NCLEX-RN Examination 2026 – 200 Practice Questions with
Rationales
1. A client with chronic kidney disease is prescribed epoetin alfa. Which laboratory value
indicates a therapeutic response to this medication?
A. Decreased serum creatinine
B. Increased platelet count
C. Increased hemoglobin and hematocrit
D. Decreased blood urea nitrogen (BUN)
Rationale: Epoetin alfa stimulates red blood cell production in the bone marrow. A
therapeutic response is evidenced by a rise in hemoglobin and hematocrit, which helps
alleviate anemia associated with chronic kidney disease. Options A, B, and D are not
direct indicators of this medication's efficacy.
2. A nurse is caring for a client immediately following a thyroidectomy. Which piece of
equipment should the nurse place at the bedside?
A. Oxygen mask
B. Suction equipment
C. Tracheostomy set
D. Cardiac monitor
Rationale: A tracheostomy set must be readily available at the bedside post-
thyroidectomy in case of laryngeal stridor or respiratory distress from edema or
hematoma formation. While oxygen and suction are important, a tracheostomy set is the
priority for emergent airway management. A cardiac monitor is not the primary concern
in this immediate post-op period.
3. A client with a history of seizures is prescribed phenytoin. Which assessment finding
indicates a potential toxic level of the medication?
A. Hypertension
B. Hyperglycemia
C. Nystagmus and ataxia
D. Tachycardia
Rationale: Nystagmus and ataxia are classic signs of phenytoin toxicity. Early signs
include nystagmus, while more severe toxicity involves ataxia, diplopia, and lethargy.
Hypertension, hyperglycemia, and tachycardia are not characteristic of phenytoin
toxicity.
4. A nurse is providing teaching to a client with type 1 diabetes mellitus who is prescribed
insulin glargine. Which statement by the client indicates understanding of the
medication?
A. "I will take this insulin 30 minutes before meals."
B. "This insulin should be mixed with regular insulin in the same syringe."
, C. "This insulin provides a basal level of insulin throughout the day."
D. "I should expect a peak effect from this insulin in about 4 hours."
Rationale: Insulin glargine is a long-acting basal insulin with a relatively constant
concentration over 24 hours and no pronounced peak. It should not be mixed with other
insulins. It is administered once daily, not before meals. Options A and D describe rapid
or short-acting insulins.
5. A nurse is assessing a client with a diagnosis of hypovolemic shock. Which finding would
the nurse expect?
A. Bounding peripheral pulses
B. Crackles in the lung bases
C. Decreased urine output
D. Jugular venous distention
Rationale: In hypovolemic shock, decreased intravascular volume leads to decreased
renal perfusion and subsequently decreased urine output (oliguria). Bounding pulses,
crackles, and jugular venous distention are signs of fluid volume excess, not deficit.
6. A client with heart failure is prescribed digoxin. The nurse should monitor for signs of
toxicity, which include:
A. Tachycardia and hypertension
B. Anorexia and visual disturbances (yellow halos)
C. Hyperkalemia and polyuria
D. Weight gain and peripheral edema
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms like anorexia,
nausea, and vomiting, as well as visual disturbances such as yellow-green halos or
blurred vision. Cardiac dysrhythmias, including bradycardia, are also common. Options
A, C, and D are not indicative of digoxin toxicity.
7. A nurse is preparing to administer a blood transfusion to a client. Which IV solution
should be used to prime the blood administration tubing?
A. Dextrose 5% in water (D5W)
B. Lactated Ringer's solution
C. 0.9% Normal Saline
D. Dextrose 5% in 0.45% Normal Saline
Rationale: 0.9% Normal Saline is the only IV solution compatible with blood products.
Dextrose solutions and Lactated Ringer's can cause hemolysis or clotting of the blood.
The tubing must be primed with Normal Saline to prevent hemolysis and ensure the
integrity of the blood cells.
8. A client is admitted with a diagnosis of acute pancreatitis. Which laboratory value is
most consistent with this diagnosis?
A. Decreased serum calcium
, B. Elevated serum lipase and amylase
C. Elevated serum bilirubin
D. Decreased serum albumin
Rationale: Amylase and lipase are digestive enzymes produced by the pancreas. In acute
pancreatitis, these enzymes are released into the bloodstream, leading to elevated
serum levels, with lipase being more specific. While calcium may decrease in severe
pancreatitis, the hallmark is the elevation of amylase and lipase.
9. A nurse is planning care for a client with an indwelling urinary catheter. Which
intervention is most important to prevent catheter-associated urinary tract infection
(CAUTI)?
A. Irrigate the catheter daily with sterile normal saline.
B. Clamp the catheter for 2 hours every 6 hours.
C. Maintain a closed drainage system.
D. Change the catheter every 48 hours.
Rationale: Maintaining a closed drainage system is the most crucial intervention to
prevent CAUTI, as it prevents bacteria from entering the urinary tract. Routine irrigation,
clamping, or frequent catheter changes increase the risk of infection and are not
recommended for infection prevention.
10. A client is receiving total parenteral nutrition (TPN). Which assessment finding indicates
a complication related to the therapy?
A. Blood glucose level of 110 mg/dL
B. Weight gain of 1 kg in 2 days
C. Crackles auscultated in the lung bases
D. Serum sodium level of 140 mEq/L
Rationale: Crackles in the lung bases suggest fluid overload, a potential complication of
TPN due to the large volume of fluid administered. This warrants immediate action. Mild
hyperglycemia is a more common complication than hypoglycemia. Weight gain from
TPN is expected if the client is malnourished.
11. A client with a new diagnosis of hypertension is prescribed lisinopril. The nurse should
monitor the client for which side effect?
A. Hyperkalemia
B. Tachycardia
C. Persistent dry cough
D. Weight gain
Rationale: A persistent, dry, non-productive cough is a common side effect of ACE
inhibitors like lisinopril due to the accumulation of bradykinin. Hyperkalemia is a
potential but less common side effect. Tachycardia and weight gain are not typical side
effects of this medication class.
, 12. A nurse is caring for a client who has just returned from the post-anesthesia care unit
(PACU) following a right total knee arthroplasty. Which assessment finding requires
immediate intervention?
A. Oxygen saturation of 92% on room air
B. Pain level of 5 on a 0-10 scale
C. Drainage of bright red blood from the surgical site
D. Urine output of 60 mL over 2 hours
Rationale: Bright red blood drainage from the surgical site indicates active bleeding and
requires immediate intervention to prevent hemorrhagic shock. An O2 sat of 92% may
require oxygen but is not as immediately life-threatening. Pain is expected and can be
managed. A urine output of 30 mL/hr is acceptable.
13. A client with cirrhosis is at risk for bleeding. Which laboratory value is most indicative of
this risk?
A. Elevated serum ammonia
B. Prolonged prothrombin time (PT)
C. Elevated aspartate aminotransferase (AST)
D. Decreased serum albumin
Rationale: The liver synthesizes clotting factors. In cirrhosis, this function is impaired,
leading to a prolonged PT/INR, which indicates an increased risk for bleeding. Elevated
ammonia reflects hepatic encephalopathy, and decreased albumin reflects decreased
synthetic function, but PT is the direct measure of clotting ability.
14. A nurse is administering intravenous potassium chloride (KCl) to a client with
hypokalemia. Which action is a priority for safe administration?
A. Administer as a rapid IV push.
B. Mix the KCl in a solution of D5W.
C. Ensure the maximum infusion rate is 10 mEq/hr.
D. Use a microdrip chamber for the IV tubing.
Rationale: Intravenous potassium must NEVER be given as a bolus or rapid infusion. The
maximum recommended rate of peripheral IV potassium administration is 10 mEq/hr to
prevent fatal hyperkalemia and cardiac arrest. While it can be mixed in other solutions,
Normal Saline is preferred, and a microdrip may not be strictly necessary if the rate is
carefully controlled.
15. A client with a terminal illness tells the nurse, "I don't know if I can handle this anymore.
I just want it to end." Which is the most appropriate response by the nurse?
A. "Don't say that, you still have so much to live for."
B. "Are you thinking about wanting to hurt yourself?"
C. "I understand, this must be very difficult for you."
D. "It sounds like you are feeling very overwhelmed. Tell me more about what you're
feeling."
Rationales
1. A client with chronic kidney disease is prescribed epoetin alfa. Which laboratory value
indicates a therapeutic response to this medication?
A. Decreased serum creatinine
B. Increased platelet count
C. Increased hemoglobin and hematocrit
D. Decreased blood urea nitrogen (BUN)
Rationale: Epoetin alfa stimulates red blood cell production in the bone marrow. A
therapeutic response is evidenced by a rise in hemoglobin and hematocrit, which helps
alleviate anemia associated with chronic kidney disease. Options A, B, and D are not
direct indicators of this medication's efficacy.
2. A nurse is caring for a client immediately following a thyroidectomy. Which piece of
equipment should the nurse place at the bedside?
A. Oxygen mask
B. Suction equipment
C. Tracheostomy set
D. Cardiac monitor
Rationale: A tracheostomy set must be readily available at the bedside post-
thyroidectomy in case of laryngeal stridor or respiratory distress from edema or
hematoma formation. While oxygen and suction are important, a tracheostomy set is the
priority for emergent airway management. A cardiac monitor is not the primary concern
in this immediate post-op period.
3. A client with a history of seizures is prescribed phenytoin. Which assessment finding
indicates a potential toxic level of the medication?
A. Hypertension
B. Hyperglycemia
C. Nystagmus and ataxia
D. Tachycardia
Rationale: Nystagmus and ataxia are classic signs of phenytoin toxicity. Early signs
include nystagmus, while more severe toxicity involves ataxia, diplopia, and lethargy.
Hypertension, hyperglycemia, and tachycardia are not characteristic of phenytoin
toxicity.
4. A nurse is providing teaching to a client with type 1 diabetes mellitus who is prescribed
insulin glargine. Which statement by the client indicates understanding of the
medication?
A. "I will take this insulin 30 minutes before meals."
B. "This insulin should be mixed with regular insulin in the same syringe."
, C. "This insulin provides a basal level of insulin throughout the day."
D. "I should expect a peak effect from this insulin in about 4 hours."
Rationale: Insulin glargine is a long-acting basal insulin with a relatively constant
concentration over 24 hours and no pronounced peak. It should not be mixed with other
insulins. It is administered once daily, not before meals. Options A and D describe rapid
or short-acting insulins.
5. A nurse is assessing a client with a diagnosis of hypovolemic shock. Which finding would
the nurse expect?
A. Bounding peripheral pulses
B. Crackles in the lung bases
C. Decreased urine output
D. Jugular venous distention
Rationale: In hypovolemic shock, decreased intravascular volume leads to decreased
renal perfusion and subsequently decreased urine output (oliguria). Bounding pulses,
crackles, and jugular venous distention are signs of fluid volume excess, not deficit.
6. A client with heart failure is prescribed digoxin. The nurse should monitor for signs of
toxicity, which include:
A. Tachycardia and hypertension
B. Anorexia and visual disturbances (yellow halos)
C. Hyperkalemia and polyuria
D. Weight gain and peripheral edema
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms like anorexia,
nausea, and vomiting, as well as visual disturbances such as yellow-green halos or
blurred vision. Cardiac dysrhythmias, including bradycardia, are also common. Options
A, C, and D are not indicative of digoxin toxicity.
7. A nurse is preparing to administer a blood transfusion to a client. Which IV solution
should be used to prime the blood administration tubing?
A. Dextrose 5% in water (D5W)
B. Lactated Ringer's solution
C. 0.9% Normal Saline
D. Dextrose 5% in 0.45% Normal Saline
Rationale: 0.9% Normal Saline is the only IV solution compatible with blood products.
Dextrose solutions and Lactated Ringer's can cause hemolysis or clotting of the blood.
The tubing must be primed with Normal Saline to prevent hemolysis and ensure the
integrity of the blood cells.
8. A client is admitted with a diagnosis of acute pancreatitis. Which laboratory value is
most consistent with this diagnosis?
A. Decreased serum calcium
, B. Elevated serum lipase and amylase
C. Elevated serum bilirubin
D. Decreased serum albumin
Rationale: Amylase and lipase are digestive enzymes produced by the pancreas. In acute
pancreatitis, these enzymes are released into the bloodstream, leading to elevated
serum levels, with lipase being more specific. While calcium may decrease in severe
pancreatitis, the hallmark is the elevation of amylase and lipase.
9. A nurse is planning care for a client with an indwelling urinary catheter. Which
intervention is most important to prevent catheter-associated urinary tract infection
(CAUTI)?
A. Irrigate the catheter daily with sterile normal saline.
B. Clamp the catheter for 2 hours every 6 hours.
C. Maintain a closed drainage system.
D. Change the catheter every 48 hours.
Rationale: Maintaining a closed drainage system is the most crucial intervention to
prevent CAUTI, as it prevents bacteria from entering the urinary tract. Routine irrigation,
clamping, or frequent catheter changes increase the risk of infection and are not
recommended for infection prevention.
10. A client is receiving total parenteral nutrition (TPN). Which assessment finding indicates
a complication related to the therapy?
A. Blood glucose level of 110 mg/dL
B. Weight gain of 1 kg in 2 days
C. Crackles auscultated in the lung bases
D. Serum sodium level of 140 mEq/L
Rationale: Crackles in the lung bases suggest fluid overload, a potential complication of
TPN due to the large volume of fluid administered. This warrants immediate action. Mild
hyperglycemia is a more common complication than hypoglycemia. Weight gain from
TPN is expected if the client is malnourished.
11. A client with a new diagnosis of hypertension is prescribed lisinopril. The nurse should
monitor the client for which side effect?
A. Hyperkalemia
B. Tachycardia
C. Persistent dry cough
D. Weight gain
Rationale: A persistent, dry, non-productive cough is a common side effect of ACE
inhibitors like lisinopril due to the accumulation of bradykinin. Hyperkalemia is a
potential but less common side effect. Tachycardia and weight gain are not typical side
effects of this medication class.
, 12. A nurse is caring for a client who has just returned from the post-anesthesia care unit
(PACU) following a right total knee arthroplasty. Which assessment finding requires
immediate intervention?
A. Oxygen saturation of 92% on room air
B. Pain level of 5 on a 0-10 scale
C. Drainage of bright red blood from the surgical site
D. Urine output of 60 mL over 2 hours
Rationale: Bright red blood drainage from the surgical site indicates active bleeding and
requires immediate intervention to prevent hemorrhagic shock. An O2 sat of 92% may
require oxygen but is not as immediately life-threatening. Pain is expected and can be
managed. A urine output of 30 mL/hr is acceptable.
13. A client with cirrhosis is at risk for bleeding. Which laboratory value is most indicative of
this risk?
A. Elevated serum ammonia
B. Prolonged prothrombin time (PT)
C. Elevated aspartate aminotransferase (AST)
D. Decreased serum albumin
Rationale: The liver synthesizes clotting factors. In cirrhosis, this function is impaired,
leading to a prolonged PT/INR, which indicates an increased risk for bleeding. Elevated
ammonia reflects hepatic encephalopathy, and decreased albumin reflects decreased
synthetic function, but PT is the direct measure of clotting ability.
14. A nurse is administering intravenous potassium chloride (KCl) to a client with
hypokalemia. Which action is a priority for safe administration?
A. Administer as a rapid IV push.
B. Mix the KCl in a solution of D5W.
C. Ensure the maximum infusion rate is 10 mEq/hr.
D. Use a microdrip chamber for the IV tubing.
Rationale: Intravenous potassium must NEVER be given as a bolus or rapid infusion. The
maximum recommended rate of peripheral IV potassium administration is 10 mEq/hr to
prevent fatal hyperkalemia and cardiac arrest. While it can be mixed in other solutions,
Normal Saline is preferred, and a microdrip may not be strictly necessary if the rate is
carefully controlled.
15. A client with a terminal illness tells the nurse, "I don't know if I can handle this anymore.
I just want it to end." Which is the most appropriate response by the nurse?
A. "Don't say that, you still have so much to live for."
B. "Are you thinking about wanting to hurt yourself?"
C. "I understand, this must be very difficult for you."
D. "It sounds like you are feeling very overwhelmed. Tell me more about what you're
feeling."
