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NCLEX 2025 Ultimate Survival Bundle | 300 RN & PN
Exam Questions with NGN & A+ Rationales |
Prioritization, Pharm, SATA, OB/Peds, Lab Cheats
Question 1 (SATA – Pharmacology)
The nurse is administering warfarin to a patient with atrial fibrillation. Which findings require
immediate nursing intervention? (Select all that apply)
A. INR of 4.2
B. Bruising on arms and legs
C. Hemoglobin 8.5 g/dL
D. Patient reports mild headache
E. Blood pressure 118/70 mmHg
✅ Correct Answers: A, B, C
💡 Rationale:
An INR of 4.2 is above the therapeutic range (2.0–3.0 for most patients), indicating an increased
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risk for bleeding. The presence of bruising and a low hemoglobin confirms that the patient
may already be experiencing internal or external bleeding. These findings require immediate
intervention, including holding the warfarin and notifying the provider. A mild headache is not
necessarily an urgent sign unless neurological symptoms develop, and a blood pressure of 118/70
mmHg is within normal limits. Recognizing these critical signs early helps prevent life-
threatening hemorrhagic events.
Question 2 (Prioritization)
Four patients arrive at the emergency department. Which patient should the nurse assess first?
A. 40-year-old with a fractured arm and pain level 7/10
B. 52-year-old with new-onset chest pain radiating to the left arm
C. 22-year-old with a sprained ankle and stable vital signs
D. 35-year-old with a migraine requesting IV medication
✅ Correct Answer: B
💡 Rationale:
The patient with new-onset chest pain radiating to the left arm is at highest risk for an acute
myocardial infarction (MI). MI is a life-threatening emergency that requires immediate
assessment and interventions such as ECG, oxygen, and possible cardiac medications. The
other patients, while experiencing discomfort or pain, are stable and non-life-threatening. Pain
management for a fracture, sprained ankle, or migraine can safely be delayed until the unstable
cardiac patient is assessed and stabilized.
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Question 3 (OB – Multiple Choice)
A postpartum client is experiencing heavy lochia with a boggy uterus. What is the priority
nursing action?
A. Notify the healthcare provider immediately
B. Administer oxytocin per protocol
C. Massage the fundus firmly
D. Increase IV fluids
✅ Correct Answer: C
💡 Rationale:
A boggy uterus indicates uterine atony, the most common cause of postpartum hemorrhage.
The priority intervention is to massage the fundus firmly, which stimulates contraction of the
uterine muscle and reduces bleeding. While oxytocin may be administered if the uterus does not
respond to massage, physical stimulation is the first and fastest action. Increasing IV fluids or
calling the provider are secondary measures that support treatment but do not directly stop the
bleeding. Prompt fundal massage can be lifesaving by reducing blood loss immediately.
Question 4 (Pharmacology – Dosage Calc)
Order: Heparin 5,000 units subcut q8h
Available: Heparin 10,000 units/mL
How many mL should the nurse administer?
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✅ Correct Answer: 0.5 mL
💡 Rationale:
The nurse calculates the volume to administer using the formula Desired ÷ Available × Volume
on hand:
5,000 ÷ 10,000 × 1 mL = 0.5 mL.
It is critical to double-check the calculation because heparin is a high-alert medication that
can cause severe bleeding if overdosed. The nurse should also verify syringe selection and
injection technique, ensuring the medication is given subcutaneously in an appropriate site such
as the abdomen, while rotating injection sites to prevent tissue damage.
Question 5 (SATA – Med-Surg)
The nurse is caring for a patient with heart failure. Which signs indicate fluid overload? (Select
all that apply)
A. Crackles in lung bases
B. 2+ pitting edema in ankles
C. Blood pressure 88/56 mmHg
D. Jugular vein distention
E. Weight gain of 3 lbs in 24 hours
✅ Correct Answers: A, B, D, E
💡 Rationale:
Fluid overload in heart failure occurs when the heart cannot effectively pump blood, causing
fluid retention in the lungs and tissues. Crackles in the lung bases indicate pulmonary
NCLEX 2025 Ultimate Survival Bundle | 300 RN & PN
Exam Questions with NGN & A+ Rationales |
Prioritization, Pharm, SATA, OB/Peds, Lab Cheats
Question 1 (SATA – Pharmacology)
The nurse is administering warfarin to a patient with atrial fibrillation. Which findings require
immediate nursing intervention? (Select all that apply)
A. INR of 4.2
B. Bruising on arms and legs
C. Hemoglobin 8.5 g/dL
D. Patient reports mild headache
E. Blood pressure 118/70 mmHg
✅ Correct Answers: A, B, C
💡 Rationale:
An INR of 4.2 is above the therapeutic range (2.0–3.0 for most patients), indicating an increased
, 2
risk for bleeding. The presence of bruising and a low hemoglobin confirms that the patient
may already be experiencing internal or external bleeding. These findings require immediate
intervention, including holding the warfarin and notifying the provider. A mild headache is not
necessarily an urgent sign unless neurological symptoms develop, and a blood pressure of 118/70
mmHg is within normal limits. Recognizing these critical signs early helps prevent life-
threatening hemorrhagic events.
Question 2 (Prioritization)
Four patients arrive at the emergency department. Which patient should the nurse assess first?
A. 40-year-old with a fractured arm and pain level 7/10
B. 52-year-old with new-onset chest pain radiating to the left arm
C. 22-year-old with a sprained ankle and stable vital signs
D. 35-year-old with a migraine requesting IV medication
✅ Correct Answer: B
💡 Rationale:
The patient with new-onset chest pain radiating to the left arm is at highest risk for an acute
myocardial infarction (MI). MI is a life-threatening emergency that requires immediate
assessment and interventions such as ECG, oxygen, and possible cardiac medications. The
other patients, while experiencing discomfort or pain, are stable and non-life-threatening. Pain
management for a fracture, sprained ankle, or migraine can safely be delayed until the unstable
cardiac patient is assessed and stabilized.
, 3
Question 3 (OB – Multiple Choice)
A postpartum client is experiencing heavy lochia with a boggy uterus. What is the priority
nursing action?
A. Notify the healthcare provider immediately
B. Administer oxytocin per protocol
C. Massage the fundus firmly
D. Increase IV fluids
✅ Correct Answer: C
💡 Rationale:
A boggy uterus indicates uterine atony, the most common cause of postpartum hemorrhage.
The priority intervention is to massage the fundus firmly, which stimulates contraction of the
uterine muscle and reduces bleeding. While oxytocin may be administered if the uterus does not
respond to massage, physical stimulation is the first and fastest action. Increasing IV fluids or
calling the provider are secondary measures that support treatment but do not directly stop the
bleeding. Prompt fundal massage can be lifesaving by reducing blood loss immediately.
Question 4 (Pharmacology – Dosage Calc)
Order: Heparin 5,000 units subcut q8h
Available: Heparin 10,000 units/mL
How many mL should the nurse administer?
, 4
✅ Correct Answer: 0.5 mL
💡 Rationale:
The nurse calculates the volume to administer using the formula Desired ÷ Available × Volume
on hand:
5,000 ÷ 10,000 × 1 mL = 0.5 mL.
It is critical to double-check the calculation because heparin is a high-alert medication that
can cause severe bleeding if overdosed. The nurse should also verify syringe selection and
injection technique, ensuring the medication is given subcutaneously in an appropriate site such
as the abdomen, while rotating injection sites to prevent tissue damage.
Question 5 (SATA – Med-Surg)
The nurse is caring for a patient with heart failure. Which signs indicate fluid overload? (Select
all that apply)
A. Crackles in lung bases
B. 2+ pitting edema in ankles
C. Blood pressure 88/56 mmHg
D. Jugular vein distention
E. Weight gain of 3 lbs in 24 hours
✅ Correct Answers: A, B, D, E
💡 Rationale:
Fluid overload in heart failure occurs when the heart cannot effectively pump blood, causing
fluid retention in the lungs and tissues. Crackles in the lung bases indicate pulmonary
