NCLEX-PN 2025/2026 COMPREHENSIVE EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A patient with COPD reports increased shortness of breath while
ambulating. Which nursing action is priority?
A. Encourage deep breathing exercises
B. Administer oxygen per protocol
C. Assist patient to sit upright
D. Call respiratory therapy
Answer: C. Assist patient to sit upright
Rationale: Upright positioning improves lung expansion and gas exchange
immediately. Oxygen may be needed, but positioning is the fastest and safest
initial intervention.
2. A patient with type 1 diabetes has blood glucose of 320 mg/dL and reports
nausea. Which intervention is priority?
A. Administer insulin as ordered
B. Encourage oral fluids
C. Assess for ketones in urine
D. Notify provider
Answer: C. Assess for ketones in urine
Rationale: Hyperglycemia with nausea may indicate diabetic ketoacidosis (DKA).
Early identification of ketones is crucial for prioritizing treatment.
,3. A patient is receiving digoxin. Which assessment finding requires
immediate intervention?
A. Heart rate 88 bpm
B. BP 120/70 mmHg
C. Heart rate 48 bpm
D. Mild fatigue
Answer: C. Heart rate 48 bpm
Rationale: Bradycardia (<60 bpm) may indicate digoxin toxicity. Hold medication
and notify provider.
4. A postoperative patient reports sudden shortness of breath, chest pain, and
anxiety. Which is the priority nursing action?
A. Administer morphine
B. Assess vital signs and oxygen saturation
C. Encourage deep breathing
D. Reposition for comfort
Answer: B. Assess vital signs and oxygen saturation
Rationale: These symptoms may indicate a pulmonary embolism. Immediate
assessment and oxygen support are critical.
5. A patient with heart failure has 3+ pitting edema of lower extremities.
Which intervention is most appropriate?
A. Encourage ambulation
B. Elevate legs and monitor daily weight
C. Restrict fluids completely
D. Apply heat to legs
Answer: B. Elevate legs and monitor daily weight
,Rationale: Elevation promotes venous return; monitoring weight helps detect fluid
retention. Fluid restriction may be ordered but is not the initial intervention without
provider orders.
6. A patient with a nasogastric tube reports nausea and abdominal distention.
Which is the priority?
A. Irrigate the tube with water
B. Assess tube placement and patency
C. Notify provider
D. Administer antiemetic
Answer: B. Assess tube placement and patency
Rationale: Obstruction or malposition can cause nausea and distention. Correct
placement and patency should be verified before interventions.
7. A patient with a new tracheostomy begins to develop respiratory distress.
Which action is immediate?
A. Suction the tracheostomy
B. Remove inner cannula and assess airway
C. Increase oxygen flow
D. Call respiratory therapy
Answer: B. Remove inner cannula and assess airway
Rationale: Immediate assessment and clearance of airway obstruction are critical;
suctioning may follow if obstruction persists.
, 8. A patient on warfarin reports unusual bruising. Which lab value is priority
to check?
A. Platelets
B. PT/INR
C. Hemoglobin
D. WBC count
Answer: B. PT/INR
Rationale: PT/INR indicates coagulation status and bleeding risk; elevated levels
increase hemorrhage risk.
9. A patient with chest tube for pneumothorax reports continuous bubbling in
water-seal chamber. Which action is priority?
A. Clamp the tube
B. Assess the system for air leak
C. Strip the tubing
D. Notify provider immediately
Answer: B. Assess the system for air leak
Rationale: Continuous bubbling may indicate an air leak. Clamping can be
dangerous unless provider-directed.
10. A patient is scheduled for a cardiac stress test. Which instruction should
the nurse provide?
A. Avoid food and fluids for 12 hours
B. Hold beta-blocker medications as prescribed
C. Avoid caffeine and tobacco before test
D. Take extra antihypertensive dose
Answer: C. Avoid caffeine and tobacco before test
Rationale: Caffeine and nicotine can interfere with cardiac stress test results.
Medications are held only as ordered.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A patient with COPD reports increased shortness of breath while
ambulating. Which nursing action is priority?
A. Encourage deep breathing exercises
B. Administer oxygen per protocol
C. Assist patient to sit upright
D. Call respiratory therapy
Answer: C. Assist patient to sit upright
Rationale: Upright positioning improves lung expansion and gas exchange
immediately. Oxygen may be needed, but positioning is the fastest and safest
initial intervention.
2. A patient with type 1 diabetes has blood glucose of 320 mg/dL and reports
nausea. Which intervention is priority?
A. Administer insulin as ordered
B. Encourage oral fluids
C. Assess for ketones in urine
D. Notify provider
Answer: C. Assess for ketones in urine
Rationale: Hyperglycemia with nausea may indicate diabetic ketoacidosis (DKA).
Early identification of ketones is crucial for prioritizing treatment.
,3. A patient is receiving digoxin. Which assessment finding requires
immediate intervention?
A. Heart rate 88 bpm
B. BP 120/70 mmHg
C. Heart rate 48 bpm
D. Mild fatigue
Answer: C. Heart rate 48 bpm
Rationale: Bradycardia (<60 bpm) may indicate digoxin toxicity. Hold medication
and notify provider.
4. A postoperative patient reports sudden shortness of breath, chest pain, and
anxiety. Which is the priority nursing action?
A. Administer morphine
B. Assess vital signs and oxygen saturation
C. Encourage deep breathing
D. Reposition for comfort
Answer: B. Assess vital signs and oxygen saturation
Rationale: These symptoms may indicate a pulmonary embolism. Immediate
assessment and oxygen support are critical.
5. A patient with heart failure has 3+ pitting edema of lower extremities.
Which intervention is most appropriate?
A. Encourage ambulation
B. Elevate legs and monitor daily weight
C. Restrict fluids completely
D. Apply heat to legs
Answer: B. Elevate legs and monitor daily weight
,Rationale: Elevation promotes venous return; monitoring weight helps detect fluid
retention. Fluid restriction may be ordered but is not the initial intervention without
provider orders.
6. A patient with a nasogastric tube reports nausea and abdominal distention.
Which is the priority?
A. Irrigate the tube with water
B. Assess tube placement and patency
C. Notify provider
D. Administer antiemetic
Answer: B. Assess tube placement and patency
Rationale: Obstruction or malposition can cause nausea and distention. Correct
placement and patency should be verified before interventions.
7. A patient with a new tracheostomy begins to develop respiratory distress.
Which action is immediate?
A. Suction the tracheostomy
B. Remove inner cannula and assess airway
C. Increase oxygen flow
D. Call respiratory therapy
Answer: B. Remove inner cannula and assess airway
Rationale: Immediate assessment and clearance of airway obstruction are critical;
suctioning may follow if obstruction persists.
, 8. A patient on warfarin reports unusual bruising. Which lab value is priority
to check?
A. Platelets
B. PT/INR
C. Hemoglobin
D. WBC count
Answer: B. PT/INR
Rationale: PT/INR indicates coagulation status and bleeding risk; elevated levels
increase hemorrhage risk.
9. A patient with chest tube for pneumothorax reports continuous bubbling in
water-seal chamber. Which action is priority?
A. Clamp the tube
B. Assess the system for air leak
C. Strip the tubing
D. Notify provider immediately
Answer: B. Assess the system for air leak
Rationale: Continuous bubbling may indicate an air leak. Clamping can be
dangerous unless provider-directed.
10. A patient is scheduled for a cardiac stress test. Which instruction should
the nurse provide?
A. Avoid food and fluids for 12 hours
B. Hold beta-blocker medications as prescribed
C. Avoid caffeine and tobacco before test
D. Take extra antihypertensive dose
Answer: C. Avoid caffeine and tobacco before test
Rationale: Caffeine and nicotine can interfere with cardiac stress test results.
Medications are held only as ordered.
