NCLEX-PN PRACTICE EXAM QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
1. A nurse is caring for a client with heart failure who has
gained 5 pounds in 3 days. Which action should the nurse take
first?
A. Encourage a low-sodium diet
B. Administer prescribed diuretics
C. Teach the client about fluid restriction
D. Assess lung sounds
Rationale: Assessing lung sounds helps identify early signs of
pulmonary edema, which is critical in heart failure
management before interventions.
2. A client is prescribed digoxin. Which finding requires the
nurse to hold the medication?
A. Blood pressure 120/80 mmHg
B. Heart rate 48 bpm
C. Respiratory rate 18/min
D. Oxygen saturation 96%
Rationale: Digoxin can cause bradycardia; a heart rate below
,60 bpm in adults requires holding the medication and
notifying the provider.
3. The nurse is caring for a client with a nasogastric tube.
Which action is appropriate before feeding?
A. Administer the feeding without checking
B. Check tube placement and residual
C. Flush the tube with 50 mL water only
D. Give feeding in a supine position
Rationale: Checking placement and residual ensures safe
administration and prevents aspiration.
4. Which action should the nurse take for a client experiencing
hypoglycemia?
A. Administer 10 units of insulin
B. Provide a high-protein snack
C. Give 15–20 g of fast-acting carbohydrate
D. Monitor blood pressure
Rationale: Fast-acting carbohydrates quickly raise blood
glucose levels to treat hypoglycemia.
5. A client is receiving IV potassium chloride. Which action is
most important?
A. Assess for edema
B. Monitor urine output
C. Check serum sodium
D. Ensure the IV is diluted and infused slowly
,Rationale: Rapid IV potassium can cause cardiac arrest; it
must be diluted and infused slowly.
6. A nurse notes a reddened, raised area on a client’s sacrum.
What stage of pressure ulcer is this?
A. Stage II
B. Stage III
C. Stage I
D. Stage IV
Rationale: Stage I pressure ulcers present as non-blanchable
redness without skin breakdown.
7. A client is on a low-sodium diet. Which food choice is
appropriate?
A. Canned soup
B. Fresh fruit
C. Processed cheese
D. Pickles
Rationale: Fresh fruits are low in sodium, making them safe
for a low-sodium diet.
8. Which intervention is priority for a client with COPD
experiencing dyspnea?
A. Administer oral corticosteroids
B. Encourage ambulation
C. Assist to high-Fowler’s position
D. Restrict fluid intake
, Rationale: High-Fowler’s position maximizes lung expansion
and eases breathing.
9. A client has a new prescription for warfarin. Which teaching
point is essential?
A. Eat more green vegetables
B. Monitor for signs of bleeding
C. Take with milk
D. Avoid exercise
Rationale: Warfarin increases bleeding risk; clients should be
educated on signs like bruising or blood in stools.
10. A nurse is preparing to administer a subcutaneous
injection. Which site is appropriate?
A. Vastus lateralis
B. Abdomen
C. Deltoid
D. Dorsal gluteal
Rationale: The abdomen is preferred for subcutaneous
injections due to consistent absorption and accessibility.
11. A client is experiencing anxiety before surgery. Which
intervention is most effective?
A. Encourage the client to read
B. Suggest watching TV
C. Teach relaxation techniques
D. Administer high-protein snack
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
1. A nurse is caring for a client with heart failure who has
gained 5 pounds in 3 days. Which action should the nurse take
first?
A. Encourage a low-sodium diet
B. Administer prescribed diuretics
C. Teach the client about fluid restriction
D. Assess lung sounds
Rationale: Assessing lung sounds helps identify early signs of
pulmonary edema, which is critical in heart failure
management before interventions.
2. A client is prescribed digoxin. Which finding requires the
nurse to hold the medication?
A. Blood pressure 120/80 mmHg
B. Heart rate 48 bpm
C. Respiratory rate 18/min
D. Oxygen saturation 96%
Rationale: Digoxin can cause bradycardia; a heart rate below
,60 bpm in adults requires holding the medication and
notifying the provider.
3. The nurse is caring for a client with a nasogastric tube.
Which action is appropriate before feeding?
A. Administer the feeding without checking
B. Check tube placement and residual
C. Flush the tube with 50 mL water only
D. Give feeding in a supine position
Rationale: Checking placement and residual ensures safe
administration and prevents aspiration.
4. Which action should the nurse take for a client experiencing
hypoglycemia?
A. Administer 10 units of insulin
B. Provide a high-protein snack
C. Give 15–20 g of fast-acting carbohydrate
D. Monitor blood pressure
Rationale: Fast-acting carbohydrates quickly raise blood
glucose levels to treat hypoglycemia.
5. A client is receiving IV potassium chloride. Which action is
most important?
A. Assess for edema
B. Monitor urine output
C. Check serum sodium
D. Ensure the IV is diluted and infused slowly
,Rationale: Rapid IV potassium can cause cardiac arrest; it
must be diluted and infused slowly.
6. A nurse notes a reddened, raised area on a client’s sacrum.
What stage of pressure ulcer is this?
A. Stage II
B. Stage III
C. Stage I
D. Stage IV
Rationale: Stage I pressure ulcers present as non-blanchable
redness without skin breakdown.
7. A client is on a low-sodium diet. Which food choice is
appropriate?
A. Canned soup
B. Fresh fruit
C. Processed cheese
D. Pickles
Rationale: Fresh fruits are low in sodium, making them safe
for a low-sodium diet.
8. Which intervention is priority for a client with COPD
experiencing dyspnea?
A. Administer oral corticosteroids
B. Encourage ambulation
C. Assist to high-Fowler’s position
D. Restrict fluid intake
, Rationale: High-Fowler’s position maximizes lung expansion
and eases breathing.
9. A client has a new prescription for warfarin. Which teaching
point is essential?
A. Eat more green vegetables
B. Monitor for signs of bleeding
C. Take with milk
D. Avoid exercise
Rationale: Warfarin increases bleeding risk; clients should be
educated on signs like bruising or blood in stools.
10. A nurse is preparing to administer a subcutaneous
injection. Which site is appropriate?
A. Vastus lateralis
B. Abdomen
C. Deltoid
D. Dorsal gluteal
Rationale: The abdomen is preferred for subcutaneous
injections due to consistent absorption and accessibility.
11. A client is experiencing anxiety before surgery. Which
intervention is most effective?
A. Encourage the client to read
B. Suggest watching TV
C. Teach relaxation techniques
D. Administer high-protein snack
