NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
NCLEX-SAUNDERS COMPREHENSIVE
REVIEW EXAM
2026/2027 | 150 QUESTIONS | NEWEST VERSION
VERIFIED | GRADED A+
Introduction
This NCLEX Saunders Comprehensive Review Exam measures integrated knowledge across core
client needs: Safe and Effective Care Environment, Health Promotion, Psychosocial Integrity,
and Physiological Integrity. It utilizes Next Generation NCLEX (NGN) item types aligned with
the NCSBN Clinical Judgment Measurement Model (CJMM).
1. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg. Which nursing
intervention is the priority?
A. Elevate the head of the bed to 30 degrees.
B. Perform deep tracheal suctioning every 2 hours.
C. Encourage the client to cough and deep breathe.
D. Administer a bolus of hypotonic intravenous fluids.
Rationale: An ICP over 20 mmHg indicates intracranial hypertension. Elevating the head of the bed
to 30 degrees facilitates venous drainage from the brain, effectively lowering ICP. Suctioning and
coughing increase intrathoracic pressure, which can worsen ICP.
2. (Select All That Apply) The nurse is assessing a client with suspected hyperthyroidism. Which findings
should the nurse expect? Select all that apply.
• Tachycardia
• Heat intolerance
• Exophthalmos
• Diaphoresis
• Weight gain
Rationale: Hyperthyroidism causes a hypermetabolic state resulting in tachycardia, heat intolerance,
and weight loss.
3. A client is admitted with a potassium level of 6.4 mEq/L. Which provider order should the nurse
implement first?
A. Administer Sodium Polystyrene Sulfonate.
B. Administer Calcium Gluconate 10% IV.
C. Obtain a STAT 12-lead ECG.
1
,NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
D. Administer regular insulin and 50% dextrose.
Rationale: Calcium gluconate stabilizes the myocardial cell membrane to prevent lethal dysrhythmias
in hyperkalemia.
4. The nurse notes continuous bubbling in the water-seal chamber of a chest tube. This indicates:
A. Normal operation.
B. An air leak in the system.
C. Suction is too high.
D. The lung has re-expanded.
Rationale: Continuous bubbling in the water-seal chamber indicates air is entering the system through a
leak.
5. (Matrix) Identify the therapeutic status of the following lab values:
Lab Value Therapeutic Intervention Needed
Lithium 0.8 X
mEq/L
Digoxin 2.5 ng/mL X
Rationale: Digoxin levels above 2.0 ng/mL indicate toxicity requiring immediate intervention.
6. The nurse is preparing to administer 0.25 mg of Digoxin. Available is 0.125 mg tablets. Give:
A. 1 tablet
B. 2 tablets
Rationale: 0..125 = 2.
7. A client with Addison’s disease is being discharged. Which instruction is most impor- tant?
A. ”Carry an emergency kit with hydrocortisone at all times.”
B. ”Limit fluid intake to 1500 mL per day.”
C. ”Decrease sodium intake during hot weather.”
D. ”Stop the steroid medication if you feel nauseated.”
Rationale: Adrenal crisis is life-threatening; patients must carry emergency replacement hormones.
8. (NGN Trend) A client with heart failure has gained 4 lbs in 24 hours and has +3 pitting edema. The nurse
should:
A. Notify the healthcare provider and request a diuretic.
B. Encourage increased oral fluid intake.
C. Place the client in a flat, supine position.
D. Apply a compression bandage to the lower extremities.
2
,NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
Rationale: Rapid weight gain and worsening edema indicate fluid volume overload requiring diuretic
therapy.
9. A toddler is admitted with suspected epiglottitis. Which action is contraindicated?
A. Using a tongue blade to visualize the throat.
B. Assessing oxygen saturation.
C. Allowing the child to sit in a tripod position.
D. Preparing for immediate intubation.
Rationale: Throat inspection can cause total airway obstruction in epiglottitis.
10. A client is taking Phenelzine (an MAOI). Which food choice requires intervention?
A. Pepperoni pizza
B. Fresh grilled salmon
C. Steamed broccoli
D. Sliced apples
Rationale: MAOIs react with tyramine-rich foods (aged meats, cheese) to cause hypertensive crisis.
11. The nurse is caring for a client post-appendectomy. Which finding is the most priority?
A. Pain rating 6/10.
B. Rigid, board-like abdomen.
C. Absence of bowel sounds in all quadrants.
D. Scant serosanguinous drainage on the dressing.
Rationale: A rigid, board-like abdomen is a classic sign of peritonitis, a medical emergency following
surgery.
12. A client has a prescription for Nitroglycerin sublingual tablets. Which instruction is correct?
A. ”Take one tablet every 5 minutes, up to 3 doses, then call 911 if pain persists.”
B. ”Swallow the tablet with a full glass of water.”
C. ”Store the tablets in a clear plastic bag for easy access.”
D. ”Expect the tablet to cause a tingling sensation; if it doesn’t, it’s expired.”
Rationale: Standard protocol for angina is 3 doses 5 minutes apart. Tingling indicates potency.
13. A client is being treated for Deep Vein Thrombosis (DVT) with Heparin IV. The nurse monitors which
lab value?
A. aPTT
B. PT/INR
3
, NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
C. Platelet count
D. Hemoglobin
Rationale: aPTT is used to monitor the therapeutic effect of Heparin.
14. The nurse is educating a client with Type 1 Diabetes on exercise. Which statement by the client indicates
understanding?
A. ”I will eat a carbohydrate snack before exercising.”
B. ”I will exercise only when my blood sugar is above 300.”
C. ”I will inject my insulin into my thigh right before I go for a run.”
D. ”I should exercise when my insulin is at its peak.”
Rationale: Carbs prevent hypoglycemia during exercise. Peak insulin times and injecting into working
muscles increase risk of hypoglycemia.
15. A client with a fracture of the right femur develops sudden shortness of breath and chest pain. The nurse
suspects:
A. Fat embolism.
B. Pulmonary edema.
C. Pneumonia.
D. Atelectasis.
Rationale: Fat embolism is a high risk following long bone fractures, presenting with sudden respira-
tory distress.
16. The nurse is assessing a newborn with suspected developmental dysplasia of the hip (DDH). Which
finding is expected?
A. Asymmetrical gluteal folds.
B. Even leg length.
C. Negative Ortolani’s maneuver.
D. Symmetric abduction of both hips.
Rationale: Asymmetry of skin folds and leg length discrepancy are key signs of DDH.
17. Which medication should the nurse expect to administer to a client with a C. difficile infection?
A. Oral Vancomycin.
B. IV Gentamicin.
C. Oral Ciprofloxacin.
D. IV Penicillin.
4
NCLEX-SAUNDERS COMPREHENSIVE
REVIEW EXAM
2026/2027 | 150 QUESTIONS | NEWEST VERSION
VERIFIED | GRADED A+
Introduction
This NCLEX Saunders Comprehensive Review Exam measures integrated knowledge across core
client needs: Safe and Effective Care Environment, Health Promotion, Psychosocial Integrity,
and Physiological Integrity. It utilizes Next Generation NCLEX (NGN) item types aligned with
the NCSBN Clinical Judgment Measurement Model (CJMM).
1. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg. Which nursing
intervention is the priority?
A. Elevate the head of the bed to 30 degrees.
B. Perform deep tracheal suctioning every 2 hours.
C. Encourage the client to cough and deep breathe.
D. Administer a bolus of hypotonic intravenous fluids.
Rationale: An ICP over 20 mmHg indicates intracranial hypertension. Elevating the head of the bed
to 30 degrees facilitates venous drainage from the brain, effectively lowering ICP. Suctioning and
coughing increase intrathoracic pressure, which can worsen ICP.
2. (Select All That Apply) The nurse is assessing a client with suspected hyperthyroidism. Which findings
should the nurse expect? Select all that apply.
• Tachycardia
• Heat intolerance
• Exophthalmos
• Diaphoresis
• Weight gain
Rationale: Hyperthyroidism causes a hypermetabolic state resulting in tachycardia, heat intolerance,
and weight loss.
3. A client is admitted with a potassium level of 6.4 mEq/L. Which provider order should the nurse
implement first?
A. Administer Sodium Polystyrene Sulfonate.
B. Administer Calcium Gluconate 10% IV.
C. Obtain a STAT 12-lead ECG.
1
,NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
D. Administer regular insulin and 50% dextrose.
Rationale: Calcium gluconate stabilizes the myocardial cell membrane to prevent lethal dysrhythmias
in hyperkalemia.
4. The nurse notes continuous bubbling in the water-seal chamber of a chest tube. This indicates:
A. Normal operation.
B. An air leak in the system.
C. Suction is too high.
D. The lung has re-expanded.
Rationale: Continuous bubbling in the water-seal chamber indicates air is entering the system through a
leak.
5. (Matrix) Identify the therapeutic status of the following lab values:
Lab Value Therapeutic Intervention Needed
Lithium 0.8 X
mEq/L
Digoxin 2.5 ng/mL X
Rationale: Digoxin levels above 2.0 ng/mL indicate toxicity requiring immediate intervention.
6. The nurse is preparing to administer 0.25 mg of Digoxin. Available is 0.125 mg tablets. Give:
A. 1 tablet
B. 2 tablets
Rationale: 0..125 = 2.
7. A client with Addison’s disease is being discharged. Which instruction is most impor- tant?
A. ”Carry an emergency kit with hydrocortisone at all times.”
B. ”Limit fluid intake to 1500 mL per day.”
C. ”Decrease sodium intake during hot weather.”
D. ”Stop the steroid medication if you feel nauseated.”
Rationale: Adrenal crisis is life-threatening; patients must carry emergency replacement hormones.
8. (NGN Trend) A client with heart failure has gained 4 lbs in 24 hours and has +3 pitting edema. The nurse
should:
A. Notify the healthcare provider and request a diuretic.
B. Encourage increased oral fluid intake.
C. Place the client in a flat, supine position.
D. Apply a compression bandage to the lower extremities.
2
,NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
Rationale: Rapid weight gain and worsening edema indicate fluid volume overload requiring diuretic
therapy.
9. A toddler is admitted with suspected epiglottitis. Which action is contraindicated?
A. Using a tongue blade to visualize the throat.
B. Assessing oxygen saturation.
C. Allowing the child to sit in a tripod position.
D. Preparing for immediate intubation.
Rationale: Throat inspection can cause total airway obstruction in epiglottitis.
10. A client is taking Phenelzine (an MAOI). Which food choice requires intervention?
A. Pepperoni pizza
B. Fresh grilled salmon
C. Steamed broccoli
D. Sliced apples
Rationale: MAOIs react with tyramine-rich foods (aged meats, cheese) to cause hypertensive crisis.
11. The nurse is caring for a client post-appendectomy. Which finding is the most priority?
A. Pain rating 6/10.
B. Rigid, board-like abdomen.
C. Absence of bowel sounds in all quadrants.
D. Scant serosanguinous drainage on the dressing.
Rationale: A rigid, board-like abdomen is a classic sign of peritonitis, a medical emergency following
surgery.
12. A client has a prescription for Nitroglycerin sublingual tablets. Which instruction is correct?
A. ”Take one tablet every 5 minutes, up to 3 doses, then call 911 if pain persists.”
B. ”Swallow the tablet with a full glass of water.”
C. ”Store the tablets in a clear plastic bag for easy access.”
D. ”Expect the tablet to cause a tingling sensation; if it doesn’t, it’s expired.”
Rationale: Standard protocol for angina is 3 doses 5 minutes apart. Tingling indicates potency.
13. A client is being treated for Deep Vein Thrombosis (DVT) with Heparin IV. The nurse monitors which
lab value?
A. aPTT
B. PT/INR
3
, NCLEX-RN Saunders Review 2026/2027 100% Correct Answers
C. Platelet count
D. Hemoglobin
Rationale: aPTT is used to monitor the therapeutic effect of Heparin.
14. The nurse is educating a client with Type 1 Diabetes on exercise. Which statement by the client indicates
understanding?
A. ”I will eat a carbohydrate snack before exercising.”
B. ”I will exercise only when my blood sugar is above 300.”
C. ”I will inject my insulin into my thigh right before I go for a run.”
D. ”I should exercise when my insulin is at its peak.”
Rationale: Carbs prevent hypoglycemia during exercise. Peak insulin times and injecting into working
muscles increase risk of hypoglycemia.
15. A client with a fracture of the right femur develops sudden shortness of breath and chest pain. The nurse
suspects:
A. Fat embolism.
B. Pulmonary edema.
C. Pneumonia.
D. Atelectasis.
Rationale: Fat embolism is a high risk following long bone fractures, presenting with sudden respira-
tory distress.
16. The nurse is assessing a newborn with suspected developmental dysplasia of the hip (DDH). Which
finding is expected?
A. Asymmetrical gluteal folds.
B. Even leg length.
C. Negative Ortolani’s maneuver.
D. Symmetric abduction of both hips.
Rationale: Asymmetry of skin folds and leg length discrepancy are key signs of DDH.
17. Which medication should the nurse expect to administer to a client with a C. difficile infection?
A. Oral Vancomycin.
B. IV Gentamicin.
C. Oral Ciprofloxacin.
D. IV Penicillin.
4
