NCLEX CASE STUDY PRACTICE EXAM – PRACTICE QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
*Core Domains*
*Management of Care*
*Pharmacological and Parenteral Therapies*
*Reduction of Risk Potential*
*Physiological Adaptation*
*Safety and Infection Control*
*Psychosocial Integrity*
*Health Promotion and Maintenance*
*Basic Care and Comfort*
*Introduction*
*The purpose of this comprehensive practice exam is to provide nursing candidat
SECTION ONE: QUESTIONS 1–100
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The nurse notes the client's oxygen saturation is 89% and the
client is experiencing mild dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min
B. Place the client in a high-Fowler's position
C. Administer a PRN dose of albuterol
D. Contact the healthcare provider immediately
🟢 Correct answer: B. Place the client in a high-Fowler's position
🔴 RATIONALE: High-Fowler's position maximizes lung expansion and eases the work of
breathing in clients with respiratory distress. Increasing oxygen in COPD patients must be done
,cautiously to avoid suppressing the hypoxic drive, and positioning is the least invasive first
intervention.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which clinical
finding would require the nurse to withhold the medication?
A. Blood pressure of 110/70 mm Hg
B. Respiratory rate of 18 breaths/min
C. Apical pulse of 52 beats/min
D. Serum potassium level of 4.5 mEq/L
🟢 Correct answer: C. Apical pulse of 52 beats/min
🔴 RATIONALE: Digoxin is an inotropic agent that slows the heart rate. It is typically withheld if
the apical pulse is less than 60 beats per minute in an adult to prevent further bradycardia and
potential toxicity.
3. A client is admitted with a diagnosis of acute pancreatitis. Which laboratory result should
the nurse expect to find?
A. Decreased serum amylase
B. Increased serum calcium
C. Increased serum lipase
D. Decreased white blood cell count
🟢 Correct answer: C. Increased serum lipase
🔴 RATIONALE: Serum lipase and amylase levels increase significantly in acute pancreatitis
due to pancreatic inflammation and the release of enzymes into the bloodstream. Lipase is
considered more specific to the pancreas than amylase.
4. Which assessment finding in a client three days postoperative following a total hip
arthroplasty suggests a deep vein thrombosis (DVT)?
A. Pale, cool extremity
B. Diminished pedal pulses
,C. Sudden shortness of breath
D. Unilateral calf warmth and tenderness
🟢 Correct answer: D. Unilateral calf warmth and tenderness
🔴 RATIONALE: Classic signs of DVT include unilateral swelling, warmth, redness, and
tenderness in the affected calf. Shortness of breath would suggest a pulmonary embolism, which
is a complication of DVT.
5. A nurse is caring for a client with a prescription for lithium carbonate. Which dietary
instruction is most important for the nurse to provide?
A. Maintain a consistent sodium intake
B. Restrict fluid intake to 1,000 mL per day
C. Avoid foods high in tyramine
D. Increase intake of green leafy vegetables
🟢 Correct answer: A. Maintain a consistent sodium intake
🔴 RATIONALE: Lithium is a salt. A decrease in sodium intake can lead to lithium retention and
toxicity, while an increase in sodium can lead to subtherapeutic lithium levels. Consistency is
vital.
6. The nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client with a chest tube who has 50 mL of drainage in the last hour
B. A client with type 1 diabetes who is diaphoretic and trembling
C. A client who is two hours postoperative and reporting pain as 7/10
D. A client with pneumonia who has an oral temperature of 101.2 F
🟢 Correct answer: B. A client with type 1 diabetes who is diaphoretic and trembling
🔴 RATIONALE: Diaphoresis and trembling are signs of hypoglycemia, which is an acute, life-
threatening emergency requiring immediate intervention to prevent brain damage or coma.
7. Which action should the nurse take to maintain a sterile field during a dressing change?
, A. Reach over the sterile field to pick up supplies
B. Keep the sterile field in constant view
C. Open sterile packages toward the body
D. Place sterile items within the 1-inch border of the field
🟢 Correct answer: B. Keep the sterile field in constant view
🔴 RATIONALE: Maintaining a sterile field requires that the field never be left unattended or out
of the nurse's line of vision to ensure no contamination occurs unnoticed.
8. A client has been prescribed warfarin for atrial fibrillation. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft-bristled toothbrush."
B. "I will take aspirin if I get a headache."
C. "I will keep my intake of spinach consistent."
D. "I will report any unusual bruising to my doctor."
🟢 Correct answer: B. "I will take aspirin if I get a headache."
🔴 RATIONALE: Aspirin is an antiplatelet agent that increases the risk of bleeding when taken
with anticoagulants like warfarin. Clients should use acetaminophen for pain unless otherwise
directed.
9. A nurse is caring for a client in the active phase of labor. The fetal heart rate monitor
shows early decelerations. Which action should the nurse take?
A. Administer oxygen via face mask
B. Increase the rate of IV fluids
C. Document the finding and continue to monitor
D. Prepare the client for an emergency Cesarean section
🟢 Correct answer: C. Document the finding and continue to monitor
🔴 RATIONALE: Early decelerations are caused by fetal head compression during contractions
and are considered a benign, reassuring finding that does not require intervention.
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
*Core Domains*
*Management of Care*
*Pharmacological and Parenteral Therapies*
*Reduction of Risk Potential*
*Physiological Adaptation*
*Safety and Infection Control*
*Psychosocial Integrity*
*Health Promotion and Maintenance*
*Basic Care and Comfort*
*Introduction*
*The purpose of this comprehensive practice exam is to provide nursing candidat
SECTION ONE: QUESTIONS 1–100
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The nurse notes the client's oxygen saturation is 89% and the
client is experiencing mild dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min
B. Place the client in a high-Fowler's position
C. Administer a PRN dose of albuterol
D. Contact the healthcare provider immediately
🟢 Correct answer: B. Place the client in a high-Fowler's position
🔴 RATIONALE: High-Fowler's position maximizes lung expansion and eases the work of
breathing in clients with respiratory distress. Increasing oxygen in COPD patients must be done
,cautiously to avoid suppressing the hypoxic drive, and positioning is the least invasive first
intervention.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which clinical
finding would require the nurse to withhold the medication?
A. Blood pressure of 110/70 mm Hg
B. Respiratory rate of 18 breaths/min
C. Apical pulse of 52 beats/min
D. Serum potassium level of 4.5 mEq/L
🟢 Correct answer: C. Apical pulse of 52 beats/min
🔴 RATIONALE: Digoxin is an inotropic agent that slows the heart rate. It is typically withheld if
the apical pulse is less than 60 beats per minute in an adult to prevent further bradycardia and
potential toxicity.
3. A client is admitted with a diagnosis of acute pancreatitis. Which laboratory result should
the nurse expect to find?
A. Decreased serum amylase
B. Increased serum calcium
C. Increased serum lipase
D. Decreased white blood cell count
🟢 Correct answer: C. Increased serum lipase
🔴 RATIONALE: Serum lipase and amylase levels increase significantly in acute pancreatitis
due to pancreatic inflammation and the release of enzymes into the bloodstream. Lipase is
considered more specific to the pancreas than amylase.
4. Which assessment finding in a client three days postoperative following a total hip
arthroplasty suggests a deep vein thrombosis (DVT)?
A. Pale, cool extremity
B. Diminished pedal pulses
,C. Sudden shortness of breath
D. Unilateral calf warmth and tenderness
🟢 Correct answer: D. Unilateral calf warmth and tenderness
🔴 RATIONALE: Classic signs of DVT include unilateral swelling, warmth, redness, and
tenderness in the affected calf. Shortness of breath would suggest a pulmonary embolism, which
is a complication of DVT.
5. A nurse is caring for a client with a prescription for lithium carbonate. Which dietary
instruction is most important for the nurse to provide?
A. Maintain a consistent sodium intake
B. Restrict fluid intake to 1,000 mL per day
C. Avoid foods high in tyramine
D. Increase intake of green leafy vegetables
🟢 Correct answer: A. Maintain a consistent sodium intake
🔴 RATIONALE: Lithium is a salt. A decrease in sodium intake can lead to lithium retention and
toxicity, while an increase in sodium can lead to subtherapeutic lithium levels. Consistency is
vital.
6. The nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client with a chest tube who has 50 mL of drainage in the last hour
B. A client with type 1 diabetes who is diaphoretic and trembling
C. A client who is two hours postoperative and reporting pain as 7/10
D. A client with pneumonia who has an oral temperature of 101.2 F
🟢 Correct answer: B. A client with type 1 diabetes who is diaphoretic and trembling
🔴 RATIONALE: Diaphoresis and trembling are signs of hypoglycemia, which is an acute, life-
threatening emergency requiring immediate intervention to prevent brain damage or coma.
7. Which action should the nurse take to maintain a sterile field during a dressing change?
, A. Reach over the sterile field to pick up supplies
B. Keep the sterile field in constant view
C. Open sterile packages toward the body
D. Place sterile items within the 1-inch border of the field
🟢 Correct answer: B. Keep the sterile field in constant view
🔴 RATIONALE: Maintaining a sterile field requires that the field never be left unattended or out
of the nurse's line of vision to ensure no contamination occurs unnoticed.
8. A client has been prescribed warfarin for atrial fibrillation. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft-bristled toothbrush."
B. "I will take aspirin if I get a headache."
C. "I will keep my intake of spinach consistent."
D. "I will report any unusual bruising to my doctor."
🟢 Correct answer: B. "I will take aspirin if I get a headache."
🔴 RATIONALE: Aspirin is an antiplatelet agent that increases the risk of bleeding when taken
with anticoagulants like warfarin. Clients should use acetaminophen for pain unless otherwise
directed.
9. A nurse is caring for a client in the active phase of labor. The fetal heart rate monitor
shows early decelerations. Which action should the nurse take?
A. Administer oxygen via face mask
B. Increase the rate of IV fluids
C. Document the finding and continue to monitor
D. Prepare the client for an emergency Cesarean section
🟢 Correct answer: C. Document the finding and continue to monitor
🔴 RATIONALE: Early decelerations are caused by fetal head compression during contractions
and are considered a benign, reassuring finding that does not require intervention.
