NCSBN-Style NCLEX-RN Exam 1 2026 –
180 Questions with Answers & Rationales
1. A nurse is caring for a client receiving a blood transfusion who reports
chills and low back pain. Which action should the nurse take first?
A. Stop the transfusion.
B. Slow the infusion rate.
C. Notify the healthcare provider.
D. Obtain a urine sample.
✅ Correct Answer: A
Rationale: Chills and low back pain indicate an acute hemolytic reaction.
The priority is to stop the transfusion immediately to prevent further
reaction. Then infuse normal saline with new tubing and notify the provider.
2. A client with type 1 diabetes mellitus has a blood glucose of 45 mg/dL and
is unconscious. Which intervention should the nurse implement first?
A. Administer glucagon 1 mg IM.
B. Give orange juice orally.
C. Start an IV of D5W.
D. Recheck blood glucose in 15 minutes.
✅ Correct Answer: A
Rationale: Unconscious client cannot safely swallow. Glucagon IM raises
blood glucose rapidly. IV dextrose is also appropriate but requires IV access,
which takes longer.
3. A nurse is assessing a client’s IV site and notes warmth, erythema, and a
palpable cord along the vein. What is the priority action?
,A. Apply a cold compress.
B. Discontinue the IV.
C. Document the findings.
D. Flush the IV with saline.
✅ Correct Answer: B
Rationale: Warmth, redness, and a palpable cord indicate phlebitis. The IV
must be discontinued immediately to prevent further inflammation or
infection.
4. A client with a history of falls is prescribed a waist restraint. Which action
by the nurse is correct?
A. Tie the restraint to the side rail.
B. Apply the restraint tightly to prevent slipping.
C. Secure the restraint to the bed frame.
D. Remove the restraint every 8 hours.
✅ Correct Answer: C
Rationale: Restraints must be secured to the bed frame (never side rails) to
prevent injury during bed movement. Remove every 2 hours for ROM and
toileting.
5. A nurse is teaching a client about warfarin (Coumadin). Which statement
indicates understanding?
A. “I will eat more green leafy vegetables.”
B. “I will take ibuprofen for headaches.”
C. “I will have my INR checked regularly.”
D. “I can stop warfarin when I feel better.”
✅ Correct Answer: C
Rationale: Regular INR monitoring is essential for warfarin therapy to
maintain therapeutic levels and prevent bleeding or clotting complications.
,6. A client with heart failure has crackles in both lungs and an SpO2 of 88%
on room air. Which oxygen delivery device is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 8 L/min
D. Venturi mask at 40% FiO2
✅ Correct Answer: A
*Rationale: Severe hypoxemia (SpO2 <90%) requires high-flow oxygen. A
non-rebreather delivers 80–95% FiO2. Nasal cannula 2 L/min is insufficient
for this degree of hypoxemia.*
7. A nurse is assessing a client with opioid use disorder who received
naloxone (Narcan) for respiratory depression. Which finding indicates the
naloxone is effective?
A. Respiratory rate increases from 8 to 14 breaths/min.
B. Pupils become more constricted.
C. Blood pressure decreases from 140/90 to 110/70.
D. Sedation deepens.
✅ Correct Answer: A
Rationale: Naloxone reverses opioid-induced respiratory depression. An
increased respiratory rate and improved level of consciousness indicate
effectiveness.
8. A client with a new colostomy asks how to prevent a blockage. Which
instruction is correct?
A. “Eat plenty of raw vegetables and popcorn.”
B. “Chew foods thoroughly and avoid large amounts of nuts.”
, C. “Drink only clear liquids.”
D. “Avoid all fiber.”
✅ Correct Answer: B
Rationale: Thorough chewing and avoiding large amounts of nuts, seeds, and
raw vegetables reduces the risk of ostomy blockage.
9. A nurse is caring for a client with a traumatic brain injury. Which finding
indicates increased intracranial pressure (ICP)?
A. Glasgow Coma Scale (GCS) score of 15
B. Pupils equal and reactive to light
C. Widening pulse pressure (hypertension, bradycardia, irregular
respirations)
D. Blood pressure 110/70 mm Hg
✅ Correct Answer: C
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
is a late sign of increased ICP. GCS 15 is normal.
10. A client with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG change is expected?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged QT interval
✅ Correct Answer: C
Rationale: Hyperkalemia causes tall, peaked T waves. Flattened T waves and
U waves are seen in hypokalemia.
180 Questions with Answers & Rationales
1. A nurse is caring for a client receiving a blood transfusion who reports
chills and low back pain. Which action should the nurse take first?
A. Stop the transfusion.
B. Slow the infusion rate.
C. Notify the healthcare provider.
D. Obtain a urine sample.
✅ Correct Answer: A
Rationale: Chills and low back pain indicate an acute hemolytic reaction.
The priority is to stop the transfusion immediately to prevent further
reaction. Then infuse normal saline with new tubing and notify the provider.
2. A client with type 1 diabetes mellitus has a blood glucose of 45 mg/dL and
is unconscious. Which intervention should the nurse implement first?
A. Administer glucagon 1 mg IM.
B. Give orange juice orally.
C. Start an IV of D5W.
D. Recheck blood glucose in 15 minutes.
✅ Correct Answer: A
Rationale: Unconscious client cannot safely swallow. Glucagon IM raises
blood glucose rapidly. IV dextrose is also appropriate but requires IV access,
which takes longer.
3. A nurse is assessing a client’s IV site and notes warmth, erythema, and a
palpable cord along the vein. What is the priority action?
,A. Apply a cold compress.
B. Discontinue the IV.
C. Document the findings.
D. Flush the IV with saline.
✅ Correct Answer: B
Rationale: Warmth, redness, and a palpable cord indicate phlebitis. The IV
must be discontinued immediately to prevent further inflammation or
infection.
4. A client with a history of falls is prescribed a waist restraint. Which action
by the nurse is correct?
A. Tie the restraint to the side rail.
B. Apply the restraint tightly to prevent slipping.
C. Secure the restraint to the bed frame.
D. Remove the restraint every 8 hours.
✅ Correct Answer: C
Rationale: Restraints must be secured to the bed frame (never side rails) to
prevent injury during bed movement. Remove every 2 hours for ROM and
toileting.
5. A nurse is teaching a client about warfarin (Coumadin). Which statement
indicates understanding?
A. “I will eat more green leafy vegetables.”
B. “I will take ibuprofen for headaches.”
C. “I will have my INR checked regularly.”
D. “I can stop warfarin when I feel better.”
✅ Correct Answer: C
Rationale: Regular INR monitoring is essential for warfarin therapy to
maintain therapeutic levels and prevent bleeding or clotting complications.
,6. A client with heart failure has crackles in both lungs and an SpO2 of 88%
on room air. Which oxygen delivery device is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 8 L/min
D. Venturi mask at 40% FiO2
✅ Correct Answer: A
*Rationale: Severe hypoxemia (SpO2 <90%) requires high-flow oxygen. A
non-rebreather delivers 80–95% FiO2. Nasal cannula 2 L/min is insufficient
for this degree of hypoxemia.*
7. A nurse is assessing a client with opioid use disorder who received
naloxone (Narcan) for respiratory depression. Which finding indicates the
naloxone is effective?
A. Respiratory rate increases from 8 to 14 breaths/min.
B. Pupils become more constricted.
C. Blood pressure decreases from 140/90 to 110/70.
D. Sedation deepens.
✅ Correct Answer: A
Rationale: Naloxone reverses opioid-induced respiratory depression. An
increased respiratory rate and improved level of consciousness indicate
effectiveness.
8. A client with a new colostomy asks how to prevent a blockage. Which
instruction is correct?
A. “Eat plenty of raw vegetables and popcorn.”
B. “Chew foods thoroughly and avoid large amounts of nuts.”
, C. “Drink only clear liquids.”
D. “Avoid all fiber.”
✅ Correct Answer: B
Rationale: Thorough chewing and avoiding large amounts of nuts, seeds, and
raw vegetables reduces the risk of ostomy blockage.
9. A nurse is caring for a client with a traumatic brain injury. Which finding
indicates increased intracranial pressure (ICP)?
A. Glasgow Coma Scale (GCS) score of 15
B. Pupils equal and reactive to light
C. Widening pulse pressure (hypertension, bradycardia, irregular
respirations)
D. Blood pressure 110/70 mm Hg
✅ Correct Answer: C
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
is a late sign of increased ICP. GCS 15 is normal.
10. A client with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG change is expected?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged QT interval
✅ Correct Answer: C
Rationale: Hyperkalemia causes tall, peaked T waves. Flattened T waves and
U waves are seen in hypokalemia.
