NCLEX-RN COMPREHENSIVE REVIEW NEWEST
MAIN EXAM PRACTICE QUESTIONS 2025 -
2026| ORIGINAL QUESTIONS & ANSWERS |
DETAILED RATIONALES |HINTED COMPLETE
EXAM PREP GRADED A+
1. A nurse is caring for a client who is 4 hours postoperative following a total
hip arthroplasty. The client suddenly reports sharp chest pain and severe
shortness of breath. The respiratory rate is 32/min, oxygen saturation is
84% on room air, and the client is restless. Which action should the nurse
take first?
A. Obtain a prescription for a CT pulmonary angiogram
B. Administer prescribed IV analgesic medication
C. Apply oxygen and assess the client's airway and breathing
D. Encourage the client to use the incentive spirometer
Answer: C. Apply oxygen and assess the client's airway and breathing
The client has acute hypoxemia with possible pulmonary embolism. Airway and
breathing are immediate priorities. Diagnostic testing and additional interventions
should occur after stabilization.
2. A client with diabetic ketoacidosis is receiving an IV regular insulin infusion.
The client's potassium concentration decreases from 4.8 mEq/L to 3.1
mEq/L. Which action is most important?
A. Increase the insulin infusion rate
B. Notify the provider and anticipate potassium replacement
C. Administer sodium bicarbonate immediately
D. Restrict IV fluids
Answer: B. Notify the provider and anticipate potassium replacement
,Insulin drives potassium into cells and can cause dangerous hypokalemia during
DKA treatment. A potassium level of 3.1 mEq/L requires prompt correction and
careful monitoring.
3. A client receiving a continuous heparin infusion develops sudden severe
abdominal pain and hypotension. The nurse notes a rapidly decreasing
hemoglobin level. Which action has priority?
A. Increase the heparin infusion
B. Administer the next scheduled dose of aspirin
C. Stop the heparin infusion and notify the provider
D. Encourage oral fluids
Answer: C. Stop the heparin infusion and notify the provider
The findings suggest significant internal bleeding. Heparin should be stopped
while urgent assessment and management are initiated.
4. A client with heart failure takes furosemide and digoxin. Which laboratory
result requires the nurse to intervene immediately?
A. Sodium 138 mEq/L
B. Potassium 2.7 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Answer: B. Potassium 2.7 mEq/L
Severe hypokalemia increases the risk of digoxin toxicity and potentially fatal
dysrhythmias. The potassium level requires immediate attention.
5. A nurse is assessing four clients. Which client should the nurse assess first?
A. A client with pneumonia who has a temperature of 38.4°C (101.1°F)
B. A client with asthma who has a respiratory rate of 34/min and cannot speak in
complete sentences
C. A client with a urinary tract infection who reports dysuria
D. A client with chronic arthritis who reports pain of 7/10
,Answer: B. A client with asthma who has a respiratory rate of 34/min and
cannot speak in complete sentences
Inability to speak in complete sentences indicates severe respiratory compromise.
Airway and breathing take priority over the other findings.
6. A client receiving a blood transfusion develops chills, fever, flank pain, and
dark urine. What should the nurse do first?
A. Slow the transfusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Recheck the client's temperature in 30 minutes
Answer: B. Stop the transfusion immediately
These findings are consistent with an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately to prevent further exposure to the
incompatible blood.
7. A client with increased intracranial pressure becomes increasingly difficult
to arouse. The blood pressure is 188/60 mm Hg, pulse is 48/min, and
respirations are irregular. Which intervention is the priority?
A. Place the client in Trendelenburg position
B. Maintain airway and oxygenation
C. Encourage coughing every hour
D. Administer oral fluids
Answer: B. Maintain airway and oxygenation
The findings are consistent with worsening intracranial pressure and Cushing
response. Maintaining oxygenation is essential because hypoxia can further
increase cerebral injury.
8. A client receiving IV morphine after surgery has a respiratory rate of 7/min
and is difficult to arouse. Which medication should the nurse anticipate
administering?
, A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Acetylcysteine
Answer: B. Naloxone
Naloxone reverses opioid-induced respiratory depression. The client's respiratory
rate and level of consciousness indicate potentially life-threatening opioid toxicity.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which intervention should the nurse anticipate
first?
A. Oral potassium supplementation
B. IV calcium administration
C. Encourage foods high in potassium
D. Administer a potassium-sparing diuretic
Answer: B. IV calcium administration
Severe hyperkalemia with ECG changes creates an immediate risk of fatal
dysrhythmia. IV calcium stabilizes the cardiac membrane while definitive
potassium-lowering therapy is initiated.
10.A client with sepsis has a blood pressure of 82/48 mm Hg, heart rate of
126/min, and urine output of 15 mL/hr. Which intervention should the
nurse anticipate?
A. Fluid resuscitation with isotonic crystalloid
B. Fluid restriction
C. Administration of a potassium supplement
D. Immediate oral nutrition
Answer: A. Fluid resuscitation with isotonic crystalloid
Hypotension, tachycardia, and oliguria indicate poor tissue perfusion associated
with septic shock. Initial management includes rapid IV crystalloid resuscitation.
MAIN EXAM PRACTICE QUESTIONS 2025 -
2026| ORIGINAL QUESTIONS & ANSWERS |
DETAILED RATIONALES |HINTED COMPLETE
EXAM PREP GRADED A+
1. A nurse is caring for a client who is 4 hours postoperative following a total
hip arthroplasty. The client suddenly reports sharp chest pain and severe
shortness of breath. The respiratory rate is 32/min, oxygen saturation is
84% on room air, and the client is restless. Which action should the nurse
take first?
A. Obtain a prescription for a CT pulmonary angiogram
B. Administer prescribed IV analgesic medication
C. Apply oxygen and assess the client's airway and breathing
D. Encourage the client to use the incentive spirometer
Answer: C. Apply oxygen and assess the client's airway and breathing
The client has acute hypoxemia with possible pulmonary embolism. Airway and
breathing are immediate priorities. Diagnostic testing and additional interventions
should occur after stabilization.
2. A client with diabetic ketoacidosis is receiving an IV regular insulin infusion.
The client's potassium concentration decreases from 4.8 mEq/L to 3.1
mEq/L. Which action is most important?
A. Increase the insulin infusion rate
B. Notify the provider and anticipate potassium replacement
C. Administer sodium bicarbonate immediately
D. Restrict IV fluids
Answer: B. Notify the provider and anticipate potassium replacement
,Insulin drives potassium into cells and can cause dangerous hypokalemia during
DKA treatment. A potassium level of 3.1 mEq/L requires prompt correction and
careful monitoring.
3. A client receiving a continuous heparin infusion develops sudden severe
abdominal pain and hypotension. The nurse notes a rapidly decreasing
hemoglobin level. Which action has priority?
A. Increase the heparin infusion
B. Administer the next scheduled dose of aspirin
C. Stop the heparin infusion and notify the provider
D. Encourage oral fluids
Answer: C. Stop the heparin infusion and notify the provider
The findings suggest significant internal bleeding. Heparin should be stopped
while urgent assessment and management are initiated.
4. A client with heart failure takes furosemide and digoxin. Which laboratory
result requires the nurse to intervene immediately?
A. Sodium 138 mEq/L
B. Potassium 2.7 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Answer: B. Potassium 2.7 mEq/L
Severe hypokalemia increases the risk of digoxin toxicity and potentially fatal
dysrhythmias. The potassium level requires immediate attention.
5. A nurse is assessing four clients. Which client should the nurse assess first?
A. A client with pneumonia who has a temperature of 38.4°C (101.1°F)
B. A client with asthma who has a respiratory rate of 34/min and cannot speak in
complete sentences
C. A client with a urinary tract infection who reports dysuria
D. A client with chronic arthritis who reports pain of 7/10
,Answer: B. A client with asthma who has a respiratory rate of 34/min and
cannot speak in complete sentences
Inability to speak in complete sentences indicates severe respiratory compromise.
Airway and breathing take priority over the other findings.
6. A client receiving a blood transfusion develops chills, fever, flank pain, and
dark urine. What should the nurse do first?
A. Slow the transfusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Recheck the client's temperature in 30 minutes
Answer: B. Stop the transfusion immediately
These findings are consistent with an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately to prevent further exposure to the
incompatible blood.
7. A client with increased intracranial pressure becomes increasingly difficult
to arouse. The blood pressure is 188/60 mm Hg, pulse is 48/min, and
respirations are irregular. Which intervention is the priority?
A. Place the client in Trendelenburg position
B. Maintain airway and oxygenation
C. Encourage coughing every hour
D. Administer oral fluids
Answer: B. Maintain airway and oxygenation
The findings are consistent with worsening intracranial pressure and Cushing
response. Maintaining oxygenation is essential because hypoxia can further
increase cerebral injury.
8. A client receiving IV morphine after surgery has a respiratory rate of 7/min
and is difficult to arouse. Which medication should the nurse anticipate
administering?
, A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Acetylcysteine
Answer: B. Naloxone
Naloxone reverses opioid-induced respiratory depression. The client's respiratory
rate and level of consciousness indicate potentially life-threatening opioid toxicity.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which intervention should the nurse anticipate
first?
A. Oral potassium supplementation
B. IV calcium administration
C. Encourage foods high in potassium
D. Administer a potassium-sparing diuretic
Answer: B. IV calcium administration
Severe hyperkalemia with ECG changes creates an immediate risk of fatal
dysrhythmia. IV calcium stabilizes the cardiac membrane while definitive
potassium-lowering therapy is initiated.
10.A client with sepsis has a blood pressure of 82/48 mm Hg, heart rate of
126/min, and urine output of 15 mL/hr. Which intervention should the
nurse anticipate?
A. Fluid resuscitation with isotonic crystalloid
B. Fluid restriction
C. Administration of a potassium supplement
D. Immediate oral nutrition
Answer: A. Fluid resuscitation with isotonic crystalloid
Hypotension, tachycardia, and oliguria indicate poor tissue perfusion associated
with septic shock. Initial management includes rapid IV crystalloid resuscitation.
