NCLEX-RN MIDTERM
COMPREHENSIVE EXAM QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%.
B. A client who is 2 hours post-operative following a thyroidectomy reporting tingling in
the fingers.
C. A client receiving a blood transfusion who reports a new onset of lower back pain and
restlessness.
D. A client with a history of heart failure who has developed 2+ pitting edema in the lower
extremities.
Answer: C
Conceptual Explanation: Lower back pain and restlessness during a blood transfusion are
classic signs of a hemolytic reaction, which is a life-threatening emergency requiring
immediate intervention.
,2. A client is receiving digoxin 0.25 mg daily for heart failure. Which assessment finding
should the nurse prioritize as a sign of toxicity?
A. Occasional premature ventricular contractions (PVCs).
B. Increased urinary output following administration.
C. A heart rate of 72 beats per minute.
D. Reports of seeing yellow-green halos around lights.
Answer: D
Conceptual Explanation: Visual disturbances, such as seeing yellow, green, or white halos,
are specific and early indicators of digoxin toxicity.
3. Which laboratory value should the nurse monitor most closely for a client receiving a high
dose of furosemide?
A. Serum sodium of 135 mEq/L.
B. Serum creatinine of 0.8 mg/dL.
C. Serum potassium of 3.2 mEq/L.
D. Serum calcium of 9.0 mg/dL.
Answer: C
Conceptual Explanation: Furosemide is a loop diuretic that causes significant potassium
loss; a level of 3.2 mEq/L indicates hypokalemia, which increases the risk of cardiac
arrhythmias.
, 4. A 4-year-old child is brought to the emergency department with drooling, muffled voice,
and a tripod sitting position. What is the priority nursing action?
A. Obtain a throat culture to identify the causative organism.
B. Prepare for immediate endotracheal intubation or tracheostomy.
C. Examine the throat using a tongue blade to assess for edema.
D. Administer an oral antipyretic to reduce the child’s fever.
Answer: B
Conceptual Explanation: These are classic signs of epiglottitis. Any attempt to visualize
the throat can cause complete airway obstruction; maintaining a patent airway is the
absolute priority.
5. A client in active labor is receiving a magnesium sulfate infusion for pre-eclampsia. Which
finding requires the nurse to stop the infusion?
A. Blood pressure of 140/90 mmHg.
B. Respiratory rate of 10 breaths per minute.
C. Deep tendon reflexes of 2+.
D. Urinary output of 40 mL/hour.
Answer: B
Conceptual Explanation: Magnesium sulfate toxicity causes central nervous system
depression, leading to bradypnea (RR < 12) and loss of deep tendon reflexes.
COMPREHENSIVE EXAM QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%.
B. A client who is 2 hours post-operative following a thyroidectomy reporting tingling in
the fingers.
C. A client receiving a blood transfusion who reports a new onset of lower back pain and
restlessness.
D. A client with a history of heart failure who has developed 2+ pitting edema in the lower
extremities.
Answer: C
Conceptual Explanation: Lower back pain and restlessness during a blood transfusion are
classic signs of a hemolytic reaction, which is a life-threatening emergency requiring
immediate intervention.
,2. A client is receiving digoxin 0.25 mg daily for heart failure. Which assessment finding
should the nurse prioritize as a sign of toxicity?
A. Occasional premature ventricular contractions (PVCs).
B. Increased urinary output following administration.
C. A heart rate of 72 beats per minute.
D. Reports of seeing yellow-green halos around lights.
Answer: D
Conceptual Explanation: Visual disturbances, such as seeing yellow, green, or white halos,
are specific and early indicators of digoxin toxicity.
3. Which laboratory value should the nurse monitor most closely for a client receiving a high
dose of furosemide?
A. Serum sodium of 135 mEq/L.
B. Serum creatinine of 0.8 mg/dL.
C. Serum potassium of 3.2 mEq/L.
D. Serum calcium of 9.0 mg/dL.
Answer: C
Conceptual Explanation: Furosemide is a loop diuretic that causes significant potassium
loss; a level of 3.2 mEq/L indicates hypokalemia, which increases the risk of cardiac
arrhythmias.
, 4. A 4-year-old child is brought to the emergency department with drooling, muffled voice,
and a tripod sitting position. What is the priority nursing action?
A. Obtain a throat culture to identify the causative organism.
B. Prepare for immediate endotracheal intubation or tracheostomy.
C. Examine the throat using a tongue blade to assess for edema.
D. Administer an oral antipyretic to reduce the child’s fever.
Answer: B
Conceptual Explanation: These are classic signs of epiglottitis. Any attempt to visualize
the throat can cause complete airway obstruction; maintaining a patent airway is the
absolute priority.
5. A client in active labor is receiving a magnesium sulfate infusion for pre-eclampsia. Which
finding requires the nurse to stop the infusion?
A. Blood pressure of 140/90 mmHg.
B. Respiratory rate of 10 breaths per minute.
C. Deep tendon reflexes of 2+.
D. Urinary output of 40 mL/hour.
Answer: B
Conceptual Explanation: Magnesium sulfate toxicity causes central nervous system
depression, leading to bradypnea (RR < 12) and loss of deep tendon reflexes.
