1
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NCLEX PN ACTUAL EXAM
2025-2026 QUESTIONS AND
ANSWERS WITH RATIONALE.
Q1. A patient on enoxaparin reports dark stools. What should the nurse do first?
A. Continue the medication
B. Assess for gastrointestinal bleeding ✅
C. Recommend iron supplements
D. Schedule a colonoscopy
Rationale
Enoxaparin is an anticoagulant used to prevent thromboembolic disorders such as DVT. One
of its serious side effects is bleeding, including gastrointestinal bleeding. Dark, tarry stools
are often a sign of GI bleeding and should never be ignored. The nurse’s first action is to
assess the patient for further signs of bleeding, including vital signs and hemoglobin levels.
Continuing the medication without assessing could worsen the condition. Iron supplements
and colonoscopies are not immediate priorities. Early recognition of adverse effects can
, 2
prevent complications. Patient safety is always the top NCLEX priority, especially when
medications with bleeding risk are involved.
Page | 2
Q2. Which finding in a patient receiving vancomycin requires immediate attention?
A. Mild nausea
B. Red rash on face and neck
C. Serum creatinine 2.2 mg/dL ✅
D. Tinnitus
Rationale
Vancomycin is a powerful antibiotic used for severe infections such as MRSA. It is
nephrotoxic and requires monitoring of renal function. A serum creatinine of 2.2 mg/dL is
elevated and indicates potential kidney damage, which demands immediate attention. While
red rash (Red Man Syndrome) and tinnitus are side effects, they are not as immediately life-
threatening as renal impairment. Red Man Syndrome can often be managed by slowing the
infusion rate. Elevated creatinine may necessitate stopping the drug or adjusting the dose.
Immediate intervention can prevent acute kidney injury. Nurses must prioritize organ-
threatening complications on NCLEX-style questions.
Q3. A patient with chronic kidney disease is prescribed calcium carbonate. What is the
primary purpose?
A. Bind phosphate in the gut ✅
B. Treat hypocalcemia
C. Strengthen bones
D. Enhance vitamin D absorption
, 3
Rationale
In chronic kidney disease (CKD), phosphate excretion is impaired, leading to
hyperphosphatemia. Calcium carbonate is a phosphate binder that binds to dietary phosphate
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in the gastrointestinal tract, reducing absorption and lowering serum phosphate levels. This
action indirectly helps manage calcium-phosphate balance and reduces the risk of renal
osteodystrophy. Although it does contain calcium, its main therapeutic goal is not to treat
hypocalcemia but to manage phosphate levels. Bone health and vitamin D absorption are
secondary concerns. This is a frequently tested concept on the NCLEX due to the complex
metabolic imbalances seen in CKD patients.
Q4. A client with schizophrenia says, "The voices won’t leave me alone." What is the best
response by the nurse?
A. Ignore the comment
B. Ask what the voices are saying
C. Acknowledge the experience and offer support ✅
D. Tell the client that hallucinations are not real
Rationale
The therapeutic communication approach to hallucinations involves acknowledging the
patient’s experience without validating the hallucination itself. Saying something like “That
sounds scary; I'm here for you” demonstrates empathy and builds trust. Ignoring or denying
the hallucination can increase the client’s distress or lead to mistrust. Asking what the voices
are saying may reinforce the hallucination and lead to escalation. In NCLEX scenarios,
prioritizing therapeutic and supportive interventions is essential for patients with psychiatric
conditions, particularly schizophrenia. It’s critical for nurses to maintain safety while
promoting a supportive and nonjudgmental environment to foster therapeutic relationships.
, 4
Q5. A patient is taking spironolactone. Which lab value should be closely monitored?
A. Sodium
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B. Calcium
C. Potassium ✅
D. Magnesium
Rationale
Spironolactone is a potassium-sparing diuretic often prescribed for hypertension, heart
failure, or hyperaldosteronism. It inhibits sodium reabsorption in the distal tubules while
retaining potassium, placing the patient at risk for hyperkalemia. Elevated potassium levels
can lead to life-threatening cardiac arrhythmias. While sodium and magnesium are also
electrolytes affected by diuretics, potassium is the priority for monitoring with
spironolactone. Nurses should regularly check serum potassium and assess for signs such as
muscle weakness, bradycardia, or EKG changes. Understanding lab monitoring for
commonly prescribed medications is a high-yield concept for the NCLEX.
Q6. Which vaccine is contraindicated in pregnancy?
A. Influenza (inactivated)
B. Tdap
C. MMR (measles, mumps, rubella) ✅
D. Hepatitis B
Rationale
The MMR vaccine is a live attenuated vaccine and is contraindicated during pregnancy due to
the theoretical risk of transmitting live virus to the fetus. Live vaccines pose potential harm in
Page | 1
NCLEX PN ACTUAL EXAM
2025-2026 QUESTIONS AND
ANSWERS WITH RATIONALE.
Q1. A patient on enoxaparin reports dark stools. What should the nurse do first?
A. Continue the medication
B. Assess for gastrointestinal bleeding ✅
C. Recommend iron supplements
D. Schedule a colonoscopy
Rationale
Enoxaparin is an anticoagulant used to prevent thromboembolic disorders such as DVT. One
of its serious side effects is bleeding, including gastrointestinal bleeding. Dark, tarry stools
are often a sign of GI bleeding and should never be ignored. The nurse’s first action is to
assess the patient for further signs of bleeding, including vital signs and hemoglobin levels.
Continuing the medication without assessing could worsen the condition. Iron supplements
and colonoscopies are not immediate priorities. Early recognition of adverse effects can
, 2
prevent complications. Patient safety is always the top NCLEX priority, especially when
medications with bleeding risk are involved.
Page | 2
Q2. Which finding in a patient receiving vancomycin requires immediate attention?
A. Mild nausea
B. Red rash on face and neck
C. Serum creatinine 2.2 mg/dL ✅
D. Tinnitus
Rationale
Vancomycin is a powerful antibiotic used for severe infections such as MRSA. It is
nephrotoxic and requires monitoring of renal function. A serum creatinine of 2.2 mg/dL is
elevated and indicates potential kidney damage, which demands immediate attention. While
red rash (Red Man Syndrome) and tinnitus are side effects, they are not as immediately life-
threatening as renal impairment. Red Man Syndrome can often be managed by slowing the
infusion rate. Elevated creatinine may necessitate stopping the drug or adjusting the dose.
Immediate intervention can prevent acute kidney injury. Nurses must prioritize organ-
threatening complications on NCLEX-style questions.
Q3. A patient with chronic kidney disease is prescribed calcium carbonate. What is the
primary purpose?
A. Bind phosphate in the gut ✅
B. Treat hypocalcemia
C. Strengthen bones
D. Enhance vitamin D absorption
, 3
Rationale
In chronic kidney disease (CKD), phosphate excretion is impaired, leading to
hyperphosphatemia. Calcium carbonate is a phosphate binder that binds to dietary phosphate
Page | 3
in the gastrointestinal tract, reducing absorption and lowering serum phosphate levels. This
action indirectly helps manage calcium-phosphate balance and reduces the risk of renal
osteodystrophy. Although it does contain calcium, its main therapeutic goal is not to treat
hypocalcemia but to manage phosphate levels. Bone health and vitamin D absorption are
secondary concerns. This is a frequently tested concept on the NCLEX due to the complex
metabolic imbalances seen in CKD patients.
Q4. A client with schizophrenia says, "The voices won’t leave me alone." What is the best
response by the nurse?
A. Ignore the comment
B. Ask what the voices are saying
C. Acknowledge the experience and offer support ✅
D. Tell the client that hallucinations are not real
Rationale
The therapeutic communication approach to hallucinations involves acknowledging the
patient’s experience without validating the hallucination itself. Saying something like “That
sounds scary; I'm here for you” demonstrates empathy and builds trust. Ignoring or denying
the hallucination can increase the client’s distress or lead to mistrust. Asking what the voices
are saying may reinforce the hallucination and lead to escalation. In NCLEX scenarios,
prioritizing therapeutic and supportive interventions is essential for patients with psychiatric
conditions, particularly schizophrenia. It’s critical for nurses to maintain safety while
promoting a supportive and nonjudgmental environment to foster therapeutic relationships.
, 4
Q5. A patient is taking spironolactone. Which lab value should be closely monitored?
A. Sodium
Page | 4
B. Calcium
C. Potassium ✅
D. Magnesium
Rationale
Spironolactone is a potassium-sparing diuretic often prescribed for hypertension, heart
failure, or hyperaldosteronism. It inhibits sodium reabsorption in the distal tubules while
retaining potassium, placing the patient at risk for hyperkalemia. Elevated potassium levels
can lead to life-threatening cardiac arrhythmias. While sodium and magnesium are also
electrolytes affected by diuretics, potassium is the priority for monitoring with
spironolactone. Nurses should regularly check serum potassium and assess for signs such as
muscle weakness, bradycardia, or EKG changes. Understanding lab monitoring for
commonly prescribed medications is a high-yield concept for the NCLEX.
Q6. Which vaccine is contraindicated in pregnancy?
A. Influenza (inactivated)
B. Tdap
C. MMR (measles, mumps, rubella) ✅
D. Hepatitis B
Rationale
The MMR vaccine is a live attenuated vaccine and is contraindicated during pregnancy due to
the theoretical risk of transmitting live virus to the fetus. Live vaccines pose potential harm in
