NCLEX-RN Simulation Final Exam V3 - 2026 Update
UPDATED ACTUAL Questions and CORRECT Answers
1. A nurse is caring for a client with heart failure. Which clinical manifestation
should the nurse prioritize as an early sign of pulmonary edema?
A. Peripheral edema in lower extremities
B. Pink, frothy sputum
C. Coarse crackles at the lung bases
D. Restlessness and anxiety
D. Tachypnea and agitation
Answer: D
Rationale: Restlessness and agitation are early signs of hypoxia related to pulmonary
edema. Pink, frothy sputum is a late sign.
2. A client is receiving Digoxin for atrial fibrillation. Which laboratory value
should the nurse monitor most closely to prevent toxicity?
A. Serum Calcium
B. Serum Sodium
C. Serum Potassium
D. Serum Magnesium
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of Digoxin toxicity because
potassium and digoxin compete for binding sites.
,3. Which task is most appropriate for the RN to delegate to an unlicensed
assistive personnel (UAP)?
A. Performing a sterile dressing change
B. Measuring the output of a urinary catheter
C. Feeding a client with a high risk of aspiration
D. Evaluating a client’s response to pain medication
Answer: B
Rationale: UAPs can perform routine tasks like measuring intake and output. Sterile
procedures, high-risk feeding, and evaluation require nursing judgment.
4. A client is diagnosed with Pulmonary Tuberculosis (TB). Which type of
isolation precautions should the nurse implement?
A. Contact Precautions
B. Airborne Precautions
C. Droplet Precautions
D. Standard Precautions only
Answer: B
Rationale: TB is transmitted via small droplets that remain suspended in the air, requiring
Airborne Precautions and an N95 respirator.
5. A nurse is teaching a client about a newly prescribed Warfarin regimen.
Which food should the nurse instruct the client to consume consistently?
A. Milk and dairy products
B. Red meat and liver
C. Citrus fruits and juices
D. Spinach and kale
Answer: D
Rationale: Warfarin works by inhibiting Vitamin K. Consistent intake of green leafy
vegetables (high in Vitamin K) is necessary to maintain a stable INR.
, 6. A client with Type 1 Diabetes is found unresponsive and clammy. What is the
priority nursing action?
A. Check the blood glucose level
B. Administer Glucagon IM per standing order
C. Administer 15g of simple carbohydrates orally
D. Call the healthcare provider immediately
Answer: B
Rationale: An unresponsive client cannot safely swallow; Glucagon or IV Dextrose is
required for emergency treatment of hypoglycemia.
7. A client in the second trimester of pregnancy has a blood pressure of 152/96
mmHg. Which additional finding would suggest preeclampsia?
A. Proteinuria
B. Glucosuria
C. Increased fetal movement
D. Weight gain of 1 lb per week
Answer: A
Rationale: The classic triad for preeclampsia includes hypertension and proteinuria after
20 weeks of gestation.
8. The nurse is caring for a client with a Potassium level of 6.2 mEq/L. Which
ECG change should the nurse expect?
A. Tall, peaked T waves
B. ST-segment depression
C. U waves
D. Prolonged QT interval
Answer: A
Rationale: Hyperkalemia typically causes tall, peaked T waves and widened QRS
complexes.
UPDATED ACTUAL Questions and CORRECT Answers
1. A nurse is caring for a client with heart failure. Which clinical manifestation
should the nurse prioritize as an early sign of pulmonary edema?
A. Peripheral edema in lower extremities
B. Pink, frothy sputum
C. Coarse crackles at the lung bases
D. Restlessness and anxiety
D. Tachypnea and agitation
Answer: D
Rationale: Restlessness and agitation are early signs of hypoxia related to pulmonary
edema. Pink, frothy sputum is a late sign.
2. A client is receiving Digoxin for atrial fibrillation. Which laboratory value
should the nurse monitor most closely to prevent toxicity?
A. Serum Calcium
B. Serum Sodium
C. Serum Potassium
D. Serum Magnesium
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of Digoxin toxicity because
potassium and digoxin compete for binding sites.
,3. Which task is most appropriate for the RN to delegate to an unlicensed
assistive personnel (UAP)?
A. Performing a sterile dressing change
B. Measuring the output of a urinary catheter
C. Feeding a client with a high risk of aspiration
D. Evaluating a client’s response to pain medication
Answer: B
Rationale: UAPs can perform routine tasks like measuring intake and output. Sterile
procedures, high-risk feeding, and evaluation require nursing judgment.
4. A client is diagnosed with Pulmonary Tuberculosis (TB). Which type of
isolation precautions should the nurse implement?
A. Contact Precautions
B. Airborne Precautions
C. Droplet Precautions
D. Standard Precautions only
Answer: B
Rationale: TB is transmitted via small droplets that remain suspended in the air, requiring
Airborne Precautions and an N95 respirator.
5. A nurse is teaching a client about a newly prescribed Warfarin regimen.
Which food should the nurse instruct the client to consume consistently?
A. Milk and dairy products
B. Red meat and liver
C. Citrus fruits and juices
D. Spinach and kale
Answer: D
Rationale: Warfarin works by inhibiting Vitamin K. Consistent intake of green leafy
vegetables (high in Vitamin K) is necessary to maintain a stable INR.
, 6. A client with Type 1 Diabetes is found unresponsive and clammy. What is the
priority nursing action?
A. Check the blood glucose level
B. Administer Glucagon IM per standing order
C. Administer 15g of simple carbohydrates orally
D. Call the healthcare provider immediately
Answer: B
Rationale: An unresponsive client cannot safely swallow; Glucagon or IV Dextrose is
required for emergency treatment of hypoglycemia.
7. A client in the second trimester of pregnancy has a blood pressure of 152/96
mmHg. Which additional finding would suggest preeclampsia?
A. Proteinuria
B. Glucosuria
C. Increased fetal movement
D. Weight gain of 1 lb per week
Answer: A
Rationale: The classic triad for preeclampsia includes hypertension and proteinuria after
20 weeks of gestation.
8. The nurse is caring for a client with a Potassium level of 6.2 mEq/L. Which
ECG change should the nurse expect?
A. Tall, peaked T waves
B. ST-segment depression
C. U waves
D. Prolonged QT interval
Answer: A
Rationale: Hyperkalemia typically causes tall, peaked T waves and widened QRS
complexes.
