NCLEX-RN ADVANCED FINAL EXAM
COMPREHENSIVE REVIEW QUESTIONS
& ANSWERS (VERIFIED ANSWERS)
WITH EXPERT EXPLANATIONS | 2026 –
2027 UPDATE (PDF)
1. A client is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following
laboratory findings should the nurse expect to observe?
A. Serum osmolality 350 mOsm/kg and blood glucose 800 mg/dL.
B. Serum pH 7.48, HCO3 28 mEq/L, and negative urine ketones.
C. Blood glucose 250 mg/dL, pH 7.36, and trace ketones.
D. Serum pH 7.28, HCO3 14 mEq/L, and positive urine ketones.
Answer: D
Conceptual Explanation: DKA is characterized by metabolic acidosis (low pH and low
bicarbonate) and the presence of ketones in the blood and urine due to fat breakdown.
2. A patient with Chronic Heart Failure is prescribed Digoxin 0.25 mg daily. Which assessment
finding would indicate the need to withhold the medication?
A. Blood pressure 110/70 mmHg.
B. Respiratory rate of 18 breaths per minute.
,C. Apical pulse of 72 beats per minute.
D. Serum potassium level of 3.2 mEq/L.
Answer: D
Conceptual Explanation: Hypokalemia (low potassium) significantly increases the risk of
digoxin toxicity; the medication should be held and the provider notified if potassium is
low.
3. Which client should the nurse assess first after receiving the change-of-shift report?
A. A client with pneumonia who has an oxygen saturation of 94% on 2L NC.
B. A client with a head injury whose Glasgow Coma Scale score decreased from 13 to 11.
C. A client post-appendectomy reporting pain as 6 out of 10.
D. A client with type 1 diabetes whose fasting blood glucose is 150 mg/dL.
Answer: B
Conceptual Explanation: A decrease in Glasgow Coma Scale (GCS) score indicates
neurological deterioration and is an acute priority over stable respiratory status or post-op
pain.
4. A client is receiving a continuous intravenous infusion of Heparin for a Deep Vein
Thrombosis. The PTT is 110 seconds (Control: 30 seconds). Which action should the nurse take
first?
A. Increase the infusion rate by 10%.
, B. Continue the infusion and recheck in 4 hours.
C. Administer Vitamin K intramuscularly.
D. Stop the Heparin infusion.
Answer: D
Conceptual Explanation: A PTT of 110 seconds is significantly above the therapeutic
range (usually 1.5-2.5 times the control). The priority is to stop the infusion to prevent
hemorrhage.
5. The nurse is caring for a client with a C5 spinal cord injury. Which clinical manifestation
most strongly suggests autonomic dysreflexia?
A. Sudden hypertension and severe pounding headache.
B. Tachycardia and hypotension.
C. Flaccid paralysis below the level of injury.
D. Extreme thirst and polyuria.
Answer: A
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
a sharp rise in blood pressure, bradycardia, and a severe headache, triggered by stimuli
below the level of injury.
COMPREHENSIVE REVIEW QUESTIONS
& ANSWERS (VERIFIED ANSWERS)
WITH EXPERT EXPLANATIONS | 2026 –
2027 UPDATE (PDF)
1. A client is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following
laboratory findings should the nurse expect to observe?
A. Serum osmolality 350 mOsm/kg and blood glucose 800 mg/dL.
B. Serum pH 7.48, HCO3 28 mEq/L, and negative urine ketones.
C. Blood glucose 250 mg/dL, pH 7.36, and trace ketones.
D. Serum pH 7.28, HCO3 14 mEq/L, and positive urine ketones.
Answer: D
Conceptual Explanation: DKA is characterized by metabolic acidosis (low pH and low
bicarbonate) and the presence of ketones in the blood and urine due to fat breakdown.
2. A patient with Chronic Heart Failure is prescribed Digoxin 0.25 mg daily. Which assessment
finding would indicate the need to withhold the medication?
A. Blood pressure 110/70 mmHg.
B. Respiratory rate of 18 breaths per minute.
,C. Apical pulse of 72 beats per minute.
D. Serum potassium level of 3.2 mEq/L.
Answer: D
Conceptual Explanation: Hypokalemia (low potassium) significantly increases the risk of
digoxin toxicity; the medication should be held and the provider notified if potassium is
low.
3. Which client should the nurse assess first after receiving the change-of-shift report?
A. A client with pneumonia who has an oxygen saturation of 94% on 2L NC.
B. A client with a head injury whose Glasgow Coma Scale score decreased from 13 to 11.
C. A client post-appendectomy reporting pain as 6 out of 10.
D. A client with type 1 diabetes whose fasting blood glucose is 150 mg/dL.
Answer: B
Conceptual Explanation: A decrease in Glasgow Coma Scale (GCS) score indicates
neurological deterioration and is an acute priority over stable respiratory status or post-op
pain.
4. A client is receiving a continuous intravenous infusion of Heparin for a Deep Vein
Thrombosis. The PTT is 110 seconds (Control: 30 seconds). Which action should the nurse take
first?
A. Increase the infusion rate by 10%.
, B. Continue the infusion and recheck in 4 hours.
C. Administer Vitamin K intramuscularly.
D. Stop the Heparin infusion.
Answer: D
Conceptual Explanation: A PTT of 110 seconds is significantly above the therapeutic
range (usually 1.5-2.5 times the control). The priority is to stop the infusion to prevent
hemorrhage.
5. The nurse is caring for a client with a C5 spinal cord injury. Which clinical manifestation
most strongly suggests autonomic dysreflexia?
A. Sudden hypertension and severe pounding headache.
B. Tachycardia and hypotension.
C. Flaccid paralysis below the level of injury.
D. Extreme thirst and polyuria.
Answer: A
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
a sharp rise in blood pressure, bradycardia, and a severe headache, triggered by stimuli
below the level of injury.
