NCLEX-RN ACTUAL EXAM TEST BANK 2027-2028 Questions
& Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
QUESTION 1
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. Which assessment finding indicates that the oxygen therapy is
effective?
A. The client's respiratory rate is 28 breaths per minute
B. The client's oxygen saturation is 92%
C. The client's oxygen saturation is 88%
D. The client's PaCO2 is 55 mmHg
CORRECT ANSWER: B. The client's oxygen saturation is 92%
RATIONALE: For clients with COPD, oxygen therapy is effective when SpO2 is maintained
between 88-92% (or as prescribed) and the client is comfortable. SpO2 of 92% indicates
adequate oxygenation. A respiratory rate of 28 (A) is still elevated and may indicate
ongoing respiratory distress. SpO2 of 88% (C) is borderline and may require adjustment. A
PaCO2 of 55 mmHg (D) is elevated and may indicate CO2 retention, requiring further
intervention. The nurse should monitor for signs of oxygen toxicity and CO2 narcosis.
QUESTION 2
A client is admitted with a diagnosis of acute myocardial infarction (MI). The nurse
should anticipate which immediate intervention?
A. Administering morphine sulfate for pain
B. Preparing the client for emergency coronary artery bypass graft (CABG) surgery
,C. Administering aspirin and sublingual nitroglycerin
D. Placing the client in Trendelenburg position
CORRECT ANSWER: C. Administering aspirin and sublingual nitroglycerin
RATIONALE: Immediate interventions for acute MI include aspirin (to prevent further
platelet aggregation) and sublingual nitroglycerin (to reduce preload and afterload and
relieve chest pain). Morphine (A) may be administered for pain but is not the first
intervention. CABG (B) may be indicated later but is not the immediate priority.
Trendelenburg position (D) is contraindicated as it increases preload and myocardial
oxygen demand. Oxygen therapy is also a priority.
QUESTION 3
The nurse is assessing a client with a suspected gastrointestinal bleed. Which finding is
most concerning?
A. Hemoglobin level of 10.0 g/dL
B. Blood pressure of 110/70 mmHg
C. Heart rate of 120 beats per minute
D. Dark, tarry stools
CORRECT ANSWER: C. Heart rate of 120 beats per minute
RATIONALE: A heart rate of 120 bpm (tachycardia) in a client with a suspected GI bleed
indicates significant blood loss and impending hypovolemic shock. This requires
immediate intervention. A hemoglobin of 10.0 g/dL (A) is low but not immediately life-
threatening. A blood pressure of 110/70 mmHg (B) may be within normal limits but could
drop further. Dark, tarry stools (D) indicate upper GI bleeding but do not necessarily
indicate acute severity. The nurse should also assess for orthostatic changes, pallor, and
signs of shock.
,QUESTION 4
A client with a history of seizures is prescribed valproic acid (Depakote). Which
laboratory test should be monitored regularly?
A. Serum sodium
B. Serum potassium
C. Liver function tests (AST, ALT)
D. Thyroid function tests
CORRECT ANSWER: C. Liver function tests (AST, ALT)
RATIONALE: Valproic acid can cause hepatotoxicity, especially in children and clients
with pre-existing liver disease. Liver function tests should be monitored at baseline and
regularly during treatment. Serum sodium (A) and potassium (B) are not specifically
monitored for valproic acid. Thyroid function tests (D) are not indicated for valproic acid.
The nurse should also monitor for signs of liver dysfunction such as jaundice, abdominal
pain, and fatigue.
QUESTION 5
A client is being discharged with a new prescription for clopidogrel (Plavix). Which
instruction should the nurse include in the discharge teaching?
A. "You may stop taking this medication if you experience side effects."
B. "Avoid taking this medication with aspirin."
C. "Report any unusual bleeding or bruising to your healthcare provider."
D. "Take this medication with food to prevent stomach upset."
CORRECT ANSWER: C. "Report any unusual bleeding or bruising to your healthcare
provider."
RATIONALE: Clopidogrel is an antiplatelet medication that increases the risk of bleeding.
Clients should be instructed to report any unusual bleeding, bruising, or signs of internal
, bleeding (black stools, hematuria). The medication should not be stopped abruptly (A).
Aspirin (B) may be taken with clopidogrel if prescribed (dual antiplatelet therapy) but
should not be taken without provider approval. Clopidogrel can be taken with or without
food (D).
QUESTION 6
A client with a new diagnosis of diabetes mellitus is learning to mix regular and NPH
insulin. Which sequence is correct?
A. Draw up NPH insulin first, then regular insulin
B. Draw up regular insulin first, then NPH insulin
C. Draw up both insulins in the same syringe at the same time
D. Use two separate syringes
CORRECT ANSWER: B. Draw up regular insulin first, then NPH insulin
RATIONALE: Regular insulin should be drawn up first (clear before cloudy) to prevent
contamination of the regular insulin with the NPH insulin. This ensures accurate dosing
and maintains the short-acting insulin's rapid onset. Drawing up NPH first (A) can
contaminate the regular insulin with the cloudy insulin, altering its action. Using two
separate syringes (D) is wasteful and not recommended. The nurse should also teach
proper injection site rotation and storage of insulin.
QUESTION 7
The nurse is caring for a client with a head injury who is at risk for increased intracranial
pressure (ICP). Which nursing intervention is most appropriate?
A. Cluster all nursing activities together to minimize disruption
B. Elevate the head of the bed 30 degrees
C. Place the client in a prone position
D. Encourage the client to cough and deep breathe frequently
& Answers with Detailed Rationales
Updated for 2027 NCLEX Exam
QUESTION 1
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. Which assessment finding indicates that the oxygen therapy is
effective?
A. The client's respiratory rate is 28 breaths per minute
B. The client's oxygen saturation is 92%
C. The client's oxygen saturation is 88%
D. The client's PaCO2 is 55 mmHg
CORRECT ANSWER: B. The client's oxygen saturation is 92%
RATIONALE: For clients with COPD, oxygen therapy is effective when SpO2 is maintained
between 88-92% (or as prescribed) and the client is comfortable. SpO2 of 92% indicates
adequate oxygenation. A respiratory rate of 28 (A) is still elevated and may indicate
ongoing respiratory distress. SpO2 of 88% (C) is borderline and may require adjustment. A
PaCO2 of 55 mmHg (D) is elevated and may indicate CO2 retention, requiring further
intervention. The nurse should monitor for signs of oxygen toxicity and CO2 narcosis.
QUESTION 2
A client is admitted with a diagnosis of acute myocardial infarction (MI). The nurse
should anticipate which immediate intervention?
A. Administering morphine sulfate for pain
B. Preparing the client for emergency coronary artery bypass graft (CABG) surgery
,C. Administering aspirin and sublingual nitroglycerin
D. Placing the client in Trendelenburg position
CORRECT ANSWER: C. Administering aspirin and sublingual nitroglycerin
RATIONALE: Immediate interventions for acute MI include aspirin (to prevent further
platelet aggregation) and sublingual nitroglycerin (to reduce preload and afterload and
relieve chest pain). Morphine (A) may be administered for pain but is not the first
intervention. CABG (B) may be indicated later but is not the immediate priority.
Trendelenburg position (D) is contraindicated as it increases preload and myocardial
oxygen demand. Oxygen therapy is also a priority.
QUESTION 3
The nurse is assessing a client with a suspected gastrointestinal bleed. Which finding is
most concerning?
A. Hemoglobin level of 10.0 g/dL
B. Blood pressure of 110/70 mmHg
C. Heart rate of 120 beats per minute
D. Dark, tarry stools
CORRECT ANSWER: C. Heart rate of 120 beats per minute
RATIONALE: A heart rate of 120 bpm (tachycardia) in a client with a suspected GI bleed
indicates significant blood loss and impending hypovolemic shock. This requires
immediate intervention. A hemoglobin of 10.0 g/dL (A) is low but not immediately life-
threatening. A blood pressure of 110/70 mmHg (B) may be within normal limits but could
drop further. Dark, tarry stools (D) indicate upper GI bleeding but do not necessarily
indicate acute severity. The nurse should also assess for orthostatic changes, pallor, and
signs of shock.
,QUESTION 4
A client with a history of seizures is prescribed valproic acid (Depakote). Which
laboratory test should be monitored regularly?
A. Serum sodium
B. Serum potassium
C. Liver function tests (AST, ALT)
D. Thyroid function tests
CORRECT ANSWER: C. Liver function tests (AST, ALT)
RATIONALE: Valproic acid can cause hepatotoxicity, especially in children and clients
with pre-existing liver disease. Liver function tests should be monitored at baseline and
regularly during treatment. Serum sodium (A) and potassium (B) are not specifically
monitored for valproic acid. Thyroid function tests (D) are not indicated for valproic acid.
The nurse should also monitor for signs of liver dysfunction such as jaundice, abdominal
pain, and fatigue.
QUESTION 5
A client is being discharged with a new prescription for clopidogrel (Plavix). Which
instruction should the nurse include in the discharge teaching?
A. "You may stop taking this medication if you experience side effects."
B. "Avoid taking this medication with aspirin."
C. "Report any unusual bleeding or bruising to your healthcare provider."
D. "Take this medication with food to prevent stomach upset."
CORRECT ANSWER: C. "Report any unusual bleeding or bruising to your healthcare
provider."
RATIONALE: Clopidogrel is an antiplatelet medication that increases the risk of bleeding.
Clients should be instructed to report any unusual bleeding, bruising, or signs of internal
, bleeding (black stools, hematuria). The medication should not be stopped abruptly (A).
Aspirin (B) may be taken with clopidogrel if prescribed (dual antiplatelet therapy) but
should not be taken without provider approval. Clopidogrel can be taken with or without
food (D).
QUESTION 6
A client with a new diagnosis of diabetes mellitus is learning to mix regular and NPH
insulin. Which sequence is correct?
A. Draw up NPH insulin first, then regular insulin
B. Draw up regular insulin first, then NPH insulin
C. Draw up both insulins in the same syringe at the same time
D. Use two separate syringes
CORRECT ANSWER: B. Draw up regular insulin first, then NPH insulin
RATIONALE: Regular insulin should be drawn up first (clear before cloudy) to prevent
contamination of the regular insulin with the NPH insulin. This ensures accurate dosing
and maintains the short-acting insulin's rapid onset. Drawing up NPH first (A) can
contaminate the regular insulin with the cloudy insulin, altering its action. Using two
separate syringes (D) is wasteful and not recommended. The nurse should also teach
proper injection site rotation and storage of insulin.
QUESTION 7
The nurse is caring for a client with a head injury who is at risk for increased intracranial
pressure (ICP). Which nursing intervention is most appropriate?
A. Cluster all nursing activities together to minimize disruption
B. Elevate the head of the bed 30 degrees
C. Place the client in a prone position
D. Encourage the client to cough and deep breathe frequently
