NURS_901: NCLEX-RN NGN Comprehensive Exam
Question Bank 2026/2027 Next-Generation Edition
Detailed Rationales and Verified Answers
Course Code: NURS_901
Course Name: NCLEX-RN Next-Generation Comprehensive Review
Topic: High-Yield Multi-System Clinical Judgment Bank
Academic Year: 2026/2027
1. A nurse is evaluating a client diagnosed with an acute myocardial
infarction who is receiving an intravenous infusion of nitroglycerin. Which
assessment finding is the correct answer or primary safety indicator that
requires the nurse to reduce the infusion rate?
A. Chronic non-productive cough
B. Systemic blood pressure of 88/52 mm Hg and severe dizziness
C. Trace ankle pitting edema
D. Serum potassium level of 4.1 mEq/L
CORRECT ANSWER: B. Systemic blood pressure of 88/52 mm Hg and
severe dizziness
RATIONALE: Nitroglycerin is a potent smooth muscle relaxant and vasodilator
that predominantly reduces preload but can significantly lower systemic vascular
resistance. A blood pressure under 90 mm Hg systolic accompanied by
symptoms of hypoperfusion (dizziness, lightheadedness) constitutes a major
adverse outcome (nitroglycerin-induced hypotension), requiring an immediate
reduction in the infusion rate or temporary discontinuation. A dry cough is linked
to ACE inhibitors. Trace edema can be a long-term finding but is not an acute
safety marker for nitrates.
2. A nurse is caring for a client at 34 weeks of gestation who presents with a
sudden onset of painful, dark red vaginal bleeding and a rigid, board-like
abdomen. Which of the following conditions is the correct answer?
A. Placenta previa
B. Abruptio placentae
C. Cervical insufficiency
D. Hydatidiform mole
, CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae is the premature detachment of a normally
situated placenta from the uterine wall. The classic clinical presentation features
localized, intense abdominal pain, a rigid board-like uterus, and dark red
vaginal bleeding. In contrast, placenta previa presents as painless, bright red
vaginal bleeding without abdominal or uterine rigidity. Cervical insufficiency
presents with painless cervical dilation in the second trimester.
3. A nurse is reviewing lab values for an adult client with a history of chronic
kidney disease. The client’s serum potassium level is 6.4 mEq/L and the
ECG demonstrates peaked T waves. Which medication should the nurse
anticipate administering first to protect the myocardium from lethal
arrhythmias?
A. Intravenous calcium gluconate
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide bolus
D. Subcutaneous insulin glargine
CORRECT ANSWER: A. Intravenous calcium gluconate
RATIONALE: Severe hyperkalemia with corresponding ECG changes
(peaked T waves) requires immediate clinical stabilization of the myocardial cell
membrane to prevent ventricular fibrillation. Intravenous calcium gluconate
works rapidly to raise the cardiac threshold potential, protecting the heart without
directly lowering the serum potassium level. Once the myocardium is protected,
other agents (insulin with dextrose, sodium polystyrene sulfonate) are deployed to
lower the absolute potassium load. Glargine is long-acting and completely
ineffective for acute hyperkalemic rescue.
4. A nurse is managing a client post-craniotomy. The client's urine output
suddenly spikes to 450 mL/hr for two consecutive hours, the urine specific
gravity is 1.002, and the client reports extreme thirst. Which condition
represents the correct answer?
A. Syndrome of inappropriate antidiuretic hormone (SIADH)
B. Acute kidney injury
C. Diabetes insipidus (DI)
D. Diabetic ketoacidosis (DKA)
, CORRECT ANSWER: C. Diabetes insipidus (DI)
RATIONALE: Neurotrauma or intracranial surgical manipulation can damage
the posterior pituitary gland or hypothalamus, causing a deficiency in antidiuretic
hormone (ADH) and resulting in diabetes insipidus (DI). DI is characterized by
massive polyuria (high volumes of dilute urine), a low urine specific gravity
(<1.005), high serum osmolality, and extreme polydipsia. SIADH presents with the
exact opposite paradigm (fluid retention and low urine output).
5. A nurse is assessing a child with suspected acute epiglottitis. The child is
drooling, sitting in a tripod position, and exhibiting severe inspiratory
stridor. Which assessment action is strictly contraindicated as the correct
answer to prevent a fatal airway occlusion?
A. Obtaining a peripheral pulse oximetry reading
B. Auscultating the bilateral lung fields for aeration
C. Inspecting the throat using a tongue blade or obtaining a throat
culture
D. Evaluating the peripheral capillary refill duration
CORRECT ANSWER: C. Inspecting the throat using a tongue blade or
obtaining a throat culture
RATIONALE: Acute epiglottitis is a life-threatening pediatric emergency
characterized by severe, rapid edema of the epiglottis. Any physical manipulation
or visual inspection of the pharynx using a tongue blade or swab is strictly
contraindicated, as it can trigger immediate, irreversible laryngospasm and
complete airway obstruction. Throat exams must only occur in an operating suite
where emergency intubation or surgical airway options are ready.
6. A client with an acute deep vein thrombosis (DVT) of the right calf is
receiving a continuous intravenous infusion of unfractionated heparin. The
client’s latest activated partial thromboplastin time (aPTT) is 135 seconds
(control is 30 seconds). Which action is the priority safety intervention?
A. Discontinue the heparin infusion immediately and prepare to
administer protamine sulfate.
B. Increase the heparin infusion rate to maintain therapeutic efficacy.
C. Draw a stat international normalized ratio (INR) level immediately.
D. Administer a prescribed dose of vitamin K intramuscularly.
, CORRECT ANSWER: A. Discontinue the heparin infusion immediately and
prepare to administer protamine sulfate.
RATIONALE: A therapeutic aPTT target for a client receiving heparin is
typically 1.5 to 2.5 times the control baseline (roughly 45 to 75 seconds). An aPTT
of 145 seconds indicates severe over-anticoagulation, placing the client at extreme
risk for spontaneous internal or intracranial hemorrhage. The immediate safety
action is to stop the infusion and prepare the antidote, protamine sulfate. INR
and vitamin K are specific to warfarin management, not heparin.
7. A nurse is caring for a client with a history of severe chronic plaque
psoriasis who is prescribed methotrexate. Which laboratory parameter
combination represents the correct answer as a mandatory baseline and
ongoing surveillance requirement?
A. Serum amylase and total lipase clearance
B. Serum thyroid panel and free T4 indices
C. Complete blood count (CBC) and liver function tests (AST/ALT)
D. Baseline serum uric acid levels only
CORRECT ANSWER: C. Complete blood count (CBC) and liver function
tests (AST/ALT)
RATIONALE: Methotrexate carries prominent black box warnings for severe
bone marrow suppression (leukopenia, anemia, thrombocytopenia) and
progressive hepatotoxicity (liver fibrosis and cirrhosis). Therefore, regular
tracking of a CBC and liver function tests is mandatory to prevent irreversible
organ damage.
8. A nurse is monitoring a client post-thyroidectomy. The client exhibits
muscle twitching, numbness around the mouth, and a positive Trousseau’s
sign. Which electrolyte imbalance is the underlying cause of these
findings?
A. Hypercalcemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
CORRECT ANSWER: C. Hypocalcemia
RATIONALE: Inadvertent trauma to or removal of the parathyroid glands
during a thyroidectomy leads to a drop in parathyroid hormone secretion,
Question Bank 2026/2027 Next-Generation Edition
Detailed Rationales and Verified Answers
Course Code: NURS_901
Course Name: NCLEX-RN Next-Generation Comprehensive Review
Topic: High-Yield Multi-System Clinical Judgment Bank
Academic Year: 2026/2027
1. A nurse is evaluating a client diagnosed with an acute myocardial
infarction who is receiving an intravenous infusion of nitroglycerin. Which
assessment finding is the correct answer or primary safety indicator that
requires the nurse to reduce the infusion rate?
A. Chronic non-productive cough
B. Systemic blood pressure of 88/52 mm Hg and severe dizziness
C. Trace ankle pitting edema
D. Serum potassium level of 4.1 mEq/L
CORRECT ANSWER: B. Systemic blood pressure of 88/52 mm Hg and
severe dizziness
RATIONALE: Nitroglycerin is a potent smooth muscle relaxant and vasodilator
that predominantly reduces preload but can significantly lower systemic vascular
resistance. A blood pressure under 90 mm Hg systolic accompanied by
symptoms of hypoperfusion (dizziness, lightheadedness) constitutes a major
adverse outcome (nitroglycerin-induced hypotension), requiring an immediate
reduction in the infusion rate or temporary discontinuation. A dry cough is linked
to ACE inhibitors. Trace edema can be a long-term finding but is not an acute
safety marker for nitrates.
2. A nurse is caring for a client at 34 weeks of gestation who presents with a
sudden onset of painful, dark red vaginal bleeding and a rigid, board-like
abdomen. Which of the following conditions is the correct answer?
A. Placenta previa
B. Abruptio placentae
C. Cervical insufficiency
D. Hydatidiform mole
, CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae is the premature detachment of a normally
situated placenta from the uterine wall. The classic clinical presentation features
localized, intense abdominal pain, a rigid board-like uterus, and dark red
vaginal bleeding. In contrast, placenta previa presents as painless, bright red
vaginal bleeding without abdominal or uterine rigidity. Cervical insufficiency
presents with painless cervical dilation in the second trimester.
3. A nurse is reviewing lab values for an adult client with a history of chronic
kidney disease. The client’s serum potassium level is 6.4 mEq/L and the
ECG demonstrates peaked T waves. Which medication should the nurse
anticipate administering first to protect the myocardium from lethal
arrhythmias?
A. Intravenous calcium gluconate
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide bolus
D. Subcutaneous insulin glargine
CORRECT ANSWER: A. Intravenous calcium gluconate
RATIONALE: Severe hyperkalemia with corresponding ECG changes
(peaked T waves) requires immediate clinical stabilization of the myocardial cell
membrane to prevent ventricular fibrillation. Intravenous calcium gluconate
works rapidly to raise the cardiac threshold potential, protecting the heart without
directly lowering the serum potassium level. Once the myocardium is protected,
other agents (insulin with dextrose, sodium polystyrene sulfonate) are deployed to
lower the absolute potassium load. Glargine is long-acting and completely
ineffective for acute hyperkalemic rescue.
4. A nurse is managing a client post-craniotomy. The client's urine output
suddenly spikes to 450 mL/hr for two consecutive hours, the urine specific
gravity is 1.002, and the client reports extreme thirst. Which condition
represents the correct answer?
A. Syndrome of inappropriate antidiuretic hormone (SIADH)
B. Acute kidney injury
C. Diabetes insipidus (DI)
D. Diabetic ketoacidosis (DKA)
, CORRECT ANSWER: C. Diabetes insipidus (DI)
RATIONALE: Neurotrauma or intracranial surgical manipulation can damage
the posterior pituitary gland or hypothalamus, causing a deficiency in antidiuretic
hormone (ADH) and resulting in diabetes insipidus (DI). DI is characterized by
massive polyuria (high volumes of dilute urine), a low urine specific gravity
(<1.005), high serum osmolality, and extreme polydipsia. SIADH presents with the
exact opposite paradigm (fluid retention and low urine output).
5. A nurse is assessing a child with suspected acute epiglottitis. The child is
drooling, sitting in a tripod position, and exhibiting severe inspiratory
stridor. Which assessment action is strictly contraindicated as the correct
answer to prevent a fatal airway occlusion?
A. Obtaining a peripheral pulse oximetry reading
B. Auscultating the bilateral lung fields for aeration
C. Inspecting the throat using a tongue blade or obtaining a throat
culture
D. Evaluating the peripheral capillary refill duration
CORRECT ANSWER: C. Inspecting the throat using a tongue blade or
obtaining a throat culture
RATIONALE: Acute epiglottitis is a life-threatening pediatric emergency
characterized by severe, rapid edema of the epiglottis. Any physical manipulation
or visual inspection of the pharynx using a tongue blade or swab is strictly
contraindicated, as it can trigger immediate, irreversible laryngospasm and
complete airway obstruction. Throat exams must only occur in an operating suite
where emergency intubation or surgical airway options are ready.
6. A client with an acute deep vein thrombosis (DVT) of the right calf is
receiving a continuous intravenous infusion of unfractionated heparin. The
client’s latest activated partial thromboplastin time (aPTT) is 135 seconds
(control is 30 seconds). Which action is the priority safety intervention?
A. Discontinue the heparin infusion immediately and prepare to
administer protamine sulfate.
B. Increase the heparin infusion rate to maintain therapeutic efficacy.
C. Draw a stat international normalized ratio (INR) level immediately.
D. Administer a prescribed dose of vitamin K intramuscularly.
, CORRECT ANSWER: A. Discontinue the heparin infusion immediately and
prepare to administer protamine sulfate.
RATIONALE: A therapeutic aPTT target for a client receiving heparin is
typically 1.5 to 2.5 times the control baseline (roughly 45 to 75 seconds). An aPTT
of 145 seconds indicates severe over-anticoagulation, placing the client at extreme
risk for spontaneous internal or intracranial hemorrhage. The immediate safety
action is to stop the infusion and prepare the antidote, protamine sulfate. INR
and vitamin K are specific to warfarin management, not heparin.
7. A nurse is caring for a client with a history of severe chronic plaque
psoriasis who is prescribed methotrexate. Which laboratory parameter
combination represents the correct answer as a mandatory baseline and
ongoing surveillance requirement?
A. Serum amylase and total lipase clearance
B. Serum thyroid panel and free T4 indices
C. Complete blood count (CBC) and liver function tests (AST/ALT)
D. Baseline serum uric acid levels only
CORRECT ANSWER: C. Complete blood count (CBC) and liver function
tests (AST/ALT)
RATIONALE: Methotrexate carries prominent black box warnings for severe
bone marrow suppression (leukopenia, anemia, thrombocytopenia) and
progressive hepatotoxicity (liver fibrosis and cirrhosis). Therefore, regular
tracking of a CBC and liver function tests is mandatory to prevent irreversible
organ damage.
8. A nurse is monitoring a client post-thyroidectomy. The client exhibits
muscle twitching, numbness around the mouth, and a positive Trousseau’s
sign. Which electrolyte imbalance is the underlying cause of these
findings?
A. Hypercalcemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
CORRECT ANSWER: C. Hypocalcemia
RATIONALE: Inadvertent trauma to or removal of the parathyroid glands
during a thyroidectomy leads to a drop in parathyroid hormone secretion,
