NCLEX RN ACTUAL EXAM TEST BANK WITH REAL AND
EXACT EXAM QUESTIONS & ANSWERS NCLEX 2025/2026
NCLEX EXAM - 221 Questions and Answers Already Graded
A+ Premium Exam Tested And Verified
Subject Area Nursing
Description This comprehensive examination assesses advanced clinical reasoning and
application of nursing concepts across major body systems, pharmacology, mental
health, maternal-newborn care, infection control, and safety. It mirrors the rigor of
the NCLEX-RN, requiring synthesis of knowledge from medical-surgical,
pediatric, obstetrical, psychiatric, and community health nursing.
Expected Grade A+
Total Questions 221
Duration 3 hours
Learning Outcomes 1. Apply evidence-based clinical judgment to complex patient scenarios
2. Integrate knowledge of pharmacology, pathophysiology, and nursing
interventions
3. Prioritize care and delegate effectively across interdisciplinary teams
4. Interpret diagnostic data and anticipate emergent complications
Accreditation This exam meets the standards of the National Council of State Boards of Nursing
(NCSBN) for NCLEX-RN preparation and is designed to reflect current
2025/2026 clinical practice guidelines.
Page 1
,1. A patient with septic shock is receiving norepinephrine infusion. Which
assessment finding indicates the need to increase the infusion rate?
A. Mean arterial pressure (MAP) of 72 mm Hg
B. Central venous pressure (CVP) of 12 mm Hg
C. Serum lactate level of 4.2 mmol/L
D. Urine output of 40 mL/hour
Answer: C. Serum lactate level of 4.2 mmol/L
In septic shock, lactate levels >4 mmol/L indicate persistent tissue hypoperfusion
despite fluids/vassopressors, requiring increased vasopressor support. MAP >65
mm Hg, CVP 8-12, and adequate urine output suggest adequate perfusion.
2. A patient with heart failure is prescribed lisinopril, furosemide, metoprolol,
and spironolactone. Which laboratory value requires immediate intervention?
A. Potassium 5.8 mEq/L
B. Sodium 138 mEq/L
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mEq/L
Answer: A. Potassium 5.8 mEq/L
Hyperkalemia (K+ >5.5) is life-threatening, especially with lisinopril (ACEi) and
spironolactone (K-sparing diuretic). This increases risk of cardiac arrhythmias.
Other values are within normal limits.
3. Question content: Which intervention should the nurse implement first when
caring for a patient with a suspected pulmonary embolism?
A. Draw blood for d-dimer and ABG analysis
B. Prepare for computed tomography pulmonary angiography
C. Administer supplemental oxygen via non-rebreather mask
D. Notify the rapid response team
Answer: C. Administer supplemental oxygen via non-rebreather mask
The priority is airway/breathing: supplemental oxygen corrects hypoxemia.
Subsequent steps include diagnostic confirmation, notification, and definitive
treatment.
Page 2
,4. A postpartum patient with vaginal delivery 6 hours ago has a fundus firm at
the umbilicus and moderate lochia rubra. The nurse notes a saturated perineal
pad in 20 minutes. What should the nurse do first?
A. Assess the perineum for lacerations
B. Massage the fundus and check for clots
C. Increase the IV oxytocin rate
D. Prepare for manual removal of retained products
Answer: B. Massage the fundus and check for clots
Although the fundus is firm now, heavy bleeding may indicate uterine atony or
retained clots. Massage expels clots, promotes contraction, and is the immediate
intervention. If ineffective, escalate.
5. A client with bipolar disorder, manic episode, is admitted. Which
intervention should the nurse include in the plan of care?
A. Provide structured group activities with competition to channel energy
B. Maintain a calm, low-stimulation environment with simple limits
C. Allow the client to engage in high-energy physical activities as needed
D. Encourage the client to make all decisions regarding daily schedule
Answer: B. Maintain a calm, low-stimulation environment with simple limits
Manic patients require decreased stimulation to prevent escalation. Structured
but non-competitive activities, limit setting, and providing choices within
boundaries (not full autonomy) are therapeutic.
6. A patient receiving total parenteral nutrition (TPN) via central line develops
sudden dyspnea, chest pain, and hypotension. What is the priority action?
A. Obtain a STAT chest radiograph
B. Place the patient in Trendelenburg position on left side
C. Clamp the TPN line and administer oxygen
D. Notify the provider for catheter removal
Answer: B. Place the patient in Trendelenburg position on left side
These signs suggest air embolism. Immediate management includes positioning
patient in left lateral Trendelenburg to trap air in the right atrium, then clamping
the line, giving oxygen, and notifying provider.
Page 3
, 7. questionType: "table", stem: "A patient with heart failure (NYHA Class III)
is admitted for dyspnea on exertion. The nurse reviews the provider's
prescriptions.", exhibits: [{"title": "Vital Signs", "body": "HR 98, BP 110/70,
RR 24, SpO2 91% on room air, Temp 37.2°C"}, {"title": "Labs", "body":
"BNP 1200 pg/mL, Potassium 4.0 mEq/L, Creatinine 1.2 mg/dL, Hemoglobin
13 g/dL"}], tablePrompt: "For each potential provider prescription, indicate if
it is anticipated, nonessential, or contraindicated.", tableInstruction: "Click to
specify.", tableHeaders: ["Prescription", "Anticipated", "Nonessential",
"Contraindicated"], tableRows: [{"label": "Furosemide 40 mg IV push now",
"correct": 0}, {"label": "Metoprolol succinate 25 mg PO daily", "correct": 1},
{"label": "Enalapril 5 mg PO twice daily", "correct": 0}, {"label":
"Potassium chloride 20 mEq IVPB now", "correct": 2}, {"label":
"Supplemental oxygen 2 L/min nasal cannula", "correct": 0}, {"label":
"Enoxaparin 40 mg subcutaneously daily", "correct": 1}],
A. Furosemide: Anticipated; Metoprolol: Nonessential; Enalapril: Anticipated;
Potassium: Contraindicated; Oxygen: Anticipated; Enoxaparin: Nonessential
B. All are anticipated
C. Furosemide: Contraindicated; Metoprolol: Anticipated; Enalapril: Nonessential
D. Potassium: Anticipated; Oxygen: Contraindicated
Answer: A. Furosemide: Anticipated; Metoprolol: Nonessential; Enalapril:
Anticipated; Potassium: Contraindicated; Oxygen: Anticipated; Enoxaparin:
Nonessential
Furosemide relieves fluid overload (anticipated). Metoprolol is nonessential
acutely due to potential for worsening heart failure (compensation relies on
sympathetic tone). Enalapril is anticipated. Potassium is contraindicated because
potassium is normal and with ACEi risk of hyperkalemia. Oxygen is anticipated
for SpO2<92%. Enoxaparin is nonessential for DVT prophylaxis unless immobile
(not indicated here).
Page 4
EXACT EXAM QUESTIONS & ANSWERS NCLEX 2025/2026
NCLEX EXAM - 221 Questions and Answers Already Graded
A+ Premium Exam Tested And Verified
Subject Area Nursing
Description This comprehensive examination assesses advanced clinical reasoning and
application of nursing concepts across major body systems, pharmacology, mental
health, maternal-newborn care, infection control, and safety. It mirrors the rigor of
the NCLEX-RN, requiring synthesis of knowledge from medical-surgical,
pediatric, obstetrical, psychiatric, and community health nursing.
Expected Grade A+
Total Questions 221
Duration 3 hours
Learning Outcomes 1. Apply evidence-based clinical judgment to complex patient scenarios
2. Integrate knowledge of pharmacology, pathophysiology, and nursing
interventions
3. Prioritize care and delegate effectively across interdisciplinary teams
4. Interpret diagnostic data and anticipate emergent complications
Accreditation This exam meets the standards of the National Council of State Boards of Nursing
(NCSBN) for NCLEX-RN preparation and is designed to reflect current
2025/2026 clinical practice guidelines.
Page 1
,1. A patient with septic shock is receiving norepinephrine infusion. Which
assessment finding indicates the need to increase the infusion rate?
A. Mean arterial pressure (MAP) of 72 mm Hg
B. Central venous pressure (CVP) of 12 mm Hg
C. Serum lactate level of 4.2 mmol/L
D. Urine output of 40 mL/hour
Answer: C. Serum lactate level of 4.2 mmol/L
In septic shock, lactate levels >4 mmol/L indicate persistent tissue hypoperfusion
despite fluids/vassopressors, requiring increased vasopressor support. MAP >65
mm Hg, CVP 8-12, and adequate urine output suggest adequate perfusion.
2. A patient with heart failure is prescribed lisinopril, furosemide, metoprolol,
and spironolactone. Which laboratory value requires immediate intervention?
A. Potassium 5.8 mEq/L
B. Sodium 138 mEq/L
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mEq/L
Answer: A. Potassium 5.8 mEq/L
Hyperkalemia (K+ >5.5) is life-threatening, especially with lisinopril (ACEi) and
spironolactone (K-sparing diuretic). This increases risk of cardiac arrhythmias.
Other values are within normal limits.
3. Question content: Which intervention should the nurse implement first when
caring for a patient with a suspected pulmonary embolism?
A. Draw blood for d-dimer and ABG analysis
B. Prepare for computed tomography pulmonary angiography
C. Administer supplemental oxygen via non-rebreather mask
D. Notify the rapid response team
Answer: C. Administer supplemental oxygen via non-rebreather mask
The priority is airway/breathing: supplemental oxygen corrects hypoxemia.
Subsequent steps include diagnostic confirmation, notification, and definitive
treatment.
Page 2
,4. A postpartum patient with vaginal delivery 6 hours ago has a fundus firm at
the umbilicus and moderate lochia rubra. The nurse notes a saturated perineal
pad in 20 minutes. What should the nurse do first?
A. Assess the perineum for lacerations
B. Massage the fundus and check for clots
C. Increase the IV oxytocin rate
D. Prepare for manual removal of retained products
Answer: B. Massage the fundus and check for clots
Although the fundus is firm now, heavy bleeding may indicate uterine atony or
retained clots. Massage expels clots, promotes contraction, and is the immediate
intervention. If ineffective, escalate.
5. A client with bipolar disorder, manic episode, is admitted. Which
intervention should the nurse include in the plan of care?
A. Provide structured group activities with competition to channel energy
B. Maintain a calm, low-stimulation environment with simple limits
C. Allow the client to engage in high-energy physical activities as needed
D. Encourage the client to make all decisions regarding daily schedule
Answer: B. Maintain a calm, low-stimulation environment with simple limits
Manic patients require decreased stimulation to prevent escalation. Structured
but non-competitive activities, limit setting, and providing choices within
boundaries (not full autonomy) are therapeutic.
6. A patient receiving total parenteral nutrition (TPN) via central line develops
sudden dyspnea, chest pain, and hypotension. What is the priority action?
A. Obtain a STAT chest radiograph
B. Place the patient in Trendelenburg position on left side
C. Clamp the TPN line and administer oxygen
D. Notify the provider for catheter removal
Answer: B. Place the patient in Trendelenburg position on left side
These signs suggest air embolism. Immediate management includes positioning
patient in left lateral Trendelenburg to trap air in the right atrium, then clamping
the line, giving oxygen, and notifying provider.
Page 3
, 7. questionType: "table", stem: "A patient with heart failure (NYHA Class III)
is admitted for dyspnea on exertion. The nurse reviews the provider's
prescriptions.", exhibits: [{"title": "Vital Signs", "body": "HR 98, BP 110/70,
RR 24, SpO2 91% on room air, Temp 37.2°C"}, {"title": "Labs", "body":
"BNP 1200 pg/mL, Potassium 4.0 mEq/L, Creatinine 1.2 mg/dL, Hemoglobin
13 g/dL"}], tablePrompt: "For each potential provider prescription, indicate if
it is anticipated, nonessential, or contraindicated.", tableInstruction: "Click to
specify.", tableHeaders: ["Prescription", "Anticipated", "Nonessential",
"Contraindicated"], tableRows: [{"label": "Furosemide 40 mg IV push now",
"correct": 0}, {"label": "Metoprolol succinate 25 mg PO daily", "correct": 1},
{"label": "Enalapril 5 mg PO twice daily", "correct": 0}, {"label":
"Potassium chloride 20 mEq IVPB now", "correct": 2}, {"label":
"Supplemental oxygen 2 L/min nasal cannula", "correct": 0}, {"label":
"Enoxaparin 40 mg subcutaneously daily", "correct": 1}],
A. Furosemide: Anticipated; Metoprolol: Nonessential; Enalapril: Anticipated;
Potassium: Contraindicated; Oxygen: Anticipated; Enoxaparin: Nonessential
B. All are anticipated
C. Furosemide: Contraindicated; Metoprolol: Anticipated; Enalapril: Nonessential
D. Potassium: Anticipated; Oxygen: Contraindicated
Answer: A. Furosemide: Anticipated; Metoprolol: Nonessential; Enalapril:
Anticipated; Potassium: Contraindicated; Oxygen: Anticipated; Enoxaparin:
Nonessential
Furosemide relieves fluid overload (anticipated). Metoprolol is nonessential
acutely due to potential for worsening heart failure (compensation relies on
sympathetic tone). Enalapril is anticipated. Potassium is contraindicated because
potassium is normal and with ACEi risk of hyperkalemia. Oxygen is anticipated
for SpO2<92%. Enoxaparin is nonessential for DVT prophylaxis unless immobile
(not indicated here).
Page 4
