KNAT KAPLAN NCLEX-RN PREP EXAM EMERGENCY
NURSING 2026 Q&A
1. A 54-year-old male arrives in the emergency department
with sudden, severe chest pain described as “tearing” and
radiating to the back. His blood pressure is 190/110 mmHg
in the right arm and 140/85 mmHg in the left arm. What is
the priority nursing action?
A. Administer morphine IV for pain
B. Obtain a CT angiogram of the chest
C. Initiate beta-blocker therapy to reduce blood pressure
D. Prepare for immediate surgical consultation
Correct Answer: C
Explanation: The clinical presentation suggests aortic
dissection. The priority is to reduce shear stress on the
aortic wall by lowering blood pressure and heart rate,
typically with IV beta-blockers like labetalol or atenolol.
Surgical consultation is critical but secondary to immediate
BP control. CT angiogram confirms diagnosis but does not
precede hemodynamic stabilization.
2. A child aged 3 years is brought in after ingesting multiple
ibuprofen tablets. He is alert but has nausea and vomiting.
Which assessment finding would indicate the most serious
complication?
A. Tachycardia
B. Metabolic alkalosis
C. Acute kidney injury
D. Hypoglycemia
, Correct Answer: C
Explanation: Ibuprofen toxicity can cause acute kidney
injury due to direct renal toxicity and decreased
prostaglandin-mediated renal perfusion. Metabolic acidosis
(not alkalosis) is more common. Hypoglycemia is rare with
NSAIDs. Tachycardia is common but less concerning than
renal failure.
3. During triage, a patient presents with severe shortness of
breath, wheezing, and hypotension after eating shellfish.
What is the FIRST nursing intervention?
A. Administer oxygen via non-rebreather mask
B. Administer epinephrine IM
C. Start IV fluids
D. Administer albuterol nebulizer
Correct Answer: B
Explanation: This is anaphylaxis. Epinephrine is the first-
line treatment and must be given immediately to reverse
bronchoconstriction and vasodilation. Oxygen and fluids
are important but secondary. Albuterol treats
bronchospasm but does not address the underlying
mediating pathway.
4. A 28-year-old female is brought in after a motor vehicle
crash. She has a deformity of the right forearm, pale skin,
and is diaphoretic. Her heart rate is 128 bpm, and blood
pressure is 88/54 mmHg. What is the most likely cause of
her instability?
A. Cardiac tamponade
, B. Hemorrhagic shock
C. Neurogenic shock
D. Pulmonary embolism
Correct Answer: B
Explanation: The patient shows signs of
hypovolemic/hemorrhagic shock (tachycardia,
hypotension, pale/diaphoretic skin) likely due to bleeding
from trauma. Cardiac tamponade presents with muffled
heart sounds and distended neck veins. Neurogenic shock
causes bradycardia and warm skin. PE typically presents
with sudden dyspnea and tachycardia but not these trauma
signs.
5. A patient with a known history of seizure disorder presents
post-ictally with a temperature of 40.2°C (104.4°F),
tachycardia, and confusion. He took phenytoin recently.
What is the most appropriate initial intervention?
A. Administer lorazepam IV
B. Initiate active cooling measures
C. Obtain a CT head scan
D. Start IV levetiracetam
Correct Answer: B
Explanation: This suggests serotonin syndrome or drug-
induced hyperthermia, possibly from phenytoin toxicity or
interaction. Active cooling is critical to prevent neurological
damage. Benzodiazepines treat seizures but not
hyperthermia. CT is for structural causes. Antiepileptics
don't address the hyperthermia.
, 6. A 65-year-old male presents with sudden onset of right-sided
weakness and slurred speech 45 minutes ago. His BP is
188/92 mmHg. CT head shows no hemorrhage. What is the
next appropriate step?
A. Administer aspirin 325 mg
B. Start IV heparin
C. Administer IV alteplase (tPA)
D. Transfer to stroke unit for monitoring
Correct Answer: C
Explanation: The patient is within the 3–4.5-hour window
for tPA eligibility for acute ischemic stroke.BP must be
<185/110 before tPA; current BP is slightly elevated but
may be managed. Aspirin is given after tPA or if tPA is
contraindicated. Heparin is not used in acute stroke.
7. A patient arrives with a deep laceration to the thigh after a
gunshot wound. Active bleeding is present. What is the
PRIORITY nursing action?
A. Apply direct pressure to the wound
B. Insert two large-bore IVs
C. Administer tranexamic acid IV
D. Prepare for emergent surgery
Correct Answer: A
Explanation: Direct pressure is the immediate intervention
to control hemorrhage. IV access and blood products follow.
TXA may be used in trauma but is not the first step. Surgery
is necessary but hemorrhage control precedes it.
NURSING 2026 Q&A
1. A 54-year-old male arrives in the emergency department
with sudden, severe chest pain described as “tearing” and
radiating to the back. His blood pressure is 190/110 mmHg
in the right arm and 140/85 mmHg in the left arm. What is
the priority nursing action?
A. Administer morphine IV for pain
B. Obtain a CT angiogram of the chest
C. Initiate beta-blocker therapy to reduce blood pressure
D. Prepare for immediate surgical consultation
Correct Answer: C
Explanation: The clinical presentation suggests aortic
dissection. The priority is to reduce shear stress on the
aortic wall by lowering blood pressure and heart rate,
typically with IV beta-blockers like labetalol or atenolol.
Surgical consultation is critical but secondary to immediate
BP control. CT angiogram confirms diagnosis but does not
precede hemodynamic stabilization.
2. A child aged 3 years is brought in after ingesting multiple
ibuprofen tablets. He is alert but has nausea and vomiting.
Which assessment finding would indicate the most serious
complication?
A. Tachycardia
B. Metabolic alkalosis
C. Acute kidney injury
D. Hypoglycemia
, Correct Answer: C
Explanation: Ibuprofen toxicity can cause acute kidney
injury due to direct renal toxicity and decreased
prostaglandin-mediated renal perfusion. Metabolic acidosis
(not alkalosis) is more common. Hypoglycemia is rare with
NSAIDs. Tachycardia is common but less concerning than
renal failure.
3. During triage, a patient presents with severe shortness of
breath, wheezing, and hypotension after eating shellfish.
What is the FIRST nursing intervention?
A. Administer oxygen via non-rebreather mask
B. Administer epinephrine IM
C. Start IV fluids
D. Administer albuterol nebulizer
Correct Answer: B
Explanation: This is anaphylaxis. Epinephrine is the first-
line treatment and must be given immediately to reverse
bronchoconstriction and vasodilation. Oxygen and fluids
are important but secondary. Albuterol treats
bronchospasm but does not address the underlying
mediating pathway.
4. A 28-year-old female is brought in after a motor vehicle
crash. She has a deformity of the right forearm, pale skin,
and is diaphoretic. Her heart rate is 128 bpm, and blood
pressure is 88/54 mmHg. What is the most likely cause of
her instability?
A. Cardiac tamponade
, B. Hemorrhagic shock
C. Neurogenic shock
D. Pulmonary embolism
Correct Answer: B
Explanation: The patient shows signs of
hypovolemic/hemorrhagic shock (tachycardia,
hypotension, pale/diaphoretic skin) likely due to bleeding
from trauma. Cardiac tamponade presents with muffled
heart sounds and distended neck veins. Neurogenic shock
causes bradycardia and warm skin. PE typically presents
with sudden dyspnea and tachycardia but not these trauma
signs.
5. A patient with a known history of seizure disorder presents
post-ictally with a temperature of 40.2°C (104.4°F),
tachycardia, and confusion. He took phenytoin recently.
What is the most appropriate initial intervention?
A. Administer lorazepam IV
B. Initiate active cooling measures
C. Obtain a CT head scan
D. Start IV levetiracetam
Correct Answer: B
Explanation: This suggests serotonin syndrome or drug-
induced hyperthermia, possibly from phenytoin toxicity or
interaction. Active cooling is critical to prevent neurological
damage. Benzodiazepines treat seizures but not
hyperthermia. CT is for structural causes. Antiepileptics
don't address the hyperthermia.
, 6. A 65-year-old male presents with sudden onset of right-sided
weakness and slurred speech 45 minutes ago. His BP is
188/92 mmHg. CT head shows no hemorrhage. What is the
next appropriate step?
A. Administer aspirin 325 mg
B. Start IV heparin
C. Administer IV alteplase (tPA)
D. Transfer to stroke unit for monitoring
Correct Answer: C
Explanation: The patient is within the 3–4.5-hour window
for tPA eligibility for acute ischemic stroke.BP must be
<185/110 before tPA; current BP is slightly elevated but
may be managed. Aspirin is given after tPA or if tPA is
contraindicated. Heparin is not used in acute stroke.
7. A patient arrives with a deep laceration to the thigh after a
gunshot wound. Active bleeding is present. What is the
PRIORITY nursing action?
A. Apply direct pressure to the wound
B. Insert two large-bore IVs
C. Administer tranexamic acid IV
D. Prepare for emergent surgery
Correct Answer: A
Explanation: Direct pressure is the immediate intervention
to control hemorrhage. IV access and blood products follow.
TXA may be used in trauma but is not the first step. Surgery
is necessary but hemorrhage control precedes it.
