NCLEX-RN UWorld-Style Practice Exam 2026–
2027 — Comprehensive Nursing Exam Prep |
Updated Questions, Detailed Answers,
Explanations & In-Depth Rationales
1. — HARD
A client with septic shock has received 30 mL/kg of isotonic
crystalloid. The blood pressure remains 82/48 mmHg, and the
serum lactate is 5.1 mmol/L. Which prescription should the
nurse anticipate implementing next?
A. Administer IV furosemide
B. Initiate a continuous norepinephrine infusion
C. Administer subcutaneous insulin
D. Restrict further IV fluids
Answer: B. Initiate a continuous norepinephrine infusion
Rationale: Persistent hypotension after adequate initial
crystalloid resuscitation in septic shock requires vasopressor
therapy. Norepinephrine is the preferred first-line vasopressor
because it increases vascular tone and mean arterial
pressure. Diuretics can worsen hypoperfusion, insulin does
not correct the underlying shock, and fluid restriction alone is
inappropriate when perfusion remains inadequate.
2. — HARD
,A client taking warfarin for mechanical valve replacement
reports several new symptoms. Which finding requires the
nurse's immediate intervention?
A. INR of 2.8
B. Small bruise on the forearm
C. Black, tarry stool
D. Mild gingival bleeding after brushing
Answer: C. Black, tarry stool
Rationale: Melena indicates possible gastrointestinal
hemorrhage and can represent significant anticoagulation-
associated bleeding. The nurse should immediately assess the
client, notify the provider, and anticipate evaluation of
hemoglobin, hematocrit, and coagulation status. An INR of
2.8 may be therapeutic for many mechanical-valve clients,
while minor bruising or gingival bleeding may occur with
anticoagulation but is less immediately concerning.
3. — HARD
A client with diabetic ketoacidosis is receiving an IV insulin
infusion. The glucose level has decreased from 510 mg/dL to
210 mg/dL, but the anion gap remains elevated. Which action
is most appropriate?
A. Discontinue the insulin infusion
B. Administer IV sodium bicarbonate routinely
C. Add dextrose-containing IV fluids while continuing insulin
D. Administer long-acting insulin and stop IV therapy
,Answer: C. Add dextrose-containing IV fluids while
continuing insulin
Rationale: In DKA, insulin must continue until the ketoacidosis
and elevated anion gap resolve, not merely until the serum
glucose normalizes. Once glucose falls substantially, dextrose
is added to prevent hypoglycemia while insulin continues
suppressing ketone production. Routine bicarbonate is
generally not indicated and is reserved for severe acidemia
under specific circumstances.
4. — HARD
A client with increased intracranial pressure suddenly
develops hypertension, bradycardia, and irregular
respirations. How should the nurse interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Acute hypovolemic shock
D. Spinal shock
Answer: B. Cushing response
Rationale: The combination of hypertension, particularly
increased systolic pressure or widened pulse pressure,
bradycardia, and abnormal respirations is the Cushing
response. It indicates severe intracranial pressure and
possible brainstem compression. This is a neurologic
emergency requiring immediate intervention to reduce
intracranial pressure and maintain cerebral perfusion.
, 5. — HARD
A client receiving a continuous heparin infusion has a platelet
count that decreases from 220,000/mm³ to 92,000/mm³
several days after therapy begins. The client develops new
unilateral calf pain and swelling. Which action should the
nurse take first?
A. Increase the heparin infusion
B. Administer prescribed warfarin immediately
C. Stop the heparin infusion
D. Apply a warm compress to the calf
Answer: C. Stop the heparin infusion
Rationale: A substantial platelet decrease accompanied by
new thrombosis strongly suggests heparin-induced
thrombocytopenia (HIT). All heparin products should be
discontinued promptly, and the provider should be notified
because an alternative non-heparin anticoagulant is generally
required. Increasing heparin would worsen the condition, and
warfarin should not be initiated as the sole immediate
treatment during acute HIT.
6. — HARD
A client with heart failure takes digoxin and furosemide. The
client reports nausea, weakness, and seeing yellow-green
halos around lights. Which laboratory result most increases
the risk for the suspected complication?
2027 — Comprehensive Nursing Exam Prep |
Updated Questions, Detailed Answers,
Explanations & In-Depth Rationales
1. — HARD
A client with septic shock has received 30 mL/kg of isotonic
crystalloid. The blood pressure remains 82/48 mmHg, and the
serum lactate is 5.1 mmol/L. Which prescription should the
nurse anticipate implementing next?
A. Administer IV furosemide
B. Initiate a continuous norepinephrine infusion
C. Administer subcutaneous insulin
D. Restrict further IV fluids
Answer: B. Initiate a continuous norepinephrine infusion
Rationale: Persistent hypotension after adequate initial
crystalloid resuscitation in septic shock requires vasopressor
therapy. Norepinephrine is the preferred first-line vasopressor
because it increases vascular tone and mean arterial
pressure. Diuretics can worsen hypoperfusion, insulin does
not correct the underlying shock, and fluid restriction alone is
inappropriate when perfusion remains inadequate.
2. — HARD
,A client taking warfarin for mechanical valve replacement
reports several new symptoms. Which finding requires the
nurse's immediate intervention?
A. INR of 2.8
B. Small bruise on the forearm
C. Black, tarry stool
D. Mild gingival bleeding after brushing
Answer: C. Black, tarry stool
Rationale: Melena indicates possible gastrointestinal
hemorrhage and can represent significant anticoagulation-
associated bleeding. The nurse should immediately assess the
client, notify the provider, and anticipate evaluation of
hemoglobin, hematocrit, and coagulation status. An INR of
2.8 may be therapeutic for many mechanical-valve clients,
while minor bruising or gingival bleeding may occur with
anticoagulation but is less immediately concerning.
3. — HARD
A client with diabetic ketoacidosis is receiving an IV insulin
infusion. The glucose level has decreased from 510 mg/dL to
210 mg/dL, but the anion gap remains elevated. Which action
is most appropriate?
A. Discontinue the insulin infusion
B. Administer IV sodium bicarbonate routinely
C. Add dextrose-containing IV fluids while continuing insulin
D. Administer long-acting insulin and stop IV therapy
,Answer: C. Add dextrose-containing IV fluids while
continuing insulin
Rationale: In DKA, insulin must continue until the ketoacidosis
and elevated anion gap resolve, not merely until the serum
glucose normalizes. Once glucose falls substantially, dextrose
is added to prevent hypoglycemia while insulin continues
suppressing ketone production. Routine bicarbonate is
generally not indicated and is reserved for severe acidemia
under specific circumstances.
4. — HARD
A client with increased intracranial pressure suddenly
develops hypertension, bradycardia, and irregular
respirations. How should the nurse interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Acute hypovolemic shock
D. Spinal shock
Answer: B. Cushing response
Rationale: The combination of hypertension, particularly
increased systolic pressure or widened pulse pressure,
bradycardia, and abnormal respirations is the Cushing
response. It indicates severe intracranial pressure and
possible brainstem compression. This is a neurologic
emergency requiring immediate intervention to reduce
intracranial pressure and maintain cerebral perfusion.
, 5. — HARD
A client receiving a continuous heparin infusion has a platelet
count that decreases from 220,000/mm³ to 92,000/mm³
several days after therapy begins. The client develops new
unilateral calf pain and swelling. Which action should the
nurse take first?
A. Increase the heparin infusion
B. Administer prescribed warfarin immediately
C. Stop the heparin infusion
D. Apply a warm compress to the calf
Answer: C. Stop the heparin infusion
Rationale: A substantial platelet decrease accompanied by
new thrombosis strongly suggests heparin-induced
thrombocytopenia (HIT). All heparin products should be
discontinued promptly, and the provider should be notified
because an alternative non-heparin anticoagulant is generally
required. Increasing heparin would worsen the condition, and
warfarin should not be initiated as the sole immediate
treatment during acute HIT.
6. — HARD
A client with heart failure takes digoxin and furosemide. The
client reports nausea, weakness, and seeing yellow-green
halos around lights. Which laboratory result most increases
the risk for the suspected complication?
