NCLEX-RN Comprehensive Practice Exam 2026/2027 – Verified
Q&As with Detailed Rationales (Test Bank Bundle - 87
Questions)
---
**QUESTION 1:**
A 68-year-old male with heart failure presents with dyspnea and 3+ pitting edema in both lower
extremities. Which assessment finding indicates worsening decompensation?
A) Jugular venous distention
B) Decreased heart rate
C) Increased urine output
D) Clear lung sounds
> 🎯 **CORRECT ANSWER:** A) Jugular venous distention
> 💡 **CLINICAL RATIONALE:** JVD reflects elevated central venous pressure from fluid overload. HR
often increases as compensation. Urine output drops; lungs show crackles.
---
**QUESTION 2:**
A nurse receives a handoff report for a patient with a chest tube attached to suction. The drainage
system is accidentally knocked over, and the water seal is broken. What is the priority action?
A) Clamp the chest tube immediately
B) Place the drainage system upright and reconnect suction
C) Submerge the distal end of the chest tube in sterile water
D) Notify the provider
> 🎯 **CORRECT ANSWER:** C) Submerge the distal end of the chest tube in sterile water
> 💡 **CLINICAL RATIONALE:** Restores water seal to prevent pneumothorax. Clamping can cause
tension. Notify after securing.
---
,**QUESTION 3:**
A 45-year-old patient with type 1 diabetes reports nausea, vomiting, and abdominal pain. Blood glucose
is 450 mg/dL, and serum ketones are positive. Which laboratory value is most indicative of diabetic
ketoacidosis?
A) Serum pH 7.30
B) Serum bicarbonate 18 mEq/L
C) Anion gap of 15
D) All of the above
> 🎯 **CORRECT ANSWER:** D) All of the above
> 💡 **CLINICAL RATIONALE:** Metabolic acidosis with low pH, low HCO3, and elevated anion gap
defines DKA.
---
**QUESTION 4:**
A 6-month-old infant with a fever of 102°F has a petechial rash, bulging fontanelle, and is irritable.
Which action should the nurse take first?
A) Administer acetaminophen
B) Obtain blood cultures
C) Start IV antibiotics
D) Perform a lumbar puncture
> 🎯 **CORRECT ANSWER:** C) Start IV antibiotics
> 💡 **CLINICAL RATIONALE:** Suspected meningitis; antibiotics must be started immediately after
cultures (but before LP if delay).
---
**QUESTION 5:**
A patient with an indwelling urinary catheter reports suprapubic discomfort and urine output is 50 mL
over the last 4 hours. What is the most appropriate nursing action?
A) Irrigate the catheter with sterile saline
B) Check for kinks and ensure the bag is below the bladder
C) Increase IV fluid infusion rate
,D) Remove and replace the catheter
> 🎯 **CORRECT ANSWER:** B) Check for kinks and ensure the bag is below the bladder
> 💡 **CLINICAL RATIONALE:** Obstruction is most common cause; assess mechanical factors first.
---
**QUESTION 6:**
A 30-year-old woman is admitted with acute pancreatitis. Which laboratory result is most specific to this
diagnosis?
A) Serum amylase 300 U/L
B) Serum lipase 400 U/L
C) White blood cell count 15,000/mm³
D) Calcium 7.8 mg/dL
> 🎯 **CORRECT ANSWER:** B) Serum lipase 400 U/L
> 💡 **CLINICAL RATIONALE:** Lipase is more specific and stays elevated longer than amylase for
pancreatitis.
---
**QUESTION 7:**
A nurse is teaching a patient about warfarin. Which statement indicates the patient needs further
education?
A) "I will eat a consistent amount of green leafy vegetables."
B) "I will report any bruising or bleeding."
C) "I will take aspirin daily for pain."
D) "I will wear a medical alert bracelet."
> 🎯 **CORRECT ANSWER:** C) "I will take aspirin daily for pain."
> 💡 **CLINICAL RATIONALE:** Aspirin increases bleeding risk with warfarin; avoid unless prescribed.
---
**QUESTION 8:**
, A patient with COPD has a pulse oximetry reading of 88% and is receiving oxygen at 2 L/min via nasal
cannula. Which action is most appropriate?
A) Increase oxygen to 4 L/min
B) Ask the patient to cough and deep breathe
C) Check the oxygen delivery device and assess for respiratory distress
D) Administer bronchodilator therapy
> 🎯 **CORRECT ANSWER:** C) Check the oxygen delivery device and assess for respiratory distress
> 💡 **CLINICAL RATIONALE:** Assess device and patient status first; avoid high FiO2 in COPD; escalate
only if needed.
---
**QUESTION 9:**
A 25-year-old male is brought to the ED after a motorcycle accident. He has a decreased level of
consciousness and a blood pressure of 90/60 mm Hg. Which assessment finding suggests increased
intracranial pressure?
A) Normal pupil response to light
B) Decerebrate posturing
C) Heart rate of 100 bpm
D) Urinary incontinence
> 🎯 **CORRECT ANSWER:** B) Decerebrate posturing
> 💡 **CLINICAL RATIONALE:** Abnormal posturing indicates brainstem injury and elevated ICP. Late
sign.
---
**QUESTION 10:**
A patient in labor is receiving an oxytocin infusion. The nurse notes a contraction frequency of every 2
minutes with a duration of 90 seconds. What is the priority action?
A) Turn off the oxytocin infusion
B) Increase the infusion rate
C) Administer oxygen
D) Position the patient on her left side
Q&As with Detailed Rationales (Test Bank Bundle - 87
Questions)
---
**QUESTION 1:**
A 68-year-old male with heart failure presents with dyspnea and 3+ pitting edema in both lower
extremities. Which assessment finding indicates worsening decompensation?
A) Jugular venous distention
B) Decreased heart rate
C) Increased urine output
D) Clear lung sounds
> 🎯 **CORRECT ANSWER:** A) Jugular venous distention
> 💡 **CLINICAL RATIONALE:** JVD reflects elevated central venous pressure from fluid overload. HR
often increases as compensation. Urine output drops; lungs show crackles.
---
**QUESTION 2:**
A nurse receives a handoff report for a patient with a chest tube attached to suction. The drainage
system is accidentally knocked over, and the water seal is broken. What is the priority action?
A) Clamp the chest tube immediately
B) Place the drainage system upright and reconnect suction
C) Submerge the distal end of the chest tube in sterile water
D) Notify the provider
> 🎯 **CORRECT ANSWER:** C) Submerge the distal end of the chest tube in sterile water
> 💡 **CLINICAL RATIONALE:** Restores water seal to prevent pneumothorax. Clamping can cause
tension. Notify after securing.
---
,**QUESTION 3:**
A 45-year-old patient with type 1 diabetes reports nausea, vomiting, and abdominal pain. Blood glucose
is 450 mg/dL, and serum ketones are positive. Which laboratory value is most indicative of diabetic
ketoacidosis?
A) Serum pH 7.30
B) Serum bicarbonate 18 mEq/L
C) Anion gap of 15
D) All of the above
> 🎯 **CORRECT ANSWER:** D) All of the above
> 💡 **CLINICAL RATIONALE:** Metabolic acidosis with low pH, low HCO3, and elevated anion gap
defines DKA.
---
**QUESTION 4:**
A 6-month-old infant with a fever of 102°F has a petechial rash, bulging fontanelle, and is irritable.
Which action should the nurse take first?
A) Administer acetaminophen
B) Obtain blood cultures
C) Start IV antibiotics
D) Perform a lumbar puncture
> 🎯 **CORRECT ANSWER:** C) Start IV antibiotics
> 💡 **CLINICAL RATIONALE:** Suspected meningitis; antibiotics must be started immediately after
cultures (but before LP if delay).
---
**QUESTION 5:**
A patient with an indwelling urinary catheter reports suprapubic discomfort and urine output is 50 mL
over the last 4 hours. What is the most appropriate nursing action?
A) Irrigate the catheter with sterile saline
B) Check for kinks and ensure the bag is below the bladder
C) Increase IV fluid infusion rate
,D) Remove and replace the catheter
> 🎯 **CORRECT ANSWER:** B) Check for kinks and ensure the bag is below the bladder
> 💡 **CLINICAL RATIONALE:** Obstruction is most common cause; assess mechanical factors first.
---
**QUESTION 6:**
A 30-year-old woman is admitted with acute pancreatitis. Which laboratory result is most specific to this
diagnosis?
A) Serum amylase 300 U/L
B) Serum lipase 400 U/L
C) White blood cell count 15,000/mm³
D) Calcium 7.8 mg/dL
> 🎯 **CORRECT ANSWER:** B) Serum lipase 400 U/L
> 💡 **CLINICAL RATIONALE:** Lipase is more specific and stays elevated longer than amylase for
pancreatitis.
---
**QUESTION 7:**
A nurse is teaching a patient about warfarin. Which statement indicates the patient needs further
education?
A) "I will eat a consistent amount of green leafy vegetables."
B) "I will report any bruising or bleeding."
C) "I will take aspirin daily for pain."
D) "I will wear a medical alert bracelet."
> 🎯 **CORRECT ANSWER:** C) "I will take aspirin daily for pain."
> 💡 **CLINICAL RATIONALE:** Aspirin increases bleeding risk with warfarin; avoid unless prescribed.
---
**QUESTION 8:**
, A patient with COPD has a pulse oximetry reading of 88% and is receiving oxygen at 2 L/min via nasal
cannula. Which action is most appropriate?
A) Increase oxygen to 4 L/min
B) Ask the patient to cough and deep breathe
C) Check the oxygen delivery device and assess for respiratory distress
D) Administer bronchodilator therapy
> 🎯 **CORRECT ANSWER:** C) Check the oxygen delivery device and assess for respiratory distress
> 💡 **CLINICAL RATIONALE:** Assess device and patient status first; avoid high FiO2 in COPD; escalate
only if needed.
---
**QUESTION 9:**
A 25-year-old male is brought to the ED after a motorcycle accident. He has a decreased level of
consciousness and a blood pressure of 90/60 mm Hg. Which assessment finding suggests increased
intracranial pressure?
A) Normal pupil response to light
B) Decerebrate posturing
C) Heart rate of 100 bpm
D) Urinary incontinence
> 🎯 **CORRECT ANSWER:** B) Decerebrate posturing
> 💡 **CLINICAL RATIONALE:** Abnormal posturing indicates brainstem injury and elevated ICP. Late
sign.
---
**QUESTION 10:**
A patient in labor is receiving an oxytocin infusion. The nurse notes a contraction frequency of every 2
minutes with a duration of 90 seconds. What is the priority action?
A) Turn off the oxytocin infusion
B) Increase the infusion rate
C) Administer oxygen
D) Position the patient on her left side
