NCSBN LEARNING EXTENSION MOCK
EXAMINATION (2026–2027)
PRACTICE EXAMINATION FOR NCLEX-RN AND
NCLEX-PN SUCCESS
Field of Study: Comprehensive Nursing / NCLEX Review
Edition: 2026–2027
1. The nurse is caring for a client with a chest tube to water seal drainage. Which observation
indicates that the system is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Fluctuation (tidaling) of the water level in the water seal chamber with respirations
C) No fluctuation in the water seal chamber
D) Continuous bubbling in the suction control chamber
Correct Answer: B
Rationale: Tidaling reflects changes in intrapleural pressure during breathing and indicates a patent,
functioning system. Continuous bubbling in the water seal chamber (A) indicates an air leak. No
fluctuation (C) could mean the lung has re-expanded or the tube is blocked. Continuous bubbling in
the suction control chamber (D) is expected when suction is applied.
2. A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The TPN bag
is empty, and a new bag is not available. The nurse should administer:
A) 0.9% sodium chloride at the same rate
B) 10% dextrose in water at the same rate
C) Lactated Ringer's solution at a keep-vein-open rate
D) Nothing until the new TPN bag arrives
,Correct Answer: B
Rationale: Abruptly discontinuing TPN can cause hypoglycemia. Administering 10% dextrose in water
at the same infusion rate prevents this complication until TPN is available. 0.9% saline (A) and
lactated Ringer's (C) do not provide glucose. Waiting (D) risks severe hypoglycemia.
3. The nurse is preparing to administer an intramuscular injection to a 6-month-old infant. Which
site should the nurse select?
A) Deltoid muscle
B) Vastus lateralis muscle
C) Dorsogluteal muscle
D) Ventrogluteal muscle
Correct Answer: B
Rationale: The vastus lateralis is the preferred IM site for infants because it is well-developed, easily
accessible, and free of major nerves and blood vessels. The deltoid (A) is used for older children and
adults. The dorsogluteal (C) is not recommended for children under 3 years. The ventrogluteal (D) may
be used but is less commonly selected for infants.
4. A client with heart failure is receiving furosemide and digoxin. The nurse should monitor the
client for which sign of digoxin toxicity?
A) Weight loss
B) Yellow-green halos around lights
C) Increased urine output
D) Decreased respiratory rate
Correct Answer: B
Rationale: Digoxin toxicity commonly presents with visual disturbances such as yellow-green halos,
nausea, vomiting, and arrhythmias. Hypokalemia from furosemide increases toxicity risk. Weight loss
(A) and increased urine output (C) are expected diuretic effects. Respiratory rate changes (D) are not
primary signs.
,5. The nurse is teaching a client about collecting a 24-hour urine specimen. Which statement by the
client indicates correct understanding?
A) "I will collect the first morning void and then all urine for 24 hours."
B) "I will discard the first morning void, collect all subsequent urine for 24 hours, including the
final void at the end of the 24 hours."
C) "I will collect urine only during the daytime hours."
D) "I will keep the urine at room temperature."
Correct Answer: B
Rationale: The timed collection begins after discarding the first morning void. All urine for the next 24
hours is collected, ending with the final void exactly 24 hours later. The specimen must be kept
refrigerated or on ice (D is incorrect).
6. A client with diabetes mellitus has a blood glucose of 55 mg/dL. The client is alert and able to
swallow. Which food should the nurse offer first?
A) A peanut butter sandwich
B) 4 ounces of orange juice
C) A diet soda
D) A slice of cheese
Correct Answer: B
Rationale: For conscious hypoglycemia, the nurse should administer 15–20 grams of a fast-acting
carbohydrate such as orange juice. Peanut butter (A) and cheese (D) contain protein and fat that delay
absorption. Diet soda (C) does not contain sugar.
7. The nurse is caring for a client who is 2 days postoperative after abdominal surgery. The client
reports nausea and has hypoactive bowel sounds. Which intervention should the nurse perform
first?
A) Administer an antiemetic as prescribed
B) Encourage ambulation
, C) Insert a nasogastric tube
D) Provide sips of water
Correct Answer: B
Rationale: Ambulation stimulates peristalsis and can help relieve postoperative ileus. Antiemetics (A)
may be given but do not address the underlying cause. An NG tube (C) is not indicated at this stage.
Providing fluids (D) may worsen nausea if bowel function has not returned.
8. A client is receiving a continuous heparin infusion. The nurse should have which antidote readily
available?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Protamine sulfate reverses the anticoagulant effects of heparin. Vitamin K (A) is the
antidote for warfarin. Naloxone (C) reverses opioids. Flumazenil (D) reverses benzodiazepines.
9. The nurse is assessing a client with a cast on the right lower leg. The client reports unrelieved
pain despite opioid medication, and the toes are pale and cool. What should the nurse suspect?
A) Compartment syndrome
B) Venous insufficiency
C) Infection
D) Fat embolism
Correct Answer: A
Rationale: Unrelieved pain, pallor, coolness, and paresthesia are classic signs of compartment
syndrome, a medical emergency requiring immediate intervention. Venous insufficiency (B) typically
presents with edema and brown discoloration. Infection (C) would present with fever and drainage. Fat
embolism (D) causes respiratory distress and petechiae.
EXAMINATION (2026–2027)
PRACTICE EXAMINATION FOR NCLEX-RN AND
NCLEX-PN SUCCESS
Field of Study: Comprehensive Nursing / NCLEX Review
Edition: 2026–2027
1. The nurse is caring for a client with a chest tube to water seal drainage. Which observation
indicates that the system is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Fluctuation (tidaling) of the water level in the water seal chamber with respirations
C) No fluctuation in the water seal chamber
D) Continuous bubbling in the suction control chamber
Correct Answer: B
Rationale: Tidaling reflects changes in intrapleural pressure during breathing and indicates a patent,
functioning system. Continuous bubbling in the water seal chamber (A) indicates an air leak. No
fluctuation (C) could mean the lung has re-expanded or the tube is blocked. Continuous bubbling in
the suction control chamber (D) is expected when suction is applied.
2. A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The TPN bag
is empty, and a new bag is not available. The nurse should administer:
A) 0.9% sodium chloride at the same rate
B) 10% dextrose in water at the same rate
C) Lactated Ringer's solution at a keep-vein-open rate
D) Nothing until the new TPN bag arrives
,Correct Answer: B
Rationale: Abruptly discontinuing TPN can cause hypoglycemia. Administering 10% dextrose in water
at the same infusion rate prevents this complication until TPN is available. 0.9% saline (A) and
lactated Ringer's (C) do not provide glucose. Waiting (D) risks severe hypoglycemia.
3. The nurse is preparing to administer an intramuscular injection to a 6-month-old infant. Which
site should the nurse select?
A) Deltoid muscle
B) Vastus lateralis muscle
C) Dorsogluteal muscle
D) Ventrogluteal muscle
Correct Answer: B
Rationale: The vastus lateralis is the preferred IM site for infants because it is well-developed, easily
accessible, and free of major nerves and blood vessels. The deltoid (A) is used for older children and
adults. The dorsogluteal (C) is not recommended for children under 3 years. The ventrogluteal (D) may
be used but is less commonly selected for infants.
4. A client with heart failure is receiving furosemide and digoxin. The nurse should monitor the
client for which sign of digoxin toxicity?
A) Weight loss
B) Yellow-green halos around lights
C) Increased urine output
D) Decreased respiratory rate
Correct Answer: B
Rationale: Digoxin toxicity commonly presents with visual disturbances such as yellow-green halos,
nausea, vomiting, and arrhythmias. Hypokalemia from furosemide increases toxicity risk. Weight loss
(A) and increased urine output (C) are expected diuretic effects. Respiratory rate changes (D) are not
primary signs.
,5. The nurse is teaching a client about collecting a 24-hour urine specimen. Which statement by the
client indicates correct understanding?
A) "I will collect the first morning void and then all urine for 24 hours."
B) "I will discard the first morning void, collect all subsequent urine for 24 hours, including the
final void at the end of the 24 hours."
C) "I will collect urine only during the daytime hours."
D) "I will keep the urine at room temperature."
Correct Answer: B
Rationale: The timed collection begins after discarding the first morning void. All urine for the next 24
hours is collected, ending with the final void exactly 24 hours later. The specimen must be kept
refrigerated or on ice (D is incorrect).
6. A client with diabetes mellitus has a blood glucose of 55 mg/dL. The client is alert and able to
swallow. Which food should the nurse offer first?
A) A peanut butter sandwich
B) 4 ounces of orange juice
C) A diet soda
D) A slice of cheese
Correct Answer: B
Rationale: For conscious hypoglycemia, the nurse should administer 15–20 grams of a fast-acting
carbohydrate such as orange juice. Peanut butter (A) and cheese (D) contain protein and fat that delay
absorption. Diet soda (C) does not contain sugar.
7. The nurse is caring for a client who is 2 days postoperative after abdominal surgery. The client
reports nausea and has hypoactive bowel sounds. Which intervention should the nurse perform
first?
A) Administer an antiemetic as prescribed
B) Encourage ambulation
, C) Insert a nasogastric tube
D) Provide sips of water
Correct Answer: B
Rationale: Ambulation stimulates peristalsis and can help relieve postoperative ileus. Antiemetics (A)
may be given but do not address the underlying cause. An NG tube (C) is not indicated at this stage.
Providing fluids (D) may worsen nausea if bowel function has not returned.
8. A client is receiving a continuous heparin infusion. The nurse should have which antidote readily
available?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Flumazenil
Correct Answer: B
Rationale: Protamine sulfate reverses the anticoagulant effects of heparin. Vitamin K (A) is the
antidote for warfarin. Naloxone (C) reverses opioids. Flumazenil (D) reverses benzodiazepines.
9. The nurse is assessing a client with a cast on the right lower leg. The client reports unrelieved
pain despite opioid medication, and the toes are pale and cool. What should the nurse suspect?
A) Compartment syndrome
B) Venous insufficiency
C) Infection
D) Fat embolism
Correct Answer: A
Rationale: Unrelieved pain, pallor, coolness, and paresthesia are classic signs of compartment
syndrome, a medical emergency requiring immediate intervention. Venous insufficiency (B) typically
presents with edema and brown discoloration. Infection (C) would present with fever and drainage. Fat
embolism (D) causes respiratory distress and petechiae.
