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NCLEX-RN 2025 Mega Question Bank | 200
High-Yield Practice Questions with Answers &
NGN Updates
1. Pharmacology – Warfarin Therapy
A client on warfarin has an INR of 4.8. Which is the priority nursing action?
A. Continue the current dose
B. Administer vitamin K as prescribed
C. Encourage a high-vitamin K diet
D. Prepare for platelet transfusion
Answer: B. Administer vitamin K as prescribed
Rationale:
An INR of 4.8 is above the therapeutic range (2–3 for most conditions), indicating high
bleeding risk. Vitamin K is the antidote for warfarin toxicity and helps reverse
anticoagulation. Platelet transfusions are not indicated unless there is active bleeding.
2. Maternal – Preeclampsia
, 2
A client with preeclampsia reports headache and visual disturbances. Which is the priority
nursing action?
A. Administer acetaminophen for headache
B. Assess for clonus and check reflexes
C. Prepare the client for cesarean delivery
D. Provide a dark, quiet environment
Answer: B. Assess for clonus and check reflexes
Rationale:
Severe headache and visual changes are warning signs of worsening preeclampsia and
potential impending eclampsia. Hyperreflexia or clonus indicates neurological irritability
and risk for seizures, which requires prompt magnesium sulfate therapy.
3. Pediatric – Epiglottitis
A 3-year-old child presents with drooling, tripod positioning, and stridor. What is the
priority action?
A. Obtain a throat culture
B. Start IV antibiotics immediately
C. Prepare for emergency intubation
D. Place the child supine with the neck extended
Answer: C. Prepare for emergency intubation
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Rationale:
Acute epiglottitis is a life-threatening airway emergency. Drooling, tripod position, and
stridor indicate severe airway obstruction. Airway stabilization with intubation is the
priority, and throat exams or cultures are avoided to prevent spasm and obstruction.
4. Pharmacology – Digoxin
The nurse is reviewing a digoxin level of 2.5 ng/mL. Which action is priority?
A. Continue medication as ordered
B. Assess for nausea, vomiting, and visual changes
C. Administer the next scheduled dose
D. Increase the client’s potassium intake
Answer: B. Assess for nausea, vomiting, and visual changes
Rationale:
The therapeutic range for digoxin is 0.5–2.0 ng/mL. A level of 2.5 ng/mL indicates toxicity,
which often presents with GI upset, visual disturbances (yellow halos), and arrhythmias. The
nurse should withhold the medication and notify the provider.
5. Medical-Surgical – Chest Tube
A client with a chest tube for pneumothorax has continuous bubbling in the water seal
chamber. What does this indicate?
, 4
A. Normal functioning of the chest tube
B. The chest tube is clamped accidentally
C. An air leak in the system
D. Lung re-expansion
Answer: C. An air leak in the system
Rationale:
Continuous bubbling in the water seal chamber indicates an air leak in the drainage system.
Intermittent bubbling may occur initially with a pneumothorax, but continuous bubbling
requires investigation to prevent loss of suction and potential lung collapse.
6. Maternal – Umbilical Cord Prolapse
During labor, the nurse notices the umbilical cord protruding from the vagina. What is the
priority action?
A. Apply a warm sterile saline-soaked dressing
B. Elevate the presenting part off the cord
C. Administer terbutaline to relax the uterus
D. Prepare the client for an emergent C-section
Answer: B. Elevate the presenting part off the cord
Rationale:
Cord prolapse is an obstetric emergency that can compress fetal circulation. Manually
NCLEX-RN 2025 Mega Question Bank | 200
High-Yield Practice Questions with Answers &
NGN Updates
1. Pharmacology – Warfarin Therapy
A client on warfarin has an INR of 4.8. Which is the priority nursing action?
A. Continue the current dose
B. Administer vitamin K as prescribed
C. Encourage a high-vitamin K diet
D. Prepare for platelet transfusion
Answer: B. Administer vitamin K as prescribed
Rationale:
An INR of 4.8 is above the therapeutic range (2–3 for most conditions), indicating high
bleeding risk. Vitamin K is the antidote for warfarin toxicity and helps reverse
anticoagulation. Platelet transfusions are not indicated unless there is active bleeding.
2. Maternal – Preeclampsia
, 2
A client with preeclampsia reports headache and visual disturbances. Which is the priority
nursing action?
A. Administer acetaminophen for headache
B. Assess for clonus and check reflexes
C. Prepare the client for cesarean delivery
D. Provide a dark, quiet environment
Answer: B. Assess for clonus and check reflexes
Rationale:
Severe headache and visual changes are warning signs of worsening preeclampsia and
potential impending eclampsia. Hyperreflexia or clonus indicates neurological irritability
and risk for seizures, which requires prompt magnesium sulfate therapy.
3. Pediatric – Epiglottitis
A 3-year-old child presents with drooling, tripod positioning, and stridor. What is the
priority action?
A. Obtain a throat culture
B. Start IV antibiotics immediately
C. Prepare for emergency intubation
D. Place the child supine with the neck extended
Answer: C. Prepare for emergency intubation
, 3
Rationale:
Acute epiglottitis is a life-threatening airway emergency. Drooling, tripod position, and
stridor indicate severe airway obstruction. Airway stabilization with intubation is the
priority, and throat exams or cultures are avoided to prevent spasm and obstruction.
4. Pharmacology – Digoxin
The nurse is reviewing a digoxin level of 2.5 ng/mL. Which action is priority?
A. Continue medication as ordered
B. Assess for nausea, vomiting, and visual changes
C. Administer the next scheduled dose
D. Increase the client’s potassium intake
Answer: B. Assess for nausea, vomiting, and visual changes
Rationale:
The therapeutic range for digoxin is 0.5–2.0 ng/mL. A level of 2.5 ng/mL indicates toxicity,
which often presents with GI upset, visual disturbances (yellow halos), and arrhythmias. The
nurse should withhold the medication and notify the provider.
5. Medical-Surgical – Chest Tube
A client with a chest tube for pneumothorax has continuous bubbling in the water seal
chamber. What does this indicate?
, 4
A. Normal functioning of the chest tube
B. The chest tube is clamped accidentally
C. An air leak in the system
D. Lung re-expansion
Answer: C. An air leak in the system
Rationale:
Continuous bubbling in the water seal chamber indicates an air leak in the drainage system.
Intermittent bubbling may occur initially with a pneumothorax, but continuous bubbling
requires investigation to prevent loss of suction and potential lung collapse.
6. Maternal – Umbilical Cord Prolapse
During labor, the nurse notices the umbilical cord protruding from the vagina. What is the
priority action?
A. Apply a warm sterile saline-soaked dressing
B. Elevate the presenting part off the cord
C. Administer terbutaline to relax the uterus
D. Prepare the client for an emergent C-section
Answer: B. Elevate the presenting part off the cord
Rationale:
Cord prolapse is an obstetric emergency that can compress fetal circulation. Manually
