NCLEX-RN Practice Questions with Rationales 100% correct answers.
25 original questions across pharmacology, prioritization, med-surg, maternal-newborn, pediatrics, and
mental health. Every question includes the correct answer and a full rationale. Verify drug values against
a current reference before publishing.
How to Use This Guide
Answer each question before reading the rationale. For every item, ask yourself: what is the question
really asking, and which option is safest? Mark questions you miss and revisit them in 48 hours.
Section 1: Pharmacology
1. A client prescribed furosemide is due for lab work. Which result should the nurse monitor most
closely?
A. Sodium B. Potassium C. Calcium D. Phosphorus
Answer: B. Loop diuretics cause potassium loss, so hypokalemia is the main risk. It can lead to muscle
weakness, cramping, and cardiac arrhythmias. Normal potassium is about 3.5 to 5.0 mEq/L. Teach
clients to eat potassium-rich foods unless told otherwise.
2. Before administering digoxin, the nurse finds an apical pulse of 54 bpm. What is the priority action?
A. Administer the dose as scheduled B. Recheck the pulse in 4 hours C. Hold the dose and notify the
provider D. Give the dose with a banana
Answer: C. Hold digoxin for an adult apical pulse below 60 and notify the provider. Bradycardia can be a
sign of digoxin toxicity. Other signs include nausea, visual changes (yellow-green halos), and confusion.
Therapeutic level is about 0.5 to 2.0 ng/mL.
3. A client taking warfarin has an INR of 5.2 with no active bleeding. Which order does the nurse
anticipate?
A. Protamine sulfate B. Hold warfarin and possibly give vitamin K C. Double the next dose D. Increase
green leafy vegetables
Answer: B. The antidote for warfarin is vitamin K (phytonadione). Protamine sulfate reverses heparin.
The goal INR for most clients on warfarin is 2 to 3.
4. A client taking metformin is scheduled for a CT scan with contrast. What does the nurse expect?
A. Give an extra dose before the scan B. Hold metformin per protocol C. Switch to insulin permanently
D. No change to the regimen
Answer: B. Contrast dye can impair kidney function, and impaired clearance of metformin raises the risk
of lactic acidosis. Metformin is typically held before and for about 48 hours after contrast, then
restarted once kidney function is confirmed stable.
5. (Select all that apply) Which findings suggest lithium toxicity?
, A. Coarse hand tremors B. Persistent diarrhea C. Ataxia D. Dry mouth E. Mild fine tremor
Answer: A, B, C. Fine tremor and dry mouth are common, expected effects. Coarse tremors, GI distress,
and ataxia signal toxicity. Therapeutic range is about 0.6 to 1.2 mEq/L. Clients need consistent sodium
and fluid intake.
6. A client is receiving a heparin infusion. Which lab value should the nurse monitor?
A. PT/INR B. aPTT C. Hemoglobin A1c D. BUN
Answer: B. Heparin is monitored with aPTT (therapeutic is typically 1.5 to 2.5 times the control value).
Warfarin is monitored with PT/INR. Also watch platelets for heparin-induced thrombocytopenia.
7. A nurse is teaching a client who is starting an ACE inhibitor such as lisinopril. Which statement
indicates the need for further teaching?
A. "I should report a persistent dry cough." B. "I should rise slowly from a seated position." C. "I can use
a salt substitute with potassium." D. "I should report swelling of my lips or tongue."
Answer: C. ACE inhibitors raise potassium, and potassium-based salt substitutes can cause
hyperkalemia. A dry cough is a common side effect, and lip or tongue swelling (angioedema) is an
emergency.
8. A client has been prescribed levothyroxine. Which instruction is most appropriate?
A. Take it with breakfast B. Take it on an empty stomach in the morning C. Take it at bedtime with milk
D. Stop if heart rate increases slightly
Answer: B. Levothyroxine is best absorbed on an empty stomach, usually 30 to 60 minutes before
breakfast. Calcium and iron reduce absorption. The client should report chest pain, palpitations, or
significant weight loss, which can signal too high a dose.
9. A client receiving morphine has a respiratory rate of 8 breaths per minute. Which medication should
the nurse prepare?
A. Flumazenil B. Naloxone C. Acetylcysteine D. Atropine
Answer: B. Naloxone reverses opioid-induced respiratory depression. Flumazenil reverses
benzodiazepines. Acetylcysteine is the antidote for acetaminophen overdose. Always assess respiratory
rate before giving opioids.
10. A client is prescribed gentamicin. Which finding should the nurse report immediately?
A. Mild nausea B. Ringing in the ears C. Dry mouth D. Mild headache
Answer: B. Aminoglycosides are ototoxic and nephrotoxic. Tinnitus, hearing loss, or dizziness can signal
damage to cranial nerve VIII. Monitor peak and trough levels, BUN, and creatinine.
Section 2: Prioritization and Delegation
11. Which client should the nurse assess first?
25 original questions across pharmacology, prioritization, med-surg, maternal-newborn, pediatrics, and
mental health. Every question includes the correct answer and a full rationale. Verify drug values against
a current reference before publishing.
How to Use This Guide
Answer each question before reading the rationale. For every item, ask yourself: what is the question
really asking, and which option is safest? Mark questions you miss and revisit them in 48 hours.
Section 1: Pharmacology
1. A client prescribed furosemide is due for lab work. Which result should the nurse monitor most
closely?
A. Sodium B. Potassium C. Calcium D. Phosphorus
Answer: B. Loop diuretics cause potassium loss, so hypokalemia is the main risk. It can lead to muscle
weakness, cramping, and cardiac arrhythmias. Normal potassium is about 3.5 to 5.0 mEq/L. Teach
clients to eat potassium-rich foods unless told otherwise.
2. Before administering digoxin, the nurse finds an apical pulse of 54 bpm. What is the priority action?
A. Administer the dose as scheduled B. Recheck the pulse in 4 hours C. Hold the dose and notify the
provider D. Give the dose with a banana
Answer: C. Hold digoxin for an adult apical pulse below 60 and notify the provider. Bradycardia can be a
sign of digoxin toxicity. Other signs include nausea, visual changes (yellow-green halos), and confusion.
Therapeutic level is about 0.5 to 2.0 ng/mL.
3. A client taking warfarin has an INR of 5.2 with no active bleeding. Which order does the nurse
anticipate?
A. Protamine sulfate B. Hold warfarin and possibly give vitamin K C. Double the next dose D. Increase
green leafy vegetables
Answer: B. The antidote for warfarin is vitamin K (phytonadione). Protamine sulfate reverses heparin.
The goal INR for most clients on warfarin is 2 to 3.
4. A client taking metformin is scheduled for a CT scan with contrast. What does the nurse expect?
A. Give an extra dose before the scan B. Hold metformin per protocol C. Switch to insulin permanently
D. No change to the regimen
Answer: B. Contrast dye can impair kidney function, and impaired clearance of metformin raises the risk
of lactic acidosis. Metformin is typically held before and for about 48 hours after contrast, then
restarted once kidney function is confirmed stable.
5. (Select all that apply) Which findings suggest lithium toxicity?
, A. Coarse hand tremors B. Persistent diarrhea C. Ataxia D. Dry mouth E. Mild fine tremor
Answer: A, B, C. Fine tremor and dry mouth are common, expected effects. Coarse tremors, GI distress,
and ataxia signal toxicity. Therapeutic range is about 0.6 to 1.2 mEq/L. Clients need consistent sodium
and fluid intake.
6. A client is receiving a heparin infusion. Which lab value should the nurse monitor?
A. PT/INR B. aPTT C. Hemoglobin A1c D. BUN
Answer: B. Heparin is monitored with aPTT (therapeutic is typically 1.5 to 2.5 times the control value).
Warfarin is monitored with PT/INR. Also watch platelets for heparin-induced thrombocytopenia.
7. A nurse is teaching a client who is starting an ACE inhibitor such as lisinopril. Which statement
indicates the need for further teaching?
A. "I should report a persistent dry cough." B. "I should rise slowly from a seated position." C. "I can use
a salt substitute with potassium." D. "I should report swelling of my lips or tongue."
Answer: C. ACE inhibitors raise potassium, and potassium-based salt substitutes can cause
hyperkalemia. A dry cough is a common side effect, and lip or tongue swelling (angioedema) is an
emergency.
8. A client has been prescribed levothyroxine. Which instruction is most appropriate?
A. Take it with breakfast B. Take it on an empty stomach in the morning C. Take it at bedtime with milk
D. Stop if heart rate increases slightly
Answer: B. Levothyroxine is best absorbed on an empty stomach, usually 30 to 60 minutes before
breakfast. Calcium and iron reduce absorption. The client should report chest pain, palpitations, or
significant weight loss, which can signal too high a dose.
9. A client receiving morphine has a respiratory rate of 8 breaths per minute. Which medication should
the nurse prepare?
A. Flumazenil B. Naloxone C. Acetylcysteine D. Atropine
Answer: B. Naloxone reverses opioid-induced respiratory depression. Flumazenil reverses
benzodiazepines. Acetylcysteine is the antidote for acetaminophen overdose. Always assess respiratory
rate before giving opioids.
10. A client is prescribed gentamicin. Which finding should the nurse report immediately?
A. Mild nausea B. Ringing in the ears C. Dry mouth D. Mild headache
Answer: B. Aminoglycosides are ototoxic and nephrotoxic. Tinnitus, hearing loss, or dizziness can signal
damage to cranial nerve VIII. Monitor peak and trough levels, BUN, and creatinine.
Section 2: Prioritization and Delegation
11. Which client should the nurse assess first?
