NCLEX-RN ADVANCED PRACTICE
EXAM QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A nurse is caring for a client with a suspected pheochromocytoma. Which assessment
finding should the nurse prioritize for immediate intervention?
A. Profuse diaphoresis and pallor
B. Blood pressure of 210/110 mmHg
C. Report of a severe, pounding headache
D. Heart rate of 115 beats per minute
Answer: B
Conceptual Explanation: Pheochromocytoma causes excessive catecholamine release.
While all options are signs, the hypertensive crisis (210/110) poses the most immediate
risk for stroke or organ damage.
2. Which client should the nurse assess first after receiving the change-of-shift report?
A. A client with chronic obstructive pulmonary disease (COPD) and an SpO2 of 89% on 2L
NC
,B. A client with a chest tube for a pneumothorax who has tidaling in the water seal
chamber
C. A client 2 days post-appendectomy reporting pain at a level of 6 out of 10
D. A client with a femoral fracture who is suddenly confused and has petechiae on the chest
Answer: D
Conceptual Explanation: Confusion and petechiae in a client with a long bone fracture are
classic signs of Fat Embolism Syndrome, a life-threatening emergency requiring immediate
intervention.
3. A client is prescribed intravenous Magnesium Sulfate for preeclampsia. Which finding
would necessitate stopping the infusion immediately?
A. Deep tendon reflexes of 2+
B. Respiratory rate of 10 breaths per minute
C. Urinary output of 40 mL/hour
D. Serum magnesium level of 6 mEq/L
Answer: B
Conceptual Explanation: Magnesium toxicity causes CNS depression. A respiratory rate
below 12 is a primary indicator of toxicity. Normal therapeutic levels are 4-7 mEq/L, and
2+ DTRs are normal.
, 4. The nurse is monitoring a client with an acute myocardial infarction. The monitor shows
frequent premature ventricular contractions (PVCs). Which lab value is most likely
contributing to this rhythm?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mEq/L
Answer: B
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) increases myocardial
irritability, leading to PVCs and potentially ventricular tachycardia or fibrillation, especially
in a post-MI patient.
5. A patient with cirrhosis and esophageal varices is prescribed Propranolol. What is the
primary purpose of this medication for this patient?
A. To decrease heart rate and oxygen demand
B. To lower portal venous pressure to prevent bleeding
C. To treat underlying essential hypertension
D. To reduce the risk of hepatic encephalopathy
Answer: B
EXAM QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A nurse is caring for a client with a suspected pheochromocytoma. Which assessment
finding should the nurse prioritize for immediate intervention?
A. Profuse diaphoresis and pallor
B. Blood pressure of 210/110 mmHg
C. Report of a severe, pounding headache
D. Heart rate of 115 beats per minute
Answer: B
Conceptual Explanation: Pheochromocytoma causes excessive catecholamine release.
While all options are signs, the hypertensive crisis (210/110) poses the most immediate
risk for stroke or organ damage.
2. Which client should the nurse assess first after receiving the change-of-shift report?
A. A client with chronic obstructive pulmonary disease (COPD) and an SpO2 of 89% on 2L
NC
,B. A client with a chest tube for a pneumothorax who has tidaling in the water seal
chamber
C. A client 2 days post-appendectomy reporting pain at a level of 6 out of 10
D. A client with a femoral fracture who is suddenly confused and has petechiae on the chest
Answer: D
Conceptual Explanation: Confusion and petechiae in a client with a long bone fracture are
classic signs of Fat Embolism Syndrome, a life-threatening emergency requiring immediate
intervention.
3. A client is prescribed intravenous Magnesium Sulfate for preeclampsia. Which finding
would necessitate stopping the infusion immediately?
A. Deep tendon reflexes of 2+
B. Respiratory rate of 10 breaths per minute
C. Urinary output of 40 mL/hour
D. Serum magnesium level of 6 mEq/L
Answer: B
Conceptual Explanation: Magnesium toxicity causes CNS depression. A respiratory rate
below 12 is a primary indicator of toxicity. Normal therapeutic levels are 4-7 mEq/L, and
2+ DTRs are normal.
, 4. The nurse is monitoring a client with an acute myocardial infarction. The monitor shows
frequent premature ventricular contractions (PVCs). Which lab value is most likely
contributing to this rhythm?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mEq/L
Answer: B
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) increases myocardial
irritability, leading to PVCs and potentially ventricular tachycardia or fibrillation, especially
in a post-MI patient.
5. A patient with cirrhosis and esophageal varices is prescribed Propranolol. What is the
primary purpose of this medication for this patient?
A. To decrease heart rate and oxygen demand
B. To lower portal venous pressure to prevent bleeding
C. To treat underlying essential hypertension
D. To reduce the risk of hepatic encephalopathy
Answer: B
