NCLEX-RN COMPREHENSIVE FINAL
EXAM QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A nurse is caring for a client with heart failure who is receiving digoxin. Which of the
following laboratory results should the nurse report to the provider immediately?
A. Sodium 138 mEq/L
B. Digoxin level 1.2 ng/mL
C. Potassium 2.8 mEq/L
D. Calcium 9.2 mg/dL
Answer: C
Conceptual Explanation: Hypokalemia (potassium level below 3.5 mEq/L) significantly
increases the risk of digoxin toxicity, even if the digoxin level is within the therapeutic
range (0.8 to 2.0 ng/mL).
2. A client is admitted with diabetic ketoacidosis (DKA). Which of the following arterial blood
gas results is most consistent with this condition?
A. pH 7.52, PaCO2 45 mmHg, HCO3 34 mEq/L
,B. pH 7.48, PaCO2 32 mmHg, HCO3 22 mEq/L
C. pH 7.32, PaCO2 50 mmHg, HCO3 28 mEq/L
D. pH 7.28, PaCO2 30 mmHg, HCO3 14 mEq/L
Answer: D
Conceptual Explanation: DKA results in metabolic acidosis. A pH below 7.35 and a low
HCO3 (below 22 mEq/L) indicate metabolic acidosis. The low PaCO2 represents
respiratory compensation (Kussmaul respirations).
3. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a chest tube for a pneumothorax reporting mild discomfort
B. A client with a history of asthma who is suddenly restless and confused
C. A client who had a total hip replacement 12 hours ago and is requesting pain medication
D. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%
A.
Answer: B
Conceptual Explanation: New-onset restlessness and confusion are early signs of hypoxia
(hypoxemia). According to the ABC (Airway-Breathing-Circulation) priority framework,
this client is the most unstable.
, 4. A client is receiving a continuous intravenous heparin infusion for a pulmonary embolism.
The nurse should ensure which of the following medications is readily available?
A. Vitamin K
B. Acetylcysteine
C. Protamine sulfate
D. Aminocaproic acid
Answer: C
Conceptual Explanation: Protamine sulfate is the antidote for heparin. Vitamin K is the
antidote for warfarin.
5. A nurse is assessing a client with preeclampsia who is receiving magnesium sulfate. Which
finding should the nurse identify as a sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Urine output of 40 mL/hr
C. Respiratory rate of 10 breaths per minute
D. Serum magnesium level of 5 mg/dL
Answer: C
Conceptual Explanation: Signs of magnesium toxicity include a respiratory rate below
12/min, absent deep tendon reflexes, and decreased level of consciousness. The
therapeutic range for magnesium is 4-7 mg/dL.
EXAM QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A nurse is caring for a client with heart failure who is receiving digoxin. Which of the
following laboratory results should the nurse report to the provider immediately?
A. Sodium 138 mEq/L
B. Digoxin level 1.2 ng/mL
C. Potassium 2.8 mEq/L
D. Calcium 9.2 mg/dL
Answer: C
Conceptual Explanation: Hypokalemia (potassium level below 3.5 mEq/L) significantly
increases the risk of digoxin toxicity, even if the digoxin level is within the therapeutic
range (0.8 to 2.0 ng/mL).
2. A client is admitted with diabetic ketoacidosis (DKA). Which of the following arterial blood
gas results is most consistent with this condition?
A. pH 7.52, PaCO2 45 mmHg, HCO3 34 mEq/L
,B. pH 7.48, PaCO2 32 mmHg, HCO3 22 mEq/L
C. pH 7.32, PaCO2 50 mmHg, HCO3 28 mEq/L
D. pH 7.28, PaCO2 30 mmHg, HCO3 14 mEq/L
Answer: D
Conceptual Explanation: DKA results in metabolic acidosis. A pH below 7.35 and a low
HCO3 (below 22 mEq/L) indicate metabolic acidosis. The low PaCO2 represents
respiratory compensation (Kussmaul respirations).
3. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a chest tube for a pneumothorax reporting mild discomfort
B. A client with a history of asthma who is suddenly restless and confused
C. A client who had a total hip replacement 12 hours ago and is requesting pain medication
D. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%
A.
Answer: B
Conceptual Explanation: New-onset restlessness and confusion are early signs of hypoxia
(hypoxemia). According to the ABC (Airway-Breathing-Circulation) priority framework,
this client is the most unstable.
, 4. A client is receiving a continuous intravenous heparin infusion for a pulmonary embolism.
The nurse should ensure which of the following medications is readily available?
A. Vitamin K
B. Acetylcysteine
C. Protamine sulfate
D. Aminocaproic acid
Answer: C
Conceptual Explanation: Protamine sulfate is the antidote for heparin. Vitamin K is the
antidote for warfarin.
5. A nurse is assessing a client with preeclampsia who is receiving magnesium sulfate. Which
finding should the nurse identify as a sign of magnesium toxicity?
A. Hyperactive deep tendon reflexes
B. Urine output of 40 mL/hr
C. Respiratory rate of 10 breaths per minute
D. Serum magnesium level of 5 mg/dL
Answer: C
Conceptual Explanation: Signs of magnesium toxicity include a respiratory rate below
12/min, absent deep tendon reflexes, and decreased level of consciousness. The
therapeutic range for magnesium is 4-7 mg/dL.
