NCLEX-RN Comprehensive Practice Exam
2026/2027 – Verified Q&As with Detailed
Rationales (Test Bank Bundle - 87 Questions)
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**QUESTION 1:**
A nurse is caring for a client with hyperkalemia. Which ECG change should the nurse anticipate?
A) Prominent U waves
B) Flattened T waves
C) Peaked T waves
D) Prolonged PR interval
> 🎯 **CORRECT ANSWER:** C) Peaked T waves
> 💡 **DETAILED RATIONALE:** Peaked T waves are the earliest and most characteristic ECG sign of
hyperkalemia due to increased potassium levels affecting myocardial repolarization. Prominent U waves
(A) and flattened T waves (B) are classic signs of hypokalemia, not hyperkalemia. A prolonged PR interval
(D) is seen in first-degree heart block or with hyperkalemia but is a later, less specific finding compared
to peaked T waves.
---
**QUESTION 2:**
A patient with chronic kidney disease has a serum phosphate level of 7.2 mg/dL. Which intervention is
most appropriate?
A) Administer oral calcium acetate with meals
B) Encourage a high-phosphorus diet
C) Administer IV potassium chloride
D) Restrict oral fluid intake to 1 L/day
> 🎯 **CORRECT ANSWER:** A) Administer oral calcium acetate with meals
> 💡 **DETAILED RATIONALE:** Calcium acetate is a phosphate binder that binds dietary phosphate in
the GI tract to reduce absorption and lower serum phosphate levels. A high-phosphorus diet (B) would
,exacerbate hyperphosphatemia. IV potassium (C) is unrelated to phosphate management. Fluid
restriction (D) is not the primary treatment for hyperphosphatemia and may be harmful.
---
**QUESTION 3:**
What is the priority nursing action for a client experiencing a tonic-clonic seizure?
A) Insert a padded tongue blade
B) Restrain the client's limbs
C) Turn the client to the side
D) Administer oral diazepam
> 🎯 **CORRECT ANSWER:** C) Turn the client to the side
> 💡 **DETAILED RATIONALE:** Turning the client to the side maintains a patent airway and allows
secretions to drain, preventing aspiration. Inserting a padded tongue blade (A) is contraindicated as it
can cause injury. Restraining limbs (B) can cause fractures. Oral diazepam (D) cannot be given during the
active seizure due to aspiration risk; IV administration is used.
---
**QUESTION 4:**
A nurse is assessing a newborn with jaundice. Which finding requires immediate intervention?
A) Yellowish discoloration of the face
B) Yellowish discoloration of the chest
C) Yellowish discoloration of the palms and soles
D) Bilirubin level of 10 mg/dL at 48 hours
> 🎯 **CORRECT ANSWER:** C) Yellowish discoloration of the palms and soles
> 💡 **DETAILED RATIONALE:** Jaundice progressing to the palms and soles indicates severe
hyperbilirubinemia (cephalocaudal progression) and risk of kernicterus requiring immediate
intervention. Facial (A) or chest (B) jaundice is common and less concerning. A bilirubin level of 10
mg/dL (D) is generally within normal limits for a 48-hour-old newborn.
---
**QUESTION 5:**
,Which finding is a sign of respiratory distress in a 6-month-old infant?
A) Respiratory rate of 30 breaths/min
B) Nasal flaring
C) Heart rate of 110 bpm
D) Mild intercostal retractions
> 🎯 **CORRECT ANSWER:** B) Nasal flaring
> 💡 **DETAILED RATIONALE:** Nasal flaring is a compensatory mechanism in infants to decrease
airway resistance and is a clear sign of respiratory distress. A rate of 30 (A) is normal for a 6-month-old.
A heart rate of 110 (C) is normal. Mild intercostal retractions (D) can be normal in infants but are less
specific than nasal flaring for distress.
---
**QUESTION 6:**
The healthcare provider orders 500 mL of normal saline to infuse over 4 hours. The drip factor is 15
gtt/mL. What is the flow rate in gtt/min?
A) 31 gtt/min
B) 125 gtt/min
C) 21 gtt/min
D) 15 gtt/min
> 🎯 **CORRECT ANSWER:** A) 31 gtt/min
> 💡 **DETAILED RATIONALE:** Calculate using the formula: (Volume × Drip Factor) / Time in minutes =
(500 mL × 15 gtt/mL) / (4 hours × 60 min/hour) = = 31.25, rounded to 31 gtt/min. 125 gtt/min
(B) fails to convert time to minutes. 21 (C) and 15 (D) are miscalculations.
---
**QUESTION 7:**
A client with heart failure has an order for furosemide. Which lab value should the nurse monitor most
closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
, D) Serum magnesium
> 🎯 **CORRECT ANSWER:** B) Serum potassium
> 💡 **DETAILED RATIONALE:** Furosemide is a loop diuretic that causes significant potassium loss in
the distal tubule, leading to hypokalemia, which can precipitate cardiac arrhythmias. While sodium (A),
calcium (C), and magnesium (D) can be affected, potassium is the most critical and immediate concern.
---
**QUESTION 8:**
Which action is essential when caring for a client on mechanical ventilation with a cuffed endotracheal
tube?
A) Deflate the cuff every 2 hours
B) Maintain cuff pressure between 20-30 cm H2O
C) Keep the cuff inflated at all times
D) Check cuff pressure every 24 hours
> 🎯 **CORRECT ANSWER:** B) Maintain cuff pressure between 20-30 cm H2O
> 💡 **DETAILED RATIONALE:** This cuff pressure range ensures an adequate seal to prevent aspiration
and air leaks while avoiding tracheal mucosal ischemia. Deflating the cuff every 2 hours (A) is outdated
and increases aspiration risk. Cuff pressure must be checked at least every 8 hours, not 24 (D), and is not
kept inflated at all times without monitoring.
---
**QUESTION 9:**
A client is prescribed warfarin. Which food should the nurse advise the client to avoid?
A) Apples
B) Green leafy vegetables
C) Chicken
D) Pasta
> 🎯 **CORRECT ANSWER:** B) Green leafy vegetables
> 💡 **DETAILED RATIONALE:** Green leafy vegetables are rich in vitamin K, which antagonizes the
effects of warfarin, reducing its anticoagulant efficacy and potentially leading to subtherapeutic INR
levels. Apples (A), chicken (C), and pasta (D) contain minimal vitamin K and do not significantly affect
warfarin therapy.
2026/2027 – Verified Q&As with Detailed
Rationales (Test Bank Bundle - 87 Questions)
---
**QUESTION 1:**
A nurse is caring for a client with hyperkalemia. Which ECG change should the nurse anticipate?
A) Prominent U waves
B) Flattened T waves
C) Peaked T waves
D) Prolonged PR interval
> 🎯 **CORRECT ANSWER:** C) Peaked T waves
> 💡 **DETAILED RATIONALE:** Peaked T waves are the earliest and most characteristic ECG sign of
hyperkalemia due to increased potassium levels affecting myocardial repolarization. Prominent U waves
(A) and flattened T waves (B) are classic signs of hypokalemia, not hyperkalemia. A prolonged PR interval
(D) is seen in first-degree heart block or with hyperkalemia but is a later, less specific finding compared
to peaked T waves.
---
**QUESTION 2:**
A patient with chronic kidney disease has a serum phosphate level of 7.2 mg/dL. Which intervention is
most appropriate?
A) Administer oral calcium acetate with meals
B) Encourage a high-phosphorus diet
C) Administer IV potassium chloride
D) Restrict oral fluid intake to 1 L/day
> 🎯 **CORRECT ANSWER:** A) Administer oral calcium acetate with meals
> 💡 **DETAILED RATIONALE:** Calcium acetate is a phosphate binder that binds dietary phosphate in
the GI tract to reduce absorption and lower serum phosphate levels. A high-phosphorus diet (B) would
,exacerbate hyperphosphatemia. IV potassium (C) is unrelated to phosphate management. Fluid
restriction (D) is not the primary treatment for hyperphosphatemia and may be harmful.
---
**QUESTION 3:**
What is the priority nursing action for a client experiencing a tonic-clonic seizure?
A) Insert a padded tongue blade
B) Restrain the client's limbs
C) Turn the client to the side
D) Administer oral diazepam
> 🎯 **CORRECT ANSWER:** C) Turn the client to the side
> 💡 **DETAILED RATIONALE:** Turning the client to the side maintains a patent airway and allows
secretions to drain, preventing aspiration. Inserting a padded tongue blade (A) is contraindicated as it
can cause injury. Restraining limbs (B) can cause fractures. Oral diazepam (D) cannot be given during the
active seizure due to aspiration risk; IV administration is used.
---
**QUESTION 4:**
A nurse is assessing a newborn with jaundice. Which finding requires immediate intervention?
A) Yellowish discoloration of the face
B) Yellowish discoloration of the chest
C) Yellowish discoloration of the palms and soles
D) Bilirubin level of 10 mg/dL at 48 hours
> 🎯 **CORRECT ANSWER:** C) Yellowish discoloration of the palms and soles
> 💡 **DETAILED RATIONALE:** Jaundice progressing to the palms and soles indicates severe
hyperbilirubinemia (cephalocaudal progression) and risk of kernicterus requiring immediate
intervention. Facial (A) or chest (B) jaundice is common and less concerning. A bilirubin level of 10
mg/dL (D) is generally within normal limits for a 48-hour-old newborn.
---
**QUESTION 5:**
,Which finding is a sign of respiratory distress in a 6-month-old infant?
A) Respiratory rate of 30 breaths/min
B) Nasal flaring
C) Heart rate of 110 bpm
D) Mild intercostal retractions
> 🎯 **CORRECT ANSWER:** B) Nasal flaring
> 💡 **DETAILED RATIONALE:** Nasal flaring is a compensatory mechanism in infants to decrease
airway resistance and is a clear sign of respiratory distress. A rate of 30 (A) is normal for a 6-month-old.
A heart rate of 110 (C) is normal. Mild intercostal retractions (D) can be normal in infants but are less
specific than nasal flaring for distress.
---
**QUESTION 6:**
The healthcare provider orders 500 mL of normal saline to infuse over 4 hours. The drip factor is 15
gtt/mL. What is the flow rate in gtt/min?
A) 31 gtt/min
B) 125 gtt/min
C) 21 gtt/min
D) 15 gtt/min
> 🎯 **CORRECT ANSWER:** A) 31 gtt/min
> 💡 **DETAILED RATIONALE:** Calculate using the formula: (Volume × Drip Factor) / Time in minutes =
(500 mL × 15 gtt/mL) / (4 hours × 60 min/hour) = = 31.25, rounded to 31 gtt/min. 125 gtt/min
(B) fails to convert time to minutes. 21 (C) and 15 (D) are miscalculations.
---
**QUESTION 7:**
A client with heart failure has an order for furosemide. Which lab value should the nurse monitor most
closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
, D) Serum magnesium
> 🎯 **CORRECT ANSWER:** B) Serum potassium
> 💡 **DETAILED RATIONALE:** Furosemide is a loop diuretic that causes significant potassium loss in
the distal tubule, leading to hypokalemia, which can precipitate cardiac arrhythmias. While sodium (A),
calcium (C), and magnesium (D) can be affected, potassium is the most critical and immediate concern.
---
**QUESTION 8:**
Which action is essential when caring for a client on mechanical ventilation with a cuffed endotracheal
tube?
A) Deflate the cuff every 2 hours
B) Maintain cuff pressure between 20-30 cm H2O
C) Keep the cuff inflated at all times
D) Check cuff pressure every 24 hours
> 🎯 **CORRECT ANSWER:** B) Maintain cuff pressure between 20-30 cm H2O
> 💡 **DETAILED RATIONALE:** This cuff pressure range ensures an adequate seal to prevent aspiration
and air leaks while avoiding tracheal mucosal ischemia. Deflating the cuff every 2 hours (A) is outdated
and increases aspiration risk. Cuff pressure must be checked at least every 8 hours, not 24 (D), and is not
kept inflated at all times without monitoring.
---
**QUESTION 9:**
A client is prescribed warfarin. Which food should the nurse advise the client to avoid?
A) Apples
B) Green leafy vegetables
C) Chicken
D) Pasta
> 🎯 **CORRECT ANSWER:** B) Green leafy vegetables
> 💡 **DETAILED RATIONALE:** Green leafy vegetables are rich in vitamin K, which antagonizes the
effects of warfarin, reducing its anticoagulant efficacy and potentially leading to subtherapeutic INR
levels. Apples (A), chicken (C), and pasta (D) contain minimal vitamin K and do not significantly affect
warfarin therapy.
