UWORLD NCLEX-RN 2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS RATED A+
✔✔The nurse is caring for a client who is 2 days postoperative craniotomy with bone
flap removal. The nurse notes clear wound drainage saturating the dressing over the
incision. Which action by the nurse is most appropriate at this time?
1. Cleanse the incision site with saline and apply a new, sterile dressing
2. Mark the edges of the drainage on the dressing and continue to monitor
3. Notify the health care provider of the color and amount of drainage
4. Turn the client onto the nonoperative side using the log-rolling technique -
✔✔CORRECT ANSWER: 3
A craniotomy involves incision into the cranium and is indicated for elevated intracranial
pressure or removal of tumors, blood, or abscesses. Postoperative clients are at risk for
developing a cerebrospinal fluid (CS) leak from an intraoperative dural injury, which
increases the risk for meningitis.
Excessive drainage from a craniotomy incision (eg, saturated dressing, >50 mL per shift
into the drain) or from the nose or ear suggests a possible CSF leak requiring
immediate notification of the health care provider (HCP) (Option 3 is correct).
Interventions focus on decreasing strain on the dural tear to encourage closure and
include bedrest, lumbar drain placement, and surgical intervention.
(Option 1 is wrong) The incision should not be re-dressed until the HCP can evaluate
the wound and drainage.
(Option 2 is wrong) The nurse should mark the drainage edges at least once per shift
for comparison. However, a saturated dressing may indicate a CSF leak.
(Option 4 is wrong) Repositioning may be indicated but is not the most appropriate
action at this time. Specific client positioning postoperative craniotomy is prescribed by
the HCP. The head of the bed is usually elevated approximately 30 degrees to facilitate
venous drainage and prevent increased intracranial pressure. If flat positioning is
prescribed, the nurse should log-roll the client to alternate between the back and the
nonoperative side.
✔✔An earthquake has caused a mass-casualty incident in the community. Stable
clients must be released to make room for incoming clients affected by the incident.
Which client should the nurse recognize as most appropriate for discharge?
1. Client with an acute head injury and a Glasgow Coma Scale score of 12
2. Client with an asthma exacerbation who has a peak flow at 85% of personal best
3. Client with deep venous thrombosis on IV heparin and platelet count of 40.000/mm3
4. Client with liver cirrhosis and oozing esophageal varices who is receiving lactulose -
✔✔CORRECT ANSWER: 2
,In a disaster situation, the nurse should discharge stable clients to make space
available for a high volume of incoming injured clients.
A client with asthma who has a peak flow of ≥80% of personal best has good control of
symptoms and airway compliance and is considered stable for discharge. Peak flow is
the best measurement of airway compliance for asthma; a peak flow of <80% indicates
uncontrolled symptoms requiring further acute treatment and monitoring (Option 2 is
wrong).
(Option 1 is wrong) The Glasgow Coma Scale is used to assess level of consciousness
in clients, with a score of 15 being normal. A client who sustained an acute head injury
and has a Glasgow Coma Scale score of 12 has moderate neurologic impairment
requiring further observation and care.
(Option 3 is wrong) A client who is receiving IV anticoagulation and has
thrombocytopenia (ie, platelets <150,000/mm3) may have heparin-induced
thrombocytopenia and is at risk for paradoxical arterial thrombosis (eg, stroke) and,
rarely, bleeding. This client requires further evaluation and care.
(Option 4 is wrong) A client with oozing esophageal varices may experience
gastrointestinal hemorrhage if the varices rupture and is at risk for increasing ammonia
(from the digestion of protein in the blood). This client needs continued care (eg,
lactulose administration) and intervention.
✔✔The nurse is providing postoperative care for a client who had an aortic valve
replacement two days ago and has a chest tube. Which finding is most important to
report to the supervising registered nurse?
1. Chest tube output of 175 mL in the past hour
2. International normalized ratio of 1.5
3. Temperature of 100.3 F (37.9 C)
4. Urine output of 90 mL over the past 3 hours - ✔✔CORRECT ANSWER: 1
Diagram of chest drainage system: https://imgur.com/T4fX6Mu
Chest tubes are used to drain air or fluid from the mediastinal or pleural space. Chest
tube drainage >100 mL/hr may indicate hemorrhage from a disrupted suture site (Option
1 is correct). The client can quickly become hemodynamically unstable from large
amounts of blood loss and may require blood transfusion or emergency surgery.
(Option 2 is wrong) Clients who receive a mechanical valve replacement should receive
anticoagulation (eg, warfarin) after surgery to prevent thrombus formation on the valve,
which could embolize and cause stroke. The goal INR for a client with a mechanical
valve is 2.5-3.5 and should be achieved within 5 to 7 days after starting warfarin.
,(Option 3 is wrong) Fevers are common and expected during the first few days following
major surgery. The nurse should monitor the client for other signs of infection (eg,
incisional redness, heat, swelling) because a low-grade fever (eg, 100.3 F [37.9 C]) is
not a reliable indicator of postoperative infection.
(Option 4 is wrong) The nurse should closely monitor the client's urine output (minimum
≥30 mL/hr). Low urine output can indicate a decrease in cardiac output due to
complications of valve replacement (eg, bleeding, valve dysfunction, dysrhythmias).
✔✔Which client in the emergency department should the nurse see first?
1. 2-year-old with fever and sore throat who is restless and drooling
2. 7-year-old with appendicitis who has right lower quadrant pain and vomiting
3. 9-year-old with immune thrombocytopenia who has generalized petechia
4. 17-year-old with cystic fibrosis who is coughing up thick, blood-tinged sputum -
✔✔CORRECT ANSWER: 1
Diagram of epiglottis: https://imgur.com/vQYUhlH
Acute epiglottitis is a supraglottic inflammatory process that occurs most commonly in
children with Haemophilus influenza type b (Hib) infection. Inflammation of the epiglottis
can cause airway obstruction and is a medical emergency. Common signs of impending
airway obstruction include restlessness, stridor, and drooling due to dysphagia (Option
1 is correct). The nurse should prepare to assist with emergent endotracheal intubation.
(Option 2 is wrong) If left untreated, the inflamed appendix may rupture, causing
peritonitis, major abscess, or partial bowel obstruction. The client with acute
appendicitis may require antibiotic administration and emergent surgical appendectomy.
Although appendicitis is an emergent condition, a client with impending airway
obstruction from epiglottitis must be seen immediately.
(Option 3 is wrong) Immune thrombocytopenia (ITP) is an acquired disorder in which
antibodies cause decreased platelet survival and production. Petechiae, pinpoint lesions
on the skin from capillary hemorrhages, are a common sign of ITP. Acute ITP usually
resolves spontaneously without complications, and management is primarily supportive
(eg, platelet monitoring, corticosteroids, IV immunoglobulin).
(Option 4 is wrong) Cystic fibrosis affects the secretory glands, resulting in thick sputum
that may become blood-tinged from frequent coughing. A client with cystic fibrosis who
has blood-tinged sputum should be evaluated, but care may be safely delayed until after
caring for the client with impending airway obstruction.
✔✔The nurse receives report on four clients at change of shift. Which client should the
nurse see first?
, 1. Client who smokes who has intermittent leg pain that is worse with walking and eases
with rest
2. Client with diabetes who has burning and numbness in both lower legs and feet
3. Client with leg swelling and calf pain who was on a 15-hour flight 2 days ago
4. Client with pain, edema, and redness in the leg following a dog bite 1 hour ago -
✔✔CORRECT ANSWER: 3
Diagram of Deep Vein Thrombosis: https://imgur.com/fwiYE2h
Life-threatening physiological problems (eg, airway, breathing, circulation) are the
highest priority followed by less threatening problems (eg, pain, potential for infection).
Unilateral edema and calf pain could be signs of a deep venous thrombosis (DVT), a
high-priority circulation problem in which a lower-extremity clot may dislodge, travel, and
cause life-threatening complications (eg, pulmonary embolism) (Option 3 is correct).
Prolonged immobilization (eg, airplane travel, bed rest) increases the risk for DVT.
(Option 1 is wrong) A client with leg pain during activity that is relieved by rest may have
intermittent claudication, a classic sign of peripheral artery disease. This condition is not
an immediate threat to survival.
(Option 2 is wrong) The diabetic client with poor glucose control is at risk for developing
neuropathy (burning, tingling, or loss of sensation) of a limb due to changes in the
nerves. This is a chronic, progressive condition and is not an immediate threat to
survival.
(Option 4 is wrong) The client with a dog bite will need antibiotics and possibly a rabies
vaccination, but there is no immediate threat to survival.
✔✔The nurse cares for a 74-year-old client with Clostridioides (formerly Clostridium)
difficile colitis and a history of stroke with left-sided weakness. Which of the following
nursing actions are appropriate to promote client safety? Select all that apply.
1. Apply color-coded, nonslip socks to the client's feet
2. Encourage the client to use a cane on the left side for support
3. Lower the bed and raise all bed rails before exiting the room
4. Place a bedside commode on the client's right side
5. Remind the client to call for assistance before toileting - ✔✔CORRECT ANSWER: 1,
4, 5
List of fall risk precautions: https://imgur.com/k3AJriX
The nurse should ensure that fall risk precautions (eg, nonslip socks, lowering the bed)
are implemented for clients with multiple fall risk factors (eg, advanced age,
neuromuscular weakness). Color-coded, nonslip socks help prevent a client from
slipping and alert staff to a client's increased risk for falls (Option 1 is correct).
SOLUTIONS RATED A+
✔✔The nurse is caring for a client who is 2 days postoperative craniotomy with bone
flap removal. The nurse notes clear wound drainage saturating the dressing over the
incision. Which action by the nurse is most appropriate at this time?
1. Cleanse the incision site with saline and apply a new, sterile dressing
2. Mark the edges of the drainage on the dressing and continue to monitor
3. Notify the health care provider of the color and amount of drainage
4. Turn the client onto the nonoperative side using the log-rolling technique -
✔✔CORRECT ANSWER: 3
A craniotomy involves incision into the cranium and is indicated for elevated intracranial
pressure or removal of tumors, blood, or abscesses. Postoperative clients are at risk for
developing a cerebrospinal fluid (CS) leak from an intraoperative dural injury, which
increases the risk for meningitis.
Excessive drainage from a craniotomy incision (eg, saturated dressing, >50 mL per shift
into the drain) or from the nose or ear suggests a possible CSF leak requiring
immediate notification of the health care provider (HCP) (Option 3 is correct).
Interventions focus on decreasing strain on the dural tear to encourage closure and
include bedrest, lumbar drain placement, and surgical intervention.
(Option 1 is wrong) The incision should not be re-dressed until the HCP can evaluate
the wound and drainage.
(Option 2 is wrong) The nurse should mark the drainage edges at least once per shift
for comparison. However, a saturated dressing may indicate a CSF leak.
(Option 4 is wrong) Repositioning may be indicated but is not the most appropriate
action at this time. Specific client positioning postoperative craniotomy is prescribed by
the HCP. The head of the bed is usually elevated approximately 30 degrees to facilitate
venous drainage and prevent increased intracranial pressure. If flat positioning is
prescribed, the nurse should log-roll the client to alternate between the back and the
nonoperative side.
✔✔An earthquake has caused a mass-casualty incident in the community. Stable
clients must be released to make room for incoming clients affected by the incident.
Which client should the nurse recognize as most appropriate for discharge?
1. Client with an acute head injury and a Glasgow Coma Scale score of 12
2. Client with an asthma exacerbation who has a peak flow at 85% of personal best
3. Client with deep venous thrombosis on IV heparin and platelet count of 40.000/mm3
4. Client with liver cirrhosis and oozing esophageal varices who is receiving lactulose -
✔✔CORRECT ANSWER: 2
,In a disaster situation, the nurse should discharge stable clients to make space
available for a high volume of incoming injured clients.
A client with asthma who has a peak flow of ≥80% of personal best has good control of
symptoms and airway compliance and is considered stable for discharge. Peak flow is
the best measurement of airway compliance for asthma; a peak flow of <80% indicates
uncontrolled symptoms requiring further acute treatment and monitoring (Option 2 is
wrong).
(Option 1 is wrong) The Glasgow Coma Scale is used to assess level of consciousness
in clients, with a score of 15 being normal. A client who sustained an acute head injury
and has a Glasgow Coma Scale score of 12 has moderate neurologic impairment
requiring further observation and care.
(Option 3 is wrong) A client who is receiving IV anticoagulation and has
thrombocytopenia (ie, platelets <150,000/mm3) may have heparin-induced
thrombocytopenia and is at risk for paradoxical arterial thrombosis (eg, stroke) and,
rarely, bleeding. This client requires further evaluation and care.
(Option 4 is wrong) A client with oozing esophageal varices may experience
gastrointestinal hemorrhage if the varices rupture and is at risk for increasing ammonia
(from the digestion of protein in the blood). This client needs continued care (eg,
lactulose administration) and intervention.
✔✔The nurse is providing postoperative care for a client who had an aortic valve
replacement two days ago and has a chest tube. Which finding is most important to
report to the supervising registered nurse?
1. Chest tube output of 175 mL in the past hour
2. International normalized ratio of 1.5
3. Temperature of 100.3 F (37.9 C)
4. Urine output of 90 mL over the past 3 hours - ✔✔CORRECT ANSWER: 1
Diagram of chest drainage system: https://imgur.com/T4fX6Mu
Chest tubes are used to drain air or fluid from the mediastinal or pleural space. Chest
tube drainage >100 mL/hr may indicate hemorrhage from a disrupted suture site (Option
1 is correct). The client can quickly become hemodynamically unstable from large
amounts of blood loss and may require blood transfusion or emergency surgery.
(Option 2 is wrong) Clients who receive a mechanical valve replacement should receive
anticoagulation (eg, warfarin) after surgery to prevent thrombus formation on the valve,
which could embolize and cause stroke. The goal INR for a client with a mechanical
valve is 2.5-3.5 and should be achieved within 5 to 7 days after starting warfarin.
,(Option 3 is wrong) Fevers are common and expected during the first few days following
major surgery. The nurse should monitor the client for other signs of infection (eg,
incisional redness, heat, swelling) because a low-grade fever (eg, 100.3 F [37.9 C]) is
not a reliable indicator of postoperative infection.
(Option 4 is wrong) The nurse should closely monitor the client's urine output (minimum
≥30 mL/hr). Low urine output can indicate a decrease in cardiac output due to
complications of valve replacement (eg, bleeding, valve dysfunction, dysrhythmias).
✔✔Which client in the emergency department should the nurse see first?
1. 2-year-old with fever and sore throat who is restless and drooling
2. 7-year-old with appendicitis who has right lower quadrant pain and vomiting
3. 9-year-old with immune thrombocytopenia who has generalized petechia
4. 17-year-old with cystic fibrosis who is coughing up thick, blood-tinged sputum -
✔✔CORRECT ANSWER: 1
Diagram of epiglottis: https://imgur.com/vQYUhlH
Acute epiglottitis is a supraglottic inflammatory process that occurs most commonly in
children with Haemophilus influenza type b (Hib) infection. Inflammation of the epiglottis
can cause airway obstruction and is a medical emergency. Common signs of impending
airway obstruction include restlessness, stridor, and drooling due to dysphagia (Option
1 is correct). The nurse should prepare to assist with emergent endotracheal intubation.
(Option 2 is wrong) If left untreated, the inflamed appendix may rupture, causing
peritonitis, major abscess, or partial bowel obstruction. The client with acute
appendicitis may require antibiotic administration and emergent surgical appendectomy.
Although appendicitis is an emergent condition, a client with impending airway
obstruction from epiglottitis must be seen immediately.
(Option 3 is wrong) Immune thrombocytopenia (ITP) is an acquired disorder in which
antibodies cause decreased platelet survival and production. Petechiae, pinpoint lesions
on the skin from capillary hemorrhages, are a common sign of ITP. Acute ITP usually
resolves spontaneously without complications, and management is primarily supportive
(eg, platelet monitoring, corticosteroids, IV immunoglobulin).
(Option 4 is wrong) Cystic fibrosis affects the secretory glands, resulting in thick sputum
that may become blood-tinged from frequent coughing. A client with cystic fibrosis who
has blood-tinged sputum should be evaluated, but care may be safely delayed until after
caring for the client with impending airway obstruction.
✔✔The nurse receives report on four clients at change of shift. Which client should the
nurse see first?
, 1. Client who smokes who has intermittent leg pain that is worse with walking and eases
with rest
2. Client with diabetes who has burning and numbness in both lower legs and feet
3. Client with leg swelling and calf pain who was on a 15-hour flight 2 days ago
4. Client with pain, edema, and redness in the leg following a dog bite 1 hour ago -
✔✔CORRECT ANSWER: 3
Diagram of Deep Vein Thrombosis: https://imgur.com/fwiYE2h
Life-threatening physiological problems (eg, airway, breathing, circulation) are the
highest priority followed by less threatening problems (eg, pain, potential for infection).
Unilateral edema and calf pain could be signs of a deep venous thrombosis (DVT), a
high-priority circulation problem in which a lower-extremity clot may dislodge, travel, and
cause life-threatening complications (eg, pulmonary embolism) (Option 3 is correct).
Prolonged immobilization (eg, airplane travel, bed rest) increases the risk for DVT.
(Option 1 is wrong) A client with leg pain during activity that is relieved by rest may have
intermittent claudication, a classic sign of peripheral artery disease. This condition is not
an immediate threat to survival.
(Option 2 is wrong) The diabetic client with poor glucose control is at risk for developing
neuropathy (burning, tingling, or loss of sensation) of a limb due to changes in the
nerves. This is a chronic, progressive condition and is not an immediate threat to
survival.
(Option 4 is wrong) The client with a dog bite will need antibiotics and possibly a rabies
vaccination, but there is no immediate threat to survival.
✔✔The nurse cares for a 74-year-old client with Clostridioides (formerly Clostridium)
difficile colitis and a history of stroke with left-sided weakness. Which of the following
nursing actions are appropriate to promote client safety? Select all that apply.
1. Apply color-coded, nonslip socks to the client's feet
2. Encourage the client to use a cane on the left side for support
3. Lower the bed and raise all bed rails before exiting the room
4. Place a bedside commode on the client's right side
5. Remind the client to call for assistance before toileting - ✔✔CORRECT ANSWER: 1,
4, 5
List of fall risk precautions: https://imgur.com/k3AJriX
The nurse should ensure that fall risk precautions (eg, nonslip socks, lowering the bed)
are implemented for clients with multiple fall risk factors (eg, advanced age,
neuromuscular weakness). Color-coded, nonslip socks help prevent a client from
slipping and alert staff to a client's increased risk for falls (Option 1 is correct).
