NCLEX RN ACTUAL EXAM REAL QUSTIONS & VERIFIED ANSWERS
2026/2027
A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient
about the medication, which of the following will the healthcare provider include?
"Be sure to include a number of foods in your diet that are rich in potassium."
"I'll teach you how to take your radial pulse before taking the medication."
"Take this medication every day with a large glass of water after your evening meal."
"Stop taking this medication if you notice changes in how much you urinate."
Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the
medication in the evening so that sleep is not interrupted. Potassium is lost in the urine along with sodium
and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid
hypokalemia. Examples of potassium-rich foods include avocados, spinach, sweet potatoes, yogurt, and
bananas.
A patient receiving vancomycin has an order for a trough level to be drawn. When should the lab collect
the blood sample?
30 minutes after the infusion
1 hour before the infusion
1 hour after the infusion
30 minutes before the infusion
A patient with a diagnosis of hepatic coma is admitted to the ICU. The provider orders neomycin 300mg
q6h to be administered via the NG tube. The nurse knows the rationale for this drug order is
to prevent further liver damage.
to prevent fulminate sepsis.
to decrease the pH level in the small intestine.
to decrease the serum ammonia level.
Although neomycin is generally prescribed to treat infection, it is also prescribed for patients with liver
disease to kill intestinal bacteria. The bacteria produce ammonia when breaking down protein. The
diseased liver is unable to clear the ammonia, so serum levels build and lead to hepatic encephalopathy.
Neomycin does not affect pH or prevent further liver damage.
The pediatrician prescribes amoxicillin suspension 200 mg PO q 8 hr for a 3-year-old client with acute otitis
media. The child weighs 38 pounds (17.2 kg). The recommended daily dose range for children up to 40 kg is
20-40 mg/kg/day in divided doses every 8 hours. Following the 10 Rights of Medication Administration,
what is the nurse's BEST action?
Contact the pediatrician to clarify the dose.
Administer the medication as prescribed.
Withhold the dose because it is too low.
Refuse to give because it is not the drug of choice.
The nurse should administer the dose, since it is within appropriate guidelines. The child may safely receive
344-688 mg/day, in divided doses of 115-230 mg each. Amoxicillin (20-40/kg/day) is the antibiotic of choice
for treating acute otitis media in clients older than 2 years who are not allergic to penicillin. Approximately
80% of children will have at least one episode of acute otitis media. The 10 Rights of Medication
Administration that are applicable here: Right patient, right medication, right dose, right route, right time,
and right assessment.
, The nurse hangs an IV piggyback (IVPB) of vancomycin for a client who had a total knee replacement.
When the nurse returns a few minutes later, which of the following indicates that the client is experiencing
a serious reaction to the vancomycin?
Rash on the face and neck
Hypertension and bradycardia
Sudden shortness of breath
Cyanosis around the face and lips
Vancomycin flushing syndrome (VFS) [previously called red man syndrome (RMS)] is a common allergic
reaction to vancomycin that typically presents with a rash on the face, neck, and upper torso after
intravenous administration of vancomycin. VFS is related to a rapid rate of infusion; it should not be
administered faster than 1 gram/hour. Other symptoms are hypotension, itching, nausea/vomiting,
fever/chills, weakness, dizziness, and tachycardia. VFS most often begins 4-10 minutes after the start of the
first dose of vancomycin, although it can occur with doses as late as 7 days later. The nurse should
immediately stop the infusion and notify the HCP. Treatment is with steroids and antihistamines. Future
doses are given at slower rates. Sudden shortness of breath is indicative of anaphylaxis. Cyanosis is not
related to VFS.
While a healthcare provider is caring for a patient following a laryngectomy, the patient suddenly becomes
pale and nonresponsive with a BP of 90/40. What should be done first?
Move the emergency cart to the patient's bedside.
Administer atropine intravenously.
Increase the infusion of dextrose in normal saline (D5NS).
Place the client in the Trendelenburg position.
D5NS infusion is hypertonic, so it will draw fluid into the circulation. Trendelenburg position could
compromise the airway in a patient who has had head or neck surgery. Atropine could cause hyponatremia
and further hypotension. It is not necessary to move the emergency cart to the patient's bedside at this
time.
The nurse is preparing to administer procedural morphine sulfate as an analgesic to a 4-year-old child who
weighs 40 pounds. The health care provider (HCP) has prescribed 4 mg morphine sulfate IV. What is the
nurse's BEST action?
Contact the pharmacy for advice.
Verify the dosage for the child.
Administer the dose as ordered.
Give half the prescribed dose.
The nurse should verify the dosage strength (Right Dose) for the child before administering. For this child
(40 lbs = 18.2 kg) the dosage should be 1.5-1.8 mg/dose. For procedural analgesia and sedation in children,
morphine sulfate is given 0.08-0.1 mg/kg/dose IV, IM, or SC before the procedure and every 5-10 minutes
as needed. Peak effect is 15-30 minutes after IV administration and 30-60 minutes after IM administration.
Morphine sulfate is indicated for procedural analgesia because it is reliable, predictable, and easily
reversed with naloxone. NOTE: An average 4-year-old weighs 40 pounds and is 40 inches tall.
The purpose of holding a sterile gauze pad on the site of an IM injection while removing the needle is to
increase the absorption of the medication.
seal off the track left by the needle.
decrease the discomfort of the needle pulling on the skin.
prevent pathogens from entering through the puncture.
Pressing the gauze pad against the skin while removing the needle reduces the discomfort of the pulling
sensation. Once the medication has been completely injected, remove the needle using a smooth, steady
motion. Remove the needle at the same angle at which it was inserted.
2026/2027
A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient
about the medication, which of the following will the healthcare provider include?
"Be sure to include a number of foods in your diet that are rich in potassium."
"I'll teach you how to take your radial pulse before taking the medication."
"Take this medication every day with a large glass of water after your evening meal."
"Stop taking this medication if you notice changes in how much you urinate."
Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the
medication in the evening so that sleep is not interrupted. Potassium is lost in the urine along with sodium
and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid
hypokalemia. Examples of potassium-rich foods include avocados, spinach, sweet potatoes, yogurt, and
bananas.
A patient receiving vancomycin has an order for a trough level to be drawn. When should the lab collect
the blood sample?
30 minutes after the infusion
1 hour before the infusion
1 hour after the infusion
30 minutes before the infusion
A patient with a diagnosis of hepatic coma is admitted to the ICU. The provider orders neomycin 300mg
q6h to be administered via the NG tube. The nurse knows the rationale for this drug order is
to prevent further liver damage.
to prevent fulminate sepsis.
to decrease the pH level in the small intestine.
to decrease the serum ammonia level.
Although neomycin is generally prescribed to treat infection, it is also prescribed for patients with liver
disease to kill intestinal bacteria. The bacteria produce ammonia when breaking down protein. The
diseased liver is unable to clear the ammonia, so serum levels build and lead to hepatic encephalopathy.
Neomycin does not affect pH or prevent further liver damage.
The pediatrician prescribes amoxicillin suspension 200 mg PO q 8 hr for a 3-year-old client with acute otitis
media. The child weighs 38 pounds (17.2 kg). The recommended daily dose range for children up to 40 kg is
20-40 mg/kg/day in divided doses every 8 hours. Following the 10 Rights of Medication Administration,
what is the nurse's BEST action?
Contact the pediatrician to clarify the dose.
Administer the medication as prescribed.
Withhold the dose because it is too low.
Refuse to give because it is not the drug of choice.
The nurse should administer the dose, since it is within appropriate guidelines. The child may safely receive
344-688 mg/day, in divided doses of 115-230 mg each. Amoxicillin (20-40/kg/day) is the antibiotic of choice
for treating acute otitis media in clients older than 2 years who are not allergic to penicillin. Approximately
80% of children will have at least one episode of acute otitis media. The 10 Rights of Medication
Administration that are applicable here: Right patient, right medication, right dose, right route, right time,
and right assessment.
, The nurse hangs an IV piggyback (IVPB) of vancomycin for a client who had a total knee replacement.
When the nurse returns a few minutes later, which of the following indicates that the client is experiencing
a serious reaction to the vancomycin?
Rash on the face and neck
Hypertension and bradycardia
Sudden shortness of breath
Cyanosis around the face and lips
Vancomycin flushing syndrome (VFS) [previously called red man syndrome (RMS)] is a common allergic
reaction to vancomycin that typically presents with a rash on the face, neck, and upper torso after
intravenous administration of vancomycin. VFS is related to a rapid rate of infusion; it should not be
administered faster than 1 gram/hour. Other symptoms are hypotension, itching, nausea/vomiting,
fever/chills, weakness, dizziness, and tachycardia. VFS most often begins 4-10 minutes after the start of the
first dose of vancomycin, although it can occur with doses as late as 7 days later. The nurse should
immediately stop the infusion and notify the HCP. Treatment is with steroids and antihistamines. Future
doses are given at slower rates. Sudden shortness of breath is indicative of anaphylaxis. Cyanosis is not
related to VFS.
While a healthcare provider is caring for a patient following a laryngectomy, the patient suddenly becomes
pale and nonresponsive with a BP of 90/40. What should be done first?
Move the emergency cart to the patient's bedside.
Administer atropine intravenously.
Increase the infusion of dextrose in normal saline (D5NS).
Place the client in the Trendelenburg position.
D5NS infusion is hypertonic, so it will draw fluid into the circulation. Trendelenburg position could
compromise the airway in a patient who has had head or neck surgery. Atropine could cause hyponatremia
and further hypotension. It is not necessary to move the emergency cart to the patient's bedside at this
time.
The nurse is preparing to administer procedural morphine sulfate as an analgesic to a 4-year-old child who
weighs 40 pounds. The health care provider (HCP) has prescribed 4 mg morphine sulfate IV. What is the
nurse's BEST action?
Contact the pharmacy for advice.
Verify the dosage for the child.
Administer the dose as ordered.
Give half the prescribed dose.
The nurse should verify the dosage strength (Right Dose) for the child before administering. For this child
(40 lbs = 18.2 kg) the dosage should be 1.5-1.8 mg/dose. For procedural analgesia and sedation in children,
morphine sulfate is given 0.08-0.1 mg/kg/dose IV, IM, or SC before the procedure and every 5-10 minutes
as needed. Peak effect is 15-30 minutes after IV administration and 30-60 minutes after IM administration.
Morphine sulfate is indicated for procedural analgesia because it is reliable, predictable, and easily
reversed with naloxone. NOTE: An average 4-year-old weighs 40 pounds and is 40 inches tall.
The purpose of holding a sterile gauze pad on the site of an IM injection while removing the needle is to
increase the absorption of the medication.
seal off the track left by the needle.
decrease the discomfort of the needle pulling on the skin.
prevent pathogens from entering through the puncture.
Pressing the gauze pad against the skin while removing the needle reduces the discomfort of the pulling
sensation. Once the medication has been completely injected, remove the needle using a smooth, steady
motion. Remove the needle at the same angle at which it was inserted.
