COMPREHENSIVE NURSING EDUCATION AND
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
Subject: Nursing Fundamentals and Clinical Judgment
Subtopic: Pharmacological Management and Electrolyte Homeostasis
Question 1: A nurse is caring for a client with heart failure who is receiving digoxin 0.25 mg orally daily.
Which of the following findings should the nurse identify as a manifestation of digoxin toxicity?
A) Serum potassium 4.2 mEq/L
B) Visual disturbances, such as green-yellow halos around objects
C) Heart rate of 78 beats/min
D) Presence of peripheral edema
Correct Answer: B) - Visual disturbances, such as green-yellow halos around objects
Rationale: Digoxin toxicity manifests through various clinical signs, with visual disturbances like blurred
vision or yellow-green halos being classic indicators. Bradycardia is also a common sign; therefore, a
heart rate of 78 is within normal limits. Hypokalemia, not a normal potassium level, significantly
increases the risk of digoxin toxicity. Peripheral edema is an indicator of heart failure progression rather
than a sign of digoxin toxicity.
Question 2: A nurse is planning care for a client who has a prescription for a potassium-sparing diuretic.
Which of the following laboratory values should the nurse monitor to prevent a life-threatening adverse
effect?
A) Serum sodium
B) Serum potassium
C) Blood urea nitrogen (BUN)
D) Serum glucose
Correct Answer: B) - Serum potassium
Rationale: Potassium-sparing diuretics, such as spironolactone, function by inhibiting the action of
aldosterone in the distal tubule, which leads to potassium retention. Monitoring serum potassium is
critical because hyperkalemia is a serious and potentially fatal adverse effect of these medications. While
sodium, BUN, and glucose are important to track in renal and metabolic contexts, potassium levels have
the most direct and dangerous correlation with the administration of potassium-sparing diuretics.
Question 3: A nurse is assessing a client who is in the early stages of diabetic ketoacidosis (DKA). Which
of the following respiratory patterns should the nurse anticipate?
A) Shallow, rapid respirations
B) Kussmaul respirations
,COMPREHENSIVE NURSING EDUCATION AND
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
C) Cheyne-Stokes respirations
D) Biot's respirations
Correct Answer: B) - Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid, and labored breathing patterns that serve as a
compensatory mechanism to blow off excess carbon dioxide (an acid) to correct metabolic acidosis,
which is characteristic of DKA. Shallow, rapid respirations are not compensatory for acidosis. Cheyne-
Stokes and Biot's respirations are generally associated with neurological impairment or brainstem injury,
not metabolic endocrine emergencies.
Question 4: A nurse is caring for a client who is suspected of having an acute myocardial infarction (MI).
Which of the following is the priority action for the nurse to perform upon the client's arrival at the
emergency department?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead electrocardiogram (ECG)
C) Draw troponin levels
D) Administer morphine sulfate
Correct Answer: B) - Obtain a 12-lead electrocardiogram (ECG)
Rationale: According to evidence-based practice and ACLS guidelines, an ECG must be obtained and
interpreted within 10 minutes of arrival for any client presenting with chest pain suggestive of an MI.
While nitroglycerin, troponin labs, and morphine are critical components of the management of ACS, the
ECG is the diagnostic gold standard required to determine if the client is experiencing an ST-elevation
myocardial infarction (STEMI) and to guide immediate reperfusion therapy.
Question 5: A nurse is prioritizing care for a group of clients. Which of the following clients should the
nurse assess first?
A) A client who is postoperative and requesting pain medication
B) A client who has a potassium level of 6.0 mEq/L
C) A client who has a stage 2 pressure injury on the coccyx
D) A client who is receiving intravenous antibiotics and has a temperature of 38.2°C (100.8°F)
Correct Answer: B) - A client who has a potassium level of 6.0 mEq/L
Rationale: Using the ABC (Airway, Breathing, Circulation) framework and the prioritization of life-
threatening electrolyte imbalances, a potassium level of 6.0 mEq/L indicates severe hyperkalemia, which
places the client at high risk for fatal cardiac arrhythmias. Pain management, wound care, and
, COMPREHENSIVE NURSING EDUCATION AND
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
managing a low-grade fever are important, but they do not pose an immediate threat to the client's life
compared to the cardiac risk associated with extreme hyperkalemia.
Question 6: A nurse is caring for a client who is diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following clinical manifestations should the nurse expect to assess?
A) Serum sodium 120 mEq/L
B) Polyuria and polydipsia
C) Urine specific gravity 1.002
D) Serum osmolality 310 mOsm/kg
Correct Answer: A) - Serum sodium 120 mEq/L
Rationale: SIADH is characterized by excessive release of antidiuretic hormone, leading to water
retention and dilutional hyponatremia. A sodium level of 120 mEq/L indicates significant hyponatremia.
Polyuria and low urine specific gravity (1.002) are manifestations of diabetes insipidus, the opposite of
SIADH. An elevated serum osmolality would indicate dehydration, whereas SIADH typically presents with
low serum osmolality.
Question 7: A nurse is preparing to administer packed red blood cells to a client. Which of the following
actions is the priority before starting the transfusion?
A) Obtain the client's vital signs
B) Verify the client's identity and blood product information with another nurse
C) Prime the infusion tubing with lactated Ringer's solution
D) Explain the procedure to the client
Correct Answer: B) - Verify the client's identity and blood product information with another nurse
Rationale: The most critical step in blood transfusion safety is the verification process. The Joint
Commission requires a two-nurse verification of the blood component, the unit number, the client's
identification, and blood type compatibility to prevent fatal hemolytic transfusion reactions. While taking
vital signs and patient education are essential, they do not supersede the primary safety mandate of
double-checking the product.
Question 8: A nurse is caring for a client who has acute pancreatitis. Which of the following laboratory
findings is most indicative of this condition?
A) Elevated serum amylase
B) Decreased white blood cell count
C) Elevated serum calcium
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
Subject: Nursing Fundamentals and Clinical Judgment
Subtopic: Pharmacological Management and Electrolyte Homeostasis
Question 1: A nurse is caring for a client with heart failure who is receiving digoxin 0.25 mg orally daily.
Which of the following findings should the nurse identify as a manifestation of digoxin toxicity?
A) Serum potassium 4.2 mEq/L
B) Visual disturbances, such as green-yellow halos around objects
C) Heart rate of 78 beats/min
D) Presence of peripheral edema
Correct Answer: B) - Visual disturbances, such as green-yellow halos around objects
Rationale: Digoxin toxicity manifests through various clinical signs, with visual disturbances like blurred
vision or yellow-green halos being classic indicators. Bradycardia is also a common sign; therefore, a
heart rate of 78 is within normal limits. Hypokalemia, not a normal potassium level, significantly
increases the risk of digoxin toxicity. Peripheral edema is an indicator of heart failure progression rather
than a sign of digoxin toxicity.
Question 2: A nurse is planning care for a client who has a prescription for a potassium-sparing diuretic.
Which of the following laboratory values should the nurse monitor to prevent a life-threatening adverse
effect?
A) Serum sodium
B) Serum potassium
C) Blood urea nitrogen (BUN)
D) Serum glucose
Correct Answer: B) - Serum potassium
Rationale: Potassium-sparing diuretics, such as spironolactone, function by inhibiting the action of
aldosterone in the distal tubule, which leads to potassium retention. Monitoring serum potassium is
critical because hyperkalemia is a serious and potentially fatal adverse effect of these medications. While
sodium, BUN, and glucose are important to track in renal and metabolic contexts, potassium levels have
the most direct and dangerous correlation with the administration of potassium-sparing diuretics.
Question 3: A nurse is assessing a client who is in the early stages of diabetic ketoacidosis (DKA). Which
of the following respiratory patterns should the nurse anticipate?
A) Shallow, rapid respirations
B) Kussmaul respirations
,COMPREHENSIVE NURSING EDUCATION AND
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
C) Cheyne-Stokes respirations
D) Biot's respirations
Correct Answer: B) - Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid, and labored breathing patterns that serve as a
compensatory mechanism to blow off excess carbon dioxide (an acid) to correct metabolic acidosis,
which is characteristic of DKA. Shallow, rapid respirations are not compensatory for acidosis. Cheyne-
Stokes and Biot's respirations are generally associated with neurological impairment or brainstem injury,
not metabolic endocrine emergencies.
Question 4: A nurse is caring for a client who is suspected of having an acute myocardial infarction (MI).
Which of the following is the priority action for the nurse to perform upon the client's arrival at the
emergency department?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead electrocardiogram (ECG)
C) Draw troponin levels
D) Administer morphine sulfate
Correct Answer: B) - Obtain a 12-lead electrocardiogram (ECG)
Rationale: According to evidence-based practice and ACLS guidelines, an ECG must be obtained and
interpreted within 10 minutes of arrival for any client presenting with chest pain suggestive of an MI.
While nitroglycerin, troponin labs, and morphine are critical components of the management of ACS, the
ECG is the diagnostic gold standard required to determine if the client is experiencing an ST-elevation
myocardial infarction (STEMI) and to guide immediate reperfusion therapy.
Question 5: A nurse is prioritizing care for a group of clients. Which of the following clients should the
nurse assess first?
A) A client who is postoperative and requesting pain medication
B) A client who has a potassium level of 6.0 mEq/L
C) A client who has a stage 2 pressure injury on the coccyx
D) A client who is receiving intravenous antibiotics and has a temperature of 38.2°C (100.8°F)
Correct Answer: B) - A client who has a potassium level of 6.0 mEq/L
Rationale: Using the ABC (Airway, Breathing, Circulation) framework and the prioritization of life-
threatening electrolyte imbalances, a potassium level of 6.0 mEq/L indicates severe hyperkalemia, which
places the client at high risk for fatal cardiac arrhythmias. Pain management, wound care, and
, COMPREHENSIVE NURSING EDUCATION AND
NCLEX-RN PRACTICE EXAM WITH QUESTIONS AND
ANSWERS .. UPDATED 2026 (GRADED A+)
managing a low-grade fever are important, but they do not pose an immediate threat to the client's life
compared to the cardiac risk associated with extreme hyperkalemia.
Question 6: A nurse is caring for a client who is diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following clinical manifestations should the nurse expect to assess?
A) Serum sodium 120 mEq/L
B) Polyuria and polydipsia
C) Urine specific gravity 1.002
D) Serum osmolality 310 mOsm/kg
Correct Answer: A) - Serum sodium 120 mEq/L
Rationale: SIADH is characterized by excessive release of antidiuretic hormone, leading to water
retention and dilutional hyponatremia. A sodium level of 120 mEq/L indicates significant hyponatremia.
Polyuria and low urine specific gravity (1.002) are manifestations of diabetes insipidus, the opposite of
SIADH. An elevated serum osmolality would indicate dehydration, whereas SIADH typically presents with
low serum osmolality.
Question 7: A nurse is preparing to administer packed red blood cells to a client. Which of the following
actions is the priority before starting the transfusion?
A) Obtain the client's vital signs
B) Verify the client's identity and blood product information with another nurse
C) Prime the infusion tubing with lactated Ringer's solution
D) Explain the procedure to the client
Correct Answer: B) - Verify the client's identity and blood product information with another nurse
Rationale: The most critical step in blood transfusion safety is the verification process. The Joint
Commission requires a two-nurse verification of the blood component, the unit number, the client's
identification, and blood type compatibility to prevent fatal hemolytic transfusion reactions. While taking
vital signs and patient education are essential, they do not supersede the primary safety mandate of
double-checking the product.
Question 8: A nurse is caring for a client who has acute pancreatitis. Which of the following laboratory
findings is most indicative of this condition?
A) Elevated serum amylase
B) Decreased white blood cell count
C) Elevated serum calcium
