NCLEX-RN LEVEL IV EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT
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1. A nurse is caring for a patient with a new diagnosis of heart failure.
Which assessment finding requires immediate intervention?
A. Peripheral edema
B. Shortness of breath at rest
C. Weight gain of 2 pounds in a week
D. Fatigue with exertion
B. Shortness of breath at rest
Immediate intervention is required for acute respiratory distress, which
can indicate worsening heart failure.
2. The nurse is preparing to administer digoxin. Which assessment
finding should the nurse check before giving the medication?
A. Blood pressure
B. Respiratory rate
C. Apical pulse
D. Oxygen saturation
C. Apical pulse
Digoxin can cause bradycardia; the apical pulse must be assessed
before administration.
3. A patient with diabetes mellitus reports feeling shaky and sweaty.
What is the nurse’s priority action?
A. Administer insulin
B. Check blood glucose
,C. Encourage exercise
D. Give a high-protein snack
B. Check blood glucose
Hypoglycemia must be confirmed before administering treatment;
symptoms like shakiness and sweating indicate low blood sugar.
4. Which of the following is the best method to prevent central line-
associated bloodstream infections (CLABSI)?
A. Routine dressing changes every 2 weeks
B. Using sterile technique during insertion and maintenance
C. Flushing the line with water
D. Removing the line once a month
B. Using sterile technique during insertion and maintenance
Maintaining strict sterile technique is essential to prevent CLABSI.
5. A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which finding is most
concerning?
A. SpO₂ 91%
B. Respiratory rate 10 breaths/min
C. Use of accessory muscles
D. Mild cough
B. Respiratory rate 10 breaths/min
Hypoventilation in COPD patients receiving oxygen can lead to CO₂
retention; a low respiratory rate is concerning.
6. Which intervention is most important for a patient receiving
chemotherapy?
A. Encourage high-calorie diet
B. Monitor for neutropenia and infection
C. Assess for hair loss
D. Encourage physical exercise
, B. Monitor for neutropenia and infection
Chemotherapy suppresses bone marrow, increasing infection risk;
monitoring WBC and infection signs is critical.
7. A patient is prescribed warfarin. Which lab test should the nurse
monitor?
A. Hemoglobin A1c
B. INR (International Normalized Ratio)
C. Serum potassium
D. WBC count
B. INR (International Normalized Ratio)
Warfarin therapy is monitored using INR to ensure safe anticoagulation.
8. The nurse is teaching a patient about a low-sodium diet. Which
food choice indicates understanding?
A. Canned soup
B. Fresh fruit
C. Processed cheese
D. Salty crackers
B. Fresh fruit
Fresh fruits are naturally low in sodium and appropriate for a low-
sodium diet.
9. A patient with a nasogastric tube reports nausea. What is the
nurse’s first action?
A. Administer antiemetic
B. Check tube placement and patency
C. Notify the physician
D. Reposition the patient
B. Check tube placement and patency
Nausea may indicate tube obstruction or displacement; assessment
comes first.
CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD
1. A nurse is caring for a patient with a new diagnosis of heart failure.
Which assessment finding requires immediate intervention?
A. Peripheral edema
B. Shortness of breath at rest
C. Weight gain of 2 pounds in a week
D. Fatigue with exertion
B. Shortness of breath at rest
Immediate intervention is required for acute respiratory distress, which
can indicate worsening heart failure.
2. The nurse is preparing to administer digoxin. Which assessment
finding should the nurse check before giving the medication?
A. Blood pressure
B. Respiratory rate
C. Apical pulse
D. Oxygen saturation
C. Apical pulse
Digoxin can cause bradycardia; the apical pulse must be assessed
before administration.
3. A patient with diabetes mellitus reports feeling shaky and sweaty.
What is the nurse’s priority action?
A. Administer insulin
B. Check blood glucose
,C. Encourage exercise
D. Give a high-protein snack
B. Check blood glucose
Hypoglycemia must be confirmed before administering treatment;
symptoms like shakiness and sweating indicate low blood sugar.
4. Which of the following is the best method to prevent central line-
associated bloodstream infections (CLABSI)?
A. Routine dressing changes every 2 weeks
B. Using sterile technique during insertion and maintenance
C. Flushing the line with water
D. Removing the line once a month
B. Using sterile technique during insertion and maintenance
Maintaining strict sterile technique is essential to prevent CLABSI.
5. A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which finding is most
concerning?
A. SpO₂ 91%
B. Respiratory rate 10 breaths/min
C. Use of accessory muscles
D. Mild cough
B. Respiratory rate 10 breaths/min
Hypoventilation in COPD patients receiving oxygen can lead to CO₂
retention; a low respiratory rate is concerning.
6. Which intervention is most important for a patient receiving
chemotherapy?
A. Encourage high-calorie diet
B. Monitor for neutropenia and infection
C. Assess for hair loss
D. Encourage physical exercise
, B. Monitor for neutropenia and infection
Chemotherapy suppresses bone marrow, increasing infection risk;
monitoring WBC and infection signs is critical.
7. A patient is prescribed warfarin. Which lab test should the nurse
monitor?
A. Hemoglobin A1c
B. INR (International Normalized Ratio)
C. Serum potassium
D. WBC count
B. INR (International Normalized Ratio)
Warfarin therapy is monitored using INR to ensure safe anticoagulation.
8. The nurse is teaching a patient about a low-sodium diet. Which
food choice indicates understanding?
A. Canned soup
B. Fresh fruit
C. Processed cheese
D. Salty crackers
B. Fresh fruit
Fresh fruits are naturally low in sodium and appropriate for a low-
sodium diet.
9. A patient with a nasogastric tube reports nausea. What is the
nurse’s first action?
A. Administer antiemetic
B. Check tube placement and patency
C. Notify the physician
D. Reposition the patient
B. Check tube placement and patency
Nausea may indicate tube obstruction or displacement; assessment
comes first.
