# Latest NCLEX Study Guide 2024/2025:
Ace Your Exams on the First Attempt,
Avoid Resits
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**01.** A nurse is caring for a client who is 1 hour post‑operative following a thyroidectomy. The client
reports tingling around the mouth and muscle twitching. Which laboratory value should the nurse check
first?
A) Serum calcium
B) Serum potassium
C) Serum magnesium
D) Serum sodium
🔍 RATIONALE💡-- Tingling and twitching indicate hypocalcemia due to accidental parathyroid injury
during surgery. Serum calcium should be checked immediately.
ANSWER💫✔️-- A) Serum calcium
---
**02.** A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which
statement by the client indicates a need for further teaching?
A) “I will use an electric razor to shave.”
B) “I will eat the same amount of leafy green vegetables each week.”
C) “I can take ibuprofen for my headaches.”
D) “I will have my INR checked regularly.”
,🔍 RATIONALE💡-- Ibuprofen (NSAID) increases bleeding risk when taken with warfarin. Acetaminophen
is safer. The other statements are correct.
ANSWER💫✔️-- C) “I can take ibuprofen for my headaches.”
---
**03.** A nurse is assessing a client with a potassium level of 6.0 mEq/L. Which ECG change is
expected?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
🔍 RATIONALE💡-- Hyperkalemia causes peaked (tented) T waves, widened QRS, and eventually a sine
wave pattern.
ANSWER💫✔️-- C) Peaked T waves
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**04.** A nurse is caring for a client who is receiving a blood transfusion. The client reports low back
pain and chills. What is the priority action?
A) Slow the infusion rate and reassess
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen as prescribed
D) Notify the blood bank
🔍 RATIONALE💡-- Low back pain and chills suggest an acute hemolytic reaction. Stop the transfusion
immediately, keep IV line open with normal saline, and notify the provider.
,ANSWER💫✔️-- B) Stop the transfusion and infuse normal saline
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**05.** A nurse is teaching a client with a new colostomy about stoma care. Which statement indicates
correct understanding?
A) “I will change the pouch every day to prevent infection.”
B) “My stoma should look dark purple and dry.”
C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
D) “I can use hydrogen peroxide to clean the stoma.”
🔍 RATIONALE💡-- The skin barrier opening should be cut 1‑2 mm larger than the stoma to prevent skin
irritation. A healthy stoma is pink/red and moist; hydrogen peroxide is too harsh.
ANSWER💫✔️-- C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
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**06.** A nurse is caring for a client with a chest tube connected to a water‑seal drainage system. The
nurse notes continuous bubbling in the water seal chamber. Which action should the nurse take first?
A) Clamp the chest tube near the insertion site
B) Increase the suction pressure
C) Check the system for an air leak
D) Document the finding as normal
🔍 RATIONALE💡-- Continuous bubbling indicates an air leak. The nurse should check all connections for
loose fittings. Clamping can cause tension pneumothorax.
ANSWER💫✔️-- C) Check the system for an air leak
, ---
**07.** A nurse is assessing a client with a traumatic brain injury. Which finding suggests increased
intracranial pressure (ICP)?
A) Glasgow Coma Scale score of 15
B) Pupils equal and reactive to light
C) Widening pulse pressure with bradycardia
D) Tachycardia and hypotension
🔍 RATIONALE💡-- Widening pulse pressure (increasing systolic with stable diastolic) and bradycardia
are components of Cushing’s triad, a late sign of increased ICP.
ANSWER💫✔️-- C) Widening pulse pressure with bradycardia
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**08.** A nurse is preparing to administer digoxin to a client with heart failure. The client’s apical pulse
is 52 bpm and they report nausea. What should the nurse do first?
A) Administer the digoxin as ordered
B) Check the digoxin level
C) Hold the dose and notify the provider
D) Administer atropine to increase heart rate
🔍 RATIONALE💡-- Bradycardia (<60 bpm) and nausea are signs of digoxin toxicity. The nurse should hold
the dose and notify the provider.
ANSWER💫✔️-- C) Hold the dose and notify the provider
---
Ace Your Exams on the First Attempt,
Avoid Resits
---
**01.** A nurse is caring for a client who is 1 hour post‑operative following a thyroidectomy. The client
reports tingling around the mouth and muscle twitching. Which laboratory value should the nurse check
first?
A) Serum calcium
B) Serum potassium
C) Serum magnesium
D) Serum sodium
🔍 RATIONALE💡-- Tingling and twitching indicate hypocalcemia due to accidental parathyroid injury
during surgery. Serum calcium should be checked immediately.
ANSWER💫✔️-- A) Serum calcium
---
**02.** A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which
statement by the client indicates a need for further teaching?
A) “I will use an electric razor to shave.”
B) “I will eat the same amount of leafy green vegetables each week.”
C) “I can take ibuprofen for my headaches.”
D) “I will have my INR checked regularly.”
,🔍 RATIONALE💡-- Ibuprofen (NSAID) increases bleeding risk when taken with warfarin. Acetaminophen
is safer. The other statements are correct.
ANSWER💫✔️-- C) “I can take ibuprofen for my headaches.”
---
**03.** A nurse is assessing a client with a potassium level of 6.0 mEq/L. Which ECG change is
expected?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
🔍 RATIONALE💡-- Hyperkalemia causes peaked (tented) T waves, widened QRS, and eventually a sine
wave pattern.
ANSWER💫✔️-- C) Peaked T waves
---
**04.** A nurse is caring for a client who is receiving a blood transfusion. The client reports low back
pain and chills. What is the priority action?
A) Slow the infusion rate and reassess
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen as prescribed
D) Notify the blood bank
🔍 RATIONALE💡-- Low back pain and chills suggest an acute hemolytic reaction. Stop the transfusion
immediately, keep IV line open with normal saline, and notify the provider.
,ANSWER💫✔️-- B) Stop the transfusion and infuse normal saline
---
**05.** A nurse is teaching a client with a new colostomy about stoma care. Which statement indicates
correct understanding?
A) “I will change the pouch every day to prevent infection.”
B) “My stoma should look dark purple and dry.”
C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
D) “I can use hydrogen peroxide to clean the stoma.”
🔍 RATIONALE💡-- The skin barrier opening should be cut 1‑2 mm larger than the stoma to prevent skin
irritation. A healthy stoma is pink/red and moist; hydrogen peroxide is too harsh.
ANSWER💫✔️-- C) “I will cut the skin barrier opening 1‑2 mm larger than my stoma.”
---
**06.** A nurse is caring for a client with a chest tube connected to a water‑seal drainage system. The
nurse notes continuous bubbling in the water seal chamber. Which action should the nurse take first?
A) Clamp the chest tube near the insertion site
B) Increase the suction pressure
C) Check the system for an air leak
D) Document the finding as normal
🔍 RATIONALE💡-- Continuous bubbling indicates an air leak. The nurse should check all connections for
loose fittings. Clamping can cause tension pneumothorax.
ANSWER💫✔️-- C) Check the system for an air leak
, ---
**07.** A nurse is assessing a client with a traumatic brain injury. Which finding suggests increased
intracranial pressure (ICP)?
A) Glasgow Coma Scale score of 15
B) Pupils equal and reactive to light
C) Widening pulse pressure with bradycardia
D) Tachycardia and hypotension
🔍 RATIONALE💡-- Widening pulse pressure (increasing systolic with stable diastolic) and bradycardia
are components of Cushing’s triad, a late sign of increased ICP.
ANSWER💫✔️-- C) Widening pulse pressure with bradycardia
---
**08.** A nurse is preparing to administer digoxin to a client with heart failure. The client’s apical pulse
is 52 bpm and they report nausea. What should the nurse do first?
A) Administer the digoxin as ordered
B) Check the digoxin level
C) Hold the dose and notify the provider
D) Administer atropine to increase heart rate
🔍 RATIONALE💡-- Bradycardia (<60 bpm) and nausea are signs of digoxin toxicity. The nurse should hold
the dose and notify the provider.
ANSWER💫✔️-- C) Hold the dose and notify the provider
---
