Open the 2026 Naxlex Questions

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Sample questions from Open the 2026 Naxlex Questions

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.During a home health visit, a 76-year-old client with heart failure reports worsening shortness of breath. The client has crackles, an SpO2 of 88% on room air, and a respiratory rate of 28/min. Which action should the nurse take first?

   • A.Review the client's low-sodium diet.
   • B.Position the client upright and apply prescribed oxygen.
   • C.Call the client's family to arrange transportation.
   • D.Ask the client to weigh daily and record the result.

   Rationale: Upright positioning and oxygen support address the immediate oxygenation problem. Diet teaching, family coordination, and daily weights are important but do not take priority over respiratory distress. The exam takeaway is to stabilize an urgent airway or breathing problem before routine teaching and planning.

2. 2.In a hospital discharge-planning meeting, a 59-year-old client with a new colostomy says the family cannot manage the care at home. Which action best supports coordinated care?

   • A.Ask the client about care preferences and arrange a meeting with the interprofessional team.
   • B.Delay discharge indefinitely until the family agrees to provide care.
   • C.Ask the surgeon to decide the discharge destination without client input.
   • D.Tell the family that home care is the only reasonable discharge plan.

   Rationale: Care planning should center on the client's preferences and include the appropriate team members to identify safe, feasible options. Dictating a plan, delaying without assessment, or excluding the client undermines shared decision-making. The exam takeaway is to coordinate resources while respecting client autonomy.

3. 3.Refer to the client's chart. Which findings should the nurse report promptly to the provider as evidence of possible worsening sepsis? Select all that apply.

   • A.Lactate is 3.8 mmol/L (reference range 0.5-2.0 mmol/L).
   • B.Temperature decreased from 39.0 C to 38.4 C.
   • C.Client is newly confused and difficult to arouse.
   • D.Blood pressure has fallen from 118/72 to 88/52 mm Hg.
   • E.Urine output is 20 mL in the last hour.

   Rationale: Hypotension, elevated lactate, low urine output, and new altered mental status are signs of impaired perfusion or organ dysfunction and require urgent escalation. A lower temperature alone does not establish improvement when other signs are worsening. The exam takeaway is to evaluate trends and perfusion, not temperature in isolation.

4. 4.At change of shift on a medical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 45-year-old requesting a PRN medication for incisional pain rated 7 of 10.
   • B.A 30-year-old whose urine output was 45 mL during the previous hour.
   • C.A 72-year-old with a new onset of stridor after thyroid surgery.
   • D.A 60-year-old awaiting discharge who needs medication teaching.

   Answer and rationale are in the full material.

5. 5.A primigravida at 32 weeks visits the prenatal clinic. She reports a severe headache and seeing flashing lights; BP is 168/110 mm Hg on repeat measurement. Which action should the nurse take?

   • A.Recommend a quiet room at home and a routine appointment in 1 week.
   • B.Encourage increased exercise and repeat the blood pressure next month.
   • C.Reassure her that visual changes are a normal effect of pregnancy.
   • D.Arrange immediate obstetric evaluation for severe hypertension and possible preeclampsia.

   Answer and rationale are in the full material.