NCLEX-RN Comprehensive Review 155-
Question Practice Bank & Detailed
Rationales (2026 Edition)
Pass your exam on the first try with this NCLEX-RN
comprehensive review practice bank featuring 155 high-
yield questions designed for complete nursing school
mastery. Every question includes a clearly marked correct
answer followed by a deeply detailed, concept-focused
rationale analyzing critical nursing interventions, system
priorities, and diagnostic lab values. Perfect for active
recall and quick retrieval, this premium resource targets
the exact clinical judgment scenarios, safety standards,
and pharmacology facts frequently tested on the modern
NCLEX-RN exam.
,Question 1
A nurse is preparing to administer digoxin to a client with heart failure. Which of the
following laboratory values should the nurse review before administering the
medication?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.2 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Answer: B
Rationale: Hypokalemia (low serum potassium) significantly increases the risk of
digoxin toxicity. The nurse must check potassium levels before administration. A
value of 3.2 mEq/L is below the normal reference range of 3.5 to 5.0 mEq/L,
requiring the nurse to hold the medication and notify the provider. Other listed
values fall within standard normal ranges and do not immediately threaten
digoxin safety.
Question 2
A client is prescribed oral tetracycline for the treatment of acne vulgaris. Which
instruction should the nurse include in the client's discharge teaching?
A) Take the medication with a full glass of milk.
B) Apply sunscreen before going outdoors.
C) Double the dose if a day of medication is missed.
D) Take the medication right before lying down for bed.
Answer: B
Rationale: Tetracycline causes photosensitivity, making the skin highly
susceptible to severe sunburns. Clients must use sunscreen and wear protective
clothing outdoors. Dairy products like milk bind to the drug and prevent
absorption. Taking it right before bed increases the risk of esophageal ulceration,
and clients should never double up on missed doses.
Question 3
A nurse is caring for a client receiving a continuous intravenous heparin infusion for a
deep vein thrombosis. Which of the following laboratory results indicates that the
therapy is therapeutic?
A) Prothrombin time (PT) of 12 seconds
B) International Normalized Ratio (INR) of 2.5
C) Activated partial thromboplastin time (aPTT) of 70 seconds
D) Platelet count of 95,000/mm³
Answer: C
Rationale: Continuous IV heparin efficacy is monitored using the aPTT. A
therapeutic level is typically 1.5 to 2.5 times the normal baseline value, making 70
seconds a desired therapeutic target. PT and INR are used to monitor warfarin
,therapy, not heparin. A platelet count of 95,000/mm³ indicates thrombocytopenia,
which is an adverse effect rather than a therapeutic target.
Question 4
A provider prescribes spironolactone for a client with hepatic cirrhosis. Which dietary
choice by the client demonstrates a need for further teaching?
A) Eating a banana with breakfast every morning
B) Choosing skinless chicken breast for dinner
C) Using apple slices as a afternoon snack
D) Drinking cranberry juice instead of soda
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Bananas are exceptionally high in potassium, so clients taking this
medication should limit their intake to avoid dangerous cardiac arrhythmias.
Chicken, apples, and cranberry juice do not contain excessive potassium levels
and are safe to consume.
Question 5
A client with diabetes mellitus is prescribed subcutaneous insulin glargine. Which
characteristic of this medication should the nurse emphasize during education?
A) It must be mixed with short-acting insulin in the same syringe.
B) It has a rapid onset of action of roughly 15 minutes.
C) It lacks a peak concentration time and lasts up to 24 hours.
D) It should only be administered when a meal tray is present.
Answer: C
Rationale: Insulin glargine is a long-acting insulin formulation designed to
provide a steady basal level of insulin over a 24-hour period without a distinct
peak. Because of its unique pH formulation, it cannot be mixed in the same
syringe with any other insulin type. It does not require immediate food intake
because it lacks a rapid peak effect.
Question 6
A nurse is preparing to administer regular insulin and NPH insulin to a client. Which
action should the nurse take first?
A) Inject air into the regular insulin vial.
B) Inject air into the NPH insulin vial.
C) Withdraw the regular insulin from the vial.
D) Withdraw the NPH insulin from the vial.
Answer: B
, Rationale: When mixing regular (clear) and NPH (cloudy) insulin in the same
syringe, the nurse must first inject air into the cloudy (NPH) vial without touching
the solution. Next, the nurse injects air into the clear (regular) vial, withdraws the
regular insulin, and finally withdraws the NPH insulin. This sequence prevents the
contamination of regular insulin with the NPH protein modifier.
Question 7
A client is prescribed alendronate for the treatment of osteoporosis. Which instruction
should the nurse include in the medication teaching?
A) Take the medication with a full meal to avoid gastric upset.
B) Lie down for 30 minutes after taking the medication to rest.
C) Take the medication first thing in the morning with a full glass of water.
D) Chew the tablet thoroughly before swallowing to speed up absorption.
Answer: C
Rationale: Alendronate is a bisphosphonate that must be taken first thing in the
morning on an empty stomach with at least 8 ounces of plain water. This
maximizes absorption and minimizes esophageal irritation. The client must
remain completely upright for at least 30 minutes afterward; lying down can
cause severe esophageal erosion and ulceration.
Question 8
A nurse is assessing a client who is taking a loop diuretic, furosemide. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A) Hyperkalemia
B) Hypoactivity
C) Muscle weakness
D) Hypertension
Answer: C
Rationale: Furosemide is a potent loop diuretic that causes excretion of water,
sodium, and potassium. A major adverse effect is hypokalemia (low potassium).
Muscle weakness, cramping, and cardiac arrhythmias are classic signs of low
potassium levels. Furosemide causes hypotension, not hypertension, and
hypokalemia causes muscle issues rather than general behavioral hypoactivity.
Question 9
A client with a history of deep vein thrombosis is prescribed warfarin. Which of the
following laboratory values indicates that the client's dose is within the therapeutic
range?
A) aPTT of 35 seconds
B) INR of 2.5
C) PT of 11 seconds
D) Platelets of 150,000/mm³
Answer: B
Question Practice Bank & Detailed
Rationales (2026 Edition)
Pass your exam on the first try with this NCLEX-RN
comprehensive review practice bank featuring 155 high-
yield questions designed for complete nursing school
mastery. Every question includes a clearly marked correct
answer followed by a deeply detailed, concept-focused
rationale analyzing critical nursing interventions, system
priorities, and diagnostic lab values. Perfect for active
recall and quick retrieval, this premium resource targets
the exact clinical judgment scenarios, safety standards,
and pharmacology facts frequently tested on the modern
NCLEX-RN exam.
,Question 1
A nurse is preparing to administer digoxin to a client with heart failure. Which of the
following laboratory values should the nurse review before administering the
medication?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.2 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Answer: B
Rationale: Hypokalemia (low serum potassium) significantly increases the risk of
digoxin toxicity. The nurse must check potassium levels before administration. A
value of 3.2 mEq/L is below the normal reference range of 3.5 to 5.0 mEq/L,
requiring the nurse to hold the medication and notify the provider. Other listed
values fall within standard normal ranges and do not immediately threaten
digoxin safety.
Question 2
A client is prescribed oral tetracycline for the treatment of acne vulgaris. Which
instruction should the nurse include in the client's discharge teaching?
A) Take the medication with a full glass of milk.
B) Apply sunscreen before going outdoors.
C) Double the dose if a day of medication is missed.
D) Take the medication right before lying down for bed.
Answer: B
Rationale: Tetracycline causes photosensitivity, making the skin highly
susceptible to severe sunburns. Clients must use sunscreen and wear protective
clothing outdoors. Dairy products like milk bind to the drug and prevent
absorption. Taking it right before bed increases the risk of esophageal ulceration,
and clients should never double up on missed doses.
Question 3
A nurse is caring for a client receiving a continuous intravenous heparin infusion for a
deep vein thrombosis. Which of the following laboratory results indicates that the
therapy is therapeutic?
A) Prothrombin time (PT) of 12 seconds
B) International Normalized Ratio (INR) of 2.5
C) Activated partial thromboplastin time (aPTT) of 70 seconds
D) Platelet count of 95,000/mm³
Answer: C
Rationale: Continuous IV heparin efficacy is monitored using the aPTT. A
therapeutic level is typically 1.5 to 2.5 times the normal baseline value, making 70
seconds a desired therapeutic target. PT and INR are used to monitor warfarin
,therapy, not heparin. A platelet count of 95,000/mm³ indicates thrombocytopenia,
which is an adverse effect rather than a therapeutic target.
Question 4
A provider prescribes spironolactone for a client with hepatic cirrhosis. Which dietary
choice by the client demonstrates a need for further teaching?
A) Eating a banana with breakfast every morning
B) Choosing skinless chicken breast for dinner
C) Using apple slices as a afternoon snack
D) Drinking cranberry juice instead of soda
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Bananas are exceptionally high in potassium, so clients taking this
medication should limit their intake to avoid dangerous cardiac arrhythmias.
Chicken, apples, and cranberry juice do not contain excessive potassium levels
and are safe to consume.
Question 5
A client with diabetes mellitus is prescribed subcutaneous insulin glargine. Which
characteristic of this medication should the nurse emphasize during education?
A) It must be mixed with short-acting insulin in the same syringe.
B) It has a rapid onset of action of roughly 15 minutes.
C) It lacks a peak concentration time and lasts up to 24 hours.
D) It should only be administered when a meal tray is present.
Answer: C
Rationale: Insulin glargine is a long-acting insulin formulation designed to
provide a steady basal level of insulin over a 24-hour period without a distinct
peak. Because of its unique pH formulation, it cannot be mixed in the same
syringe with any other insulin type. It does not require immediate food intake
because it lacks a rapid peak effect.
Question 6
A nurse is preparing to administer regular insulin and NPH insulin to a client. Which
action should the nurse take first?
A) Inject air into the regular insulin vial.
B) Inject air into the NPH insulin vial.
C) Withdraw the regular insulin from the vial.
D) Withdraw the NPH insulin from the vial.
Answer: B
, Rationale: When mixing regular (clear) and NPH (cloudy) insulin in the same
syringe, the nurse must first inject air into the cloudy (NPH) vial without touching
the solution. Next, the nurse injects air into the clear (regular) vial, withdraws the
regular insulin, and finally withdraws the NPH insulin. This sequence prevents the
contamination of regular insulin with the NPH protein modifier.
Question 7
A client is prescribed alendronate for the treatment of osteoporosis. Which instruction
should the nurse include in the medication teaching?
A) Take the medication with a full meal to avoid gastric upset.
B) Lie down for 30 minutes after taking the medication to rest.
C) Take the medication first thing in the morning with a full glass of water.
D) Chew the tablet thoroughly before swallowing to speed up absorption.
Answer: C
Rationale: Alendronate is a bisphosphonate that must be taken first thing in the
morning on an empty stomach with at least 8 ounces of plain water. This
maximizes absorption and minimizes esophageal irritation. The client must
remain completely upright for at least 30 minutes afterward; lying down can
cause severe esophageal erosion and ulceration.
Question 8
A nurse is assessing a client who is taking a loop diuretic, furosemide. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A) Hyperkalemia
B) Hypoactivity
C) Muscle weakness
D) Hypertension
Answer: C
Rationale: Furosemide is a potent loop diuretic that causes excretion of water,
sodium, and potassium. A major adverse effect is hypokalemia (low potassium).
Muscle weakness, cramping, and cardiac arrhythmias are classic signs of low
potassium levels. Furosemide causes hypotension, not hypertension, and
hypokalemia causes muscle issues rather than general behavioral hypoactivity.
Question 9
A client with a history of deep vein thrombosis is prescribed warfarin. Which of the
following laboratory values indicates that the client's dose is within the therapeutic
range?
A) aPTT of 35 seconds
B) INR of 2.5
C) PT of 11 seconds
D) Platelets of 150,000/mm³
Answer: B
