NCLEX-RN MIDTERM EXAM
COMPREHENSIVE STUDY GUIDE
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A client is admitted with suspected right-sided heart failure. Which assessment finding
should the nurse prioritize as most indicative of this condition?
A. Pulmonary crackles and wheezing
B. Dependent peripheral edema and jugular venous distention
C. Pink, frothy sputum and orthopnea
D. Decreased peripheral pulses and cool extremities
Answer: B
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
which manifests as dependent edema, jugular venous distention, and hepatomegaly. Left-
sided failure primarily involves pulmonary symptoms.
2. A nurse interprets the following arterial blood gas results for a client: pH 7.28, PaCO2 55
mmHg, and HCO3 26 mEq/L. Which interpretation is correct?
A. Respiratory Acidosis
,B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the bicarbonate is normal, it is uncompensated
respiratory acidosis.
3. The nurse is monitoring a client receiving Digoxin. Which clinical manifestation is an early
sign of Digoxin toxicity?
A. Visual disturbances such as yellow halos
B. Sudden increase in urinary output
C. Hyperkalemia and tall T waves
D. Anorexia, nausea, and vomiting
Answer: D
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are typically the earliest signs of digoxin toxicity. Visual changes occur later.
4. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is most
appropriate for the UAP?
A. Evaluating the effectiveness of pain medication
, B. Measuring and recording intake and output on a stable client
C. Providing discharge instructions to a client after a colonoscopy
D. Performing a sterile dressing change for a surgical wound
Answer: B
Conceptual Explanation: UAPs can perform routine tasks on stable clients, such as
measuring I&O. Evaluation, teaching, and sterile procedures require RN clinical judgment.
5. A client is placed on Contact Precautions due to a Clostridioides difficile infection. Which
action by the nurse is mandatory?
A. Wearing a surgical mask when within 3 feet of the client
B. Using soap and water for hand hygiene after leaving the room
C. Performing hand hygiene with alcohol-based rub after care
D. Ensuring the client remains in a negative-pressure room
Answer: B
Conceptual Explanation: C. difficile spores are resistant to alcohol-based sanitizers;
therefore, washing hands with soap and water is required to mechanically remove the
spores.
6. A client’s ECG shows peaked T waves and a widened QRS complex. Which laboratory result
should the nurse expect to see?
A. Potassium 6.8 mEq/L
COMPREHENSIVE STUDY GUIDE
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A client is admitted with suspected right-sided heart failure. Which assessment finding
should the nurse prioritize as most indicative of this condition?
A. Pulmonary crackles and wheezing
B. Dependent peripheral edema and jugular venous distention
C. Pink, frothy sputum and orthopnea
D. Decreased peripheral pulses and cool extremities
Answer: B
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
which manifests as dependent edema, jugular venous distention, and hepatomegaly. Left-
sided failure primarily involves pulmonary symptoms.
2. A nurse interprets the following arterial blood gas results for a client: pH 7.28, PaCO2 55
mmHg, and HCO3 26 mEq/L. Which interpretation is correct?
A. Respiratory Acidosis
,B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the bicarbonate is normal, it is uncompensated
respiratory acidosis.
3. The nurse is monitoring a client receiving Digoxin. Which clinical manifestation is an early
sign of Digoxin toxicity?
A. Visual disturbances such as yellow halos
B. Sudden increase in urinary output
C. Hyperkalemia and tall T waves
D. Anorexia, nausea, and vomiting
Answer: D
Conceptual Explanation: Gastrointestinal symptoms like anorexia, nausea, and vomiting
are typically the earliest signs of digoxin toxicity. Visual changes occur later.
4. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is most
appropriate for the UAP?
A. Evaluating the effectiveness of pain medication
, B. Measuring and recording intake and output on a stable client
C. Providing discharge instructions to a client after a colonoscopy
D. Performing a sterile dressing change for a surgical wound
Answer: B
Conceptual Explanation: UAPs can perform routine tasks on stable clients, such as
measuring I&O. Evaluation, teaching, and sterile procedures require RN clinical judgment.
5. A client is placed on Contact Precautions due to a Clostridioides difficile infection. Which
action by the nurse is mandatory?
A. Wearing a surgical mask when within 3 feet of the client
B. Using soap and water for hand hygiene after leaving the room
C. Performing hand hygiene with alcohol-based rub after care
D. Ensuring the client remains in a negative-pressure room
Answer: B
Conceptual Explanation: C. difficile spores are resistant to alcohol-based sanitizers;
therefore, washing hands with soap and water is required to mechanically remove the
spores.
6. A client’s ECG shows peaked T waves and a widened QRS complex. Which laboratory result
should the nurse expect to see?
A. Potassium 6.8 mEq/L
