NCLEX-RN: Lippincott Q&A Review for NCLEX-
RN (14th Edition) – High-Yield Exam Questions
& Detailed Rationales
Course Code: NCLEX-RN
Course Name: Lippincott Q&A Review for NCLEX-RN (14th Edition)
Topic: High-Yield Exam Prep Questions & Detailed Rationales
Academic Year: 2026/2027
1. A nurse is evaluating an adult client admitted with an acute exacerbation of
ulcerative colitis. Which clinical finding should the nurse recognize as the
most characteristic manifestation of this chronic inflammatory bowel
pathology?
A) Alternating episodes of constipation and pencil-thin stools containing soft
mucus.
B) Severe, localized right lower quadrant pain with a palpable sausage-
shaped mass.
C) Frequent, liquid stools mixed with blood, mucus, and pus
accompanied by severe tenesmus.
D) Intermittent steatorrhea and clay-colored stools due to malabsorption of
dietary lipids.
CORRECT ANSWER: C
RATIONALE: Ulcerative colitis is an inflammatory disease that affects
the mucosa and submucosa of the colon and rectum, leading to diffuse
ulceration. Its hallmark clinical manifestation includes frequent, liquid
diarrhea entries mixed with blood, mucus, and pus, often exceeding 10 to
20 stools per day during an acute exacerbation, which causes severe rectal
tenesmus and cramping. Option A describes manifestations more typical of
irritable bowel syndrome or colorectal lesions. Option B is characteristic of
acute appendicitis or Crohn's disease (which typically targets the ileocecal
region). Option D describes biliary obstruction or severe exocrine pancreatic
insufficiency, not an ulcerated colonic mucosa.
,2. A client diagnosed with major depressive disorder has been prescribed
phenelzine sulfate. The nurse is providing comprehensive discharge
education regarding food-drug interactions. The nurse should instruct the
client to strictly avoid which food item to prevent a life-threatening crisis?
A) Fresh white fish and broiled chicken breast.
B) Aged cheddar cheese, red wine, and smoked meats containing high
levels of tyramine.
C) Whole-grain breads, brown rice, and fresh green leafy vegetables.
D) Pasteurized milk, cottage cheese, and scrambled chicken eggs.
CORRECT ANSWER: B
RATIONALE: Phenelzine sulfate is a monoamine oxidase inhibitor
(MAOI). MAOIs prevent the breakdown of tyramine in the liver.
Consuming foods high in tyramine—such as aged cheeses, red wines, draft
beers, and cured or smoked meats—leads to an accumulation of tyramine,
which displaces norepinephrine from storage vesicles, triggering a
catastrophic hypertensive crisis. Options A, C, and D contain negligible or
safe levels of tyramine and do not pose a risk for a hypertensive crisis when
taking MAOI medications.
3. The nurse is caring for an older adult client who is 48 hours postoperative
following a total knee arthroplasty. The client suddenly displays acute
confusion, a low-grade fever, tachycardia, and widespread petechiae across
the anterior chest and axillae. The nurse should immediately suspect which
postoperative complication?
A) Acute deep vein thrombosis (DVT) extending to the femoral vein.
B) Systemic hospital-acquired septic shock secondary to surgical site
infection.
C) Fat embolism syndrome (FES) resulting from micro-globule
displacement from the bone marrow.
D) Acute ischemic stroke secondary to an atrial fibrillation mural thrombus.
CORRECT ANSWER: C
RATIONALE: Fat embolism syndrome (FES) is a high-yield
complication of long bone fractures or extensive orthopedic joint
arthroplasties. The classic triad includes central nervous system changes
(acute confusion), respiratory distress/tachycardia, and a pathognomonic
petechial rash across the chest, neck, and axillae caused by microvascular
, occlusion by fat droplets. Option A causes localized limb swelling and pain
but does not cause petechiae on the torso. Option B causes hypotension and
fever but lacks the focal petechial rash. Option D presents with focal
neurological deficits (such as aphasia or hemiplegia) rather than a
dermatological petechial distribution.
4. A client with chronic structural atrial fibrillation is prescribed long-term
anticoagulation therapy with warfarin sodium. The nurse reviews the
client's morning laboratory results. Which international normalized ratio
(INR) value indicates that the medication is within the standard therapeutic
range for this client's condition?
A) INR of 1.2
B) INR of 2.5
C) INR of 4.8
D) INR of 0.8
CORRECT ANSWER: B
RATIONALE: For clients receiving warfarin sodium for atrial
fibrillation or mechanical valve prophylaxis, the standard target
therapeutic INR range is 2.0 to 3.0. An INR of 2.5 indicates effective
anticoagulation without excessive bleeding risk. Options A and D represent
subtherapeutic levels where the blood is too hypercoagulable (normal un-
anticoagulated INR is roughly 0.8 to 1.1). Option C represents a
supratherapeutic level that places the client at a dangerously high risk for
spontaneous internal hemorrhage.
5. A pediatric nurse is conducting an admission assessment on a 2-year-old
child suspected of having tetralogy of fallot. The nurse notes the child
instinctively assumes a squatting position during a severe crying spell.
What is the physiological rationale for this behavioral adaptation?
A) It decreases systemic vascular resistance, reducing the workload of the
left ventricle.
B) It increases systemic vascular resistance, diverting blood flow into
the pulmonary artery to enhance oxygenation.
C) It expands the total thoracic volume, increasing alveolar compliance and
surface area.
D) It traps poorly oxygenated blood in the upper extremities to protect the
kidneys.
, CORRECT ANSWER: B
RATIONALE: In tetralogy of fallot, a severe hypercyanotic spell ("tet
spell") occurs when pulmonary vascular resistance increases or systemic
resistance drops, shunting deoxygenated blood from right to left through the
ventricular septal defect. Assuming a squatting position kinks the femoral
arteries, which increases systemic vascular resistance (SVR). This higher
systemic pressure forces more blood to flow through the stenotic pulmonary
valve into the lungs instead of escaping through the septal defect, which
helps relieve systemic hypoxemia. Options A, C, and D do not accurately
describe the hemodynamic mechanism of squatting during a hypercyanotic
spell.
6. A nurse is reviewing safety protocols before administering intravenous
potassium chloride (KCl) to a client with severe hypokalemia. Which
planned nursing action represents a fatal medication error?
A) Infusing the diluted potassium solution at a maximum controlled rate of
10 mEq/hr via a volumetric pump.
B) Administering the prescribed potassium chloride via a direct
intravenous push injection over 2 minutes.
C) Assisting the client onto a telemetry monitor to track the cardiac rhythm
during the infusion.
D) Verifying that the client's total urinary output exceeds 30 mL/hr before
starting the line.
CORRECT ANSWER: B
RATIONALE: Intravenous potassium chloride (KCl) must NEVER be
administered via IV push, IV bolus, or as an undiluted solution. A direct
bolus of potassium causes an immediate, massive intracellular spike in
cardiac muscle cells, causing fatal cardiac arrest in diastole. Potassium must
always be thoroughly diluted in a carrier fluid and delivered slowly via an
infusion pump (Option A). Telemetry tracking (Option C) and confirming
renal function (Option D) are correct, standard nursing safety requirements.
7. An LPN is reviewing a client's chart who has been diagnosed with diabetes
insipidus (DI). The nurse should anticipate which specific combination of
objective findings in the client's vital signs and laboratory panels?
A) Marked fluid volume excess, high urine specific gravity, and severe
hyponatremia.
RN (14th Edition) – High-Yield Exam Questions
& Detailed Rationales
Course Code: NCLEX-RN
Course Name: Lippincott Q&A Review for NCLEX-RN (14th Edition)
Topic: High-Yield Exam Prep Questions & Detailed Rationales
Academic Year: 2026/2027
1. A nurse is evaluating an adult client admitted with an acute exacerbation of
ulcerative colitis. Which clinical finding should the nurse recognize as the
most characteristic manifestation of this chronic inflammatory bowel
pathology?
A) Alternating episodes of constipation and pencil-thin stools containing soft
mucus.
B) Severe, localized right lower quadrant pain with a palpable sausage-
shaped mass.
C) Frequent, liquid stools mixed with blood, mucus, and pus
accompanied by severe tenesmus.
D) Intermittent steatorrhea and clay-colored stools due to malabsorption of
dietary lipids.
CORRECT ANSWER: C
RATIONALE: Ulcerative colitis is an inflammatory disease that affects
the mucosa and submucosa of the colon and rectum, leading to diffuse
ulceration. Its hallmark clinical manifestation includes frequent, liquid
diarrhea entries mixed with blood, mucus, and pus, often exceeding 10 to
20 stools per day during an acute exacerbation, which causes severe rectal
tenesmus and cramping. Option A describes manifestations more typical of
irritable bowel syndrome or colorectal lesions. Option B is characteristic of
acute appendicitis or Crohn's disease (which typically targets the ileocecal
region). Option D describes biliary obstruction or severe exocrine pancreatic
insufficiency, not an ulcerated colonic mucosa.
,2. A client diagnosed with major depressive disorder has been prescribed
phenelzine sulfate. The nurse is providing comprehensive discharge
education regarding food-drug interactions. The nurse should instruct the
client to strictly avoid which food item to prevent a life-threatening crisis?
A) Fresh white fish and broiled chicken breast.
B) Aged cheddar cheese, red wine, and smoked meats containing high
levels of tyramine.
C) Whole-grain breads, brown rice, and fresh green leafy vegetables.
D) Pasteurized milk, cottage cheese, and scrambled chicken eggs.
CORRECT ANSWER: B
RATIONALE: Phenelzine sulfate is a monoamine oxidase inhibitor
(MAOI). MAOIs prevent the breakdown of tyramine in the liver.
Consuming foods high in tyramine—such as aged cheeses, red wines, draft
beers, and cured or smoked meats—leads to an accumulation of tyramine,
which displaces norepinephrine from storage vesicles, triggering a
catastrophic hypertensive crisis. Options A, C, and D contain negligible or
safe levels of tyramine and do not pose a risk for a hypertensive crisis when
taking MAOI medications.
3. The nurse is caring for an older adult client who is 48 hours postoperative
following a total knee arthroplasty. The client suddenly displays acute
confusion, a low-grade fever, tachycardia, and widespread petechiae across
the anterior chest and axillae. The nurse should immediately suspect which
postoperative complication?
A) Acute deep vein thrombosis (DVT) extending to the femoral vein.
B) Systemic hospital-acquired septic shock secondary to surgical site
infection.
C) Fat embolism syndrome (FES) resulting from micro-globule
displacement from the bone marrow.
D) Acute ischemic stroke secondary to an atrial fibrillation mural thrombus.
CORRECT ANSWER: C
RATIONALE: Fat embolism syndrome (FES) is a high-yield
complication of long bone fractures or extensive orthopedic joint
arthroplasties. The classic triad includes central nervous system changes
(acute confusion), respiratory distress/tachycardia, and a pathognomonic
petechial rash across the chest, neck, and axillae caused by microvascular
, occlusion by fat droplets. Option A causes localized limb swelling and pain
but does not cause petechiae on the torso. Option B causes hypotension and
fever but lacks the focal petechial rash. Option D presents with focal
neurological deficits (such as aphasia or hemiplegia) rather than a
dermatological petechial distribution.
4. A client with chronic structural atrial fibrillation is prescribed long-term
anticoagulation therapy with warfarin sodium. The nurse reviews the
client's morning laboratory results. Which international normalized ratio
(INR) value indicates that the medication is within the standard therapeutic
range for this client's condition?
A) INR of 1.2
B) INR of 2.5
C) INR of 4.8
D) INR of 0.8
CORRECT ANSWER: B
RATIONALE: For clients receiving warfarin sodium for atrial
fibrillation or mechanical valve prophylaxis, the standard target
therapeutic INR range is 2.0 to 3.0. An INR of 2.5 indicates effective
anticoagulation without excessive bleeding risk. Options A and D represent
subtherapeutic levels where the blood is too hypercoagulable (normal un-
anticoagulated INR is roughly 0.8 to 1.1). Option C represents a
supratherapeutic level that places the client at a dangerously high risk for
spontaneous internal hemorrhage.
5. A pediatric nurse is conducting an admission assessment on a 2-year-old
child suspected of having tetralogy of fallot. The nurse notes the child
instinctively assumes a squatting position during a severe crying spell.
What is the physiological rationale for this behavioral adaptation?
A) It decreases systemic vascular resistance, reducing the workload of the
left ventricle.
B) It increases systemic vascular resistance, diverting blood flow into
the pulmonary artery to enhance oxygenation.
C) It expands the total thoracic volume, increasing alveolar compliance and
surface area.
D) It traps poorly oxygenated blood in the upper extremities to protect the
kidneys.
, CORRECT ANSWER: B
RATIONALE: In tetralogy of fallot, a severe hypercyanotic spell ("tet
spell") occurs when pulmonary vascular resistance increases or systemic
resistance drops, shunting deoxygenated blood from right to left through the
ventricular septal defect. Assuming a squatting position kinks the femoral
arteries, which increases systemic vascular resistance (SVR). This higher
systemic pressure forces more blood to flow through the stenotic pulmonary
valve into the lungs instead of escaping through the septal defect, which
helps relieve systemic hypoxemia. Options A, C, and D do not accurately
describe the hemodynamic mechanism of squatting during a hypercyanotic
spell.
6. A nurse is reviewing safety protocols before administering intravenous
potassium chloride (KCl) to a client with severe hypokalemia. Which
planned nursing action represents a fatal medication error?
A) Infusing the diluted potassium solution at a maximum controlled rate of
10 mEq/hr via a volumetric pump.
B) Administering the prescribed potassium chloride via a direct
intravenous push injection over 2 minutes.
C) Assisting the client onto a telemetry monitor to track the cardiac rhythm
during the infusion.
D) Verifying that the client's total urinary output exceeds 30 mL/hr before
starting the line.
CORRECT ANSWER: B
RATIONALE: Intravenous potassium chloride (KCl) must NEVER be
administered via IV push, IV bolus, or as an undiluted solution. A direct
bolus of potassium causes an immediate, massive intracellular spike in
cardiac muscle cells, causing fatal cardiac arrest in diastole. Potassium must
always be thoroughly diluted in a carrier fluid and delivered slowly via an
infusion pump (Option A). Telemetry tracking (Option C) and confirming
renal function (Option D) are correct, standard nursing safety requirements.
7. An LPN is reviewing a client's chart who has been diagnosed with diabetes
insipidus (DI). The nurse should anticipate which specific combination of
objective findings in the client's vital signs and laboratory panels?
A) Marked fluid volume excess, high urine specific gravity, and severe
hyponatremia.
