NCLEX-RN Test Bank Exam 2026 with NGN 450+
Questions and Correct Answers with Rationales
Medical-Surgical Nursing
1. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
assessment finding should the nurse expect?
A. Bradycardia
B. Hypotension
C. Kussmaul respirations
D. Hyperthermia
Answer: C. Kussmaul respirations
Rationale: DKA causes metabolic acidosis. The body compensates with deep, rapid
respirations (Kussmaul) to blow off CO₂ and increase pH.
2. A client with COPD has O₂ saturation of 88% on room air. What should the
nurse do first?
A. Encourage coughing
B. Increase oxygen via nasal cannula
C. Administer bronchodilator
D. Call respiratory therapy
Answer: B. Increase oxygen via nasal cannula
Rationale: Ensuring adequate oxygenation is the first priority per airway and
breathing priorities.
,3. A client taking warfarin reports taking aspirin for headache. What is the best
action?
A. Document the information
B. Educate about bleeding risk
C. Advise to continue aspirin
D. Notify provider for order change
Answer: B. Educate about bleeding risk
Rationale: Aspirin increases bleeding risk in clients on warfarin. Education reduces
risk and ensures safety.
4. A client with Alzheimer's disease is agitated at night. What intervention is
most appropriate?
A. Reorient frequently
B. Increase daytime naps
C. Maintain a consistent routine
D. Allow unrestricted visitors
Answer: C. Maintain a consistent routine
Rationale: Consistent routines reduce confusion and agitation in clients with
Alzheimer's disease. Sundowning is managed with structure and familiarity.
5. Which finding needs immediate intervention in a client with a chest tube?
A. Serosanguineous drainage
B. Continuous bubbling in water seal chamber
C. Pain at insertion site
D. No drainage for 2 hours
Answer: B. Continuous bubbling in water seal chamber
Rationale: Continuous bubbling suggests an air leak, requiring immediate corrective
action to prevent complications.
,6. A client with heart failure has 3+ pitting edema and SOB. Which lab should
the nurse assess first?
A. CBC
B. BNP
C. Blood glucose
D. Serum magnesium
Answer: B. BNP
Rationale: BNP is elevated in fluid overload and helps determine heart failure
severity.
7. Which action is priority when a client on IV potassium reports burning at the
IV site?
A. Stop infusion
B. Slow the rate and assess site
C. Apply cold compress
D. Flush IV with saline
Answer: B. Slow the rate and assess site
Rationale: Potassium is irritating; slowing and inspecting for infiltration is essential
for safety before stopping completely.
8. A nurse teaching a client about insulin storage should include which
statement?
A. Store opened vials at room temperature
B. Refrigerate before every injection
C. Keep unused vials in sunlight
D. Shake the vial before use
Answer: A. Store opened vials at room temperature
Rationale: Room temperature decreases injection discomfort and maintains potency.
Insulin should not be shaken or exposed to extreme temperatures.
, 9. A postoperative client's wound edges separate. What is the priority action?
A. Apply sterile dressing
B. Notify provider immediately
C. Encourage deep breathing
D. Document the finding
Answer: B. Notify provider immediately
Rationale: Wound dehiscence is a serious complication needing prompt provider
assessment.
10. A client receiving morphine has RR 8/min. What is the best action?
A. Continue monitoring
B. Administer naloxone
C. Call provider immediately
D. Encourage coughing
Answer: B. Administer naloxone
Rationale: Respiratory depression from opioids is life-threatening; naloxone reverses
this effect.
11. A nurse assesses a client with hypoglycemia. Which sign is most likely?
A. Polydipsia
B. Cool, clammy skin
C. Weight gain
D. Fruity breath
Answer: B. Cool, clammy skin
Rationale: Hypoglycemia presents with sympathetic symptoms (cool, clammy skin,
tachycardia, anxiety) due to adrenergic response.
Questions and Correct Answers with Rationales
Medical-Surgical Nursing
1. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
assessment finding should the nurse expect?
A. Bradycardia
B. Hypotension
C. Kussmaul respirations
D. Hyperthermia
Answer: C. Kussmaul respirations
Rationale: DKA causes metabolic acidosis. The body compensates with deep, rapid
respirations (Kussmaul) to blow off CO₂ and increase pH.
2. A client with COPD has O₂ saturation of 88% on room air. What should the
nurse do first?
A. Encourage coughing
B. Increase oxygen via nasal cannula
C. Administer bronchodilator
D. Call respiratory therapy
Answer: B. Increase oxygen via nasal cannula
Rationale: Ensuring adequate oxygenation is the first priority per airway and
breathing priorities.
,3. A client taking warfarin reports taking aspirin for headache. What is the best
action?
A. Document the information
B. Educate about bleeding risk
C. Advise to continue aspirin
D. Notify provider for order change
Answer: B. Educate about bleeding risk
Rationale: Aspirin increases bleeding risk in clients on warfarin. Education reduces
risk and ensures safety.
4. A client with Alzheimer's disease is agitated at night. What intervention is
most appropriate?
A. Reorient frequently
B. Increase daytime naps
C. Maintain a consistent routine
D. Allow unrestricted visitors
Answer: C. Maintain a consistent routine
Rationale: Consistent routines reduce confusion and agitation in clients with
Alzheimer's disease. Sundowning is managed with structure and familiarity.
5. Which finding needs immediate intervention in a client with a chest tube?
A. Serosanguineous drainage
B. Continuous bubbling in water seal chamber
C. Pain at insertion site
D. No drainage for 2 hours
Answer: B. Continuous bubbling in water seal chamber
Rationale: Continuous bubbling suggests an air leak, requiring immediate corrective
action to prevent complications.
,6. A client with heart failure has 3+ pitting edema and SOB. Which lab should
the nurse assess first?
A. CBC
B. BNP
C. Blood glucose
D. Serum magnesium
Answer: B. BNP
Rationale: BNP is elevated in fluid overload and helps determine heart failure
severity.
7. Which action is priority when a client on IV potassium reports burning at the
IV site?
A. Stop infusion
B. Slow the rate and assess site
C. Apply cold compress
D. Flush IV with saline
Answer: B. Slow the rate and assess site
Rationale: Potassium is irritating; slowing and inspecting for infiltration is essential
for safety before stopping completely.
8. A nurse teaching a client about insulin storage should include which
statement?
A. Store opened vials at room temperature
B. Refrigerate before every injection
C. Keep unused vials in sunlight
D. Shake the vial before use
Answer: A. Store opened vials at room temperature
Rationale: Room temperature decreases injection discomfort and maintains potency.
Insulin should not be shaken or exposed to extreme temperatures.
, 9. A postoperative client's wound edges separate. What is the priority action?
A. Apply sterile dressing
B. Notify provider immediately
C. Encourage deep breathing
D. Document the finding
Answer: B. Notify provider immediately
Rationale: Wound dehiscence is a serious complication needing prompt provider
assessment.
10. A client receiving morphine has RR 8/min. What is the best action?
A. Continue monitoring
B. Administer naloxone
C. Call provider immediately
D. Encourage coughing
Answer: B. Administer naloxone
Rationale: Respiratory depression from opioids is life-threatening; naloxone reverses
this effect.
11. A nurse assesses a client with hypoglycemia. Which sign is most likely?
A. Polydipsia
B. Cool, clammy skin
C. Weight gain
D. Fruity breath
Answer: B. Cool, clammy skin
Rationale: Hypoglycemia presents with sympathetic symptoms (cool, clammy skin,
tachycardia, anxiety) due to adrenergic response.
