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NCLEX-RN Master Bundle 2025–2026 | 100+ Exam
Questions with Rationales (Pharm, OB, Med-Surg,
Psych)
Question 1 — Medical-Surgical (Cardiac)
Q: A 67-year-old patient with a history of chronic heart failure (CHF) is admitted with
worsening dyspnea, peripheral edema, and weight gain. The physician initiates treatment with
furosemide (Lasix), a loop diuretic commonly prescribed for fluid overload management. During
the nurse’s morning assessment, the patient reports mild leg cramps and weakness. Vital signs
are: BP 132/84 mmHg, HR 78 bpm, and RR 18. The patient has lost 2 pounds since yesterday.
Lab values return with a serum potassium level of 3.1 mEq/L. Based on the assessment data and
lab results, which clinical finding should the nurse prioritize reporting to the healthcare provider?
A. Serum potassium level of 3.1 mEq/L
B. Blood pressure of 132/84 mmHg
C. Heart rate of 78 bpm
D. Weight loss of 2 pounds overnight
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✅ Correct Answer: A
🧠 Rationale: Furosemide increases potassium excretion, leading to hypokalemia. A level of 3.1
mEq/L is critically low and may trigger arrhythmias in heart failure patients. Unlike the BP, HR,
or expected weight loss from diuresis, this potassium level must be corrected promptly to prevent
cardiac complications.
✅ Question 2 — Pharmacology
Q: A patient admitted for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is
started on intravenous vancomycin. The order specifies that the medication is to be administered
over 90 minutes via a peripheral IV line. On the second day of therapy, the nurse begins the
vancomycin infusion and remains at the bedside for initial observation. During the infusion, the
patient reports slight itching on the upper torso, but no rash or shortness of breath. The nurse
checks the latest labs: creatinine is 1.9 mg/dL (elevated), and the patient reports slight tinnitus
that started that morning. In managing this patient’s vancomycin therapy, which action is most
important for the nurse during the infusion?
A. Monitor for ototoxicity and nephrotoxicity
B. Administer as a rapid IV push
C. Use a central line for all doses
D. Stop the infusion if the patient reports itching
✅ Correct Answer: A
🧠 Rationale: Vancomycin can cause both kidney and hearing damage. Monitoring renal labs
,3
(BUN/creatinine) and hearing changes is vital. Infusions should be slow to avoid “Red Man
Syndrome.” Itching alone may not require stopping; rather, slow the rate. Ototoxicity and
nephrotoxicity monitoring is the priority.
Question 3 — Obstetrics (Magnesium Sulfate Toxicity)
Q: A 29-year-old woman who is 32 weeks pregnant is admitted to the labor and delivery unit
with a diagnosis of preeclampsia. Her symptoms include elevated blood pressure readings of
150/96 mmHg, proteinuria, and generalized edema. The provider initiates magnesium sulfate
therapy to prevent the onset of eclamptic seizures. The nurse is closely monitoring the patient’s
response to the medication, performing hourly assessments that include deep tendon reflexes
(DTRs), respiratory rate, urine output, and fetal heart monitoring. During the assessment, the
nurse notes that the patient’s patellar and biceps reflexes are absent, but other vital signs remain
stable. Urine output is measured at 35 mL/hour, and the fetal heart rate is recorded at 140 bpm.
Which assessment finding should prompt the nurse to immediately discontinue the magnesium
sulfate infusion and notify the provider?
A. Absent deep tendon reflexes
B. Blood pressure of 142/92 mmHg
C. Fetal heart rate of 140 bpm
D. Urine output of 35 mL/hour
✅ Correct Answer: A
🧠 Rationale: Loss of deep tendon reflexes signals magnesium toxicity and precedes respiratory
depression. Although urine output and fetal heart rate are within safe limits, absent reflexes
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require immediate discontinuation of the infusion and preparation to administer calcium
gluconate, the antidote.
✅ Question 4 — Psychiatry (Suicidal Ideation)
Q: A 45-year-old patient hospitalized for major depressive disorder shares the following
statement with the nurse during a routine mental health assessment: “I feel like a burden to
everyone around me. They’d all be better off if I weren’t here.” The patient’s affect is flat, and
they’ve exhibited reduced appetite and insomnia during their stay. The nurse recognizes the
seriousness of the patient’s comment and considers how to respond appropriately. The goal is to
prioritize safety and provide therapeutic support that opens the door for honest communication.
Considering this patient’s expression of hopelessness and perceived burden, what is the nurse’s
best immediate response?
A. “You should think positively. Things will get better.”
B. “Let’s focus on the progress you’ve made recently.”
C. “Do you have any plans to hurt yourself?”
D. “You’re just feeling down right now — it’s temporary.”
✅ Correct Answer: C
🧠 Rationale: Suicidal ideation requires direct assessment. Asking clearly about intent and
plans is essential for safety. Avoid minimizing, deflecting, or providing false reassurance. A
therapeutic response includes validating feelings and evaluating risk to prevent potential self-
harm and initiate psychiatric intervention if needed.
NCLEX-RN Master Bundle 2025–2026 | 100+ Exam
Questions with Rationales (Pharm, OB, Med-Surg,
Psych)
Question 1 — Medical-Surgical (Cardiac)
Q: A 67-year-old patient with a history of chronic heart failure (CHF) is admitted with
worsening dyspnea, peripheral edema, and weight gain. The physician initiates treatment with
furosemide (Lasix), a loop diuretic commonly prescribed for fluid overload management. During
the nurse’s morning assessment, the patient reports mild leg cramps and weakness. Vital signs
are: BP 132/84 mmHg, HR 78 bpm, and RR 18. The patient has lost 2 pounds since yesterday.
Lab values return with a serum potassium level of 3.1 mEq/L. Based on the assessment data and
lab results, which clinical finding should the nurse prioritize reporting to the healthcare provider?
A. Serum potassium level of 3.1 mEq/L
B. Blood pressure of 132/84 mmHg
C. Heart rate of 78 bpm
D. Weight loss of 2 pounds overnight
,2
✅ Correct Answer: A
🧠 Rationale: Furosemide increases potassium excretion, leading to hypokalemia. A level of 3.1
mEq/L is critically low and may trigger arrhythmias in heart failure patients. Unlike the BP, HR,
or expected weight loss from diuresis, this potassium level must be corrected promptly to prevent
cardiac complications.
✅ Question 2 — Pharmacology
Q: A patient admitted for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is
started on intravenous vancomycin. The order specifies that the medication is to be administered
over 90 minutes via a peripheral IV line. On the second day of therapy, the nurse begins the
vancomycin infusion and remains at the bedside for initial observation. During the infusion, the
patient reports slight itching on the upper torso, but no rash or shortness of breath. The nurse
checks the latest labs: creatinine is 1.9 mg/dL (elevated), and the patient reports slight tinnitus
that started that morning. In managing this patient’s vancomycin therapy, which action is most
important for the nurse during the infusion?
A. Monitor for ototoxicity and nephrotoxicity
B. Administer as a rapid IV push
C. Use a central line for all doses
D. Stop the infusion if the patient reports itching
✅ Correct Answer: A
🧠 Rationale: Vancomycin can cause both kidney and hearing damage. Monitoring renal labs
,3
(BUN/creatinine) and hearing changes is vital. Infusions should be slow to avoid “Red Man
Syndrome.” Itching alone may not require stopping; rather, slow the rate. Ototoxicity and
nephrotoxicity monitoring is the priority.
Question 3 — Obstetrics (Magnesium Sulfate Toxicity)
Q: A 29-year-old woman who is 32 weeks pregnant is admitted to the labor and delivery unit
with a diagnosis of preeclampsia. Her symptoms include elevated blood pressure readings of
150/96 mmHg, proteinuria, and generalized edema. The provider initiates magnesium sulfate
therapy to prevent the onset of eclamptic seizures. The nurse is closely monitoring the patient’s
response to the medication, performing hourly assessments that include deep tendon reflexes
(DTRs), respiratory rate, urine output, and fetal heart monitoring. During the assessment, the
nurse notes that the patient’s patellar and biceps reflexes are absent, but other vital signs remain
stable. Urine output is measured at 35 mL/hour, and the fetal heart rate is recorded at 140 bpm.
Which assessment finding should prompt the nurse to immediately discontinue the magnesium
sulfate infusion and notify the provider?
A. Absent deep tendon reflexes
B. Blood pressure of 142/92 mmHg
C. Fetal heart rate of 140 bpm
D. Urine output of 35 mL/hour
✅ Correct Answer: A
🧠 Rationale: Loss of deep tendon reflexes signals magnesium toxicity and precedes respiratory
depression. Although urine output and fetal heart rate are within safe limits, absent reflexes
, 4
require immediate discontinuation of the infusion and preparation to administer calcium
gluconate, the antidote.
✅ Question 4 — Psychiatry (Suicidal Ideation)
Q: A 45-year-old patient hospitalized for major depressive disorder shares the following
statement with the nurse during a routine mental health assessment: “I feel like a burden to
everyone around me. They’d all be better off if I weren’t here.” The patient’s affect is flat, and
they’ve exhibited reduced appetite and insomnia during their stay. The nurse recognizes the
seriousness of the patient’s comment and considers how to respond appropriately. The goal is to
prioritize safety and provide therapeutic support that opens the door for honest communication.
Considering this patient’s expression of hopelessness and perceived burden, what is the nurse’s
best immediate response?
A. “You should think positively. Things will get better.”
B. “Let’s focus on the progress you’ve made recently.”
C. “Do you have any plans to hurt yourself?”
D. “You’re just feeling down right now — it’s temporary.”
✅ Correct Answer: C
🧠 Rationale: Suicidal ideation requires direct assessment. Asking clearly about intent and
plans is essential for safety. Avoid minimizing, deflecting, or providing false reassurance. A
therapeutic response includes validating feelings and evaluating risk to prevent potential self-
harm and initiate psychiatric intervention if needed.
