NCLEX-RN CAPSTONE COMPREHENSIVE PRE-TEST EXAM |
QUESTIONS AND ANSWERS (VERIFIED ANSWERS) | EXAM
PREP PRACTICE QUESTIONS AND ANSWERS | LATEST EXAM
GUIDE 2026&2027
1. A nurse is caring for a client who is 2 hours postoperative following abdominal surgery.
The client reports increasing abdominal pain despite receiving the prescribed opioid 30
minutes ago. The nurse notes a respiratory rate of 8/min and difficulty arousing the client.
Which action should the nurse take first?
A. Administer another dose of the prescribed analgesic
B. Apply oxygen and stimulate the client while preparing to support ventilation
C. Notify the surgeon about the uncontrolled postoperative pain
D. Place the client in a supine position and reassess in 15 minutes
Answer: B
The client demonstrates opioid-induced respiratory depression, which is an immediate airway
and breathing priority. The nurse should stimulate the client, provide oxygen, and prepare for
ventilatory support while anticipating administration of an opioid antagonist such as
naloxone.
2. A client with heart failure is receiving IV furosemide. Which finding is most important
for the nurse to report?
A. Urine output of 900 mL during the previous 8 hours
B. Blood pressure of 108/68 mm Hg
C. Potassium level of 2.8 mEq/L
D. Decrease in bilateral ankle edema
Answer: C
Furosemide can cause significant potassium loss. A potassium level of 2.8 mEq/L places the
client at risk for dysrhythmias and requires prompt intervention.
3. A nurse is teaching a client newly prescribed warfarin. Which statement by the client
indicates correct understanding of the teaching?
A. “I should avoid all foods containing vitamin K.”
B. “I can take aspirin whenever I develop a headache.”
C. “I should report unusual bleeding or black, tarry stools.”
D. “I can stop taking the medication once my bruising improves.”
Answer: C
,Warfarin increases bleeding risk. Unusual bleeding, melena, hematuria, or other evidence of
hemorrhage should be reported promptly. Clients should maintain a consistent vitamin K
intake rather than eliminate vitamin K-containing foods.
4. A client with diabetic ketoacidosis is receiving IV regular insulin and fluids. Which
laboratory finding requires the nurse's immediate attention?
A. Serum glucose of 280 mg/dL
B. Serum potassium of 3.1 mEq/L
C. Serum bicarbonate of 17 mEq/L
D. Positive serum ketones
Answer: B
Insulin drives potassium into cells and can worsen hypokalemia. A potassium level of 3.1
mEq/L places the client at risk for potentially life-threatening dysrhythmias and requires
immediate attention before continuing aggressive insulin therapy.
5. A nurse is assessing a client who has a new tracheostomy. Which finding requires
immediate intervention?
A. Small amount of blood-tinged secretions
B. Oxygen saturation of 96%
C. Sudden absence of airflow through the tracheostomy tube
D. Mild discomfort at the insertion site
Answer: C
Sudden absence of airflow through a new tracheostomy may indicate obstruction or
displacement of the tube. Airway compromise is an immediate priority.
6. A client receiving a blood transfusion develops chills, fever, and lower back pain 15
minutes after the transfusion begins. What should the nurse do first?
A. Slow the transfusion rate
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain a urine specimen
Answer: B
The findings suggest an acute transfusion reaction. The nurse should stop the transfusion
immediately and maintain IV access with appropriate compatible solution according to
institutional protocol.
7. A nurse is caring for four clients. Which client should the nurse assess first?
,A. A client with pneumonia who has a respiratory rate of 30/min
B. A client with diabetes whose glucose is 220 mg/dL
C. A client with chronic kidney disease reporting fatigue
D. A postoperative client requesting assistance to the bathroom
Answer: A
Tachypnea in a client with pneumonia may indicate worsening respiratory compromise.
Airway and breathing concerns take priority over the other findings.
8. A client with chronic obstructive pulmonary disease is receiving oxygen at 2 L/min by
nasal cannula. Which finding indicates the therapy is effective?
A. Oxygen saturation increases from 86% to 91%
B. Respiratory rate increases from 20/min to 30/min
C. The client becomes increasingly drowsy
D. The client develops cyanosis
Answer: A
A modest improvement in oxygen saturation accompanied by improved clinical status
indicates effective oxygen therapy. Oxygen should be carefully titrated in clients with COPD
according to prescribed targets.
9. A nurse is assessing a client with suspected increased intracranial pressure. Which
finding is most concerning?
A. Mild headache
B. Nausea after eating
C. New unequal pupils
D. Fatigue after physical activity
Answer: C
New unequal pupils can indicate worsening neurologic status and possible brain herniation.
This requires immediate assessment and intervention.
10. A client taking lisinopril reports swelling of the lips and tongue. Which action should
the nurse take first?
A. Administer the next scheduled dose
B. Assess the airway and prepare for emergency intervention
C. Encourage the client to drink water
D. Document the expected medication effect
Answer: B
, Lip and tongue swelling may indicate angioedema, a potentially life-threatening reaction to
an ACE inhibitor. Airway assessment and emergency intervention are priorities.
11. A nurse is preparing to administer insulin glargine. Which action is appropriate?
A. Mix it with regular insulin in the same syringe
B. Administer it intravenously for rapid effect
C. Administer it subcutaneously without mixing it with other insulins
D. Hold it whenever the client's blood glucose is below 200 mg/dL
Answer: C
Insulin glargine is a long-acting insulin administered subcutaneously and should not be mixed
with other insulins in the same syringe.
12. A client with a nasogastric tube connected to suction has a potassium level of 2.9
mEq/L. Which assessment finding is most concerning?
A. Muscle weakness
B. Mild thirst
C. Increased bowel sounds
D. Warm skin
Answer: A
Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. Prolonged gastric suction can contribute to potassium loss.
13. A nurse is caring for a client receiving magnesium sulfate for severe preeclampsia.
Which finding requires immediate action?
A. Respiratory rate of 10/min
B. Blood pressure of 142/88 mm Hg
C. Urine output of 45 mL/hr
D. Patellar reflexes of 2+
Answer: A
A respiratory rate of 10/min suggests magnesium toxicity. The nurse should stop the infusion
and prepare to administer calcium gluconate as prescribed while supporting respiratory
function.
14. A postpartum client has a boggy uterus and heavy vaginal bleeding. Which intervention
should the nurse perform first?
QUESTIONS AND ANSWERS (VERIFIED ANSWERS) | EXAM
PREP PRACTICE QUESTIONS AND ANSWERS | LATEST EXAM
GUIDE 2026&2027
1. A nurse is caring for a client who is 2 hours postoperative following abdominal surgery.
The client reports increasing abdominal pain despite receiving the prescribed opioid 30
minutes ago. The nurse notes a respiratory rate of 8/min and difficulty arousing the client.
Which action should the nurse take first?
A. Administer another dose of the prescribed analgesic
B. Apply oxygen and stimulate the client while preparing to support ventilation
C. Notify the surgeon about the uncontrolled postoperative pain
D. Place the client in a supine position and reassess in 15 minutes
Answer: B
The client demonstrates opioid-induced respiratory depression, which is an immediate airway
and breathing priority. The nurse should stimulate the client, provide oxygen, and prepare for
ventilatory support while anticipating administration of an opioid antagonist such as
naloxone.
2. A client with heart failure is receiving IV furosemide. Which finding is most important
for the nurse to report?
A. Urine output of 900 mL during the previous 8 hours
B. Blood pressure of 108/68 mm Hg
C. Potassium level of 2.8 mEq/L
D. Decrease in bilateral ankle edema
Answer: C
Furosemide can cause significant potassium loss. A potassium level of 2.8 mEq/L places the
client at risk for dysrhythmias and requires prompt intervention.
3. A nurse is teaching a client newly prescribed warfarin. Which statement by the client
indicates correct understanding of the teaching?
A. “I should avoid all foods containing vitamin K.”
B. “I can take aspirin whenever I develop a headache.”
C. “I should report unusual bleeding or black, tarry stools.”
D. “I can stop taking the medication once my bruising improves.”
Answer: C
,Warfarin increases bleeding risk. Unusual bleeding, melena, hematuria, or other evidence of
hemorrhage should be reported promptly. Clients should maintain a consistent vitamin K
intake rather than eliminate vitamin K-containing foods.
4. A client with diabetic ketoacidosis is receiving IV regular insulin and fluids. Which
laboratory finding requires the nurse's immediate attention?
A. Serum glucose of 280 mg/dL
B. Serum potassium of 3.1 mEq/L
C. Serum bicarbonate of 17 mEq/L
D. Positive serum ketones
Answer: B
Insulin drives potassium into cells and can worsen hypokalemia. A potassium level of 3.1
mEq/L places the client at risk for potentially life-threatening dysrhythmias and requires
immediate attention before continuing aggressive insulin therapy.
5. A nurse is assessing a client who has a new tracheostomy. Which finding requires
immediate intervention?
A. Small amount of blood-tinged secretions
B. Oxygen saturation of 96%
C. Sudden absence of airflow through the tracheostomy tube
D. Mild discomfort at the insertion site
Answer: C
Sudden absence of airflow through a new tracheostomy may indicate obstruction or
displacement of the tube. Airway compromise is an immediate priority.
6. A client receiving a blood transfusion develops chills, fever, and lower back pain 15
minutes after the transfusion begins. What should the nurse do first?
A. Slow the transfusion rate
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain a urine specimen
Answer: B
The findings suggest an acute transfusion reaction. The nurse should stop the transfusion
immediately and maintain IV access with appropriate compatible solution according to
institutional protocol.
7. A nurse is caring for four clients. Which client should the nurse assess first?
,A. A client with pneumonia who has a respiratory rate of 30/min
B. A client with diabetes whose glucose is 220 mg/dL
C. A client with chronic kidney disease reporting fatigue
D. A postoperative client requesting assistance to the bathroom
Answer: A
Tachypnea in a client with pneumonia may indicate worsening respiratory compromise.
Airway and breathing concerns take priority over the other findings.
8. A client with chronic obstructive pulmonary disease is receiving oxygen at 2 L/min by
nasal cannula. Which finding indicates the therapy is effective?
A. Oxygen saturation increases from 86% to 91%
B. Respiratory rate increases from 20/min to 30/min
C. The client becomes increasingly drowsy
D. The client develops cyanosis
Answer: A
A modest improvement in oxygen saturation accompanied by improved clinical status
indicates effective oxygen therapy. Oxygen should be carefully titrated in clients with COPD
according to prescribed targets.
9. A nurse is assessing a client with suspected increased intracranial pressure. Which
finding is most concerning?
A. Mild headache
B. Nausea after eating
C. New unequal pupils
D. Fatigue after physical activity
Answer: C
New unequal pupils can indicate worsening neurologic status and possible brain herniation.
This requires immediate assessment and intervention.
10. A client taking lisinopril reports swelling of the lips and tongue. Which action should
the nurse take first?
A. Administer the next scheduled dose
B. Assess the airway and prepare for emergency intervention
C. Encourage the client to drink water
D. Document the expected medication effect
Answer: B
, Lip and tongue swelling may indicate angioedema, a potentially life-threatening reaction to
an ACE inhibitor. Airway assessment and emergency intervention are priorities.
11. A nurse is preparing to administer insulin glargine. Which action is appropriate?
A. Mix it with regular insulin in the same syringe
B. Administer it intravenously for rapid effect
C. Administer it subcutaneously without mixing it with other insulins
D. Hold it whenever the client's blood glucose is below 200 mg/dL
Answer: C
Insulin glargine is a long-acting insulin administered subcutaneously and should not be mixed
with other insulins in the same syringe.
12. A client with a nasogastric tube connected to suction has a potassium level of 2.9
mEq/L. Which assessment finding is most concerning?
A. Muscle weakness
B. Mild thirst
C. Increased bowel sounds
D. Warm skin
Answer: A
Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. Prolonged gastric suction can contribute to potassium loss.
13. A nurse is caring for a client receiving magnesium sulfate for severe preeclampsia.
Which finding requires immediate action?
A. Respiratory rate of 10/min
B. Blood pressure of 142/88 mm Hg
C. Urine output of 45 mL/hr
D. Patellar reflexes of 2+
Answer: A
A respiratory rate of 10/min suggests magnesium toxicity. The nurse should stop the infusion
and prepare to administer calcium gluconate as prescribed while supporting respiratory
function.
14. A postpartum client has a boggy uterus and heavy vaginal bleeding. Which intervention
should the nurse perform first?
