NCLEX Exam NCLEX-PN Actual Exams Questions and
Answers
100% Verified, 2026/2027 Version
1. Sudden crushing chest pressure radiates to the left arm and jaw while climbing stairs.
Skin is pale and diaphoretic, and nausea is reported. Blood pressure is 88/54 mm Hg and
heart rate is 118 beats per minute. What is the priority nursing action?
Immediate activation of the emergency cardiac response and administration of oxygen are
required while preparing for a 12-lead ECG. These findings strongly suggest acute myocardial
infarction with hemodynamic instability. Rapid recognition and intervention reduce myocardial
damage and improve survival.
2. Increasing confusion and restlessness develop in an older adult admitted for pneumonia.
Oxygen saturation falls to 89% on room air and crackles are heard bilaterally. What
should be assessed and implemented first?
Hypoxia should be addressed immediately by applying supplemental oxygen and reassessing
saturation. Decreased oxygen levels commonly cause acute confusion in older adults. Correcting
oxygenation may rapidly improve mental status and prevent further decline.
3. Severe lower abdominal pain begins suddenly in early pregnancy and is accompanied by
shoulder pain and light vaginal spotting. Blood pressure is decreasing and pulse is rising.
What emergency condition is suspected?
Ectopic pregnancy with possible rupture is suspected. Immediate surgical evaluation is required
due to risk of internal hemorrhage. Rapid intervention prevents hypovolemic shock and maternal
death.
4. Persistent hyperglycemia of 480 mg/dL is accompanied by fruity breath odor and deep
rapid respirations. Skin is dry and mental status is lethargic. What is the priority
treatment?
Diabetic ketoacidosis is present and requires immediate IV insulin therapy and aggressive fluid
replacement. Correcting dehydration and hyperglycemia stabilizes acid-base balance. Continuous
electrolyte monitoring is essential during treatment.
5. Sudden swelling of the lips and tongue occurs after administration of a new antibiotic.
Hoarseness and stridor are noted. What is the nurse’s immediate priority?
Anaphylaxis is occurring and intramuscular epinephrine must be administered without delay.
Airway protection is the highest priority due to risk of obstruction. Emergency support should be
activated immediately.
6. Severe headache described as “the worst ever” develops abruptly along with vomiting
and neck stiffness. Consciousness begins to decline. What condition should be suspected?
Subarachnoid hemorrhage is suspected due to sudden intense pain and neurological changes.
, Immediate neuroimaging and stabilization are critical. Rapid management reduces risk of
permanent brain injury.
7. Increasing calf pain, warmth, and unilateral swelling develop after prolonged
immobility. Skin appears reddened and tender to touch. What complication is most likely?
Deep vein thrombosis is suspected based on classic signs. Immediate provider notification and
initiation of anticoagulation therapy are necessary. Early treatment prevents pulmonary
embolism.
8. Persistent productive cough, night sweats, and weight loss occur over several weeks.
Chest imaging reveals upper lobe infiltrates. What infection is likely and what precaution is
required?
Tuberculosis is likely given chronic symptoms and imaging findings. Airborne precautions must
be implemented immediately. Early isolation prevents transmission to others.
9. Gradual onset of bradycardia, cold intolerance, weight gain, and dry skin is observed.
Laboratory findings reveal elevated TSH levels. What endocrine disorder is present and
what is the treatment focus?
Hypothyroidism is present due to insufficient thyroid hormone production. Treatment involves
gradual thyroid hormone replacement therapy. Careful monitoring prevents cardiac strain and
ensures proper dosing.
10. Severe epigastric pain radiates to the back and worsens after eating fatty meals. Serum
amylase and lipase levels are elevated. What is the priority nursing intervention?
Acute pancreatitis is indicated and bowel rest by keeping the individual NPO is essential. IV
fluids and pain management are primary components of care. Early intervention reduces
pancreatic inflammation.
11. High fever, rigid muscles, and altered mental status develop after starting antipsychotic
medication. Blood pressure and heart rate are elevated. What life-threatening complication
is occurring?
Neuroleptic malignant syndrome is suspected. Immediate discontinuation of the medication and
emergency treatment are required. Rapid intervention reduces mortality.
12. Persistent black tarry stools are reported along with weakness and dizziness. Blood
pressure trends downward and pulse is rapid. What complication should be suspected?
Upper gastrointestinal bleeding is likely occurring. Immediate IV access and fluid resuscitation
are priorities. Stabilizing circulation prevents shock.
13. Sudden unilateral facial droop and difficulty speaking are noted during breakfast.
Symptoms began 30 minutes ago. What is the most critical action?
Immediate activation of stroke protocol is required. Rapid imaging determines eligibility for
thrombolytic therapy. Time-sensitive treatment improves neurological outcomes.
14. Severe shortness of breath and absent breath sounds on one side follow chest trauma.
Tracheal deviation is observed. What emergency condition is present?
Answers
100% Verified, 2026/2027 Version
1. Sudden crushing chest pressure radiates to the left arm and jaw while climbing stairs.
Skin is pale and diaphoretic, and nausea is reported. Blood pressure is 88/54 mm Hg and
heart rate is 118 beats per minute. What is the priority nursing action?
Immediate activation of the emergency cardiac response and administration of oxygen are
required while preparing for a 12-lead ECG. These findings strongly suggest acute myocardial
infarction with hemodynamic instability. Rapid recognition and intervention reduce myocardial
damage and improve survival.
2. Increasing confusion and restlessness develop in an older adult admitted for pneumonia.
Oxygen saturation falls to 89% on room air and crackles are heard bilaterally. What
should be assessed and implemented first?
Hypoxia should be addressed immediately by applying supplemental oxygen and reassessing
saturation. Decreased oxygen levels commonly cause acute confusion in older adults. Correcting
oxygenation may rapidly improve mental status and prevent further decline.
3. Severe lower abdominal pain begins suddenly in early pregnancy and is accompanied by
shoulder pain and light vaginal spotting. Blood pressure is decreasing and pulse is rising.
What emergency condition is suspected?
Ectopic pregnancy with possible rupture is suspected. Immediate surgical evaluation is required
due to risk of internal hemorrhage. Rapid intervention prevents hypovolemic shock and maternal
death.
4. Persistent hyperglycemia of 480 mg/dL is accompanied by fruity breath odor and deep
rapid respirations. Skin is dry and mental status is lethargic. What is the priority
treatment?
Diabetic ketoacidosis is present and requires immediate IV insulin therapy and aggressive fluid
replacement. Correcting dehydration and hyperglycemia stabilizes acid-base balance. Continuous
electrolyte monitoring is essential during treatment.
5. Sudden swelling of the lips and tongue occurs after administration of a new antibiotic.
Hoarseness and stridor are noted. What is the nurse’s immediate priority?
Anaphylaxis is occurring and intramuscular epinephrine must be administered without delay.
Airway protection is the highest priority due to risk of obstruction. Emergency support should be
activated immediately.
6. Severe headache described as “the worst ever” develops abruptly along with vomiting
and neck stiffness. Consciousness begins to decline. What condition should be suspected?
Subarachnoid hemorrhage is suspected due to sudden intense pain and neurological changes.
, Immediate neuroimaging and stabilization are critical. Rapid management reduces risk of
permanent brain injury.
7. Increasing calf pain, warmth, and unilateral swelling develop after prolonged
immobility. Skin appears reddened and tender to touch. What complication is most likely?
Deep vein thrombosis is suspected based on classic signs. Immediate provider notification and
initiation of anticoagulation therapy are necessary. Early treatment prevents pulmonary
embolism.
8. Persistent productive cough, night sweats, and weight loss occur over several weeks.
Chest imaging reveals upper lobe infiltrates. What infection is likely and what precaution is
required?
Tuberculosis is likely given chronic symptoms and imaging findings. Airborne precautions must
be implemented immediately. Early isolation prevents transmission to others.
9. Gradual onset of bradycardia, cold intolerance, weight gain, and dry skin is observed.
Laboratory findings reveal elevated TSH levels. What endocrine disorder is present and
what is the treatment focus?
Hypothyroidism is present due to insufficient thyroid hormone production. Treatment involves
gradual thyroid hormone replacement therapy. Careful monitoring prevents cardiac strain and
ensures proper dosing.
10. Severe epigastric pain radiates to the back and worsens after eating fatty meals. Serum
amylase and lipase levels are elevated. What is the priority nursing intervention?
Acute pancreatitis is indicated and bowel rest by keeping the individual NPO is essential. IV
fluids and pain management are primary components of care. Early intervention reduces
pancreatic inflammation.
11. High fever, rigid muscles, and altered mental status develop after starting antipsychotic
medication. Blood pressure and heart rate are elevated. What life-threatening complication
is occurring?
Neuroleptic malignant syndrome is suspected. Immediate discontinuation of the medication and
emergency treatment are required. Rapid intervention reduces mortality.
12. Persistent black tarry stools are reported along with weakness and dizziness. Blood
pressure trends downward and pulse is rapid. What complication should be suspected?
Upper gastrointestinal bleeding is likely occurring. Immediate IV access and fluid resuscitation
are priorities. Stabilizing circulation prevents shock.
13. Sudden unilateral facial droop and difficulty speaking are noted during breakfast.
Symptoms began 30 minutes ago. What is the most critical action?
Immediate activation of stroke protocol is required. Rapid imaging determines eligibility for
thrombolytic therapy. Time-sensitive treatment improves neurological outcomes.
14. Severe shortness of breath and absent breath sounds on one side follow chest trauma.
Tracheal deviation is observed. What emergency condition is present?
