NCLEX-RN BSN Year 3 Clinical Final Exam Prep 2026/2027 UPDATE
1. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.2 mEq/L. Which medication should the nurse anticipate administering first?
A. Spironolactone
B. Furosemide
C. Sodium polystyrene sulfonate
D. Lisinopril
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that
removes potassium via the GI tract, addressing hyperkalemia. Spironolactone and
Lisinopril can increase potassium.
2. Which assessment finding in a patient 24 hours post-abdominal surgery
requires immediate intervention?
A. Absent bowel sounds in all four quadrants
B. Serosanguinous drainage on the dressing
C. Pain level of 6/10 on the numeric scale
D. Urine output of 20 mL per hour for two consecutive hours
Answer: D
Rationale: A urine output of less than 30 mL/hr indicates poor renal perfusion or potential
shock and requires immediate notification of the provider.
,3. A nurse is caring for a client with Type 1 Diabetes Mellitus who is sweating
and shaky. The fingerstick glucose is 55 mg/dL. What is the priority action?
A. Notify the healthcare provider immediately
B. Administer 10 units of regular insulin
C. Administer 15g of simple carbohydrates
D. Re-check the blood glucose in 30 minutes
Answer: C
Rationale: The rule of 15 applies for hypoglycemia: 15g of simple carbs, wait 15 minutes,
and re-test.
4. A client is diagnosed with right-sided heart failure. Which clinical
manifestation should the nurse expect to find?
A. Crackles in the lungs
B. Dyspnea on exertion
C. Peripheral edema
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure leads to systemic congestion, manifested by peripheral
edema, JVD, and hepatomegaly. Left-sided failure causes pulmonary symptoms.
5. Which fetal heart rate pattern requires the nurse to reposition the mother to
her left side and start oxygen?
A. Early decelerations
B. Accelerations
C. Late decelerations
D. Variability
Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency and are a non-
reassuring sign requiring immediate intrauterine resuscitation.
, 6. A nurse is preparing to administer Digoxin. Which vital sign must be checked
prior to administration?
A. Blood pressure
B. Respiratory rate
C. Apical pulse
D. Temperature
Answer: C
Rationale: Digoxin should be held if the apical pulse is less than 60 bpm in adults to
prevent bradycardia.
7. A patient is receiving a blood transfusion and begins to complain of back pain
and chills. What is the nurse’s first action?
A. Slow the infusion rate
B. Check the patient’s temperature
C. Administer diphenhydramine
D. Stop the infusion immediately
Answer: D
Rationale: Back pain and chills suggest a hemolytic reaction. The infusion must be stopped
immediately to prevent further injury.
8. In a patient with a suspected stroke, what is the most important question for
the nurse to ask family members?
A. Does the patient have high blood pressure?
B. What did the patient eat last?
C. When did the symptoms first begin?
D. Is there a family history of stroke?
Answer: C
Rationale: The timing of symptom onset determines eligibility for thrombolytic therapy
(tPA), which has a narrow therapeutic window.
1. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.2 mEq/L. Which medication should the nurse anticipate administering first?
A. Spironolactone
B. Furosemide
C. Sodium polystyrene sulfonate
D. Lisinopril
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that
removes potassium via the GI tract, addressing hyperkalemia. Spironolactone and
Lisinopril can increase potassium.
2. Which assessment finding in a patient 24 hours post-abdominal surgery
requires immediate intervention?
A. Absent bowel sounds in all four quadrants
B. Serosanguinous drainage on the dressing
C. Pain level of 6/10 on the numeric scale
D. Urine output of 20 mL per hour for two consecutive hours
Answer: D
Rationale: A urine output of less than 30 mL/hr indicates poor renal perfusion or potential
shock and requires immediate notification of the provider.
,3. A nurse is caring for a client with Type 1 Diabetes Mellitus who is sweating
and shaky. The fingerstick glucose is 55 mg/dL. What is the priority action?
A. Notify the healthcare provider immediately
B. Administer 10 units of regular insulin
C. Administer 15g of simple carbohydrates
D. Re-check the blood glucose in 30 minutes
Answer: C
Rationale: The rule of 15 applies for hypoglycemia: 15g of simple carbs, wait 15 minutes,
and re-test.
4. A client is diagnosed with right-sided heart failure. Which clinical
manifestation should the nurse expect to find?
A. Crackles in the lungs
B. Dyspnea on exertion
C. Peripheral edema
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure leads to systemic congestion, manifested by peripheral
edema, JVD, and hepatomegaly. Left-sided failure causes pulmonary symptoms.
5. Which fetal heart rate pattern requires the nurse to reposition the mother to
her left side and start oxygen?
A. Early decelerations
B. Accelerations
C. Late decelerations
D. Variability
Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency and are a non-
reassuring sign requiring immediate intrauterine resuscitation.
, 6. A nurse is preparing to administer Digoxin. Which vital sign must be checked
prior to administration?
A. Blood pressure
B. Respiratory rate
C. Apical pulse
D. Temperature
Answer: C
Rationale: Digoxin should be held if the apical pulse is less than 60 bpm in adults to
prevent bradycardia.
7. A patient is receiving a blood transfusion and begins to complain of back pain
and chills. What is the nurse’s first action?
A. Slow the infusion rate
B. Check the patient’s temperature
C. Administer diphenhydramine
D. Stop the infusion immediately
Answer: D
Rationale: Back pain and chills suggest a hemolytic reaction. The infusion must be stopped
immediately to prevent further injury.
8. In a patient with a suspected stroke, what is the most important question for
the nurse to ask family members?
A. Does the patient have high blood pressure?
B. What did the patient eat last?
C. When did the symptoms first begin?
D. Is there a family history of stroke?
Answer: C
Rationale: The timing of symptom onset determines eligibility for thrombolytic therapy
(tPA), which has a narrow therapeutic window.
