NCLEX-RN 2026 ACTUAL EXAM 2026/2027
WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
The nurse is teaching a client with hyperparathyroidism how to manage
the condition at home. Which response by the client indicates the need
for additional teaching?
A. "I should consume less than 1 liter of fluid per day."
B. "I should use my treadmill or go for walks daily."
C. "I should follow a moderate-calcium, high-fiber diet."
D. "My alendronate helps keep calcium from coming out of my bones."
A
Rationale:
In hyperparathyroidism, clients experience excess parathyroid hormone
(PTH) secretion. A role of PTH in the body is to maintain serum calcium
homeostasis. When PTH levels are high, there is excess bone resorption
(calcium is pulled from the bones). In clients with elevated serum
calcium levels, there is a risk of nephrolithiasis. One to two liters of
fluids daily should be encouraged to protect the kidneys and decrease
the risk of nephrolithiasis. Moderate physical activity, particularly
weight-bearing activity, minimizes bone resorption and helps protect
against pathological fracture. Walking, as an exercise, should be
encouraged in the client with hyperparathyroidism. Even though serum
calcium is already high, clients should follow a moderate-calcium diet,
because a low-calcium diet will surge PTH. Calcium causes constipation,
so a diet high in fiber is recommended. Alendronate is a bisphosphate
Page 1 of 96
,that inhibits bone resorption. In bone resorption, bone is broken down
and calcium is deposited into the serum.
A client with a diagnosis of addisonian crisis is being admitted to the
intensive care unit. Which findings will the interprofessional health care
team focus on? Select all that apply.
A. Hypotension
B. Leukocytosis
C. Hyperkalemia
D. Hypercalcemia
E. Hypernatremia
A, C
Rationale:
In Addison's disease, also known as adrenal insufficiency, destruction of
the adrenal gland leads to decreased production of adrenocortical
hormones, including the glucocorticoid cortisol and the
mineralocorticoid aldosterone. Addisonian crisis, also known as acute
adrenal insufficiency, occurs when there is extreme physical or
emotional stress and lack of sufficient adrenocortical hormones to
manage the stressor. Addisonian crisis is a life-threatening emergency.
One of the roles of endogenous cortisol is to enhance vascular tone and
vascular response to the catecholamines epinephrine and
norepinephrine. Hypotension occurs when vascular tone is decreased
and blood vessels cannot respond to epinephrine and norepinephrine.
The role of aldosterone in the body is to support the blood pressure by
holding salt and water and excreting potassium. When there is
insufficient aldosterone, salt and water are lost and potassium builds
up; this leads to hypotension from decreased vascular volume,
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,hyponatremia, and hyperkalemia. The remaining options are not
associated with addisonian crisis.
The nurse is monitoring a client who was diagnosed with type 1
diabetes mellitus and is being treated with NPH and regular insulin.
Which manifestations would alert the nurse to the presence of a
possible hypoglycemic reaction? Select all that apply.
A. Tremors
B. Anorexia
C. Irritability
D. Nervousness
E. Hot, dry skin
F. Muscle cramps
A, C, D
Rationale:Decreased blood glucose levels produce autonomic nervous
system symptoms, which are manifested classically as nervousness,
irritability, and tremors. Option 5 is more likely to occur with
hyperglycemia. Options 2 and 6 are unrelated to the manifestations of
hypoglycemia. In hypoglycemia, usually the client feels hunger.
The nurse is performing an assessment on a client with
pheochromocytoma. Which assessment data would indicate a potential
complication associated with this disorder?
A. A urinary output of 50 mL/hr
B. A coagulation time of 5 minutes
C. A heart rate that is 90 beats per minute and irregular
D. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)
Page 3 of 96
, C
Rationale:
Pheochromocytoma is a catecholamine-producing tumor usually found
in the adrenal medulla, but extra-adrenal locations include the chest,
bladder, abdomen, and brain; it is typically a benign tumor but can be
malignant. Excessive amounts of epinephrine and norepinephrine are
secreted. The complications associated with pheochromocytoma
include hypertensive retinopathy and nephropathy, myocarditis,
increased platelet aggregation, and stroke. Death can occur from shock,
stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An
irregular heart rate indicates the presence of a dysrhythmia. A
coagulation time of 5 minutes is normal. A urinary output of 50 mL/hr is
an adequate output. A blood urea nitrogen level of 20 mg/dL (7.1
mmol/L) is a normal finding.
The nurse is monitoring a client diagnosed with acromegaly who was
treated with transsphenoidal hypophysectomy and is recovering in the
intensive care unit. Which findings should alert the nurse to the
presence of a possible postoperative complication? Select all that apply.
A. Anxiety
B. Leukocytosis
C. Chvostek's sign
D. Urinary output of 800 mL/hr
E. Clear drainage on nasal dripper pad
B, D, E
Rationale:
Acromegaly results from excess secretion of growth hormone, usually
caused by a benign tumor on the anterior pituitary gland. Treatment is
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WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
The nurse is teaching a client with hyperparathyroidism how to manage
the condition at home. Which response by the client indicates the need
for additional teaching?
A. "I should consume less than 1 liter of fluid per day."
B. "I should use my treadmill or go for walks daily."
C. "I should follow a moderate-calcium, high-fiber diet."
D. "My alendronate helps keep calcium from coming out of my bones."
A
Rationale:
In hyperparathyroidism, clients experience excess parathyroid hormone
(PTH) secretion. A role of PTH in the body is to maintain serum calcium
homeostasis. When PTH levels are high, there is excess bone resorption
(calcium is pulled from the bones). In clients with elevated serum
calcium levels, there is a risk of nephrolithiasis. One to two liters of
fluids daily should be encouraged to protect the kidneys and decrease
the risk of nephrolithiasis. Moderate physical activity, particularly
weight-bearing activity, minimizes bone resorption and helps protect
against pathological fracture. Walking, as an exercise, should be
encouraged in the client with hyperparathyroidism. Even though serum
calcium is already high, clients should follow a moderate-calcium diet,
because a low-calcium diet will surge PTH. Calcium causes constipation,
so a diet high in fiber is recommended. Alendronate is a bisphosphate
Page 1 of 96
,that inhibits bone resorption. In bone resorption, bone is broken down
and calcium is deposited into the serum.
A client with a diagnosis of addisonian crisis is being admitted to the
intensive care unit. Which findings will the interprofessional health care
team focus on? Select all that apply.
A. Hypotension
B. Leukocytosis
C. Hyperkalemia
D. Hypercalcemia
E. Hypernatremia
A, C
Rationale:
In Addison's disease, also known as adrenal insufficiency, destruction of
the adrenal gland leads to decreased production of adrenocortical
hormones, including the glucocorticoid cortisol and the
mineralocorticoid aldosterone. Addisonian crisis, also known as acute
adrenal insufficiency, occurs when there is extreme physical or
emotional stress and lack of sufficient adrenocortical hormones to
manage the stressor. Addisonian crisis is a life-threatening emergency.
One of the roles of endogenous cortisol is to enhance vascular tone and
vascular response to the catecholamines epinephrine and
norepinephrine. Hypotension occurs when vascular tone is decreased
and blood vessels cannot respond to epinephrine and norepinephrine.
The role of aldosterone in the body is to support the blood pressure by
holding salt and water and excreting potassium. When there is
insufficient aldosterone, salt and water are lost and potassium builds
up; this leads to hypotension from decreased vascular volume,
Page 2 of 96
,hyponatremia, and hyperkalemia. The remaining options are not
associated with addisonian crisis.
The nurse is monitoring a client who was diagnosed with type 1
diabetes mellitus and is being treated with NPH and regular insulin.
Which manifestations would alert the nurse to the presence of a
possible hypoglycemic reaction? Select all that apply.
A. Tremors
B. Anorexia
C. Irritability
D. Nervousness
E. Hot, dry skin
F. Muscle cramps
A, C, D
Rationale:Decreased blood glucose levels produce autonomic nervous
system symptoms, which are manifested classically as nervousness,
irritability, and tremors. Option 5 is more likely to occur with
hyperglycemia. Options 2 and 6 are unrelated to the manifestations of
hypoglycemia. In hypoglycemia, usually the client feels hunger.
The nurse is performing an assessment on a client with
pheochromocytoma. Which assessment data would indicate a potential
complication associated with this disorder?
A. A urinary output of 50 mL/hr
B. A coagulation time of 5 minutes
C. A heart rate that is 90 beats per minute and irregular
D. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L)
Page 3 of 96
, C
Rationale:
Pheochromocytoma is a catecholamine-producing tumor usually found
in the adrenal medulla, but extra-adrenal locations include the chest,
bladder, abdomen, and brain; it is typically a benign tumor but can be
malignant. Excessive amounts of epinephrine and norepinephrine are
secreted. The complications associated with pheochromocytoma
include hypertensive retinopathy and nephropathy, myocarditis,
increased platelet aggregation, and stroke. Death can occur from shock,
stroke, kidney failure, dysrhythmias, or dissecting aortic aneurysm. An
irregular heart rate indicates the presence of a dysrhythmia. A
coagulation time of 5 minutes is normal. A urinary output of 50 mL/hr is
an adequate output. A blood urea nitrogen level of 20 mg/dL (7.1
mmol/L) is a normal finding.
The nurse is monitoring a client diagnosed with acromegaly who was
treated with transsphenoidal hypophysectomy and is recovering in the
intensive care unit. Which findings should alert the nurse to the
presence of a possible postoperative complication? Select all that apply.
A. Anxiety
B. Leukocytosis
C. Chvostek's sign
D. Urinary output of 800 mL/hr
E. Clear drainage on nasal dripper pad
B, D, E
Rationale:
Acromegaly results from excess secretion of growth hormone, usually
caused by a benign tumor on the anterior pituitary gland. Treatment is
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