NCLEX-RN ULTIMATE 2026/2027 EXAM
PREPARATION GUIDE
50+ PRACTICE QUESTIONS, DETAILED RATIONALES,
SATA QUESTIONS, AND CLINICAL JUDGMENT
CASES GRADED A+ 100% PASS
Question 1
A nurse is caring for a client with heart failure. Which assessment finding should
the nurse report immediately?
A. Weight gain of 0.5 kg (1 lb) in 24 hours
B. Bilateral ankle edema
C. Crackles throughout both lung fields
D. Fatigue after ambulation
Answer: C. Crackles throughout both lung fields
Rationale: Crackles throughout the lungs may indicate worsening pulmonary
edema and impaired oxygenation, requiring immediate intervention.
Question 2
The nurse is preparing to administer insulin. Which action is the priority?
A. Check the client's blood pressure
B. Assess the client's blood glucose level
C. Measure urine output
,D. Obtain the client's weight
Answer: B. Assess the client's blood glucose level
Rationale: Blood glucose must be assessed before insulin administration to
determine safety and dosage requirements.
Question 3
A client suddenly develops shortness of breath after surgery. What is the nurse's
priority action?
A. Encourage fluid intake
B. Place the client in a supine position
C. Assess airway and oxygen saturation
D. Administer pain medication
Answer: C. Assess airway and oxygen saturation
Rationale: Following the ABCs (Airway, Breathing, Circulation), breathing status is
the priority.
Question 4 (Select All That Apply)
Which findings are signs of hypoglycemia?
A. Sweating
B. Tremors
C. Confusion
D. Polyuria
E. Tachycardia
Answers: A, B, C, E
,Rationale: Hypoglycemia commonly causes sweating, tremors, confusion, and
tachycardia. Polyuria is more common with hyperglycemia.
Question 5
A nurse is caring for a client receiving warfarin therapy. Which laboratory value is
most important to monitor?
A. Hemoglobin
B. Potassium
C. INR
D. Creatinine
Answer: C. INR
Rationale: INR is used to evaluate the effectiveness and safety of warfarin
therapy.
Question 6
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD).
Which assessment finding requires immediate intervention?
A. Productive cough
B. Barrel chest
C. Oxygen saturation of 84%
D. Mild fatigue
Answer: C. Oxygen saturation of 84%
Rationale: An oxygen saturation below 90% indicates significant hypoxemia
requiring prompt intervention.
Question 7
, A client with diabetes mellitus reports shakiness, sweating, and hunger. What
should the nurse do first?
A. Administer insulin
B. Check blood glucose level
C. Encourage exercise
D. Restrict carbohydrates
Answer: B. Check blood glucose level
Rationale: These symptoms suggest hypoglycemia. Blood glucose should be
assessed immediately.
Question 8
Which client should the nurse assess first?
A. Client with a temperature of 38°C (100.4°F)
B. Client with blood pressure of 118/70 mmHg
C. Client with sudden chest pain and shortness of breath
D. Client requesting pain medication
Answer: C. Client with sudden chest pain and shortness of breath
Rationale: This may indicate myocardial infarction or pulmonary embolism and is
potentially life-threatening.
Question 9
The nurse is caring for a client receiving morphine. Which adverse effect is the
priority concern?
A. Constipation
B. Nausea
PREPARATION GUIDE
50+ PRACTICE QUESTIONS, DETAILED RATIONALES,
SATA QUESTIONS, AND CLINICAL JUDGMENT
CASES GRADED A+ 100% PASS
Question 1
A nurse is caring for a client with heart failure. Which assessment finding should
the nurse report immediately?
A. Weight gain of 0.5 kg (1 lb) in 24 hours
B. Bilateral ankle edema
C. Crackles throughout both lung fields
D. Fatigue after ambulation
Answer: C. Crackles throughout both lung fields
Rationale: Crackles throughout the lungs may indicate worsening pulmonary
edema and impaired oxygenation, requiring immediate intervention.
Question 2
The nurse is preparing to administer insulin. Which action is the priority?
A. Check the client's blood pressure
B. Assess the client's blood glucose level
C. Measure urine output
,D. Obtain the client's weight
Answer: B. Assess the client's blood glucose level
Rationale: Blood glucose must be assessed before insulin administration to
determine safety and dosage requirements.
Question 3
A client suddenly develops shortness of breath after surgery. What is the nurse's
priority action?
A. Encourage fluid intake
B. Place the client in a supine position
C. Assess airway and oxygen saturation
D. Administer pain medication
Answer: C. Assess airway and oxygen saturation
Rationale: Following the ABCs (Airway, Breathing, Circulation), breathing status is
the priority.
Question 4 (Select All That Apply)
Which findings are signs of hypoglycemia?
A. Sweating
B. Tremors
C. Confusion
D. Polyuria
E. Tachycardia
Answers: A, B, C, E
,Rationale: Hypoglycemia commonly causes sweating, tremors, confusion, and
tachycardia. Polyuria is more common with hyperglycemia.
Question 5
A nurse is caring for a client receiving warfarin therapy. Which laboratory value is
most important to monitor?
A. Hemoglobin
B. Potassium
C. INR
D. Creatinine
Answer: C. INR
Rationale: INR is used to evaluate the effectiveness and safety of warfarin
therapy.
Question 6
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD).
Which assessment finding requires immediate intervention?
A. Productive cough
B. Barrel chest
C. Oxygen saturation of 84%
D. Mild fatigue
Answer: C. Oxygen saturation of 84%
Rationale: An oxygen saturation below 90% indicates significant hypoxemia
requiring prompt intervention.
Question 7
, A client with diabetes mellitus reports shakiness, sweating, and hunger. What
should the nurse do first?
A. Administer insulin
B. Check blood glucose level
C. Encourage exercise
D. Restrict carbohydrates
Answer: B. Check blood glucose level
Rationale: These symptoms suggest hypoglycemia. Blood glucose should be
assessed immediately.
Question 8
Which client should the nurse assess first?
A. Client with a temperature of 38°C (100.4°F)
B. Client with blood pressure of 118/70 mmHg
C. Client with sudden chest pain and shortness of breath
D. Client requesting pain medication
Answer: C. Client with sudden chest pain and shortness of breath
Rationale: This may indicate myocardial infarction or pulmonary embolism and is
potentially life-threatening.
Question 9
The nurse is caring for a client receiving morphine. Which adverse effect is the
priority concern?
A. Constipation
B. Nausea
