NCLEX-RN Comprehensive Practice
Exam 006 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
Download Pdf
1. A client with heart failure is receiving IV furosemide. Which finding
requires the nurse's immediate attention?
A. Urine output of 1,200 mL in 8 hours
B. Potassium level of 2.8 mEq/L
C. Blood pressure of 108/68 mm Hg
D. Weight loss of 1 kg in 24 hours
Answer: Potassium level of 2.8 mEq/L
Rationale: A potassium level of 2.8 mEq/L indicates significant hypokalemia,
which can cause life-threatening dysrhythmias. Furosemide promotes
potassium loss, so this finding requires prompt intervention.
2. A nurse is assessing a client with suspected increased intracranial pressure.
Which finding is most concerning?
A. Headache
B. Nausea
C. Unequal pupils
D. Photophobia
Answer: Unequal pupils
Rationale: Unequal or dilated pupils can indicate cranial nerve compression
from increased intracranial pressure and may signal neurological
deterioration.
3. Which instruction should the nurse give a client taking warfarin?
,A. Increase intake of spinach
B. Use aspirin for headaches
C. Maintain a consistent intake of vitamin K
D. Stop the medication when bruising occurs
Answer: Maintain a consistent intake of vitamin K
Rationale: Vitamin K affects warfarin effectiveness. Clients should maintain a
consistent intake rather than avoiding vitamin K completely.
4. A client with diabetes mellitus becomes confused, diaphoretic, and shaky.
What should the nurse do first?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Encourage the client to exercise
D. Administer glucagon immediately
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: These findings are classic manifestations of hypoglycemia. If the
client is conscious and able to swallow, 15 g of rapid-acting carbohydrate is
appropriate.
5. Which assessment finding is expected in a client with chronic obstructive
pulmonary disease?
A. Severe bradycardia
B. Barrel-shaped chest
C. Decreased anteroposterior chest diameter
D. Absent respiratory effort
Answer: Barrel-shaped chest
Rationale: Chronic air trapping in COPD can increase the anteroposterior
diameter of the chest, producing a barrel-shaped appearance.
6. A client receiving digoxin has an apical pulse of 52/min. What should the
nurse do?
A. Administer the medication
B. Hold the medication
,C. Double the next dose
D. Give the medication with food
Answer: Hold the medication
Rationale: Digoxin can cause bradycardia. The medication should generally
be withheld when the adult apical pulse is below 60/min and the provider
should be notified according to the prescription and facility policy.
7. Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema
B. Ascites
C. Pulmonary crackles
D. Enlarged liver
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion, which can
produce crackles, dyspnea, and orthopnea.
8. A client with a chest tube has continuous bubbling in the water-seal
chamber. What does this finding indicate?
A. Normal lung re-expansion
B. An air leak
C. Adequate suction
D. Tube obstruction
Answer: An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates
an air leak somewhere in the system. The nurse should assess the tubing and
connections.
9. Which intervention is appropriate for a client experiencing an acute
asthma exacerbation?
A. Encourage prolonged ambulation
B. Administer the prescribed short-acting bronchodilator
C. Restrict fluids completely
D. Place the client flat in bed
, Answer: Administer the prescribed short-acting bronchodilator
Rationale: Short-acting bronchodilators such as albuterol rapidly relax
bronchial smooth muscle and are commonly used for acute asthma
symptoms.
10. Which laboratory result is most concerning for a client receiving heparin?
A. Hemoglobin 13 g/dL
B. Platelets 48,000/mm³
C. Sodium 138 mEq/L
D. Potassium 4.1 mEq/L
Answer: Platelets 48,000/mm³
Rationale: Severe thrombocytopenia increases bleeding risk and may indicate
heparin-induced thrombocytopenia, requiring immediate evaluation.
11. A client with a new prescription for lisinopril reports swelling of the lips
and tongue. What is the nurse's priority action?
A. Administer the next dose
B. Encourage oral fluids
C. Treat the finding as a potential airway emergency
D. Reassure the client that this is expected
Answer: Treat the finding as a potential airway emergency
Rationale: Angioedema is a potentially life-threatening adverse effect of ACE
inhibitors. Airway assessment and emergency intervention are priorities.
12. Which food should a client with chronic kidney disease limit because of its
high potassium content?
A. Apples
B. White rice
C. Bananas
D. Bread
Answer: Bananas
Rationale: Bananas are high in potassium. Clients with impaired renal
potassium excretion may need to restrict high-potassium foods.
Exam 006 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
Download Pdf
1. A client with heart failure is receiving IV furosemide. Which finding
requires the nurse's immediate attention?
A. Urine output of 1,200 mL in 8 hours
B. Potassium level of 2.8 mEq/L
C. Blood pressure of 108/68 mm Hg
D. Weight loss of 1 kg in 24 hours
Answer: Potassium level of 2.8 mEq/L
Rationale: A potassium level of 2.8 mEq/L indicates significant hypokalemia,
which can cause life-threatening dysrhythmias. Furosemide promotes
potassium loss, so this finding requires prompt intervention.
2. A nurse is assessing a client with suspected increased intracranial pressure.
Which finding is most concerning?
A. Headache
B. Nausea
C. Unequal pupils
D. Photophobia
Answer: Unequal pupils
Rationale: Unequal or dilated pupils can indicate cranial nerve compression
from increased intracranial pressure and may signal neurological
deterioration.
3. Which instruction should the nurse give a client taking warfarin?
,A. Increase intake of spinach
B. Use aspirin for headaches
C. Maintain a consistent intake of vitamin K
D. Stop the medication when bruising occurs
Answer: Maintain a consistent intake of vitamin K
Rationale: Vitamin K affects warfarin effectiveness. Clients should maintain a
consistent intake rather than avoiding vitamin K completely.
4. A client with diabetes mellitus becomes confused, diaphoretic, and shaky.
What should the nurse do first?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Encourage the client to exercise
D. Administer glucagon immediately
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: These findings are classic manifestations of hypoglycemia. If the
client is conscious and able to swallow, 15 g of rapid-acting carbohydrate is
appropriate.
5. Which assessment finding is expected in a client with chronic obstructive
pulmonary disease?
A. Severe bradycardia
B. Barrel-shaped chest
C. Decreased anteroposterior chest diameter
D. Absent respiratory effort
Answer: Barrel-shaped chest
Rationale: Chronic air trapping in COPD can increase the anteroposterior
diameter of the chest, producing a barrel-shaped appearance.
6. A client receiving digoxin has an apical pulse of 52/min. What should the
nurse do?
A. Administer the medication
B. Hold the medication
,C. Double the next dose
D. Give the medication with food
Answer: Hold the medication
Rationale: Digoxin can cause bradycardia. The medication should generally
be withheld when the adult apical pulse is below 60/min and the provider
should be notified according to the prescription and facility policy.
7. Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema
B. Ascites
C. Pulmonary crackles
D. Enlarged liver
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion, which can
produce crackles, dyspnea, and orthopnea.
8. A client with a chest tube has continuous bubbling in the water-seal
chamber. What does this finding indicate?
A. Normal lung re-expansion
B. An air leak
C. Adequate suction
D. Tube obstruction
Answer: An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates
an air leak somewhere in the system. The nurse should assess the tubing and
connections.
9. Which intervention is appropriate for a client experiencing an acute
asthma exacerbation?
A. Encourage prolonged ambulation
B. Administer the prescribed short-acting bronchodilator
C. Restrict fluids completely
D. Place the client flat in bed
, Answer: Administer the prescribed short-acting bronchodilator
Rationale: Short-acting bronchodilators such as albuterol rapidly relax
bronchial smooth muscle and are commonly used for acute asthma
symptoms.
10. Which laboratory result is most concerning for a client receiving heparin?
A. Hemoglobin 13 g/dL
B. Platelets 48,000/mm³
C. Sodium 138 mEq/L
D. Potassium 4.1 mEq/L
Answer: Platelets 48,000/mm³
Rationale: Severe thrombocytopenia increases bleeding risk and may indicate
heparin-induced thrombocytopenia, requiring immediate evaluation.
11. A client with a new prescription for lisinopril reports swelling of the lips
and tongue. What is the nurse's priority action?
A. Administer the next dose
B. Encourage oral fluids
C. Treat the finding as a potential airway emergency
D. Reassure the client that this is expected
Answer: Treat the finding as a potential airway emergency
Rationale: Angioedema is a potentially life-threatening adverse effect of ACE
inhibitors. Airway assessment and emergency intervention are priorities.
12. Which food should a client with chronic kidney disease limit because of its
high potassium content?
A. Apples
B. White rice
C. Bananas
D. Bread
Answer: Bananas
Rationale: Bananas are high in potassium. Clients with impaired renal
potassium excretion may need to restrict high-potassium foods.