NCLEX RN STUDY GUIDE ACTUAL PRACTICE EXAM
WITH WELL ELABORATED AND MOST TESTED REAL
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY 2026-2027 Q&A 100%
GUARANTEED PASS A+ INSTANT DOWNLOAD PDF
Based on the NCLEX-RN Test Plan Effective April 2026
1. A nurse is caring for a client with a new diagnosis of heart failure. Which
assessment finding requires immediate intervention?
A. Weight gain of 1 kg over 24 hours
B. Bibasilar crackles and oxygen saturation of 88% on room air
C. Heart rate of 92 beats per minute
D. Blood pressure of 128/78 mm Hg
B. Bibasilar crackles and oxygen saturation of 88% on room air
Bibasilar crackles with an oxygen saturation below 90% indicate pulmonary
congestion and impaired gas exchange, which are signs of acute decompensation
in heart failure requiring immediate intervention. The other findings are within
acceptable parameters or expected for a client with heart failure.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which
finding should the nurse report before administering the medication?
A. Heart rate of 88 beats per minute
B. Potassium level of 4.2 mEq/L
,C. Heart rate of 52 beats per minute
D. Digoxin level of 1.2 ng/mL
C. Heart rate of 52 beats per minute
Digoxin should be withheld and the provider notified if the adult apical pulse is
below 60 beats per minute, as bradycardia is a sign of digoxin toxicity. A
therapeutic digoxin level is 0.5 to 2.0 ng/mL, and a potassium level of 4.2 mEq/L
is within normal limits.
3. A nurse is assessing a client who is receiving furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
B. Serum potassium
Furosemide is a loop diuretic that causes potassium loss, placing the client at
risk for hypokalemia. Normal serum potassium is 3.5 to 5.0 mEq/L. The nurse
should monitor potassium levels closely and assess for signs of hypokalemia,
including muscle weakness and cardiac dysrhythmias.
4. A nurse is teaching a client about a low-sodium diet. Which statement by the
client indicates understanding?
A. "I can use soy sauce in place of salt."
B. "I should avoid canned soups and processed meats."
C. "I can add table salt when cooking."
D. "I should drink at least 3 liters of water daily."
B. "I should avoid canned soups and processed meats."
,Canned soups and processed meats are high in sodium due to preservatives and
added salt. A low-sodium diet restricts sodium to less than 2 grams per day. Soy
sauce is also high in sodium. Increased water intake is not specifically indicated
for a low-sodium diet.
5. A nurse is caring for a client who is 2 hours postoperative following a total knee
arthroplasty. Which finding should the nurse report to the provider immediately?
A. Pain rated 6/10 at the surgical site
B. Drainage of 50 mL in the past hour
C. Development of a pressure injury on the heel
D. Bilateral calf pain with redness and warmth in the left calf
D. Bilateral calf pain with redness and warmth in the left calf
Unilateral calf pain with redness and warmth is a classic sign of deep vein
thrombosis, a life-threatening complication following orthopedic surgery that
can lead to pulmonary embolism. The nurse should report this immediately.
6. A nurse is reviewing the laboratory results of a client receiving heparin. Which
finding indicates a therapeutic response?
A. Activated partial thromboplastin time (aPTT) of 35 seconds
B. aPTT of 65 seconds
C. Prothrombin time (PT) of 12 seconds
D. International normalized ratio (INR) of 1.0
B. aPTT of 65 seconds
The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5
times the control value (approximately 45 to 70 seconds). An aPTT of 65 seconds
indicates a therapeutic response. PT and INR are used to monitor warfarin
therapy, not heparin.
, 7. A nurse is caring for a client with a chest tube following a thoracotomy. Which
finding should the nurse report immediately?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 50 mL in the first 8 hours
D. Insertion site covered with an occlusive dressing
B. Continuous bubbling in the water-seal chamber
Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which requires immediate investigation and intervention. Tidaling is
expected with respiration. Drainage of 50 mL in 8 hours is acceptable. The
insertion site should be covered with an occlusive dressing.
8. A nurse is providing discharge teaching to a client following a myocardial
infarction. Which instruction should the nurse include?
A. "You may resume sexual activity within 48 hours."
B. "Avoid isometric exercises such as heavy lifting."
C. "You should limit walking to 10 minutes per day."
D. "Stop taking aspirin once you feel better."
B. "Avoid isometric exercises such as heavy lifting."
Isometric exercises increase cardiac workload and should be avoided after a
myocardial infarction. Clients should be taught to avoid heavy lifting and
straining. Sexual activity may typically resume after 1 to 2 weeks, depending on
the provider's recommendation. Aspirin therapy is usually continued indefinitely.
9. A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD). Which finding indicates a late sign of hypoxia?
WITH WELL ELABORATED AND MOST TESTED REAL
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY 2026-2027 Q&A 100%
GUARANTEED PASS A+ INSTANT DOWNLOAD PDF
Based on the NCLEX-RN Test Plan Effective April 2026
1. A nurse is caring for a client with a new diagnosis of heart failure. Which
assessment finding requires immediate intervention?
A. Weight gain of 1 kg over 24 hours
B. Bibasilar crackles and oxygen saturation of 88% on room air
C. Heart rate of 92 beats per minute
D. Blood pressure of 128/78 mm Hg
B. Bibasilar crackles and oxygen saturation of 88% on room air
Bibasilar crackles with an oxygen saturation below 90% indicate pulmonary
congestion and impaired gas exchange, which are signs of acute decompensation
in heart failure requiring immediate intervention. The other findings are within
acceptable parameters or expected for a client with heart failure.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which
finding should the nurse report before administering the medication?
A. Heart rate of 88 beats per minute
B. Potassium level of 4.2 mEq/L
,C. Heart rate of 52 beats per minute
D. Digoxin level of 1.2 ng/mL
C. Heart rate of 52 beats per minute
Digoxin should be withheld and the provider notified if the adult apical pulse is
below 60 beats per minute, as bradycardia is a sign of digoxin toxicity. A
therapeutic digoxin level is 0.5 to 2.0 ng/mL, and a potassium level of 4.2 mEq/L
is within normal limits.
3. A nurse is assessing a client who is receiving furosemide. Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
B. Serum potassium
Furosemide is a loop diuretic that causes potassium loss, placing the client at
risk for hypokalemia. Normal serum potassium is 3.5 to 5.0 mEq/L. The nurse
should monitor potassium levels closely and assess for signs of hypokalemia,
including muscle weakness and cardiac dysrhythmias.
4. A nurse is teaching a client about a low-sodium diet. Which statement by the
client indicates understanding?
A. "I can use soy sauce in place of salt."
B. "I should avoid canned soups and processed meats."
C. "I can add table salt when cooking."
D. "I should drink at least 3 liters of water daily."
B. "I should avoid canned soups and processed meats."
,Canned soups and processed meats are high in sodium due to preservatives and
added salt. A low-sodium diet restricts sodium to less than 2 grams per day. Soy
sauce is also high in sodium. Increased water intake is not specifically indicated
for a low-sodium diet.
5. A nurse is caring for a client who is 2 hours postoperative following a total knee
arthroplasty. Which finding should the nurse report to the provider immediately?
A. Pain rated 6/10 at the surgical site
B. Drainage of 50 mL in the past hour
C. Development of a pressure injury on the heel
D. Bilateral calf pain with redness and warmth in the left calf
D. Bilateral calf pain with redness and warmth in the left calf
Unilateral calf pain with redness and warmth is a classic sign of deep vein
thrombosis, a life-threatening complication following orthopedic surgery that
can lead to pulmonary embolism. The nurse should report this immediately.
6. A nurse is reviewing the laboratory results of a client receiving heparin. Which
finding indicates a therapeutic response?
A. Activated partial thromboplastin time (aPTT) of 35 seconds
B. aPTT of 65 seconds
C. Prothrombin time (PT) of 12 seconds
D. International normalized ratio (INR) of 1.0
B. aPTT of 65 seconds
The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5
times the control value (approximately 45 to 70 seconds). An aPTT of 65 seconds
indicates a therapeutic response. PT and INR are used to monitor warfarin
therapy, not heparin.
, 7. A nurse is caring for a client with a chest tube following a thoracotomy. Which
finding should the nurse report immediately?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 50 mL in the first 8 hours
D. Insertion site covered with an occlusive dressing
B. Continuous bubbling in the water-seal chamber
Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which requires immediate investigation and intervention. Tidaling is
expected with respiration. Drainage of 50 mL in 8 hours is acceptable. The
insertion site should be covered with an occlusive dressing.
8. A nurse is providing discharge teaching to a client following a myocardial
infarction. Which instruction should the nurse include?
A. "You may resume sexual activity within 48 hours."
B. "Avoid isometric exercises such as heavy lifting."
C. "You should limit walking to 10 minutes per day."
D. "Stop taking aspirin once you feel better."
B. "Avoid isometric exercises such as heavy lifting."
Isometric exercises increase cardiac workload and should be avoided after a
myocardial infarction. Clients should be taught to avoid heavy lifting and
straining. Sexual activity may typically resume after 1 to 2 weeks, depending on
the provider's recommendation. Aspirin therapy is usually continued indefinitely.
9. A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD). Which finding indicates a late sign of hypoxia?
