NCLEX-RN NGN 2025/2026 Test Bank – 300 Real
Exam Questions + Rationales | 100% Verified |
HESI/ATI Aligned
1. A nurse is caring for a client admitted with diabetic ketoacidosis (DKA).
Which clinical finding should the nurse expect?
A. Cold, clammy skin
B. Kussmaul respirations
C. Bradycardia
D. Hypertension
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid breathing patterns commonly
seen in metabolic acidosis like DKA, as the body attempts to blow off excess CO₂.
Cold, clammy skin and bradycardia are more associated with hypoglycemia or
shock.
2. Which client should the nurse assess first?
A. A client with asthma requesting their rescue inhaler
B. A client with shortness of breath and oxygen saturation of 88%
C. A client post-op day 2 reporting pain level 6/10
D. A client with a history of hypertension and BP of 142/90
Correct Answer: B. A client with shortness of breath and oxygen saturation of
88%
Rationale: Airway and oxygenation take priority in NCLEX clinical judgment. An
O₂ sat below 90% is hypoxic and demands immediate intervention.
3. A client receiving IV potassium reports burning at the IV site. What is the
nurse’s best action?
A. Stop the infusion immediately
,B. Slow the rate and assess the IV site
C. Apply a cold compress
D. Flush with normal saline
Correct Answer: B. Slow the rate and assess the IV site
Rationale: IV potassium is irritating to veins. Slowing the rate and assessing for
phlebitis or infiltration is the most appropriate first step. If infiltration is confirmed,
the infusion should then be stopped.
4. Which of the following findings in a newborn requires immediate
intervention?
A. Positive Babinski reflex
B. Nasal flaring with grunting
C. Moro reflex present
D. Irregular breathing pattern
Correct Answer: B. Nasal flaring with grunting
Rationale: These are signs of respiratory distress in a newborn and require
immediate action. Other options are normal newborn findings.
5. A nurse receives a handoff report. Which client should be seen first?
A. A client 24 hours post-op with mild incisional pain
B. A client with COPD who is requesting a PRN inhaler
C. A client with a Stage II pressure ulcer needing wound care
D. A client 3 hours post-op with absent bowel sounds and rigid abdomen
Correct Answer: D. A client 3 hours post-op with absent bowel sounds and
rigid abdomen
Rationale: This may indicate a surgical complication such as internal bleeding or
peritonitis. It is the most urgent.
6. A nurse is reinforcing teaching to a client prescribed warfarin. Which
statement indicates a need for further teaching?
A. “I’ll use an electric razor to shave.”
,B. “I’ll avoid contact sports.”
C. “I can eat spinach daily as long as I’m consistent.”
D. “I can take aspirin if I have a headache.”
Correct Answer: D. “I can take aspirin if I have a headache.”
Rationale: Aspirin increases bleeding risk and should be avoided with warfarin.
All other statements show understanding.
7. A client with a history of heart failure presents with 3+ pitting edema and
shortness of breath. Which lab value should the nurse evaluate first?
A. Hemoglobin
B. Hematocrit
C. BNP
D. Troponin
Correct Answer: C. BNP
Rationale: BNP (B-type natriuretic peptide) is elevated in heart failure due to fluid
overload and ventricular stretching. It's a key marker in diagnosing or monitoring
CHF.
8. Which assessment finding requires priority intervention in a client with a
chest tube?
A. Serosanguineous drainage in the collection chamber
B. Continuous bubbling in the water seal chamber
C. Absence of drainage for 3 hours
D. Pain at the insertion site
Correct Answer: B. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling indicates an air leak and must be addressed
immediately. Intermittent bubbling is expected, but continuous suggests a problem.
9. A nurse is planning care for a client with Alzheimer’s disease. What is the
best intervention to reduce agitation?
A. Provide multiple activity choices
, B. Reorient frequently using long explanations
C. Maintain a consistent routine
D. Use restraints as needed
Correct Answer: C. Maintain a consistent routine
Rationale: Clients with Alzheimer’s benefit from structure and predictability.
Changing routines increases confusion and agitation.
10. A newly admitted client reports taking herbal supplements. Which
supplement should the nurse report to the provider before surgery?
A. Ginger
B. Ginkgo biloba
C. Echinacea
D. Valerian root
Correct Answer: B. Ginkgo biloba
Rationale: Ginkgo increases bleeding risk and must be discontinued before
surgery. It inhibits platelet aggregation.
11. Which of the following is the best indicator that a client’s pain medication
is effective?
A. The client’s vital signs have returned to normal
B. The client appears more relaxed
C. The client is sleeping
D. The client reports pain has decreased
Correct Answer: D. The client reports pain has decreased
Rationale: Pain is subjective; the most accurate measure of effectiveness is the
client’s own report.
12. A client with pneumonia is prescribed IV antibiotics. Which action should
the nurse take first?
A. Start IV fluids
B. Obtain a sputum culture
Exam Questions + Rationales | 100% Verified |
HESI/ATI Aligned
1. A nurse is caring for a client admitted with diabetic ketoacidosis (DKA).
Which clinical finding should the nurse expect?
A. Cold, clammy skin
B. Kussmaul respirations
C. Bradycardia
D. Hypertension
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid breathing patterns commonly
seen in metabolic acidosis like DKA, as the body attempts to blow off excess CO₂.
Cold, clammy skin and bradycardia are more associated with hypoglycemia or
shock.
2. Which client should the nurse assess first?
A. A client with asthma requesting their rescue inhaler
B. A client with shortness of breath and oxygen saturation of 88%
C. A client post-op day 2 reporting pain level 6/10
D. A client with a history of hypertension and BP of 142/90
Correct Answer: B. A client with shortness of breath and oxygen saturation of
88%
Rationale: Airway and oxygenation take priority in NCLEX clinical judgment. An
O₂ sat below 90% is hypoxic and demands immediate intervention.
3. A client receiving IV potassium reports burning at the IV site. What is the
nurse’s best action?
A. Stop the infusion immediately
,B. Slow the rate and assess the IV site
C. Apply a cold compress
D. Flush with normal saline
Correct Answer: B. Slow the rate and assess the IV site
Rationale: IV potassium is irritating to veins. Slowing the rate and assessing for
phlebitis or infiltration is the most appropriate first step. If infiltration is confirmed,
the infusion should then be stopped.
4. Which of the following findings in a newborn requires immediate
intervention?
A. Positive Babinski reflex
B. Nasal flaring with grunting
C. Moro reflex present
D. Irregular breathing pattern
Correct Answer: B. Nasal flaring with grunting
Rationale: These are signs of respiratory distress in a newborn and require
immediate action. Other options are normal newborn findings.
5. A nurse receives a handoff report. Which client should be seen first?
A. A client 24 hours post-op with mild incisional pain
B. A client with COPD who is requesting a PRN inhaler
C. A client with a Stage II pressure ulcer needing wound care
D. A client 3 hours post-op with absent bowel sounds and rigid abdomen
Correct Answer: D. A client 3 hours post-op with absent bowel sounds and
rigid abdomen
Rationale: This may indicate a surgical complication such as internal bleeding or
peritonitis. It is the most urgent.
6. A nurse is reinforcing teaching to a client prescribed warfarin. Which
statement indicates a need for further teaching?
A. “I’ll use an electric razor to shave.”
,B. “I’ll avoid contact sports.”
C. “I can eat spinach daily as long as I’m consistent.”
D. “I can take aspirin if I have a headache.”
Correct Answer: D. “I can take aspirin if I have a headache.”
Rationale: Aspirin increases bleeding risk and should be avoided with warfarin.
All other statements show understanding.
7. A client with a history of heart failure presents with 3+ pitting edema and
shortness of breath. Which lab value should the nurse evaluate first?
A. Hemoglobin
B. Hematocrit
C. BNP
D. Troponin
Correct Answer: C. BNP
Rationale: BNP (B-type natriuretic peptide) is elevated in heart failure due to fluid
overload and ventricular stretching. It's a key marker in diagnosing or monitoring
CHF.
8. Which assessment finding requires priority intervention in a client with a
chest tube?
A. Serosanguineous drainage in the collection chamber
B. Continuous bubbling in the water seal chamber
C. Absence of drainage for 3 hours
D. Pain at the insertion site
Correct Answer: B. Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling indicates an air leak and must be addressed
immediately. Intermittent bubbling is expected, but continuous suggests a problem.
9. A nurse is planning care for a client with Alzheimer’s disease. What is the
best intervention to reduce agitation?
A. Provide multiple activity choices
, B. Reorient frequently using long explanations
C. Maintain a consistent routine
D. Use restraints as needed
Correct Answer: C. Maintain a consistent routine
Rationale: Clients with Alzheimer’s benefit from structure and predictability.
Changing routines increases confusion and agitation.
10. A newly admitted client reports taking herbal supplements. Which
supplement should the nurse report to the provider before surgery?
A. Ginger
B. Ginkgo biloba
C. Echinacea
D. Valerian root
Correct Answer: B. Ginkgo biloba
Rationale: Ginkgo increases bleeding risk and must be discontinued before
surgery. It inhibits platelet aggregation.
11. Which of the following is the best indicator that a client’s pain medication
is effective?
A. The client’s vital signs have returned to normal
B. The client appears more relaxed
C. The client is sleeping
D. The client reports pain has decreased
Correct Answer: D. The client reports pain has decreased
Rationale: Pain is subjective; the most accurate measure of effectiveness is the
client’s own report.
12. A client with pneumonia is prescribed IV antibiotics. Which action should
the nurse take first?
A. Start IV fluids
B. Obtain a sputum culture
