NCLEX-RN Practice Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
1. A client with septic shock has received 30 mL/kg of crystalloid. The blood
pressure remains 82/48 mm Hg, and the MAP is 59 mm Hg. Which prescription
should the nurse anticipate?
A. Administer another 2 L of crystalloid rapidly
B. Administer IV furosemide
C. Initiate a norepinephrine infusion
D. Administer oral midodrine
Answer: C. Initiate a norepinephrine infusion
Rationale: Persistent hypotension and a MAP below 65 mm Hg after adequate
fluid resuscitation indicate the need for a vasopressor. Norepinephrine is the
preferred first-line vasopressor for septic shock because it increases vascular
tone while generally producing less tachyarrhythmia than alternatives.
2. A client receiving a heparin infusion has a platelet count that falls from
240,000/mm³ to 105,000/mm³ on day 6. The client develops a new painful,
swollen calf. Which action is the priority?
A. Continue heparin and administer aspirin
B. Stop all heparin and notify the provider
,C. Administer protamine sulfate immediately
D. Increase the heparin infusion rate
Answer: B. Stop all heparin and notify the provider
Rationale: A platelet decrease of more than 50% occurring 5–10 days after
heparin exposure with new thrombosis strongly suggests heparin-induced
thrombocytopenia. Heparin must be discontinued, including heparin-containing
flushes, and an alternative non-heparin anticoagulant is generally initiated.
3. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L and a
glucose of 520 mg/dL. Which prescription should the nurse question?
A. Continuous cardiac monitoring
B. IV regular insulin infusion
C. IV potassium replacement
D. Isotonic IV fluids
Answer: B. IV regular insulin infusion
Rationale: Although total-body potassium is depleted in DKA, insulin drives
potassium into cells and can cause life-threatening hypokalemia. When
potassium is below approximately 3.3 mEq/L, potassium replacement is
prioritized and insulin is temporarily withheld until the potassium level is
corrected.
4. A client with increased intracranial pressure suddenly develops a blood
pressure of 210/70 mm Hg, heart rate of 46/min, and irregular respirations.
How should the nurse interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Hypovolemic shock
D. Spinal shock
,Answer: B. Cushing response
Rationale: Hypertension with widened pulse pressure, bradycardia, and
abnormal respirations is the Cushing response, a late sign of increased
intracranial pressure and possible impending brain herniation. Immediate
neurologic assessment and intervention are required.
5. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 8/min, absent patellar reflexes, and urine output of 20
mL/hr. Which medication should the nurse prepare to administer?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B. Calcium gluconate
Rationale: Respiratory depression, absent deep-tendon reflexes, and oliguria
indicate magnesium toxicity. Calcium gluconate is the antidote and should be
readily available when magnesium sulfate is administered.
6. A client with acute pulmonary edema is severely dyspneic and coughing pink,
frothy sputum. Which intervention should the nurse implement first?
A. Place the client in high-Fowler position
B. Encourage oral fluids
C. Place the client supine
D. Administer a sedative
Answer: A. Place the client in high-Fowler position
Rationale: Positioning the client upright immediately improves lung expansion
and decreases venous return, helping reduce pulmonary congestion.
, Oxygenation and prescribed medications such as diuretics or vasodilators follow
rapidly.
7. A client with Addison disease is admitted with vomiting, severe weakness,
hypotension, hyponatremia, and hyperkalemia. Which prescription is the
priority?
A. IV hydrocortisone
B. Fluid restriction
C. Oral potassium supplementation
D. IV furosemide alone
Answer: A. IV hydrocortisone
Rationale: These findings indicate adrenal crisis, a life-threatening deficiency of
cortisol and often aldosterone. Immediate glucocorticoid replacement,
aggressive isotonic fluid therapy, and correction of hypoglycemia and
electrolyte abnormalities are essential.
8. A client taking warfarin has an INR of 6.8 and reports black, tarry stools.
Which action is most appropriate?
A. Administer the next dose of warfarin
B. Hold warfarin and notify the provider immediately
C. Encourage foods high in vitamin K and discharge the client
D. Administer aspirin
Answer: B. Hold warfarin and notify the provider immediately
Rationale: A markedly elevated INR accompanied by melena indicates
significant bleeding. Warfarin should be withheld, the provider notified
urgently, and reversal with vitamin K and possibly a four-factor prothrombin
complex concentrate considered depending on severity.
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. A client with septic shock has received 30 mL/kg of crystalloid. The blood
pressure remains 82/48 mm Hg, and the MAP is 59 mm Hg. Which prescription
should the nurse anticipate?
A. Administer another 2 L of crystalloid rapidly
B. Administer IV furosemide
C. Initiate a norepinephrine infusion
D. Administer oral midodrine
Answer: C. Initiate a norepinephrine infusion
Rationale: Persistent hypotension and a MAP below 65 mm Hg after adequate
fluid resuscitation indicate the need for a vasopressor. Norepinephrine is the
preferred first-line vasopressor for septic shock because it increases vascular
tone while generally producing less tachyarrhythmia than alternatives.
2. A client receiving a heparin infusion has a platelet count that falls from
240,000/mm³ to 105,000/mm³ on day 6. The client develops a new painful,
swollen calf. Which action is the priority?
A. Continue heparin and administer aspirin
B. Stop all heparin and notify the provider
,C. Administer protamine sulfate immediately
D. Increase the heparin infusion rate
Answer: B. Stop all heparin and notify the provider
Rationale: A platelet decrease of more than 50% occurring 5–10 days after
heparin exposure with new thrombosis strongly suggests heparin-induced
thrombocytopenia. Heparin must be discontinued, including heparin-containing
flushes, and an alternative non-heparin anticoagulant is generally initiated.
3. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L and a
glucose of 520 mg/dL. Which prescription should the nurse question?
A. Continuous cardiac monitoring
B. IV regular insulin infusion
C. IV potassium replacement
D. Isotonic IV fluids
Answer: B. IV regular insulin infusion
Rationale: Although total-body potassium is depleted in DKA, insulin drives
potassium into cells and can cause life-threatening hypokalemia. When
potassium is below approximately 3.3 mEq/L, potassium replacement is
prioritized and insulin is temporarily withheld until the potassium level is
corrected.
4. A client with increased intracranial pressure suddenly develops a blood
pressure of 210/70 mm Hg, heart rate of 46/min, and irregular respirations.
How should the nurse interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Hypovolemic shock
D. Spinal shock
,Answer: B. Cushing response
Rationale: Hypertension with widened pulse pressure, bradycardia, and
abnormal respirations is the Cushing response, a late sign of increased
intracranial pressure and possible impending brain herniation. Immediate
neurologic assessment and intervention are required.
5. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 8/min, absent patellar reflexes, and urine output of 20
mL/hr. Which medication should the nurse prepare to administer?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Answer: B. Calcium gluconate
Rationale: Respiratory depression, absent deep-tendon reflexes, and oliguria
indicate magnesium toxicity. Calcium gluconate is the antidote and should be
readily available when magnesium sulfate is administered.
6. A client with acute pulmonary edema is severely dyspneic and coughing pink,
frothy sputum. Which intervention should the nurse implement first?
A. Place the client in high-Fowler position
B. Encourage oral fluids
C. Place the client supine
D. Administer a sedative
Answer: A. Place the client in high-Fowler position
Rationale: Positioning the client upright immediately improves lung expansion
and decreases venous return, helping reduce pulmonary congestion.
, Oxygenation and prescribed medications such as diuretics or vasodilators follow
rapidly.
7. A client with Addison disease is admitted with vomiting, severe weakness,
hypotension, hyponatremia, and hyperkalemia. Which prescription is the
priority?
A. IV hydrocortisone
B. Fluid restriction
C. Oral potassium supplementation
D. IV furosemide alone
Answer: A. IV hydrocortisone
Rationale: These findings indicate adrenal crisis, a life-threatening deficiency of
cortisol and often aldosterone. Immediate glucocorticoid replacement,
aggressive isotonic fluid therapy, and correction of hypoglycemia and
electrolyte abnormalities are essential.
8. A client taking warfarin has an INR of 6.8 and reports black, tarry stools.
Which action is most appropriate?
A. Administer the next dose of warfarin
B. Hold warfarin and notify the provider immediately
C. Encourage foods high in vitamin K and discharge the client
D. Administer aspirin
Answer: B. Hold warfarin and notify the provider immediately
Rationale: A markedly elevated INR accompanied by melena indicates
significant bleeding. Warfarin should be withheld, the provider notified
urgently, and reversal with vitamin K and possibly a four-factor prothrombin
complex concentrate considered depending on severity.
