2026/2027 NCLEX RN Uworld Comprehensive Study Guide
100 Pages PDF Download Bonus 2,600 + Nclex Practice
Questions + Rationales
Course
NCLEX RN Uworld Comprehensive
1. A client with heart failure suddenly develops severe dyspnea, crackles throughout both
lungs, and pink, frothy sputum. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain the client's daily weight
D. Administer a prescribed oral diuretic
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes lung expansion and decreases venous return,
helping reduce pulmonary congestion. Severe dyspnea with pink, frothy sputum suggests acute
pulmonary edema and requires immediate intervention.
2. A nurse is administering IV potassium chloride. The client reports burning at the IV site,
and the nurse observes redness and swelling. What should the nurse do first?
A. Slow the infusion
B. Apply a warm compress
C. Stop the infusion
D. Flush the IV catheter
Answer: C. Stop the infusion
Rationale: Burning, redness, and swelling suggest IV infiltration or irritation. Potassium
chloride is irritating to tissues and should not continue through a compromised IV site.
3. A conscious client with diabetes has a blood glucose level of 54 mg/dL and is able to
swallow. Which intervention is most appropriate?
A. Administer 15 g of rapid-acting carbohydrate
B. Administer regular insulin
C. Give a high-protein meal immediately
D. Administer glucagon intramuscularly
Answer: A. Administer 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow and has hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of glucose.
,4. A postoperative client suddenly develops shortness of breath, pleuritic chest pain,
tachycardia, and anxiety. Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are classic findings
associated with pulmonary embolism. This is a potentially life-threatening emergency.
5. The nurse is assessing four clients. Which client requires the most immediate attention?
A. Client with a temperature of 38.1°C (100.6°F)
B. Client with blood pressure of 82/48 mm Hg and suspected sepsis
C. Client reporting chronic arthritis pain
D. Client requesting assistance with bathing
Answer: B. Client with blood pressure of 82/48 mm Hg and suspected sepsis
Rationale: Severe hypotension in a client with suspected sepsis may indicate septic shock and
inadequate tissue perfusion. Airway, breathing, circulation, and life-threatening instability take
priority.
6. A client taking warfarin has an INR of 5.8 and reports bleeding from the gums. What
should the nurse do?
A. Administer the scheduled dose
B. Encourage foods high in vitamin K and give the medication
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An elevated INR combined with active bleeding indicates excessive anticoagulation.
The nurse should withhold the dose and promptly notify the provider for further management.
7. A client with COPD becomes increasingly somnolent and difficult to arouse. Which
action should the nurse take first?
A. Encourage oral fluids
B. Assess respiratory status immediately
C. Place the client flat
D. Administer a sedative
,Answer: B. Assess respiratory status immediately
Rationale: Increasing somnolence in a client with COPD may indicate worsening hypoxemia or
hypercapnia. Immediate respiratory assessment is necessary to determine the severity of the
problem.
8. A client receiving chemotherapy has an absolute neutrophil count of 400/mm³. Which
nursing intervention is most important?
A. Encourage fresh flowers in the room
B. Perform meticulous hand hygiene
C. Encourage raw fruits and vegetables
D. Limit oral hygiene
Answer: B. Perform meticulous hand hygiene
Rationale: Severe neutropenia significantly increases infection risk. Hand hygiene is one of the
most important measures for preventing transmission of microorganisms.
9. A client arrives in the emergency department with sudden right-sided weakness and
difficulty speaking. Which information is most important for the nurse to obtain?
A. The client's last bowel movement
B. The client's usual diet
C. The exact time the symptoms began or the client was last known well
D. The client's immunization history
Answer: C. The exact time the symptoms began or the client was last known well
Rationale: Determining the time of symptom onset or last-known-well time is critical when
evaluating a possible acute stroke because treatment eligibility can depend on timing.
10. A client receiving IV morphine has a respiratory rate of 6/min and is difficult to arouse.
Which medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Protamine sulfate
D. Vitamin K
Answer: A. Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced respiratory
depression. The client's severe respiratory depression requires immediate intervention.
11. The nurse receives reports on four clients. Which client should be assessed first?
, A. Client with asthma who cannot speak in complete sentences
B. Client with chronic back pain requesting medication
C. Client with stable diabetes awaiting discharge
D. Client with a healing surgical incision
Answer: A. Client with asthma who cannot speak in complete sentences
Rationale: Inability to speak in complete sentences indicates significant respiratory distress.
Airway and breathing problems take priority over stable or nonurgent conditions.
12. A client taking lisinopril develops swelling of the lips and tongue. What is the nurse's
priority action?
A. Give the next dose with food
B. Assess the airway and seek emergency intervention
C. Encourage increased fluid intake
D. Place the client in a supine position
Answer: B. Assess the airway and seek emergency intervention
Rationale: ACE inhibitors can cause angioedema involving the lips, tongue, and airway. Airway
compromise can rapidly become life-threatening.
13. Which statement by a client taking alendronate indicates correct understanding of
administration instructions?
A. "I will take it with orange juice."
B. "I will take it with milk before going to bed."
C. "I will take it with plain water and remain upright afterward."
D. "I will crush the tablet and mix it with food."
Answer: C. "I will take it with plain water and remain upright afterward."
Rationale: Alendronate should be taken with plain water, typically on an empty stomach, and
the client should remain upright to reduce the risk of esophageal irritation.
14. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which ECG
finding should the nurse expect?
A. Peaked T waves
B. ST-segment elevation caused by myocardial infarction
C. Prolonged QT interval only
D. Narrowed QRS complexes with no other changes
Answer: A. Peaked T waves
100 Pages PDF Download Bonus 2,600 + Nclex Practice
Questions + Rationales
Course
NCLEX RN Uworld Comprehensive
1. A client with heart failure suddenly develops severe dyspnea, crackles throughout both
lungs, and pink, frothy sputum. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain the client's daily weight
D. Administer a prescribed oral diuretic
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes lung expansion and decreases venous return,
helping reduce pulmonary congestion. Severe dyspnea with pink, frothy sputum suggests acute
pulmonary edema and requires immediate intervention.
2. A nurse is administering IV potassium chloride. The client reports burning at the IV site,
and the nurse observes redness and swelling. What should the nurse do first?
A. Slow the infusion
B. Apply a warm compress
C. Stop the infusion
D. Flush the IV catheter
Answer: C. Stop the infusion
Rationale: Burning, redness, and swelling suggest IV infiltration or irritation. Potassium
chloride is irritating to tissues and should not continue through a compromised IV site.
3. A conscious client with diabetes has a blood glucose level of 54 mg/dL and is able to
swallow. Which intervention is most appropriate?
A. Administer 15 g of rapid-acting carbohydrate
B. Administer regular insulin
C. Give a high-protein meal immediately
D. Administer glucagon intramuscularly
Answer: A. Administer 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow and has hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of glucose.
,4. A postoperative client suddenly develops shortness of breath, pleuritic chest pain,
tachycardia, and anxiety. Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are classic findings
associated with pulmonary embolism. This is a potentially life-threatening emergency.
5. The nurse is assessing four clients. Which client requires the most immediate attention?
A. Client with a temperature of 38.1°C (100.6°F)
B. Client with blood pressure of 82/48 mm Hg and suspected sepsis
C. Client reporting chronic arthritis pain
D. Client requesting assistance with bathing
Answer: B. Client with blood pressure of 82/48 mm Hg and suspected sepsis
Rationale: Severe hypotension in a client with suspected sepsis may indicate septic shock and
inadequate tissue perfusion. Airway, breathing, circulation, and life-threatening instability take
priority.
6. A client taking warfarin has an INR of 5.8 and reports bleeding from the gums. What
should the nurse do?
A. Administer the scheduled dose
B. Encourage foods high in vitamin K and give the medication
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An elevated INR combined with active bleeding indicates excessive anticoagulation.
The nurse should withhold the dose and promptly notify the provider for further management.
7. A client with COPD becomes increasingly somnolent and difficult to arouse. Which
action should the nurse take first?
A. Encourage oral fluids
B. Assess respiratory status immediately
C. Place the client flat
D. Administer a sedative
,Answer: B. Assess respiratory status immediately
Rationale: Increasing somnolence in a client with COPD may indicate worsening hypoxemia or
hypercapnia. Immediate respiratory assessment is necessary to determine the severity of the
problem.
8. A client receiving chemotherapy has an absolute neutrophil count of 400/mm³. Which
nursing intervention is most important?
A. Encourage fresh flowers in the room
B. Perform meticulous hand hygiene
C. Encourage raw fruits and vegetables
D. Limit oral hygiene
Answer: B. Perform meticulous hand hygiene
Rationale: Severe neutropenia significantly increases infection risk. Hand hygiene is one of the
most important measures for preventing transmission of microorganisms.
9. A client arrives in the emergency department with sudden right-sided weakness and
difficulty speaking. Which information is most important for the nurse to obtain?
A. The client's last bowel movement
B. The client's usual diet
C. The exact time the symptoms began or the client was last known well
D. The client's immunization history
Answer: C. The exact time the symptoms began or the client was last known well
Rationale: Determining the time of symptom onset or last-known-well time is critical when
evaluating a possible acute stroke because treatment eligibility can depend on timing.
10. A client receiving IV morphine has a respiratory rate of 6/min and is difficult to arouse.
Which medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Protamine sulfate
D. Vitamin K
Answer: A. Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced respiratory
depression. The client's severe respiratory depression requires immediate intervention.
11. The nurse receives reports on four clients. Which client should be assessed first?
, A. Client with asthma who cannot speak in complete sentences
B. Client with chronic back pain requesting medication
C. Client with stable diabetes awaiting discharge
D. Client with a healing surgical incision
Answer: A. Client with asthma who cannot speak in complete sentences
Rationale: Inability to speak in complete sentences indicates significant respiratory distress.
Airway and breathing problems take priority over stable or nonurgent conditions.
12. A client taking lisinopril develops swelling of the lips and tongue. What is the nurse's
priority action?
A. Give the next dose with food
B. Assess the airway and seek emergency intervention
C. Encourage increased fluid intake
D. Place the client in a supine position
Answer: B. Assess the airway and seek emergency intervention
Rationale: ACE inhibitors can cause angioedema involving the lips, tongue, and airway. Airway
compromise can rapidly become life-threatening.
13. Which statement by a client taking alendronate indicates correct understanding of
administration instructions?
A. "I will take it with orange juice."
B. "I will take it with milk before going to bed."
C. "I will take it with plain water and remain upright afterward."
D. "I will crush the tablet and mix it with food."
Answer: C. "I will take it with plain water and remain upright afterward."
Rationale: Alendronate should be taken with plain water, typically on an empty stomach, and
the client should remain upright to reduce the risk of esophageal irritation.
14. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which ECG
finding should the nurse expect?
A. Peaked T waves
B. ST-segment elevation caused by myocardial infarction
C. Prolonged QT interval only
D. Narrowed QRS complexes with no other changes
Answer: A. Peaked T waves
