National Council of State Boards of
6 2 0 2 N R -X E L C N
★ ★
NCLEX Nursing
NCSBN
NCLEX-RN Examination — Official Practice Q&A
PAT I E N T S A F E TY • C L I N I C A L J U D G M E N T • E V I D E N C E - B A S E D P R A CT I C E
NCLEX-RN Examination
L AT E ST 2 0 2 0 2 7 U P D AT E | Q & A G U I D E | G R A D E A V E R I F I E D
NCSBN — National Council of
TESTING ORGANIZATION EXAM TYPE NCLEX-RN (Next Generation
State Boards of Nursing NCLEX Style)
EDITION Latest Update TOTAL QUESTIONS 20 High-Yield Q&A with Clinical
Rationale
FORMAT Multiple Choice – Select the GRADE A – 100% Correct Verified
Single Best Answer Answers
NCLEX-RN EXAMINATION REVIEW GUIDE
▸ This document contains verified Q&A for the NCLEX-RN Examination (2026/2027 Update).
▸ Covers high-priority topics: pharmacology, medical-surgical nursing, maternity, mental health, emergency care,
and patient safety.
▸ Each answer includes clinical rationale, NCLEX tips, and common wrong answer explanations.
▸ Use this guide to prepare for the NCLEX-RN and for clinical application in nursing practice.
SECTION I — MEDICAL-SURGICAL & PHARMACOLOGY Q1–Q10
1. A nurse is caring for a client with heart failure who has been prescribed furosemide. Which assessment
finding requires immediate intervention?
CORRECT ANSWER: Serum potassium 2.9 mEq/L and client reports muscle weakness.
RATIONALE: Furosemide is a loop diuretic that causes significant potassium wasting; hypokalemia (K+ <3.5 mEq/L)
increases risk of ventricular dysrhythmias and digoxin toxicity. Muscle weakness is a classic symptom of moderate-to-
severe hypokalemia. A potassium level of 2.9 mEq/L requires immediate potassium replacement; delayed action
could lead to cardiac arrest or respiratory muscle weakness. Weight loss reflects expected diuresis; dry mouth
indicates mild dehydration but not immediate life-threatening electrolyte imbalance.
2. A postpartum client with Rh-negative blood type gives birth to an Rh-positive newborn. Which
medication should the nurse administer within 72 hours of delivery?
CORRECT ANSWER: Rho(D) immune globulin (RhoGAM).
RATIONALE: RhoGAM prevents sensitization of the Rh-negative mother to Rh-positive fetal red blood cells, reducing
the risk of hemolytic disease of the newborn in subsequent pregnancies. Administration within 72 hours after delivery,
miscarriage, or invasive procedures is standard evidence-based care. Hepatitis B immune globulin is given to infants
of HBsAg-positive mothers, not for Rh incompatibility.
, 3. During a mental health assessment, a client with major depressive disorder states, "Life is pointless. I
don't see any reason to keep waking up." What is the priority nursing action?
CORRECT ANSWER: Perform a suicide risk assessment including ideation, plan, intent, and means.
RATIONALE: Statements expressing hopelessness and worthlessness are red flags for suicide risk. The priority is
direct, non-judgmental assessment of suicidal ideation, plan, lethality, and access to means. The SAFE-T protocol
mandates immediate risk stratification. Providing reassurance avoids the lethal risk and delays necessary safety
interventions; therapeutic alliance is secondary to safety.
4. A nurse is monitoring a client receiving a blood transfusion of packed red blood cells. Which clinical
manifestation indicates an acute hemolytic transfusion reaction?
CORRECT ANSWER: Low back pain, dark urine, and chills with fever.
RATIONALE: Acute hemolytic reaction occurs within minutes due to ABO incompatibility. Classic signs include low
back pain (hemoglobin release in renal tubules), hemoglobinuria (dark urine), fever, chills, and hypotension.
Immediate nursing action: stop transfusion, maintain IV line with normal saline, notify provider, and send blood bag
to blood bank. Urticaria indicates mild allergic reaction; crackles suggest fluid overload.
5. A client with chronic kidney disease (Stage 4) has a laboratory result of hemoglobin 8.2 g/dL. Which
medication order should the nurse anticipate?
CORRECT ANSWER: Erythropoiesis-stimulating agent (ESA), such as epoetin alfa.
RATIONALE: Anemia in CKD results from insufficient erythropoietin production by damaged kidneys. ESAs stimulate
bone marrow RBC production and are indicated when hemoglobin is <10 g/dL in CKD. Iron supplementation is
adjunctive but ESAs are primary therapy. Target hemoglobin is 10-11 g/dL to avoid cardiovascular risks. Blood
transfusion is reserved for severe, symptomatic anemia (Hgb <7).
6. The nurse is preparing to administer digoxin 0.25 mg PO to a client with atrial fibrillation. Which
finding would warrant holding the dose and contacting the provider?
CORRECT ANSWER: Apical pulse 52 beats/min and ECG shows new onset of premature ventricular
contractions (PVCs).
RATIONALE: Digoxin toxicity is common in older adults and renal impairment. A heart rate <60 bpm or significant
arrhythmia (bigeminy, multifocal PVCs) indicates possible toxicity; digoxin should be held. Other signs: nausea,
vomiting, visual changes (yellow-green halos). The nurse must assess apical pulse for one full minute before
administration. Serum potassium 4.1 is normal; trace edema is expected in heart failure.
6 2 0 2 N R -X E L C N
★ ★
NCLEX Nursing
NCSBN
NCLEX-RN Examination — Official Practice Q&A
PAT I E N T S A F E TY • C L I N I C A L J U D G M E N T • E V I D E N C E - B A S E D P R A CT I C E
NCLEX-RN Examination
L AT E ST 2 0 2 0 2 7 U P D AT E | Q & A G U I D E | G R A D E A V E R I F I E D
NCSBN — National Council of
TESTING ORGANIZATION EXAM TYPE NCLEX-RN (Next Generation
State Boards of Nursing NCLEX Style)
EDITION Latest Update TOTAL QUESTIONS 20 High-Yield Q&A with Clinical
Rationale
FORMAT Multiple Choice – Select the GRADE A – 100% Correct Verified
Single Best Answer Answers
NCLEX-RN EXAMINATION REVIEW GUIDE
▸ This document contains verified Q&A for the NCLEX-RN Examination (2026/2027 Update).
▸ Covers high-priority topics: pharmacology, medical-surgical nursing, maternity, mental health, emergency care,
and patient safety.
▸ Each answer includes clinical rationale, NCLEX tips, and common wrong answer explanations.
▸ Use this guide to prepare for the NCLEX-RN and for clinical application in nursing practice.
SECTION I — MEDICAL-SURGICAL & PHARMACOLOGY Q1–Q10
1. A nurse is caring for a client with heart failure who has been prescribed furosemide. Which assessment
finding requires immediate intervention?
CORRECT ANSWER: Serum potassium 2.9 mEq/L and client reports muscle weakness.
RATIONALE: Furosemide is a loop diuretic that causes significant potassium wasting; hypokalemia (K+ <3.5 mEq/L)
increases risk of ventricular dysrhythmias and digoxin toxicity. Muscle weakness is a classic symptom of moderate-to-
severe hypokalemia. A potassium level of 2.9 mEq/L requires immediate potassium replacement; delayed action
could lead to cardiac arrest or respiratory muscle weakness. Weight loss reflects expected diuresis; dry mouth
indicates mild dehydration but not immediate life-threatening electrolyte imbalance.
2. A postpartum client with Rh-negative blood type gives birth to an Rh-positive newborn. Which
medication should the nurse administer within 72 hours of delivery?
CORRECT ANSWER: Rho(D) immune globulin (RhoGAM).
RATIONALE: RhoGAM prevents sensitization of the Rh-negative mother to Rh-positive fetal red blood cells, reducing
the risk of hemolytic disease of the newborn in subsequent pregnancies. Administration within 72 hours after delivery,
miscarriage, or invasive procedures is standard evidence-based care. Hepatitis B immune globulin is given to infants
of HBsAg-positive mothers, not for Rh incompatibility.
, 3. During a mental health assessment, a client with major depressive disorder states, "Life is pointless. I
don't see any reason to keep waking up." What is the priority nursing action?
CORRECT ANSWER: Perform a suicide risk assessment including ideation, plan, intent, and means.
RATIONALE: Statements expressing hopelessness and worthlessness are red flags for suicide risk. The priority is
direct, non-judgmental assessment of suicidal ideation, plan, lethality, and access to means. The SAFE-T protocol
mandates immediate risk stratification. Providing reassurance avoids the lethal risk and delays necessary safety
interventions; therapeutic alliance is secondary to safety.
4. A nurse is monitoring a client receiving a blood transfusion of packed red blood cells. Which clinical
manifestation indicates an acute hemolytic transfusion reaction?
CORRECT ANSWER: Low back pain, dark urine, and chills with fever.
RATIONALE: Acute hemolytic reaction occurs within minutes due to ABO incompatibility. Classic signs include low
back pain (hemoglobin release in renal tubules), hemoglobinuria (dark urine), fever, chills, and hypotension.
Immediate nursing action: stop transfusion, maintain IV line with normal saline, notify provider, and send blood bag
to blood bank. Urticaria indicates mild allergic reaction; crackles suggest fluid overload.
5. A client with chronic kidney disease (Stage 4) has a laboratory result of hemoglobin 8.2 g/dL. Which
medication order should the nurse anticipate?
CORRECT ANSWER: Erythropoiesis-stimulating agent (ESA), such as epoetin alfa.
RATIONALE: Anemia in CKD results from insufficient erythropoietin production by damaged kidneys. ESAs stimulate
bone marrow RBC production and are indicated when hemoglobin is <10 g/dL in CKD. Iron supplementation is
adjunctive but ESAs are primary therapy. Target hemoglobin is 10-11 g/dL to avoid cardiovascular risks. Blood
transfusion is reserved for severe, symptomatic anemia (Hgb <7).
6. The nurse is preparing to administer digoxin 0.25 mg PO to a client with atrial fibrillation. Which
finding would warrant holding the dose and contacting the provider?
CORRECT ANSWER: Apical pulse 52 beats/min and ECG shows new onset of premature ventricular
contractions (PVCs).
RATIONALE: Digoxin toxicity is common in older adults and renal impairment. A heart rate <60 bpm or significant
arrhythmia (bigeminy, multifocal PVCs) indicates possible toxicity; digoxin should be held. Other signs: nausea,
vomiting, visual changes (yellow-green halos). The nurse must assess apical pulse for one full minute before
administration. Serum potassium 4.1 is normal; trace edema is expected in heart failure.
