SAUNDERS COMPREHENSIVE REVIEW FOR
THE NCLEX-RN EXAMINATION (2025) |
COMPLETE NCLEX-RN PRACTICE
QUESTIONS WITH MULTIPLE-CHOICE ITEMS,
DETAILED RATIONALES & EXAM-FOCUSED
REVIEW GUIDE
• This 200-question practice exam mirrors the NCLEX-RN blueprint across all major
nursing content areas, giving you a full-spectrum simulation of the actual
examination experience.
• Use this material by reading each question carefully before reviewing the correct
answer and EXPERT RATIONALE — attempt every question independently first to
maximize retention and identify weak areas for focused review.
SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN EXAMINATION (2026)
COMPLETE NCLEX-RN PRACTICE EXAM | 200 QUESTIONS
1. A nurse is caring for a client who has been prescribed digoxin. Before
administering the medication, the nurse assesses the client's apical pulse and
finds it to be 54 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as prescribed and document the finding
B. Administer the digoxin and notify the physician after administration
C. Hold the digoxin, notify the physician, and document the findings
D. Hold the digoxin, recheck the pulse in 30 minutes, and then administer
E. Administer half the prescribed dose and monitor the client closely
Correct Answer: C. Hold the digoxin, notify the physician, and document the
findings
EXPERT RATIONALE: Digoxin is held when the apical pulse is below 60 beats per
minute in an adult. The nurse must withhold the dose, notify the prescriber
,immediately, and document all findings. Administering digoxin with bradycardia
can worsen the condition and lead to life-threatening dysrhythmias.
2. A nurse is assessing a client with left-sided heart failure. Which finding is
most expected?
A. Peripheral edema and jugular vein distension
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and ascites
D. Bounding peripheral pulses and hypertension
E. Decreased urinary output and polydipsia
Correct Answer: B. Crackles in the lung bases and orthopnea
EXPERT RATIONALE: Left-sided heart failure causes pulmonary congestion due to
backup of blood into the pulmonary circulation. This leads to crackles in the lungs
and orthopnea. Right-sided heart failure causes systemic congestion such as
peripheral edema, jugular vein distension, hepatomegaly, and ascites.
3. A nurse is preparing to administer a blood transfusion. The client develops
chills, back pain, and dark-colored urine shortly after the transfusion begins.
What type of reaction is occurring?
A. Febrile non-hemolytic transfusion reaction
B. Allergic transfusion reaction
C. Acute hemolytic transfusion reaction
D. Circulatory overload
E. Transfusion-related acute lung injury
Correct Answer: C. Acute hemolytic transfusion reaction
,EXPERT RATIONALE: Acute hemolytic transfusion reaction occurs when ABO-
incompatible blood is transfused. Symptoms include fever, chills, flank or back pain,
and hemoglobinuria (dark urine) due to red blood cell destruction. This is a medical
emergency; the transfusion must be stopped immediately.
4. A nurse is caring for a postoperative client who reports sudden onset of
chest pain and dyspnea. The nurse suspects pulmonary embolism. What is the
priority nursing action?
A. Administer oxygen and elevate the head of the bed
B. Obtain a 12-lead ECG immediately
C. Prepare the client for emergency surgery
D. Administer prescribed analgesics for pain relief
E. Place the client in Trendelenburg position
Correct Answer: A. Administer oxygen and elevate the head of the bed
EXPERT RATIONALE: In a suspected pulmonary embolism, the priority is to
maintain oxygenation. The nurse should administer oxygen immediately and
position the client with the head of the bed elevated to facilitate breathing.
Trendelenburg position is contraindicated as it worsens respiratory distress.
5. A nurse is teaching a client about warfarin therapy. Which statement by
the client indicates a need for further teaching?
A. "I will have my INR checked regularly."
B. "I should avoid foods high in vitamin K."
C. "I can take aspirin for my headaches."
D. "I will use a soft toothbrush to prevent bleeding."
E. "I should report any unusual bruising to my doctor."
Correct Answer: C. "I can take aspirin for my headaches."
, EXPERT RATIONALE: Aspirin has antiplatelet properties that can potentiate the
anticoagulant effects of warfarin, significantly increasing bleeding risk. Clients on
warfarin should avoid aspirin and NSAIDs unless specifically prescribed.
Acetaminophen is the preferred analgesic for minor pain.
6. A nurse is caring for a client with chronic kidney disease. Which laboratory
value requires immediate intervention?
A. Serum creatinine 3.2 mg/dL
B. BUN 45 mg/dL
C. Serum potassium 6.8 mEq/L
D. Serum sodium 132 mEq/L
E. Hemoglobin 9.5 g/dL
Correct Answer: C. Serum potassium 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L represents severe
hyperkalemia, which can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. This requires immediate intervention.
Although the other values are abnormal, they are not immediately life-threatening.
7. A nurse is assessing a newborn. Which finding requires immediate
reporting to the physician?
A. Vernix caseosa covering the skin
B. Acrocyanosis of the hands and feet
C. Central cyanosis of the lips and trunk
D. Molding of the head after vaginal delivery
E. Lanugo on the shoulders and back
Correct Answer: C. Central cyanosis of the lips and trunk
THE NCLEX-RN EXAMINATION (2025) |
COMPLETE NCLEX-RN PRACTICE
QUESTIONS WITH MULTIPLE-CHOICE ITEMS,
DETAILED RATIONALES & EXAM-FOCUSED
REVIEW GUIDE
• This 200-question practice exam mirrors the NCLEX-RN blueprint across all major
nursing content areas, giving you a full-spectrum simulation of the actual
examination experience.
• Use this material by reading each question carefully before reviewing the correct
answer and EXPERT RATIONALE — attempt every question independently first to
maximize retention and identify weak areas for focused review.
SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN EXAMINATION (2026)
COMPLETE NCLEX-RN PRACTICE EXAM | 200 QUESTIONS
1. A nurse is caring for a client who has been prescribed digoxin. Before
administering the medication, the nurse assesses the client's apical pulse and
finds it to be 54 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as prescribed and document the finding
B. Administer the digoxin and notify the physician after administration
C. Hold the digoxin, notify the physician, and document the findings
D. Hold the digoxin, recheck the pulse in 30 minutes, and then administer
E. Administer half the prescribed dose and monitor the client closely
Correct Answer: C. Hold the digoxin, notify the physician, and document the
findings
EXPERT RATIONALE: Digoxin is held when the apical pulse is below 60 beats per
minute in an adult. The nurse must withhold the dose, notify the prescriber
,immediately, and document all findings. Administering digoxin with bradycardia
can worsen the condition and lead to life-threatening dysrhythmias.
2. A nurse is assessing a client with left-sided heart failure. Which finding is
most expected?
A. Peripheral edema and jugular vein distension
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and ascites
D. Bounding peripheral pulses and hypertension
E. Decreased urinary output and polydipsia
Correct Answer: B. Crackles in the lung bases and orthopnea
EXPERT RATIONALE: Left-sided heart failure causes pulmonary congestion due to
backup of blood into the pulmonary circulation. This leads to crackles in the lungs
and orthopnea. Right-sided heart failure causes systemic congestion such as
peripheral edema, jugular vein distension, hepatomegaly, and ascites.
3. A nurse is preparing to administer a blood transfusion. The client develops
chills, back pain, and dark-colored urine shortly after the transfusion begins.
What type of reaction is occurring?
A. Febrile non-hemolytic transfusion reaction
B. Allergic transfusion reaction
C. Acute hemolytic transfusion reaction
D. Circulatory overload
E. Transfusion-related acute lung injury
Correct Answer: C. Acute hemolytic transfusion reaction
,EXPERT RATIONALE: Acute hemolytic transfusion reaction occurs when ABO-
incompatible blood is transfused. Symptoms include fever, chills, flank or back pain,
and hemoglobinuria (dark urine) due to red blood cell destruction. This is a medical
emergency; the transfusion must be stopped immediately.
4. A nurse is caring for a postoperative client who reports sudden onset of
chest pain and dyspnea. The nurse suspects pulmonary embolism. What is the
priority nursing action?
A. Administer oxygen and elevate the head of the bed
B. Obtain a 12-lead ECG immediately
C. Prepare the client for emergency surgery
D. Administer prescribed analgesics for pain relief
E. Place the client in Trendelenburg position
Correct Answer: A. Administer oxygen and elevate the head of the bed
EXPERT RATIONALE: In a suspected pulmonary embolism, the priority is to
maintain oxygenation. The nurse should administer oxygen immediately and
position the client with the head of the bed elevated to facilitate breathing.
Trendelenburg position is contraindicated as it worsens respiratory distress.
5. A nurse is teaching a client about warfarin therapy. Which statement by
the client indicates a need for further teaching?
A. "I will have my INR checked regularly."
B. "I should avoid foods high in vitamin K."
C. "I can take aspirin for my headaches."
D. "I will use a soft toothbrush to prevent bleeding."
E. "I should report any unusual bruising to my doctor."
Correct Answer: C. "I can take aspirin for my headaches."
, EXPERT RATIONALE: Aspirin has antiplatelet properties that can potentiate the
anticoagulant effects of warfarin, significantly increasing bleeding risk. Clients on
warfarin should avoid aspirin and NSAIDs unless specifically prescribed.
Acetaminophen is the preferred analgesic for minor pain.
6. A nurse is caring for a client with chronic kidney disease. Which laboratory
value requires immediate intervention?
A. Serum creatinine 3.2 mg/dL
B. BUN 45 mg/dL
C. Serum potassium 6.8 mEq/L
D. Serum sodium 132 mEq/L
E. Hemoglobin 9.5 g/dL
Correct Answer: C. Serum potassium 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L represents severe
hyperkalemia, which can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. This requires immediate intervention.
Although the other values are abnormal, they are not immediately life-threatening.
7. A nurse is assessing a newborn. Which finding requires immediate
reporting to the physician?
A. Vernix caseosa covering the skin
B. Acrocyanosis of the hands and feet
C. Central cyanosis of the lips and trunk
D. Molding of the head after vaginal delivery
E. Lanugo on the shoulders and back
Correct Answer: C. Central cyanosis of the lips and trunk
