NCLEX-RN PRACTICE EXAM
(ADVANCED LEVEL) QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is caring for a client with a history of heart failure who is receiving Digoxin. The
client reports nausea, vomiting, and seeing yellow-green halos around lights. What is the
nurse’s priority action?
A. Administer the next dose of Digoxin as scheduled
B. Assess the client’s apical pulse for one full minute
C. Document the findings and monitor the client’s blood pressure
D. Notify the healthcare provider immediately and request a serum digoxin level
Answer: D
Conceptual Explanation: Nausea, vomiting, and visual changes (yellow-green halos) are
classic signs of digoxin toxicity. The priority is to notify the provider and obtain serum
levels to confirm toxicity and guide treatment.
2. A client is admitted to the emergency department with suspected autonomic dysreflexia.
Which clinical manifestation should the nurse expect to find?
A. Severe pounding headache and profuse sweating above the level of injury
,B. Tachycardia and hypotension
C. Flaccid paralysis and loss of sensation below the level of injury
D. Extreme shivering and pale skin in the upper extremities
Answer: A
Conceptual Explanation: Autonomic dysreflexia is a medical emergency occurring in
spinal cord injuries (T6 or higher), characterized by severe hypertension, pounding
headache, and diaphoresis above the lesion level.
3. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a chest tube who has 50 mL of drainage in the last 2 hours
B. A client with Type 1 Diabetes whose morning blood glucose is 160 mg/dL
C. A client who underwent a thyroidectomy 4 hours ago and is complaining of tingling in
the fingers
D. A client with COPD who has an oxygen saturation of 91% on room air
Answer: C
Conceptual Explanation: Tingling in fingers post-thyroidectomy suggests hypocalcemia
due to accidental parathyroid gland removal, which can lead to life-threatening
laryngospasm.
, 4. A nurse is providing discharge instructions to a client who had a permanent pacemaker
inserted. Which statement by the client indicates a need for further teaching?
A. ‘I will avoid lifting my arm on the side of the pacemaker above my shoulder for 6 weeks.’
B. ‘I will need to avoid walking through airport security metal detectors.’
C. ‘I should tell my dentist about my pacemaker before any procedures.’
D. ‘I can safely use my microwave oven at home.’
Answer: B
Conceptual Explanation: Modern pacemakers are generally not affected by metal
detectors, but clients should not linger in the walk-through area or lean against hand-held
wands. The client needs further teaching if they think they must avoid them entirely.
5. Which laboratory value is the most important for the nurse to monitor for a client receiving
a heparin infusion for a pulmonary embolism?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Activated Partial Thromboplastin Time (aPTT)
Answer: D
Conceptual Explanation: aPTT is used to monitor the therapeutic effect of unfractionated
heparin. PT/INR are used for warfarin monitoring.
(ADVANCED LEVEL) QUESTIONS &
ANSWERS (VERIFIED ANSWERS) WITH
EXPERT EXPLANATIONS | 2026 – 2027
UPDATE (PDF)
1. A nurse is caring for a client with a history of heart failure who is receiving Digoxin. The
client reports nausea, vomiting, and seeing yellow-green halos around lights. What is the
nurse’s priority action?
A. Administer the next dose of Digoxin as scheduled
B. Assess the client’s apical pulse for one full minute
C. Document the findings and monitor the client’s blood pressure
D. Notify the healthcare provider immediately and request a serum digoxin level
Answer: D
Conceptual Explanation: Nausea, vomiting, and visual changes (yellow-green halos) are
classic signs of digoxin toxicity. The priority is to notify the provider and obtain serum
levels to confirm toxicity and guide treatment.
2. A client is admitted to the emergency department with suspected autonomic dysreflexia.
Which clinical manifestation should the nurse expect to find?
A. Severe pounding headache and profuse sweating above the level of injury
,B. Tachycardia and hypotension
C. Flaccid paralysis and loss of sensation below the level of injury
D. Extreme shivering and pale skin in the upper extremities
Answer: A
Conceptual Explanation: Autonomic dysreflexia is a medical emergency occurring in
spinal cord injuries (T6 or higher), characterized by severe hypertension, pounding
headache, and diaphoresis above the lesion level.
3. The nurse is assigned to four clients. Which client should the nurse assess first?
A. A client with a chest tube who has 50 mL of drainage in the last 2 hours
B. A client with Type 1 Diabetes whose morning blood glucose is 160 mg/dL
C. A client who underwent a thyroidectomy 4 hours ago and is complaining of tingling in
the fingers
D. A client with COPD who has an oxygen saturation of 91% on room air
Answer: C
Conceptual Explanation: Tingling in fingers post-thyroidectomy suggests hypocalcemia
due to accidental parathyroid gland removal, which can lead to life-threatening
laryngospasm.
, 4. A nurse is providing discharge instructions to a client who had a permanent pacemaker
inserted. Which statement by the client indicates a need for further teaching?
A. ‘I will avoid lifting my arm on the side of the pacemaker above my shoulder for 6 weeks.’
B. ‘I will need to avoid walking through airport security metal detectors.’
C. ‘I should tell my dentist about my pacemaker before any procedures.’
D. ‘I can safely use my microwave oven at home.’
Answer: B
Conceptual Explanation: Modern pacemakers are generally not affected by metal
detectors, but clients should not linger in the walk-through area or lean against hand-held
wands. The client needs further teaching if they think they must avoid them entirely.
5. Which laboratory value is the most important for the nurse to monitor for a client receiving
a heparin infusion for a pulmonary embolism?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Activated Partial Thromboplastin Time (aPTT)
Answer: D
Conceptual Explanation: aPTT is used to monitor the therapeutic effect of unfractionated
heparin. PT/INR are used for warfarin monitoring.
