NEW GENERATION NCLEX PN
COMPREHENSIVE TEST PAPER 2026
COMPLETE ANSWERS ACCURATE
⫸ A 10-year-old child with asthma is treated for acute exacerbation.
Which finding would indicate that the condition is worsening? Answer:
Decreased wheezing
Rationale:Decreased wheezing in a child who is not improving clinically
may be interpreted incorrectly as a positive sign, when in fact it may
signal an inability to move air. A "silent chest" is an ominous sign
during an asthma episode. With treatment, increased wheezing may
actually signal that the child's condition is improving. Warm, dry skin
indicates an improvement in the condition because the child is normally
diaphoretic during exacerbation. The normal pulse rate in a 10-year-old
is 70 to 110 beats per minute.
⫸ The nurse is assigned to assist in caring for a client with a chest tube
drainage system. In planning for the client, the nurse makes certain that
what equipment is available, in the event that the drainage system needs
to be changed? Answer: Rubber-shod clamps
Rationale:
If the drainage system needs to be changed, the registered nurse will use
rubber-shod clamps to clamp the tube near the client's chest while the
drainage system is changed. This procedure is done quickly and with the
assistance of another nurse. The clamps are removed immediately after
reconnection of the new drainage system. Agency procedure regarding
clamping chest tubes is always followed, and a health care provider's
,prescription for clamping the tube may be required. If clamps must be
used, the best time to apply them is after expiration. An occlusive
dressing such as a petrolatum (Vaseline) gauze dressing is used when a
chest tube is removed. Options 2 and 4 are not needed for changing a
drainage system.
⫸ A client has been receiving parenteral nutrition at 125 mL/hr for 5
days. On data collection, the LPN notes bilateral crackles and 2+ pedal
edema and that the client has gained 3 pounds in 5 days. Which would
be appropriate as the initial nursing action? Answer: Notify the
registered nurse of the findings.
Rationale:
The client is showing signs of fluid retention and possible excess fluid
intake. Crackles, edema, and weight gain signify fluid shifts from
intravascular spaces to the interstitial spaces. The problem may or may
not be related to the parenteral nutrition. Other possible causes of fluid
retention include impaired respiratory and cardiovascular function,
impaired kidney function, or a combination of factors. The nurse needs
to notify the registered nurse of the findings. The registered nurse will
then notify the health care provider for further prescriptions. Option 2
will have little, if any, effect on peripheral edema and weight gain.
Option 3 infers that a diuretic will help the situation, and it is possible
that the health care provider will prescribe a diuretic; however, the
health care provider needs to be aware of the change in the physical
condition of the client. The nurse should not increase or decrease the rate
of parenteral nutrition infusions without a health care provider's
prescription to do so.
,⫸ The nurse notes this rhythm on the client's cardiac monitor. The nurse
next reports that the client is experiencing which heart rhythm? Refer to
figure. Answer: Atrial fibrillation
Diagram of normal sinus rhythm as seen on ECG. In atrial fibrillation
the P waves, which represent depolarization of the top of the heart, are
absent
⫸ The nurse is changing the abdominal dressing on a client following a
suprapubic prostatectomy. A wound drain is in place in the abdominal
wound. Which nursing action would be appropriate during the dressing
change? Answer: Checking the wound site for drainage from the drain
Rationale:
The wound site needs to be checked for drainage from the drain; the
drainage can excoriate the skin. Usually the drainage from the wound is
pale, red, and watery. Active bleeding is bright red. Aseptic technique
must be used when changing the dressing to avoid contamination of the
wound, and sterile gloves are worn. The drain should be checked for
patency to provide an exit for the fluid and blood to promote healing.
The drainage needs to flow freely, and there should be no kinks in the
drains. Curling, folding, or taping the drain prevents the flow of
drainage. The tube is not advanced.
⫸ When caring for a client who is having clear drainage from his nares
after transsphenoidal hypophysectomy, which action by the nurse is
essential? Answer: Test the drainage for glucose.
, Rationale:
After hypophysectomy, the client should be monitored for rhinorrhea,
which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the
drainage should be collected and tested for glucose, indicating the
presence of CSF. The head of the bed should not be lowered to prevent
increased intracranial pressure. Clear nasal drainage would not indicate
the need for a culture. Continuing to observe the drainage without taking
action could result in a serious complication.
⫸ A 6-year-old child with leukemia is hospitalized and is receiving
combination chemotherapy. Laboratory results indicate that the child is
neutropenic, and the nurse prepares to implement protective isolation
procedures. Which interventions should the nurse initiate? Select all that
apply. Answer: 1. Place the child on a low-bacteria diet.
2. Change dressings using sterile technique.
3. Perform meticulous hand washing before caring for the child.
Rationale:
For the hospitalized neutropenic child, flowers or plants should not be
kept in the room because standing water and damp soil harbor
Aspergillus and Pseudomonas, to which these children are very
susceptible. Fruits and vegetables not peeled before being eaten harbor
molds and should be avoided until the white blood cell count rises. The
child is placed on a low-bacteria diet. Dressings are always changed
with sterile technique. Not all visitors need to be restricted, but anyone
who is ill should not be allowed in the child's room Meticulous hand
washing is required before caring for the child. In addition, gloves, a
mask, and a gown are worn (per agency policy).
COMPREHENSIVE TEST PAPER 2026
COMPLETE ANSWERS ACCURATE
⫸ A 10-year-old child with asthma is treated for acute exacerbation.
Which finding would indicate that the condition is worsening? Answer:
Decreased wheezing
Rationale:Decreased wheezing in a child who is not improving clinically
may be interpreted incorrectly as a positive sign, when in fact it may
signal an inability to move air. A "silent chest" is an ominous sign
during an asthma episode. With treatment, increased wheezing may
actually signal that the child's condition is improving. Warm, dry skin
indicates an improvement in the condition because the child is normally
diaphoretic during exacerbation. The normal pulse rate in a 10-year-old
is 70 to 110 beats per minute.
⫸ The nurse is assigned to assist in caring for a client with a chest tube
drainage system. In planning for the client, the nurse makes certain that
what equipment is available, in the event that the drainage system needs
to be changed? Answer: Rubber-shod clamps
Rationale:
If the drainage system needs to be changed, the registered nurse will use
rubber-shod clamps to clamp the tube near the client's chest while the
drainage system is changed. This procedure is done quickly and with the
assistance of another nurse. The clamps are removed immediately after
reconnection of the new drainage system. Agency procedure regarding
clamping chest tubes is always followed, and a health care provider's
,prescription for clamping the tube may be required. If clamps must be
used, the best time to apply them is after expiration. An occlusive
dressing such as a petrolatum (Vaseline) gauze dressing is used when a
chest tube is removed. Options 2 and 4 are not needed for changing a
drainage system.
⫸ A client has been receiving parenteral nutrition at 125 mL/hr for 5
days. On data collection, the LPN notes bilateral crackles and 2+ pedal
edema and that the client has gained 3 pounds in 5 days. Which would
be appropriate as the initial nursing action? Answer: Notify the
registered nurse of the findings.
Rationale:
The client is showing signs of fluid retention and possible excess fluid
intake. Crackles, edema, and weight gain signify fluid shifts from
intravascular spaces to the interstitial spaces. The problem may or may
not be related to the parenteral nutrition. Other possible causes of fluid
retention include impaired respiratory and cardiovascular function,
impaired kidney function, or a combination of factors. The nurse needs
to notify the registered nurse of the findings. The registered nurse will
then notify the health care provider for further prescriptions. Option 2
will have little, if any, effect on peripheral edema and weight gain.
Option 3 infers that a diuretic will help the situation, and it is possible
that the health care provider will prescribe a diuretic; however, the
health care provider needs to be aware of the change in the physical
condition of the client. The nurse should not increase or decrease the rate
of parenteral nutrition infusions without a health care provider's
prescription to do so.
,⫸ The nurse notes this rhythm on the client's cardiac monitor. The nurse
next reports that the client is experiencing which heart rhythm? Refer to
figure. Answer: Atrial fibrillation
Diagram of normal sinus rhythm as seen on ECG. In atrial fibrillation
the P waves, which represent depolarization of the top of the heart, are
absent
⫸ The nurse is changing the abdominal dressing on a client following a
suprapubic prostatectomy. A wound drain is in place in the abdominal
wound. Which nursing action would be appropriate during the dressing
change? Answer: Checking the wound site for drainage from the drain
Rationale:
The wound site needs to be checked for drainage from the drain; the
drainage can excoriate the skin. Usually the drainage from the wound is
pale, red, and watery. Active bleeding is bright red. Aseptic technique
must be used when changing the dressing to avoid contamination of the
wound, and sterile gloves are worn. The drain should be checked for
patency to provide an exit for the fluid and blood to promote healing.
The drainage needs to flow freely, and there should be no kinks in the
drains. Curling, folding, or taping the drain prevents the flow of
drainage. The tube is not advanced.
⫸ When caring for a client who is having clear drainage from his nares
after transsphenoidal hypophysectomy, which action by the nurse is
essential? Answer: Test the drainage for glucose.
, Rationale:
After hypophysectomy, the client should be monitored for rhinorrhea,
which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the
drainage should be collected and tested for glucose, indicating the
presence of CSF. The head of the bed should not be lowered to prevent
increased intracranial pressure. Clear nasal drainage would not indicate
the need for a culture. Continuing to observe the drainage without taking
action could result in a serious complication.
⫸ A 6-year-old child with leukemia is hospitalized and is receiving
combination chemotherapy. Laboratory results indicate that the child is
neutropenic, and the nurse prepares to implement protective isolation
procedures. Which interventions should the nurse initiate? Select all that
apply. Answer: 1. Place the child on a low-bacteria diet.
2. Change dressings using sterile technique.
3. Perform meticulous hand washing before caring for the child.
Rationale:
For the hospitalized neutropenic child, flowers or plants should not be
kept in the room because standing water and damp soil harbor
Aspergillus and Pseudomonas, to which these children are very
susceptible. Fruits and vegetables not peeled before being eaten harbor
molds and should be avoided until the white blood cell count rises. The
child is placed on a low-bacteria diet. Dressings are always changed
with sterile technique. Not all visitors need to be restricted, but anyone
who is ill should not be allowed in the child's room Meticulous hand
washing is required before caring for the child. In addition, gloves, a
mask, and a gown are worn (per agency policy).
