WITH COMPLETE SOLUTIONS | NCLEX-STYLE NURSING
PRACTICE | UPDATED 2026/2027
QUESTION 1
A nurse is assessing a patient with suspected pulmonary tuberculosis.
Which finding is MOST indicative of a classic early presentation?
A. Sudden high fever and pleuritic chest pain
B. Hemoptysis and severe dyspnea at rest
C. Night sweats, fatigue, and anorexia with chronic cough lasting more
than 3 weeks
D. Wheezing and bilateral leg edema
E. Productive cough with green sputum and crackles
CORRECT ANSWER: C RATIONALE: Classic early TB presentation
includes persistent cough (>3 weeks), night sweats, fatigue, anorexia,
and unintentional weight loss. Hemoptysis occurs in advanced disease,
not early presentation. Options A and E describe bacterial pneumonia.
Option D describes heart failure or COPD exacerbation.
QUESTION 2
A patient newly diagnosed with active pulmonary TB asks why multiple
medications are prescribed. What is the nurse's BEST response?
A. "Combination therapy reduces the number of pills you need to take
each day."
,B. "Using multiple drugs prevents the bacteria from becoming resistant
to treatment."
C. "The medications work faster when taken together as a
combination."
D. "Each medication treats a different symptom of the disease."
E. "Combination therapy is less expensive than single-drug treatment."
CORRECT ANSWER: B RATIONALE: Combination therapy prevents
development of drug-resistant TB. Monotherapy promotes resistance,
which is why multi-drug regimens are standard. Options A, C, D, and E
are incorrect rationales for combination therapy.
QUESTION 3
The nurse is administering isoniazid (INH) to a patient with active TB.
Which laboratory value should the nurse monitor most closely?
A. Serum creatinine
B. Serum potassium
C. Liver function tests (AST, ALT)
D. Complete blood count
E. Serum sodium
CORRECT ANSWER: C RATIONALE: Isoniazid is hepatotoxic and can
cause elevated liver enzymes. Baseline and periodic liver function tests
are essential. Regular monitoring of AST and ALT is the standard of care
for patients on INH therapy.
QUESTION 4
A patient on rifampin therapy reports orange-red discoloration of urine,
,sweat, and tears. What is the nurse's priority action?
A. Notify the provider immediately for possible drug toxicity
B. Reassure the patient this is a normal and harmless side effect
C. Obtain a urine sample for occult blood testing
D. Instruct the patient to stop the medication and report to the
emergency department
E. Administer diphenhydramine for possible allergic reaction
CORRECT ANSWER: B RATIONALE: Rifampin causes harmless orange-
red discoloration of body fluids including urine, sweat, saliva, and tears.
Patient education about this expected side effect prevents unnecessary
alarm and promotes medication adherence.
QUESTION 5
A patient with active TB has been on the RIPE regimen for 3 weeks and
reports feeling better. The patient asks if medications can be stopped.
Which response by the nurse is correct?
A. "Yes, you may stop when you are symptom-free for 48 hours."
B. "You must complete at least 2 months of therapy before stopping."
C. "You need to complete the full 6- to 9-month course to prevent drug
resistance."
D. "Stopping early is acceptable if your sputum culture is negative."
E. "You can switch to a single medication once symptoms resolve."
CORRECT ANSWER: C RATIONALE: TB treatment requires 6-9 months of
multidrug therapy regardless of symptom resolution. Early
discontinuation is the primary cause of MDR-TB and XDR-TB. Non-
adherence remains a critical nursing concern.
, QUESTION 6
Which infection control precautions should the nurse implement for a
patient with confirmed active pulmonary TB? Select all that apply.
A. Contact precautions with gown and gloves
B. Negative pressure airborne infection isolation room
C. N95 respirator for all healthcare workers entering the room
D. Surgical mask for nurse is sufficient protection
E. Patient to wear surgical mask during transport outside the room
CORRECT ANSWER: B, C, E RATIONALE: TB is transmitted via airborne
droplet nuclei (<5 microns). Airborne precautions require negative
pressure rooms and N95 respirators for HCWs. Patients leaving the
room must wear a surgical mask. Contact precautions alone are
insufficient.
QUESTION 7
A patient with pneumonia has an SpO2 of 88% on room air with
accessory muscle use. Which action should the nurse take FIRST?
A. Document findings and continue monitoring
B. Apply supplemental oxygen and notify the provider
C. Reposition patient to supine position
D. Encourage coughing and deep breathing exercises
E. Prepare for immediate endotracheal intubation
CORRECT ANSWER: B RATIONALE: SpO2 of 88% indicates significant
hypoxia requiring immediate supplemental oxygen. Accessory muscle
use signals increased work of breathing. Prompt intervention is needed;
immediate intubation (E) is premature at this stage.