NCLEX-PN: Exam Cram Practice Questions and
Answers Prep with Detailed Rationales
Course Code: NCLEX-PN
Course Name: NCLEX-PN Comprehensive Board Review
Topic: Multi-System Prioritization, Surgical Safety, and Maternal-Child
Pharmacology
Academic Year: 2026/2027
1. A patient returns to the progressive care unit immediately following a
transsphenoidal resection of a pituitary tumor. During the initial post-
operative assessment, which airway complication or localized physical
finding must the nurse evaluate with the highest degree of vigilance?
A. Acute nasal congestion
B. Deep lower abdominal tenderness
C. Generalized muscle tetany
D. Sudden-onset oliguria
CORRECT ANSWER: A
RATIONALE: The transsphenoidal approach accesses the pituitary gland
through the nasal cavity and sphenoid sinus. Post-operative swelling, packing, or
nasal congestion can critically compromise the airway because the patient is
forced to breathe exclusively through the mouth. Abdominal tenderness is
unrelated to this cranial site. While damage to the parathyroid glands during neck
surgery causes muscle tetany, and neurohypophyseal damage can cause diabetes
insipidus (polyuria), nasal congestion presents an immediate airway obstruction
risk.
2. A patient with advanced cancer is admitted to the oncology unit. Stat
laboratory results reveal the following values: Hemoglobin 12.6 g/dL, White
Blood Cell (WBC) count 6,500/mm³, Serum Potassium (K+) 1.9 mEq/L,
Uric Acid 7.0 mg/dL, Sodium (Na+) 136 mEq/L, and Platelets
178,000/mm³. Which electrolyte derangement or hematological
complication must the nurse prioritize for immediate medical intervention?
A. Dilutional hypernatremia
B. Severe hypokalemia
, C. Acute myelosuppression
D. Leukocytosis
CORRECT ANSWER: B
RATIONALE: The laboratory panel reveals a critically low serum potassium
level of 1.9 mEq/L (normal reference range is 3.5–5.0 mEq/L), which constitutes
severe hypokalemia. This life-threatening values requires immediate cardiac
monitoring and intravenous potassium replacement to prevent lethal ventricular
arrhythmias. The patient's hemoglobin, WBC count (6,500), sodium (136), and
platelets (178,000) fall within normal limits, ruling out hypernatremia,
myelosuppression, and leukocytosis.
3. A 24-year-old female patient is scheduled for an elective surgical procedure
in the morning. Which action represents the primary, independent
responsibility of the pre-operative nurse?
A. Measuring and documenting the patient's baseline vital signs.
B. Obtaining and verifying the official legal surgical consent permit.
C. Explaining the intricate steps and internal complications of the procedure.
D. Formulating the initial diagnostic laboratory interpretations.
CORRECT ANSWER: A
RATIONALE: The primary responsibility of the pre-operative nurse is to
obtain, verify, and document a complete set of baseline vital signs immediately
before surgery to ensure hemodynamic stability and provide a point of comparison
for the intra-operative team. Explaining the surgical procedure, detailing risks, and
obtaining the formal signed informed consent permit are strict legal responsibilities
of the operating surgeon, not the nurse.
4. An emergency department nurse is triaging a patient who sustained severe,
extensive thermal burns to the left arm, hands, face, and neck in a house
fire. Which immediate intervention takes absolute priority?
A. Cannulating a large-bore peripheral vein to initiate fluid resuscitation.
B. Applying supplemental humidified oxygen and establishing airway
patency.
C. Obtaining a stat arterial blood gas (ABG) panel.
D. Administering intravenous opioid analgesics for acute pain control.
CORRECT ANSWER: B
RATIONALE: Following the standard ABC (Airway, Breathing, Circulation)
,framework, any patient with significant thermal burns involving the face and
neck is at extreme risk for inhalation injury, upper airway edema, and rapid
asphyxiation. Therefore, the priority action is applying supplemental oxygen and
securing the airway. Intravenous fluid access, blood gas sampling, and pain
management are vital secondary steps performed immediately after airway
stabilization.
5. A home health nurse provides discharge teaching to a patient with
osteoporosis who has been prescribed alendronate (Fosamax). Which
instruction must the nurse emphasize to guarantee safe administration and
prevent severe esophageal erosion?
A. "Rest flat in bed for at least 30 minutes immediately after swallowing the
pill."
B. "Avoid rapid physical movements or bending over for 2 hours after
ingestion."
C. "Take the medication first thing in the morning with a full glass of
plain water only."
D. "Allow at least 1 hour to elapse between taking this medicine and eating
foods."
CORRECT ANSWER: C
RATIONALE: Alendronate (Fosamax) must be taken first thing in the
morning with a full glass of plain water only on an empty stomach to ensure
adequate absorption. To prevent severe chemical esophagitis and esophageal
ulceration, the patient must also remain completely upright (sitting or standing)
for at least 30 minutes after taking the medication. Taking it with juices, coffee,
or mineral water eliminates its bioavailability.
6. The nurse is performing an initial assessment on a patient with a C5 cervical
spinal fracture stabilized with Crutchfield tongs. Which specialized piece
of equipment is mandatory to maintain directly at the bedside?
A. A pair of sterile hemostatic forceps
B. A calibrated torque wrench
C. A pair of heavy-duty wire cutters
D. A magnetized philips screwdriver
CORRECT ANSWER: B
RATIONALE: A calibrated torque wrench must be kept directly at the
, bedside for any patient stabilized with Crutchfield tongs. This specialized tool
allows the healthcare team to check, tighten, or adjust the skull pins systematically,
ensuring that the exact prescribed amount of mechanical pressure is applied to
maintain spinal traction and alignment. Wire cutters are kept for halo vests or jaw
wiring, not skull tongs.
7. A newborn infant weighs exactly 7 pounds at birth. Based on standard
pediatric growth charts, what should the nurse calculate as the expected
normal weight for this child at 1 year of age?
A. 10 pounds
B. 12 pounds
C. 18 pounds
D. 21 pounds
CORRECT ANSWER: D
RATIONALE: An infant's birth weight is expected to double by 5 to 6 months
of age and triple by 1 year of age. Because the infant weighed 7 pounds at birth,
multiplying by three yields an expected operational weight of 21 pounds at 12
months of age.
8. A patient is admitted to the pediatric oncology unit with a confirmed
diagnosis of Ewing's sarcoma. Based on the characteristic pathology of this
malignancy, which symptom should the nurse anticipate as the primary
clinical complaint?
A. Sudden-onset flaccid hemiplegia
B. Expressive or receptive aphasia
C. Intractable early-morning nausea
D. Localized, deep bone pain
CORRECT ANSWER: D
RATIONALE: Ewing's sarcoma is a highly malignant primary bone cancer
that typically develops within the long bones or pelvis of children and young
adults. Consequently, the most common, defining clinical symptom is localized,
deep bone pain accompanied by localized swelling. Hemiplegia and aphasia
indicate neurological lesions, not a primary bone sarcoma.
9. A patient with epilepsy is receiving long-term anticonvulsant therapy with
carbamazepine (Tegretol). Which follow-up laboratory finding should alert
the nurse to a life-threatening hematological adverse effect of this
Answers Prep with Detailed Rationales
Course Code: NCLEX-PN
Course Name: NCLEX-PN Comprehensive Board Review
Topic: Multi-System Prioritization, Surgical Safety, and Maternal-Child
Pharmacology
Academic Year: 2026/2027
1. A patient returns to the progressive care unit immediately following a
transsphenoidal resection of a pituitary tumor. During the initial post-
operative assessment, which airway complication or localized physical
finding must the nurse evaluate with the highest degree of vigilance?
A. Acute nasal congestion
B. Deep lower abdominal tenderness
C. Generalized muscle tetany
D. Sudden-onset oliguria
CORRECT ANSWER: A
RATIONALE: The transsphenoidal approach accesses the pituitary gland
through the nasal cavity and sphenoid sinus. Post-operative swelling, packing, or
nasal congestion can critically compromise the airway because the patient is
forced to breathe exclusively through the mouth. Abdominal tenderness is
unrelated to this cranial site. While damage to the parathyroid glands during neck
surgery causes muscle tetany, and neurohypophyseal damage can cause diabetes
insipidus (polyuria), nasal congestion presents an immediate airway obstruction
risk.
2. A patient with advanced cancer is admitted to the oncology unit. Stat
laboratory results reveal the following values: Hemoglobin 12.6 g/dL, White
Blood Cell (WBC) count 6,500/mm³, Serum Potassium (K+) 1.9 mEq/L,
Uric Acid 7.0 mg/dL, Sodium (Na+) 136 mEq/L, and Platelets
178,000/mm³. Which electrolyte derangement or hematological
complication must the nurse prioritize for immediate medical intervention?
A. Dilutional hypernatremia
B. Severe hypokalemia
, C. Acute myelosuppression
D. Leukocytosis
CORRECT ANSWER: B
RATIONALE: The laboratory panel reveals a critically low serum potassium
level of 1.9 mEq/L (normal reference range is 3.5–5.0 mEq/L), which constitutes
severe hypokalemia. This life-threatening values requires immediate cardiac
monitoring and intravenous potassium replacement to prevent lethal ventricular
arrhythmias. The patient's hemoglobin, WBC count (6,500), sodium (136), and
platelets (178,000) fall within normal limits, ruling out hypernatremia,
myelosuppression, and leukocytosis.
3. A 24-year-old female patient is scheduled for an elective surgical procedure
in the morning. Which action represents the primary, independent
responsibility of the pre-operative nurse?
A. Measuring and documenting the patient's baseline vital signs.
B. Obtaining and verifying the official legal surgical consent permit.
C. Explaining the intricate steps and internal complications of the procedure.
D. Formulating the initial diagnostic laboratory interpretations.
CORRECT ANSWER: A
RATIONALE: The primary responsibility of the pre-operative nurse is to
obtain, verify, and document a complete set of baseline vital signs immediately
before surgery to ensure hemodynamic stability and provide a point of comparison
for the intra-operative team. Explaining the surgical procedure, detailing risks, and
obtaining the formal signed informed consent permit are strict legal responsibilities
of the operating surgeon, not the nurse.
4. An emergency department nurse is triaging a patient who sustained severe,
extensive thermal burns to the left arm, hands, face, and neck in a house
fire. Which immediate intervention takes absolute priority?
A. Cannulating a large-bore peripheral vein to initiate fluid resuscitation.
B. Applying supplemental humidified oxygen and establishing airway
patency.
C. Obtaining a stat arterial blood gas (ABG) panel.
D. Administering intravenous opioid analgesics for acute pain control.
CORRECT ANSWER: B
RATIONALE: Following the standard ABC (Airway, Breathing, Circulation)
,framework, any patient with significant thermal burns involving the face and
neck is at extreme risk for inhalation injury, upper airway edema, and rapid
asphyxiation. Therefore, the priority action is applying supplemental oxygen and
securing the airway. Intravenous fluid access, blood gas sampling, and pain
management are vital secondary steps performed immediately after airway
stabilization.
5. A home health nurse provides discharge teaching to a patient with
osteoporosis who has been prescribed alendronate (Fosamax). Which
instruction must the nurse emphasize to guarantee safe administration and
prevent severe esophageal erosion?
A. "Rest flat in bed for at least 30 minutes immediately after swallowing the
pill."
B. "Avoid rapid physical movements or bending over for 2 hours after
ingestion."
C. "Take the medication first thing in the morning with a full glass of
plain water only."
D. "Allow at least 1 hour to elapse between taking this medicine and eating
foods."
CORRECT ANSWER: C
RATIONALE: Alendronate (Fosamax) must be taken first thing in the
morning with a full glass of plain water only on an empty stomach to ensure
adequate absorption. To prevent severe chemical esophagitis and esophageal
ulceration, the patient must also remain completely upright (sitting or standing)
for at least 30 minutes after taking the medication. Taking it with juices, coffee,
or mineral water eliminates its bioavailability.
6. The nurse is performing an initial assessment on a patient with a C5 cervical
spinal fracture stabilized with Crutchfield tongs. Which specialized piece
of equipment is mandatory to maintain directly at the bedside?
A. A pair of sterile hemostatic forceps
B. A calibrated torque wrench
C. A pair of heavy-duty wire cutters
D. A magnetized philips screwdriver
CORRECT ANSWER: B
RATIONALE: A calibrated torque wrench must be kept directly at the
, bedside for any patient stabilized with Crutchfield tongs. This specialized tool
allows the healthcare team to check, tighten, or adjust the skull pins systematically,
ensuring that the exact prescribed amount of mechanical pressure is applied to
maintain spinal traction and alignment. Wire cutters are kept for halo vests or jaw
wiring, not skull tongs.
7. A newborn infant weighs exactly 7 pounds at birth. Based on standard
pediatric growth charts, what should the nurse calculate as the expected
normal weight for this child at 1 year of age?
A. 10 pounds
B. 12 pounds
C. 18 pounds
D. 21 pounds
CORRECT ANSWER: D
RATIONALE: An infant's birth weight is expected to double by 5 to 6 months
of age and triple by 1 year of age. Because the infant weighed 7 pounds at birth,
multiplying by three yields an expected operational weight of 21 pounds at 12
months of age.
8. A patient is admitted to the pediatric oncology unit with a confirmed
diagnosis of Ewing's sarcoma. Based on the characteristic pathology of this
malignancy, which symptom should the nurse anticipate as the primary
clinical complaint?
A. Sudden-onset flaccid hemiplegia
B. Expressive or receptive aphasia
C. Intractable early-morning nausea
D. Localized, deep bone pain
CORRECT ANSWER: D
RATIONALE: Ewing's sarcoma is a highly malignant primary bone cancer
that typically develops within the long bones or pelvis of children and young
adults. Consequently, the most common, defining clinical symptom is localized,
deep bone pain accompanied by localized swelling. Hemiplegia and aphasia
indicate neurological lesions, not a primary bone sarcoma.
9. A patient with epilepsy is receiving long-term anticonvulsant therapy with
carbamazepine (Tegretol). Which follow-up laboratory finding should alert
the nurse to a life-threatening hematological adverse effect of this
