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ARCHER REVIEW-STYLE QUESTIONS EXAM
2026 QUESTIONS LATEST VERSION QUESTIONS
AND ANSWERS
ARCHER REVIEW: KEY CHARACTERISTICS
• "Is it safe? Is it effective?" — The core Archer philosophy for clinical decision-
making
• High-Yield Content: Focuses on the most frequently tested topics
• NCLEX-Style Questions: Simulates the actual exam format and difficulty
• Detailed Rationales: Explains why each answer is correct or incorrect
• Emphasis on Prioritization: Frequently asks "Which client should the nurse see
first?"
• Concise & Direct: Questions are straightforward with clear answer choices
10-Point Summary of Archer Review Coverage
1. Safe and Effective Care Environment: Management of care, delegation, client
rights, informed consent, incident reporting, disaster triage, and safety protocols.
2. Health Promotion and Maintenance: Anticipatory guidance, disease prevention,
immunizations, growth and development, prenatal care, and lifestyle modifications.
3. Psychosocial Integrity: Therapeutic communication, coping mechanisms, grief and
loss, crisis intervention, psychiatric disorders, and substance abuse.
4. Pharmacological Therapies: Medication administration, side effects, adverse
reactions, interactions, and client teaching for major drug classes.
5. Reduction of Risk Potential: Monitoring for complications, interpreting diagnostic
tests, preventing injury, and recognizing early signs of deterioration.
6. Physiological Adaptation: Managing acute and chronic conditions (cardiac,
respiratory, endocrine, renal, neurological), and responding to changes in client status.
7. Basic Care and Comfort: Mobility, nutrition, hydration, elimination, comfort
measures, and assistance with ADLs.
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8. Maternal and Newborn Health: Antepartum, intrapartum, and postpartum care,
newborn assessment, and common complications.
9. Pediatric Nursing: Common childhood illnesses, developmental milestones, safety,
and management of pediatric emergencies.
10. Leadership & Management: Delegation, supervision, prioritization, conflict
resolution, quality improvement, and legal/ethical issues.
ARCHER REVIEW-STYLE PRACTICE EXAM (250 Questions with Detailed
Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
• A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
• B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
• C. A client with heart failure who has crackles in the lung bases and is short of breath.
• D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
• Answer: C. Rationale: Is it safe? Is it effective? The client with heart failure who
has crackles and is short of breath is experiencing acute respiratory distress, which
could indicate pulmonary edema—a life-threatening emergency. This client should be
assessed first. The potassium level of 5.2 mEq/L (D) is elevated but not critical
(critical is >6.5). The blood glucose of 180 (A) is elevated but not immediately life-
threatening. The fever (B) is concerning but not the priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
• A. Administering a scheduled dose of oral metoprolol.
• B. Assessing a client's surgical wound for signs of infection.
• C. Assisting a client with a bed bath and providing oral care.
• D. Interpreting a client's telemetry rhythm strip.
• Answer: C. Rationale: Is it safe? Is it effective? Assisting with a bed bath and
providing oral care are tasks within the scope of UAP. Administration of medications
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(A), wound assessment (B), and rhythm interpretation (D) require the knowledge and
judgment of a licensed nurse and cannot be delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
• A. Tremors and diaphoresis.
• B. Nausea and vomiting.
• C. Seizure activity and autonomic hyperactivity.
• D. Insomnia and anxiety.
• Answer: C. Rationale: Is it safe? Is it effective? Alcohol withdrawal can lead
to seizures and autonomic hyperactivity (tachycardia, hypertension, hyperthermia),
which are life-threatening. Monitoring for these signs is the highest priority. While
tremors (A), nausea (B), and insomnia (D) are common withdrawal symptoms, they
are not as immediately life-threatening as seizures.
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
• A. Administer oxygen via nasal cannula at 2 L/min.
• B. Elevate the head of the bed to a high-Fowler's position.
• C. Notify the healthcare provider immediately.
• D. Assess the client's vital signs and oxygen saturation.
• Answer: C. Rationale: Is it safe? Is it effective? Sudden shortness of breath and
chest pain are classic symptoms of a pulmonary embolism (PE) , a life-threatening
complication. The nurse should notify the healthcare provider immediately while
simultaneously initiating other interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
• A. An Ambu bag and a suction catheter.
• B. An obturator and a spare tracheostomy tube.
• C. A sterile tracheostomy dressing and cleaning supplies.
• D. A pulse oximeter and an oxygen saturation monitor.
• Answer: B. Rationale: Is it safe? Is it effective? An obturator and a spare
tracheostomy tube of the same size (or one size smaller) must be kept at the bedside
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at all times to allow for immediate replacement if the tube is accidentally dislodged—
a life-threatening airway emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
• A. The client's serum potassium level increases to 4.5 mEq/L.
• B. The client's urine output increases to 1,500 mL per 24 hours.
• C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
• D. The client's heart rate decreases from 110 to 88 beats per minute.
• Answer: C. Rationale: Is it safe? Is it effective? Furosemide is a loop diuretic that
reduces fluid volume, which subsequently decreases blood pressure and reduces the
workload on the heart. A decrease in blood pressure indicates a positive therapeutic
response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
• A. "I will need to have my blood drawn regularly to check my INR."
• B. "I should avoid eating large amounts of green leafy vegetables."
• C. "I can take ibuprofen for my headaches if I need to."
• D. "I should report any unusual bleeding or bruising to my doctor."
• Answer: C. Rationale: Is it safe? Is it effective? Warfarin is an
anticoagulant. Ibuprofen (an NSAID) increases the risk of bleeding and should be
avoided. Clients should use acetaminophen for pain instead. Regular INR monitoring
(A) is required. Vitamin K-rich foods (B) can interfere with warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
• A. Continue to monitor the client's vital signs.
• B. Notify the healthcare provider immediately.
• C. Administer a bolus of magnesium sulfate.
• D. Document the finding as a normal response.
• Answer: B. Rationale: Is it safe? Is it effective? Absent DTRs is a sign
of magnesium toxicity. The antidote is calcium gluconate. The nurse must notify the
ARCHER REVIEW-STYLE QUESTIONS EXAM
2026 QUESTIONS LATEST VERSION QUESTIONS
AND ANSWERS
ARCHER REVIEW: KEY CHARACTERISTICS
• "Is it safe? Is it effective?" — The core Archer philosophy for clinical decision-
making
• High-Yield Content: Focuses on the most frequently tested topics
• NCLEX-Style Questions: Simulates the actual exam format and difficulty
• Detailed Rationales: Explains why each answer is correct or incorrect
• Emphasis on Prioritization: Frequently asks "Which client should the nurse see
first?"
• Concise & Direct: Questions are straightforward with clear answer choices
10-Point Summary of Archer Review Coverage
1. Safe and Effective Care Environment: Management of care, delegation, client
rights, informed consent, incident reporting, disaster triage, and safety protocols.
2. Health Promotion and Maintenance: Anticipatory guidance, disease prevention,
immunizations, growth and development, prenatal care, and lifestyle modifications.
3. Psychosocial Integrity: Therapeutic communication, coping mechanisms, grief and
loss, crisis intervention, psychiatric disorders, and substance abuse.
4. Pharmacological Therapies: Medication administration, side effects, adverse
reactions, interactions, and client teaching for major drug classes.
5. Reduction of Risk Potential: Monitoring for complications, interpreting diagnostic
tests, preventing injury, and recognizing early signs of deterioration.
6. Physiological Adaptation: Managing acute and chronic conditions (cardiac,
respiratory, endocrine, renal, neurological), and responding to changes in client status.
7. Basic Care and Comfort: Mobility, nutrition, hydration, elimination, comfort
measures, and assistance with ADLs.
, Page 2 of 72
8. Maternal and Newborn Health: Antepartum, intrapartum, and postpartum care,
newborn assessment, and common complications.
9. Pediatric Nursing: Common childhood illnesses, developmental milestones, safety,
and management of pediatric emergencies.
10. Leadership & Management: Delegation, supervision, prioritization, conflict
resolution, quality improvement, and legal/ethical issues.
ARCHER REVIEW-STYLE PRACTICE EXAM (250 Questions with Detailed
Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
• A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
• B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
• C. A client with heart failure who has crackles in the lung bases and is short of breath.
• D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
• Answer: C. Rationale: Is it safe? Is it effective? The client with heart failure who
has crackles and is short of breath is experiencing acute respiratory distress, which
could indicate pulmonary edema—a life-threatening emergency. This client should be
assessed first. The potassium level of 5.2 mEq/L (D) is elevated but not critical
(critical is >6.5). The blood glucose of 180 (A) is elevated but not immediately life-
threatening. The fever (B) is concerning but not the priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
• A. Administering a scheduled dose of oral metoprolol.
• B. Assessing a client's surgical wound for signs of infection.
• C. Assisting a client with a bed bath and providing oral care.
• D. Interpreting a client's telemetry rhythm strip.
• Answer: C. Rationale: Is it safe? Is it effective? Assisting with a bed bath and
providing oral care are tasks within the scope of UAP. Administration of medications
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(A), wound assessment (B), and rhythm interpretation (D) require the knowledge and
judgment of a licensed nurse and cannot be delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
• A. Tremors and diaphoresis.
• B. Nausea and vomiting.
• C. Seizure activity and autonomic hyperactivity.
• D. Insomnia and anxiety.
• Answer: C. Rationale: Is it safe? Is it effective? Alcohol withdrawal can lead
to seizures and autonomic hyperactivity (tachycardia, hypertension, hyperthermia),
which are life-threatening. Monitoring for these signs is the highest priority. While
tremors (A), nausea (B), and insomnia (D) are common withdrawal symptoms, they
are not as immediately life-threatening as seizures.
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
• A. Administer oxygen via nasal cannula at 2 L/min.
• B. Elevate the head of the bed to a high-Fowler's position.
• C. Notify the healthcare provider immediately.
• D. Assess the client's vital signs and oxygen saturation.
• Answer: C. Rationale: Is it safe? Is it effective? Sudden shortness of breath and
chest pain are classic symptoms of a pulmonary embolism (PE) , a life-threatening
complication. The nurse should notify the healthcare provider immediately while
simultaneously initiating other interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
• A. An Ambu bag and a suction catheter.
• B. An obturator and a spare tracheostomy tube.
• C. A sterile tracheostomy dressing and cleaning supplies.
• D. A pulse oximeter and an oxygen saturation monitor.
• Answer: B. Rationale: Is it safe? Is it effective? An obturator and a spare
tracheostomy tube of the same size (or one size smaller) must be kept at the bedside
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at all times to allow for immediate replacement if the tube is accidentally dislodged—
a life-threatening airway emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
• A. The client's serum potassium level increases to 4.5 mEq/L.
• B. The client's urine output increases to 1,500 mL per 24 hours.
• C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
• D. The client's heart rate decreases from 110 to 88 beats per minute.
• Answer: C. Rationale: Is it safe? Is it effective? Furosemide is a loop diuretic that
reduces fluid volume, which subsequently decreases blood pressure and reduces the
workload on the heart. A decrease in blood pressure indicates a positive therapeutic
response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
• A. "I will need to have my blood drawn regularly to check my INR."
• B. "I should avoid eating large amounts of green leafy vegetables."
• C. "I can take ibuprofen for my headaches if I need to."
• D. "I should report any unusual bleeding or bruising to my doctor."
• Answer: C. Rationale: Is it safe? Is it effective? Warfarin is an
anticoagulant. Ibuprofen (an NSAID) increases the risk of bleeding and should be
avoided. Clients should use acetaminophen for pain instead. Regular INR monitoring
(A) is required. Vitamin K-rich foods (B) can interfere with warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
• A. Continue to monitor the client's vital signs.
• B. Notify the healthcare provider immediately.
• C. Administer a bolus of magnesium sulfate.
• D. Document the finding as a normal response.
• Answer: B. Rationale: Is it safe? Is it effective? Absent DTRs is a sign
of magnesium toxicity. The antidote is calcium gluconate. The nurse must notify the
