NCSBN TEST BANK FOR THE NCLEX-RN (NGN) -
2025/2026 EDITION - VERIFIED AND ANSWERS
WITH RATIONALES - A+ GRADED
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results show: pH 7.28, PaCO2 55 mm Hg,
PaO2 60 mm Hg, HCO3- 26 mEq/L. The nurse reviews the provider's prescriptions. Which
prescription should the nurse question?
A. Administer oxygen via nasal cannula at 2 L/min to maintain SpO2 > 90%
B. Obtain sputum culture and sensitivity
C. Administer albuterol nebulizer treatment every 4 hours
D. Administer morphine sulfate 2 mg IV push for dyspnea
Answer: D
Rationale: Morphine sulfate can cause respiratory depression, which is dangerous in acute hypercapnic
respiratory failure (PaCO2 55). Oxygen therapy, sputum culture, and bronchodilators are appropriate.
Opioid-induced hypoventilation could worsen hypercapnia and acidosis.
2. A nurse is caring for a patient with a pulmonary embolism who is receiving heparin infusion.
The aPTT is 120 seconds (therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate
B. Administer protamine sulfate
C. Hold the heparin infusion and notify the provider
D. Continue the infusion and recheck aPTT in 6 hours
Answer: C
Rationale: An aPTT of 120 seconds is supratherapeutic, indicating increased bleeding risk. The infusion
should be held to prevent hemorrhage, and the provider notified for dose adjustment. Increasing the rate
would worsen the risk; protamine is reserved for reversal of severe bleeding, not as a routine response
to elevated aPTT.
3. A patient with diabetic ketoacidosis (DKA) is receiving an insulin infusion at 0.1 units/kg/hr.
Serum potassium is 3.2 mEq/L. Which action should the nurse prioritize?
A. Continue insulin infusion and monitor potassium hourly
B. Stop the insulin infusion immediately
C. Administer potassium chloride IV piggyback as prescribed
D. Administer sodium polystyrene sulfonate orally
Answer: C
Rationale: In DKA, insulin drives potassium intracellularly, worsening hypokalemia. Potassium must be
replaced to maintain cardiac function and prevent arrhythmias. Insulin infusion should continue as it
corrects acidosis, but potassium replacement is critical. Sodium polystyrene sulfonate lowers potassium
Page 1
,and is contraindicated here.
4. A nurse is evaluating a patient's understanding of a new prescription for warfarin. Which
statement by the patient indicates a need for further teaching?
A. I will avoid taking aspirin while on this medication.
B. I will use an electric razor to shave.
C. I will eat plenty of leafy green vegetables like spinach.
D. I will have my INR checked regularly.
Answer: C
Rationale: Leafy green vegetables are high in vitamin K, which antagonizes warfarin and can reduce its
effectiveness. Patients are advised to maintain consistent vitamin K intake, not to increase it. Avoiding
aspirin, using electric razors, and monitoring INR are all appropriate safety measures.
5. A patient with heart failure is receiving furosemide 40 mg IV push. Which finding requires the
nurse's immediate action?
A. Urine output 200 mL over 2 hours
B. Serum potassium 3.0 mEq/L
C. Blood pressure 110/70 mm Hg
D. Heart rate 88 beats per minute
Answer: B
Rationale: Furosemide causes potassium depletion; a potassium of 3.0 mEq/L is hypokalemia, which can
lead to life-threatening arrhythmias. The nurse should report and prepare to administer potassium
replacement. Urine output of 200 mL/2 hrs is adequate; BP and HR are within normal limits.
6. A nurse is assessing a patient who has been on bed rest for 3 days. Which finding is most
indicative of a deep vein thrombosis (DVT)?
A. Bilateral lower extremity edema with pitting
B. Unilateral calf pain and warmth
C. Positive Homan's sign
D. Symmetric pedal pulses
Answer: B
Rationale: Unilateral calf pain, warmth, and swelling are classic signs of DVT. Bilateral edema is more
consistent with systemic causes like heart failure. Homan's sign is unreliable and no longer
recommended. Symmetric pulses do not rule out DVT.
7. A patient with acute pancreatitis is reporting severe abdominal pain. Which intervention should
the nurse question?
A. Place the patient in a semi-Fowler's position
B. Administer morphine sulfate 4 mg IV every 2 hours PRN
C. Maintain NPO status
D. Administer meperidine (Demerol) 75 mg IM every 4 hours
Page 2
,Answer: D
Rationale: Meperidine is not recommended for pancreatitis due to its toxic metabolite normeperidine,
which can cause seizures, and it has no advantage over morphine. Morphine is safe; NPO and
semi-Fowler's position are standard care to reduce pancreatic stimulation.
8. A nurse is caring for a patient who has a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse
take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
C. Check the chest tube connections and dressing
D. Document the finding as normal
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can
compromise lung re-expansion. The nurse should check all connections and the dressing around the
insertion site. Clamping is dangerous and may cause tension pneumothorax; increasing suction does not
fix a leak; it is not normal.
9. A nurse is providing discharge teaching to a patient with a new colostomy. Which statement by
the patient indicates correct understanding?
A. I will change the pouch every day to prevent infection.
B. I can use a heating pad on my abdomen to help with digestion.
C. I should expect the stoma to be dark purple in color.
D. I will avoid foods that cause gas, such as beans and cabbage.
Answer: D
Rationale: Avoiding gas-producing foods helps prevent discomfort and pouch distension. Pouches are
typically changed every 3-7 days, not daily; frequent changes can irritate skin. Heating pads can burn
the stoma. A healthy stoma is pink or red, not dark purple (which indicates ischemia).
10. A nurse is assessing a patient with a suspected stroke using the National Institutes of Health
Stroke Scale (NIHSS). The patient has left facial droop, left arm drift, and slurred speech. The
nurse documents these findings. Which additional assessment is most critical to perform next?
A. Assess the patient's ability to swallow
B. Measure the patient's blood pressure
C. Check the patient's blood glucose level
D. Determine the time of symptom onset
Answer: D
Rationale: Time of symptom onset is critical for determining eligibility for thrombolytic therapy (tPA),
which must be given within 3-4.5 hours. While swallowing assessment, BP, and glucose are important,
the time window is the most time-sensitive factor that drives immediate treatment decisions.
Page 3
, 11. A client with acute pancreatitis develops sudden onset of severe respiratory distress, cyanosis,
and a drop in oxygen saturation to 84% on room air. Arterial blood gas reveals pH 7.48, PaCO2 30
mm Hg, PaO2 55 mm Hg, HCO3- 24 mEq/L. Chest X-ray shows bilateral diffuse interstitial
infiltrates. The nurse suspects acute respiratory distress syndrome (ARDS). Which intervention
should the nurse anticipate first?
A. Administer intravenous furosemide 40 mg
B. Prepare for endotracheal intubation and mechanical ventilation
C. Initiate nonrebreather mask at 15 L/min
D. Obtain a CT scan of the chest
Answer: B
Rationale: The client has severe hypoxemia (PaO2 55 mm Hg) despite supplemental oxygen, indicating
refractory hypoxemia characteristic of ARDS. Endotracheal intubation with low tidal volume
mechanical ventilation is the standard of care to prevent ventilator-induced lung injury. Furosemide is
not first-line because ARDS is not primarily cardiogenic. Nonrebreather mask may be insufficient. CT
scan would delay critical intervention.
12. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
exacerbation. The nurse notes the client is using accessory muscles, has a prolonged expiratory
phase, and oxygen saturation is 85% on 2 L nasal cannula. The healthcare provider prescribes
oxygen to maintain SpO2 of 88-92%. Which action by the nurse is most appropriate?
A. Increase oxygen to 4 L nasal cannula to achieve SpO2 >95%
B. Titrate oxygen to maintain SpO2 between 88-92% and monitor for carbon dioxide retention
C. Apply a nonrebreather mask at 15 L/min to rapidly correct hypoxemia
D. Obtain an arterial blood gas before adjusting oxygen
Answer: B
Rationale: In COPD exacerbation, the hypoxic drive may be blunted; excessive oxygen can suppress the
drive and worsen hypercapnia. Maintaining SpO2 88-92% is guideline-recommended. Increasing to
>95% can lead to CO2 narcosis. While ABG is helpful, it should not delay oxygen titration.
Nonrebreather mask would deliver too high FiO2.
13. A client is receiving a continuous intravenous infusion of heparin for deep vein thrombosis. The
activated partial thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds).
The nurse notes the client has new onset of hematuria and gingival bleeding. What is the priority
nursing action?
A. Administer vitamin K intramuscularly
B. Stop the heparin infusion and notify the healthcare provider
C. Administer protamine sulfate as prescribed
D. Apply pressure to bleeding sites and continue the infusion
Answer: B
Rationale: The aPTT is supratherapeutic and the client shows signs of bleeding. The immediate priority is
to discontinue the heparin infusion to prevent further bleeding. Protamine sulfate is the antidote but
requires a prescription and is not the first action. Vitamin K reverses warfarin, not heparin. Continuing
the infusion would worsen bleeding.
Page 4
2025/2026 EDITION - VERIFIED AND ANSWERS
WITH RATIONALES - A+ GRADED
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results show: pH 7.28, PaCO2 55 mm Hg,
PaO2 60 mm Hg, HCO3- 26 mEq/L. The nurse reviews the provider's prescriptions. Which
prescription should the nurse question?
A. Administer oxygen via nasal cannula at 2 L/min to maintain SpO2 > 90%
B. Obtain sputum culture and sensitivity
C. Administer albuterol nebulizer treatment every 4 hours
D. Administer morphine sulfate 2 mg IV push for dyspnea
Answer: D
Rationale: Morphine sulfate can cause respiratory depression, which is dangerous in acute hypercapnic
respiratory failure (PaCO2 55). Oxygen therapy, sputum culture, and bronchodilators are appropriate.
Opioid-induced hypoventilation could worsen hypercapnia and acidosis.
2. A nurse is caring for a patient with a pulmonary embolism who is receiving heparin infusion.
The aPTT is 120 seconds (therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate
B. Administer protamine sulfate
C. Hold the heparin infusion and notify the provider
D. Continue the infusion and recheck aPTT in 6 hours
Answer: C
Rationale: An aPTT of 120 seconds is supratherapeutic, indicating increased bleeding risk. The infusion
should be held to prevent hemorrhage, and the provider notified for dose adjustment. Increasing the rate
would worsen the risk; protamine is reserved for reversal of severe bleeding, not as a routine response
to elevated aPTT.
3. A patient with diabetic ketoacidosis (DKA) is receiving an insulin infusion at 0.1 units/kg/hr.
Serum potassium is 3.2 mEq/L. Which action should the nurse prioritize?
A. Continue insulin infusion and monitor potassium hourly
B. Stop the insulin infusion immediately
C. Administer potassium chloride IV piggyback as prescribed
D. Administer sodium polystyrene sulfonate orally
Answer: C
Rationale: In DKA, insulin drives potassium intracellularly, worsening hypokalemia. Potassium must be
replaced to maintain cardiac function and prevent arrhythmias. Insulin infusion should continue as it
corrects acidosis, but potassium replacement is critical. Sodium polystyrene sulfonate lowers potassium
Page 1
,and is contraindicated here.
4. A nurse is evaluating a patient's understanding of a new prescription for warfarin. Which
statement by the patient indicates a need for further teaching?
A. I will avoid taking aspirin while on this medication.
B. I will use an electric razor to shave.
C. I will eat plenty of leafy green vegetables like spinach.
D. I will have my INR checked regularly.
Answer: C
Rationale: Leafy green vegetables are high in vitamin K, which antagonizes warfarin and can reduce its
effectiveness. Patients are advised to maintain consistent vitamin K intake, not to increase it. Avoiding
aspirin, using electric razors, and monitoring INR are all appropriate safety measures.
5. A patient with heart failure is receiving furosemide 40 mg IV push. Which finding requires the
nurse's immediate action?
A. Urine output 200 mL over 2 hours
B. Serum potassium 3.0 mEq/L
C. Blood pressure 110/70 mm Hg
D. Heart rate 88 beats per minute
Answer: B
Rationale: Furosemide causes potassium depletion; a potassium of 3.0 mEq/L is hypokalemia, which can
lead to life-threatening arrhythmias. The nurse should report and prepare to administer potassium
replacement. Urine output of 200 mL/2 hrs is adequate; BP and HR are within normal limits.
6. A nurse is assessing a patient who has been on bed rest for 3 days. Which finding is most
indicative of a deep vein thrombosis (DVT)?
A. Bilateral lower extremity edema with pitting
B. Unilateral calf pain and warmth
C. Positive Homan's sign
D. Symmetric pedal pulses
Answer: B
Rationale: Unilateral calf pain, warmth, and swelling are classic signs of DVT. Bilateral edema is more
consistent with systemic causes like heart failure. Homan's sign is unreliable and no longer
recommended. Symmetric pulses do not rule out DVT.
7. A patient with acute pancreatitis is reporting severe abdominal pain. Which intervention should
the nurse question?
A. Place the patient in a semi-Fowler's position
B. Administer morphine sulfate 4 mg IV every 2 hours PRN
C. Maintain NPO status
D. Administer meperidine (Demerol) 75 mg IM every 4 hours
Page 2
,Answer: D
Rationale: Meperidine is not recommended for pancreatitis due to its toxic metabolite normeperidine,
which can cause seizures, and it has no advantage over morphine. Morphine is safe; NPO and
semi-Fowler's position are standard care to reduce pancreatic stimulation.
8. A nurse is caring for a patient who has a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse
take?
A. Clamp the chest tube near the insertion site
B. Increase the suction pressure
C. Check the chest tube connections and dressing
D. Document the finding as normal
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can
compromise lung re-expansion. The nurse should check all connections and the dressing around the
insertion site. Clamping is dangerous and may cause tension pneumothorax; increasing suction does not
fix a leak; it is not normal.
9. A nurse is providing discharge teaching to a patient with a new colostomy. Which statement by
the patient indicates correct understanding?
A. I will change the pouch every day to prevent infection.
B. I can use a heating pad on my abdomen to help with digestion.
C. I should expect the stoma to be dark purple in color.
D. I will avoid foods that cause gas, such as beans and cabbage.
Answer: D
Rationale: Avoiding gas-producing foods helps prevent discomfort and pouch distension. Pouches are
typically changed every 3-7 days, not daily; frequent changes can irritate skin. Heating pads can burn
the stoma. A healthy stoma is pink or red, not dark purple (which indicates ischemia).
10. A nurse is assessing a patient with a suspected stroke using the National Institutes of Health
Stroke Scale (NIHSS). The patient has left facial droop, left arm drift, and slurred speech. The
nurse documents these findings. Which additional assessment is most critical to perform next?
A. Assess the patient's ability to swallow
B. Measure the patient's blood pressure
C. Check the patient's blood glucose level
D. Determine the time of symptom onset
Answer: D
Rationale: Time of symptom onset is critical for determining eligibility for thrombolytic therapy (tPA),
which must be given within 3-4.5 hours. While swallowing assessment, BP, and glucose are important,
the time window is the most time-sensitive factor that drives immediate treatment decisions.
Page 3
, 11. A client with acute pancreatitis develops sudden onset of severe respiratory distress, cyanosis,
and a drop in oxygen saturation to 84% on room air. Arterial blood gas reveals pH 7.48, PaCO2 30
mm Hg, PaO2 55 mm Hg, HCO3- 24 mEq/L. Chest X-ray shows bilateral diffuse interstitial
infiltrates. The nurse suspects acute respiratory distress syndrome (ARDS). Which intervention
should the nurse anticipate first?
A. Administer intravenous furosemide 40 mg
B. Prepare for endotracheal intubation and mechanical ventilation
C. Initiate nonrebreather mask at 15 L/min
D. Obtain a CT scan of the chest
Answer: B
Rationale: The client has severe hypoxemia (PaO2 55 mm Hg) despite supplemental oxygen, indicating
refractory hypoxemia characteristic of ARDS. Endotracheal intubation with low tidal volume
mechanical ventilation is the standard of care to prevent ventilator-induced lung injury. Furosemide is
not first-line because ARDS is not primarily cardiogenic. Nonrebreather mask may be insufficient. CT
scan would delay critical intervention.
12. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
exacerbation. The nurse notes the client is using accessory muscles, has a prolonged expiratory
phase, and oxygen saturation is 85% on 2 L nasal cannula. The healthcare provider prescribes
oxygen to maintain SpO2 of 88-92%. Which action by the nurse is most appropriate?
A. Increase oxygen to 4 L nasal cannula to achieve SpO2 >95%
B. Titrate oxygen to maintain SpO2 between 88-92% and monitor for carbon dioxide retention
C. Apply a nonrebreather mask at 15 L/min to rapidly correct hypoxemia
D. Obtain an arterial blood gas before adjusting oxygen
Answer: B
Rationale: In COPD exacerbation, the hypoxic drive may be blunted; excessive oxygen can suppress the
drive and worsen hypercapnia. Maintaining SpO2 88-92% is guideline-recommended. Increasing to
>95% can lead to CO2 narcosis. While ABG is helpful, it should not delay oxygen titration.
Nonrebreather mask would deliver too high FiO2.
13. A client is receiving a continuous intravenous infusion of heparin for deep vein thrombosis. The
activated partial thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds).
The nurse notes the client has new onset of hematuria and gingival bleeding. What is the priority
nursing action?
A. Administer vitamin K intramuscularly
B. Stop the heparin infusion and notify the healthcare provider
C. Administer protamine sulfate as prescribed
D. Apply pressure to bleeding sites and continue the infusion
Answer: B
Rationale: The aPTT is supratherapeutic and the client shows signs of bleeding. The immediate priority is
to discontinue the heparin infusion to prevent further bleeding. Protamine sulfate is the antidote but
requires a prescription and is not the first action. Vitamin K reverses warfarin, not heparin. Continuing
the infusion would worsen bleeding.
Page 4
