gravity to decrease venous return
(preload) and allows diaphragmatic descent, improving lung expansion and gas exchange.
• Why not C first? Oxygen is essential, but positioning takes seconds and enhances the
effectiveness of oxygen. In many protocols, positioning is done simultaneously or even
before applying oxygen because it addresses the mechanics of breathing. However,
NCLEX often teaches that for a hypoxic client, oxygen is a high priority. But here, the
question asks for the first action among the options. High-Fowler’s can be implemented
immediately without equipment and will immediately reduce pulmonary congestion.
Oxygen can be applied next.
• Why not A? Furosemide is a diuretic that reduces preload, but it takes 5–10 minutes to
begin working. It is not the first action.
, • Why not D? Notification is important but not urgent before positioning and oxygen.
• Clinical judgment: The client has pulmonary edema from heart failure. High-Fowler’s is a
low-cost, immediate intervention that can prevent intubation by improving oxygenation.
Many NCLEX questions test that positioning is the first action for respiratory distress
unless the client is apneic.
• 2026 test plan emphasis: Clinical judgment in acute decompensation – prioritize
non-invasive, rapid interventions before medications or calls.
Question 2 (Multiple Choice)
Question:
A client with chronic kidney disease (CKD) stage 4 has a serum potassium level of 6.2 mEq/L. The
nurse assesses the cardiac monitor and sees which of the following findings?
A. Widened QRS complex and tall, peaked T waves
B. Prolonged PR interval and flattened T waves
C. ST segment elevation and presence of U waves
D. Sinus bradycardia with a heart rate of 48 bpm
Correct Answer: A. Widened QRS complex and tall, peaked T waves
Detailed Rationale:
• Pathophysiology of hyperkalemia: Elevated extracellular potassium decreases the
resting membrane potential, leading to delayed ventricular depolarization (widened QRS)
and early repolarization (peaked T waves). As potassium rises above 6.0 mEq/L, these
changes become pronounced.
• Why not B? Prolonged PR interval and flattened T waves are seen in hypokalemia (low
potassium).
• Why not C? ST elevation and U waves are classic for hypokalemia, not hyperkalemia.
• Why not D? Sinus bradycardia is not a direct effect of hyperkalemia; severe hyperkalemia
can lead to sine wave pattern, ventricular fibrillation, or asystole, but bradycardia is less
specific.
• Nursing action: Immediate notification of provider, prepare calcium gluconate (to
stabilize cardiac membrane), insulin + dextrose (shift K⁺ into cells), and kayexalate or
dialysis for removal.
• 2026 test plan emphasis: Recognizing life-threatening ECG changes and linking them to
electrolyte imbalances.
,Question 3 (Multiple Choice)
Question:
A nurse is teaching a client who has a new prescription for transdermal nitroglycerin patch for
angina. Which statement by the client indicates correct understanding?
A. “I will leave the patch on for 24 hours and then replace it with a new one.”
B. “I should remove the patch for 10–12 hours each day to prevent tolerance.”
C. “If I get a headache, I should remove the patch immediately.”
D. “I can apply the patch to the same spot every day to avoid skin irritation.”
Correct Answer: B. “I should remove the patch for 10–12 hours each day to prevent
tolerance.”
Detailed Rationale:
• Tolerance prevention: Nitroglycerin patches provide continuous nitrate delivery.
Tolerance develops within 24 hours if there is no nitrate-free interval. Standard practice is
to remove the patch for 10–12 hours each day (usually overnight) to restore sensitivity.
• Why not A? Leaving the patch on for 24 hours without a break causes tolerance, reducing
efficacy.
• Why not C? Headache is a common side effect due to vasodilation; it often diminishes
with continued use. Removing the patch is not indicated unless headache is severe.
Acetaminophen can be used for pain.
• Why not D? Rotating application sites (chest, back, upper arm) prevents skin irritation
and dermatitis.
• Additional teaching: Apply patch to clean, dry, hairless skin; remove old patch before
applying new; wash hands after handling; do not cut patches; monitor for orthostatic
hypotension.
• 2026 test plan emphasis: Medication teaching with rationale for tolerance prevention – a
high-yield pharmacology concept.
Question 4 (Multiple Choice)
Question:
A nurse is assessing a client who is 6 hours post-operative following an open cholecystectomy.
The client reports sudden onset of sharp chest pain and shortness of breath. Vital signs: BP
100/60 mm Hg, HR 120 bpm, RR 32 breaths/min, SpO₂ 88% on 2 L/min oxygen via nasal cannula.
What is the nurse’s priority action?
, A. Administer morphine sulfate 2 mg IV push as ordered for pain
B. Increase the oxygen to 6 L/min via nasal cannula
C. Perform a focused assessment of the surgical incision and abdomen
D. Elevate the head of the bed and prepare for possible intubation
Correct Answer: D. Elevate the head of the bed and prepare for possible intubation
Detailed Rationale:
• Recognizing the complication: Sudden chest pain, dyspnea, hypoxemia, and tachycardia
post-op are classic signs of pulmonary embolism (PE) – a life-threatening complication.
The client is deteriorating rapidly (SpO₂ 88% on oxygen).
• Why D is correct: Elevating the head of the bed improves ventilation and oxygenation
while preparing for possible intubation recognizes that the client may need advanced
airway support. The nurse must anticipate respiratory failure.
• Why not A? Morphine may depress respirations and is not first line for a suspected PE;
pain management is secondary to airway/breathing.
• Why not B? Increasing oxygen is appropriate but insufficient alone; the priority is
positioning and preparing for deterioration. Also, 6 L/min via nasal cannula is not
high-flow; the client may need non-rebreather or BiPAP.
• Why not C? Focused assessment on the abdomen is irrelevant; the problem is pulmonary.
• Next steps: Call rapid response or provider, obtain stat CTA or V/Q scan, prepare for
anticoagulation or thrombolytics.
• 2026 test plan emphasis: Rapid recognition of PE and prioritization of airway/breathing
over other interventions.
Question 5 (Multiple Choice)
Question:
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
reviews the laboratory results: serum glucose 450 mg/dL, serum potassium 5.1 mEq/L, arterial pH
7.25, bicarbonate 14 mEq/L. Which prescription should the nurse question?
A. Regular insulin IV at 0.1 unit/kg/hour
B. 0.9% normal saline at 1 L/hour for first hour
C. Sodium bicarbonate 50 mEq IV push over 2 minutes
D. Potassium chloride 20 mEq added to each liter of IV fluid
Correct Answer: C. Sodium bicarbonate 50 mEq IV push over 2 minutes
Detailed Rationale:
For Guaranteed 100% Pass rate | Grade A+|
NEW!!!
Question 1 (Multiple Choice)
Question:
A nurse is caring for a client who was admitted with acute exacerbation of heart failure. The
client’s current vital signs are: BP 158/92 mm Hg, HR 110 bpm, RR 28 breaths/min, SpO₂ 89% on
room air. Lung auscultation reveals coarse crackles bilaterally in the lower lobes. Which
intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Place the client in high-Fowler’s position
C. Apply oxygen at 4 L/min via nasal cannula
D. Notify the provider of the assessment findings
Correct Answer: B. Place the client in high-Fowler’s position
Detailed Rationale:
• Priority framework (ABCs with modification): While oxygenation is critical, positioning
is a rapid, non-invasive intervention that immediately improves ventilation and reduces
preload. High-Fowler’s position (head of bed 90°) uses gravity to decrease venous return
(preload) and allows diaphragmatic descent, improving lung expansion and gas exchange.
• Why not C first? Oxygen is essential, but positioning takes seconds and enhances the
effectiveness of oxygen. In many protocols, positioning is done simultaneously or even
before applying oxygen because it addresses the mechanics of breathing. However,
NCLEX often teaches that for a hypoxic client, oxygen is a high priority. But here, the
question asks for the first action among the options. High-Fowler’s can be implemented
immediately without equipment and will immediately reduce pulmonary congestion.
Oxygen can be applied next.
• Why not A? Furosemide is a diuretic that reduces preload, but it takes 5–10 minutes to
begin working. It is not the first action.
, • Why not D? Notification is important but not urgent before positioning and oxygen.
• Clinical judgment: The client has pulmonary edema from heart failure. High-Fowler’s is a
low-cost, immediate intervention that can prevent intubation by improving oxygenation.
Many NCLEX questions test that positioning is the first action for respiratory distress
unless the client is apneic.
• 2026 test plan emphasis: Clinical judgment in acute decompensation – prioritize
non-invasive, rapid interventions before medications or calls.
Question 2 (Multiple Choice)
Question:
A client with chronic kidney disease (CKD) stage 4 has a serum potassium level of 6.2 mEq/L. The
nurse assesses the cardiac monitor and sees which of the following findings?
A. Widened QRS complex and tall, peaked T waves
B. Prolonged PR interval and flattened T waves
C. ST segment elevation and presence of U waves
D. Sinus bradycardia with a heart rate of 48 bpm
Correct Answer: A. Widened QRS complex and tall, peaked T waves
Detailed Rationale:
• Pathophysiology of hyperkalemia: Elevated extracellular potassium decreases the
resting membrane potential, leading to delayed ventricular depolarization (widened QRS)
and early repolarization (peaked T waves). As potassium rises above 6.0 mEq/L, these
changes become pronounced.
• Why not B? Prolonged PR interval and flattened T waves are seen in hypokalemia (low
potassium).
• Why not C? ST elevation and U waves are classic for hypokalemia, not hyperkalemia.
• Why not D? Sinus bradycardia is not a direct effect of hyperkalemia; severe hyperkalemia
can lead to sine wave pattern, ventricular fibrillation, or asystole, but bradycardia is less
specific.
• Nursing action: Immediate notification of provider, prepare calcium gluconate (to
stabilize cardiac membrane), insulin + dextrose (shift K⁺ into cells), and kayexalate or
dialysis for removal.
• 2026 test plan emphasis: Recognizing life-threatening ECG changes and linking them to
electrolyte imbalances.
,Question 3 (Multiple Choice)
Question:
A nurse is teaching a client who has a new prescription for transdermal nitroglycerin patch for
angina. Which statement by the client indicates correct understanding?
A. “I will leave the patch on for 24 hours and then replace it with a new one.”
B. “I should remove the patch for 10–12 hours each day to prevent tolerance.”
C. “If I get a headache, I should remove the patch immediately.”
D. “I can apply the patch to the same spot every day to avoid skin irritation.”
Correct Answer: B. “I should remove the patch for 10–12 hours each day to prevent
tolerance.”
Detailed Rationale:
• Tolerance prevention: Nitroglycerin patches provide continuous nitrate delivery.
Tolerance develops within 24 hours if there is no nitrate-free interval. Standard practice is
to remove the patch for 10–12 hours each day (usually overnight) to restore sensitivity.
• Why not A? Leaving the patch on for 24 hours without a break causes tolerance, reducing
efficacy.
• Why not C? Headache is a common side effect due to vasodilation; it often diminishes
with continued use. Removing the patch is not indicated unless headache is severe.
Acetaminophen can be used for pain.
• Why not D? Rotating application sites (chest, back, upper arm) prevents skin irritation
and dermatitis.
• Additional teaching: Apply patch to clean, dry, hairless skin; remove old patch before
applying new; wash hands after handling; do not cut patches; monitor for orthostatic
hypotension.
• 2026 test plan emphasis: Medication teaching with rationale for tolerance prevention – a
high-yield pharmacology concept.
Question 4 (Multiple Choice)
Question:
A nurse is assessing a client who is 6 hours post-operative following an open cholecystectomy.
The client reports sudden onset of sharp chest pain and shortness of breath. Vital signs: BP
100/60 mm Hg, HR 120 bpm, RR 32 breaths/min, SpO₂ 88% on 2 L/min oxygen via nasal cannula.
What is the nurse’s priority action?
, A. Administer morphine sulfate 2 mg IV push as ordered for pain
B. Increase the oxygen to 6 L/min via nasal cannula
C. Perform a focused assessment of the surgical incision and abdomen
D. Elevate the head of the bed and prepare for possible intubation
Correct Answer: D. Elevate the head of the bed and prepare for possible intubation
Detailed Rationale:
• Recognizing the complication: Sudden chest pain, dyspnea, hypoxemia, and tachycardia
post-op are classic signs of pulmonary embolism (PE) – a life-threatening complication.
The client is deteriorating rapidly (SpO₂ 88% on oxygen).
• Why D is correct: Elevating the head of the bed improves ventilation and oxygenation
while preparing for possible intubation recognizes that the client may need advanced
airway support. The nurse must anticipate respiratory failure.
• Why not A? Morphine may depress respirations and is not first line for a suspected PE;
pain management is secondary to airway/breathing.
• Why not B? Increasing oxygen is appropriate but insufficient alone; the priority is
positioning and preparing for deterioration. Also, 6 L/min via nasal cannula is not
high-flow; the client may need non-rebreather or BiPAP.
• Why not C? Focused assessment on the abdomen is irrelevant; the problem is pulmonary.
• Next steps: Call rapid response or provider, obtain stat CTA or V/Q scan, prepare for
anticoagulation or thrombolytics.
• 2026 test plan emphasis: Rapid recognition of PE and prioritization of airway/breathing
over other interventions.
Question 5 (Multiple Choice)
Question:
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse
reviews the laboratory results: serum glucose 450 mg/dL, serum potassium 5.1 mEq/L, arterial pH
7.25, bicarbonate 14 mEq/L. Which prescription should the nurse question?
A. Regular insulin IV at 0.1 unit/kg/hour
B. 0.9% normal saline at 1 L/hour for first hour
C. Sodium bicarbonate 50 mEq IV push over 2 minutes
D. Potassium chloride 20 mEq added to each liter of IV fluid
Correct Answer: C. Sodium bicarbonate 50 mEq IV push over 2 minutes
Detailed Rationale:
