NCLEX-RN Comprehensive Practice Exam
2026/2027 – Verified Q&As with Detailed
Rationales (Test Bank Bundle - 64 Questions)
---
**QUESTION 1:**
A client with heart failure reports sudden weight gain and ankle swelling. What is the nurse's priority
action?
A) Restrict oral fluids to 500 mL/day.
B) Administer a diuretic as ordered.
C) Assess lung sounds and oxygen saturation.
D) Encourage leg elevation while sitting.
> 🎯 **CORRECT ANSWER:** C) Assess lung sounds and oxygen saturation.
> 💡 **CLINICAL RATIONALE:** Weight gain and edema indicate fluid overload; lung sounds assess
pulmonary congestion.
---
**QUESTION 2:**
Which EKG finding is most characteristic of atrial fibrillation?
A) Absent P waves with irregular ventricular response.
B) Wide QRS complexes with a slow rate.
C) Saw-toothed flutter waves.
D) Tall peaked T waves.
> 🎯 **CORRECT ANSWER:** A) Absent P waves with irregular ventricular response.
> 💡 **CLINICAL RATIONALE:** Chaotic atrial activity replaces P waves, causing an irregularly irregular
rhythm.
---
,**QUESTION 3:**
A patient post-MI is on aspirin and clopidogrel. Which symptom would the nurse report immediately?
A) Mild headache.
B) Black, tarry stools.
C) Muscle aches.
D) Occasional nosebleed.
> 🎯 **CORRECT ANSWER:** B) Black, tarry stools.
> 💡 **CLINICAL RATIONALE:** Indicates upper GI bleeding from antiplatelet therapy.
---
**QUESTION 4:**
A client with COPD has a SpO2 of 88% on 2L nasal cannula. What is the best next action?
A) Increase oxygen to 4L.
B) Place in high Fowler's position and reassess.
C) Notify the rapid response team.
D) Prepare for intubation.
> 🎯 **CORRECT ANSWER:** B) Place in high Fowler's position and reassess.
> 💡 **CLINICAL RATIONALE:** Optimizes ventilation; hypoxic drive risk limits oxygen increase.
---
**QUESTION 5:**
Which lab value indicates a client is ready for discharge after a DVT on heparin?
A) aPTT 40 seconds.
B) aPTT 70 seconds.
C) INR 2.5.
D) Platelets 80,000.
> 🎯 **CORRECT ANSWER:** C) INR 2.5.
> 💡 **CLINICAL RATIONALE:** Transition to warfarin requires therapeutic INR (2-3).
, ---
**QUESTION 6:**
A client with severe preeclampsia is receiving IV magnesium sulfate. Which finding indicates toxicity?
A) Deep tendon reflexes 2+.
B) Urine output 40 mL/hr.
C) Respiratory rate 10/min.
D) Blood pressure 140/90.
> 🎯 **CORRECT ANSWER:** C) Respiratory rate 10/min.
> 💡 **CLINICAL RATIONALE:** RR <12 signals magnesium toxicity; calcium gluconate is antidote.
---
**QUESTION 7:**
A client's ABG shows pH 7.32, PaCO2 48, HCO3 22. What is the interpretation?
A) Metabolic acidosis.
B) Respiratory acidosis.
C) Metabolic alkalosis.
D) Respiratory alkalosis.
> 🎯 **CORRECT ANSWER:** B) Respiratory acidosis.
> 💡 **CLINICAL RATIONALE:** Low pH with elevated CO2 indicates primary respiratory acidosis.
---
**QUESTION 8:**
A diabetic patient has a blood glucose of 320 mg/dL and ketones in urine. What intervention is priority?
A) Administer regular insulin IV push.
B) Encourage oral fluids.
C) Start an insulin drip per protocol.
D) Check serum potassium.
2026/2027 – Verified Q&As with Detailed
Rationales (Test Bank Bundle - 64 Questions)
---
**QUESTION 1:**
A client with heart failure reports sudden weight gain and ankle swelling. What is the nurse's priority
action?
A) Restrict oral fluids to 500 mL/day.
B) Administer a diuretic as ordered.
C) Assess lung sounds and oxygen saturation.
D) Encourage leg elevation while sitting.
> 🎯 **CORRECT ANSWER:** C) Assess lung sounds and oxygen saturation.
> 💡 **CLINICAL RATIONALE:** Weight gain and edema indicate fluid overload; lung sounds assess
pulmonary congestion.
---
**QUESTION 2:**
Which EKG finding is most characteristic of atrial fibrillation?
A) Absent P waves with irregular ventricular response.
B) Wide QRS complexes with a slow rate.
C) Saw-toothed flutter waves.
D) Tall peaked T waves.
> 🎯 **CORRECT ANSWER:** A) Absent P waves with irregular ventricular response.
> 💡 **CLINICAL RATIONALE:** Chaotic atrial activity replaces P waves, causing an irregularly irregular
rhythm.
---
,**QUESTION 3:**
A patient post-MI is on aspirin and clopidogrel. Which symptom would the nurse report immediately?
A) Mild headache.
B) Black, tarry stools.
C) Muscle aches.
D) Occasional nosebleed.
> 🎯 **CORRECT ANSWER:** B) Black, tarry stools.
> 💡 **CLINICAL RATIONALE:** Indicates upper GI bleeding from antiplatelet therapy.
---
**QUESTION 4:**
A client with COPD has a SpO2 of 88% on 2L nasal cannula. What is the best next action?
A) Increase oxygen to 4L.
B) Place in high Fowler's position and reassess.
C) Notify the rapid response team.
D) Prepare for intubation.
> 🎯 **CORRECT ANSWER:** B) Place in high Fowler's position and reassess.
> 💡 **CLINICAL RATIONALE:** Optimizes ventilation; hypoxic drive risk limits oxygen increase.
---
**QUESTION 5:**
Which lab value indicates a client is ready for discharge after a DVT on heparin?
A) aPTT 40 seconds.
B) aPTT 70 seconds.
C) INR 2.5.
D) Platelets 80,000.
> 🎯 **CORRECT ANSWER:** C) INR 2.5.
> 💡 **CLINICAL RATIONALE:** Transition to warfarin requires therapeutic INR (2-3).
, ---
**QUESTION 6:**
A client with severe preeclampsia is receiving IV magnesium sulfate. Which finding indicates toxicity?
A) Deep tendon reflexes 2+.
B) Urine output 40 mL/hr.
C) Respiratory rate 10/min.
D) Blood pressure 140/90.
> 🎯 **CORRECT ANSWER:** C) Respiratory rate 10/min.
> 💡 **CLINICAL RATIONALE:** RR <12 signals magnesium toxicity; calcium gluconate is antidote.
---
**QUESTION 7:**
A client's ABG shows pH 7.32, PaCO2 48, HCO3 22. What is the interpretation?
A) Metabolic acidosis.
B) Respiratory acidosis.
C) Metabolic alkalosis.
D) Respiratory alkalosis.
> 🎯 **CORRECT ANSWER:** B) Respiratory acidosis.
> 💡 **CLINICAL RATIONALE:** Low pH with elevated CO2 indicates primary respiratory acidosis.
---
**QUESTION 8:**
A diabetic patient has a blood glucose of 320 mg/dL and ketones in urine. What intervention is priority?
A) Administer regular insulin IV push.
B) Encourage oral fluids.
C) Start an insulin drip per protocol.
D) Check serum potassium.
