NCLEX-PN 2025 Practice Questions | 200 Real Exam
Q&As with Detailed Rationales for First-Time Pass
1. Vital Signs – Pediatric
A 2-year-old presents with respiratory distress. Which finding is most concerning?
A. Respiratory rate 32/min
B. Pulse 120 bpm
C. Nasal flaring and intercostal retractions
D. Oxygen saturation 95%
C
Answer: C. Nasal flaring and intercostal retractions
Rationale:
LE
Nasal flaring and retractions indicate increased work of breathing and potential respiratory
failure in young children. While the respiratory rate and heart rate are elevated for age, they are
ST
expected with mild distress. Oxygen saturation of 95% is within acceptable limits.
2. Pharmacology – Heparin
BE
A client on heparin infusion has an aPTT of 110 seconds. What is the priority nursing action?
A. Continue the infusion at the same rate
B. Stop the infusion and notify the provider
C. Administer vitamin K
D. Draw another aPTT in 1 hour
Answer: B. Stop the infusion and notify the provider
Rationale:
A therapeutic aPTT is typically 60–80 seconds for heparin therapy. 110 seconds indicates high
bleeding risk. The nurse should hold the infusion and notify the provider for possible dose
adjustment or protamine sulfate administration.
,3. Maternal – Postpartum Hemorrhage
A postpartum client is soaking one pad every 15 minutes with a boggy uterus. What is the
priority action?
A. Administer oral iron
B. Perform firm fundal massage
C. Encourage early ambulation
D. Check blood pressure in 30 minutes
Answer: B. Perform firm fundal massage
Rationale:
A boggy uterus indicates uterine atony, the leading cause of postpartum hemorrhage. Immediate
fundal massage stimulates contraction and decreases bleeding. Medication and vitals follow after
initial intervention.
C
4. Pharmacology – Metoprolol
LE
A client with hypertension and heart failure is prescribed metoprolol. Which finding requires
immediate action?
ST
A. Blood pressure 108/70 mmHg
B. Heart rate 48 bpm
C. Occasional dizziness when standing
BE
D. Reports of fatigue
Answer: B. Heart rate 48 bpm
Rationale:
Beta-blockers can cause bradycardia and worsen heart block. A heart rate <50 bpm is dangerous
and requires holding the dose and notifying the provider. Mild hypotension and fatigue are
expected side effects.
5. Pediatric – Cystic Fibrosis
Which instruction should the nurse give to the parents of a child with cystic fibrosis?
A. Restrict salt intake to prevent edema
B. Administer pancreatic enzymes with meals
,C. Avoid high-calorie foods to prevent obesity
D. Provide fluids only after meals
Answer: B. Administer pancreatic enzymes with meals
Rationale:
Children with cystic fibrosis have pancreatic enzyme insufficiency leading to malabsorption.
Enzymes must be given with meals and snacks to promote nutrient absorption. High-calorie,
high-protein diets and adequate fluids are encouraged.
6. Pharmacology – Furosemide
A client taking furosemide reports leg cramps and weakness. Which lab value is most
concerning?
A. Sodium 138 mEq/L
C
B. Potassium 2.8 mEq/L
C. Calcium 9.0 mg/dL
D. Magnesium 2.0 mg/dL
LE
Answer: B. Potassium 2.8 mEq/L
ST
Rationale:
Loop diuretics like furosemide can cause hypokalemia, which manifests as muscle weakness,
cramps, and arrhythmias. Potassium replacement is necessary to prevent cardiac complications.
BE
7. Maternal – Preeclampsia
A 32 week pregnant client with preeclampsia has a BP of 168/110 mmHg and +3 proteinuria.
What is the priority action?
A. Administer oral fluids
B. Encourage early ambulation
C. Initiate magnesium sulfate infusion
D. Prepare for amniocentesis
Answer: C. Initiate magnesium sulfate infusion
Rationale:
, Severe preeclampsia increases the risk of eclampsia (seizures). Magnesium sulfate is the first-
line seizure prophylaxis, while blood pressure is managed with antihypertensives.
8. Pediatric – Epiglottitis
A child with high fever, drooling, and tripod positioning is suspected of epiglottitis. What is the
priority nursing action?
A. Obtain a throat swab for culture
B. Start IV antibiotics immediately
C. Prepare for emergency airway management
D. Administer oral fluids to prevent dehydration
Answer: C. Prepare for emergency airway management
Rationale:
C
Epiglottitis can rapidly cause airway obstruction. The priority is to secure the airway before
LE
performing any diagnostic procedures, as throat manipulation may trigger complete obstruction.
9. Pharmacology – Warfarin
ST
A client on warfarin has an INR of 5.2. What is the nurse’s best action?
A. Continue the dose as ordered
B. Hold the next dose and notify the provider
BE
C. Administer protamine sulfate
D. Give the medication with food
Answer: B. Hold the next dose and notify the provider
Rationale:
Therapeutic INR for most indications is 2–3. An INR >5 indicates high bleeding risk, requiring
holding warfarin and notifying the provider. Protamine sulfate is for heparin, not warfarin.
10. Maternal – Fundal Assessment
A fundal assessment 1 hour after vaginal birth shows the fundus is boggy and deviated to the
right. What is the priority action?
A. Document as normal postpartum finding
Q&As with Detailed Rationales for First-Time Pass
1. Vital Signs – Pediatric
A 2-year-old presents with respiratory distress. Which finding is most concerning?
A. Respiratory rate 32/min
B. Pulse 120 bpm
C. Nasal flaring and intercostal retractions
D. Oxygen saturation 95%
C
Answer: C. Nasal flaring and intercostal retractions
Rationale:
LE
Nasal flaring and retractions indicate increased work of breathing and potential respiratory
failure in young children. While the respiratory rate and heart rate are elevated for age, they are
ST
expected with mild distress. Oxygen saturation of 95% is within acceptable limits.
2. Pharmacology – Heparin
BE
A client on heparin infusion has an aPTT of 110 seconds. What is the priority nursing action?
A. Continue the infusion at the same rate
B. Stop the infusion and notify the provider
C. Administer vitamin K
D. Draw another aPTT in 1 hour
Answer: B. Stop the infusion and notify the provider
Rationale:
A therapeutic aPTT is typically 60–80 seconds for heparin therapy. 110 seconds indicates high
bleeding risk. The nurse should hold the infusion and notify the provider for possible dose
adjustment or protamine sulfate administration.
,3. Maternal – Postpartum Hemorrhage
A postpartum client is soaking one pad every 15 minutes with a boggy uterus. What is the
priority action?
A. Administer oral iron
B. Perform firm fundal massage
C. Encourage early ambulation
D. Check blood pressure in 30 minutes
Answer: B. Perform firm fundal massage
Rationale:
A boggy uterus indicates uterine atony, the leading cause of postpartum hemorrhage. Immediate
fundal massage stimulates contraction and decreases bleeding. Medication and vitals follow after
initial intervention.
C
4. Pharmacology – Metoprolol
LE
A client with hypertension and heart failure is prescribed metoprolol. Which finding requires
immediate action?
ST
A. Blood pressure 108/70 mmHg
B. Heart rate 48 bpm
C. Occasional dizziness when standing
BE
D. Reports of fatigue
Answer: B. Heart rate 48 bpm
Rationale:
Beta-blockers can cause bradycardia and worsen heart block. A heart rate <50 bpm is dangerous
and requires holding the dose and notifying the provider. Mild hypotension and fatigue are
expected side effects.
5. Pediatric – Cystic Fibrosis
Which instruction should the nurse give to the parents of a child with cystic fibrosis?
A. Restrict salt intake to prevent edema
B. Administer pancreatic enzymes with meals
,C. Avoid high-calorie foods to prevent obesity
D. Provide fluids only after meals
Answer: B. Administer pancreatic enzymes with meals
Rationale:
Children with cystic fibrosis have pancreatic enzyme insufficiency leading to malabsorption.
Enzymes must be given with meals and snacks to promote nutrient absorption. High-calorie,
high-protein diets and adequate fluids are encouraged.
6. Pharmacology – Furosemide
A client taking furosemide reports leg cramps and weakness. Which lab value is most
concerning?
A. Sodium 138 mEq/L
C
B. Potassium 2.8 mEq/L
C. Calcium 9.0 mg/dL
D. Magnesium 2.0 mg/dL
LE
Answer: B. Potassium 2.8 mEq/L
ST
Rationale:
Loop diuretics like furosemide can cause hypokalemia, which manifests as muscle weakness,
cramps, and arrhythmias. Potassium replacement is necessary to prevent cardiac complications.
BE
7. Maternal – Preeclampsia
A 32 week pregnant client with preeclampsia has a BP of 168/110 mmHg and +3 proteinuria.
What is the priority action?
A. Administer oral fluids
B. Encourage early ambulation
C. Initiate magnesium sulfate infusion
D. Prepare for amniocentesis
Answer: C. Initiate magnesium sulfate infusion
Rationale:
, Severe preeclampsia increases the risk of eclampsia (seizures). Magnesium sulfate is the first-
line seizure prophylaxis, while blood pressure is managed with antihypertensives.
8. Pediatric – Epiglottitis
A child with high fever, drooling, and tripod positioning is suspected of epiglottitis. What is the
priority nursing action?
A. Obtain a throat swab for culture
B. Start IV antibiotics immediately
C. Prepare for emergency airway management
D. Administer oral fluids to prevent dehydration
Answer: C. Prepare for emergency airway management
Rationale:
C
Epiglottitis can rapidly cause airway obstruction. The priority is to secure the airway before
LE
performing any diagnostic procedures, as throat manipulation may trigger complete obstruction.
9. Pharmacology – Warfarin
ST
A client on warfarin has an INR of 5.2. What is the nurse’s best action?
A. Continue the dose as ordered
B. Hold the next dose and notify the provider
BE
C. Administer protamine sulfate
D. Give the medication with food
Answer: B. Hold the next dose and notify the provider
Rationale:
Therapeutic INR for most indications is 2–3. An INR >5 indicates high bleeding risk, requiring
holding warfarin and notifying the provider. Protamine sulfate is for heparin, not warfarin.
10. Maternal – Fundal Assessment
A fundal assessment 1 hour after vaginal birth shows the fundus is boggy and deviated to the
right. What is the priority action?
A. Document as normal postpartum finding
