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NCLEX-RN Ultimate Practice Pack 2025–2026 | 100+ Clinical Scenario
Questions with Rationales
1. A nurse is caring for a 74-year-old client admitted with pneumonia. The client is
alert but weak, with productive cough, oxygen saturation of 90% on room air,
respiratory rate of 26, and crackles in both lower lobes. Which nursing intervention
should take priority?
A. Administer acetaminophen for fever
B. Encourage oral fluid intake
C. Apply oxygen via nasal cannula
D. Collect a sputum sample for culture
Correct Answer: C. Apply oxygen via nasal cannula
Rationale: In clients with pneumonia showing signs of hypoxia (SpO₂ < 92% and
increased respiratory rate), improving oxygenation is the priority to prevent further
respiratory distress. Although fluids, cultures, and antipyretics are important,
airway and oxygenation are the top priorities per ABCs (Airway, Breathing,
Circulation). Administering oxygen immediately improves perfusion and supports
respiratory effort.
(Saunders 10th Ed., 2023, Ch. 33 – Respiratory Disorders)
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2. A nurse is caring for a client newly diagnosed with Type 1 Diabetes Mellitus.
The client has been NPO for a diagnostic procedure and asks whether they should
take their morning insulin. The most appropriate action by the nurse is:
A. Hold the insulin until after the procedure
B. Administer the full dose of long-acting insulin
C. Consult the healthcare provider for insulin orders
D. Administer sliding scale insulin for NPO status
Correct Answer: C. Consult the healthcare provider for insulin orders
Rationale: Clients who are NPO require individualized insulin management to
prevent both hypoglycemia and hyperglycemia. Long-acting insulin may still be
needed in partial doses, but this decision must be based on the provider's guidance.
Consulting the provider ensures safe insulin management. Administering a full
dose or withholding without instruction may result in adverse outcomes.
(Saunders 10th Ed., 2023, Ch. 49 – Endocrine System)
3. A 36-year-old client presents to the emergency department with severe right
lower quadrant abdominal pain, fever, nausea, and rebound tenderness. The nurse
suspects appendicitis. Which intervention is most appropriate at this stage?
A. Apply a warm compress to the abdomen
B. Administer a laxative to relieve constipation
C. Prepare the client for immediate surgery
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D. Maintain NPO status and initiate IV fluids
Correct Answer: D. Maintain NPO status and initiate IV fluids
Rationale: Appendicitis requires surgical intervention. To prevent complications
such as perforation, the client must remain NPO. IV fluids are necessary to
maintain hydration. Heat and laxatives are contraindicated as they may increase
risk of rupture. Surgery will be considered after diagnostic imaging confirms
appendicitis.
(Saunders 10th Ed., 2023, Ch. 53 – Gastrointestinal Disorders)
4. A nurse is preparing to discharge a client with chronic heart failure (CHF).
Which client statement indicates a need for further teaching?
A. "I will weigh myself daily at the same time."
B. "I can skip my diuretic if I don't feel swollen."
C. "I'll avoid canned soups and processed meats."
D. "I will sleep with extra pillows to ease breathing."
Correct Answer: B. "I can skip my diuretic if I don't feel swollen."
Rationale: Clients with CHF must adhere strictly to their medication regimen,
including diuretics, even if symptoms seem absent. Skipping doses can lead to
fluid overload and worsening heart failure. Daily weights, sodium restriction, and
elevating the head while sleeping are appropriate self-care strategies.
(Saunders 10th Ed., 2023, Ch. 35 – Cardiovascular Disorders)
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5. A nurse is assessing a client with cirrhosis and notes abdominal distension,
confusion, and asterixis. Which provider order should the nurse prioritize?
A. Administer lactulose
B. Provide a low-fat, high-protein diet
C. Administer furosemide IV
D. Insert a nasogastric tube for decompression
Correct Answer: A. Administer lactulose
Rationale: The client shows signs of hepatic encephalopathy, including confusion
and asterixis (flapping tremor), due to increased ammonia levels. Lactulose is the
first-line treatment to promote excretion of ammonia through the stool. Diuretics
are used for ascites, and high-protein diets may worsen encephalopathy.
(Saunders 10th Ed., 2023, Ch. 52 – Hepatic Disorders)
6. A nurse receives a new prescription to administer potassium chloride 20 mEq IV
to a client with hypokalemia. The client's IV is a peripheral line. What is the safest
action?
A. Dilute the potassium in 50 mL and infuse over 15 minutes
B. Administer potassium IV push for rapid correction
C. Infuse over at least 1 hour using an infusion pump
NCLEX-RN Ultimate Practice Pack 2025–2026 | 100+ Clinical Scenario
Questions with Rationales
1. A nurse is caring for a 74-year-old client admitted with pneumonia. The client is
alert but weak, with productive cough, oxygen saturation of 90% on room air,
respiratory rate of 26, and crackles in both lower lobes. Which nursing intervention
should take priority?
A. Administer acetaminophen for fever
B. Encourage oral fluid intake
C. Apply oxygen via nasal cannula
D. Collect a sputum sample for culture
Correct Answer: C. Apply oxygen via nasal cannula
Rationale: In clients with pneumonia showing signs of hypoxia (SpO₂ < 92% and
increased respiratory rate), improving oxygenation is the priority to prevent further
respiratory distress. Although fluids, cultures, and antipyretics are important,
airway and oxygenation are the top priorities per ABCs (Airway, Breathing,
Circulation). Administering oxygen immediately improves perfusion and supports
respiratory effort.
(Saunders 10th Ed., 2023, Ch. 33 – Respiratory Disorders)
, 2
2. A nurse is caring for a client newly diagnosed with Type 1 Diabetes Mellitus.
The client has been NPO for a diagnostic procedure and asks whether they should
take their morning insulin. The most appropriate action by the nurse is:
A. Hold the insulin until after the procedure
B. Administer the full dose of long-acting insulin
C. Consult the healthcare provider for insulin orders
D. Administer sliding scale insulin for NPO status
Correct Answer: C. Consult the healthcare provider for insulin orders
Rationale: Clients who are NPO require individualized insulin management to
prevent both hypoglycemia and hyperglycemia. Long-acting insulin may still be
needed in partial doses, but this decision must be based on the provider's guidance.
Consulting the provider ensures safe insulin management. Administering a full
dose or withholding without instruction may result in adverse outcomes.
(Saunders 10th Ed., 2023, Ch. 49 – Endocrine System)
3. A 36-year-old client presents to the emergency department with severe right
lower quadrant abdominal pain, fever, nausea, and rebound tenderness. The nurse
suspects appendicitis. Which intervention is most appropriate at this stage?
A. Apply a warm compress to the abdomen
B. Administer a laxative to relieve constipation
C. Prepare the client for immediate surgery
, 3
D. Maintain NPO status and initiate IV fluids
Correct Answer: D. Maintain NPO status and initiate IV fluids
Rationale: Appendicitis requires surgical intervention. To prevent complications
such as perforation, the client must remain NPO. IV fluids are necessary to
maintain hydration. Heat and laxatives are contraindicated as they may increase
risk of rupture. Surgery will be considered after diagnostic imaging confirms
appendicitis.
(Saunders 10th Ed., 2023, Ch. 53 – Gastrointestinal Disorders)
4. A nurse is preparing to discharge a client with chronic heart failure (CHF).
Which client statement indicates a need for further teaching?
A. "I will weigh myself daily at the same time."
B. "I can skip my diuretic if I don't feel swollen."
C. "I'll avoid canned soups and processed meats."
D. "I will sleep with extra pillows to ease breathing."
Correct Answer: B. "I can skip my diuretic if I don't feel swollen."
Rationale: Clients with CHF must adhere strictly to their medication regimen,
including diuretics, even if symptoms seem absent. Skipping doses can lead to
fluid overload and worsening heart failure. Daily weights, sodium restriction, and
elevating the head while sleeping are appropriate self-care strategies.
(Saunders 10th Ed., 2023, Ch. 35 – Cardiovascular Disorders)
, 4
5. A nurse is assessing a client with cirrhosis and notes abdominal distension,
confusion, and asterixis. Which provider order should the nurse prioritize?
A. Administer lactulose
B. Provide a low-fat, high-protein diet
C. Administer furosemide IV
D. Insert a nasogastric tube for decompression
Correct Answer: A. Administer lactulose
Rationale: The client shows signs of hepatic encephalopathy, including confusion
and asterixis (flapping tremor), due to increased ammonia levels. Lactulose is the
first-line treatment to promote excretion of ammonia through the stool. Diuretics
are used for ascites, and high-protein diets may worsen encephalopathy.
(Saunders 10th Ed., 2023, Ch. 52 – Hepatic Disorders)
6. A nurse receives a new prescription to administer potassium chloride 20 mEq IV
to a client with hypokalemia. The client's IV is a peripheral line. What is the safest
action?
A. Dilute the potassium in 50 mL and infuse over 15 minutes
B. Administer potassium IV push for rapid correction
C. Infuse over at least 1 hour using an infusion pump
