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NCLEX RN 2025–2026 Updated Question Bank (200+ Practice Questions with
Detailed Rationales) | Pharmacology, Med-Surg, Maternity, Pediatrics,
Leadership & Mental Health
Question 1: Furosemide IV Push Safety
A client with acute decompensated heart failure is prescribed furosemide 80 mg IV push now.
Which is the safest administration plan?
A. Push the dose over 1 minute
B. Push the dose over 2–3 minutes
C. Push the dose over at least 4 minutes using a pump (≈20 mg/min maximum)
D. Push the dose over 15 seconds
Answer: C
Rationale: Furosemide is a loop diuretic that must be administered slowly to avoid adverse
reactions such as ototoxicity and severe hypotension. The maximum safe rate is 20 mg/min,
meaning an 80 mg dose requires at least 4 minutes of administration. Using an infusion pump
provides the most accurate and controlled delivery. Administering the medication in 1–3 minutes
or faster exceeds the safe threshold, while pushing in 15 seconds is extremely unsafe and likely
to cause immediate harm.
Question 2: Warfarin and Vitamin K Education
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A client newly prescribed warfarin asks how to eat to keep their INR therapeutic. Which
statement shows correct understanding?
A. “I’ll avoid all green leafy vegetables.”
B. “I’ll keep my vitamin K intake consistent from week to week.”
C. “I’ll double my dose if I eat spinach.”
D. “Cranberry juice lowers bleeding risk.”
Answer: B
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, so dietary vitamin K intake
directly affects INR. The correct approach is to maintain consistency in vitamin K intake rather
than eliminating it. Avoiding leafy vegetables altogether is unnecessary and unrealistic. Doubling
a dose without medical advice is dangerous and can lead to over-anticoagulation. Cranberry juice
does not reduce bleeding risk; in fact, it may interact with warfarin and increase bleeding risk.
Consistent dietary intake is therefore the safest and correct strategy for maintaining a therapeutic
INR.
Question 3: Mixing Insulin Correctly
Which technique is correct when preparing a syringe with regular insulin and NPH insulin?
A. Draw NPH first, then regular
B. Inject air into NPH vial, inject air into regular, withdraw regular, then withdraw NPH
C. Inject air only into the NPH vial, then withdraw both
D. Roll regular insulin to mix before drawing up
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Answer: B
Rationale: The correct process for mixing insulin is often remembered as “clear before cloudy.”
Air is first injected into the NPH (cloudy) vial, followed by air into the regular (clear) vial. The
nurse then withdraws the regular insulin first to prevent contamination of the short-acting
insulin with intermediate-acting NPH. Only NPH requires gentle rolling for resuspension;
regular insulin should never be rolled. Drawing NPH first or skipping air injection risks
contamination and dosing errors. This stepwise approach ensures accuracy and patient safety.
Question 4: Vancomycin Infusion Reaction
Thirty minutes into a first vancomycin infusion, the client develops flushing of the face and
neck with pruritus. What is the priority nursing action?
A. Stop the infusion and flush with saline; never give vancomycin again
B. Slow or temporarily stop the infusion and notify the provider; consider premedication
C. Administer epinephrine IM immediately
D. Continue the infusion and reassess in 30 minutes
Answer: B
Rationale: The findings are consistent with Red Man Syndrome, an infusion reaction caused
by rapid administration of vancomycin. This is not a true allergy but a histamine-mediated
response. The nurse should slow or temporarily stop the infusion, notify the provider, and
anticipate orders for antihistamines and longer infusion times. Epinephrine (option C) is reserved
for true anaphylaxis with airway compromise, hypotension, or angioedema. Permanently
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discontinuing vancomycin (option A) is unnecessary unless a true allergic reaction is confirmed.
Continuing the infusion (option D) would worsen the reaction.
Question 5: Diabetic Ketoacidosis Priority
A client with type 1 diabetes presents with Kussmaul respirations, fruity breath, BG 520 mg/dL,
and BP 92/54. Which order should the nurse implement first?
A. Administer IV regular insulin bolus
B. Begin 0.9% normal saline bolus
C. Administer IV sodium bicarbonate
D. Administer IV potassium chloride
Answer: B
Rationale: In diabetic ketoacidosis, the priority is fluid resuscitation to correct hypovolemia
and restore tissue perfusion. Only after volume is restored should insulin be given to lower blood
glucose and correct acidosis. Potassium replacement is considered once levels are known and
urine output is adequate. Sodium bicarbonate is rarely used and reserved for severe acidosis (pH
< 6.9). Therefore, normal saline is the immediate priority intervention to stabilize circulation.
Question 6: Post-Operative Pulmonary Embolism
A post-op client suddenly develops chest pain, shortness of breath, and tachycardia. What is the
nurse’s first action?
A. Call the provider immediately
NCLEX RN 2025–2026 Updated Question Bank (200+ Practice Questions with
Detailed Rationales) | Pharmacology, Med-Surg, Maternity, Pediatrics,
Leadership & Mental Health
Question 1: Furosemide IV Push Safety
A client with acute decompensated heart failure is prescribed furosemide 80 mg IV push now.
Which is the safest administration plan?
A. Push the dose over 1 minute
B. Push the dose over 2–3 minutes
C. Push the dose over at least 4 minutes using a pump (≈20 mg/min maximum)
D. Push the dose over 15 seconds
Answer: C
Rationale: Furosemide is a loop diuretic that must be administered slowly to avoid adverse
reactions such as ototoxicity and severe hypotension. The maximum safe rate is 20 mg/min,
meaning an 80 mg dose requires at least 4 minutes of administration. Using an infusion pump
provides the most accurate and controlled delivery. Administering the medication in 1–3 minutes
or faster exceeds the safe threshold, while pushing in 15 seconds is extremely unsafe and likely
to cause immediate harm.
Question 2: Warfarin and Vitamin K Education
,2
A client newly prescribed warfarin asks how to eat to keep their INR therapeutic. Which
statement shows correct understanding?
A. “I’ll avoid all green leafy vegetables.”
B. “I’ll keep my vitamin K intake consistent from week to week.”
C. “I’ll double my dose if I eat spinach.”
D. “Cranberry juice lowers bleeding risk.”
Answer: B
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, so dietary vitamin K intake
directly affects INR. The correct approach is to maintain consistency in vitamin K intake rather
than eliminating it. Avoiding leafy vegetables altogether is unnecessary and unrealistic. Doubling
a dose without medical advice is dangerous and can lead to over-anticoagulation. Cranberry juice
does not reduce bleeding risk; in fact, it may interact with warfarin and increase bleeding risk.
Consistent dietary intake is therefore the safest and correct strategy for maintaining a therapeutic
INR.
Question 3: Mixing Insulin Correctly
Which technique is correct when preparing a syringe with regular insulin and NPH insulin?
A. Draw NPH first, then regular
B. Inject air into NPH vial, inject air into regular, withdraw regular, then withdraw NPH
C. Inject air only into the NPH vial, then withdraw both
D. Roll regular insulin to mix before drawing up
,3
Answer: B
Rationale: The correct process for mixing insulin is often remembered as “clear before cloudy.”
Air is first injected into the NPH (cloudy) vial, followed by air into the regular (clear) vial. The
nurse then withdraws the regular insulin first to prevent contamination of the short-acting
insulin with intermediate-acting NPH. Only NPH requires gentle rolling for resuspension;
regular insulin should never be rolled. Drawing NPH first or skipping air injection risks
contamination and dosing errors. This stepwise approach ensures accuracy and patient safety.
Question 4: Vancomycin Infusion Reaction
Thirty minutes into a first vancomycin infusion, the client develops flushing of the face and
neck with pruritus. What is the priority nursing action?
A. Stop the infusion and flush with saline; never give vancomycin again
B. Slow or temporarily stop the infusion and notify the provider; consider premedication
C. Administer epinephrine IM immediately
D. Continue the infusion and reassess in 30 minutes
Answer: B
Rationale: The findings are consistent with Red Man Syndrome, an infusion reaction caused
by rapid administration of vancomycin. This is not a true allergy but a histamine-mediated
response. The nurse should slow or temporarily stop the infusion, notify the provider, and
anticipate orders for antihistamines and longer infusion times. Epinephrine (option C) is reserved
for true anaphylaxis with airway compromise, hypotension, or angioedema. Permanently
, 4
discontinuing vancomycin (option A) is unnecessary unless a true allergic reaction is confirmed.
Continuing the infusion (option D) would worsen the reaction.
Question 5: Diabetic Ketoacidosis Priority
A client with type 1 diabetes presents with Kussmaul respirations, fruity breath, BG 520 mg/dL,
and BP 92/54. Which order should the nurse implement first?
A. Administer IV regular insulin bolus
B. Begin 0.9% normal saline bolus
C. Administer IV sodium bicarbonate
D. Administer IV potassium chloride
Answer: B
Rationale: In diabetic ketoacidosis, the priority is fluid resuscitation to correct hypovolemia
and restore tissue perfusion. Only after volume is restored should insulin be given to lower blood
glucose and correct acidosis. Potassium replacement is considered once levels are known and
urine output is adequate. Sodium bicarbonate is rarely used and reserved for severe acidosis (pH
< 6.9). Therefore, normal saline is the immediate priority intervention to stabilize circulation.
Question 6: Post-Operative Pulmonary Embolism
A post-op client suddenly develops chest pain, shortness of breath, and tachycardia. What is the
nurse’s first action?
A. Call the provider immediately
