NCLEX-RN 2026 Questions with Correct Answers FINAL EXAM TEST BANK VERSION 2026 UPDATE

NCLEX-RN 2026 Questions with Correct
Answers FINAL EXAM TEST BANK VERSION
2026 UPDATE
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial
blood glucose level is 950 mg/dL (52.9 mmol/L). A continuous intravenous (IV) infusion of short-
acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level
is now decreased to 240 mg/dL (13.3 mmol/L). The nurse would next prepare to administer
which medication?

A. An ampule of 50% dextrose
B. NPH insulin subcutaneously
C. IV fluids containing dextrose
D. Phenytoin for the prevention of seizures
C

Rationale:
Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and
normalizing the serum glucose level. If the corrections occur too quickly, serious consequences,
including hypoglycemia and cerebral edema, can occur. During management of DKA, when the
blood glucose level falls to 250 to 300 mg/dL (13.9 to 16.7 mmol/L), the IV infusion rate is
reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL
(13.9 mmol/L), or until the client recovers from ketosis. Fifty percent dextrose is used to treat
hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin is not a usual treatment measure
for DKA.
The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of
complications. Which sign or symptom, if frequently exhibited in the client, indicates that the
client is at risk for chronic complications of diabetes if the blood glucose is not adequately
managed?

A. Polyuria
B. Diaphoresis
C. Pedal edema
D. Decreased respiratory rate
A


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,Rationale:
Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular
and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia
include polydipsia, polyuria, and polyphagia. Diaphoresis may occur in hypoglycemia.
Hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a
client to the chronic complications of diabetes mellitus. Therefore, option 2 can be eliminated
because this finding is characteristic of hypoglycemia. Options 3 and 4 are not associated with
diabetes mellitus.
The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia.
The nurse places priority on which client problem?

A. Lack of knowledge
B. Inadequate fluid volume
C. Compromised family coping
D. Inadequate consumption of nutrients
B

Rationale:
An increased blood glucose level will cause the kidneys to excrete the glucose in the urine. This
glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to
dehydration. This fluid loss must be replaced when it becomes severe. Options 1, 3, and 4 are
not related specifically to the information in the question.
The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client
reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed
for the last 24 hours. Which additional statement by the client indicates a need for further
teaching?

A. "I need to stop my insulin."
B. "I need to increase my fluid intake."
C. "I need to monitor my blood glucose every 3 to 4 hours."
D. "I need to call my primary health care provider (PHCP) because of these symptoms."
A

Rationale:
When a client with diabetes mellitus is unable to eat normally because of illness, the client still
should take the prescribed insulin or oral medication. The client should consume additional
fluids and should notify the PHCP. The client should monitor the blood glucose level every 3 to 4
hours. The client should also monitor the urine for ketones during illness.

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,The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the
client's nostril. The nurse should take which initial action?

A. Lower the head of the bed.
B. Test the drainage for glucose.
C. Obtain a culture of the drainage.
D. Continue to observe the drainage.
B

Rationale:
After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a
cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the
presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would
indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to
prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a
culture. Continuing to observe the drainage without taking action could result in a serious
complication.
The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic
hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary
health care provider prescriptions should the nurse anticipate receiving? Select all that apply.

A. Initiate an infusion of 3% NaCl.
B. Administer intravenous furosemide.
C. Restrict fluids to 800 mL over 24 hours.
D. Elevate the head of the bed to high-Fowler's.
E. Administer a vasopressin antagonist as prescribed.
A, C, E

Rationale:
Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to
excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia.
Management is directed at correcting the hyponatremia and preventing cerebral edema.
Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120
mmol/L). When furosemide is used, potassium supplementation should also occur and serum
potassium levels should be monitored. To promote venous return, the head of the bed should
not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps
avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is
needed.

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, A client is admitted to an emergency department, and a diagnosis of myxedema coma is made.
Which action should the nurse prepare to carry out initially?

A. Warm the client.
B. Maintain a patent airway.
C. Administer thyroid hormone.
D. Administer fluid replacement.
B

Rationale:
Myxedema coma is a rare but serious disorder that results from persistently low thyroid
production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication,
anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In
myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be
administered, followed by fluid replacement, keeping the client warm, monitoring vital signs,
and administering thyroid hormones by the intravenous route.
The nurse is caring for a client admitted to the emergency department with diabetic
ketoacidosis (DKA). In the acute phase, the nurse plans for which priority intervention?

A. Correct the acidosis.
B. Administer 5% dextrose intravenously.
C. Apply a monitor for an electrocardiogram.
D. Administer short-duration insulin intravenously.
D

Rationale:
Lack of insulin (absolute or relative) is the primary cause of DKA. Treatment consists of insulin
administration (short- or rapid-acting), intravenous fluid administration (normal saline initially,
not 5% dextrose), and potassium replacement, followed by correcting acidosis. Cardiac
monitoring is important due to alterations in potassium levels associated with DKA and its
treatment, but applying an electrocardiogram monitor is not the priority action.
A client with type 1 diabetes mellitus who takes NPH daily in the morning calls the nurse to
report recurrent episodes of hypoglycemia with exercising. Which statement by the client
indicates an adequate understanding of the peak action of NPH insulin and exercise?

A. "I should not exercise since I am taking insulin."
B. "The best time for me to exercise is after breakfast."


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