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100 NCLEX-Style Exam Questions on Renal Failure,
Clotting Disorders, Burns, Sepsis, Cirrhosis, and Mental
Health – Updated to 2026 Guidelines
Description 100 NCLEX-style questions on renal failure, clotting, burns, sepsis, cirrhosis, SCI, & depression. Updated to 2026 guidelines with answers & explanations
Exam Paper: Renal, Clotting, Burns, Sepsis, and Mobility (
Update)
1. A patient presents with acute kidney injury (AKI) after severe trauma. Which electrolyte imbalance is most consistent with the oliguric phase of AKI?
A) Hyponatremia, hyperkalemia, hyperphosphatemia B) Hypernatremia, hypokalemia, hypophosphatemia C) Hyponatremia, hypokalemia, hypocalcemia D) Hypernatremia, hyperkalemia, hypophosphatemia Answer: A Explanation: In the oliguric phase of AKI, the kidneys cannot excrete potassium, phosphorus, or water effectively, leading to hyperkalemia, hyperphosphatemia, and dilutional hyponatremia. Hypocalcemia is also common due to decreased vitamin D activation and hyperphosphatemia.
2. A patient with chronic kidney disease (CKD) has a creatinine clearance of 60 mL/min. According to 2026 KDIGO guidelines, this corresponds to which CKD stage? A) Stage 1 B) Stage 2 C) Stage 3a D) Stage 4 Answer: C Explanation: CKD stage 3a is defined by a GFR of 45–59 mL/min. Normal creatinine clearance approximates GFR. Stage 2 is 60–89 mL/min, but current guidelines stage 3a starts at <60 mL/min with a split at 45 mL/min for 3b. 3. A patient on hemodialysis develops a fever and hypotension during dialysis. What is the priority nursing action? A) Increase the blood flow rate B) Administer IV antibiotics immediately
colon. Rifaximin is an adjunct for recurrent episodes. Neomycin is rarely used due to ototoxicity and nephrotoxicity.
6. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite 30 mL/kg crystalloid. According to 2026 Surviving Sepsis Campaign, what is the next recommended intervention? A) Start norepinephrine B) Administer hydrocortisone C) Give a second fluid bolus of 20 mL/kg D) Start vasopressin Answer: A Explanation: Norepinephrine is the first‑line vasopressor in septic shock when fluids fail to maintain MAP ≥65 mmHg. Vasopressin is second‑line. Steroids are considered if vasopressors are required at high doses. 7. A patient with a deep partial‑thickness burn to the anterior chest has a wound that is pale, waxy, and non‑blanching. Which statement is correct? A) Healing typically occurs within 7 days B) Pain and light touch sensation are absent C) It may require more than 21 days to heal D) It is classified as a superficial burn Answer: C Explanation: Deep partial‑thickness burns (deep dermis) are pale, waxy, non‑blanching, and often take >21 days to heal, sometimes requiring grafting. Sensation is decreased but not always absent.
8. Using the Parkland formula (4 mL × TBSA% × weight in kg), calculate the first 8‑hour fluid requirement for a 70 kg patient with 30% total body surface area (TBSA) burned. A) 2,100 mL B) 4,200 mL C) 8,400 mL D) 16,800 mL Answer: B Explanation: Total 24‑hour fluid = 4 × 30 × 70 = 8,400 mL. Half is given in the first 8 hours → 4,200 mL. The other half over the next 16 hours. 9. A patient with a spinal cord injury at C5 develops bradycardia and hypotension. What is the most likely cause? A) Autonomic dysreflexia B) Neurogenic shock C) Hemorrhagic shock D) Septic shock Answer: B Explanation: Neurogenic shock from acute spinal cord injury above T6 causes unopposed vagal tone → bradycardia, hypotension, and vasodilation. Autonomic dysreflexia causes hypertension, not hypotension. 10. A patient with major depressive disorder is started on a monoamine oxidase inhibitor (MAOI). Which food must be avoided to prevent hypertensive crisis (2026 guidelines)? A) Grapefruit juice B) Aged cheese, cured meats, and soy sauce
Answer: C Explanation: Therapeutic aPTT on heparin is roughly 60–80 seconds (2× control). 110 seconds is supratherapeutic. Hold heparin; protamine is used for major bleeding. Vitamin K reverses warfarin, not heparin.
13. Which of the following is a 2026 indication for direct oral anticoagulants (DOACs) over warfarin? A) Mechanical heart valve B) Atrial fibrillation with moderate mitral stenosis C) Nonvalvular atrial fibrillation D) Antiphospholipid syndrome Answer: C Explanation: DOACs (apixaban, rivaroxaban) are preferred for nonvalvular AFib due to lower bleeding risk and no routine monitoring. Mechanical valves and antiphospholipid syndrome still require warfarin. 14. A patient with disseminated intravascular coagulation (DIC) has bleeding and thrombosis simultaneously. Which laboratory finding is most consistent with DIC in 2026? A) Elevated fibrinogen, normal D-dimer B) Low platelets, elevated D-dimer, prolonged PT/PTT C) Normal PT, low D-dimer D) High platelets, low D-dimer Answer: B Explanation: DIC causes consumption of platelets and clotting factors → low platelets, prolonged PT/PTT, and elevated D-dimer (from fibrinolysis). Fibrinogen is often low but can be normal.
15. A patient with heart failure exacerbation has crackles in both lung bases and an S gallop. According to 2026 ACC/AHA guidelines, which medication is first-line for acute decompensated heart failure with volume overload? A) Digoxin B) Metoprolol C) Intravenous furosemide D) Spironolactone Answer: C Explanation: IV loop diuretics (furosemide) are first-line for acute volume overload. Beta- blockers are not started in acute decompensation. Digoxin is for refractory cases or atrial fibrillation. 16. A patient with acute pancreatitis has a serum calcium of 7.2 mg/dL (normal 9–11). What is the most likely explanation? A) Primary hyperparathyroidism B) Saponification of calcium in necrotic fat C) Vitamin D overdose D) Milk-alkali syndrome Answer: B Explanation: Hypocalcemia in acute pancreatitis is due to calcium binding with fatty acids released by pancreatic lipase (saponification). It predicts severe disease. 17. A patient with cirrhosis develops ascites and hyponatremia (serum sodium 122 mEq/L). According to 2026 guidelines, which diuretic regimen is preferred? A) Furosemide alone B) Spironolactone alone
pain), and do not heal spontaneously. Excision and grafting are standard. Blanching is absent.
20. Using the Rule of Nines (updated 2026), what is the estimated TBSA burned for a patient with burns to the entire right arm, anterior chest, and anterior right leg? A) 18% B) 27% C) 36% D) 45% Answer: B Explanation: Right arm = 9%, anterior chest = 9% (half of anterior trunk 18%), anterior right leg = 9% (half of leg 18%). Total = 27%. Rule of Nines: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%. 21. A patient with a spinal cord injury at T4 develops sudden hypertension (200/110), severe headache, and bradycardia. What is the priority intervention? A) Administer nitroglycerin B) Raise the head of the bed C) Lower the head of the bed D) Give IV fluids Answer: B Explanation: These symptoms indicate autonomic dysreflexia, a medical emergency. Raise the head of the bed to lower blood pressure, then check for a distended bladder or fecal impaction. 22. A patient with major depressive disorder is started on a selective serotonin reuptake inhibitor (SSRI). Which side effect is most common in the first 2 weeks?
A) Hypertensive crisis B) Gastrointestinal distress (nausea, diarrhea) C) Weight gain D) Sedation Answer: B Explanation: GI side effects (nausea, diarrhea, dyspepsia) are most common early with SSRIs. Hypertensive crisis is MAOI-related. Weight gain and sedation are more delayed.
23. According to 2026 guidelines, which antidepressant is generally considered safest during pregnancy? A) Paroxetine B) Fluoxetine C) Sertraline D) Phenelzine Answer: C Explanation: Sertraline is preferred in pregnancy due to extensive safety data. Paroxetine is associated with fetal cardiac defects. MAOIs are avoided. 24. A patient with complicated grief reports persistent yearning and emotional numbness 18 months after a loss. Which intervention is evidence-based for 2026? A) Supportive therapy only B) Complicated grief treatment (CGT) focused on loss and restoration C) Benzodiazepines for sleep D) High-dose SSRIs alone
B) Soft toothbrush, electric razor, avoid IM injections C) Administer vitamin K 10 mg IV daily D) Transfuse platelets for any minor bleed Answer: B Explanation: Bleeding precautions are essential for INR >1.5 or platelets <50,000. Vitamin K may help but not for liver synthetic dysfunction. Platelet transfusion only for major bleeding or procedures.
28. A patient with sepsis has a central venous pressure (CVP) of 6 mmHg and MAP 65 mmHg after fluids. What is the next step per 2026 guidelines? A) Start norepinephrine B) Give another 30 mL/kg crystalloid C) Start dobutamine D) Measure ScvO Answer: A Explanation: If MAP <65 mmHg despite adequate fluid (CVP 8–12 mmHg typically), start norepinephrine. Dobutamine is for low cardiac output with adequate BP. 29. A patient with an electrical burn has dark urine. Which laboratory test is most specific for muscle breakdown? A) BUN B) Creatinine kinase (CK) C) Serum potassium D) Troponin I
Answer: B Explanation: Electrical burns cause rhabdomyolysis → elevated CK. Myoglobinuria causes dark urine but CK is more specific. Potassium may be elevated but not specific.
30. A patient with a spinal cord injury at C6 is 3 days post-injury and has a heart rate of 45 bpm and BP 80/50. What is the most likely cause? A) Hemorrhagic shock B) Cardiogenic shock C) Neurogenic shock D) Septic shock Answer: C Explanation: Neurogenic shock (bradycardia + hypotension) occurs in acute SCI above T due to loss of sympathetic tone. It typically lasts days to weeks. 31. A patient with depression and chronic pain is started on duloxetine. This medication is a: A) SSRI B) Tricyclic antidepressant C) SNRI (serotonin-norepinephrine reuptake inhibitor) D) MAOI Answer: C Explanation: Duloxetine is an SNRI, approved for depression, anxiety, and chronic pain (e.g., diabetic neuropathy, fibromyalgia). 32. A patient with cirrhosis has a serum ammonia level of 120 μmol/L (normal <50) and is confused. Lactulose is started. What is the therapeutic goal? A) Reduce ammonia to normal within 24 hours
35. A patient with a C7 spinal cord injury asks about bowel management. Which intervention is recommended in 2026 guidelines? A) Daily suppositories only B) Digital stimulation and scheduled bowel program every 1–2 days C) Enemas every morning D) Low-fiber diet Answer: B Explanation: A scheduled bowel program (digital stimulation, suppositories if needed) every 1–2 days promotes predictability and dignity. High-fiber diet and adequate fluids are also key. 36. A patient with major depression and insomnia is started on mirtazapine. Which side effect is beneficial in this case? A) Weight loss B) Sedation at low doses C) Diarrhea D) Hypertension Answer: B Explanation: Mirtazapine antagonizes histamine H1 receptors, causing sedation, especially at low doses (7.5–15 mg). It also increases appetite – beneficial for weight loss from depression. 37. A patient with DIC has active bleeding. According to 2026 guidelines, when should platelet transfusion be given? A) Platelets <10,000/μL with no bleeding B) Platelets <50,000/μL with bleeding
C) Platelets <100,000/μL regardless of bleeding D) Platelets <150,000/μL Answer: B Explanation: In DIC with bleeding, transfuse platelets if count <50,000. For non-bleeding, higher thresholds are not used. Cryoprecipitate for fibrinogen <100 mg/dL.
38. A patient with acute heart failure has a BNP of 1,200 pg/mL (normal <100). After 24 hours of diuresis, repeat BNP is 900 pg/mL. What does this indicate? A) Worsening heart failure B) Adequate response to treatment C) Need for inotropic support D) Normalization of heart failure Answer: B Explanation: A decrease in BNP by ≥30% indicates a good response to therapy. BNP correlates with ventricular wall stress. 39. A patient with acute pancreatitis has a Ranson score of 4 at 48 hours. What does this predict? A) Mild disease with low mortality B) Moderate to severe disease with increased mortality C) No risk of organ failure D) Discharge in 24 hours Answer: B Explanation: Ranson score ≥3 indicates severe pancreatitis with higher morbidity and mortality. Updated 2026 guidelines also use the BISAP score for early prediction.
Answer: B Explanation: Hoarseness and carbonaceous sputum indicate inhalation injury. Airway edema can progress rapidly; early intubation is life-saving.
43. A patient with a T10 spinal cord injury develops a pressure ulcer on the sacrum. Which intervention is most effective for prevention in 2026? A) Reposition every 4 hours B) Use of a pressure redistribution mattress and reposition every 2 hours C) Massage bony prominences D) Keep the patient supine at all times Answer: B Explanation: High-quality pressure redistribution surface + repositioning every 2 hours is standard. Massage over bony areas is contraindicated. 44. A patient with depression is switched from fluoxetine to phenelzine (MAOI). How long should the washout period be per 2026 guidelines? A) 24 hours B) 5–7 days C) At least 14 days (5 weeks for fluoxetine due to long half-life) D) No washout needed Answer: C Explanation: Fluoxetine has a very long half-life (active metabolite 7–15 days). Washout of at least 5 weeks is required before starting an MAOI to avoid serotonin syndrome. 45. A patient with cirrhosis has a Child-Pugh score of 10. What does this indicate? A) Class A (mild) B) Class B (moderate)
C) Class C (severe) D) No liver disease Answer: C Explanation: Child-Pugh class: A 5–6 (mild), B 7–9 (moderate), C 10–15 (severe). Class C has 1-year survival ~50%.
46. A patient with septic shock is started on hydrocortisone. According to 2026 guidelines, when is this indicated? A) All patients with septic shock B) Patients requiring high-dose vasopressors (norepinephrine ≥0.25 mcg/kg/min) C) Patients with fever only D) Patients with lactate <2 mmol/L Answer: B Explanation: Corticosteroids are recommended in septic shock when vasopressors are required at high doses. They are not for all patients. 47. A patient with an electrical burn has a CK of 25,000 U/L. What complication must be anticipated? A) Hypokalemia B) Acute kidney injury from myoglobinuria C) Hypercalcemia D) Metabolic alkalosis Answer: B Explanation: Rhabdomyolysis releases myoglobin, which precipitates in renal tubules → AKI. Aggressive IV fluids (goal urine output 100–150 mL/hr) and possibly sodium bicarbonate are used.
