NCLEX-RN Comprehensive Final Exam
2025/2026 | Updated Study Guide Q&A
With Rationales
Category: Management of Care & Safety
1. A client with a history of heart failure is prescribed Furosemide 40 mg IV daily. Which
finding is the priority for the nurse to report to the physician?
a) Blood pressure of 102/68 mmHg
b) Potassium level of 3.2 mEq/L
c) Reports of mild thirst
d) 1+ pitting edema in the ankles
Rationale: While all options are relevant, hypokalemia (K+ < 3.5 mEq/L) is a dangerous side
effect of loop diuretics like Furosemide. It can precipitate life-threatening cardiac dysrhythmias,
especially in a client with heart failure, making it the priority.
2. When delegating tasks to a Licensed Practical Nurse (LPN), the RN understands which client
should be assigned to the LPN?
a) A client newly admitted with diabetic ketoacidosis.
b) A post-operative client requiring discharge teaching.
c) A stable client with COPD receiving routine medications.
d) A client with a fresh tracheostomy needing suctioning for the first time.
Rationale: LPNs are skilled in providing care to stable clients with predictable outcomes.
Unstable, complex clients (like DKA, new trach, or those needing complex teaching) require the
comprehensive assessment and critical thinking skills of an RN.
3. A client is scheduled for a colonoscopy. The nurse should question which order?
a) Clear liquid diet for 24 hours prior.
b) Administer Polyethylene glycol preparation the evening before.
c) Administer Aspirin 81 mg on the morning of the procedure.
d) Keep the client NPO after midnight.
Rationale: Aspirin is an antiplatelet agent that increases the risk of bleeding during an invasive
procedure like a colonoscopy. The nurse should clarify this order with the provider. The other
options are standard pre-procedure protocols.
4. The nurse discovers a small fire in a client's room. What is the nurse's first action?
a) Activate the fire alarm.
,b) Evacuate the clients in immediate danger.
c) Use the nearest fire extinguisher.
d) Confine the fire by closing the door.
Rationale: The acronym RACE is used. The first action is to Rescue anyone in immediate danger.
Then Alarm, Confine, and Extinguish.
5. A client with a suspected myocardial infarction is anxious and reports severe chest pain.
What is the nurse's best initial action?
a) Administer Morphine Sulfate IV as ordered.
b) Obtain a 12-lead EKG.
c) Provide reassurance and stay with the client.
d) Notify the physician immediately.
Rationale: The priority in a suspected MI is to obtain a 12-lead EKG within 10 minutes of arrival
to diagnose ischemia/infarction and guide treatment (like thrombolytics or catheterization).
While all actions are important, the EKG is the time-sensitive, diagnostic priority.
Category: Pharmacological and Parenteral Therapies
6. A client is receiving Heparin via continuous IV infusion for a pulmonary embolism. The
nurse should ensure which antidote is readily available?
a) Vitamin K
b) Protamine Sulfate
c) Naloxone
d) Flumazenil
Rationale: Protamine Sulfate is the specific antidote for Heparin overdose. Vitamin K is the
antidote for Warfarin.
7. The nurse is preparing to administer Insulin Glargine 20 units subcutaneously. Which action
is correct?
a) Shake the vial vigorously to ensure it's mixed.
b) Administer the dose 30 minutes before the client's meal.
c) Draw up the dose from a vial that is clear in appearance.
d) Mix the Insulin Glargine with NPH insulin in the same syringe.
Rationale: Insulin Glargine is a clear, long-acting insulin that should never be mixed with any
other insulin. It is not shaken vigorously and is typically given at the same time daily, regardless
of meals.
8. A client receiving a blood transfusion develops chills, tachycardia, and flushing. What is the
nurse's priority action?
a) Slow the infusion rate and monitor vital signs.
, b) Administer an antihistamine as ordered.
c) Stop the transfusion and keep the IV line open with normal saline.
d) Notify the blood bank and the physician.
Rationale: These are signs of a potential febrile non-hemolytic or hemolytic reaction. The
immediate action is to stop the transfusion to prevent further complications, then keep the line
open with NS for possible emergency medication administration.
9. A client with Parkinson's disease is prescribed Levodopa-Carbidopa. The nurse should teach
the client to avoid which over-the-counter product?
a) Acetaminophen
b) Ibuprofen
c) Vitamin C supplements
d) Multivitamins with Vitamin B6 (Pyridoxine)
Rationale: Vitamin B6 can reverse the effects of Levodopa, making the medication less effective.
Clients should be educated to avoid multivitamins or supplements containing Pyridoxine.
10. When administering Digoxin, the nurse must assess the apical pulse for a full minute. For
what finding would the nurse hold the dose and notify the provider?
a) Apical pulse of 72 bpm in an adult.
b) Apical pulse of 58 bpm in an adult.
c) Apical pulse of 102 bpm in an adult.
d) Irregular radial pulse of 80 bpm.
Rationale: Digoxin is held for an apical pulse below 60 bpm in an adult (or per facility policy,
often 50-60) due to the risk of worsening bradycardia and heart block.
Category: Reduction of Risk Potential
11. A client had a total hip replacement 2 days ago. Which action by the client
requires immediate intervention by the nurse?
a) The client uses a trapeze to move up in bed.
b) The client bends at the waist to pick up slippers from the floor.
c) The client places a pillow between their legs while turning.
d) The client uses a raised toilet seat.
Rationale: Bending at the waist beyond 90 degrees is a primary restriction after a total hip
replacement to prevent dislocation of the prosthesis.
12. The nurse is caring for a client 4 hours post-cataract surgery. Which complaint by the client
is most concerning?
a) "My eye feels itchy."
b) "I have a sensation of something in my eye."
2025/2026 | Updated Study Guide Q&A
With Rationales
Category: Management of Care & Safety
1. A client with a history of heart failure is prescribed Furosemide 40 mg IV daily. Which
finding is the priority for the nurse to report to the physician?
a) Blood pressure of 102/68 mmHg
b) Potassium level of 3.2 mEq/L
c) Reports of mild thirst
d) 1+ pitting edema in the ankles
Rationale: While all options are relevant, hypokalemia (K+ < 3.5 mEq/L) is a dangerous side
effect of loop diuretics like Furosemide. It can precipitate life-threatening cardiac dysrhythmias,
especially in a client with heart failure, making it the priority.
2. When delegating tasks to a Licensed Practical Nurse (LPN), the RN understands which client
should be assigned to the LPN?
a) A client newly admitted with diabetic ketoacidosis.
b) A post-operative client requiring discharge teaching.
c) A stable client with COPD receiving routine medications.
d) A client with a fresh tracheostomy needing suctioning for the first time.
Rationale: LPNs are skilled in providing care to stable clients with predictable outcomes.
Unstable, complex clients (like DKA, new trach, or those needing complex teaching) require the
comprehensive assessment and critical thinking skills of an RN.
3. A client is scheduled for a colonoscopy. The nurse should question which order?
a) Clear liquid diet for 24 hours prior.
b) Administer Polyethylene glycol preparation the evening before.
c) Administer Aspirin 81 mg on the morning of the procedure.
d) Keep the client NPO after midnight.
Rationale: Aspirin is an antiplatelet agent that increases the risk of bleeding during an invasive
procedure like a colonoscopy. The nurse should clarify this order with the provider. The other
options are standard pre-procedure protocols.
4. The nurse discovers a small fire in a client's room. What is the nurse's first action?
a) Activate the fire alarm.
,b) Evacuate the clients in immediate danger.
c) Use the nearest fire extinguisher.
d) Confine the fire by closing the door.
Rationale: The acronym RACE is used. The first action is to Rescue anyone in immediate danger.
Then Alarm, Confine, and Extinguish.
5. A client with a suspected myocardial infarction is anxious and reports severe chest pain.
What is the nurse's best initial action?
a) Administer Morphine Sulfate IV as ordered.
b) Obtain a 12-lead EKG.
c) Provide reassurance and stay with the client.
d) Notify the physician immediately.
Rationale: The priority in a suspected MI is to obtain a 12-lead EKG within 10 minutes of arrival
to diagnose ischemia/infarction and guide treatment (like thrombolytics or catheterization).
While all actions are important, the EKG is the time-sensitive, diagnostic priority.
Category: Pharmacological and Parenteral Therapies
6. A client is receiving Heparin via continuous IV infusion for a pulmonary embolism. The
nurse should ensure which antidote is readily available?
a) Vitamin K
b) Protamine Sulfate
c) Naloxone
d) Flumazenil
Rationale: Protamine Sulfate is the specific antidote for Heparin overdose. Vitamin K is the
antidote for Warfarin.
7. The nurse is preparing to administer Insulin Glargine 20 units subcutaneously. Which action
is correct?
a) Shake the vial vigorously to ensure it's mixed.
b) Administer the dose 30 minutes before the client's meal.
c) Draw up the dose from a vial that is clear in appearance.
d) Mix the Insulin Glargine with NPH insulin in the same syringe.
Rationale: Insulin Glargine is a clear, long-acting insulin that should never be mixed with any
other insulin. It is not shaken vigorously and is typically given at the same time daily, regardless
of meals.
8. A client receiving a blood transfusion develops chills, tachycardia, and flushing. What is the
nurse's priority action?
a) Slow the infusion rate and monitor vital signs.
, b) Administer an antihistamine as ordered.
c) Stop the transfusion and keep the IV line open with normal saline.
d) Notify the blood bank and the physician.
Rationale: These are signs of a potential febrile non-hemolytic or hemolytic reaction. The
immediate action is to stop the transfusion to prevent further complications, then keep the line
open with NS for possible emergency medication administration.
9. A client with Parkinson's disease is prescribed Levodopa-Carbidopa. The nurse should teach
the client to avoid which over-the-counter product?
a) Acetaminophen
b) Ibuprofen
c) Vitamin C supplements
d) Multivitamins with Vitamin B6 (Pyridoxine)
Rationale: Vitamin B6 can reverse the effects of Levodopa, making the medication less effective.
Clients should be educated to avoid multivitamins or supplements containing Pyridoxine.
10. When administering Digoxin, the nurse must assess the apical pulse for a full minute. For
what finding would the nurse hold the dose and notify the provider?
a) Apical pulse of 72 bpm in an adult.
b) Apical pulse of 58 bpm in an adult.
c) Apical pulse of 102 bpm in an adult.
d) Irregular radial pulse of 80 bpm.
Rationale: Digoxin is held for an apical pulse below 60 bpm in an adult (or per facility policy,
often 50-60) due to the risk of worsening bradycardia and heart block.
Category: Reduction of Risk Potential
11. A client had a total hip replacement 2 days ago. Which action by the client
requires immediate intervention by the nurse?
a) The client uses a trapeze to move up in bed.
b) The client bends at the waist to pick up slippers from the floor.
c) The client places a pillow between their legs while turning.
d) The client uses a raised toilet seat.
Rationale: Bending at the waist beyond 90 degrees is a primary restriction after a total hip
replacement to prevent dislocation of the prosthesis.
12. The nurse is caring for a client 4 hours post-cataract surgery. Which complaint by the client
is most concerning?
a) "My eye feels itchy."
b) "I have a sensation of something in my eye."
