COMPREHENSIVE NCLEX-RN HIGH-
LEVEL PRACTICE EXAM QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is caring for a client with a history of heart failure who is receiving an intravenous
infusion of nitroprusside. Which assessment finding is most critical for the nurse to monitor
to prevent toxicity?
A. Blood pressure every 15 minutes
B. Serum thiocyanate levels
C. Urinary output hourly
D. Cardiac rhythm via telemetry
Answer: B
Conceptual Explanation: Nitroprusside is metabolized to cyanide and then to thiocyanate.
Prolonged use or high doses can lead to thiocyanate toxicity, which can be fatal. Monitoring
these levels is a specific safety requirement for this medication.
2. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a femoral artery sheath following an angioplasty complaining of lower back
pain.
,B. A client with a chest tube for a pneumothorax with 100 mL of drainage in the last hour.
C. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 89%.
D. A client two days postoperative following a colon resection with no bowel sounds.
Answer: A
Conceptual Explanation: Lower back pain or flank pain in a client with a femoral artery
sheath may indicate a retroperitoneal bleed, which is a medical emergency. The other
clients are relatively stable or showing expected findings.
3. A client is admitted with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory result should the nurse expect?
A. Serum sodium 124 mEq/L
B. Serum osmolarity 310 mOsm/kg
C. Urine specific gravity 1.002
D. Hematocrit 52%
Answer: A
Conceptual Explanation: SIADH causes excessive water retention, leading to dilutional
hyponatremia. Therefore, a low serum sodium level (below 135 mEq/L) is expected. Urine
specific gravity would be high (concentrated), and serum osmolarity would be low.
, 4. A nurse is teaching a client with Type 1 Diabetes about the Dawn Phenomenon. Which
instruction is most appropriate?
A. Decrease the evening dose of intermediate-acting insulin.
B. Increase the evening intake of protein-rich snacks.
C. Check blood glucose at 3:00 AM to look for hypoglycemia.
D. Increase the evening dose of intermediate-acting insulin.
Answer: D
Conceptual Explanation: The Dawn Phenomenon is a surge of hormones in the early
morning causing hyperglycemia. Treatment involves increasing the evening insulin dose.
Checking at 3:00 AM is used to differentiate it from the Somogyi effect (which shows
hypoglycemia at 3 AM).
5. Which fetal heart rate pattern should the nurse immediately report to the healthcare
provider?
A. Late decelerations with minimal variability
B. Accelerations of 15 bpm above baseline
C. Variable decelerations that resolve quickly
D. Early decelerations during contractions
Answer: A
LEVEL PRACTICE EXAM QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is caring for a client with a history of heart failure who is receiving an intravenous
infusion of nitroprusside. Which assessment finding is most critical for the nurse to monitor
to prevent toxicity?
A. Blood pressure every 15 minutes
B. Serum thiocyanate levels
C. Urinary output hourly
D. Cardiac rhythm via telemetry
Answer: B
Conceptual Explanation: Nitroprusside is metabolized to cyanide and then to thiocyanate.
Prolonged use or high doses can lead to thiocyanate toxicity, which can be fatal. Monitoring
these levels is a specific safety requirement for this medication.
2. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a femoral artery sheath following an angioplasty complaining of lower back
pain.
,B. A client with a chest tube for a pneumothorax with 100 mL of drainage in the last hour.
C. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 89%.
D. A client two days postoperative following a colon resection with no bowel sounds.
Answer: A
Conceptual Explanation: Lower back pain or flank pain in a client with a femoral artery
sheath may indicate a retroperitoneal bleed, which is a medical emergency. The other
clients are relatively stable or showing expected findings.
3. A client is admitted with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory result should the nurse expect?
A. Serum sodium 124 mEq/L
B. Serum osmolarity 310 mOsm/kg
C. Urine specific gravity 1.002
D. Hematocrit 52%
Answer: A
Conceptual Explanation: SIADH causes excessive water retention, leading to dilutional
hyponatremia. Therefore, a low serum sodium level (below 135 mEq/L) is expected. Urine
specific gravity would be high (concentrated), and serum osmolarity would be low.
, 4. A nurse is teaching a client with Type 1 Diabetes about the Dawn Phenomenon. Which
instruction is most appropriate?
A. Decrease the evening dose of intermediate-acting insulin.
B. Increase the evening intake of protein-rich snacks.
C. Check blood glucose at 3:00 AM to look for hypoglycemia.
D. Increase the evening dose of intermediate-acting insulin.
Answer: D
Conceptual Explanation: The Dawn Phenomenon is a surge of hormones in the early
morning causing hyperglycemia. Treatment involves increasing the evening insulin dose.
Checking at 3:00 AM is used to differentiate it from the Somogyi effect (which shows
hypoglycemia at 3 AM).
5. Which fetal heart rate pattern should the nurse immediately report to the healthcare
provider?
A. Late decelerations with minimal variability
B. Accelerations of 15 bpm above baseline
C. Variable decelerations that resolve quickly
D. Early decelerations during contractions
Answer: A
