NCLEX-RN 2026 LATEST COMPREHENSIVE STUDY GUIDE
Practice Questions with Detailed Rationales | Complete
Exam Review | Verified Answers
QUESTION 1
A nurse is caring for a client who is postoperative day 1 following abdominal
surgery. The client's blood pressure is 88/52 mmHg, heart rate is 118 bpm,
respirations are 24/min, and oxygen saturation is 89% on room air. Which
action should the nurse take FIRST?
A. Apply oxygen at 2L/min via nasal cannula
B. Notify the healthcare provider immediately
C. Position the client in Trendelenburg position
D. Increase the IV fluid rate to 200 mL/hr
Rationale:
• Correct Answer: C - The client is showing signs of hypovolemic shock
(hypotension, tachycardia, tachypnea, decreased oxygen saturation).
Trendelenburg position promotes venous return and improves cerebral
perfusion, which is the initial priority intervention while preparing for
further interventions.
• Option A - While oxygen is needed, positioning to improve circulation
takes priority as the FIRST action.
• Option B - Notification is necessary but not the first action; immediate
positioning is critical.
• Option D - Fluid resuscitation is important but requires a provider
order; positioning can be initiated independently by the nurse.
QUESTION 2
,A nurse is preparing to administer a blood transfusion to a client with anemia.
The client has a history of allergic reactions to blood products. Which action is
MOST appropriate?
A. Administer the blood transfusion as prescribed without premedication
B. Premedicate with diphenhydramine and acetaminophen as
prescribed
C. Administer normal saline with the blood transfusion
D. Start the blood transfusion at 100 mL/hr
Rationale:
• Correct Answer: B - Clients with known allergic reactions should
receive premedication with antihistamines (diphenhydramine) and
antipyretics (acetaminophen) to minimize transfusion reactions.
• Option A - Administering without premedication increases the risk of
severe allergic reaction in susceptible clients.
• Option C - Normal saline is used to maintain IV access but does not
prevent allergic reactions.
• Option D - Blood transfusion should be started slowly (approximately 2
mL/min or 120 mL/hr) for the first 15 minutes, but premedication is
the priority for this client.
QUESTION 3
A nurse is caring for a client with a central venous catheter. During the
dressing change, the nurse notes purulent drainage at the insertion site. What
is the nurse's PRIORITY action?
A. Clean the site with chlorhexidine and apply a new sterile dressing
B. Obtain cultures from the insertion site and catheter tip
C. Apply an antibiotic ointment to the insertion site
D. Increase the frequency of dressing changes
,Rationale:
• Correct Answer: B - Purulent drainage indicates infection. The priority
is to obtain cultures to identify the causative organism and guide
appropriate antibiotic therapy. This should be done before applying any
new dressing or administering antibiotics.
• Option A - Cleansing is needed but should follow culture collection to
avoid contaminating the specimen.
• Option C - Antibiotic ointment should not be applied without culture
results and provider order.
• Option D - Increasing dressing changes addresses infection prevention
but does not address the active infection management.
QUESTION 4
A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables"
B. "I will report any unusual bleeding or bruising to my healthcare provider"
C. "I can take ibuprofen for my occasional headaches"
D. "I will have my blood drawn regularly to check my INR levels"
Rationale:
• Correct Answer: C - Ibuprofen (NSAIDs) increases the risk of bleeding
when taken with warfarin and should be avoided. Acetaminophen is the
preferred analgesic for clients on warfarin.
• Option A - Correct understanding; vitamin K-rich foods (leafy green
vegetables) can interfere with warfarin effectiveness.
• Option B - Correct understanding; bleeding and bruising are signs of
excessive anticoagulation.
• Option D - Correct understanding; regular INR monitoring is essential
for warfarin therapy.
, QUESTION 5
A nurse in the emergency department is triaging clients following a mass
casualty incident. Which client should be assigned the HIGHEST priority?
A. A client with a closed femur fracture and normal vital signs
B. A client with a penetrating chest wound and absent breath sounds on
one side
C. A client with a minor laceration and stable vital signs
D. A client with a simple sprained ankle and mild pain
Rationale:
• Correct Answer: B - In mass casualty triage, this client has a life-
threatening condition (tension pneumothorax) requiring immediate
intervention. This represents a "RED" or immediate priority category.
• Option A - Closed femur fracture is urgent but not immediately life-
threatening.
• Option C - Minor laceration is non-urgent and can wait.
• Option D - Simple sprain is non-urgent and can wait.
QUESTION 6
A nurse is preparing to administer a medication via a nasogastric tube. The
medication is available in tablet form. Which action should the nurse take?
A. Crush the tablet and dissolve it in warm water
B. Check with the pharmacist if the tablet can be crushed safely
C. Open the capsule and mix with apple juice
D. Administer the tablet whole through the NG tube
Rationale:
Practice Questions with Detailed Rationales | Complete
Exam Review | Verified Answers
QUESTION 1
A nurse is caring for a client who is postoperative day 1 following abdominal
surgery. The client's blood pressure is 88/52 mmHg, heart rate is 118 bpm,
respirations are 24/min, and oxygen saturation is 89% on room air. Which
action should the nurse take FIRST?
A. Apply oxygen at 2L/min via nasal cannula
B. Notify the healthcare provider immediately
C. Position the client in Trendelenburg position
D. Increase the IV fluid rate to 200 mL/hr
Rationale:
• Correct Answer: C - The client is showing signs of hypovolemic shock
(hypotension, tachycardia, tachypnea, decreased oxygen saturation).
Trendelenburg position promotes venous return and improves cerebral
perfusion, which is the initial priority intervention while preparing for
further interventions.
• Option A - While oxygen is needed, positioning to improve circulation
takes priority as the FIRST action.
• Option B - Notification is necessary but not the first action; immediate
positioning is critical.
• Option D - Fluid resuscitation is important but requires a provider
order; positioning can be initiated independently by the nurse.
QUESTION 2
,A nurse is preparing to administer a blood transfusion to a client with anemia.
The client has a history of allergic reactions to blood products. Which action is
MOST appropriate?
A. Administer the blood transfusion as prescribed without premedication
B. Premedicate with diphenhydramine and acetaminophen as
prescribed
C. Administer normal saline with the blood transfusion
D. Start the blood transfusion at 100 mL/hr
Rationale:
• Correct Answer: B - Clients with known allergic reactions should
receive premedication with antihistamines (diphenhydramine) and
antipyretics (acetaminophen) to minimize transfusion reactions.
• Option A - Administering without premedication increases the risk of
severe allergic reaction in susceptible clients.
• Option C - Normal saline is used to maintain IV access but does not
prevent allergic reactions.
• Option D - Blood transfusion should be started slowly (approximately 2
mL/min or 120 mL/hr) for the first 15 minutes, but premedication is
the priority for this client.
QUESTION 3
A nurse is caring for a client with a central venous catheter. During the
dressing change, the nurse notes purulent drainage at the insertion site. What
is the nurse's PRIORITY action?
A. Clean the site with chlorhexidine and apply a new sterile dressing
B. Obtain cultures from the insertion site and catheter tip
C. Apply an antibiotic ointment to the insertion site
D. Increase the frequency of dressing changes
,Rationale:
• Correct Answer: B - Purulent drainage indicates infection. The priority
is to obtain cultures to identify the causative organism and guide
appropriate antibiotic therapy. This should be done before applying any
new dressing or administering antibiotics.
• Option A - Cleansing is needed but should follow culture collection to
avoid contaminating the specimen.
• Option C - Antibiotic ointment should not be applied without culture
results and provider order.
• Option D - Increasing dressing changes addresses infection prevention
but does not address the active infection management.
QUESTION 4
A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables"
B. "I will report any unusual bleeding or bruising to my healthcare provider"
C. "I can take ibuprofen for my occasional headaches"
D. "I will have my blood drawn regularly to check my INR levels"
Rationale:
• Correct Answer: C - Ibuprofen (NSAIDs) increases the risk of bleeding
when taken with warfarin and should be avoided. Acetaminophen is the
preferred analgesic for clients on warfarin.
• Option A - Correct understanding; vitamin K-rich foods (leafy green
vegetables) can interfere with warfarin effectiveness.
• Option B - Correct understanding; bleeding and bruising are signs of
excessive anticoagulation.
• Option D - Correct understanding; regular INR monitoring is essential
for warfarin therapy.
, QUESTION 5
A nurse in the emergency department is triaging clients following a mass
casualty incident. Which client should be assigned the HIGHEST priority?
A. A client with a closed femur fracture and normal vital signs
B. A client with a penetrating chest wound and absent breath sounds on
one side
C. A client with a minor laceration and stable vital signs
D. A client with a simple sprained ankle and mild pain
Rationale:
• Correct Answer: B - In mass casualty triage, this client has a life-
threatening condition (tension pneumothorax) requiring immediate
intervention. This represents a "RED" or immediate priority category.
• Option A - Closed femur fracture is urgent but not immediately life-
threatening.
• Option C - Minor laceration is non-urgent and can wait.
• Option D - Simple sprain is non-urgent and can wait.
QUESTION 6
A nurse is preparing to administer a medication via a nasogastric tube. The
medication is available in tablet form. Which action should the nurse take?
A. Crush the tablet and dissolve it in warm water
B. Check with the pharmacist if the tablet can be crushed safely
C. Open the capsule and mix with apple juice
D. Administer the tablet whole through the NG tube
Rationale:
