NCLEX Mastery Volume 6 – 100 Practice
Questions with Rationales.
Q1. A patient with COPD is on 2 L/min oxygen via nasal cannula. Which finding requires
immediate intervention?
A) SpO₂ 90%
B) Patient using pursed-lip breathing
C) Patient confused and drowsy
D) Respiratory rate 20/min
Answer: C) Patient confused and drowsy
Rationale: Confusion indicates possible CO₂ retention or hypoxemia; this requires urgent action.
Q2. A nurse prepares to administer digoxin to a patient. Which lab result is most concerning?
A) Potassium 3.0 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mEq/L
Answer: A) Potassium 3.0 mEq/L
Rationale: Hypokalemia increases risk of digoxin toxicity; hold medication and notify provider.
Q3. Which instruction is essential for a patient prescribed warfarin?
A) Avoid green leafy vegetables
B) Report any bleeding or bruising
C) Increase intake of vitamin K
D) Stop medication if feeling well
Answer: B) Report any bleeding or bruising
Rationale: Bleeding is the main complication of warfarin; early reporting is critical.
Q4. A patient receiving a blood transfusion develops chills and back pain. What should the nurse
do first?
A) Administer acetaminophen
B) Stop the transfusion
C) Call the provider
D) Check blood type again
Answer: B) Stop the transfusion
Rationale: Transfusion reaction requires immediate discontinuation to prevent further
complications.
Q5. Which patient should the nurse see first?
A) Asthma patient with mild wheezing
B) Pneumonia patient with SpO₂ 84%
C) Appendicitis patient with abdominal pain
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,D) CHF patient with mild ankle swelling
Answer: B) Pneumonia patient with SpO₂ 84%
Rationale: Severe hypoxemia is life-threatening and requires immediate intervention.
Q6. A patient on furosemide reports muscle cramps. Which electrolyte imbalance is most likely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics increase potassium excretion; cramps are a common symptom of
hypokalemia.
Q7. Which assessment finding in a patient with heart failure requires immediate action?
A) 2+ ankle edema
B) Weight gain of 2 lbs overnight
C) Pink frothy sputum
D) Fatigue with exertion
Answer: C) Pink frothy sputum
Rationale: This indicates pulmonary edema, an emergency complication.
Q8. A patient post-thyroidectomy has hoarseness and difficulty swallowing. Which action is
priority?
A) Offer warm fluids
B) Assess airway
C) Reassure patient
D) Document finding
Answer: B) Assess airway
Rationale: Airway obstruction from swelling or hematoma is life-threatening.
Q9. The nurse notes a pressure injury with exposed bone on a patient’s sacrum. What stage is
this?
A) Stage 2
B) Stage 3
C) Stage 4
D) Unstageable
Answer: C) Stage 4
Rationale: Stage 4 pressure injuries extend to muscle or bone.
Q10. A patient receiving heparin infusion has a PTT of 120 seconds. What should the nurse do?
A) Continue infusion
B) Stop infusion and notify provider
C) Increase infusion rate
D) Administer aspirin
Answer: B) Stop infusion and notify provider
Rationale: PTT above therapeutic range indicates risk of bleeding.
For expert assistance contact us on WhatsApp: +254700486651
, Q11. A patient with cirrhosis develops confusion and asterixis. Which medication is expected?
A) Furosemide
B) Lactulose
C) Omeprazole
D) Metformin
Answer: B) Lactulose
Rationale: Lactulose reduces ammonia levels in hepatic encephalopathy.
Q12. Which isolation is required for a patient with tuberculosis?
A) Droplet
B) Airborne
C) Contact
D) Standard
Answer: B) Airborne
Rationale: TB spreads via airborne droplets; N95 mask and negative-pressure room needed.
Q13. A patient is prescribed levothyroxine. Which statement shows correct understanding?
A) “I will take this with my breakfast.”
B) “I can stop taking it when I feel better.”
C) “I should take it every morning on an empty stomach.”
D) “I’ll take it at night with food.”
Answer: C) “I should take it every morning on an empty stomach.”
Rationale: Absorption is best on an empty stomach, same time daily.
Q14. Which patient should not receive the influenza vaccine?
A) Adult with asthma
B) Elderly patient
C) Child with severe egg allergy
D) Pregnant woman
Answer: C) Child with severe egg allergy
Rationale: Severe egg allergy is a contraindication.
Q15. Which order should the nurse question?
A) Warfarin for atrial fibrillation
B) Metoprolol for hypertension
C) Ibuprofen for a patient with gastric ulcer
D) Furosemide for pulmonary edema
Answer: C) Ibuprofen for a patient with gastric ulcer
Rationale: NSAIDs worsen gastric ulcers.
Q16. A patient has an NG tube for suction. Which electrolyte imbalance is expected?
A) Hyperkalemia
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Questions with Rationales.
Q1. A patient with COPD is on 2 L/min oxygen via nasal cannula. Which finding requires
immediate intervention?
A) SpO₂ 90%
B) Patient using pursed-lip breathing
C) Patient confused and drowsy
D) Respiratory rate 20/min
Answer: C) Patient confused and drowsy
Rationale: Confusion indicates possible CO₂ retention or hypoxemia; this requires urgent action.
Q2. A nurse prepares to administer digoxin to a patient. Which lab result is most concerning?
A) Potassium 3.0 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mEq/L
Answer: A) Potassium 3.0 mEq/L
Rationale: Hypokalemia increases risk of digoxin toxicity; hold medication and notify provider.
Q3. Which instruction is essential for a patient prescribed warfarin?
A) Avoid green leafy vegetables
B) Report any bleeding or bruising
C) Increase intake of vitamin K
D) Stop medication if feeling well
Answer: B) Report any bleeding or bruising
Rationale: Bleeding is the main complication of warfarin; early reporting is critical.
Q4. A patient receiving a blood transfusion develops chills and back pain. What should the nurse
do first?
A) Administer acetaminophen
B) Stop the transfusion
C) Call the provider
D) Check blood type again
Answer: B) Stop the transfusion
Rationale: Transfusion reaction requires immediate discontinuation to prevent further
complications.
Q5. Which patient should the nurse see first?
A) Asthma patient with mild wheezing
B) Pneumonia patient with SpO₂ 84%
C) Appendicitis patient with abdominal pain
For expert assistance contact us on WhatsApp: +254700486651
,D) CHF patient with mild ankle swelling
Answer: B) Pneumonia patient with SpO₂ 84%
Rationale: Severe hypoxemia is life-threatening and requires immediate intervention.
Q6. A patient on furosemide reports muscle cramps. Which electrolyte imbalance is most likely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics increase potassium excretion; cramps are a common symptom of
hypokalemia.
Q7. Which assessment finding in a patient with heart failure requires immediate action?
A) 2+ ankle edema
B) Weight gain of 2 lbs overnight
C) Pink frothy sputum
D) Fatigue with exertion
Answer: C) Pink frothy sputum
Rationale: This indicates pulmonary edema, an emergency complication.
Q8. A patient post-thyroidectomy has hoarseness and difficulty swallowing. Which action is
priority?
A) Offer warm fluids
B) Assess airway
C) Reassure patient
D) Document finding
Answer: B) Assess airway
Rationale: Airway obstruction from swelling or hematoma is life-threatening.
Q9. The nurse notes a pressure injury with exposed bone on a patient’s sacrum. What stage is
this?
A) Stage 2
B) Stage 3
C) Stage 4
D) Unstageable
Answer: C) Stage 4
Rationale: Stage 4 pressure injuries extend to muscle or bone.
Q10. A patient receiving heparin infusion has a PTT of 120 seconds. What should the nurse do?
A) Continue infusion
B) Stop infusion and notify provider
C) Increase infusion rate
D) Administer aspirin
Answer: B) Stop infusion and notify provider
Rationale: PTT above therapeutic range indicates risk of bleeding.
For expert assistance contact us on WhatsApp: +254700486651
, Q11. A patient with cirrhosis develops confusion and asterixis. Which medication is expected?
A) Furosemide
B) Lactulose
C) Omeprazole
D) Metformin
Answer: B) Lactulose
Rationale: Lactulose reduces ammonia levels in hepatic encephalopathy.
Q12. Which isolation is required for a patient with tuberculosis?
A) Droplet
B) Airborne
C) Contact
D) Standard
Answer: B) Airborne
Rationale: TB spreads via airborne droplets; N95 mask and negative-pressure room needed.
Q13. A patient is prescribed levothyroxine. Which statement shows correct understanding?
A) “I will take this with my breakfast.”
B) “I can stop taking it when I feel better.”
C) “I should take it every morning on an empty stomach.”
D) “I’ll take it at night with food.”
Answer: C) “I should take it every morning on an empty stomach.”
Rationale: Absorption is best on an empty stomach, same time daily.
Q14. Which patient should not receive the influenza vaccine?
A) Adult with asthma
B) Elderly patient
C) Child with severe egg allergy
D) Pregnant woman
Answer: C) Child with severe egg allergy
Rationale: Severe egg allergy is a contraindication.
Q15. Which order should the nurse question?
A) Warfarin for atrial fibrillation
B) Metoprolol for hypertension
C) Ibuprofen for a patient with gastric ulcer
D) Furosemide for pulmonary edema
Answer: C) Ibuprofen for a patient with gastric ulcer
Rationale: NSAIDs worsen gastric ulcers.
Q16. A patient has an NG tube for suction. Which electrolyte imbalance is expected?
A) Hyperkalemia
For expert assistance contact us on WhatsApp: +254700486651
