1
Page | 1
NCLEX-PN Actual Exam Questions & Answers with
Rationales | 2025–2026 | A+ Prep for Guaranteed Pass
Q1. A patient is prescribed furosemide. Which electrolyte imbalance is most likely to occur?
A. Hyperkalemia
B. Hypokalemia ✅
C. Hypernatremia
D. Hypercalcemia
Rationale
Furosemide (Lasix) is a loop diuretic used to manage fluid overload in conditions like heart
failure and renal disease. It acts on the ascending loop of Henle to inhibit sodium, chloride,
and potassium reabsorption. This leads to increased urine output and significant potassium
loss, making hypokalemia the most common electrolyte imbalance. Symptoms include
, 2
muscle weakness, cramps, and arrhythmias. Monitoring serum potassium levels and
supplementing as needed is essential. Nurses should assess for signs of dehydration and
monitor renal function. This question highlights the importance of understanding medication
Page | 2
side effects, a core component of pharmacological safety on the NCLEX.
Q2. A nurse is caring for a patient on digoxin. Which of the following is a sign of digoxin
toxicity?
A. Hypertension
B. Blurred vision with yellow halos ✅
C. Increased appetite
D. Hyperactivity
Rationale
Digoxin is a cardiac glycoside used to treat heart failure and atrial fibrillation. It works by
increasing cardiac contractility and slowing heart rate. Toxic levels can lead to visual
disturbances such as blurred vision and yellow or green halos, gastrointestinal symptoms like
nausea, and cardiac arrhythmias. The therapeutic range is narrow (0.5–2.0 ng/mL).
Hypokalemia increases the risk of toxicity. Nurses should assess apical pulse before
administration and withhold if the heart rate is below 60 bpm. Regularly monitoring digoxin
levels and patient symptoms helps prevent complications. Early identification of toxicity is
crucial to prevent life-threatening arrhythmias or organ damage.
Q3. A patient is prescribed warfarin for atrial fibrillation. Which lab value should the nurse
monitor?
A. Activated partial thromboplastin time (aPTT)
B. Hemoglobin
, 3
C. International normalized ratio (INR) ✅
D. Platelet count
Rationale
Page | 3
Warfarin is an oral anticoagulant that inhibits vitamin K–dependent clotting factors, reducing
the risk of thromboembolism in conditions like atrial fibrillation. The INR is used to monitor
its therapeutic effect, with a target range of 2.0–3.0 for most indications. A high INR
increases bleeding risk, while a low INR may be ineffective in preventing clots. Nurses
should assess for signs of bleeding (e.g., bruising, hematuria, melena) and educate patients to
avoid foods high in vitamin K. Routine INR monitoring is essential for dose adjustment and
safe use. Other labs like hemoglobin and platelets are useful but not the primary measure.
Q4. A nurse is preparing to administer enoxaparin to a patient with a DVT. Which action is
appropriate?
A. Aspirate before injecting
B. Administer intramuscularly
C. Inject into the abdomen ✅
D. Massage the site after injection
Rationale
Enoxaparin (Lovenox) is a low-molecular-weight heparin used for the prevention and
treatment of deep vein thrombosis. It is administered via subcutaneous injection, commonly
into the abdomen at least 2 inches from the umbilicus. The nurse should not aspirate or
massage the site, as this can cause tissue damage and increase the risk of bruising or
hematoma formation. It is important to rotate injection sites to avoid irritation. Monitoring for
bleeding, especially if the patient is on other anticoagulants, is critical. Proper administration
, 4
technique ensures drug effectiveness and minimizes complications, which is a priority on
NCLEX safety questions.
Page | 4
Q5. A patient is prescribed albuterol for asthma. Which side effect should the nurse
anticipate?
A. Bradycardia
B. Drowsiness
C. Tachycardia ✅
D. Constipation
Rationale
Albuterol is a short-acting beta-2 adrenergic agonist used for quick relief of bronchospasm in
asthma and COPD. It works by relaxing bronchial smooth muscles, improving airflow. A
common side effect is tachycardia due to beta-1 cross-reactivity, especially with frequent or
high doses. Other side effects may include nervousness, tremors, and palpitations. Nurses
should monitor heart rate and instruct patients on proper inhaler use. Overuse can lead to
reduced effectiveness and increased side effects. This question emphasizes knowledge of
expected pharmacologic effects and client teaching, both of which are essential for ensuring
patient safety and optimal therapeutic outcomes on the NCLEX.
Q6. A client taking lithium carbonate reports excessive thirst and frequent urination. What
should the nurse do first?
A. Hold the next lithium dose ✅
B. Encourage increased fluid intake
C. Provide salt-rich snacks
D. Document as a normal finding
Page | 1
NCLEX-PN Actual Exam Questions & Answers with
Rationales | 2025–2026 | A+ Prep for Guaranteed Pass
Q1. A patient is prescribed furosemide. Which electrolyte imbalance is most likely to occur?
A. Hyperkalemia
B. Hypokalemia ✅
C. Hypernatremia
D. Hypercalcemia
Rationale
Furosemide (Lasix) is a loop diuretic used to manage fluid overload in conditions like heart
failure and renal disease. It acts on the ascending loop of Henle to inhibit sodium, chloride,
and potassium reabsorption. This leads to increased urine output and significant potassium
loss, making hypokalemia the most common electrolyte imbalance. Symptoms include
, 2
muscle weakness, cramps, and arrhythmias. Monitoring serum potassium levels and
supplementing as needed is essential. Nurses should assess for signs of dehydration and
monitor renal function. This question highlights the importance of understanding medication
Page | 2
side effects, a core component of pharmacological safety on the NCLEX.
Q2. A nurse is caring for a patient on digoxin. Which of the following is a sign of digoxin
toxicity?
A. Hypertension
B. Blurred vision with yellow halos ✅
C. Increased appetite
D. Hyperactivity
Rationale
Digoxin is a cardiac glycoside used to treat heart failure and atrial fibrillation. It works by
increasing cardiac contractility and slowing heart rate. Toxic levels can lead to visual
disturbances such as blurred vision and yellow or green halos, gastrointestinal symptoms like
nausea, and cardiac arrhythmias. The therapeutic range is narrow (0.5–2.0 ng/mL).
Hypokalemia increases the risk of toxicity. Nurses should assess apical pulse before
administration and withhold if the heart rate is below 60 bpm. Regularly monitoring digoxin
levels and patient symptoms helps prevent complications. Early identification of toxicity is
crucial to prevent life-threatening arrhythmias or organ damage.
Q3. A patient is prescribed warfarin for atrial fibrillation. Which lab value should the nurse
monitor?
A. Activated partial thromboplastin time (aPTT)
B. Hemoglobin
, 3
C. International normalized ratio (INR) ✅
D. Platelet count
Rationale
Page | 3
Warfarin is an oral anticoagulant that inhibits vitamin K–dependent clotting factors, reducing
the risk of thromboembolism in conditions like atrial fibrillation. The INR is used to monitor
its therapeutic effect, with a target range of 2.0–3.0 for most indications. A high INR
increases bleeding risk, while a low INR may be ineffective in preventing clots. Nurses
should assess for signs of bleeding (e.g., bruising, hematuria, melena) and educate patients to
avoid foods high in vitamin K. Routine INR monitoring is essential for dose adjustment and
safe use. Other labs like hemoglobin and platelets are useful but not the primary measure.
Q4. A nurse is preparing to administer enoxaparin to a patient with a DVT. Which action is
appropriate?
A. Aspirate before injecting
B. Administer intramuscularly
C. Inject into the abdomen ✅
D. Massage the site after injection
Rationale
Enoxaparin (Lovenox) is a low-molecular-weight heparin used for the prevention and
treatment of deep vein thrombosis. It is administered via subcutaneous injection, commonly
into the abdomen at least 2 inches from the umbilicus. The nurse should not aspirate or
massage the site, as this can cause tissue damage and increase the risk of bruising or
hematoma formation. It is important to rotate injection sites to avoid irritation. Monitoring for
bleeding, especially if the patient is on other anticoagulants, is critical. Proper administration
, 4
technique ensures drug effectiveness and minimizes complications, which is a priority on
NCLEX safety questions.
Page | 4
Q5. A patient is prescribed albuterol for asthma. Which side effect should the nurse
anticipate?
A. Bradycardia
B. Drowsiness
C. Tachycardia ✅
D. Constipation
Rationale
Albuterol is a short-acting beta-2 adrenergic agonist used for quick relief of bronchospasm in
asthma and COPD. It works by relaxing bronchial smooth muscles, improving airflow. A
common side effect is tachycardia due to beta-1 cross-reactivity, especially with frequent or
high doses. Other side effects may include nervousness, tremors, and palpitations. Nurses
should monitor heart rate and instruct patients on proper inhaler use. Overuse can lead to
reduced effectiveness and increased side effects. This question emphasizes knowledge of
expected pharmacologic effects and client teaching, both of which are essential for ensuring
patient safety and optimal therapeutic outcomes on the NCLEX.
Q6. A client taking lithium carbonate reports excessive thirst and frequent urination. What
should the nurse do first?
A. Hold the next lithium dose ✅
B. Encourage increased fluid intake
C. Provide salt-rich snacks
D. Document as a normal finding
