NCLEX RN 2025/2026 – 250 High-Yield Next Gen Questions with In-Depth Rationales |
Real Exam Prep
Q1. A patient on warfarin should have which laboratory value monitored regularly?
A. INR
B. Potassium
C. Glucose
✅
D. BUN
🩺
Answer: INR
Explanation:
Warfarin is an anticoagulant that interferes with vitamin K–dependent clotting factors. The INR
(International Normalized Ratio) is used to monitor its effectiveness. An INR that’s too low
increases the risk of clotting; too high increases bleeding risk. The therapeutic range for most
patients on warfarin is 2.0–3.0. Monitoring INR ensures the patient is neither under- nor
over-anticoagulated.
Q2. A patient is prescribed furosemide. What lab value should the nurse monitor?
A. INR
B. Potassium
C. Sodium
✅
D. Hemoglobin
🩺
Answer: Potassium
Explanation:
Furosemide is a loop diuretic that promotes diuresis (urine output) by inhibiting sodium and
chloride reabsorption in the loop of Henle. This causes the excretion of potassium as well,
potentially leading to hypokalemia, which can result in muscle weakness, arrhythmias, and
fatigue. Nurses must monitor serum potassium levels and educate patients to consume
potassium-rich foods or supplements if needed.
Q3. Before administering digoxin, which assessment is most important?
A. Blood pressure
B. Respiratory rate
C. Apical heart rate
✅
D. Bowel sounds
🩺
Answer: Apical heart rate
Explanation:
Digoxin slows the heart rate and increases cardiac contractility, making it useful in treating heart
failure and atrial fibrillation. However, it can cause bradycardia and digoxin toxicity, especially
in the elderly or those with renal issues. Nurses must check the apical pulse for a full 60
,seconds before giving if it’s below 60 bpm, the medication should be held and the provider
notified.
Q4. What is a serious side effect of lisinopril the nurse should monitor for?
A. Tachycardia
B. Constipation
C. Angioedema
✅
D. Photosensitivity
🩺
Answer: Angioedema
Explanation:
Lisinopril is an ACE inhibitor used to treat hypertension and heart failure. A rare but
life-threatening adverse effect is angioedema, which is the rapid swelling of the face, tongue,
throat, and airway. It may occur shortly after the first dose or later during treatment. If suspected,
the drug must be stopped immediately, and emergency intervention provided due to risk of
airway obstruction.
Q5. Which medication requires regular blood glucose monitoring?
A. Warfarin
B. Furosemide
C. Insulin
✅
D. Albuterol
🩺
Answer: Insulin
Explanation:
Insulin is a hormone used to manage blood glucose in diabetic patients. Without proper dosing,
it can cause hypoglycemia, which may lead to confusion, sweating, dizziness, loss of
consciousness, or seizures. Patients must regularly check their blood glucose levels,
especially before meals and at bedtime, and adjust insulin doses based on blood sugar
readings, carbohydrate intake, and activity.
Q6. A patient taking gentamicin should be monitored for which complication?
A. Hyperkalemia
B. Tinnitus
C. Seizures
✅
D. Bradycardia
🩺
Answer: B. Tinnitus
Explanation: Gentamicin is an aminoglycoside antibiotic that can cause ototoxicity,
especially with prolonged use or high doses. Ototoxicity often presents as tinnitus (ringing in
the ears) and may progress to irreversible hearing loss. The nurse should monitor auditory
function and report early symptoms immediately.
,Q7. Which lab is most important to monitor for a patient on vancomycin?
A. Platelets
B. White blood cells
C. Trough level
✅
D. Hematocrit
🩺
Answer: C. Trough level
Explanation: Vancomycin has a narrow therapeutic index, and levels must be monitored
to prevent toxicity, especially nephrotoxicity and ototoxicity. The trough level (measured just
before the next dose) indicates whether the drug concentration is within safe limits.
Q8. Which side effect is most concerning with amiodarone use?
A. Headache
B. Photosensitivity
C. Pulmonary toxicity
✅
D. Increased appetite
🩺
Answer: C. Pulmonary toxicity
Explanation: Amiodarone, a powerful antiarrhythmic, can cause pulmonary fibrosis or
pneumonitis as a serious adverse effect. Patients may present with new or worsening cough,
dyspnea, or infiltrates on chest X-ray. Lung function tests are often required during therapy.
Q9. What assessment is critical before giving morphine?
A. Measure blood glucose
B. Assess pain level and respirations
C. Give food with medication
✅
D. Monitor liver enzymes
🩺
Answer: B. Assess pain level and respirations
Explanation: Morphine is a potent opioid analgesic that can depress the respiratory
center. Always assess the patient’s respiratory rate (hold if <12 breaths/min), pain level, and
sedation level before administration.
Q10. Which teaching point is important for a patient on prednisone?
A. Avoid sun exposure
B. Report signs of infection
C. Limit salt intake
✅
D. Stop taking when feeling better
🩺
Answer: B. Report signs of infection
Explanation: Prednisone is a corticosteroid that suppresses the immune system,
increasing the patient’s susceptibility to infection. Even minor symptoms like sore throat or fever
should be reported immediately.
, Q11. What is a priority action before giving potassium chloride IV?
A. Administer quickly
B. Give via IM route
C. Dilute and infuse slowly
✅
D. Mix with dextrose
🩺
Answer: C. Dilute and infuse slowly
Explanation: IV potassium chloride must always be diluted and administered slowly
through an infusion pump. Rapid administration can lead to fatal arrhythmias. It must never be
given IV push.
Q12. Which medication is associated with a dry, persistent cough as a common side effect?
A. Metoprolol
B. Lisinopril
C. Amlodipine
✅
D. Furosemide
🩺
Answer: B. Lisinopril
Explanation: ACE inhibitors like lisinopril increase bradykinin levels, which can cause a
nonproductive, persistent dry cough. If bothersome, the medication may be switched to an
ARB like losartan.
Q13. Which medication reverses the effects of opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
✅
D. Vitamin K
🩺
Answer: B. Naloxone
Explanation: Naloxone (Narcan) is an opioid antagonist that rapidly reverses respiratory
depression and sedation from opioid overdose. It can be given IV, IM, or intranasally and may
require repeat dosing.
Q14. A patient taking phenytoin should be monitored for which long-term side effect?
A. Hypoglycemia
B. Gingival hyperplasia
C. Hypotension
✅
D. Jaundice
🩺
Answer: B. Gingival hyperplasia
Explanation: Phenytoin, an anti-seizure medication, can cause overgrowth of the gums,
Real Exam Prep
Q1. A patient on warfarin should have which laboratory value monitored regularly?
A. INR
B. Potassium
C. Glucose
✅
D. BUN
🩺
Answer: INR
Explanation:
Warfarin is an anticoagulant that interferes with vitamin K–dependent clotting factors. The INR
(International Normalized Ratio) is used to monitor its effectiveness. An INR that’s too low
increases the risk of clotting; too high increases bleeding risk. The therapeutic range for most
patients on warfarin is 2.0–3.0. Monitoring INR ensures the patient is neither under- nor
over-anticoagulated.
Q2. A patient is prescribed furosemide. What lab value should the nurse monitor?
A. INR
B. Potassium
C. Sodium
✅
D. Hemoglobin
🩺
Answer: Potassium
Explanation:
Furosemide is a loop diuretic that promotes diuresis (urine output) by inhibiting sodium and
chloride reabsorption in the loop of Henle. This causes the excretion of potassium as well,
potentially leading to hypokalemia, which can result in muscle weakness, arrhythmias, and
fatigue. Nurses must monitor serum potassium levels and educate patients to consume
potassium-rich foods or supplements if needed.
Q3. Before administering digoxin, which assessment is most important?
A. Blood pressure
B. Respiratory rate
C. Apical heart rate
✅
D. Bowel sounds
🩺
Answer: Apical heart rate
Explanation:
Digoxin slows the heart rate and increases cardiac contractility, making it useful in treating heart
failure and atrial fibrillation. However, it can cause bradycardia and digoxin toxicity, especially
in the elderly or those with renal issues. Nurses must check the apical pulse for a full 60
,seconds before giving if it’s below 60 bpm, the medication should be held and the provider
notified.
Q4. What is a serious side effect of lisinopril the nurse should monitor for?
A. Tachycardia
B. Constipation
C. Angioedema
✅
D. Photosensitivity
🩺
Answer: Angioedema
Explanation:
Lisinopril is an ACE inhibitor used to treat hypertension and heart failure. A rare but
life-threatening adverse effect is angioedema, which is the rapid swelling of the face, tongue,
throat, and airway. It may occur shortly after the first dose or later during treatment. If suspected,
the drug must be stopped immediately, and emergency intervention provided due to risk of
airway obstruction.
Q5. Which medication requires regular blood glucose monitoring?
A. Warfarin
B. Furosemide
C. Insulin
✅
D. Albuterol
🩺
Answer: Insulin
Explanation:
Insulin is a hormone used to manage blood glucose in diabetic patients. Without proper dosing,
it can cause hypoglycemia, which may lead to confusion, sweating, dizziness, loss of
consciousness, or seizures. Patients must regularly check their blood glucose levels,
especially before meals and at bedtime, and adjust insulin doses based on blood sugar
readings, carbohydrate intake, and activity.
Q6. A patient taking gentamicin should be monitored for which complication?
A. Hyperkalemia
B. Tinnitus
C. Seizures
✅
D. Bradycardia
🩺
Answer: B. Tinnitus
Explanation: Gentamicin is an aminoglycoside antibiotic that can cause ototoxicity,
especially with prolonged use or high doses. Ototoxicity often presents as tinnitus (ringing in
the ears) and may progress to irreversible hearing loss. The nurse should monitor auditory
function and report early symptoms immediately.
,Q7. Which lab is most important to monitor for a patient on vancomycin?
A. Platelets
B. White blood cells
C. Trough level
✅
D. Hematocrit
🩺
Answer: C. Trough level
Explanation: Vancomycin has a narrow therapeutic index, and levels must be monitored
to prevent toxicity, especially nephrotoxicity and ototoxicity. The trough level (measured just
before the next dose) indicates whether the drug concentration is within safe limits.
Q8. Which side effect is most concerning with amiodarone use?
A. Headache
B. Photosensitivity
C. Pulmonary toxicity
✅
D. Increased appetite
🩺
Answer: C. Pulmonary toxicity
Explanation: Amiodarone, a powerful antiarrhythmic, can cause pulmonary fibrosis or
pneumonitis as a serious adverse effect. Patients may present with new or worsening cough,
dyspnea, or infiltrates on chest X-ray. Lung function tests are often required during therapy.
Q9. What assessment is critical before giving morphine?
A. Measure blood glucose
B. Assess pain level and respirations
C. Give food with medication
✅
D. Monitor liver enzymes
🩺
Answer: B. Assess pain level and respirations
Explanation: Morphine is a potent opioid analgesic that can depress the respiratory
center. Always assess the patient’s respiratory rate (hold if <12 breaths/min), pain level, and
sedation level before administration.
Q10. Which teaching point is important for a patient on prednisone?
A. Avoid sun exposure
B. Report signs of infection
C. Limit salt intake
✅
D. Stop taking when feeling better
🩺
Answer: B. Report signs of infection
Explanation: Prednisone is a corticosteroid that suppresses the immune system,
increasing the patient’s susceptibility to infection. Even minor symptoms like sore throat or fever
should be reported immediately.
, Q11. What is a priority action before giving potassium chloride IV?
A. Administer quickly
B. Give via IM route
C. Dilute and infuse slowly
✅
D. Mix with dextrose
🩺
Answer: C. Dilute and infuse slowly
Explanation: IV potassium chloride must always be diluted and administered slowly
through an infusion pump. Rapid administration can lead to fatal arrhythmias. It must never be
given IV push.
Q12. Which medication is associated with a dry, persistent cough as a common side effect?
A. Metoprolol
B. Lisinopril
C. Amlodipine
✅
D. Furosemide
🩺
Answer: B. Lisinopril
Explanation: ACE inhibitors like lisinopril increase bradykinin levels, which can cause a
nonproductive, persistent dry cough. If bothersome, the medication may be switched to an
ARB like losartan.
Q13. Which medication reverses the effects of opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
✅
D. Vitamin K
🩺
Answer: B. Naloxone
Explanation: Naloxone (Narcan) is an opioid antagonist that rapidly reverses respiratory
depression and sedation from opioid overdose. It can be given IV, IM, or intranasally and may
require repeat dosing.
Q14. A patient taking phenytoin should be monitored for which long-term side effect?
A. Hypoglycemia
B. Gingival hyperplasia
C. Hypotension
✅
D. Jaundice
🩺
Answer: B. Gingival hyperplasia
Explanation: Phenytoin, an anti-seizure medication, can cause overgrowth of the gums,
