NCLEX-RN: Saunders Comprehensive Exam Question
Bank Review for the NCLEX-RN Examination Prep with
Detailed Rationales
Course Code: NCLEX-RN
Course Name: Saunders Comprehensive Review for the NCLEX-RN
Examinations
Topic: High-Yield Comprehensive Exam Prep
Academic Year: 2026/2027
Question 1
A nurse is caring for a client admitted with diabetic ketoacidosis (DKA). The
nurse notes the client has deep, rapid respirations, and the arterial blood gas
(ABG) results show a pH of 7.21 and a HCO3- of 14 mEq/L. Which immediate
nursing intervention is the highest priority?
A. Administering a rapid IV bolus of 5% Dextrose in Water
B. Initiating continuous intravenous regular insulin infusion
C. Administering subcutaneous insulin glargine immediately
D. Administering intravenous sodium bicarbonate push
CORRECT ANSWER: B. Initiating continuous intravenous regular insulin
infusion
RATIONALE: Diabetic ketoacidosis (DKA) is characterized by severe
hyperglycemia, metabolic acidosis, and ketone production. The definitive
treatment to stop ketone production and reverse acidosis is the administration
of intravenous regular insulin, which allows glucose to enter cells and halts
lipolysis. Option A is incorrect because dextrose is only added once blood
,glucose drops to around 250–300 mg/dL to prevent hypoglycemia and
cerebral edema. Option C is incorrect because subcutaneous long-acting
insulin (glargine) takes too long to act and cannot be titrated for acute DKA
management. Option D is avoided unless the pH drops below 6.9, as
aggressive bicarbonate administration can cause profound hypokalemia and
rebound tissue hypoxia.
Question 2
The nurse is preparing to administer digitalis therapy to an infant with a
diagnosis of congenital heart failure. Which clinical finding would require the
nurse to hold the medication and immediately notify the primary healthcare
provider?
A. An apical heart rate of 88 beats per minute
B. Increased urine output over the last 4 hours
C. A serum potassium level of 4.5 mEq/L
D. Mild diaphoresis during feeding periods
CORRECT ANSWER: A. An apical heart rate of 88 beats per minute
RATIONALE: Digoxin toxicity can manifest as severe bradycardia. For
infants, digoxin is generally withheld if the apical pulse is less than 90 to 110
beats per minute (depending on institutional protocol; 88 bpm is critically low
for an infant). Option B is a desired therapeutic effect of improved cardiac
output and renal perfusion. Option C represents a normal potassium level;
hypokalemia increases digoxin toxicity risk, but 4.5 mEq/L is safe. Option D is
a baseline clinical symptom of infant heart failure due to increased metabolic
demand during feeding, not a sign of digoxin toxicity.
Question 3
A client with chronic kidney disease (CKD) presents with a serum potassium
level of 6.8 mEq/L and demonstrates peaked T waves on the cardiac monitor.
Which medication should the nurse expect to administer first to protect the
myocardium?
A. Sodium polystyrene sulfonate orally
B. Calcium gluconate intravenously
,C. Regular insulin with 50% dextrose intravenously
D. Furosemide intravenously
CORRECT ANSWER: B. Calcium gluconate intravenously
RATIONALE: Severe hyperkalemia (potassium > 6.5 mEq/L) with ECG
changes such as peaked T waves is a medical emergency that can rapidly
degenerate into lethal arrhythmias like ventricular fibrillation. Calcium
gluconate does not lower the serum potassium level, but it immediately
stabilizes the myocardial cell membrane, reducing the risk of arrhythmias.
Options A and C are interventions that actually lower potassium levels (by
binding it in the gut or shifting it into cells), but they take longer to act than
calcium gluconate. Option D is less effective in advanced chronic kidney
disease due to diminished nephron function.
Question 4
A nurse is reviewing the laboratory results of a client receiving heparin
sodium via continuous intravenous infusion for a deep vein thrombosis (DVT).
The client’s activated partial thromboplastin time (aPTT) is 110 seconds.
Which action should the nurse take first?
A. Turn off the continuous heparin infusion immediately
B. Administer a full dose of protamine sulfate
C. Redraw the blood sample from the opposite arm
D. Increase the infusion rate by 10% per protocol
CORRECT ANSWER: A. Turn off the continuous heparin infusion
immediately
RATIONALE: The normal therapeutic range for aPTT during heparin
therapy is typically 1.5 to 2.5 times the control value (around 60 to 80
seconds). An aPTT of 110 seconds is significantly prolonged, placing the client
at a critical risk for major spontaneous hemorrhage. The immediate priority
is to stop the continuous infusion to allow aPTT levels to drop. Option B
(protamine sulfate) is the antidote for heparin, but it is reserved for severe,
active bleeding due to its own risks of anaphylaxis and hypotension. Option C
delays necessary action. Option D would worsen the overdose.
, Question 5
The nurse is assessing a pregnant client at 34 weeks gestation who presents
with sudden-onset, severe, painful vaginal bleeding and a rigid, board-like
abdomen. The nurse recognizes these clinical manifestations as highly
indicative of which obstetric emergency?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Cervical incompetence
CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae occurs when the placenta prematurely
separates from the uterine wall before birth. The classic symptoms include
painful vaginal bleeding, severe abdominal pain, and a hypertonic, rigid,
board-like abdomen due to concealed intra-uterine hemorrhage. Option A
(placenta previa) is characterized by painless, bright red vaginal bleeding
without abdominal rigidity. Option C (uterine rupture) typically presents with
a sudden sharp tearing pain during active labor, accompanied by a cessation
of uterine contractions and recession of the fetal presenting part. Option D
causes painless cervical dilation in the second trimester, not painful late-
pregnancy bleeding.
Question 6
A client with a history of grave's disease undergoes a total thyroidectomy.
Twelve hours postoperatively, the client reports numbness and tingling
around the mouth and muscle twitching in the fingers. Which medication
should the nurse prepare to administer?
A. Levothyroxine sodium
B. Calcium gluconate
C. Potassium iodide
D. Calcitonin salmon
CORRECT ANSWER: B. Calcium gluconate
RATIONALE: During a total thyroidectomy, the parathyroid glands can
be inadvertently damaged or removed, resulting in hypoparathyroidism. This
Bank Review for the NCLEX-RN Examination Prep with
Detailed Rationales
Course Code: NCLEX-RN
Course Name: Saunders Comprehensive Review for the NCLEX-RN
Examinations
Topic: High-Yield Comprehensive Exam Prep
Academic Year: 2026/2027
Question 1
A nurse is caring for a client admitted with diabetic ketoacidosis (DKA). The
nurse notes the client has deep, rapid respirations, and the arterial blood gas
(ABG) results show a pH of 7.21 and a HCO3- of 14 mEq/L. Which immediate
nursing intervention is the highest priority?
A. Administering a rapid IV bolus of 5% Dextrose in Water
B. Initiating continuous intravenous regular insulin infusion
C. Administering subcutaneous insulin glargine immediately
D. Administering intravenous sodium bicarbonate push
CORRECT ANSWER: B. Initiating continuous intravenous regular insulin
infusion
RATIONALE: Diabetic ketoacidosis (DKA) is characterized by severe
hyperglycemia, metabolic acidosis, and ketone production. The definitive
treatment to stop ketone production and reverse acidosis is the administration
of intravenous regular insulin, which allows glucose to enter cells and halts
lipolysis. Option A is incorrect because dextrose is only added once blood
,glucose drops to around 250–300 mg/dL to prevent hypoglycemia and
cerebral edema. Option C is incorrect because subcutaneous long-acting
insulin (glargine) takes too long to act and cannot be titrated for acute DKA
management. Option D is avoided unless the pH drops below 6.9, as
aggressive bicarbonate administration can cause profound hypokalemia and
rebound tissue hypoxia.
Question 2
The nurse is preparing to administer digitalis therapy to an infant with a
diagnosis of congenital heart failure. Which clinical finding would require the
nurse to hold the medication and immediately notify the primary healthcare
provider?
A. An apical heart rate of 88 beats per minute
B. Increased urine output over the last 4 hours
C. A serum potassium level of 4.5 mEq/L
D. Mild diaphoresis during feeding periods
CORRECT ANSWER: A. An apical heart rate of 88 beats per minute
RATIONALE: Digoxin toxicity can manifest as severe bradycardia. For
infants, digoxin is generally withheld if the apical pulse is less than 90 to 110
beats per minute (depending on institutional protocol; 88 bpm is critically low
for an infant). Option B is a desired therapeutic effect of improved cardiac
output and renal perfusion. Option C represents a normal potassium level;
hypokalemia increases digoxin toxicity risk, but 4.5 mEq/L is safe. Option D is
a baseline clinical symptom of infant heart failure due to increased metabolic
demand during feeding, not a sign of digoxin toxicity.
Question 3
A client with chronic kidney disease (CKD) presents with a serum potassium
level of 6.8 mEq/L and demonstrates peaked T waves on the cardiac monitor.
Which medication should the nurse expect to administer first to protect the
myocardium?
A. Sodium polystyrene sulfonate orally
B. Calcium gluconate intravenously
,C. Regular insulin with 50% dextrose intravenously
D. Furosemide intravenously
CORRECT ANSWER: B. Calcium gluconate intravenously
RATIONALE: Severe hyperkalemia (potassium > 6.5 mEq/L) with ECG
changes such as peaked T waves is a medical emergency that can rapidly
degenerate into lethal arrhythmias like ventricular fibrillation. Calcium
gluconate does not lower the serum potassium level, but it immediately
stabilizes the myocardial cell membrane, reducing the risk of arrhythmias.
Options A and C are interventions that actually lower potassium levels (by
binding it in the gut or shifting it into cells), but they take longer to act than
calcium gluconate. Option D is less effective in advanced chronic kidney
disease due to diminished nephron function.
Question 4
A nurse is reviewing the laboratory results of a client receiving heparin
sodium via continuous intravenous infusion for a deep vein thrombosis (DVT).
The client’s activated partial thromboplastin time (aPTT) is 110 seconds.
Which action should the nurse take first?
A. Turn off the continuous heparin infusion immediately
B. Administer a full dose of protamine sulfate
C. Redraw the blood sample from the opposite arm
D. Increase the infusion rate by 10% per protocol
CORRECT ANSWER: A. Turn off the continuous heparin infusion
immediately
RATIONALE: The normal therapeutic range for aPTT during heparin
therapy is typically 1.5 to 2.5 times the control value (around 60 to 80
seconds). An aPTT of 110 seconds is significantly prolonged, placing the client
at a critical risk for major spontaneous hemorrhage. The immediate priority
is to stop the continuous infusion to allow aPTT levels to drop. Option B
(protamine sulfate) is the antidote for heparin, but it is reserved for severe,
active bleeding due to its own risks of anaphylaxis and hypotension. Option C
delays necessary action. Option D would worsen the overdose.
, Question 5
The nurse is assessing a pregnant client at 34 weeks gestation who presents
with sudden-onset, severe, painful vaginal bleeding and a rigid, board-like
abdomen. The nurse recognizes these clinical manifestations as highly
indicative of which obstetric emergency?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Cervical incompetence
CORRECT ANSWER: B. Abruptio placentae
RATIONALE: Abruptio placentae occurs when the placenta prematurely
separates from the uterine wall before birth. The classic symptoms include
painful vaginal bleeding, severe abdominal pain, and a hypertonic, rigid,
board-like abdomen due to concealed intra-uterine hemorrhage. Option A
(placenta previa) is characterized by painless, bright red vaginal bleeding
without abdominal rigidity. Option C (uterine rupture) typically presents with
a sudden sharp tearing pain during active labor, accompanied by a cessation
of uterine contractions and recession of the fetal presenting part. Option D
causes painless cervical dilation in the second trimester, not painful late-
pregnancy bleeding.
Question 6
A client with a history of grave's disease undergoes a total thyroidectomy.
Twelve hours postoperatively, the client reports numbness and tingling
around the mouth and muscle twitching in the fingers. Which medication
should the nurse prepare to administer?
A. Levothyroxine sodium
B. Calcium gluconate
C. Potassium iodide
D. Calcitonin salmon
CORRECT ANSWER: B. Calcium gluconate
RATIONALE: During a total thyroidectomy, the parathyroid glands can
be inadvertently damaged or removed, resulting in hypoparathyroidism. This
