NCLEX RN
Updated 2025/26 Exam Test Bank, Questions And Answers
(Verified Answers) With Rationales, 100% Guaranteed Pass
||Complete A+ Guide
This Document Contains:
NCLEX RN Updated 2025/26 Exam Test Bank
Questions And Answers (Verified Answers) With Rationales
850+ Multiple Choice Questions With Rationales
100% Guaranteed Pass
Complete A+ Guide
,NCLEX RN Updated 2025/26 Exam Test Bank, Questions And
Answers (Verified Answers) With Rationales, 100%
Guaranteed Pass ||Complete A+ Guide
QUESTION 1
A 42-year-old client presents with a diagnosis of paranoid schizophrenia. She has become increasingly restless
and verbally argumentative, and her speech has become pressured. She is exhibiting signs of:
A. Depression
B. Agitation
C. Psychotic ideation
D. Anhedonia
Ans: B
Rationale:
(A) Signs of depression would include withdrawal, sadness, morbid thoughts, insomnia, early awakening, etc.
(B) These clinical features are classic signs of agitation. (C) Psychotic ideation includes delusional
thoughts, bizarre behavior, disorganized thinking, etc. (D) Anhedonia is the inability to experience
pleasure.
QUESTION 2
A client is having a vertical partial laryngectomy, and the nurse is planning his postoperative care. A priority
postoperative nursing diagnosis for a client having a vertical partial laryngectomy would be:
A. Activity intolerance
B. Ineffective airway clearance
C. High risk for infection
D. Altered oral mucous membrane
Ans: B
Rationale:
(E) The laryngectomy client should be able to gradually increase activities without difficulty.
(F) The laryngectomy client may have copious amounts of secretions and require suctioning for the first 24–48
hours. The cannula will require cleaning even after the first 24 hours because mucus collects in it. (C) The
client does have a potential for infection, but it is not a more importantnursing priority than the ineffective
airway clearance. (D) This problem is not a more important nursing priority than ineffective airway clearance.
The
,client‘s mouth may become dry, but good oral care should take care of the dryness.
QUESTION 3
A client who is a breast-feeding mother develops mastitis. The clinical signs and symptoms of mastitis include:
“
, A. Marked engorgement, elevated temperature, chills, and breast pain with an area that is red and hardened
B. Marked engorgement and breast pain
C. Elevated temperature and general malaise
D. Cracked nipple with complaints of soreness
Ans: A
Rationale:
(A) Mastitis is a bacterial inflammation of the breast tissue found primarily in breast-feeding mothers. The
bacteria usually enter the breast through a cracked nipple, or the infection results from stasis of milk
behind a blocked duct. (B) With breast engorgement during breast-feeding, there may be marked breast
pain. This is not necessarily a sign of infection.
(C) Women may become ill during breast-feeding with other bacterial or viral infections that are not related to
mastitis. (D) Improper care of the nipples or improper positioning of the
infant during breastfeeding may result in cracked or sore nipples.
QUESTION 4
A client diagnosed with severe anemia is to receive 2 U of packed red blood cells. Prior to starting the
blood transfusion, the nurse must:
A. Take a baseline set of vital signs
B. Hang Ringer‘s lactate as the companion fluid
C. Use microdrip tubing for the blood administration
D. Have the registered nurse in charge assume responsibility for verifying the client and blood
product information
Ans: A
Rationale:
(A) A baseline set of vital signs is necessary to determine if any transfusion reactions occur as the blood
product is being administered. (B) The only companion fluid to be used during a blood transfusion is normal
saline. The calcium in Ringer‘s lactate can cause clotting. (C) Only a blood administration set should be
used. A microdrip tube would cause lysis of the red blood cells. (D) Proper identification of the recipient and
the blood product must be validated by at least two people.
QUESTION 5
The nurse caring for a client who has pneumonia, which is caused by a gram-positive bacteria, inspects
her sputum. Because the client‘s pneumonia is caused by a gram-positive bacteria, the nurse experts to
find the sputum to be:
A. Bright red with streaks
B. Rust colored
C. Green colored
D. Pink-tinged and frothy
Ans: B
Rationale:
Updated 2025/26 Exam Test Bank, Questions And Answers
(Verified Answers) With Rationales, 100% Guaranteed Pass
||Complete A+ Guide
This Document Contains:
NCLEX RN Updated 2025/26 Exam Test Bank
Questions And Answers (Verified Answers) With Rationales
850+ Multiple Choice Questions With Rationales
100% Guaranteed Pass
Complete A+ Guide
,NCLEX RN Updated 2025/26 Exam Test Bank, Questions And
Answers (Verified Answers) With Rationales, 100%
Guaranteed Pass ||Complete A+ Guide
QUESTION 1
A 42-year-old client presents with a diagnosis of paranoid schizophrenia. She has become increasingly restless
and verbally argumentative, and her speech has become pressured. She is exhibiting signs of:
A. Depression
B. Agitation
C. Psychotic ideation
D. Anhedonia
Ans: B
Rationale:
(A) Signs of depression would include withdrawal, sadness, morbid thoughts, insomnia, early awakening, etc.
(B) These clinical features are classic signs of agitation. (C) Psychotic ideation includes delusional
thoughts, bizarre behavior, disorganized thinking, etc. (D) Anhedonia is the inability to experience
pleasure.
QUESTION 2
A client is having a vertical partial laryngectomy, and the nurse is planning his postoperative care. A priority
postoperative nursing diagnosis for a client having a vertical partial laryngectomy would be:
A. Activity intolerance
B. Ineffective airway clearance
C. High risk for infection
D. Altered oral mucous membrane
Ans: B
Rationale:
(E) The laryngectomy client should be able to gradually increase activities without difficulty.
(F) The laryngectomy client may have copious amounts of secretions and require suctioning for the first 24–48
hours. The cannula will require cleaning even after the first 24 hours because mucus collects in it. (C) The
client does have a potential for infection, but it is not a more importantnursing priority than the ineffective
airway clearance. (D) This problem is not a more important nursing priority than ineffective airway clearance.
The
,client‘s mouth may become dry, but good oral care should take care of the dryness.
QUESTION 3
A client who is a breast-feeding mother develops mastitis. The clinical signs and symptoms of mastitis include:
“
, A. Marked engorgement, elevated temperature, chills, and breast pain with an area that is red and hardened
B. Marked engorgement and breast pain
C. Elevated temperature and general malaise
D. Cracked nipple with complaints of soreness
Ans: A
Rationale:
(A) Mastitis is a bacterial inflammation of the breast tissue found primarily in breast-feeding mothers. The
bacteria usually enter the breast through a cracked nipple, or the infection results from stasis of milk
behind a blocked duct. (B) With breast engorgement during breast-feeding, there may be marked breast
pain. This is not necessarily a sign of infection.
(C) Women may become ill during breast-feeding with other bacterial or viral infections that are not related to
mastitis. (D) Improper care of the nipples or improper positioning of the
infant during breastfeeding may result in cracked or sore nipples.
QUESTION 4
A client diagnosed with severe anemia is to receive 2 U of packed red blood cells. Prior to starting the
blood transfusion, the nurse must:
A. Take a baseline set of vital signs
B. Hang Ringer‘s lactate as the companion fluid
C. Use microdrip tubing for the blood administration
D. Have the registered nurse in charge assume responsibility for verifying the client and blood
product information
Ans: A
Rationale:
(A) A baseline set of vital signs is necessary to determine if any transfusion reactions occur as the blood
product is being administered. (B) The only companion fluid to be used during a blood transfusion is normal
saline. The calcium in Ringer‘s lactate can cause clotting. (C) Only a blood administration set should be
used. A microdrip tube would cause lysis of the red blood cells. (D) Proper identification of the recipient and
the blood product must be validated by at least two people.
QUESTION 5
The nurse caring for a client who has pneumonia, which is caused by a gram-positive bacteria, inspects
her sputum. Because the client‘s pneumonia is caused by a gram-positive bacteria, the nurse experts to
find the sputum to be:
A. Bright red with streaks
B. Rust colored
C. Green colored
D. Pink-tinged and frothy
Ans: B
Rationale:
