NCLEX-RN ACTUAL EXAM TEST BANK 2027-2028
Questions & Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
QUESTION 1
A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. Temperature of 99.2°F (37.3°C)
B. Blood pressure of 100/60 mmHg
C. Heart rate of 88 beats per minute
D. Fistula site with palpable thrill and audible bruit
CORRECT ANSWER: B. Blood pressure of 100/60 mmHg
RATIONALE: A blood pressure of 100/60 mmHg is concerning because hemodialysis
removes fluid from the vascular space, which can further decrease blood pressure and lead
to hypotension during treatment. The client may require a different ultrafiltration rate or
fluid replacement. A temperature of 99.2°F (A) is slightly elevated but not immediately
concerning. A heart rate of 88 bpm (C) is within normal range. A palpable thrill and
audible bruit (D) indicate a patent fistula, which is an expected and desired finding.
QUESTION 2
A nurse is caring for a client who has just undergone a total thyroidectomy. Which
assessment finding requires immediate intervention?
A. Hoarseness of voice
B. Pain at the incision site rated 4/10
C. Serum calcium level of 7.8 mg/dL
D. Small amount of serosanguinous drainage on dressing
,CORRECT ANSWER: C. Serum calcium level of 7.8 mg/dL
RATIONALE: A serum calcium level of 7.8 mg/dL (normal 8.5-10.5 mg/dL) indicates
hypocalcemia, a complication of thyroidectomy due to accidental removal or damage to
the parathyroid glands. Hypocalcemia can cause neuromuscular irritability and life-
threatening laryngospasm. This requires immediate intervention with calcium
supplementation. Hoarseness (A) may occur due to laryngeal nerve irritation but is not
immediately life-threatening. Pain (B) is expected and manageable. Serosanguinous
drainage (D) is normal in the immediate postoperative period.
QUESTION 3
A client diagnosed with tuberculosis (TB) is being discharged. The client asks the nurse,
"How long will I need to take my TB medications?" What is the nurse's best response?
A. "You will take medications for 2 weeks until your symptoms resolve."
B. "You will take medications for 6 to 12 months as prescribed by your healthcare
provider."
C. "You will take medications for 1 month and then have a follow-up chest X-ray."
D. "You will take medications only until your sputum culture is negative."
CORRECT ANSWER: B. "You will take medications for 6 to 12 months as prescribed
by your healthcare provider."
RATIONALE: The standard treatment for TB requires a multi-drug regimen for 6 to 12
months (typically 6 months for drug-susceptible TB). It is critical for the client to complete
the full course to prevent drug resistance and relapse. Stopping after 2 weeks (A) is
insufficient. A 1-month course (C) is also inadequate. Even after sputum cultures become
negative (D), treatment must continue to eliminate dormant organisms. Non-adherence is
a major concern and directly observed therapy (DOT) is often recommended.
,QUESTION 4
The nurse is assessing a client with suspected appendicitis. Which assessment finding is
most characteristic of this condition?
A. Rebound tenderness at McBurney's point
B. Pain that radiates to the right shoulder
C. Pain that is relieved by eating
D. Diffuse abdominal pain with bloating
CORRECT ANSWER: A. Rebound tenderness at McBurney's point
RATIONALE: McBurney's point (one-third of the distance from the anterior superior iliac
spine to the umbilicus) is the classic location for appendicitis pain and rebound tenderness.
Right shoulder pain (B) suggests gallbladder disease (referred pain). Pain relieved by
eating (C) suggests peptic ulcer. Diffuse pain with bloating (D) suggests bowel obstruction.
The nurse should also monitor for fever, nausea, and elevated white blood cell count.
QUESTION 5
A client with chronic kidney disease (CKD) is receiving erythropoietin (Epogen). The
nurse should monitor the client for which therapeutic effect?
A. Decreased blood pressure
B. Increased red blood cell count
C. Decreased serum creatinine
D. Increased urine output
CORRECT ANSWER: B. Increased red blood cell count
RATIONALE: Erythropoietin stimulates red blood cell production in the bone marrow,
treating anemia associated with CKD. The therapeutic effect is an increase in hemoglobin
and hematocrit levels. Decreased blood pressure (A) is not the primary effect;
erythropoietin may actually cause hypertension. Decreased creatinine (C) reflects
, improved kidney function, which is not the action of erythropoietin. Increased urine output
(D) is not an effect of this medication.
QUESTION 6
A client is receiving a blood transfusion and develops chills, fever, and low back pain.
What is the nurse's priority action?
A. Slow the transfusion rate and monitor vital signs
B. Stop the transfusion and infuse normal saline
C. Administer diphenhydramine (Benadryl) as prescribed
D. Notify the healthcare provider immediately
CORRECT ANSWER: B. Stop the transfusion and infuse normal saline
RATIONALE: These signs and symptoms indicate a possible acute hemolytic transfusion
reaction, a life-threatening emergency. The priority is to stop the transfusion immediately
to prevent further reaction. Infusing normal saline maintains IV access and helps flush the
line. Slowing the rate (A) is inadequate; the transfusion must be stopped. Administering
antihistamines (C) may be done later but is not the priority. Notifying the provider (D)
should occur after the transfusion is stopped and the line is maintained with normal
saline.
QUESTION 7
The nurse is caring for a client with a chest tube connected to a closed drainage system.
Which finding requires immediate intervention?
A. Intermittent bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 50 mL in the first hour
Questions & Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
QUESTION 1
A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. Temperature of 99.2°F (37.3°C)
B. Blood pressure of 100/60 mmHg
C. Heart rate of 88 beats per minute
D. Fistula site with palpable thrill and audible bruit
CORRECT ANSWER: B. Blood pressure of 100/60 mmHg
RATIONALE: A blood pressure of 100/60 mmHg is concerning because hemodialysis
removes fluid from the vascular space, which can further decrease blood pressure and lead
to hypotension during treatment. The client may require a different ultrafiltration rate or
fluid replacement. A temperature of 99.2°F (A) is slightly elevated but not immediately
concerning. A heart rate of 88 bpm (C) is within normal range. A palpable thrill and
audible bruit (D) indicate a patent fistula, which is an expected and desired finding.
QUESTION 2
A nurse is caring for a client who has just undergone a total thyroidectomy. Which
assessment finding requires immediate intervention?
A. Hoarseness of voice
B. Pain at the incision site rated 4/10
C. Serum calcium level of 7.8 mg/dL
D. Small amount of serosanguinous drainage on dressing
,CORRECT ANSWER: C. Serum calcium level of 7.8 mg/dL
RATIONALE: A serum calcium level of 7.8 mg/dL (normal 8.5-10.5 mg/dL) indicates
hypocalcemia, a complication of thyroidectomy due to accidental removal or damage to
the parathyroid glands. Hypocalcemia can cause neuromuscular irritability and life-
threatening laryngospasm. This requires immediate intervention with calcium
supplementation. Hoarseness (A) may occur due to laryngeal nerve irritation but is not
immediately life-threatening. Pain (B) is expected and manageable. Serosanguinous
drainage (D) is normal in the immediate postoperative period.
QUESTION 3
A client diagnosed with tuberculosis (TB) is being discharged. The client asks the nurse,
"How long will I need to take my TB medications?" What is the nurse's best response?
A. "You will take medications for 2 weeks until your symptoms resolve."
B. "You will take medications for 6 to 12 months as prescribed by your healthcare
provider."
C. "You will take medications for 1 month and then have a follow-up chest X-ray."
D. "You will take medications only until your sputum culture is negative."
CORRECT ANSWER: B. "You will take medications for 6 to 12 months as prescribed
by your healthcare provider."
RATIONALE: The standard treatment for TB requires a multi-drug regimen for 6 to 12
months (typically 6 months for drug-susceptible TB). It is critical for the client to complete
the full course to prevent drug resistance and relapse. Stopping after 2 weeks (A) is
insufficient. A 1-month course (C) is also inadequate. Even after sputum cultures become
negative (D), treatment must continue to eliminate dormant organisms. Non-adherence is
a major concern and directly observed therapy (DOT) is often recommended.
,QUESTION 4
The nurse is assessing a client with suspected appendicitis. Which assessment finding is
most characteristic of this condition?
A. Rebound tenderness at McBurney's point
B. Pain that radiates to the right shoulder
C. Pain that is relieved by eating
D. Diffuse abdominal pain with bloating
CORRECT ANSWER: A. Rebound tenderness at McBurney's point
RATIONALE: McBurney's point (one-third of the distance from the anterior superior iliac
spine to the umbilicus) is the classic location for appendicitis pain and rebound tenderness.
Right shoulder pain (B) suggests gallbladder disease (referred pain). Pain relieved by
eating (C) suggests peptic ulcer. Diffuse pain with bloating (D) suggests bowel obstruction.
The nurse should also monitor for fever, nausea, and elevated white blood cell count.
QUESTION 5
A client with chronic kidney disease (CKD) is receiving erythropoietin (Epogen). The
nurse should monitor the client for which therapeutic effect?
A. Decreased blood pressure
B. Increased red blood cell count
C. Decreased serum creatinine
D. Increased urine output
CORRECT ANSWER: B. Increased red blood cell count
RATIONALE: Erythropoietin stimulates red blood cell production in the bone marrow,
treating anemia associated with CKD. The therapeutic effect is an increase in hemoglobin
and hematocrit levels. Decreased blood pressure (A) is not the primary effect;
erythropoietin may actually cause hypertension. Decreased creatinine (C) reflects
, improved kidney function, which is not the action of erythropoietin. Increased urine output
(D) is not an effect of this medication.
QUESTION 6
A client is receiving a blood transfusion and develops chills, fever, and low back pain.
What is the nurse's priority action?
A. Slow the transfusion rate and monitor vital signs
B. Stop the transfusion and infuse normal saline
C. Administer diphenhydramine (Benadryl) as prescribed
D. Notify the healthcare provider immediately
CORRECT ANSWER: B. Stop the transfusion and infuse normal saline
RATIONALE: These signs and symptoms indicate a possible acute hemolytic transfusion
reaction, a life-threatening emergency. The priority is to stop the transfusion immediately
to prevent further reaction. Infusing normal saline maintains IV access and helps flush the
line. Slowing the rate (A) is inadequate; the transfusion must be stopped. Administering
antihistamines (C) may be done later but is not the priority. Notifying the provider (D)
should occur after the transfusion is stopped and the line is maintained with normal
saline.
QUESTION 7
The nurse is caring for a client with a chest tube connected to a closed drainage system.
Which finding requires immediate intervention?
A. Intermittent bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber
C. Continuous bubbling in the water seal chamber
D. Drainage of 50 mL in the first hour
