NCLEX-RN Integrated Review Exam Prep – Real Practice
Questions, Answers & Detailed Rationales (Updated 2026) |
Medical-Surgical Nursing, Pharmacology & Dosage
Calculations, Maternal-Newborn & Pediatric Nursing, Mental
Health & Psychiatric Care, Critical Care & Emergency
Nursing, Patient Safety & Infection Control, NCLEX-Style
Clinical Judgment, Prioritization & Comprehensive RN
Review
Question 1: A nurse is caring for a client with heart failure who has been prescribed
furosemide 40 mg IV push. Which assessment finding requires the nurse to hold
the medication and notify the provider?
A. Blood pressure 138/86 mm Hg
B. Serum potassium 3.2 mEq/L
C. Urine output 45 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, increasing
the risk of hypokalemia. A serum potassium level of 3.2 mEq/L is below the normal
range (3.5-5.0 mEq/L) and can predispose the client to life-threatening cardiac
dysrhythmias. The nurse should hold the dose and notify the provider for possible
potassium replacement or dosage adjustment. Options A, C, and D are expected
findings in heart failure management and do not contraindicate furosemide
administration.
Question 2: A nurse is preparing to administer insulin glargine and insulin aspart to
a client with type 1 diabetes. Which action should the nurse take first?
A. Draw up insulin glargine into a syringe
B. Verify the client's blood glucose level
C. Administer insulin aspart subcutaneously
D. Rotate the injection site from the previous dose
CORRECT ANSWER: B. Verify the client's blood glucose level
Rationale: Before administering any insulin, the nurse must verify the client's current
blood glucose level to determine the appropriate dose, especially for rapid-acting
insulin like aspart, which is often dosed based on sliding scale parameters.
Administering insulin without confirming blood glucose can lead to severe
hypoglycemia. Insulin glargine is a long-acting basal insulin and should never be mixed
with other insulins. While site rotation is important, it is not the priority action before
administration.
,Question 3: A postoperative client reports sudden onset of shortness of breath and
chest pain. The nurse notes tachycardia and oxygen saturation of 88% on room air.
Which intervention should the nurse implement first?
A. Administer prescribed morphine sulfate IV
B. Apply oxygen via nasal cannula at 2 L/min
C. Notify the rapid response team
D. Obtain a stat chest x-ray
CORRECT ANSWER: B. Apply oxygen via nasal cannula at 2 L/min
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the nurse's
first action is to address the client's hypoxia by applying supplemental oxygen to
improve oxygen saturation. While notifying the rapid response team is critical, initiating
oxygen therapy can be done simultaneously and addresses the immediate life-
threatening issue of hypoxemia. Morphine may be indicated for pain or pulmonary
embolism but is not the first intervention. A chest x-ray is diagnostic but does not
address the immediate physiological need.
Question 4: A nurse is teaching a client with chronic obstructive pulmonary disease
(COPD) about energy conservation techniques. Which statement by the client
indicates a need for further teaching?
A. "I will sit while brushing my teeth and combing my hair."
B. "I will take frequent rest breaks during activities."
C. "I will perform all my household chores in the morning when I have the most energy."
D. "I will use a rolling cart to transport items when cleaning."
CORRECT ANSWER: C. "I will perform all my household chores in the morning when
I have the most energy."
Rationale: Clients with COPD should pace activities throughout the day rather than
clustering them in one time period, even if energy levels are higher in the morning.
Performing all chores at once can lead to excessive fatigue and dyspnea. Energy
conservation involves spreading tasks out, sitting when possible, taking rest breaks, and
using assistive devices. Options A, B, and D demonstrate correct understanding of
energy conservation principles.
Question 5: A nurse is assessing a client who is 2 hours postoperative from a total
hip arthroplasty. Which finding should the nurse report to the provider
immediately?
A. Pain rating of 6 on a 0-10 scale
B. Serous drainage on the dressing
C. Shortening and external rotation of the affected leg
D. Temperature of 99.1°F (37.3°C)
CORRECT ANSWER: C. Shortening and external rotation of the affected leg
,Rationale: Shortening and external rotation of the affected leg are classic signs of hip
prosthesis dislocation, a serious complication requiring immediate reduction. Pain,
serous drainage, and a low-grade fever are expected findings in the immediate
postoperative period. The nurse must recognize orthopedic emergency signs to prevent
further joint damage and ensure prompt intervention.
Question 6: A nurse is caring for a client with a new colostomy. Which observation
indicates that the client is beginning to accept the change in body image?
A. The client asks the nurse to perform all stoma care
B. The client looks at the stoma during a dressing change
C. The client states, "I can't believe this is happening to me."
D. The client refuses to discuss discharge planning
CORRECT ANSWER: B. The client looks at the stoma during a dressing change
Rationale: Looking at the stoma represents an initial step toward acceptance of the
altered body image. Avoidance behaviors (options A, C, D) indicate denial or difficulty
coping. Acceptance is a gradual process; visual engagement with the stoma
demonstrates willingness to acknowledge and eventually manage the change. The
nurse should support this progress with education and emotional support.
Question 7: A nurse is preparing to administer digoxin 0.125 mg orally to a client
with heart failure. The client's apical pulse is 58 beats per minute. Which action
should the nurse take?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the dose and notify the provider
Rationale: Digoxin can cause bradycardia, and the medication should be held if the
apical pulse is below 60 beats per minute in adults. Administering digoxin with a pulse
of 58 bpm increases the risk of severe bradycardia or heart block. The nurse must follow
facility protocol and provider parameters for holding cardiac medications. Rechecking
the pulse or altering the dose without an order is outside the nurse's scope.
Question 8: A nurse is caring for a client receiving continuous enteral feedings via a
nasogastric tube. Which intervention is most important to prevent aspiration?
A. Check gastric residual volume every 4 hours
B. Keep the head of the bed elevated at least 30 degrees
C. Flush the tube with 30 mL of water every 4 hours
D. Change the feeding bag every 24 hours
CORRECT ANSWER: B. Keep the head of the bed elevated at least 30 degrees
, Rationale: Elevating the head of the bed to at least 30 degrees (preferably 45 degrees) is
the most effective intervention to reduce the risk of aspiration during enteral feedings by
using gravity to keep gastric contents from refluxing. While checking residuals, flushing
the tube, and changing equipment are important for tube patency and infection control,
they do not directly prevent aspiration as effectively as proper positioning.
Question 9: A nurse is reviewing the laboratory results for a client with chronic
kidney disease. Which value requires immediate notification of the provider?
A. Serum creatinine 2.1 mg/dL
B. Blood urea nitrogen (BUN) 38 mg/dL
C. Serum potassium 6.8 mEq/L
D. Hemoglobin 10.2 g/dL
CORRECT ANSWER: C. Serum potassium 6.8 mEq/L
Rationale: A serum potassium level of 6.8 mEq/L is critically high (normal 3.5-5.0
mEq/L) and places the client at immediate risk for life-threatening cardiac dysrhythmias
or cardiac arrest. Hyperkalemia is a common and dangerous complication of chronic
kidney disease due to decreased excretion. While elevated creatinine, BUN, and low
hemoglobin are expected in CKD, they do not require the same urgent intervention as
severe hyperkalemia.
Question 10: A nurse is caring for a client who is experiencing acute anxiety. Which
communication technique is most therapeutic?
A. "Try not to worry; everything will be fine."
B. "What do you think is causing your anxiety?"
C. "I can see you're feeling anxious. I'm here with you."
D. "Let's focus on something positive right now."
CORRECT ANSWER: C. "I can see you're feeling anxious. I'm here with you."
Rationale: This response uses therapeutic communication by acknowledging the
client's feelings, demonstrating empathy, and offering presence without minimizing or
redirecting the emotion. Options A and D dismiss the client's experience, while option B
may increase anxiety by demanding cognitive processing during acute distress. The
nurse's calm presence validates the client's feelings and promotes safety.
Question 11: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Assess the IV site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse
Questions, Answers & Detailed Rationales (Updated 2026) |
Medical-Surgical Nursing, Pharmacology & Dosage
Calculations, Maternal-Newborn & Pediatric Nursing, Mental
Health & Psychiatric Care, Critical Care & Emergency
Nursing, Patient Safety & Infection Control, NCLEX-Style
Clinical Judgment, Prioritization & Comprehensive RN
Review
Question 1: A nurse is caring for a client with heart failure who has been prescribed
furosemide 40 mg IV push. Which assessment finding requires the nurse to hold
the medication and notify the provider?
A. Blood pressure 138/86 mm Hg
B. Serum potassium 3.2 mEq/L
C. Urine output 45 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, increasing
the risk of hypokalemia. A serum potassium level of 3.2 mEq/L is below the normal
range (3.5-5.0 mEq/L) and can predispose the client to life-threatening cardiac
dysrhythmias. The nurse should hold the dose and notify the provider for possible
potassium replacement or dosage adjustment. Options A, C, and D are expected
findings in heart failure management and do not contraindicate furosemide
administration.
Question 2: A nurse is preparing to administer insulin glargine and insulin aspart to
a client with type 1 diabetes. Which action should the nurse take first?
A. Draw up insulin glargine into a syringe
B. Verify the client's blood glucose level
C. Administer insulin aspart subcutaneously
D. Rotate the injection site from the previous dose
CORRECT ANSWER: B. Verify the client's blood glucose level
Rationale: Before administering any insulin, the nurse must verify the client's current
blood glucose level to determine the appropriate dose, especially for rapid-acting
insulin like aspart, which is often dosed based on sliding scale parameters.
Administering insulin without confirming blood glucose can lead to severe
hypoglycemia. Insulin glargine is a long-acting basal insulin and should never be mixed
with other insulins. While site rotation is important, it is not the priority action before
administration.
,Question 3: A postoperative client reports sudden onset of shortness of breath and
chest pain. The nurse notes tachycardia and oxygen saturation of 88% on room air.
Which intervention should the nurse implement first?
A. Administer prescribed morphine sulfate IV
B. Apply oxygen via nasal cannula at 2 L/min
C. Notify the rapid response team
D. Obtain a stat chest x-ray
CORRECT ANSWER: B. Apply oxygen via nasal cannula at 2 L/min
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the nurse's
first action is to address the client's hypoxia by applying supplemental oxygen to
improve oxygen saturation. While notifying the rapid response team is critical, initiating
oxygen therapy can be done simultaneously and addresses the immediate life-
threatening issue of hypoxemia. Morphine may be indicated for pain or pulmonary
embolism but is not the first intervention. A chest x-ray is diagnostic but does not
address the immediate physiological need.
Question 4: A nurse is teaching a client with chronic obstructive pulmonary disease
(COPD) about energy conservation techniques. Which statement by the client
indicates a need for further teaching?
A. "I will sit while brushing my teeth and combing my hair."
B. "I will take frequent rest breaks during activities."
C. "I will perform all my household chores in the morning when I have the most energy."
D. "I will use a rolling cart to transport items when cleaning."
CORRECT ANSWER: C. "I will perform all my household chores in the morning when
I have the most energy."
Rationale: Clients with COPD should pace activities throughout the day rather than
clustering them in one time period, even if energy levels are higher in the morning.
Performing all chores at once can lead to excessive fatigue and dyspnea. Energy
conservation involves spreading tasks out, sitting when possible, taking rest breaks, and
using assistive devices. Options A, B, and D demonstrate correct understanding of
energy conservation principles.
Question 5: A nurse is assessing a client who is 2 hours postoperative from a total
hip arthroplasty. Which finding should the nurse report to the provider
immediately?
A. Pain rating of 6 on a 0-10 scale
B. Serous drainage on the dressing
C. Shortening and external rotation of the affected leg
D. Temperature of 99.1°F (37.3°C)
CORRECT ANSWER: C. Shortening and external rotation of the affected leg
,Rationale: Shortening and external rotation of the affected leg are classic signs of hip
prosthesis dislocation, a serious complication requiring immediate reduction. Pain,
serous drainage, and a low-grade fever are expected findings in the immediate
postoperative period. The nurse must recognize orthopedic emergency signs to prevent
further joint damage and ensure prompt intervention.
Question 6: A nurse is caring for a client with a new colostomy. Which observation
indicates that the client is beginning to accept the change in body image?
A. The client asks the nurse to perform all stoma care
B. The client looks at the stoma during a dressing change
C. The client states, "I can't believe this is happening to me."
D. The client refuses to discuss discharge planning
CORRECT ANSWER: B. The client looks at the stoma during a dressing change
Rationale: Looking at the stoma represents an initial step toward acceptance of the
altered body image. Avoidance behaviors (options A, C, D) indicate denial or difficulty
coping. Acceptance is a gradual process; visual engagement with the stoma
demonstrates willingness to acknowledge and eventually manage the change. The
nurse should support this progress with education and emotional support.
Question 7: A nurse is preparing to administer digoxin 0.125 mg orally to a client
with heart failure. The client's apical pulse is 58 beats per minute. Which action
should the nurse take?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes
CORRECT ANSWER: B. Hold the dose and notify the provider
Rationale: Digoxin can cause bradycardia, and the medication should be held if the
apical pulse is below 60 beats per minute in adults. Administering digoxin with a pulse
of 58 bpm increases the risk of severe bradycardia or heart block. The nurse must follow
facility protocol and provider parameters for holding cardiac medications. Rechecking
the pulse or altering the dose without an order is outside the nurse's scope.
Question 8: A nurse is caring for a client receiving continuous enteral feedings via a
nasogastric tube. Which intervention is most important to prevent aspiration?
A. Check gastric residual volume every 4 hours
B. Keep the head of the bed elevated at least 30 degrees
C. Flush the tube with 30 mL of water every 4 hours
D. Change the feeding bag every 24 hours
CORRECT ANSWER: B. Keep the head of the bed elevated at least 30 degrees
, Rationale: Elevating the head of the bed to at least 30 degrees (preferably 45 degrees) is
the most effective intervention to reduce the risk of aspiration during enteral feedings by
using gravity to keep gastric contents from refluxing. While checking residuals, flushing
the tube, and changing equipment are important for tube patency and infection control,
they do not directly prevent aspiration as effectively as proper positioning.
Question 9: A nurse is reviewing the laboratory results for a client with chronic
kidney disease. Which value requires immediate notification of the provider?
A. Serum creatinine 2.1 mg/dL
B. Blood urea nitrogen (BUN) 38 mg/dL
C. Serum potassium 6.8 mEq/L
D. Hemoglobin 10.2 g/dL
CORRECT ANSWER: C. Serum potassium 6.8 mEq/L
Rationale: A serum potassium level of 6.8 mEq/L is critically high (normal 3.5-5.0
mEq/L) and places the client at immediate risk for life-threatening cardiac dysrhythmias
or cardiac arrest. Hyperkalemia is a common and dangerous complication of chronic
kidney disease due to decreased excretion. While elevated creatinine, BUN, and low
hemoglobin are expected in CKD, they do not require the same urgent intervention as
severe hyperkalemia.
Question 10: A nurse is caring for a client who is experiencing acute anxiety. Which
communication technique is most therapeutic?
A. "Try not to worry; everything will be fine."
B. "What do you think is causing your anxiety?"
C. "I can see you're feeling anxious. I'm here with you."
D. "Let's focus on something positive right now."
CORRECT ANSWER: C. "I can see you're feeling anxious. I'm here with you."
Rationale: This response uses therapeutic communication by acknowledging the
client's feelings, demonstrating empathy, and offering presence without minimizing or
redirecting the emotion. Options A and D dismiss the client's experience, while option B
may increase anxiety by demanding cognitive processing during acute distress. The
nurse's calm presence validates the client's feelings and promotes safety.
Question 11: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Assess the IV site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse
