SAUNDERS COMPREHENSIVE REVIEW FOR
THE NCLEX-RN® EXAMINATION, 9TH
EDITION PRACTICE EXAM
This exam consists of 85 questions covering all Client Needs categories as outlined in the official NCLEX-
RN test plan, with a focus on clinical judgment and the NCSBN Clinical Judgment Measurement Model
(NCJMM) . The questions include traditional multiple-choice, select all that apply (SATA), ordered
response,
Section I: Safe and Effective Care Environment
1. The charge nurse is assigning clients on a medical-surgical unit. Which client should be assigned to
the registered nurse (RN) rather than the licensed practical nurse (LPN)?
1. A client requiring a nasogastric tube irrigation.
2. A client with a stable tracheostomy requiring routine suctioning.
3. A client with diabetes mellitus requiring insulin administration.
4. A client with acute chest pain and a newly started intravenous nitroglycerin drip.
Answer: 4. A client with acute chest pain and a newly started intravenous nitroglycerin drip.
Rationale: The client with acute chest pain on a titratable IV vasoactive medication (nitroglycerin) is
unstable and requires the assessment and evaluation skills of an RN. LPNs can perform stable,
predictable tasks like NG tube irrigation (1), routine tracheostomy suctioning (2), and administering
insulin (3) under the supervision of an RN.
2. The nurse is preparing to delegate tasks to an assistive personnel (AP). Which tasks are appropriate
for the nurse to delegate? Select all that apply.
1. Assisting a client with a bed bath.
2. Measuring the pulse oximetry of a client with pneumonia.
3. Feeding a client with dysphagia after a stroke.
4. Documenting the amount of food the client ate.
, 5. Assessing the skin integrity of a client during a bath.
6. Ambulating a client with a walker who is post-operative day two.
Answers: 1, 2, 4, 6.
Rationale: Delegation is based on the stability of the client and the complexity of the task. APs can
perform ADLs (bathing, ambulating), routine measurements (pulse ox), and document intake (food
consumed). 3 is incorrect because feeding a client with dysphagia requires assessment for aspiration risk
and is not appropriate for an AP. 5 is incorrect because assessment (skin integrity) is a nursing
responsibility that cannot be delegated .
3. The nurse is reinforcing fire safety teaching to a group of staff nurses. According to the RACE
protocol, what is the priority action if a fire occurs in a client's room?
1. Activate the fire alarm.
2. Close all doors and windows.
3. Rescue the client from the room.
4. Extinguish the fire if it is small.
Answer: 3. Rescue the client from the room.
Rationale: The RACE protocol stands for Rescue, Alarm, Contain, Extinguish. The priority is always to
remove the client from the immediate danger.
Section II: Health Promotion and Maintenance
This section covers Aging Process, Ante/Intra/Postpartum, Growth and Development, and Health
Screening.
4. The nurse is providing anticipatory guidance to the parents of a 4-year-old child. The parents are
concerned about their child's new habit of telling "tall tales." What is the best response by the nurse?
1. "This is a sign of a creative imagination and is developmentally appropriate."
2. "You should punish the child immediately to stop this behavior before it becomes pathological
lying."
3. "This behavior is usually a sign that the child is feeling anxious about something."
4. "You should explain the concept of honesty in detail and ask for a verbal promise to be truthful."
,Answer: 1. "This is a sign of a creative imagination and is developmentally appropriate."
Rationale: Preschoolers (ages 3-5) have vivid imaginations and often engage in magical thinking. Telling
"tall tales" or exaggerating is a normal part of their cognitive development. It is not usually a sign of lying
or anxiety, and harsh punishment or complex lectures are not effective or appropriate at this age.
5. A nurse in a prenatal clinic is reviewing the records of four clients. Which client requires immediate
intervention?
1. A client at 16 weeks gestation who has not yet felt fetal movement.
2. A client at 28 weeks gestation who reports occasional Braxton-Hicks contractions.
3. A client at 10 weeks gestation who reports nausea and vomiting in the morning.
4. A client at 36 weeks gestation who reports a sudden gush of fluid from the vagina.
Answer: 4. A client at 36 weeks gestation who reports a sudden gush of fluid from the vagina.
Rationale: A sudden gush of fluid at 36 weeks is likely rupture of membranes, which poses a risk of
infection, cord prolapse, and imminent delivery. This requires immediate assessment. Fetal movement is
usually felt between 16-25 weeks (1). Braxton-Hicks (2) are normal at 28 weeks. Nausea (3) is common
in the first trimester.
6. The nurse is teaching a community health class about colon cancer screening. According to the
American Cancer Society guidelines, at what age should routine screening for average-risk individuals
begin?
1. 40 years old
2. 45 years old
3. 50 years old
4. 55 years old
Answer: 2. 45 years old.
Rationale: The American Cancer Society recommends that adults at average risk for colorectal cancer
begin regular screening at age 45.
Section III: Psychosocial Integrity
This section covers Coping Mechanisms, Grief, Mental Health Concepts, and Therapeutic Communication.
, 7. A client who is newly diagnosed with terminal cancer says to the nurse, "I don't believe it. I feel
fine. I think the doctors mixed up my test results with someone else's." The nurse identifies that the
client is exhibiting signs of which stage of grief, according to Kübler-Ross?
1. Anger
2. Denial
3. Bargaining
4. Depression
Answer: 2. Denial.
Rationale: Denial is a defense mechanism and the first stage of grief. It acts as a buffer after unexpected
shocking news. The client's statement of disbelief and questioning the results is a classic example of
denial.
8. A nurse is caring for a client with a history of alcohol use disorder who is now 24 hours post-
admission. The client is restless, anxious, and has a fine tremor. What is the priority nursing action?
1. Administer lorazepam (Ativan) as prescribed.
2. Restrict fluids to prevent water intoxication.
3. Place the client in a room with a roommate to provide social support.
4. Encourage the client to attend a 12-step program meeting immediately.
Answer: 1. Administer lorazepam (Ativan) as prescribed.
Rationale: The client is showing early signs of alcohol withdrawal, which can progress to life-threatening
seizures and delirium tremens. Benzodiazepines like lorazepam are the standard of care to manage
withdrawal symptoms, prevent seizures, and promote safety.
9. A nurse is providing crisis intervention for a client whose home was destroyed by a fire. Which
statement by the nurse reflects the priority goal of crisis intervention?
1. "We are going to work together to explore the deep-seated reasons for your anxiety."
2. "Let's focus on helping you return to your pre-crisis level of functioning."
3. "This crisis is an opportunity for major personality reconstruction."
4. "You should focus on the positive aspects of this experience."
Answer: 2. "Let's focus on helping you return to your pre-crisis level of functioning."
Rationale: The goal of crisis intervention is to provide support and assist the individual in returning to
THE NCLEX-RN® EXAMINATION, 9TH
EDITION PRACTICE EXAM
This exam consists of 85 questions covering all Client Needs categories as outlined in the official NCLEX-
RN test plan, with a focus on clinical judgment and the NCSBN Clinical Judgment Measurement Model
(NCJMM) . The questions include traditional multiple-choice, select all that apply (SATA), ordered
response,
Section I: Safe and Effective Care Environment
1. The charge nurse is assigning clients on a medical-surgical unit. Which client should be assigned to
the registered nurse (RN) rather than the licensed practical nurse (LPN)?
1. A client requiring a nasogastric tube irrigation.
2. A client with a stable tracheostomy requiring routine suctioning.
3. A client with diabetes mellitus requiring insulin administration.
4. A client with acute chest pain and a newly started intravenous nitroglycerin drip.
Answer: 4. A client with acute chest pain and a newly started intravenous nitroglycerin drip.
Rationale: The client with acute chest pain on a titratable IV vasoactive medication (nitroglycerin) is
unstable and requires the assessment and evaluation skills of an RN. LPNs can perform stable,
predictable tasks like NG tube irrigation (1), routine tracheostomy suctioning (2), and administering
insulin (3) under the supervision of an RN.
2. The nurse is preparing to delegate tasks to an assistive personnel (AP). Which tasks are appropriate
for the nurse to delegate? Select all that apply.
1. Assisting a client with a bed bath.
2. Measuring the pulse oximetry of a client with pneumonia.
3. Feeding a client with dysphagia after a stroke.
4. Documenting the amount of food the client ate.
, 5. Assessing the skin integrity of a client during a bath.
6. Ambulating a client with a walker who is post-operative day two.
Answers: 1, 2, 4, 6.
Rationale: Delegation is based on the stability of the client and the complexity of the task. APs can
perform ADLs (bathing, ambulating), routine measurements (pulse ox), and document intake (food
consumed). 3 is incorrect because feeding a client with dysphagia requires assessment for aspiration risk
and is not appropriate for an AP. 5 is incorrect because assessment (skin integrity) is a nursing
responsibility that cannot be delegated .
3. The nurse is reinforcing fire safety teaching to a group of staff nurses. According to the RACE
protocol, what is the priority action if a fire occurs in a client's room?
1. Activate the fire alarm.
2. Close all doors and windows.
3. Rescue the client from the room.
4. Extinguish the fire if it is small.
Answer: 3. Rescue the client from the room.
Rationale: The RACE protocol stands for Rescue, Alarm, Contain, Extinguish. The priority is always to
remove the client from the immediate danger.
Section II: Health Promotion and Maintenance
This section covers Aging Process, Ante/Intra/Postpartum, Growth and Development, and Health
Screening.
4. The nurse is providing anticipatory guidance to the parents of a 4-year-old child. The parents are
concerned about their child's new habit of telling "tall tales." What is the best response by the nurse?
1. "This is a sign of a creative imagination and is developmentally appropriate."
2. "You should punish the child immediately to stop this behavior before it becomes pathological
lying."
3. "This behavior is usually a sign that the child is feeling anxious about something."
4. "You should explain the concept of honesty in detail and ask for a verbal promise to be truthful."
,Answer: 1. "This is a sign of a creative imagination and is developmentally appropriate."
Rationale: Preschoolers (ages 3-5) have vivid imaginations and often engage in magical thinking. Telling
"tall tales" or exaggerating is a normal part of their cognitive development. It is not usually a sign of lying
or anxiety, and harsh punishment or complex lectures are not effective or appropriate at this age.
5. A nurse in a prenatal clinic is reviewing the records of four clients. Which client requires immediate
intervention?
1. A client at 16 weeks gestation who has not yet felt fetal movement.
2. A client at 28 weeks gestation who reports occasional Braxton-Hicks contractions.
3. A client at 10 weeks gestation who reports nausea and vomiting in the morning.
4. A client at 36 weeks gestation who reports a sudden gush of fluid from the vagina.
Answer: 4. A client at 36 weeks gestation who reports a sudden gush of fluid from the vagina.
Rationale: A sudden gush of fluid at 36 weeks is likely rupture of membranes, which poses a risk of
infection, cord prolapse, and imminent delivery. This requires immediate assessment. Fetal movement is
usually felt between 16-25 weeks (1). Braxton-Hicks (2) are normal at 28 weeks. Nausea (3) is common
in the first trimester.
6. The nurse is teaching a community health class about colon cancer screening. According to the
American Cancer Society guidelines, at what age should routine screening for average-risk individuals
begin?
1. 40 years old
2. 45 years old
3. 50 years old
4. 55 years old
Answer: 2. 45 years old.
Rationale: The American Cancer Society recommends that adults at average risk for colorectal cancer
begin regular screening at age 45.
Section III: Psychosocial Integrity
This section covers Coping Mechanisms, Grief, Mental Health Concepts, and Therapeutic Communication.
, 7. A client who is newly diagnosed with terminal cancer says to the nurse, "I don't believe it. I feel
fine. I think the doctors mixed up my test results with someone else's." The nurse identifies that the
client is exhibiting signs of which stage of grief, according to Kübler-Ross?
1. Anger
2. Denial
3. Bargaining
4. Depression
Answer: 2. Denial.
Rationale: Denial is a defense mechanism and the first stage of grief. It acts as a buffer after unexpected
shocking news. The client's statement of disbelief and questioning the results is a classic example of
denial.
8. A nurse is caring for a client with a history of alcohol use disorder who is now 24 hours post-
admission. The client is restless, anxious, and has a fine tremor. What is the priority nursing action?
1. Administer lorazepam (Ativan) as prescribed.
2. Restrict fluids to prevent water intoxication.
3. Place the client in a room with a roommate to provide social support.
4. Encourage the client to attend a 12-step program meeting immediately.
Answer: 1. Administer lorazepam (Ativan) as prescribed.
Rationale: The client is showing early signs of alcohol withdrawal, which can progress to life-threatening
seizures and delirium tremens. Benzodiazepines like lorazepam are the standard of care to manage
withdrawal symptoms, prevent seizures, and promote safety.
9. A nurse is providing crisis intervention for a client whose home was destroyed by a fire. Which
statement by the nurse reflects the priority goal of crisis intervention?
1. "We are going to work together to explore the deep-seated reasons for your anxiety."
2. "Let's focus on helping you return to your pre-crisis level of functioning."
3. "This crisis is an opportunity for major personality reconstruction."
4. "You should focus on the positive aspects of this experience."
Answer: 2. "Let's focus on helping you return to your pre-crisis level of functioning."
Rationale: The goal of crisis intervention is to provide support and assist the individual in returning to
