2026 NCLEX- Board Exam (NCSBN) with NGN -
Quiz Questions and Answers | Fully Updated 2026
NCLEX
1. A patient with a history of chronic heart failure presents with acute dyspnea,
pink frothy sputum, and oxygen saturation of 82% on room air. The nurse
auscultates crackles throughout both lung fields. Which intervention should
the nurse implement FIRST?
A. Administer IV furosemide 40 mg
B. Place patient in high-Fowler's position
C. Apply high-flow oxygen via non-rebreather mask
D. Notify the healthcare provider of the assessment findings
Answer: C
Rationale: In acute pulmonary edema, the priority is to improve oxygenation.
High-flow oxygen is the first-line intervention to address hypoxemia. Positioning
and diuretics are important but secondary to oxygen administration. Notifying the
provider is necessary but does not take precedence over immediate life-sustaining
measures.
2. A nurse is reviewing medication orders for a patient with type 2 diabetes
mellitus and chronic kidney disease (eGFR 25 mL/min/1.73m²). Which
medication order should the nurse question?
A. Metformin 500 mg PO twice daily
B. Insulin glargine 10 units subcutaneously at bedtime
C. Empagliflozin 10 mg PO once daily
D. Lisinopril 10 mg PO once daily
Answer: A
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min/1.73m²
due to risk of lactic acidosis. Empagliflozin, an SGLT2 inhibitor, may be used with
reduced eGFR but is often discontinued below 30; however, the question
specifically targets metformin. Insulin, lisinopril, and empagliflozin may be
appropriate with monitoring.
Page 1
,3. A patient with a suspected opioid overdose has a respiratory rate of 6
breaths/min and pinpoint pupils. The nurse administers naloxone 0.4 mg IV.
Within 2 minutes, the patient becomes agitated and combative. What is the
nurse's priority action?
A. Administer a second dose of naloxone
B. Apply physical restraints to ensure safety
C. Reassess respiratory status and provide reassurance
D. Administer a benzodiazepine for agitation
Answer: C
Rationale: Naloxone can precipitate acute withdrawal, causing agitation. The
priority is to reassess respiratory status to ensure the opioid reversal is effective
and to provide reassurance. Restraints and benzodiazepines may be considered but
only after ensuring adequate ventilation and ruling out hypoxia as a cause of
agitation.
4. A nurse is caring for a patient who is 2 hours post-operative after a
thyroidectomy. The nurse notes stridor, respiratory distress, and swelling at
the incision site. Which action should the nurse take FIRST?
A. Administer IV calcium gluconate
B. Apply oxygen via face mask
C. Call for help and prepare for emergency airway management
D. Elevate the head of the bed to 45 degrees
Answer: C
Rationale: Stridor and respiratory distress after thyroidectomy indicate
postoperative hemorrhage causing tracheal compression. This is a life-threatening
emergency requiring immediate airway management. While oxygen and positioning
are supportive, the priority is to ensure a patent airway, which may require
surgical evacuation or reintubation.
5. A nurse is assessing a patient with new-onset confusion, tachycardia, and
dry, flushed skin. The patient's blood glucose is 480 mg/dL, and serum
osmolality is 310 mOsm/kg. The nurse anticipates which condition?
A. Diabetic ketoacidosis (DKA)
B. Hyperglycemic hyperosmolar state (HHS)
C. Hypoglycemia
D. Sepsis-induced delirium
Page 2
,Answer: B
Rationale: The presentation of severe hyperglycemia, hyperosmolality, and altered
mental status without significant ketosis is characteristic of HHS. DKA typically
presents with Kussmaul respirations and ketonemia. Hypoglycemia would present
with low glucose, and sepsis would not specifically cause these metabolic
derangements.
6. A nurse is providing discharge teaching to a patient prescribed warfarin.
Which statement by the patient indicates a correct understanding of the
medication?
A. I should increase my intake of leafy green vegetables.
B. I will take aspirin for headaches if needed.
C. I will report any black, tarry stools to my provider immediately.
D. I can skip doses if my INR is above the target range.
Answer: C
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious adverse
effect of warfarin that requires immediate medical attention. Increasing vitamin K
intake (leafy greens) can alter INR, aspirin increases bleeding risk, and skipping
doses without provider guidance is unsafe.
7. A nurse is evaluating the fetal heart rate (FHR) tracing of a patient in active
labor. The nurse notes variable decelerations that drop 30 beats/min below
baseline and recover to baseline within 60 seconds. What is the nurse's best
interpretation?
A. The decelerations are likely due to uteroplacental insufficiency.
B. The decelerations are likely due to umbilical cord compression.
C. The decelerations are likely due to fetal head compression.
D. The decelerations are likely due to maternal hypotension.
Answer: B
Rationale: Variable decelerations are typically caused by umbilical cord
compression, leading to a rapid fall and recovery in FHR. Late decelerations are
associated with uteroplacental insufficiency, early decelerations with head
compression, and maternal hypotension may cause late decelerations.
Page 3
, 8. A patient with schizophrenia is prescribed clozapine. The nurse should
prioritize which laboratory monitoring to detect a potentially fatal adverse
effect?
A. Liver function tests
B. Complete blood count (CBC) with differential
C. Serum creatinine and BUN
D. Thyroid function tests
Answer: B
Rationale: Clozapine can cause agranulocytosis, a potentially fatal drop in white
blood cells. Therefore, routine monitoring of CBC is mandatory, especially during
the first six months of therapy. The other tests are not specific to the most
dangerous adverse effect of clozapine.
9. A nurse is performing a community health screening for hypertension.
Which blood pressure reading requires immediate referral to a healthcare
provider?
A. 128/82 mm Hg
B. 146/90 mm Hg
C. 158/98 mm Hg
D. 172/110 mm Hg
Answer: D
Rationale: A blood pressure of 172/110 mm Hg is classified as hypertensive crisis
and requires immediate medical attention to prevent target organ damage. The
other readings indicate elevated blood pressure or stage 1/2 hypertension but are
not emergent.
10. A nurse is administering a blood transfusion. Five minutes after starting
the transfusion, the patient reports feeling flushed and anxious. The nurse
notes the patient's temperature is 38.5°C (101.3°F), heart rate 110 bpm, and
blood pressure 90/60 mm Hg. What is the nurse's priority action?
A. Slow the infusion and notify the provider
B. Stop the transfusion and maintain IV access with normal saline
C. Administer acetaminophen and diphenhydramine
D. Recheck vital signs in 15 minutes
Answer: B
Rationale: The signs are indicative of a febrile non-hemolytic transfusion reaction
or a more serious hemolytic reaction. The immediate priority is to stop the
Page 4
Quiz Questions and Answers | Fully Updated 2026
NCLEX
1. A patient with a history of chronic heart failure presents with acute dyspnea,
pink frothy sputum, and oxygen saturation of 82% on room air. The nurse
auscultates crackles throughout both lung fields. Which intervention should
the nurse implement FIRST?
A. Administer IV furosemide 40 mg
B. Place patient in high-Fowler's position
C. Apply high-flow oxygen via non-rebreather mask
D. Notify the healthcare provider of the assessment findings
Answer: C
Rationale: In acute pulmonary edema, the priority is to improve oxygenation.
High-flow oxygen is the first-line intervention to address hypoxemia. Positioning
and diuretics are important but secondary to oxygen administration. Notifying the
provider is necessary but does not take precedence over immediate life-sustaining
measures.
2. A nurse is reviewing medication orders for a patient with type 2 diabetes
mellitus and chronic kidney disease (eGFR 25 mL/min/1.73m²). Which
medication order should the nurse question?
A. Metformin 500 mg PO twice daily
B. Insulin glargine 10 units subcutaneously at bedtime
C. Empagliflozin 10 mg PO once daily
D. Lisinopril 10 mg PO once daily
Answer: A
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min/1.73m²
due to risk of lactic acidosis. Empagliflozin, an SGLT2 inhibitor, may be used with
reduced eGFR but is often discontinued below 30; however, the question
specifically targets metformin. Insulin, lisinopril, and empagliflozin may be
appropriate with monitoring.
Page 1
,3. A patient with a suspected opioid overdose has a respiratory rate of 6
breaths/min and pinpoint pupils. The nurse administers naloxone 0.4 mg IV.
Within 2 minutes, the patient becomes agitated and combative. What is the
nurse's priority action?
A. Administer a second dose of naloxone
B. Apply physical restraints to ensure safety
C. Reassess respiratory status and provide reassurance
D. Administer a benzodiazepine for agitation
Answer: C
Rationale: Naloxone can precipitate acute withdrawal, causing agitation. The
priority is to reassess respiratory status to ensure the opioid reversal is effective
and to provide reassurance. Restraints and benzodiazepines may be considered but
only after ensuring adequate ventilation and ruling out hypoxia as a cause of
agitation.
4. A nurse is caring for a patient who is 2 hours post-operative after a
thyroidectomy. The nurse notes stridor, respiratory distress, and swelling at
the incision site. Which action should the nurse take FIRST?
A. Administer IV calcium gluconate
B. Apply oxygen via face mask
C. Call for help and prepare for emergency airway management
D. Elevate the head of the bed to 45 degrees
Answer: C
Rationale: Stridor and respiratory distress after thyroidectomy indicate
postoperative hemorrhage causing tracheal compression. This is a life-threatening
emergency requiring immediate airway management. While oxygen and positioning
are supportive, the priority is to ensure a patent airway, which may require
surgical evacuation or reintubation.
5. A nurse is assessing a patient with new-onset confusion, tachycardia, and
dry, flushed skin. The patient's blood glucose is 480 mg/dL, and serum
osmolality is 310 mOsm/kg. The nurse anticipates which condition?
A. Diabetic ketoacidosis (DKA)
B. Hyperglycemic hyperosmolar state (HHS)
C. Hypoglycemia
D. Sepsis-induced delirium
Page 2
,Answer: B
Rationale: The presentation of severe hyperglycemia, hyperosmolality, and altered
mental status without significant ketosis is characteristic of HHS. DKA typically
presents with Kussmaul respirations and ketonemia. Hypoglycemia would present
with low glucose, and sepsis would not specifically cause these metabolic
derangements.
6. A nurse is providing discharge teaching to a patient prescribed warfarin.
Which statement by the patient indicates a correct understanding of the
medication?
A. I should increase my intake of leafy green vegetables.
B. I will take aspirin for headaches if needed.
C. I will report any black, tarry stools to my provider immediately.
D. I can skip doses if my INR is above the target range.
Answer: C
Rationale: Black, tarry stools indicate gastrointestinal bleeding, a serious adverse
effect of warfarin that requires immediate medical attention. Increasing vitamin K
intake (leafy greens) can alter INR, aspirin increases bleeding risk, and skipping
doses without provider guidance is unsafe.
7. A nurse is evaluating the fetal heart rate (FHR) tracing of a patient in active
labor. The nurse notes variable decelerations that drop 30 beats/min below
baseline and recover to baseline within 60 seconds. What is the nurse's best
interpretation?
A. The decelerations are likely due to uteroplacental insufficiency.
B. The decelerations are likely due to umbilical cord compression.
C. The decelerations are likely due to fetal head compression.
D. The decelerations are likely due to maternal hypotension.
Answer: B
Rationale: Variable decelerations are typically caused by umbilical cord
compression, leading to a rapid fall and recovery in FHR. Late decelerations are
associated with uteroplacental insufficiency, early decelerations with head
compression, and maternal hypotension may cause late decelerations.
Page 3
, 8. A patient with schizophrenia is prescribed clozapine. The nurse should
prioritize which laboratory monitoring to detect a potentially fatal adverse
effect?
A. Liver function tests
B. Complete blood count (CBC) with differential
C. Serum creatinine and BUN
D. Thyroid function tests
Answer: B
Rationale: Clozapine can cause agranulocytosis, a potentially fatal drop in white
blood cells. Therefore, routine monitoring of CBC is mandatory, especially during
the first six months of therapy. The other tests are not specific to the most
dangerous adverse effect of clozapine.
9. A nurse is performing a community health screening for hypertension.
Which blood pressure reading requires immediate referral to a healthcare
provider?
A. 128/82 mm Hg
B. 146/90 mm Hg
C. 158/98 mm Hg
D. 172/110 mm Hg
Answer: D
Rationale: A blood pressure of 172/110 mm Hg is classified as hypertensive crisis
and requires immediate medical attention to prevent target organ damage. The
other readings indicate elevated blood pressure or stage 1/2 hypertension but are
not emergent.
10. A nurse is administering a blood transfusion. Five minutes after starting
the transfusion, the patient reports feeling flushed and anxious. The nurse
notes the patient's temperature is 38.5°C (101.3°F), heart rate 110 bpm, and
blood pressure 90/60 mm Hg. What is the nurse's priority action?
A. Slow the infusion and notify the provider
B. Stop the transfusion and maintain IV access with normal saline
C. Administer acetaminophen and diphenhydramine
D. Recheck vital signs in 15 minutes
Answer: B
Rationale: The signs are indicative of a febrile non-hemolytic transfusion reaction
or a more serious hemolytic reaction. The immediate priority is to stop the
Page 4
