Page 1 of 270
NCSBN NCLEX-RN COMPREHENSIVE ACTUAL
TEST BANK 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |HIGHLY RECOMMENDED
BY EXPERTS |NEW AND REVISED
1. A nurse is caring for a client who is 2 hours post-operative following
a right total knee arthroplasty. Which assessment finding requires
immediate notification of the healthcare provider?
A. Pain level 6 on a 0–10 scale
B. Oxygen saturation 88% on room air
C. Temperature 99.8°F (37.7°C)
D. Urine output 40 mL over the past 2 hours
*Rationale: Post-operative hypoxemia (SpO₂ <90%) may indicate
atelectasis, pulmonary embolism, or respiratory depression; requires
prompt evaluation. Pain and mild temperature elevation are expected.
Urine output of 40 mL/2hr = 20 mL/hr is acceptable (≥30 mL/hr is
normal, but 20 is borderline; however, hypoxemia takes priority).*
2. A nurse is preparing to administer 0.9% normal saline IV at 125
mL/hr. The drop factor is 15 gtt/mL. How many drops per minute should
the nurse set the manual IV tubing to deliver?
A. 15 gtt/min
B. 21 gtt/min
C. 31 gtt/min
D. 42 gtt/min
*Rationale: Flow rate (gtt/min) = (volume (mL) × drop factor) ÷ time
(min). 125 mL/hr = 125 mL/60 min = 2.083 mL/min. 2.083 × 15 =
31.25 ≈ 31 gtt/min. Alternatively: (125 × 15) / 60 = 1875/60 = 31.25.*
,Page 2 of 270
3. A client with type 1 diabetes mellitus is admitted with diabetic
ketoacidosis (DKA). The nurse expects which laboratory finding?
A. Serum pH 7.45
B. Serum bicarbonate 12 mEq/L
C. Blood glucose 150 mg/dL
D. PaCO₂ 48 mm Hg
*Rationale: DKA causes metabolic acidosis with low bicarbonate (<18
mEq/L), low pH (<7.35), low PaCO₂ (compensatory respiratory
alkalosis), and hyperglycemia (>250 mg/dL).*
4. A nurse is assessing a client who is receiving a blood transfusion of
packed red blood cells. Fifteen minutes after the start of the transfusion,
the client reports chills and low back pain. The client’s blood pressure is
88/50 mm Hg. Which action should the nurse take first?
A. Slow the infusion rate to 50 mL/hr.
B. Stop the transfusion and infuse normal saline with new tubing.
C. Administer diphenhydramine 50 mg IV push.
D. Notify the healthcare provider.
Rationale: Low back pain, chills, and hypotension are signs of an
acute hemolytic reaction. The priority is to stop the transfusion,
maintain IV access with normal saline, and then notify the provider.
5. A nurse is educating a client with heart failure about a 2-gram sodium
diet. Which food selection by the client indicates understanding of the
teaching?
A. Canned vegetable soup and saltine crackers
B. Grilled chicken breast with steamed broccoli and brown rice
C. Ham sandwich with mustard on whole-wheat bread
D. Frozen fish fillet with instant mashed potatoes
Rationale: Fresh chicken, unprocessed vegetables, and unseasoned
grains are naturally low in sodium. Canned soups, ham, frozen
prepared meals, and instant potatoes are high in sodium.
,Page 3 of 270
6. A client who is at 32 weeks of gestation reports a sudden gush of fluid
from the vagina. The nurse notes that the fluid is clear and has a
fern-like pattern when dried on a slide. What is the priority nursing
action?
A. Assess for cervical dilation.
B. Assess fetal heart rate and maternal vital signs.
C. Administer oxytocin to augment labor.
D. Insert an indwelling urinary catheter.
Rationale: The fern test confirms rupture of membranes. Priority is
fetal assessment (heart rate, activity) and maternal assessment (signs
of infection, uterine tenderness).
7. A nurse is caring for a client with a chest tube connected to a closed
drainage system. The nurse notes continuous bubbling in the water seal
chamber. Which action should the nurse take?
A. Clamp the chest tube immediately.
B. Assess the chest tube system for an air leak at the connection sites
and the patient’s chest.
C. Increase the suction pressure to high.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates
an air leak. The nurse should first assess the system to locate the
source of the leak.
8. A client is prescribed enoxaparin 40 mg subcutaneously daily for
DVT prophylaxis. Which injection technique is correct?
A. Insert the needle at a 90-degree angle into the deltoid muscle.
B. Insert the needle at a 90-degree angle into the abdomen, 2 inches
from the umbilicus, and do not aspirate.
C. Insert the needle at a 45-degree angle into the vastus lateralis.
D. Rub the site vigorously after injection to enhance absorption.
Rationale: Enoxaparin is given subcutaneously in the abdomen
(alternating sides) using a 90° angle with a small gauge needle.
, Page 4 of 270
Aspiration is not recommended, and the site should not be massaged to
avoid bruising.
9. A nurse is reviewing laboratory results for a client with chronic
kidney disease (CKD). Which finding is most concerning?
A. Hemoglobin 11.2 g/dL
B. Serum potassium 6.5 mEq/L
C. Serum creatinine 2.1 mg/dL
D. Blood urea nitrogen 45 mg/dL
*Rationale: Hyperkalemia (K >5.5 mEq/L) can cause life-threatening
cardiac dysrhythmias. This is an emergent finding requiring
immediate intervention.*
10. A client with major depressive disorder is started on phenelzine, a
monoamine oxidase inhibitor (MAOI). Which statement by the client
indicates a need for further teaching?
A. “I will avoid aged cheeses and red wine.”
B. “I will check with my provider before taking over-the-counter cold
medications.”
C. “I can eat pizza with pepperoni as long as I limit myself to one
slice.”
D. “I will avoid fermented foods like sauerkraut.”
Rationale: MAOIs require a low-tyramine diet. Pepperoni, aged
cheeses, red wine, and fermented foods are high in tyramine and can
precipitate a hypertensive crisis.
11. A nurse is caring for a client who has a nasogastric (NG) tube set to
low intermittent suction. Which finding indicates the client is at risk for
metabolic alkalosis?
A. NG output of 1,500 mL over the past 12 hours
B. Serum potassium level of 4.2 mEq/L
C. Blood pressure 110/70 mm Hg
D. Oxygen saturation 96% on room air
Rationale: Gastric suction removes gastric acid (HCl) and potassium,
NCSBN NCLEX-RN COMPREHENSIVE ACTUAL
TEST BANK 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |HIGHLY RECOMMENDED
BY EXPERTS |NEW AND REVISED
1. A nurse is caring for a client who is 2 hours post-operative following
a right total knee arthroplasty. Which assessment finding requires
immediate notification of the healthcare provider?
A. Pain level 6 on a 0–10 scale
B. Oxygen saturation 88% on room air
C. Temperature 99.8°F (37.7°C)
D. Urine output 40 mL over the past 2 hours
*Rationale: Post-operative hypoxemia (SpO₂ <90%) may indicate
atelectasis, pulmonary embolism, or respiratory depression; requires
prompt evaluation. Pain and mild temperature elevation are expected.
Urine output of 40 mL/2hr = 20 mL/hr is acceptable (≥30 mL/hr is
normal, but 20 is borderline; however, hypoxemia takes priority).*
2. A nurse is preparing to administer 0.9% normal saline IV at 125
mL/hr. The drop factor is 15 gtt/mL. How many drops per minute should
the nurse set the manual IV tubing to deliver?
A. 15 gtt/min
B. 21 gtt/min
C. 31 gtt/min
D. 42 gtt/min
*Rationale: Flow rate (gtt/min) = (volume (mL) × drop factor) ÷ time
(min). 125 mL/hr = 125 mL/60 min = 2.083 mL/min. 2.083 × 15 =
31.25 ≈ 31 gtt/min. Alternatively: (125 × 15) / 60 = 1875/60 = 31.25.*
,Page 2 of 270
3. A client with type 1 diabetes mellitus is admitted with diabetic
ketoacidosis (DKA). The nurse expects which laboratory finding?
A. Serum pH 7.45
B. Serum bicarbonate 12 mEq/L
C. Blood glucose 150 mg/dL
D. PaCO₂ 48 mm Hg
*Rationale: DKA causes metabolic acidosis with low bicarbonate (<18
mEq/L), low pH (<7.35), low PaCO₂ (compensatory respiratory
alkalosis), and hyperglycemia (>250 mg/dL).*
4. A nurse is assessing a client who is receiving a blood transfusion of
packed red blood cells. Fifteen minutes after the start of the transfusion,
the client reports chills and low back pain. The client’s blood pressure is
88/50 mm Hg. Which action should the nurse take first?
A. Slow the infusion rate to 50 mL/hr.
B. Stop the transfusion and infuse normal saline with new tubing.
C. Administer diphenhydramine 50 mg IV push.
D. Notify the healthcare provider.
Rationale: Low back pain, chills, and hypotension are signs of an
acute hemolytic reaction. The priority is to stop the transfusion,
maintain IV access with normal saline, and then notify the provider.
5. A nurse is educating a client with heart failure about a 2-gram sodium
diet. Which food selection by the client indicates understanding of the
teaching?
A. Canned vegetable soup and saltine crackers
B. Grilled chicken breast with steamed broccoli and brown rice
C. Ham sandwich with mustard on whole-wheat bread
D. Frozen fish fillet with instant mashed potatoes
Rationale: Fresh chicken, unprocessed vegetables, and unseasoned
grains are naturally low in sodium. Canned soups, ham, frozen
prepared meals, and instant potatoes are high in sodium.
,Page 3 of 270
6. A client who is at 32 weeks of gestation reports a sudden gush of fluid
from the vagina. The nurse notes that the fluid is clear and has a
fern-like pattern when dried on a slide. What is the priority nursing
action?
A. Assess for cervical dilation.
B. Assess fetal heart rate and maternal vital signs.
C. Administer oxytocin to augment labor.
D. Insert an indwelling urinary catheter.
Rationale: The fern test confirms rupture of membranes. Priority is
fetal assessment (heart rate, activity) and maternal assessment (signs
of infection, uterine tenderness).
7. A nurse is caring for a client with a chest tube connected to a closed
drainage system. The nurse notes continuous bubbling in the water seal
chamber. Which action should the nurse take?
A. Clamp the chest tube immediately.
B. Assess the chest tube system for an air leak at the connection sites
and the patient’s chest.
C. Increase the suction pressure to high.
D. Document the finding as normal.
Rationale: Continuous bubbling in the water seal chamber indicates
an air leak. The nurse should first assess the system to locate the
source of the leak.
8. A client is prescribed enoxaparin 40 mg subcutaneously daily for
DVT prophylaxis. Which injection technique is correct?
A. Insert the needle at a 90-degree angle into the deltoid muscle.
B. Insert the needle at a 90-degree angle into the abdomen, 2 inches
from the umbilicus, and do not aspirate.
C. Insert the needle at a 45-degree angle into the vastus lateralis.
D. Rub the site vigorously after injection to enhance absorption.
Rationale: Enoxaparin is given subcutaneously in the abdomen
(alternating sides) using a 90° angle with a small gauge needle.
, Page 4 of 270
Aspiration is not recommended, and the site should not be massaged to
avoid bruising.
9. A nurse is reviewing laboratory results for a client with chronic
kidney disease (CKD). Which finding is most concerning?
A. Hemoglobin 11.2 g/dL
B. Serum potassium 6.5 mEq/L
C. Serum creatinine 2.1 mg/dL
D. Blood urea nitrogen 45 mg/dL
*Rationale: Hyperkalemia (K >5.5 mEq/L) can cause life-threatening
cardiac dysrhythmias. This is an emergent finding requiring
immediate intervention.*
10. A client with major depressive disorder is started on phenelzine, a
monoamine oxidase inhibitor (MAOI). Which statement by the client
indicates a need for further teaching?
A. “I will avoid aged cheeses and red wine.”
B. “I will check with my provider before taking over-the-counter cold
medications.”
C. “I can eat pizza with pepperoni as long as I limit myself to one
slice.”
D. “I will avoid fermented foods like sauerkraut.”
Rationale: MAOIs require a low-tyramine diet. Pepperoni, aged
cheeses, red wine, and fermented foods are high in tyramine and can
precipitate a hypertensive crisis.
11. A nurse is caring for a client who has a nasogastric (NG) tube set to
low intermittent suction. Which finding indicates the client is at risk for
metabolic alkalosis?
A. NG output of 1,500 mL over the past 12 hours
B. Serum potassium level of 4.2 mEq/L
C. Blood pressure 110/70 mm Hg
D. Oxygen saturation 96% on room air
Rationale: Gastric suction removes gastric acid (HCl) and potassium,
