NCSBN Test Bank for the NCLEX-RN (Next Gen) – 2025/2026 Edition | Verified & Updated
| 500 Questions with Answers and Rationales | A+ Graded
1. A 68-year-old with chronic COPD reports increased dyspnea and green sputum for 48
hours. Which action should the nurse take first?
A. Obtain sputum culture. B. Start oxygen at 2 L/min. C. Administer prescribed albuterol.
D. Call the healthcare provider for antibiotics.
Answer: C. Administer prescribed albuterol.
Rationale: Immediate bronchodilation can improve airflow and oxygenation; oxygen
and cultures follow based on response and assessment.
2. A client with type 1 diabetes has blood glucose 320 mg/dL, Kussmaul respirations, and
fruity breath. Which is highest priority?
A. Give subcutaneous insulin. B. Establish IV access and begin IV fluids. C. Encourage
oral fluids. D. Call respiratory therapy.
Answer: B. Establish IV access and begin IV fluids.
Rationale: DKA requires fluid resuscitation first to restore perfusion; insulin typically
after fluids and labs.
3. Postoperative client (24 hrs) urine output 120 mL in 8 hours. Which interpretation?
A. Normal. B. Oliguria — evaluate for hypovolemia/obstruction. C. Polyuria — report. D.
Expected after anesthesia.
Answer: B. Oliguria — evaluate for hypovolemia/obstruction.
Rationale: <30 mL/hr suggests oliguria; needs assessment for volume status, bladder
retention, renal perfusion.
4. A client on warfarin with INR 5.2 and minor bleeding. Which is appropriate?
A. Give vitamin K PO and hold warfarin. B. Give fresh frozen plasma immediately. C.
Continue warfarin and observe. D. Give vitamin K IV push.
Answer: A. Give vitamin K PO and hold warfarin.
Rationale: For INR >5 with minor bleeding, hold warfarin and give vitamin K orally; IV
reserved for major bleeding.
5. A newborn at 36 weeks has nasal flaring, grunting, and retractions. Which is priority?
A. Warm the baby. B. Obtain blood glucose. C. Apply oxygen and call provider. D. Begin
gavage feeding.
, Answer: C. Apply oxygen and call provider.
Rationale: Signs of respiratory distress — ensure adequate oxygenation and escalate
care.
6. An older adult with Alzheimer’s is agitated in the evening. Best nursing intervention?
A. Restrain until calm. B. Provide a quiet routine, reduce stimuli. C. Prescribe
benzodiazepine PRN. D. Allow constant wandering.
Answer: B. Provide a quiet routine, reduce stimuli.
Rationale: Sundowning responds to environmental interventions; restraints and
sedatives increase risk.
7. A client with heart failure has 3+ pitting edema and weight gain 4 kg in 3 days. Best next
action?
A. Increase diuretic dose per provider order. B. Restrict fluids to 500 mL/day. C.
Document and re-evaluate next week. D. Encourage increased potassium intake.
Answer: A. Increase diuretic dose per provider order.
Rationale: Acute volume overload requires diuresis; notify provider for possible dose
change.
8. A patient with a central line requires blood draw. Which step prevents CLABSI?
A. Draw without scrubbing catheter. B. Scrub catheter hub with chlorhexidine before
access. C. Use peripheral stick only. D. Flush with sterile water.
Answer: B. Scrub catheter hub with chlorhexidine before access.
Rationale: Aseptic hub care reduces central line–associated bloodstream infections.
9. A client with acute stroke is within tPA window. Which assessment is contraindication?
A. Blood pressure 160/90. B. Platelets 150,000. C. Recent GI bleed 2 weeks ago. D. On
warfarin with INR 1.2.
Answer: C. Recent GI bleed 2 weeks ago.
Rationale: Recent significant bleeding is a contraindication to thrombolytics.
10.A 4-year-old with suspected dehydration — which is best to assess?
A. Fontanelle status. B. Capillary refill and mucous membranes. C. Blood pressure. D.
Urine color only.
Answer: B. Capillary refill and mucous membranes.
, Rationale: In children, mucous membranes and capillary refill are sensitive indicators of
hydration.
11.SATA: Which findings are typical of hypokalemia?
A. Muscle weakness. B. Hyperreflexia. C. Flattened T waves on ECG. D. Constipation.
E. Polyuria.
Answer: A, C, D.
Rationale: Hypokalemia causes weakness, flattened T waves, GI hypomotility causing
constipation.
12.A nurse prepares to administer morphine IV bolus; client respiratory rate 8/min and
somnolent. What to do?
A. Administer naloxone per protocol. B. Give scheduled dose anyway. C. Encourage
deep breathing. D. Hold dose and notify provider.
Answer: A. Administer naloxone per protocol.
Rationale: RR <10 with somnolence indicates opioid overdose — naloxone is indicated
per protocol.
13.A client with hyperthyroidism is scheduled for radioactive iodine therapy. Which
instruction is correct?
A. Expect immediate cure. B. Avoid pregnancy for 6 months and use contraception. C.
Increase iodine intake prior to therapy. D. Breastfeed normally.
Answer: B. Avoid pregnancy for 6 months and use contraception.
Rationale: RAI is contraindicated in pregnancy; contraception recommended.
14.A client receiving total parenteral nutrition (TPN). Which lab to monitor daily?
A. Hemoglobin A1c. B. BMP (electrolytes) and glucose. C. Lipase only. D. PT/INR.
Answer: B. BMP (electrolytes) and glucose.
Rationale: TPN can cause electrolyte shifts and hyperglycemia; monitor daily.
15.Which sign suggests compartment syndrome after a fracture?
A. Pain controlled by opioids. B. Pain out of proportion to exam and pain with passive
stretch. C. Warm extremity. D. Improved distal pulses.
Answer: B. Pain out of proportion and pain with passive stretch.
Rationale: Severe pain, pain on passive stretch are early signs of compartment
syndrome; emergency.
| 500 Questions with Answers and Rationales | A+ Graded
1. A 68-year-old with chronic COPD reports increased dyspnea and green sputum for 48
hours. Which action should the nurse take first?
A. Obtain sputum culture. B. Start oxygen at 2 L/min. C. Administer prescribed albuterol.
D. Call the healthcare provider for antibiotics.
Answer: C. Administer prescribed albuterol.
Rationale: Immediate bronchodilation can improve airflow and oxygenation; oxygen
and cultures follow based on response and assessment.
2. A client with type 1 diabetes has blood glucose 320 mg/dL, Kussmaul respirations, and
fruity breath. Which is highest priority?
A. Give subcutaneous insulin. B. Establish IV access and begin IV fluids. C. Encourage
oral fluids. D. Call respiratory therapy.
Answer: B. Establish IV access and begin IV fluids.
Rationale: DKA requires fluid resuscitation first to restore perfusion; insulin typically
after fluids and labs.
3. Postoperative client (24 hrs) urine output 120 mL in 8 hours. Which interpretation?
A. Normal. B. Oliguria — evaluate for hypovolemia/obstruction. C. Polyuria — report. D.
Expected after anesthesia.
Answer: B. Oliguria — evaluate for hypovolemia/obstruction.
Rationale: <30 mL/hr suggests oliguria; needs assessment for volume status, bladder
retention, renal perfusion.
4. A client on warfarin with INR 5.2 and minor bleeding. Which is appropriate?
A. Give vitamin K PO and hold warfarin. B. Give fresh frozen plasma immediately. C.
Continue warfarin and observe. D. Give vitamin K IV push.
Answer: A. Give vitamin K PO and hold warfarin.
Rationale: For INR >5 with minor bleeding, hold warfarin and give vitamin K orally; IV
reserved for major bleeding.
5. A newborn at 36 weeks has nasal flaring, grunting, and retractions. Which is priority?
A. Warm the baby. B. Obtain blood glucose. C. Apply oxygen and call provider. D. Begin
gavage feeding.
, Answer: C. Apply oxygen and call provider.
Rationale: Signs of respiratory distress — ensure adequate oxygenation and escalate
care.
6. An older adult with Alzheimer’s is agitated in the evening. Best nursing intervention?
A. Restrain until calm. B. Provide a quiet routine, reduce stimuli. C. Prescribe
benzodiazepine PRN. D. Allow constant wandering.
Answer: B. Provide a quiet routine, reduce stimuli.
Rationale: Sundowning responds to environmental interventions; restraints and
sedatives increase risk.
7. A client with heart failure has 3+ pitting edema and weight gain 4 kg in 3 days. Best next
action?
A. Increase diuretic dose per provider order. B. Restrict fluids to 500 mL/day. C.
Document and re-evaluate next week. D. Encourage increased potassium intake.
Answer: A. Increase diuretic dose per provider order.
Rationale: Acute volume overload requires diuresis; notify provider for possible dose
change.
8. A patient with a central line requires blood draw. Which step prevents CLABSI?
A. Draw without scrubbing catheter. B. Scrub catheter hub with chlorhexidine before
access. C. Use peripheral stick only. D. Flush with sterile water.
Answer: B. Scrub catheter hub with chlorhexidine before access.
Rationale: Aseptic hub care reduces central line–associated bloodstream infections.
9. A client with acute stroke is within tPA window. Which assessment is contraindication?
A. Blood pressure 160/90. B. Platelets 150,000. C. Recent GI bleed 2 weeks ago. D. On
warfarin with INR 1.2.
Answer: C. Recent GI bleed 2 weeks ago.
Rationale: Recent significant bleeding is a contraindication to thrombolytics.
10.A 4-year-old with suspected dehydration — which is best to assess?
A. Fontanelle status. B. Capillary refill and mucous membranes. C. Blood pressure. D.
Urine color only.
Answer: B. Capillary refill and mucous membranes.
, Rationale: In children, mucous membranes and capillary refill are sensitive indicators of
hydration.
11.SATA: Which findings are typical of hypokalemia?
A. Muscle weakness. B. Hyperreflexia. C. Flattened T waves on ECG. D. Constipation.
E. Polyuria.
Answer: A, C, D.
Rationale: Hypokalemia causes weakness, flattened T waves, GI hypomotility causing
constipation.
12.A nurse prepares to administer morphine IV bolus; client respiratory rate 8/min and
somnolent. What to do?
A. Administer naloxone per protocol. B. Give scheduled dose anyway. C. Encourage
deep breathing. D. Hold dose and notify provider.
Answer: A. Administer naloxone per protocol.
Rationale: RR <10 with somnolence indicates opioid overdose — naloxone is indicated
per protocol.
13.A client with hyperthyroidism is scheduled for radioactive iodine therapy. Which
instruction is correct?
A. Expect immediate cure. B. Avoid pregnancy for 6 months and use contraception. C.
Increase iodine intake prior to therapy. D. Breastfeed normally.
Answer: B. Avoid pregnancy for 6 months and use contraception.
Rationale: RAI is contraindicated in pregnancy; contraception recommended.
14.A client receiving total parenteral nutrition (TPN). Which lab to monitor daily?
A. Hemoglobin A1c. B. BMP (electrolytes) and glucose. C. Lipase only. D. PT/INR.
Answer: B. BMP (electrolytes) and glucose.
Rationale: TPN can cause electrolyte shifts and hyperglycemia; monitor daily.
15.Which sign suggests compartment syndrome after a fracture?
A. Pain controlled by opioids. B. Pain out of proportion to exam and pain with passive
stretch. C. Warm extremity. D. Improved distal pulses.
Answer: B. Pain out of proportion and pain with passive stretch.
Rationale: Severe pain, pain on passive stretch are early signs of compartment
syndrome; emergency.
