NCLEX-RN Comprehensive Questions
And Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A Instant
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1. A client with septic shock has received 30 mL/kg of isotonic crystalloid. The
blood pressure remains 82/48 mm Hg, and the mean arterial pressure is 59
mm Hg. Which prescription should the nurse implement first?
A. Administer IV furosemide
B. Begin a norepinephrine infusion
C. Administer oral fluids
D. Place the client in a high-Fowler position
Answer: Begin a norepinephrine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor therapy. Norepinephrine is the preferred first-line
vasopressor to improve vascular tone and maintain organ perfusion.
2. A client with diabetic ketoacidosis has a potassium level of 2.9 mEq/L
before insulin therapy is started. Which action is most appropriate?
A. Start the prescribed regular insulin infusion immediately
B. Administer sodium bicarbonate
C. Replace potassium before initiating insulin
D. Restrict IV fluids
Answer: Replace potassium before initiating insulin
,Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. When serum potassium is below 3.3 mEq/L, potassium
replacement is required before insulin is started.
3. A client receiving a continuous heparin infusion has a platelet count that
decreases from 220,000/mm³ to 92,000/mm³. The client reports new calf
pain. Which action should the nurse take?
A. Continue the infusion and recheck platelets tomorrow
B. Administer protamine sulfate immediately
C. Stop heparin and notify the provider
D. Administer aspirin
Answer: Stop heparin and notify the provider
Rationale: A significant platelet decrease accompanied by thrombosis strongly
suggests heparin-induced thrombocytopenia. Heparin should be discontinued
and an alternative anticoagulant considered.
4. A client with increased intracranial pressure suddenly develops
hypertension, bradycardia, and irregular respirations. How should the nurse
interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Spinal shock
D. Hypovolemic shock
Answer: Cushing response
Rationale: The combination of hypertension, bradycardia, and abnormal
respirations is the Cushing response and indicates significant intracranial
pressure elevation with possible brainstem compression.
5. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 9/min and absent patellar reflexes. Which medication
should the nurse prepare?
,A. Calcium gluconate
B. Naloxone
C. Protamine sulfate
D. Flumazenil
Answer: Calcium gluconate
Rationale: Respiratory depression and absent deep tendon reflexes indicate
magnesium toxicity. Calcium gluconate is the antidote and should be readily
available during magnesium therapy.
6. A client with a chest tube suddenly has continuous bubbling in the water-
seal chamber. What should the nurse do first?
A. Clamp the chest tube
B. Increase wall suction
C. Assess the system for an air leak
D. Remove the chest tube
Answer: Assess the system for an air leak
Rationale: Continuous bubbling in the water-seal chamber suggests an air leak.
The nurse should systematically inspect connections, tubing, and the insertion
site. Routine clamping can cause tension pneumothorax.
7. A client with acute pulmonary edema is severely dyspneic and producing
pink, frothy sputum. Which intervention has the highest priority?
A. Place the client supine
B. Administer oxygen and position upright
C. Encourage oral fluids
D. Apply a heating pad
Answer: Administer oxygen and position upright
Rationale: Pulmonary edema causes severe impaired oxygenation. Upright
positioning decreases venous return and improves lung expansion while oxygen
supports oxygenation.
, 8. A client taking digoxin has nausea, visual disturbances, and an apical pulse
of 48/min. What should the nurse do?
A. Administer the medication with food
B. Give the medication and reassess in 30 minutes
C. Hold digoxin and notify the provider
D. Administer an additional dose
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual changes are
classic findings of digoxin toxicity. The medication should be withheld and the
provider notified.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which prescription should the nurse
implement first?
A. Oral potassium supplement
B. IV calcium gluconate
C. Low-potassium diet teaching
D. Oral iron
Answer: IV calcium gluconate
Rationale: Hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias while definitive potassium-lowering treatment is initiated.
10.A client with Addison disease develops severe weakness, vomiting,
hypotension, and hyponatremia after an infection. Which medication
should the nurse anticipate?
A. IV hydrocortisone
B. Methimazole
C. Levothyroxine only
D. Desmopressin
And Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A Instant
Download Pdf
1. A client with septic shock has received 30 mL/kg of isotonic crystalloid. The
blood pressure remains 82/48 mm Hg, and the mean arterial pressure is 59
mm Hg. Which prescription should the nurse implement first?
A. Administer IV furosemide
B. Begin a norepinephrine infusion
C. Administer oral fluids
D. Place the client in a high-Fowler position
Answer: Begin a norepinephrine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor therapy. Norepinephrine is the preferred first-line
vasopressor to improve vascular tone and maintain organ perfusion.
2. A client with diabetic ketoacidosis has a potassium level of 2.9 mEq/L
before insulin therapy is started. Which action is most appropriate?
A. Start the prescribed regular insulin infusion immediately
B. Administer sodium bicarbonate
C. Replace potassium before initiating insulin
D. Restrict IV fluids
Answer: Replace potassium before initiating insulin
,Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. When serum potassium is below 3.3 mEq/L, potassium
replacement is required before insulin is started.
3. A client receiving a continuous heparin infusion has a platelet count that
decreases from 220,000/mm³ to 92,000/mm³. The client reports new calf
pain. Which action should the nurse take?
A. Continue the infusion and recheck platelets tomorrow
B. Administer protamine sulfate immediately
C. Stop heparin and notify the provider
D. Administer aspirin
Answer: Stop heparin and notify the provider
Rationale: A significant platelet decrease accompanied by thrombosis strongly
suggests heparin-induced thrombocytopenia. Heparin should be discontinued
and an alternative anticoagulant considered.
4. A client with increased intracranial pressure suddenly develops
hypertension, bradycardia, and irregular respirations. How should the nurse
interpret these findings?
A. Neurogenic shock
B. Cushing response
C. Spinal shock
D. Hypovolemic shock
Answer: Cushing response
Rationale: The combination of hypertension, bradycardia, and abnormal
respirations is the Cushing response and indicates significant intracranial
pressure elevation with possible brainstem compression.
5. A client receiving magnesium sulfate for severe preeclampsia has a
respiratory rate of 9/min and absent patellar reflexes. Which medication
should the nurse prepare?
,A. Calcium gluconate
B. Naloxone
C. Protamine sulfate
D. Flumazenil
Answer: Calcium gluconate
Rationale: Respiratory depression and absent deep tendon reflexes indicate
magnesium toxicity. Calcium gluconate is the antidote and should be readily
available during magnesium therapy.
6. A client with a chest tube suddenly has continuous bubbling in the water-
seal chamber. What should the nurse do first?
A. Clamp the chest tube
B. Increase wall suction
C. Assess the system for an air leak
D. Remove the chest tube
Answer: Assess the system for an air leak
Rationale: Continuous bubbling in the water-seal chamber suggests an air leak.
The nurse should systematically inspect connections, tubing, and the insertion
site. Routine clamping can cause tension pneumothorax.
7. A client with acute pulmonary edema is severely dyspneic and producing
pink, frothy sputum. Which intervention has the highest priority?
A. Place the client supine
B. Administer oxygen and position upright
C. Encourage oral fluids
D. Apply a heating pad
Answer: Administer oxygen and position upright
Rationale: Pulmonary edema causes severe impaired oxygenation. Upright
positioning decreases venous return and improves lung expansion while oxygen
supports oxygenation.
, 8. A client taking digoxin has nausea, visual disturbances, and an apical pulse
of 48/min. What should the nurse do?
A. Administer the medication with food
B. Give the medication and reassess in 30 minutes
C. Hold digoxin and notify the provider
D. Administer an additional dose
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual changes are
classic findings of digoxin toxicity. The medication should be withheld and the
provider notified.
9. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which prescription should the nurse
implement first?
A. Oral potassium supplement
B. IV calcium gluconate
C. Low-potassium diet teaching
D. Oral iron
Answer: IV calcium gluconate
Rationale: Hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias while definitive potassium-lowering treatment is initiated.
10.A client with Addison disease develops severe weakness, vomiting,
hypotension, and hyponatremia after an infection. Which medication
should the nurse anticipate?
A. IV hydrocortisone
B. Methimazole
C. Levothyroxine only
D. Desmopressin
