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COMPLETE NCLEX-RN Q&A Mega Bundle 2026 | 9
Categories | 3,200 Questions And Well Graded
Solutions With Rationales Updated 2026-2027
1. A client with heart failure is prescribed digoxin. Which assessment finding indicates
digoxin toxicity?
A) Heart rate of 60 beats per minute
B) Serum potassium of 4.0 mEq/L
C) Visual disturbances (yellow halos)
D) Blood pressure of 120/80 mmHg
Correct Answer: C
Rationale: Visual disturbances, including yellow-green halos and blurred vision,
are classic signs of digoxin toxicity. A heart rate of 60 (A) is within normal
limits. Serum potassium of 4.0 (B) is normal. Hypotension is a sign of toxicity
but visual disturbances are more specific.
2. A client is receiving IV heparin. Which laboratory finding indicates the therapy is
therapeutic?
A) aPTT of 60 seconds
B) INR of 3.0
C) Platelet count of 80,000/mm³
D) PT of 22 seconds
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5 to 2.5 times
the normal control (usually 60–80 seconds). INR (B) monitors warfarin therapy.
Platelet count (C) is low and indicates possible heparin-induced
thrombocytopenia. PT (D) monitors warfarin or liver function.
3. A client with diabetes mellitus is prescribed insulin lispro (Humalog). When should
the nurse administer this medication?
A) 30 minutes before meals
B) 60 minutes before meals
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C) 15 minutes before meals
D) Immediately after meals
Correct Answer: C
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 15 minutes. It
should be given 15 minutes before meals or immediately before eating. Regular
insulin (A) is given 30 minutes before meals. NPH (B) is given 60 minutes before
meals.
4. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client
reports flank pain and chills. What is the nurse's priority action?
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Administer diphenhydramine (Benadryl)
D) Notify the blood bank
Correct Answer: B
Rationale: Flank pain and chills indicate an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, keep the IV line
open with normal saline, and then notify the provider and blood bank. Slowing
the rate (A) is incorrect. Antihistamines (C) are for allergic reactions.
5. A client with asthma is prescribed albuterol (Ventolin) and fluticasone (Flovent).
Which instruction should the nurse provide regarding the order of administration?
A) Use fluticasone first, then albuterol
B) Use albuterol first, then fluticasone
C) Use both medications together in the same inhaler
D) Wait 30 minutes between medications
Correct Answer: B
Rationale: Albuterol is a bronchodilator that opens the airways; fluticasone is
an inhaled corticosteroid that reduces inflammation. Albuterol should be given
first to dilate the airways, allowing the fluticasone to penetrate deeper. They
should not be mixed (C).
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6. A client with a urinary tract infection (UTI) is prescribed ciprofloxacin. Which
instruction should the nurse include?
A) Take the medication with milk
B) Avoid caffeine and theophylline
C) Take the medication at bedtime
D) Discontinue if gastrointestinal upset occurs
Correct Answer: B
Rationale: Ciprofloxacin increases the risk of CNS stimulation when taken with
caffeine. It should not be taken with dairy products (A) as calcium binds to the
drug. GI upset (D) is common but should not lead to discontinuation without
provider input.
7. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
medication does the nurse anticipate administering?
A) Calcium gluconate
B) Sodium polystyrene sulfonate (Kayexalate)
C) Regular insulin with dextrose
D) All of the above
Correct Answer: D
Rationale: Hyperkalemia (K >5.0 mEq/L) requires multiple interventions.
Calcium gluconate (A) stabilizes the cardiac membrane. Kayexalate (B) binds
potassium in the GI tract for elimination. Insulin with dextrose (C) shifts
potassium into cells. All are used in hyperkalemia management.
8. A client with a history of seizures is prescribed phenytoin (Dilantin). Which laboratory
value should the nurse monitor?
A) Serum albumin
B) Serum glucose
C) Serum phenytoin level
D) Serum creatinine
Correct Answer: C
Rationale: Phenytoin has a narrow therapeutic range (10–20 mcg/mL). The
nurse should monitor serum phenytoin levels to prevent toxicity. Albumin (A) is
, 2|Page
COMPLETE NCLEX-RN Q&A Mega Bundle 2026 | 9
Categories | 3,200 Questions And Well Graded
Solutions With Rationales Updated 2026-2027
1. A client with heart failure is prescribed digoxin. Which assessment finding indicates
digoxin toxicity?
A) Heart rate of 60 beats per minute
B) Serum potassium of 4.0 mEq/L
C) Visual disturbances (yellow halos)
D) Blood pressure of 120/80 mmHg
Correct Answer: C
Rationale: Visual disturbances, including yellow-green halos and blurred vision,
are classic signs of digoxin toxicity. A heart rate of 60 (A) is within normal
limits. Serum potassium of 4.0 (B) is normal. Hypotension is a sign of toxicity
but visual disturbances are more specific.
2. A client is receiving IV heparin. Which laboratory finding indicates the therapy is
therapeutic?
A) aPTT of 60 seconds
B) INR of 3.0
C) Platelet count of 80,000/mm³
D) PT of 22 seconds
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5 to 2.5 times
the normal control (usually 60–80 seconds). INR (B) monitors warfarin therapy.
Platelet count (C) is low and indicates possible heparin-induced
thrombocytopenia. PT (D) monitors warfarin or liver function.
3. A client with diabetes mellitus is prescribed insulin lispro (Humalog). When should
the nurse administer this medication?
A) 30 minutes before meals
B) 60 minutes before meals
, 3|Page
C) 15 minutes before meals
D) Immediately after meals
Correct Answer: C
Rationale: Insulin lispro is a rapid-acting insulin with an onset of 15 minutes. It
should be given 15 minutes before meals or immediately before eating. Regular
insulin (A) is given 30 minutes before meals. NPH (B) is given 60 minutes before
meals.
4. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client
reports flank pain and chills. What is the nurse's priority action?
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Administer diphenhydramine (Benadryl)
D) Notify the blood bank
Correct Answer: B
Rationale: Flank pain and chills indicate an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, keep the IV line
open with normal saline, and then notify the provider and blood bank. Slowing
the rate (A) is incorrect. Antihistamines (C) are for allergic reactions.
5. A client with asthma is prescribed albuterol (Ventolin) and fluticasone (Flovent).
Which instruction should the nurse provide regarding the order of administration?
A) Use fluticasone first, then albuterol
B) Use albuterol first, then fluticasone
C) Use both medications together in the same inhaler
D) Wait 30 minutes between medications
Correct Answer: B
Rationale: Albuterol is a bronchodilator that opens the airways; fluticasone is
an inhaled corticosteroid that reduces inflammation. Albuterol should be given
first to dilate the airways, allowing the fluticasone to penetrate deeper. They
should not be mixed (C).
, 4|Page
6. A client with a urinary tract infection (UTI) is prescribed ciprofloxacin. Which
instruction should the nurse include?
A) Take the medication with milk
B) Avoid caffeine and theophylline
C) Take the medication at bedtime
D) Discontinue if gastrointestinal upset occurs
Correct Answer: B
Rationale: Ciprofloxacin increases the risk of CNS stimulation when taken with
caffeine. It should not be taken with dairy products (A) as calcium binds to the
drug. GI upset (D) is common but should not lead to discontinuation without
provider input.
7. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
medication does the nurse anticipate administering?
A) Calcium gluconate
B) Sodium polystyrene sulfonate (Kayexalate)
C) Regular insulin with dextrose
D) All of the above
Correct Answer: D
Rationale: Hyperkalemia (K >5.0 mEq/L) requires multiple interventions.
Calcium gluconate (A) stabilizes the cardiac membrane. Kayexalate (B) binds
potassium in the GI tract for elimination. Insulin with dextrose (C) shifts
potassium into cells. All are used in hyperkalemia management.
8. A client with a history of seizures is prescribed phenytoin (Dilantin). Which laboratory
value should the nurse monitor?
A) Serum albumin
B) Serum glucose
C) Serum phenytoin level
D) Serum creatinine
Correct Answer: C
Rationale: Phenytoin has a narrow therapeutic range (10–20 mcg/mL). The
nurse should monitor serum phenytoin levels to prevent toxicity. Albumin (A) is
