The fastest way to prepare for the NCLEX-RN is to practice under realistic conditions, review rationales for every answer you get right and wrong, and repeat that cycle until clinical reasoning feels automatic. This article gives you 100 free NCLEX practice questions sorted into five high-yield categories, each with a detailed rationale explaining not just the correct answer but why the other choices fall short. Whether you are weeks from your test date or months away, working through these questions will sharpen the clinical judgment skills the exam is designed to measure.
The NCLEX-RN changed significantly when the Next Generation NCLEX (NGN) format launched, and the new test plan that took effect on April 1, 2026, further refined the exam’s activity statements to reflect current nursing practice. First-time, U.S.-educated pass rates have stabilized around 86.7%, which means roughly one in seven test-takers does not pass on the first attempt. The difference between those two groups often comes down to how candidates studied, not how much. Passive reading is not enough. Active question practice, spaced repetition, and honest self-assessment of weak areas are what move your score above the passing standard. The 100 questions below are designed to support exactly that kind of preparation.
How the NCLEX-RN Actually Works: CAT, NGN, and Partial Credit
The NCLEX-RN uses computerized adaptive testing (CAT). The algorithm selects each question based on your performance on the previous one. If you answer correctly, the next question is harder. If you answer incorrectly, it gets easier. The test continues until the algorithm determines, with 95% confidence, whether you are above or below the passing standard. You may answer as few as 85 questions or as many as 150, and the number alone tells you nothing about whether you passed.
A common misconception is that select-all-that-apply (SATA) questions are scored on an all-or-nothing basis. Under the NGN’s polytomous scoring model, you can receive partial credit for selecting some correct options even if you miss one. This is a meaningful shift. It rewards partial knowledge and accurate clinical reasoning, even when you are not 100% certain about every choice. Drag-and-drop, matrix, and enhanced hot-spot items also use this scoring approach.
The NCSBN’s 2026 NCLEX-RN Test Plan outlines the content distribution across eight client needs categories, including Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity (which is subdivided into four areas). Pharmacology, reduction of risk potential, and physiological adaptation collectively make up a large share of the exam. The questions below reflect that weighting.
The NCSBN Clinical Judgment Measurement Model
At the core of the NGN is the NCSBN Clinical Judgment Measurement Model (NCJMM). This six-step framework asks you to recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. Many NGN-style items are built around short case studies that test multiple steps of this model in sequence. As you work through the practice questions below, pay attention to which step of clinical judgment each question targets. That awareness will help you think through unfamiliar scenarios on test day.
NCLEX Study Strategy That Actually Moves the Needle
Before you start the questions, here is a brief framework for getting the most out of them. First, set a timer. On the real exam, you have roughly one minute per question on average. Practicing under time pressure trains you to make decisions efficiently rather than second-guessing yourself into a spiral.
Second, do not skip the rationale for questions you got right. Understanding why the correct answer is correct, and why each distractor is wrong, builds a network of reasoning that transfers to questions you have never seen before. Many students focus exclusively on memorizing facts, but the NCLEX tests application and analysis far more than recall.
Third, track your performance by category. If you are scoring 90% in pediatrics but 60% in pharmacology, you know where to invest your remaining study time. This kind of honest self-assessment is more productive than logging hours without direction. If you want a deeper look at effective approaches to complex material, the IMA blog has a useful post on study strategies for demanding academic content that applies well to NCLEX preparation.
Fourth, incorporate NGN-style items into your practice early. The case study format and multi-step items can feel disorienting if you encounter them for the first time on exam day. Familiarity with the format removes one layer of anxiety so you can focus on the clinical reasoning itself.
Pharmacology: Questions 1 Through 20
Question 1
A patient is prescribed digoxin. Which electrolyte imbalance most increases the risk of toxicity?
A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hypocalcemia
Correct Answer: B) Hypokalemia Rationale: Low potassium levels enhance the pharmacological effects of digoxin on the heart, significantly increasing the risk of life-threatening arrhythmias. Potassium and digoxin compete for the same binding sites on the sodium-potassium ATPase pump. When potassium is low, digoxin binds more readily, amplifying its effects. Always check potassium levels before administering digoxin.
Question 2
What is the priority assessment before administering atenolol?
A) Respiratory rate B) Urine output C) Heart rate and blood pressure D) Blood glucose
Correct Answer: C) Heart rate and blood pressure Rationale: Atenolol is a beta-blocker that reduces heart rate and blood pressure. If the heart rate is below 60 bpm or the blood pressure is below the facility’s established parameter, the medication should be held and the provider notified. Respiratory rate and blood glucose may be monitored for other medications, but they are not the priority assessments for a beta-blocker.
Question 3
A nurse is preparing to administer insulin lispro (Humalog). When should this medication be given in relation to meals?
A) 30 minutes before eating B) Within 15 minutes of eating C) 1 hour before eating D) At bedtime regardless of meals
Correct Answer: B) Within 15 minutes of eating Rationale: Insulin lispro is a rapid-acting insulin with an onset of approximately 15 minutes. It should be given within 15 minutes before or immediately after a meal to match the insulin peak with postprandial glucose elevation. Giving it 30 to 60 minutes before eating would risk hypoglycemia before the meal is consumed.
Question 4
A patient on warfarin has an INR of 5.2. The nurse should anticipate which intervention?
A) Administer an additional dose of warfarin B) Hold warfarin and notify the provider C) Administer protamine sulfate D) Increase dietary vitamin K permanently
Correct Answer: B) Hold warfarin and notify the provider Rationale: A therapeutic INR for most patients on warfarin is 2.0 to 3.0. An INR of 5.2 indicates a significantly elevated bleeding risk. The nurse should hold the medication and notify the provider, who may order vitamin K administration. Protamine sulfate is the antidote for heparin, not warfarin.
Question 5
A patient is taking metformin for type 2 diabetes. Which side effect should the nurse monitor for most closely?
A) Hypoglycemia B) Lactic acidosis C) Weight gain D) Hyperkalemia
Correct Answer: B) Lactic acidosis Rationale: Although rare, lactic acidosis is the most serious adverse effect of metformin and can be fatal. Risk increases in patients with renal impairment, liver disease, or conditions that cause hypoxia. Metformin alone rarely causes hypoglycemia and is typically weight-neutral or associated with modest weight loss.
Question 6
A patient is receiving IV vancomycin. The nurse notices flushing and a red rash on the patient’s upper body. What is the priority nursing action?
A) Document an allergic reaction and discontinue the drug permanently B) Slow the infusion rate and notify the provider C) Administer epinephrine immediately D) Increase the IV fluid rate to dilute the medication
Correct Answer: B) Slow the infusion rate and notify the provider Rationale: This presentation describes “Red Man Syndrome,” a histamine-mediated reaction caused by rapid infusion of vancomycin. It is not a true allergy. The priority action is to slow or stop the infusion and notify the provider. Antihistamines may be ordered, and the infusion can often be restarted at a slower rate.
Question 7
Which medication requires the nurse to monitor for ototoxicity?
A) Amoxicillin B) Gentamicin C) Metronidazole D) Ciprofloxacin
Correct Answer: B) Gentamicin Rationale: Aminoglycosides such as gentamicin carry a significant risk of ototoxicity and nephrotoxicity. The nurse should monitor trough and peak levels, assess hearing, and watch for complaints of tinnitus or dizziness. Amoxicillin, metronidazole, and ciprofloxacin have their own side effect profiles but ototoxicity is most strongly associated with aminoglycosides.
Question 8
A patient is prescribed lithium for bipolar disorder. Which laboratory value is most important to monitor regularly?
A) Hemoglobin A1C B) Serum lithium level C) Liver enzymes D) Serum iron
Correct Answer: B) Serum lithium level Rationale: Lithium has a narrow therapeutic index (0.6 to 1.2 mEq/L). Levels above 1.5 mEq/L can be toxic, causing tremors, confusion, seizures, and cardiac arrhythmias. Blood should be drawn 8 to 12 hours after the last dose for accurate measurement. Thyroid and renal function should also be monitored long-term.
Question 9
A patient on phenytoin (Dilantin) presents with gingival hyperplasia. What should the nurse include in patient education?
A) Discontinue the medication immediately B) Perform meticulous oral hygiene and see a dentist regularly C) Switch to a liquid form of the same medication D) Reduce the dose by half
Correct Answer: B) Perform meticulous oral hygiene and see a dentist regularly Rationale: Gingival hyperplasia is a well-known side effect of phenytoin. Patients should not discontinue the medication without provider instruction. Regular dental care and diligent oral hygiene can help manage the condition. Switching formulation does not resolve this side effect because it is related to the drug itself, not its delivery method.
Question 10
A nurse is administering a potassium chloride IV infusion. Which practice is essential?
A) Push the medication IV bolus to deliver it quickly B) Infuse via an IV pump and never push IV potassium C) Mix it with dextrose 50% for better absorption D) Administer it intramuscularly if the patient has poor IV access
Correct Answer: B) Infuse via an IV pump and never push IV potassium Rationale: IV potassium must never be given as a bolus push; doing so can cause fatal cardiac arrest. It should always be diluted and administered via an infusion pump at a controlled rate. Typical maximum rates are 10 to 20 mEq per hour in non-critical settings, with cardiac monitoring at higher rates.
Question 11
A patient taking an ACE inhibitor develops a persistent dry cough. What should the nurse anticipate?
A) The provider will increase the dose B) The provider may switch to an ARB C) The cough is unrelated to the medication D) An antitussive will be prescribed alongside the ACE inhibitor
Correct Answer: B) The provider may switch to an ARB Rationale: A dry, nonproductive cough is a common side effect of ACE inhibitors due to bradykinin accumulation. Angiotensin II receptor blockers (ARBs) achieve a similar therapeutic effect without inhibiting bradykinin breakdown, making them a common alternative.
Question 12
A patient is prescribed nitroglycerin sublingually for angina. What should the nurse teach?
A) Swallow the tablet with water B) Place the tablet under the tongue; may repeat every 5 minutes up to 3 doses C) Take only one dose per episode regardless of symptom relief D) Store the medication in a plastic bag at room temperature
Correct Answer: B) Place the tablet under the tongue; may repeat every 5 minutes up to 3 doses Rationale: Sublingual nitroglycerin is placed under the tongue and absorbed through the oral mucosa. If chest pain persists after the first dose, the patient may take up to two additional doses at 5-minute intervals. If pain is not relieved after three doses, emergency services should be called. The medication should be stored in its original dark glass container to prevent degradation from light and moisture.
Question 13
A patient on heparin has an aPTT of 120 seconds. What should the nurse do first?
A) Continue the current infusion rate B) Stop the heparin infusion and notify the provider C) Administer vitamin K D) Increase IV fluids
Correct Answer: B) Stop the heparin infusion and notify the provider Rationale: The therapeutic aPTT range for heparin therapy is typically 1.5 to 2.5 times the normal value (approximately 46 to 70 seconds, depending on the lab). An aPTT of 120 seconds indicates a significantly elevated bleeding risk. The heparin should be stopped, and the provider should be notified immediately. Protamine sulfate (not vitamin K) is the antidote for heparin.
Question 14
Which medication should the nurse question if prescribed to a patient with a sulfa allergy?
A) Amoxicillin B) Furosemide C) Azithromycin D) Metformin
Correct Answer: B) Furosemide Rationale: Furosemide is a sulfonamide-derived loop diuretic. While cross-reactivity between sulfonamide antibiotics and non-antibiotic sulfonamides is debated, nurses should verify with the provider and exercise caution. Amoxicillin and azithromycin are not sulfonamide derivatives.
Question 15
A patient on a statin reports unexplained muscle pain. What should the nurse suspect?
A) Normal medication side effect that requires no action B) Rhabdomyolysis C) Neuropathy D) Arthritis unrelated to the medication
Correct Answer: B) Rhabdomyolysis Rationale: Statins carry a risk of myopathy and, in rare cases, rhabdomyolysis, a breakdown of skeletal muscle that can lead to acute kidney injury. Unexplained muscle pain, tenderness, or weakness should be reported promptly, and creatine kinase (CK) levels should be checked. This is not a side effect to dismiss.
Question 16
A patient is receiving an aminophylline infusion for severe asthma. Which finding requires immediate intervention?
A) Heart rate of 110 bpm B) Nausea C) Seizure activity D) Mild headache
Correct Answer: C) Seizure activity Rationale: Aminophylline toxicity can cause seizures, tachyarrhythmias, and death. While tachycardia and nausea can be early signs of toxicity, seizure activity represents a medical emergency requiring immediate intervention, including stopping the infusion and providing supportive care.
Question 17
A nurse is teaching a patient about MAO inhibitors. Which dietary instruction is critical?
A) Avoid grapefruit juice B) Avoid foods high in tyramine such as aged cheese and cured meats C) Increase intake of leafy green vegetables D) Limit fluid intake to 1 liter daily
Correct Answer: B) Avoid foods high in tyramine such as aged cheese and cured meats Rationale: MAO inhibitors prevent the breakdown of tyramine. Consuming tyramine-rich foods while on an MAOI can trigger a hypertensive crisis, which can be fatal. Patients must be educated about dietary restrictions before starting the medication. Grapefruit juice interactions are more relevant to certain statins and calcium channel blockers.
Question 18
A patient is receiving morphine post-operatively. Which assessment finding warrants holding the next dose?
A) Pain rating of 4 out of 10 B) Respiratory rate of 8 breaths per minute C) Slightly constricted pupils D) Reports of mild nausea
Correct Answer: B) Respiratory rate of 8 breaths per minute Rationale: Respiratory depression is the most serious adverse effect of opioid analgesics. A respiratory rate below 12 breaths per minute is a critical finding that warrants holding the dose, notifying the provider, and having naloxone (Narcan) available. Constricted pupils and mild nausea are expected opioid effects.
Question 19
A nurse is preparing to administer an intramuscular iron dextran injection. Which technique is required?
A) Massage the injection site vigorously afterward B) Use the Z-track method C) Use a 25-gauge needle D) Apply heat to the site before injection
Correct Answer: B) Use the Z-track method Rationale: Iron dextran must be administered using the Z-track technique to prevent tracking of the medication into subcutaneous tissue, which can cause permanent skin staining and irritation. The nurse should not massage the site after injection, as this can cause leakage along the needle track.
Question 20
A patient with tuberculosis is started on isoniazid (INH). Which supplement should the nurse expect to be prescribed concurrently?
A) Vitamin C B) Vitamin B6 (pyridoxine) C) Folic acid D) Calcium
Correct Answer: B) Vitamin B6 (pyridoxine) Rationale: Isoniazid interferes with pyridoxine (vitamin B6) metabolism, which can lead to peripheral neuropathy. Concurrent supplementation with B6 is standard practice to prevent this adverse effect. Patients should also be educated about avoiding alcohol due to the hepatotoxic risk of INH.
Med-Surg: Questions 21 Through 40
Question 21
A patient 2 hours post-thyroidectomy has muscle twitching and tingling around the mouth. What is the priority action?
A) Administer pain medication B) Check serum calcium levels C) Encourage deep breathing exercises D) Reposition the patient
Correct Answer: B) Check serum calcium levels Rationale: Muscle twitching and perioral tingling after thyroidectomy suggest hypocalcemia due to inadvertent parathyroid damage or removal. This is a potentially life-threatening complication. Positive Chvostek’s sign (facial twitching when the facial nerve is tapped) and Trousseau’s sign (carpopedal spasm with BP cuff inflation) further confirm hypocalcemia. IV calcium gluconate should be readily available.
Question 22
A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?
A) The system is functioning normally B) An air leak is present C) The suction is set too high D) The lung has fully re-expanded
Correct Answer: B) An air leak is present Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system. The nurse should check all connections, tubing, and the insertion site. Intermittent bubbling during coughing or exhalation can be normal, but continuous bubbling is not. The suction control chamber is where continuous bubbling is expected when suction is applied.
Question 23
A patient with COPD is receiving oxygen. Which oxygen delivery method provides the most precise FiO2?
A) Nasal cannula B) Simple face mask C) Venturi mask D) Non-rebreather mask
Correct Answer: C) Venturi mask Rationale: The Venturi mask uses specific color-coded adapters to deliver precise oxygen concentrations (24% to 50%), making it ideal for COPD patients who require controlled oxygen delivery to prevent suppression of their hypoxic drive. Nasal cannulas and simple masks deliver variable FiO2 depending on the patient’s breathing pattern.
Question 24
A patient has an arterial blood gas result of pH 7.30, PaCO2 50 mmHg, HCO3 24 mEq/L. How should the nurse interpret this?
A) Metabolic acidosis B) Respiratory acidosis C) Respiratory alkalosis D) Metabolic alkalosis
Correct Answer: B) Respiratory acidosis Rationale: The pH is acidotic (below 7.35). The PaCO2 is elevated (above 45), indicating the respiratory system is the source of the acid-base imbalance. The HCO3 is within normal range (22 to 26), meaning the kidneys have not yet compensated. This is uncompensated respiratory acidosis. Common causes include COPD exacerbation, opioid overdose, and neuromuscular disorders.
Question 25
A patient with heart failure is prescribed furosemide. Which assessment finding indicates the medication is effective?
A) Weight gain of 2 pounds B) Decreased urine output C) Clear lung sounds and reduced peripheral edema D) Increased blood pressure
Correct Answer: C) Clear lung sounds and reduced peripheral edema Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart failure. Effective therapy results in diuresis, which leads to clearing of pulmonary congestion (improved lung sounds) and decreased peripheral edema. Weight loss, not gain, is an expected and desired outcome. A decrease in blood pressure may also occur.
Question 26
A nurse suspects a patient is developing sepsis. Which early finding is most consistent with the systemic inflammatory response?
A) Bradycardia B) Temperature above 38.3 degrees Celsius and heart rate above 90 bpm C) Hypertension D) Decreased white blood cell count
Correct Answer: B) Temperature above 38.3 degrees Celsius and heart rate above 90 bpm Rationale: Early signs of sepsis include fever (or hypothermia), tachycardia, tachypnea, and altered mental status. The qSOFA criteria include respiratory rate of 22 or greater, altered mentation, and systolic blood pressure of 100 mmHg or less. Recognizing early signs and initiating the sepsis bundle promptly improves survival.
Question 27
A patient returns from a cardiac catheterization via the right femoral artery. Which assessment is the highest priority?
A) Checking the patient’s appetite B) Assessing the insertion site and pedal pulses C) Encouraging ambulation within 1 hour D) Measuring daily weight
Correct Answer: B) Assessing the insertion site and pedal pulses Rationale: After femoral artery catheterization, the nurse must monitor the site for bleeding, hematoma formation, and signs of arterial occlusion. Pedal pulses, skin color, temperature, and sensation in the affected extremity should be assessed frequently. The patient should remain flat with the affected leg extended for the prescribed period to prevent bleeding.
Question 28
A patient with cirrhosis has a distended abdomen and shifting dullness on percussion. What condition does this suggest?
A) Pleural effusion B) Ascites C) Pneumothorax D) Bowel obstruction
Correct Answer: B) Ascites Rationale: Shifting dullness on abdominal percussion is a classic physical finding for ascites, which is the accumulation of fluid in the peritoneal cavity. It is a common complication of liver cirrhosis caused by portal hypertension and decreased albumin production. Paracentesis may be required for symptom relief.
Question 29
A patient with a new colostomy asks when the stoma should be assessed. What should the nurse teach about normal stoma appearance?
A) The stoma should be pale and dry B) The stoma should be dark red to purple C) The stoma should be pink to red, moist, and slightly raised D) The stoma should be flush with the skin and non-bleeding
Correct Answer: C) The stoma should be pink to red, moist, and slightly raised Rationale: A healthy stoma is pink to beefy red, moist, and may bleed slightly when cleaned due to its rich vascular supply. A pale, dusky, or dark-colored stoma may indicate ischemia and requires immediate reporting. Patient education about stoma assessment is a key nursing responsibility.
Question 30
A patient with diabetes mellitus has a blood glucose of 40 mg/dL and is conscious. What is the priority intervention?
A) Administer IV dextrose 50% B) Give 15 grams of a fast-acting carbohydrate orally C) Administer regular insulin subcutaneously D) Recheck the glucose in 1 hour without intervention
Correct Answer: B) Give 15 grams of a fast-acting carbohydrate orally Rationale: The “Rule of 15” guides hypoglycemia management in conscious patients: administer 15 grams of fast-acting carbohydrate (such as 4 ounces of juice), wait 15 minutes, and recheck. IV dextrose is reserved for unconscious patients or those who cannot swallow safely. Administering insulin would worsen the hypoglycemia.
Question 31
A patient with deep vein thrombosis is started on a heparin drip. Which laboratory test is used to monitor therapeutic effectiveness?
A) PT/INR B) aPTT C) Platelet count D) BUN/Creatinine
Correct Answer: B) aPTT Rationale: Activated partial thromboplastin time (aPTT) monitors unfractionated heparin therapy. The target is typically 1.5 to 2.5 times the normal control value. PT/INR is used to monitor warfarin. Platelet count should also be monitored to detect heparin-induced thrombocytopenia (HIT), but it does not measure therapeutic anticoagulation levels.
Question 32
A patient is admitted with acute pancreatitis. Which position should the nurse recommend for comfort?
A) Supine with legs elevated B) Side-lying in the fetal position C) Prone D) High Fowler’s with neck hyperextended
Correct Answer: B) Side-lying in the fetal position Rationale: Flexing the trunk and drawing the knees to the chest reduces tension on the abdominal muscles and the pancreatic area, alleviating some pain. This position is a classic comfort measure for pancreatitis. NPO status, pain management, and IV fluid resuscitation are also key components of care.
Question 33
A patient post-craniotomy is noted to have clear drainage from the nose. What should the nurse do?
A) Suction the nares gently B) Pack the nose with gauze C) Test the drainage for glucose and notify the provider D) Document the drainage as normal post-operative mucus
Correct Answer: C) Test the drainage for glucose and notify the provider Rationale: Clear drainage from the nose after a craniotomy may indicate a cerebrospinal fluid (CSF) leak. CSF tests positive for glucose, whereas normal nasal drainage does not. A “halo sign” on bed linens (a clear ring around a blood stain) also suggests CSF. Packing the nose or suctioning is contraindicated because it increases intracranial pressure and infection risk.
Question 34
A patient is in Buck’s traction for a hip fracture. Which nursing intervention is appropriate?
A) Remove the traction weights to reposition the patient B) Ensure weights hang freely and do not rest on the floor C) Apply the traction wrap directly over an open wound D) Stack additional weights as needed for comfort
Correct Answer: B) Ensure weights hang freely and do not rest on the floor Rationale: Traction weights must hang freely at all times to maintain continuous pull and alignment. Removing weights disrupts the therapeutic effect and may cause muscle spasm or further injury. The nurse should perform neurovascular checks, assess skin integrity under the traction device, and ensure proper alignment.
Question 35
A patient with Addison’s disease is at risk for which electrolyte imbalance?
A) Hypernatremia and hypokalemia B) Hyponatremia and hyperkalemia C) Hypercalcemia D) Hypermagnesemia
Correct Answer: B) Hyponatremia and hyperkalemia Rationale: Addison’s disease involves adrenal insufficiency with decreased cortisol and aldosterone. Without aldosterone, the kidneys cannot retain sodium or excrete potassium effectively, resulting in hyponatremia and hyperkalemia. Patients also experience hypotension, hypoglycemia, and bronze skin pigmentation.
Question 36
A patient has a blood transfusion reaction with fever and chills occurring 15 minutes into the infusion. What is the first nursing action?
A) Slow the infusion rate B) Stop the transfusion immediately C) Administer acetaminophen and continue D) Increase the IV normal saline rate
Correct Answer: B) Stop the transfusion immediately Rationale: At the first sign of a transfusion reaction (fever, chills, urticaria, back pain, dyspnea), the nurse must stop the transfusion immediately, keep the IV line open with normal saline, notify the provider, and send the blood bag and tubing to the lab. Slowing the rate is insufficient; the transfusion must be discontinued.
Question 37
A patient with myasthenia gravis is receiving pyridostigmine. Which finding indicates a myasthenic crisis rather than a cholinergic crisis?
A) Excessive salivation and diarrhea B) Increased muscle weakness and difficulty breathing with no improvement after medication C) Miosis and bradycardia D) Abdominal cramping
Correct Answer: B) Increased muscle weakness and difficulty breathing with no improvement after medication Rationale: Myasthenic crisis results from insufficient medication, while cholinergic crisis results from too much. Both present with weakness, but cholinergic crisis is accompanied by excessive cholinergic symptoms (salivation, lacrimation, urination, diarrhea, GI cramping, emesis). An edrophonium (Tensilon) test can help differentiate the two; improvement suggests myasthenic crisis.
Question 38
A patient recovering from a total hip replacement should avoid which position?
A) Abduction of the affected leg B) Adduction and internal rotation of the affected leg C) Elevation of the affected leg on pillows D) Sitting in a raised toilet seat
Correct Answer: B) Adduction and internal rotation of the affected leg Rationale: After total hip replacement, the patient must avoid flexing the hip beyond 90 degrees, adducting the leg past midline, and internally rotating the affected extremity. These movements increase the risk of hip dislocation. An abduction pillow should be placed between the legs when lying in bed.
Question 39
A nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which finding is expected?
A) Elevated serum sodium and dehydration B) Dilute serum (low sodium) and concentrated urine C) Polyuria and extreme thirst D) Hyperkalemia
Correct Answer: B) Dilute serum (low sodium) and concentrated urine Rationale: SIADH involves excessive ADH secretion, causing water retention. This leads to dilutional hyponatremia (low serum sodium) with concentrated urine (high specific gravity). Treatment includes fluid restriction, and in severe cases, hypertonic saline administered carefully to avoid central pontine myelinolysis.
Question 40
A patient with a pulmonary embolism is most likely to present with which triad of symptoms?
A) Bradycardia, hypertension, irregular breathing B) Sudden dyspnea, chest pain, and tachycardia C) Fever, cough, and night sweats D) Peripheral edema, weight gain, and jugular vein distention
Correct Answer: B) Sudden dyspnea, chest pain, and tachycardia Rationale: The classic presentation of a pulmonary embolism includes sudden onset of dyspnea, pleuritic chest pain, and tachycardia. Additional findings may include anxiety, hypoxemia, and a sense of impending doom. Treatment includes anticoagulation and, in severe cases, thrombolytics. Prevention through early ambulation and DVT prophylaxis is essential.
OB and Maternal-Newborn: Questions 41 Through 60
Question 41
Late decelerations appear on the f
