2025/2026 NCLEX FINAL EXAM
READINESS STUDY GUIDE WITH 100%
CORRECT ANSWERSS & RATIONALE
GRADED A+ (GUARANTEED PASS)
Question: 1
CORRECT ANSWERS: 2
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests
Rationale
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating
increased systemic circulation volume and increased right ventricular preload. Pulmonary artery
wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left
ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-
sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop
diuretic that will decrease both left- and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with
increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure
and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg,
methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right
ventricular preload and left ventricular preload.
Question: 2
CORRECT ANSWERS: 2
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks."
,Rationale
A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories of
second trimester loss or premature birth. A heavy suture is placed transvaginally or
transabdominally to keep the internal cervical os closed. Placement occurs at 12–14 weeks
gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical
dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical
insufficiency (eg, short cervix) are noted.
Discharge instructions include activity restriction and recognition of signs of preterm
labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes (Option
2).
(Option 1) Bed rest is usually recommended for a few days after the procedure. Long-term bed
rest is individualized but uncommon and increases the risk for complications (eg, deep vein
thrombosis). Pelvic rest (eg, avoiding sexual intercourse) is determined by the health care
provider.
(Option 3) Mild abdominal cramping following cerclage placement is common; however,
regular contractions, pelvic pressure, and low back aches may indicate preterm labor.
(Option 4) The cerclage remains in place until 36–37 weeks gestation. Early removal is
indicated by rupture of membranes (to prevent infection) or preterm labor (to prevent damage to
the cervix as it dilates).
Educational objective:
Following cerclage placement, discharge teaching includes recognizing and reporting signs of
preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and
understanding activity restrictions (eg, bed rest for a short time after placement)
Question: 3
,CORRECT ANSWERS: 1
During the first prenatal assessment, the client reports the last normal menstrual period starting
on March 1 and ending on March 5, but also slight spotting on March 23. The client had
unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date of birth?
1. December 8
2. December 12
3. December 22
4. December 30
Rationale
Various methods to determine the estimated date of birth (EDB) include use of Naegele's rule,
ultrasound, uterine height measurement (McDonald's measurement), and auscultation of fetal
heart rate with a Doppler device. The most accurate dating of pregnancy involves use of
ultrasound around the 16th-18th week of pregnancy. However, Naegele's rule can be used to
quickly determine an EDB early in the pregnancy. This calculation uses the date of the first day
of the last normal menstrual period (LMP) for determination of EDB.
EDB = (LMP minus 3 months) + 7 days
This client's LMP is March 1, minus 3 months = December 1. Add 7 days to obtain EDB =
December 8.
Clients who conceive in January, February, and most of March will deliver in the current
year. Those who conceive after March will deliver in the following year; as a result, a third step
is adding 1 to the current year to determine the estimated date of birth. For example, LMP of
May 10, 2014, would have an EDB of February 17, 2015.
It is important to note that Naegele's rule is based on a client having a menstrual cycle of 28
days. It therefore may not be as accurate if the client has a shorter or longer menstrual cycle.
(Option 2) Using the last day of the LMP to calculate EDB provides an inaccurate due date as
clients may have varying lengths of menstrual bleeding.
(Option 3) Conception occurs around the time of ovulation and is about 14 days from the
beginning of the LMP. Eggs are fertile for about 12-24 hours after ovulation with sperm able to
remain fertile for 24-72 hours. Implantation of the trophoblast occurs about 7-10 days after
fertilization. Using the conception date calculates the gestational age of the embryo
approximately 2 weeks later than the true gestational age.
(Option 4) Spotting around the time the next menstrual period is due may be considered normal
and is probably caused by implantation of the trophoblast into the uterine endometrial
lining. This is not considered a problem, but using this occurrence to date the pregnancy
erroneously delays the EDB by 4 weeks. It is important to calculate EDB from the beginning of
the last normal menstrual period.
Educational objective:
Naegele's rule provides a quick determination of the estimated date of birth (EDB). EDB =
(LMP minus 3 months) + 7 days. If the LMP occurs in January, February, or March, the EDB
will be in the current year. If the LMP occurs after March, the EDB will be in the next year.
, Question: 4
CORRECT ANSWERS: 1
A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat
systemic lupus erythematosus. Which intervention related to the drug's adverse effects should
the nurse include in the teaching plan?
1. Have an ophthalmologic examination every 6 months
2. Take the medication on an empty stomach
3. Take vitamin D and calcium supplements
4. Wear a MedicAlert bracelet
Rationale
Hydroxychloroquine (Plaquenil) is an antimalarial drug, but it is more commonly prescribed to
reduce fatigue and treat the skin and arthritic (eg, joint inflammation, pain) manifestations of
systemic lupus erythematosus (SLE). Hydroxychloroquine can also help to reduce lupus
exacerbations in clients with inactive to mild disease, but several months can pass before its
therapeutic effects become apparent.
Although rare, serious adverse drug reactions such as retinal toxicity and visual
disturbances can occur with hydroxychloroquine. Therefore, clients are instructed to undergo
regular ophthalmologic examination every 6-12 months (Option 1).
(Option 2) Hydroxychloroquine should be taken with food to decrease gastrointestinal upset
(common side effect).
(Option 3) Some clients with severe SLE are prescribed long-term corticosteroid (prednisone)
therapy to prevent organ damage and are at risk for adverse reactions, such as accelerated
osteoporosis. Osteoporosis is not an adverse reaction of hydroxychloroquine, and vitamin D and
calcium supplementation is not required.
(Option 4) There are no effects of hydroxychloroquine that would require wearing a MedicAlert
bracelet.
Educational objective:
Hydroxychloroquine (Plaquenil) is used to treat the skin and arthritic manifestations of
SLE. Taking the medication with food can help alleviate gastrointestinal upset. Serious adverse
drug reactions include retinopathy and visual disturbances; therefore, regular ophthalmologic
examination every 6-12 months is required.
Question: 5
CORRECT ANSWERS: 3
The nurse is caring for a client diagnosed with Guillain-Barré syndrome (GBS) after a recent
gastrointestinal (GI) illness. Monitoring for which of the following is a nursing care priority for
this client?
1. Diaphoresis with facial flushing
2. Hypoactive or absent bowel sounds
3. Inability to cough or lift the head
4. Warm, tender, and swollen leg
READINESS STUDY GUIDE WITH 100%
CORRECT ANSWERSS & RATIONALE
GRADED A+ (GUARANTEED PASS)
Question: 1
CORRECT ANSWERS: 2
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests
Rationale
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating
increased systemic circulation volume and increased right ventricular preload. Pulmonary artery
wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left
ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-
sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop
diuretic that will decrease both left- and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with
increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure
and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg,
methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right
ventricular preload and left ventricular preload.
Question: 2
CORRECT ANSWERS: 2
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks."
,Rationale
A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories of
second trimester loss or premature birth. A heavy suture is placed transvaginally or
transabdominally to keep the internal cervical os closed. Placement occurs at 12–14 weeks
gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical
dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical
insufficiency (eg, short cervix) are noted.
Discharge instructions include activity restriction and recognition of signs of preterm
labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes (Option
2).
(Option 1) Bed rest is usually recommended for a few days after the procedure. Long-term bed
rest is individualized but uncommon and increases the risk for complications (eg, deep vein
thrombosis). Pelvic rest (eg, avoiding sexual intercourse) is determined by the health care
provider.
(Option 3) Mild abdominal cramping following cerclage placement is common; however,
regular contractions, pelvic pressure, and low back aches may indicate preterm labor.
(Option 4) The cerclage remains in place until 36–37 weeks gestation. Early removal is
indicated by rupture of membranes (to prevent infection) or preterm labor (to prevent damage to
the cervix as it dilates).
Educational objective:
Following cerclage placement, discharge teaching includes recognizing and reporting signs of
preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and
understanding activity restrictions (eg, bed rest for a short time after placement)
Question: 3
,CORRECT ANSWERS: 1
During the first prenatal assessment, the client reports the last normal menstrual period starting
on March 1 and ending on March 5, but also slight spotting on March 23. The client had
unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date of birth?
1. December 8
2. December 12
3. December 22
4. December 30
Rationale
Various methods to determine the estimated date of birth (EDB) include use of Naegele's rule,
ultrasound, uterine height measurement (McDonald's measurement), and auscultation of fetal
heart rate with a Doppler device. The most accurate dating of pregnancy involves use of
ultrasound around the 16th-18th week of pregnancy. However, Naegele's rule can be used to
quickly determine an EDB early in the pregnancy. This calculation uses the date of the first day
of the last normal menstrual period (LMP) for determination of EDB.
EDB = (LMP minus 3 months) + 7 days
This client's LMP is March 1, minus 3 months = December 1. Add 7 days to obtain EDB =
December 8.
Clients who conceive in January, February, and most of March will deliver in the current
year. Those who conceive after March will deliver in the following year; as a result, a third step
is adding 1 to the current year to determine the estimated date of birth. For example, LMP of
May 10, 2014, would have an EDB of February 17, 2015.
It is important to note that Naegele's rule is based on a client having a menstrual cycle of 28
days. It therefore may not be as accurate if the client has a shorter or longer menstrual cycle.
(Option 2) Using the last day of the LMP to calculate EDB provides an inaccurate due date as
clients may have varying lengths of menstrual bleeding.
(Option 3) Conception occurs around the time of ovulation and is about 14 days from the
beginning of the LMP. Eggs are fertile for about 12-24 hours after ovulation with sperm able to
remain fertile for 24-72 hours. Implantation of the trophoblast occurs about 7-10 days after
fertilization. Using the conception date calculates the gestational age of the embryo
approximately 2 weeks later than the true gestational age.
(Option 4) Spotting around the time the next menstrual period is due may be considered normal
and is probably caused by implantation of the trophoblast into the uterine endometrial
lining. This is not considered a problem, but using this occurrence to date the pregnancy
erroneously delays the EDB by 4 weeks. It is important to calculate EDB from the beginning of
the last normal menstrual period.
Educational objective:
Naegele's rule provides a quick determination of the estimated date of birth (EDB). EDB =
(LMP minus 3 months) + 7 days. If the LMP occurs in January, February, or March, the EDB
will be in the current year. If the LMP occurs after March, the EDB will be in the next year.
, Question: 4
CORRECT ANSWERS: 1
A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat
systemic lupus erythematosus. Which intervention related to the drug's adverse effects should
the nurse include in the teaching plan?
1. Have an ophthalmologic examination every 6 months
2. Take the medication on an empty stomach
3. Take vitamin D and calcium supplements
4. Wear a MedicAlert bracelet
Rationale
Hydroxychloroquine (Plaquenil) is an antimalarial drug, but it is more commonly prescribed to
reduce fatigue and treat the skin and arthritic (eg, joint inflammation, pain) manifestations of
systemic lupus erythematosus (SLE). Hydroxychloroquine can also help to reduce lupus
exacerbations in clients with inactive to mild disease, but several months can pass before its
therapeutic effects become apparent.
Although rare, serious adverse drug reactions such as retinal toxicity and visual
disturbances can occur with hydroxychloroquine. Therefore, clients are instructed to undergo
regular ophthalmologic examination every 6-12 months (Option 1).
(Option 2) Hydroxychloroquine should be taken with food to decrease gastrointestinal upset
(common side effect).
(Option 3) Some clients with severe SLE are prescribed long-term corticosteroid (prednisone)
therapy to prevent organ damage and are at risk for adverse reactions, such as accelerated
osteoporosis. Osteoporosis is not an adverse reaction of hydroxychloroquine, and vitamin D and
calcium supplementation is not required.
(Option 4) There are no effects of hydroxychloroquine that would require wearing a MedicAlert
bracelet.
Educational objective:
Hydroxychloroquine (Plaquenil) is used to treat the skin and arthritic manifestations of
SLE. Taking the medication with food can help alleviate gastrointestinal upset. Serious adverse
drug reactions include retinopathy and visual disturbances; therefore, regular ophthalmologic
examination every 6-12 months is required.
Question: 5
CORRECT ANSWERS: 3
The nurse is caring for a client diagnosed with Guillain-Barré syndrome (GBS) after a recent
gastrointestinal (GI) illness. Monitoring for which of the following is a nursing care priority for
this client?
1. Diaphoresis with facial flushing
2. Hypoactive or absent bowel sounds
3. Inability to cough or lift the head
4. Warm, tender, and swollen leg
