UWORLD NCLEX-RN 2026 EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔The nurse reviews the laboratory results for an adult male client admitted with septic
shock. Which value requires the most immediate action?
1. BUN level of 44.4 mg/dL
2. Creatinine level of 1.1 mg/dL
3. Hematocrit of 48%
4. Potassium level of 5.9 mEq/L - ✔✔CORRECT ANSWER: 4
Serum potassium (normal: 3.5-5 mEq/L) may increase in clients with progressive shock
as a result of metabolic acidosis, which can cause a shift of potassium from the
intracellular to the extracellular compartments. Because the most significant
manifestation of hyperkalemia is a disturbance in cardiac conduction and the
development of cardiac dysrhythmias, correction of the imbalance requires immediate
action (Option 4 is correct).
(Option 1 is wrong) Although a BUN level of 44.4 mg/dL (normal: 6-20 mg/dL) is
elevated, it does not require immediate action. It can increase in clients in a shock state
as the result of decreased perfusion to the kidneys (prerenal azotemia) or extrarenal
factors such as dehydration, fever, or gastrointestinal bleed.
(Options 2 and 3 are wrong) Normal creatinine level is 0.6-1.3 mg/dL and normal
hematocrit level for an adult male is 39%-50%. Normal laboratory values require no
intervention.
✔✔A pediatric client weighing 66 lb is prescribed ibuprofen 5 mg/kg by mouth every 6 hr
PRN for fever. It is available as an oral solution of 20 mg/mL. How many milliliters (mL)
of ibuprofen should be given to the client per dose? Record your answer using one
decimal place. - ✔✔CORRECT ANSWER: 7.5 mL
Reason/work for correct answer: https://imgur.com/L5vmJ7g
✔✔A client with primary hypothyroidism who has been taking levothyroxine for 1 year
has gained 10 Ib (4.5 kg) in 6 months, despite having a poor appetite. The client states,
"| feel sleepy all the time." Laboratory results today show high levels of thyroid-
stimulating hormone (TSH). Which information should the nurse reinforce to the client?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3 months."
3. "Start taking levothyroxine with dietary fiber or calcium to increase its effectiveness."
4. "You will need to get a new prescription for an increased dose of levothyroxine." -
✔✔CORRECT ANSWER: 4
,Thyroid-stimulating hormone (TSH) is released from the pituitary gland to stimulate the
thyroid to secrete hormones (T3, T4). When sufficient thyroid hormone is circulating,
negative feedback causes a normally functioning pituitary to slow or stop the release of
TSH. However, in primary hypothyroidism, the thyroid is unable to synthesize enough
T3 or T4. In response to low circulating thyroid hormones, the pituitary continues to
release TSH, resulting in high TSH levels.
Levothyroxine, a thyroid hormone replacement, is the most common treatment for
hypothyroidism, a condition in which a thyroid hormone deficit slows the metabolic rate
(eg, weight gain despite poor appetite, lethargy, fatigue). Levothyroxine dosing is
adjusted to regulate circulating thyroid hormone levels; this creates a euthyroid (normal)
state and TSH levels are decreased (Option 4 is correct).
(Options 1 and 2 are wrong) Decreasing the dose or discontinuing levothyroxine would
lead to increased TSH and worsening hypothyroidism as the amount of circulating
thyroid hormone decreases.
(Option 3 is wrong) For best results, levothyroxine should be taken on a consistent
morning schedule, before food ingestion. Foods containing certain ingredients (eg,
walnuts, soy products, dietary fiber, calcium) can affect drug absorption.
✔✔The unlicensed assistive personnel (UAP) reports being splashed in the eye while
emptying urine from the catheter bag of a client with AIDS. The UAP is afraid of
becoming infected with HIV and requests immediate testing. What is the nurse's priority
action?
1. Direct the UAP to immediately flush the eye with water at the unit's eyewash station
2. Reassure the UAP that the risk for HIV is low because urine does not transmit the
virus
3. Refer the UAP to the occupational health department for postexposure prophylaxis
4. Send the UAP to the facility's emergency department for medical evaluation -
✔✔CORRECT ANSWER: 1
Following accidental eye exposure to body fluids (eg, blood, urine) or chemicals, health
care workers should immediately flush the affected eye with water or saline for at least
10 minutes to reduce exposure to potentially infected material and prevent/reduce injury
(eg, burn) (Option 1 is correc6). The risk of HIV transmission through urine is low unless
there is visible blood in the fluid; however, flushing the eye is the priority action with any
accidental exposure.
(Option 2 is wrong) The nurse should address the fears of the unlicensed assistive
personnel (UAP), but the most urgent action is for the UAP to flush the eye.
(Option 3 is wrong) All exposure incidents should be reported to appropriate personnel,
including the occupational health department, which is responsible for managing
,immediate postexposure (eg, testing, prophylaxis) and follow-up care (eg, testing,
counseling). However, flushing the eye is the priority.
(Option 4 is wrong) Depending on the facility, the UAP may have additional eye
irrigation in the emergency department, confidential medical evaluation for HIV by a
qualified health care provider, and occupational HIV postexposure prophylaxis if
medically indicated. However, these actions are not the priority.
✔✔The licensed practical nurse (LPN) and registered nurse (RN) are caring for a client
with systemic lupus erythematosus. Which of the following tasks delegated by the RN
should the LPN question? Select all that apply.
1. Administering oral immunosuppressant medications
2. Initiating a transfusion of packed RBCs
3. Monitoring client vital signs and pain level
4. Obtaining a sterile urine specimen for culture
5. Planning topics for client discharge teaching - ✔✔CORRECT ANSWER: 2, 5
The licensed practical nurse (LP) should recognize that the registered nurse (RN)
cannot delegate initial assessment or teaching or tasks requiring clinical judgment. The
RN is responsible for creating the plan of care and preparing discharge instructions.
Although the LP can assist in monitoring the client undergoing a blood transfusion, the
RN must initiate transfusions and evaluate the client receiving blood products. The LP
cannot accept delegation of tasks involving discharge teaching or initiating blood
product transfusion (Options 2 and 5 are correct).
(Options 1, 3, and 4 are wrong) The scope of practice for the LP includes administering
most medications (except those given as a primary IV infusion or IV push), gathering
clinical data about the client (eg, auscultating lung or bowel sounds, monitoring vital
signs), and performing sterile procedures (eg, urinary catheterization, specimen
collection).
✔✔A nurse is caring for a client who had a transurethral resection of the prostate and is
receiving continuous bladder irrigation by gravity. Which of the following tasks can the
nurse delegate to unlicensed assistive personnel? Select all that apply.
1. Calculating the difference between irrigant intake and total drainage output
2. Cleaning around the catheter insertion site daily
3. Immediately notifying the nurse if the client reports pain
4. Increasing the irrigation rate when the urine becomes more red than pink
5. Measuring the total volume of output in the drainage collection bag - ✔✔CORRECT
ANSWER: 2, 3, 5
Continuous bladder irrigation is prescribed following surgical transurethral resection of
the prostate and prevents obstruction of urine outflow by removing clotted blood from
, the bladder. A 3-way catheter is used to continuously infuse solution into the bladder by
gravity. The catheter drains urine, irrigant solution, and blood into a collection bag.
The licensed practical nurse (LPN) should consider the five rights of delegation when
delegating to unlicensed assistive personnel (UP):
• Catheter care is a routine, noncomplex task that may safely be delegated to UAP
(Option 2 is correct).
• Any client reports of pain or bladder spasms to UAP should immediately be conveyed
to the PN because these symptoms may indicate obstruction (Option 3 is correct).
• Measuring output is routine data measurement. UP should report the volume to the
LPN, who will determine the adequacy of drainage (Option 5 is correct).
(Option 1 is wrong) Clots or kinks may obstruct drainage and cause a smaller volume of
outflow than inflow. The nurse should calculate this difference to determine the need to
reestablish patency using manual irrigation.
(Option 4 is wrong) The irrigation rate should be titrated to maintain light pink outflow
drainage with few clots. UP lack the knowledge and skills necessary to titrate inflow rate
or monitor drainage quality.
✔✔The nurse is caring for a 68-year-old client. Here is their history and physical:
https://imgur.com/M5GosAT
Which clinical finding is most concerning for respiratory distress?
1. Decreased breath stounds
2. Distended neck veins
3. Nasal flaring
4. Productive cough - ✔✔CORRECT ANSWER: 3
Diagram of Chronic Obstructive Pulmonary Disease (COPD):
https://imgur.com/68Ah8Qj
Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible lower
respiratory tract condition characterized by chronic inflammation, airway remodeling,
and reduced expiratory airflow. COPD is associated with air trapping due to alveolar
enlargement and hyperinflation and/or airway obstruction due to inflammation and
increased sputum production. Infection can precipitate an acute exacerbation.
Findings that suggest acute respiratory distress or impending respiratory failure include
nasal flaring, retractions (eg, supraclavicular area), grunting (in children), and change in
body posture (leaning forward). These occur as a compensatory mechanism to reduce
AND SOLUTIONS RATED A+
✔✔The nurse reviews the laboratory results for an adult male client admitted with septic
shock. Which value requires the most immediate action?
1. BUN level of 44.4 mg/dL
2. Creatinine level of 1.1 mg/dL
3. Hematocrit of 48%
4. Potassium level of 5.9 mEq/L - ✔✔CORRECT ANSWER: 4
Serum potassium (normal: 3.5-5 mEq/L) may increase in clients with progressive shock
as a result of metabolic acidosis, which can cause a shift of potassium from the
intracellular to the extracellular compartments. Because the most significant
manifestation of hyperkalemia is a disturbance in cardiac conduction and the
development of cardiac dysrhythmias, correction of the imbalance requires immediate
action (Option 4 is correct).
(Option 1 is wrong) Although a BUN level of 44.4 mg/dL (normal: 6-20 mg/dL) is
elevated, it does not require immediate action. It can increase in clients in a shock state
as the result of decreased perfusion to the kidneys (prerenal azotemia) or extrarenal
factors such as dehydration, fever, or gastrointestinal bleed.
(Options 2 and 3 are wrong) Normal creatinine level is 0.6-1.3 mg/dL and normal
hematocrit level for an adult male is 39%-50%. Normal laboratory values require no
intervention.
✔✔A pediatric client weighing 66 lb is prescribed ibuprofen 5 mg/kg by mouth every 6 hr
PRN for fever. It is available as an oral solution of 20 mg/mL. How many milliliters (mL)
of ibuprofen should be given to the client per dose? Record your answer using one
decimal place. - ✔✔CORRECT ANSWER: 7.5 mL
Reason/work for correct answer: https://imgur.com/L5vmJ7g
✔✔A client with primary hypothyroidism who has been taking levothyroxine for 1 year
has gained 10 Ib (4.5 kg) in 6 months, despite having a poor appetite. The client states,
"| feel sleepy all the time." Laboratory results today show high levels of thyroid-
stimulating hormone (TSH). Which information should the nurse reinforce to the client?
1. "A new prescription will be issued for a decreased dose of levothyroxine."
2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3 months."
3. "Start taking levothyroxine with dietary fiber or calcium to increase its effectiveness."
4. "You will need to get a new prescription for an increased dose of levothyroxine." -
✔✔CORRECT ANSWER: 4
,Thyroid-stimulating hormone (TSH) is released from the pituitary gland to stimulate the
thyroid to secrete hormones (T3, T4). When sufficient thyroid hormone is circulating,
negative feedback causes a normally functioning pituitary to slow or stop the release of
TSH. However, in primary hypothyroidism, the thyroid is unable to synthesize enough
T3 or T4. In response to low circulating thyroid hormones, the pituitary continues to
release TSH, resulting in high TSH levels.
Levothyroxine, a thyroid hormone replacement, is the most common treatment for
hypothyroidism, a condition in which a thyroid hormone deficit slows the metabolic rate
(eg, weight gain despite poor appetite, lethargy, fatigue). Levothyroxine dosing is
adjusted to regulate circulating thyroid hormone levels; this creates a euthyroid (normal)
state and TSH levels are decreased (Option 4 is correct).
(Options 1 and 2 are wrong) Decreasing the dose or discontinuing levothyroxine would
lead to increased TSH and worsening hypothyroidism as the amount of circulating
thyroid hormone decreases.
(Option 3 is wrong) For best results, levothyroxine should be taken on a consistent
morning schedule, before food ingestion. Foods containing certain ingredients (eg,
walnuts, soy products, dietary fiber, calcium) can affect drug absorption.
✔✔The unlicensed assistive personnel (UAP) reports being splashed in the eye while
emptying urine from the catheter bag of a client with AIDS. The UAP is afraid of
becoming infected with HIV and requests immediate testing. What is the nurse's priority
action?
1. Direct the UAP to immediately flush the eye with water at the unit's eyewash station
2. Reassure the UAP that the risk for HIV is low because urine does not transmit the
virus
3. Refer the UAP to the occupational health department for postexposure prophylaxis
4. Send the UAP to the facility's emergency department for medical evaluation -
✔✔CORRECT ANSWER: 1
Following accidental eye exposure to body fluids (eg, blood, urine) or chemicals, health
care workers should immediately flush the affected eye with water or saline for at least
10 minutes to reduce exposure to potentially infected material and prevent/reduce injury
(eg, burn) (Option 1 is correc6). The risk of HIV transmission through urine is low unless
there is visible blood in the fluid; however, flushing the eye is the priority action with any
accidental exposure.
(Option 2 is wrong) The nurse should address the fears of the unlicensed assistive
personnel (UAP), but the most urgent action is for the UAP to flush the eye.
(Option 3 is wrong) All exposure incidents should be reported to appropriate personnel,
including the occupational health department, which is responsible for managing
,immediate postexposure (eg, testing, prophylaxis) and follow-up care (eg, testing,
counseling). However, flushing the eye is the priority.
(Option 4 is wrong) Depending on the facility, the UAP may have additional eye
irrigation in the emergency department, confidential medical evaluation for HIV by a
qualified health care provider, and occupational HIV postexposure prophylaxis if
medically indicated. However, these actions are not the priority.
✔✔The licensed practical nurse (LPN) and registered nurse (RN) are caring for a client
with systemic lupus erythematosus. Which of the following tasks delegated by the RN
should the LPN question? Select all that apply.
1. Administering oral immunosuppressant medications
2. Initiating a transfusion of packed RBCs
3. Monitoring client vital signs and pain level
4. Obtaining a sterile urine specimen for culture
5. Planning topics for client discharge teaching - ✔✔CORRECT ANSWER: 2, 5
The licensed practical nurse (LP) should recognize that the registered nurse (RN)
cannot delegate initial assessment or teaching or tasks requiring clinical judgment. The
RN is responsible for creating the plan of care and preparing discharge instructions.
Although the LP can assist in monitoring the client undergoing a blood transfusion, the
RN must initiate transfusions and evaluate the client receiving blood products. The LP
cannot accept delegation of tasks involving discharge teaching or initiating blood
product transfusion (Options 2 and 5 are correct).
(Options 1, 3, and 4 are wrong) The scope of practice for the LP includes administering
most medications (except those given as a primary IV infusion or IV push), gathering
clinical data about the client (eg, auscultating lung or bowel sounds, monitoring vital
signs), and performing sterile procedures (eg, urinary catheterization, specimen
collection).
✔✔A nurse is caring for a client who had a transurethral resection of the prostate and is
receiving continuous bladder irrigation by gravity. Which of the following tasks can the
nurse delegate to unlicensed assistive personnel? Select all that apply.
1. Calculating the difference between irrigant intake and total drainage output
2. Cleaning around the catheter insertion site daily
3. Immediately notifying the nurse if the client reports pain
4. Increasing the irrigation rate when the urine becomes more red than pink
5. Measuring the total volume of output in the drainage collection bag - ✔✔CORRECT
ANSWER: 2, 3, 5
Continuous bladder irrigation is prescribed following surgical transurethral resection of
the prostate and prevents obstruction of urine outflow by removing clotted blood from
, the bladder. A 3-way catheter is used to continuously infuse solution into the bladder by
gravity. The catheter drains urine, irrigant solution, and blood into a collection bag.
The licensed practical nurse (LPN) should consider the five rights of delegation when
delegating to unlicensed assistive personnel (UP):
• Catheter care is a routine, noncomplex task that may safely be delegated to UAP
(Option 2 is correct).
• Any client reports of pain or bladder spasms to UAP should immediately be conveyed
to the PN because these symptoms may indicate obstruction (Option 3 is correct).
• Measuring output is routine data measurement. UP should report the volume to the
LPN, who will determine the adequacy of drainage (Option 5 is correct).
(Option 1 is wrong) Clots or kinks may obstruct drainage and cause a smaller volume of
outflow than inflow. The nurse should calculate this difference to determine the need to
reestablish patency using manual irrigation.
(Option 4 is wrong) The irrigation rate should be titrated to maintain light pink outflow
drainage with few clots. UP lack the knowledge and skills necessary to titrate inflow rate
or monitor drainage quality.
✔✔The nurse is caring for a 68-year-old client. Here is their history and physical:
https://imgur.com/M5GosAT
Which clinical finding is most concerning for respiratory distress?
1. Decreased breath stounds
2. Distended neck veins
3. Nasal flaring
4. Productive cough - ✔✔CORRECT ANSWER: 3
Diagram of Chronic Obstructive Pulmonary Disease (COPD):
https://imgur.com/68Ah8Qj
Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible lower
respiratory tract condition characterized by chronic inflammation, airway remodeling,
and reduced expiratory airflow. COPD is associated with air trapping due to alveolar
enlargement and hyperinflation and/or airway obstruction due to inflammation and
increased sputum production. Infection can precipitate an acute exacerbation.
Findings that suggest acute respiratory distress or impending respiratory failure include
nasal flaring, retractions (eg, supraclavicular area), grunting (in children), and change in
body posture (leaning forward). These occur as a compensatory mechanism to reduce
