NCLEX-RN ADVANCED CLINICAL
REVIEW QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A patient with a history of heart failure is prescribed digoxin. Which of the following
clinical findings would most likely indicate digoxin toxicity?
A. Hyperkalemia and tachycardia
B. Increased urinary output and hypertension
C. Anorexia, nausea, and visual disturbances
D. Constipation and dry mouth
Answer: C
Conceptual Explanation: Common signs of digoxin toxicity include gastrointestinal
symptoms like anorexia, nausea, and vomiting, as well as neurological/visual changes like
yellow-green halos.
2. Which patient should the nurse prioritize during the initial shift assessment?
A. A patient with a blood glucose of 220 mg/dL awaiting breakfast
B. A patient with chronic obstructive pulmonary disease (COPD) having an SpO2 of 89%
,C. A patient with a broken femur requesting PRN pain medication
D. A patient who is two hours post-thyroidectomy reporting tingling in the fingers
Answer: D
Conceptual Explanation: Tingling in the fingers post-thyroidectomy suggests
hypocalcemia (likely due to parathyroid damage), which can lead to laryngospasm and
airway obstruction, requiring immediate intervention.
3. The nurse is caring for a patient with a closed chest tube drainage system. The nurse notes
continuous bubbling in the water seal chamber. How should the nurse interpret this finding?
A. It is a normal finding if the patient has a pneumothorax
B. There is an air leak in the system
C. The suction pressure is set too high
D. The patient is exhaling forcefully
Answer: B
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak. Intermittent bubbling is expected in a patient with a pneumothorax during expiration
or coughing.
4. A client is admitted with Addisonian Crisis. Which of the following laboratory results is the
nurse most likely to expect?
A. Hypernatremia and hypokalemia
, B. Hyponatremia and hyperkalemia
C. Hyperglycemia and hypercalcemia
D. Hypokalemia and hypoglycemia
Answer: B
Conceptual Explanation: Addison’s disease involves a lack of aldosterone and cortisol,
leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia).
5. A nurse is assigned to four patients. Which task is most appropriate to delegate to an
Unlicensed Assistive Personnel (UAP)?
A. Assessing the breath sounds of a patient with pneumonia
B. Recording the intake and output for a patient on a fluid restriction
C. Assisting a stable patient with their first ambulation after surgery
D. Administering a saline flush to a peripheral IV line
Answer: B
Conceptual Explanation: Measuring and recording I&O is a routine task within the scope
of a UAP. Assessment, medication administration, and initial post-op ambulation require
RN judgment.
6. A patient in the psychiatric unit is receiving Lithium Carbonate for Bipolar Disorder. The
nurse should monitor for which early sign of lithium toxicity?
A. Coarse tremors and mental confusion
REVIEW QUESTIONS & ANSWERS
(VERIFIED ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF)
1. A patient with a history of heart failure is prescribed digoxin. Which of the following
clinical findings would most likely indicate digoxin toxicity?
A. Hyperkalemia and tachycardia
B. Increased urinary output and hypertension
C. Anorexia, nausea, and visual disturbances
D. Constipation and dry mouth
Answer: C
Conceptual Explanation: Common signs of digoxin toxicity include gastrointestinal
symptoms like anorexia, nausea, and vomiting, as well as neurological/visual changes like
yellow-green halos.
2. Which patient should the nurse prioritize during the initial shift assessment?
A. A patient with a blood glucose of 220 mg/dL awaiting breakfast
B. A patient with chronic obstructive pulmonary disease (COPD) having an SpO2 of 89%
,C. A patient with a broken femur requesting PRN pain medication
D. A patient who is two hours post-thyroidectomy reporting tingling in the fingers
Answer: D
Conceptual Explanation: Tingling in the fingers post-thyroidectomy suggests
hypocalcemia (likely due to parathyroid damage), which can lead to laryngospasm and
airway obstruction, requiring immediate intervention.
3. The nurse is caring for a patient with a closed chest tube drainage system. The nurse notes
continuous bubbling in the water seal chamber. How should the nurse interpret this finding?
A. It is a normal finding if the patient has a pneumothorax
B. There is an air leak in the system
C. The suction pressure is set too high
D. The patient is exhaling forcefully
Answer: B
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak. Intermittent bubbling is expected in a patient with a pneumothorax during expiration
or coughing.
4. A client is admitted with Addisonian Crisis. Which of the following laboratory results is the
nurse most likely to expect?
A. Hypernatremia and hypokalemia
, B. Hyponatremia and hyperkalemia
C. Hyperglycemia and hypercalcemia
D. Hypokalemia and hypoglycemia
Answer: B
Conceptual Explanation: Addison’s disease involves a lack of aldosterone and cortisol,
leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia).
5. A nurse is assigned to four patients. Which task is most appropriate to delegate to an
Unlicensed Assistive Personnel (UAP)?
A. Assessing the breath sounds of a patient with pneumonia
B. Recording the intake and output for a patient on a fluid restriction
C. Assisting a stable patient with their first ambulation after surgery
D. Administering a saline flush to a peripheral IV line
Answer: B
Conceptual Explanation: Measuring and recording I&O is a routine task within the scope
of a UAP. Assessment, medication administration, and initial post-op ambulation require
RN judgment.
6. A patient in the psychiatric unit is receiving Lithium Carbonate for Bipolar Disorder. The
nurse should monitor for which early sign of lithium toxicity?
A. Coarse tremors and mental confusion
