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NCLEX-PN Testbank (Solved Questions And Answers Graded A +
Updated 2025/26) , 100% Guaranteed Pass ||Complete A+ Guide
A nurse cares for a postoperative patient with abdominal incision. Which intervention should
the nurse prioritize to prevent respiratory complications, considering patient’s immobility, pain,
and shallow breathing caused by abdominal discomfort?
A. Encourage coughing and deep breathing
B. Restrict fluid intake to reduce edema
C. Administer sedatives to promote rest
D. Apply warm compresses to abdomen
Answer: A
A patient with heart failure reports shortness of breath, orthopnea, and productive cough with
frothy sputum. Which nursing action takes priority to reduce pulmonary congestion and
improve oxygenation during acute episode?
A. Elevate head of bed
B. Provide fluid restriction
C. Administer antipyretics as prescribed
D. Encourage increased oral intake
Answer: A
When caring for a diabetic patient experiencing hypoglycemia with sweating, tremors, and
confusion, which nursing intervention should be implemented first to restore normal glucose
levels and prevent worsening symptoms?
A. Administer glucagon injection
B. Provide orange juice orally
C. Check blood pressure immediately
D. Initiate oxygen via nasal cannula
Answer: B
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The nurse observes an elderly patient with dementia attempting to leave bed unsafely at night.
Which nursing intervention is most appropriate to ensure safety while maintaining dignity and
preventing patient harm?
A. Apply four-point restraints
B. Use a bed alarm
C. Administer sedative medication
D. Place side rails up
Answer: B
A patient with pneumonia develops high fever, productive cough, pleuritic chest pain, and
dyspnea. Which nursing assessment finding requires immediate intervention because it
indicates worsening respiratory distress needing urgent provider notification?
A. Oxygen saturation 82%
B. Temperature 101.8°F
C. Respiratory rate 22/min
D. Pulse 96 beats/min
Answer: A
A nurse cares for a patient prescribed furosemide for heart failure. Which laboratory result
requires immediate intervention due to potential adverse drug effect, warranting provider
notification and appropriate treatment modification?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 100 mEq/L
D. Bicarbonate 25 mEq/L
Answer: B
During assessment of a postoperative patient receiving morphine, which finding requires
immediate nursing intervention because it indicates a potential adverse effect of opioid therapy
requiring prompt action to ensure patient safety?
A. Respiratory rate 8/min
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B. Blood pressure 118/78
C. Heart rate 88/min
D. Oxygen saturation 96%
Answer: A
A patient receiving blood transfusion suddenly develops chills, back pain, fever, and
hypotension. Which immediate nursing action is appropriate to prevent further complications
and promote patient safety during transfusion reaction?
A. Stop transfusion immediately
B. Administer acetaminophen
C. Obtain repeat crossmatch
D. Slow infusion rate
Answer: A
A nurse is educating a patient prescribed warfarin therapy. Which patient statement indicates
the need for further teaching because it reflects misunderstanding of important dietary and
safety considerations associated with anticoagulant therapy?
A. “I will avoid green leafy vegetables.”
B. “I should use a soft toothbrush.”
C. “I must report unusual bleeding quickly.”
D. “I can drink unlimited alcohol safely.”
Answer: D
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which
nursing intervention is essential to avoid respiratory depression while still ensuring adequate
oxygenation during oxygen administration?
A. Maintain flow rate low
B. Encourage fluid restriction
C. Provide humidified mask
D. Encourage hyperventilation
Answer: A
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A patient scheduled for surgery states, “I do not want this operation.” Which nursing action best
upholds ethical principles of autonomy and informed consent in this situation?
A. Notify healthcare provider immediately
B. Continue preoperative teaching
C. Administer preoperative sedatives
D. Persuade patient to proceed
Answer: A
The nurse prepares to administer digoxin. Which assessment finding requires withholding the
medication and notifying the healthcare provider due to risk of digoxin toxicity and potential
adverse cardiac effects?
A. Apical pulse 48 beats/min
B. Blood pressure 128/70
C. Respiratory rate 18/min
D. Oxygen saturation 94%
Answer: A
A patient with renal failure is scheduled for hemodialysis. Which laboratory value should the
nurse expect to monitor closely, as it reflects potential complications and fluid-electrolyte
imbalances associated with renal impairment?
A. Potassium 6.2 mEq/L
B. Sodium 138 mEq/L
C. Hemoglobin 13.5 g/dL
D. Calcium 9.0 mg/dL
Answer: A
When providing care for a patient with a chest tube, which finding requires immediate
intervention because it indicates a complication or problem with drainage system that could
compromise patient’s respiratory status?
A. Continuous bubbling in water seal
B. Serosanguinous drainage present
NCLEX-PN Testbank (Solved Questions And Answers Graded A +
Updated 2025/26) , 100% Guaranteed Pass ||Complete A+ Guide
A nurse cares for a postoperative patient with abdominal incision. Which intervention should
the nurse prioritize to prevent respiratory complications, considering patient’s immobility, pain,
and shallow breathing caused by abdominal discomfort?
A. Encourage coughing and deep breathing
B. Restrict fluid intake to reduce edema
C. Administer sedatives to promote rest
D. Apply warm compresses to abdomen
Answer: A
A patient with heart failure reports shortness of breath, orthopnea, and productive cough with
frothy sputum. Which nursing action takes priority to reduce pulmonary congestion and
improve oxygenation during acute episode?
A. Elevate head of bed
B. Provide fluid restriction
C. Administer antipyretics as prescribed
D. Encourage increased oral intake
Answer: A
When caring for a diabetic patient experiencing hypoglycemia with sweating, tremors, and
confusion, which nursing intervention should be implemented first to restore normal glucose
levels and prevent worsening symptoms?
A. Administer glucagon injection
B. Provide orange juice orally
C. Check blood pressure immediately
D. Initiate oxygen via nasal cannula
Answer: B
, Page |2
The nurse observes an elderly patient with dementia attempting to leave bed unsafely at night.
Which nursing intervention is most appropriate to ensure safety while maintaining dignity and
preventing patient harm?
A. Apply four-point restraints
B. Use a bed alarm
C. Administer sedative medication
D. Place side rails up
Answer: B
A patient with pneumonia develops high fever, productive cough, pleuritic chest pain, and
dyspnea. Which nursing assessment finding requires immediate intervention because it
indicates worsening respiratory distress needing urgent provider notification?
A. Oxygen saturation 82%
B. Temperature 101.8°F
C. Respiratory rate 22/min
D. Pulse 96 beats/min
Answer: A
A nurse cares for a patient prescribed furosemide for heart failure. Which laboratory result
requires immediate intervention due to potential adverse drug effect, warranting provider
notification and appropriate treatment modification?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 100 mEq/L
D. Bicarbonate 25 mEq/L
Answer: B
During assessment of a postoperative patient receiving morphine, which finding requires
immediate nursing intervention because it indicates a potential adverse effect of opioid therapy
requiring prompt action to ensure patient safety?
A. Respiratory rate 8/min
, Page |3
B. Blood pressure 118/78
C. Heart rate 88/min
D. Oxygen saturation 96%
Answer: A
A patient receiving blood transfusion suddenly develops chills, back pain, fever, and
hypotension. Which immediate nursing action is appropriate to prevent further complications
and promote patient safety during transfusion reaction?
A. Stop transfusion immediately
B. Administer acetaminophen
C. Obtain repeat crossmatch
D. Slow infusion rate
Answer: A
A nurse is educating a patient prescribed warfarin therapy. Which patient statement indicates
the need for further teaching because it reflects misunderstanding of important dietary and
safety considerations associated with anticoagulant therapy?
A. “I will avoid green leafy vegetables.”
B. “I should use a soft toothbrush.”
C. “I must report unusual bleeding quickly.”
D. “I can drink unlimited alcohol safely.”
Answer: D
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which
nursing intervention is essential to avoid respiratory depression while still ensuring adequate
oxygenation during oxygen administration?
A. Maintain flow rate low
B. Encourage fluid restriction
C. Provide humidified mask
D. Encourage hyperventilation
Answer: A
, Page |4
A patient scheduled for surgery states, “I do not want this operation.” Which nursing action best
upholds ethical principles of autonomy and informed consent in this situation?
A. Notify healthcare provider immediately
B. Continue preoperative teaching
C. Administer preoperative sedatives
D. Persuade patient to proceed
Answer: A
The nurse prepares to administer digoxin. Which assessment finding requires withholding the
medication and notifying the healthcare provider due to risk of digoxin toxicity and potential
adverse cardiac effects?
A. Apical pulse 48 beats/min
B. Blood pressure 128/70
C. Respiratory rate 18/min
D. Oxygen saturation 94%
Answer: A
A patient with renal failure is scheduled for hemodialysis. Which laboratory value should the
nurse expect to monitor closely, as it reflects potential complications and fluid-electrolyte
imbalances associated with renal impairment?
A. Potassium 6.2 mEq/L
B. Sodium 138 mEq/L
C. Hemoglobin 13.5 g/dL
D. Calcium 9.0 mg/dL
Answer: A
When providing care for a patient with a chest tube, which finding requires immediate
intervention because it indicates a complication or problem with drainage system that could
compromise patient’s respiratory status?
A. Continuous bubbling in water seal
B. Serosanguinous drainage present
