NCLEX-RN EXAM: COMPREHENSIVE TEST
BANK QUESTIONS & ANSWERS WITH
RATIONALES
Section 1: Safe and Effective Care Environment (Management of Care & Safety)
1. Multiple Choice
A nurse is preparing to administer a blood transfusion to a client. Which IV solution is appropriate to use
as a primary line for priming the tubing?
A) Lactated Ringer’s
B) 5% Dextrose in Water (D5W)
C) 0.9% Sodium Chloride (Normal Saline)
D) 0.45% Sodium Chloride (Half Normal Saline)
Correct Answer: C) 0.9% Sodium Chloride (Normal Saline)
Rationale: Only 0.9% normal saline is compatible with blood products. Dextrose solutions can cause
hemolysis and agglutination of red blood cells. Lactated Ringer’s contains calcium, which can cause
clotting in the tubing.
2. Select All That Apply (SATA)
A charge nurse is delegating tasks to licensed practical nurses (LPNs) and unlicensed assistive personnel
(UAP). Which tasks are appropriate to delegate to the UAP? (Select all that apply)
A) Measuring the orthostatic blood pressure of a post-operative patient.
B) Feeding a client with dysphagia who requires a specialized spoon.
C) Ambulating a client who is 2 days post-hip replacement.
D) Reinserting a nasogastric tube for a client with a bowel obstruction.
E) Emptying a urinary drainage bag and recording the output.
Correct Answers: A, C, E
Rationale:
, A: UAP can take vital signs, including orthostatic measurements, after being trained.
B: Feeding a dysphagia client requires assessment skills to watch for aspiration; this is not
appropriate for UAP.
C: Ambulating stable post-op patients is within the UAP scope.
D: Inserting or reinserting an NG tube is an invasive procedure requiring licensed nursing
judgment (LPN or RN).
E: Emptying foley bags and measuring I&O is a standard delegated task for UAP.
3. Bowtie Question (NGN Style)
A nurse is caring for a client 2 hours after a right total knee arthroplasty. The client reports a pain level
of 8/10 despite receiving morphine 4 mg IV 30 minutes ago. The client’s right foot is pale, cool to the
touch, and the capillary refill is 5 seconds. The pedal pulse is weak and difficult to palpate.
Complete the diagram by dragging the correct condition, intervention, and monitoring parameter.
Potential Condition Nursing Intervention Parameter to Monitor
A. Fat Embolism Syndrome A. Apply warm compresses to the knee A. Serum Potassium
B. Compartment Syndrome B. Notify the healthcare provider immediately B. Capillary refill and pulse streng
C. Deep Vein Thrombosis C. Elevate the leg above the heart level C. Blood glucose levels
D. Infection D. Massage the affected extremity D. White Blood Cell count
Correct Answer:
Condition: B. Compartment Syndrome
Intervention: B. Notify the healthcare provider immediately
Monitor: B. Capillary refill and pulse strength
,Rationale: The classic “6 Ps” of compartment syndrome (Pain, Pallor, Pulselessness, Paresthesia,
Poikilothermia, Paralysis) are present with severe pain unrelieved by opioids. This is a surgical
emergency requiring a fasciotomy. The nurse must notify the provider immediately.
Section 2: Health Promotion and Maintenance
4. Multiple Choice
A nurse is providing teaching to a client about breast self-examination (BSE). Which instruction should
the nurse include?
A) “Perform BSE on the first day of your menstrual period.”
B) “Perform BSE 7 to 10 days after the onset of menses.”
C) “Perform BSE only if you notice a lump during your shower.”
D) “Perform BSE every month after age 30.”
Correct Answer: B) “Perform BSE 7 to 10 days after the onset of menses.”
Rationale: Breasts are least tender and lumpy 7 to 10 days after the menstrual period begins. Option A
is incorrect because the first day is when estrogen levels are rising and breasts may be tender. BSE is
recommended for women starting in their 20s.
5. Multiple Choice
A nurse is assessing a newborn for gestational age using the Ballard scale. The newborn has a flexed
posture, square window of 90 degrees, arm recoil of 90 degrees, and a scrotum with faint rugae. The
nurse determines the newborn is approximately how many weeks gestation?
A) 30 weeks
B) 34 weeks
C) 38 weeks
D) 40 weeks
Correct Answer: C) 38 weeks
Rationale: The findings describe a term newborn. Flexed posture, faint rugae on the scrotum, and a
square window of 90 degrees indicate a gestational age between 38 and 40 weeks.
6. Multiple Choice
A client asks the nurse about the recommended immunization schedule for an infant. Which vaccine
should the nurse state is given at birth?
A) DTaP (Diphtheria, Tetanus, Pertussis)
B) MMR (Measles, Mumps, Rubella)
, C) Hepatitis B
D) Varicella
Correct Answer: C) Hepatitis B
Rationale: The Hepatitis B vaccine is typically administered within 24 hours of birth, followed by
additional doses at 1-2 months and 6-18 months. MMR and Varicella are given after 12 months. DTaP
starts at 2 months.
Section 3: Psychosocial Integrity
7. Multiple Choice
A nurse is caring for a client with major depressive disorder who has been prescribed a selective
serotonin reuptake inhibitor (SSRI). The client states, “I feel a little better, but I’m not sleeping well.”
Which is the most appropriate nursing response?
A) “You should stop the medication if you can’t sleep.”
B) “Let’s discuss this with your provider. It may take 4 to 6 weeks for full therapeutic effects.”
C) “I will ask the provider for a sleeping pill immediately.”
D) “You must be taking the medication at night. Switch it to the morning.”
Correct Answer: B) “Let’s discuss this with your provider. It may take 4 to 6 weeks for full
therapeutic effects.”
Rationale: SSRIs typically take 4-6 weeks to reach full therapeutic effect. Insomnia is a common side
effect that often subsides. Option A is dangerous; abrupt withdrawal can cause discontinuation
syndrome. Option D is an assumption and prescription; the nurse should not change the dosing schedule
without provider input.
8. Select All That Apply (SATA)
A nurse is assessing a client admitted with suspected post-traumatic stress disorder (PTSD) after a motor
vehicle accident. Which findings are consistent with PTSD? (Select all that apply)
A) Hypervigilance while driving
B) Difficulty remembering the accident details
C) Increased appetite and weight gain
D) Recurrent nightmares about the accident
E) Excessive talking about the accident to strangers
Correct Answers: A, B, D
Rationale: PTSD symptoms include intrusive memories (nightmares), avoidance (difficulty remembering
the event), negative mood, and hyperarousal (hypervigilance). Weight gain is not a classic symptom;
often weight loss occurs. Excessive talking is not typical; avoidance is more common.
BANK QUESTIONS & ANSWERS WITH
RATIONALES
Section 1: Safe and Effective Care Environment (Management of Care & Safety)
1. Multiple Choice
A nurse is preparing to administer a blood transfusion to a client. Which IV solution is appropriate to use
as a primary line for priming the tubing?
A) Lactated Ringer’s
B) 5% Dextrose in Water (D5W)
C) 0.9% Sodium Chloride (Normal Saline)
D) 0.45% Sodium Chloride (Half Normal Saline)
Correct Answer: C) 0.9% Sodium Chloride (Normal Saline)
Rationale: Only 0.9% normal saline is compatible with blood products. Dextrose solutions can cause
hemolysis and agglutination of red blood cells. Lactated Ringer’s contains calcium, which can cause
clotting in the tubing.
2. Select All That Apply (SATA)
A charge nurse is delegating tasks to licensed practical nurses (LPNs) and unlicensed assistive personnel
(UAP). Which tasks are appropriate to delegate to the UAP? (Select all that apply)
A) Measuring the orthostatic blood pressure of a post-operative patient.
B) Feeding a client with dysphagia who requires a specialized spoon.
C) Ambulating a client who is 2 days post-hip replacement.
D) Reinserting a nasogastric tube for a client with a bowel obstruction.
E) Emptying a urinary drainage bag and recording the output.
Correct Answers: A, C, E
Rationale:
, A: UAP can take vital signs, including orthostatic measurements, after being trained.
B: Feeding a dysphagia client requires assessment skills to watch for aspiration; this is not
appropriate for UAP.
C: Ambulating stable post-op patients is within the UAP scope.
D: Inserting or reinserting an NG tube is an invasive procedure requiring licensed nursing
judgment (LPN or RN).
E: Emptying foley bags and measuring I&O is a standard delegated task for UAP.
3. Bowtie Question (NGN Style)
A nurse is caring for a client 2 hours after a right total knee arthroplasty. The client reports a pain level
of 8/10 despite receiving morphine 4 mg IV 30 minutes ago. The client’s right foot is pale, cool to the
touch, and the capillary refill is 5 seconds. The pedal pulse is weak and difficult to palpate.
Complete the diagram by dragging the correct condition, intervention, and monitoring parameter.
Potential Condition Nursing Intervention Parameter to Monitor
A. Fat Embolism Syndrome A. Apply warm compresses to the knee A. Serum Potassium
B. Compartment Syndrome B. Notify the healthcare provider immediately B. Capillary refill and pulse streng
C. Deep Vein Thrombosis C. Elevate the leg above the heart level C. Blood glucose levels
D. Infection D. Massage the affected extremity D. White Blood Cell count
Correct Answer:
Condition: B. Compartment Syndrome
Intervention: B. Notify the healthcare provider immediately
Monitor: B. Capillary refill and pulse strength
,Rationale: The classic “6 Ps” of compartment syndrome (Pain, Pallor, Pulselessness, Paresthesia,
Poikilothermia, Paralysis) are present with severe pain unrelieved by opioids. This is a surgical
emergency requiring a fasciotomy. The nurse must notify the provider immediately.
Section 2: Health Promotion and Maintenance
4. Multiple Choice
A nurse is providing teaching to a client about breast self-examination (BSE). Which instruction should
the nurse include?
A) “Perform BSE on the first day of your menstrual period.”
B) “Perform BSE 7 to 10 days after the onset of menses.”
C) “Perform BSE only if you notice a lump during your shower.”
D) “Perform BSE every month after age 30.”
Correct Answer: B) “Perform BSE 7 to 10 days after the onset of menses.”
Rationale: Breasts are least tender and lumpy 7 to 10 days after the menstrual period begins. Option A
is incorrect because the first day is when estrogen levels are rising and breasts may be tender. BSE is
recommended for women starting in their 20s.
5. Multiple Choice
A nurse is assessing a newborn for gestational age using the Ballard scale. The newborn has a flexed
posture, square window of 90 degrees, arm recoil of 90 degrees, and a scrotum with faint rugae. The
nurse determines the newborn is approximately how many weeks gestation?
A) 30 weeks
B) 34 weeks
C) 38 weeks
D) 40 weeks
Correct Answer: C) 38 weeks
Rationale: The findings describe a term newborn. Flexed posture, faint rugae on the scrotum, and a
square window of 90 degrees indicate a gestational age between 38 and 40 weeks.
6. Multiple Choice
A client asks the nurse about the recommended immunization schedule for an infant. Which vaccine
should the nurse state is given at birth?
A) DTaP (Diphtheria, Tetanus, Pertussis)
B) MMR (Measles, Mumps, Rubella)
, C) Hepatitis B
D) Varicella
Correct Answer: C) Hepatitis B
Rationale: The Hepatitis B vaccine is typically administered within 24 hours of birth, followed by
additional doses at 1-2 months and 6-18 months. MMR and Varicella are given after 12 months. DTaP
starts at 2 months.
Section 3: Psychosocial Integrity
7. Multiple Choice
A nurse is caring for a client with major depressive disorder who has been prescribed a selective
serotonin reuptake inhibitor (SSRI). The client states, “I feel a little better, but I’m not sleeping well.”
Which is the most appropriate nursing response?
A) “You should stop the medication if you can’t sleep.”
B) “Let’s discuss this with your provider. It may take 4 to 6 weeks for full therapeutic effects.”
C) “I will ask the provider for a sleeping pill immediately.”
D) “You must be taking the medication at night. Switch it to the morning.”
Correct Answer: B) “Let’s discuss this with your provider. It may take 4 to 6 weeks for full
therapeutic effects.”
Rationale: SSRIs typically take 4-6 weeks to reach full therapeutic effect. Insomnia is a common side
effect that often subsides. Option A is dangerous; abrupt withdrawal can cause discontinuation
syndrome. Option D is an assumption and prescription; the nurse should not change the dosing schedule
without provider input.
8. Select All That Apply (SATA)
A nurse is assessing a client admitted with suspected post-traumatic stress disorder (PTSD) after a motor
vehicle accident. Which findings are consistent with PTSD? (Select all that apply)
A) Hypervigilance while driving
B) Difficulty remembering the accident details
C) Increased appetite and weight gain
D) Recurrent nightmares about the accident
E) Excessive talking about the accident to strangers
Correct Answers: A, B, D
Rationale: PTSD symptoms include intrusive memories (nightmares), avoidance (difficulty remembering
the event), negative mood, and hyperarousal (hypervigilance). Weight gain is not a classic symptom;
often weight loss occurs. Excessive talking is not typical; avoidance is more common.
