Page 1 of 53
SAUNDERS NCLEX-RN COMPREHENSIVE EXAM
TESTBANK 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A nurse is caring for a client who has a chest tube connected to a closed
drainage system following a left lower lobectomy. Which finding requires
immediate intervention?
A. Continuous bubbling in the water seal chamber
B. Fluctuation (tidaling) in the water seal chamber with respirations
C. 100 mL of serosanguinous drainage in the collection chamber over the past hour
D. Subcutaneous emphysema at the insertion site
A. Continuous bubbling in the water seal chamber
*Rationale: Continuous bubbling in the water seal chamber indicates an air
leak, which can compromise lung re-expansion and lead to tension
pneumothorax. Tidaling is normal. Drainage up to 100 mL/hr post-op is
expected initially. Subcutaneous emphysema requires monitoring but is not
immediately life-threatening.*
2. A client with a history of heart failure is receiving furosemide 40 mg IV push.
The nurse notes the client’s serum potassium level is 3.2 mEq/L. Which
assessment finding is most concerning?
A. Dry mucous membranes
B. Muscle weakness and cramping
C. Jugular vein distention
D. Blood pressure 118/72 mm Hg
B. Muscle weakness and cramping
*Rationale: Hypokalemia (K+ <3.5) can cause muscle weakness, fatigue, and leg
cramps. Severe hypokalemia (especially with digoxin therapy) can lead to life-
threatening dysrhythmias such as ventricular tachycardia. Dry mucous
membranes suggest mild dehydration but are less urgent. JVD is a sign of right-
sided failure, not directly related to low potassium.*
3. A nurse is preparing to administer an intermittent enteral feeding through a
nasogastric tube. Which action is most important before starting the feeding?
,Page 2 of 53
A. Flush the tube with 30 mL of air
B. Verify tube placement by aspirating gastric contents and checking pH
C. Warm the formula to body temperature
D. Elevate the head of the bed to 45 degrees after the feeding
B. Verify tube placement by aspirating gastric contents and checking pH
*Rationale: Confirming placement of a nasogastric tube before each feeding is
critical to prevent accidental pulmonary administration. Aspirate and check pH
(gastric pH ≤4-5). Elevation of HOB should be done before and during feeding,
not just after. Flushing with air is not a reliable placement test.*
4. A client with major depressive disorder says, “I don’t have anything to live for
anymore.” Which response by the nurse is most therapeutic?
A. “You have so much to live for; think about your children.”
B. “Are you thinking about hurting yourself or ending your life?”
C. “Everyone feels down sometimes; this feeling will pass.”
D. “Why do you feel that way? Your life seems good to me.”
B. “Are you thinking about hurting yourself or ending your life?”
Rationale: Directly assessing for suicidal ideation, plan, intent, and means is a
priority when a client expresses hopelessness. This does not plant the idea and is
a standard safety assessment. Avoid false reassurance, “why” questions, or
minimizing the client’s feelings.
5. A nurse is teaching a client with a new diagnosis of type 2 diabetes about
metformin. Which statement by the client indicates understanding?
A. “I will take this medication only when my blood sugar is high.”
B. “I should take metformin with meals to prevent stomach upset.”
C. “This medication can cause my urine to turn orange.”
D. “I can stop taking it once my blood sugar levels are normal.”
B. “I should take metformin with meals to prevent stomach upset.”
Rationale: Metformin commonly causes gastrointestinal distress (nausea,
diarrhea). Taking with meals reduces these effects. Metformin is taken daily
regardless of blood glucose levels. It does not cause orange urine (that is
rifampin or phenazopyridine). It is not a short-term medication.
6. A nurse is caring for a client who has undergone a total thyroidectomy. The
client reports tingling in the fingers and around the mouth. Which complication
should the nurse suspect?
A. Thyroid storm
,Page 3 of 53
B. Laryngeal nerve damage
C. Hypocalcemia
D. Hemorrhage
C. Hypocalcemia
Rationale: Tingling (paresthesias) of the fingers, toes, and perioral area
indicates hypocalcemia due to accidental removal or damage to the parathyroid
glands during thyroidectomy. Hypocalcemia can lead to tetany and
laryngospasm. Thyroid storm presents with hyperthermia, tachycardia, and
agitation.
7. A nurse is assessing a client who is 2 hours post-cardiac catheterization via the
right femoral artery. The nurse notes the right foot is pale and cool to the touch.
What is the priority action?
A. Elevate the right leg on a pillow
B. Apply warm blankets to both legs
C. Palpate the right dorsalis pedis pulse
D. Encourage range-of-motion exercises to the right foot
C. Palpate the right dorsalis pedis pulse
Rationale: Pallor and coolness suggest arterial occlusion or thrombus
formation. The nurse must immediately assess distal pulses (dorsalis pedis,
posterior tibial) and compare to the contralateral limb. Notify the provider if
pulses are diminished or absent. Elevation or warm blankets do not address
potential occlusion.
8. A client with schizophrenia is prescribed haloperidol. The nurse observes the
client developing a stiff neck, tongue protrusion, and oculogyric crisis. Which
medication should the nurse anticipate administering?
A. Benztropine
B. Naloxone
C. Flumazenil
D. Dantrolene
A. Benztropine
Rationale: These symptoms are acute dystonia, an extrapyramidal side effect of
first-generation antipsychotics. Benztropine (anticholinergic) or
diphenhydramine is given IM to rapidly reverse dystonia. Dantrolene is for
neuroleptic malignant syndrome or malignant hyperthermia. Naloxone reverses
opioids. Flumazenil reverses benzodiazepines.
, Page 4 of 53
9. A nurse is reinforcing discharge teaching to a client with a new prescription for
warfarin. Which over-the-counter medication should the client be advised to
avoid?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
B. Ibuprofen
Rationale: Ibuprofen and other NSAIDs increase the risk of gastrointestinal
bleeding and can potentiate warfarin’s anticoagulant effect. Acetaminophen is
generally safe in low doses (though high doses may affect INR). Antihistamines
(diphenhydramine, loratadine) have no significant interaction.
10. A client with chronic kidney disease has an order for a low-potassium diet.
Which food choice by the client indicates effective teaching?
A. Baked potato
B. Banana
C. Orange juice
D. Apple slices
D. Apple slices
*Rationale: Apples are low in potassium. Potatoes (especially with skin),
bananas, and oranges/orange juice are high-potassium foods (bananas ~400 mg,
orange juice ~500 mg per cup). Clients with CKD should limit potassium to
prevent hyperkalemia.*
11. The nurse is caring for a client who has just returned from the operating room
following a right total knee arthroplasty. Which finding should the nurse report to
the healthcare provider immediately?
A. Pain rated 6/10 on a 0-10 scale
B. Urine output of 60 mL over the past 2 hours
C. Oxygen saturation of 88% on room air
D. Serosanguinous drainage on the dressing
C. Oxygen saturation of 88% on room air
Rationale: Hypoxemia (SpO2 <90%) after major orthopedic surgery may
indicate pulmonary embolism, atelectasis, or fluid overload. This requires
immediate intervention such as supplemental oxygen and assessment. Pain, low
urine output (though concerning), and expected drainage are not immediate life
threats.
SAUNDERS NCLEX-RN COMPREHENSIVE EXAM
TESTBANK 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A nurse is caring for a client who has a chest tube connected to a closed
drainage system following a left lower lobectomy. Which finding requires
immediate intervention?
A. Continuous bubbling in the water seal chamber
B. Fluctuation (tidaling) in the water seal chamber with respirations
C. 100 mL of serosanguinous drainage in the collection chamber over the past hour
D. Subcutaneous emphysema at the insertion site
A. Continuous bubbling in the water seal chamber
*Rationale: Continuous bubbling in the water seal chamber indicates an air
leak, which can compromise lung re-expansion and lead to tension
pneumothorax. Tidaling is normal. Drainage up to 100 mL/hr post-op is
expected initially. Subcutaneous emphysema requires monitoring but is not
immediately life-threatening.*
2. A client with a history of heart failure is receiving furosemide 40 mg IV push.
The nurse notes the client’s serum potassium level is 3.2 mEq/L. Which
assessment finding is most concerning?
A. Dry mucous membranes
B. Muscle weakness and cramping
C. Jugular vein distention
D. Blood pressure 118/72 mm Hg
B. Muscle weakness and cramping
*Rationale: Hypokalemia (K+ <3.5) can cause muscle weakness, fatigue, and leg
cramps. Severe hypokalemia (especially with digoxin therapy) can lead to life-
threatening dysrhythmias such as ventricular tachycardia. Dry mucous
membranes suggest mild dehydration but are less urgent. JVD is a sign of right-
sided failure, not directly related to low potassium.*
3. A nurse is preparing to administer an intermittent enteral feeding through a
nasogastric tube. Which action is most important before starting the feeding?
,Page 2 of 53
A. Flush the tube with 30 mL of air
B. Verify tube placement by aspirating gastric contents and checking pH
C. Warm the formula to body temperature
D. Elevate the head of the bed to 45 degrees after the feeding
B. Verify tube placement by aspirating gastric contents and checking pH
*Rationale: Confirming placement of a nasogastric tube before each feeding is
critical to prevent accidental pulmonary administration. Aspirate and check pH
(gastric pH ≤4-5). Elevation of HOB should be done before and during feeding,
not just after. Flushing with air is not a reliable placement test.*
4. A client with major depressive disorder says, “I don’t have anything to live for
anymore.” Which response by the nurse is most therapeutic?
A. “You have so much to live for; think about your children.”
B. “Are you thinking about hurting yourself or ending your life?”
C. “Everyone feels down sometimes; this feeling will pass.”
D. “Why do you feel that way? Your life seems good to me.”
B. “Are you thinking about hurting yourself or ending your life?”
Rationale: Directly assessing for suicidal ideation, plan, intent, and means is a
priority when a client expresses hopelessness. This does not plant the idea and is
a standard safety assessment. Avoid false reassurance, “why” questions, or
minimizing the client’s feelings.
5. A nurse is teaching a client with a new diagnosis of type 2 diabetes about
metformin. Which statement by the client indicates understanding?
A. “I will take this medication only when my blood sugar is high.”
B. “I should take metformin with meals to prevent stomach upset.”
C. “This medication can cause my urine to turn orange.”
D. “I can stop taking it once my blood sugar levels are normal.”
B. “I should take metformin with meals to prevent stomach upset.”
Rationale: Metformin commonly causes gastrointestinal distress (nausea,
diarrhea). Taking with meals reduces these effects. Metformin is taken daily
regardless of blood glucose levels. It does not cause orange urine (that is
rifampin or phenazopyridine). It is not a short-term medication.
6. A nurse is caring for a client who has undergone a total thyroidectomy. The
client reports tingling in the fingers and around the mouth. Which complication
should the nurse suspect?
A. Thyroid storm
,Page 3 of 53
B. Laryngeal nerve damage
C. Hypocalcemia
D. Hemorrhage
C. Hypocalcemia
Rationale: Tingling (paresthesias) of the fingers, toes, and perioral area
indicates hypocalcemia due to accidental removal or damage to the parathyroid
glands during thyroidectomy. Hypocalcemia can lead to tetany and
laryngospasm. Thyroid storm presents with hyperthermia, tachycardia, and
agitation.
7. A nurse is assessing a client who is 2 hours post-cardiac catheterization via the
right femoral artery. The nurse notes the right foot is pale and cool to the touch.
What is the priority action?
A. Elevate the right leg on a pillow
B. Apply warm blankets to both legs
C. Palpate the right dorsalis pedis pulse
D. Encourage range-of-motion exercises to the right foot
C. Palpate the right dorsalis pedis pulse
Rationale: Pallor and coolness suggest arterial occlusion or thrombus
formation. The nurse must immediately assess distal pulses (dorsalis pedis,
posterior tibial) and compare to the contralateral limb. Notify the provider if
pulses are diminished or absent. Elevation or warm blankets do not address
potential occlusion.
8. A client with schizophrenia is prescribed haloperidol. The nurse observes the
client developing a stiff neck, tongue protrusion, and oculogyric crisis. Which
medication should the nurse anticipate administering?
A. Benztropine
B. Naloxone
C. Flumazenil
D. Dantrolene
A. Benztropine
Rationale: These symptoms are acute dystonia, an extrapyramidal side effect of
first-generation antipsychotics. Benztropine (anticholinergic) or
diphenhydramine is given IM to rapidly reverse dystonia. Dantrolene is for
neuroleptic malignant syndrome or malignant hyperthermia. Naloxone reverses
opioids. Flumazenil reverses benzodiazepines.
, Page 4 of 53
9. A nurse is reinforcing discharge teaching to a client with a new prescription for
warfarin. Which over-the-counter medication should the client be advised to
avoid?
A. Acetaminophen
B. Ibuprofen
C. Diphenhydramine
D. Loratadine
B. Ibuprofen
Rationale: Ibuprofen and other NSAIDs increase the risk of gastrointestinal
bleeding and can potentiate warfarin’s anticoagulant effect. Acetaminophen is
generally safe in low doses (though high doses may affect INR). Antihistamines
(diphenhydramine, loratadine) have no significant interaction.
10. A client with chronic kidney disease has an order for a low-potassium diet.
Which food choice by the client indicates effective teaching?
A. Baked potato
B. Banana
C. Orange juice
D. Apple slices
D. Apple slices
*Rationale: Apples are low in potassium. Potatoes (especially with skin),
bananas, and oranges/orange juice are high-potassium foods (bananas ~400 mg,
orange juice ~500 mg per cup). Clients with CKD should limit potassium to
prevent hyperkalemia.*
11. The nurse is caring for a client who has just returned from the operating room
following a right total knee arthroplasty. Which finding should the nurse report to
the healthcare provider immediately?
A. Pain rated 6/10 on a 0-10 scale
B. Urine output of 60 mL over the past 2 hours
C. Oxygen saturation of 88% on room air
D. Serosanguinous drainage on the dressing
C. Oxygen saturation of 88% on room air
Rationale: Hypoxemia (SpO2 <90%) after major orthopedic surgery may
indicate pulmonary embolism, atelectasis, or fluid overload. This requires
immediate intervention such as supplemental oxygen and assessment. Pain, low
urine output (though concerning), and expected drainage are not immediate life
threats.
