NCLEX-RN ACTUAL EXAM TEST BANK 2027
Questions & Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
SECTION 1: QUESTIONS 1-200
QUESTIONS 1-20
QUESTION 1
A nurse is caring for a client with a nasogastric (NG) tube attached to low intermittent
suction. Which assessment finding indicates that the tube is correctly placed?
A. The client reports a sore throat
B. The pH of the aspirate is 4.0
C. The aspirate is bright red
D. The client is able to speak clearly
CORRECT ANSWER: B. The pH of the aspirate is 4.0
RATIONALE: Gastric aspirate typically has a pH between 1.0 and 5.0, confirming correct
placement in the stomach. A sore throat (A) is a common discomfort but does not confirm
placement. Bright red aspirate (C) indicates bleeding, not correct placement. The ability to
speak clearly (D) does not confirm NG tube placement as the tube passes through the
,esophagus into the stomach and does not affect vocal cord function. The gold standard for
confirming placement is pH testing and X-ray confirmation.
QUESTION 2
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
RATIONALE: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to significant potassium loss through urine.
Hypokalemia is the most serious and common electrolyte imbalance associated with loop
diuretics and can precipitate cardiac dysrhythmias, especially in clients taking digoxin.
While sodium (A), calcium (C), and magnesium (D) may also be affected, potassium
monitoring is the priority due to its critical role in cardiac function.
QUESTION 3
The nurse is teaching a client with type 1 diabetes mellitus about sick-day rules. Which
statement by the client indicates a need for further teaching?
A. "I will check my blood glucose every 4 hours."
B. "I will continue to take my insulin even if I am not eating."
C. "I will drink regular soda if I cannot keep food down."
D. "I will call my doctor if my blood sugar is over 300 mg/dL."
,CORRECT ANSWER: C. "I will drink regular soda if I cannot keep food down."
RATIONALE: During sick days, clients with type 1 diabetes should consume clear liquids
containing carbohydrates (like broth, gelatin, or sports drinks) every hour. Regular soda
contains high sugar content that can cause rapid hyperglycemia. The client should instead
consume sugar-free liquids or small amounts of regular soda only if blood glucose is low.
Checking glucose every 4 hours (A) is correct, continuing insulin (B) is essential to prevent
DKA, and calling the doctor for glucose over 300 mg/dL (D) is appropriate.
QUESTION 4
A postoperative client reports sudden chest pain and shortness of breath. The nurse
notes tachycardia and tachypnea. What is the priority nursing action?
A. Administer PRN pain medication
B. Apply oxygen via nasal cannula
C. Encourage deep breathing and coughing
D. Ambulate the client to improve circulation
CORRECT ANSWER: B. Apply oxygen via nasal cannula
RATIONALE: The client is exhibiting signs of a possible pulmonary embolism (sudden
chest pain, dyspnea, tachycardia, tachypnea). The priority action is to apply oxygen to
address hypoxia and maintain adequate oxygenation. Administering pain medication (A)
should follow after ensuring oxygenation. Deep breathing (C) is not appropriate for sudden
onset symptoms. Ambulation (D) could dislodge a thrombus and worsen the condition.
QUESTION 5
Which client is at highest risk for developing a pressure injury?
A. A 45-year-old with a fractured femur in Buck's traction
B. A 70-year-old with incontinence and limited mobility
C. A 30-year-old with a new colostomy
D. A 60-year-old with hypertension and diabetes
, CORRECT ANSWER: B. A 70-year-old with incontinence and limited mobility
RATIONALE: The elderly client with incontinence (moisture) and limited mobility
(immobility) has multiple risk factors for pressure injury development. Age-related skin
changes, moisture from incontinence, and inability to reposition independently
significantly increase risk. While the client with a fractured femur (A) has immobility, they
lack the additional risk of moisture. The colostomy client (C) and hypertensive client (D)
have fewer risk factors.
QUESTION 6
The nurse is assessing a client with major depressive disorder who was started on
phenelzine (Nardil), an MAOI. Which dietary choice by the client requires immediate
intervention?
A. Grilled chicken with steamed rice
B. A cheeseburger with French fries
C. Aged cheddar cheese and red wine
D. Pasta with marinara sauce
CORRECT ANSWER: C. Aged cheddar cheese and red wine
RATIONALE: Phenelzine is a monoamine oxidase inhibitor (MAOI). Clients taking MAOIs
must avoid foods high in tyramine to prevent hypertensive crisis. Aged cheeses and red
wine are high in tyramine and can cause severe hypertension, headache, and possible
stroke. Grilled chicken (A), cheeseburger (B), and pasta with marinara sauce (D) are
generally safe as long as they are fresh and not aged or fermented.
QUESTION 7
A client is receiving a blood transfusion. Fifteen minutes after the start, the client reports
chills, low back pain, and nausea. What is the nurse's priority action?
Questions & Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
SECTION 1: QUESTIONS 1-200
QUESTIONS 1-20
QUESTION 1
A nurse is caring for a client with a nasogastric (NG) tube attached to low intermittent
suction. Which assessment finding indicates that the tube is correctly placed?
A. The client reports a sore throat
B. The pH of the aspirate is 4.0
C. The aspirate is bright red
D. The client is able to speak clearly
CORRECT ANSWER: B. The pH of the aspirate is 4.0
RATIONALE: Gastric aspirate typically has a pH between 1.0 and 5.0, confirming correct
placement in the stomach. A sore throat (A) is a common discomfort but does not confirm
placement. Bright red aspirate (C) indicates bleeding, not correct placement. The ability to
speak clearly (D) does not confirm NG tube placement as the tube passes through the
,esophagus into the stomach and does not affect vocal cord function. The gold standard for
confirming placement is pH testing and X-ray confirmation.
QUESTION 2
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER: B. Serum potassium
RATIONALE: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, leading to significant potassium loss through urine.
Hypokalemia is the most serious and common electrolyte imbalance associated with loop
diuretics and can precipitate cardiac dysrhythmias, especially in clients taking digoxin.
While sodium (A), calcium (C), and magnesium (D) may also be affected, potassium
monitoring is the priority due to its critical role in cardiac function.
QUESTION 3
The nurse is teaching a client with type 1 diabetes mellitus about sick-day rules. Which
statement by the client indicates a need for further teaching?
A. "I will check my blood glucose every 4 hours."
B. "I will continue to take my insulin even if I am not eating."
C. "I will drink regular soda if I cannot keep food down."
D. "I will call my doctor if my blood sugar is over 300 mg/dL."
,CORRECT ANSWER: C. "I will drink regular soda if I cannot keep food down."
RATIONALE: During sick days, clients with type 1 diabetes should consume clear liquids
containing carbohydrates (like broth, gelatin, or sports drinks) every hour. Regular soda
contains high sugar content that can cause rapid hyperglycemia. The client should instead
consume sugar-free liquids or small amounts of regular soda only if blood glucose is low.
Checking glucose every 4 hours (A) is correct, continuing insulin (B) is essential to prevent
DKA, and calling the doctor for glucose over 300 mg/dL (D) is appropriate.
QUESTION 4
A postoperative client reports sudden chest pain and shortness of breath. The nurse
notes tachycardia and tachypnea. What is the priority nursing action?
A. Administer PRN pain medication
B. Apply oxygen via nasal cannula
C. Encourage deep breathing and coughing
D. Ambulate the client to improve circulation
CORRECT ANSWER: B. Apply oxygen via nasal cannula
RATIONALE: The client is exhibiting signs of a possible pulmonary embolism (sudden
chest pain, dyspnea, tachycardia, tachypnea). The priority action is to apply oxygen to
address hypoxia and maintain adequate oxygenation. Administering pain medication (A)
should follow after ensuring oxygenation. Deep breathing (C) is not appropriate for sudden
onset symptoms. Ambulation (D) could dislodge a thrombus and worsen the condition.
QUESTION 5
Which client is at highest risk for developing a pressure injury?
A. A 45-year-old with a fractured femur in Buck's traction
B. A 70-year-old with incontinence and limited mobility
C. A 30-year-old with a new colostomy
D. A 60-year-old with hypertension and diabetes
, CORRECT ANSWER: B. A 70-year-old with incontinence and limited mobility
RATIONALE: The elderly client with incontinence (moisture) and limited mobility
(immobility) has multiple risk factors for pressure injury development. Age-related skin
changes, moisture from incontinence, and inability to reposition independently
significantly increase risk. While the client with a fractured femur (A) has immobility, they
lack the additional risk of moisture. The colostomy client (C) and hypertensive client (D)
have fewer risk factors.
QUESTION 6
The nurse is assessing a client with major depressive disorder who was started on
phenelzine (Nardil), an MAOI. Which dietary choice by the client requires immediate
intervention?
A. Grilled chicken with steamed rice
B. A cheeseburger with French fries
C. Aged cheddar cheese and red wine
D. Pasta with marinara sauce
CORRECT ANSWER: C. Aged cheddar cheese and red wine
RATIONALE: Phenelzine is a monoamine oxidase inhibitor (MAOI). Clients taking MAOIs
must avoid foods high in tyramine to prevent hypertensive crisis. Aged cheeses and red
wine are high in tyramine and can cause severe hypertension, headache, and possible
stroke. Grilled chicken (A), cheeseburger (B), and pasta with marinara sauce (D) are
generally safe as long as they are fresh and not aged or fermented.
QUESTION 7
A client is receiving a blood transfusion. Fifteen minutes after the start, the client reports
chills, low back pain, and nausea. What is the nurse's priority action?
