PN COMPREHENSIVE PRACTICE EXAM
Next Generation NCLEX (NGN) Style | 100+
Questions | With Answers & Rationales
1. A nurse is preparing to administer a scheduled dose of digoxin. The client's apical pulse is 58
beats/min. Which action should the nurse take FIRST?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Check the client's blood pressure
D. Document the finding and reassess in 1 hour
Rationale: Digoxin can cause bradycardia. Holding the dose and notifying the provider is priority when
apical pulse is <60 bpm (or per facility policy). Administering could worsen bradycardia or cause heart
block. BP check (C) is important but secondary to holding a potentially harmful medication.
Difficulty: ★★ | Content: Pharmacology/Safety
2. [NGN: Matrix] For each intervention, indicate if it is appropriate for preventing pressure injuries in
an immobile client.
Intervention Appropriate Not Appropriate
Reposition every 2 hours ✓ ☐
Massage reddened bony prominences ☐ ✓
Use donut-shaped cushion for sitting ☐ ✓
Keep head of bed ≤30 degrees ✓ ☐
Apply moisture barrier to perineal area ✓ ☐
Rationale: Repositioning, limiting head elevation (reduces shear), and moisture barriers prevent
pressure injuries. Massaging reddened areas can cause tissue damage. Donut cushions increase pressure
,on surrounding tissue and are contraindicated.
Difficulty: ★★ | NGN Skill: Take Action
3. Which statement by a client indicates understanding of proper hand hygiene?
A. "I only need to wash my hands after using the bathroom."
B. "Alcohol-based sanitizer works even when my hands are visibly soiled."
C. "I should wash with soap and water for at least 20 seconds."
D. "Gloves replace the need for handwashing."
Rationale: CDC recommends washing with soap/water ≥20 seconds, especially when hands are visibly
soiled. Sanitizers are ineffective on soiled hands (B). Hand hygiene is needed before/after patient
contact, after bodily fluid exposure, etc. (A is incomplete). Gloves do not replace hand hygiene (D).
Difficulty: ★ | Content: Infection Control
4. A client is receiving continuous enteral feedings via NG tube. Which action is essential to prevent
aspiration?
A. Check residual every 8 hours
B. Keep head of bed elevated ≥30-45 degrees
C. Flush tube with 30 mL water every 4 hours
D. Use blue dye in formula to detect aspiration
Rationale: Elevating HOB reduces reflux and aspiration risk during enteral feeding. Residual checks (A)
are facility-dependent and not universally recommended. Flushing (C) maintains patency but doesn't
prevent aspiration. Blue dye (D) is outdated and potentially harmful.
Difficulty: ★★ | Content: Nutrition/Safety
5. [NGN: Bow-Tie] Match the assessment finding to the priority nursing action for a postoperative
client.
Finding Action
Sudden chest pain, dyspnea, O₂ sat 88% A. Notify provider immediately; prepare for possible PE
Incisional pain rated 7/10, stable vitals B. Administer prescribed analgesic
Urine output 20 mL/hr for 2 hours C. Assess for bladder distension; encourage voiding
,Finding Action
Temperature 38.1°C (100.6°F) on POD#1 D. Monitor; document; report if persistent
Rationale: Chest pain + hypoxia suggests pulmonary embolism – emergency. Pain management is
priority for comfort and mobility. Low urine output may indicate retention or hypovolemia – assess
bladder first. Low-grade fever POD#1 is common inflammatory response; monitor trend.
Difficulty: ★★★ | NGN Skill: Prioritize Hypotheses
6. The nurse is teaching a client about fall prevention at home. Which recommendation is MOST
important?
A. Remove throw rugs and clutter from walkways
B. Install grab bars in the shower
C. Keep a nightlight on in the bedroom and hallway
D. Wear non-skid slippers at all times
Rationale: While all options reduce fall risk, improved visibility (nightlight) addresses the most common
cause of falls: poor lighting, especially at night. This is a high-impact, low-cost intervention. Other
options are also important but secondary to environmental visibility.
Difficulty: ★ | Content: Safety/Education
7. A client with dysphagia is prescribed thickened liquids. Which observation indicates the teaching
was effective?
A. Client drinks thin apple juice without coughing
B. Client uses a spoon to drink water thickened to honey consistency
C. Client tilts head back when swallowing pills
D. Client finishes entire meal in <15 minutes
Rationale: Thickened liquids reduce aspiration risk. Using a spoon for honey-thick liquids is correct
technique. Thin liquids (A) increase aspiration risk. Tilting head back (C) opens airway and increases
aspiration risk. Rushing meals (D) increases choking risk.
Difficulty: ★★ | Content: Nutrition/Safety
8. [NGN: Highlight] Read the nurse's note. HIGHLIGHT the sentence indicating a need for immediate
intervention.
, "Client post-op hip replacement, day 1. Ambulated 10 feet with walker. Reports pain 4/10. Incision
dressing dry and intact. Client states, 'I feel like something is tearing in my leg.' Vital signs stable. Pedal
pulses +2 bilaterally."
Rationale: "Feeling of tearing" could indicate wound dehiscence, hematoma, or vascular compromise –
requires immediate assessment. Other findings are expected post-op. This tests cue recognition for
escalation.
Difficulty: ★★★ | NGN Skill: Recognize Cues
9. Which action by the nurse demonstrates proper body mechanics when lifting a client?
A. Bend at the waist to reach the client
B. Keep feet shoulder-width apart and bend knees
C. Twist the torso while moving the client
D. Hold the client away from the body for leverage
Rationale: Wide base of support + bending knees (not waist) uses leg muscles and protects the nurse's
back. Twisting (C) or holding client away (D) increases injury risk. Bending at waist (A) strains lumbar
spine.
Difficulty: ★ | Content: Safety/Ergonomics
10. A client is prescribed warfarin. Which statement by the client requires FOLLOW-UP teaching?
A. "I will have my INR checked regularly."
B. "I will use a soft toothbrush to prevent bleeding."
C. "I can take ibuprofen for headache if needed."
D. "I will report unusual bruising or bleeding."
Rationale: NSAIDs like ibuprofen increase bleeding risk with warfarin. Acetaminophen is preferred for
pain. Options A, B, D reflect correct understanding. This tests identification of knowledge gaps.
Difficulty: ★★ | Content: Pharmacology/Patient Education
11. [NGN: Extended Multiple Response] Which findings indicate a client is experiencing hypoglycemia?
Select all that apply.
☐ Diaphoresis
☐ Tremors
☐ Polyuria
Next Generation NCLEX (NGN) Style | 100+
Questions | With Answers & Rationales
1. A nurse is preparing to administer a scheduled dose of digoxin. The client's apical pulse is 58
beats/min. Which action should the nurse take FIRST?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Check the client's blood pressure
D. Document the finding and reassess in 1 hour
Rationale: Digoxin can cause bradycardia. Holding the dose and notifying the provider is priority when
apical pulse is <60 bpm (or per facility policy). Administering could worsen bradycardia or cause heart
block. BP check (C) is important but secondary to holding a potentially harmful medication.
Difficulty: ★★ | Content: Pharmacology/Safety
2. [NGN: Matrix] For each intervention, indicate if it is appropriate for preventing pressure injuries in
an immobile client.
Intervention Appropriate Not Appropriate
Reposition every 2 hours ✓ ☐
Massage reddened bony prominences ☐ ✓
Use donut-shaped cushion for sitting ☐ ✓
Keep head of bed ≤30 degrees ✓ ☐
Apply moisture barrier to perineal area ✓ ☐
Rationale: Repositioning, limiting head elevation (reduces shear), and moisture barriers prevent
pressure injuries. Massaging reddened areas can cause tissue damage. Donut cushions increase pressure
,on surrounding tissue and are contraindicated.
Difficulty: ★★ | NGN Skill: Take Action
3. Which statement by a client indicates understanding of proper hand hygiene?
A. "I only need to wash my hands after using the bathroom."
B. "Alcohol-based sanitizer works even when my hands are visibly soiled."
C. "I should wash with soap and water for at least 20 seconds."
D. "Gloves replace the need for handwashing."
Rationale: CDC recommends washing with soap/water ≥20 seconds, especially when hands are visibly
soiled. Sanitizers are ineffective on soiled hands (B). Hand hygiene is needed before/after patient
contact, after bodily fluid exposure, etc. (A is incomplete). Gloves do not replace hand hygiene (D).
Difficulty: ★ | Content: Infection Control
4. A client is receiving continuous enteral feedings via NG tube. Which action is essential to prevent
aspiration?
A. Check residual every 8 hours
B. Keep head of bed elevated ≥30-45 degrees
C. Flush tube with 30 mL water every 4 hours
D. Use blue dye in formula to detect aspiration
Rationale: Elevating HOB reduces reflux and aspiration risk during enteral feeding. Residual checks (A)
are facility-dependent and not universally recommended. Flushing (C) maintains patency but doesn't
prevent aspiration. Blue dye (D) is outdated and potentially harmful.
Difficulty: ★★ | Content: Nutrition/Safety
5. [NGN: Bow-Tie] Match the assessment finding to the priority nursing action for a postoperative
client.
Finding Action
Sudden chest pain, dyspnea, O₂ sat 88% A. Notify provider immediately; prepare for possible PE
Incisional pain rated 7/10, stable vitals B. Administer prescribed analgesic
Urine output 20 mL/hr for 2 hours C. Assess for bladder distension; encourage voiding
,Finding Action
Temperature 38.1°C (100.6°F) on POD#1 D. Monitor; document; report if persistent
Rationale: Chest pain + hypoxia suggests pulmonary embolism – emergency. Pain management is
priority for comfort and mobility. Low urine output may indicate retention or hypovolemia – assess
bladder first. Low-grade fever POD#1 is common inflammatory response; monitor trend.
Difficulty: ★★★ | NGN Skill: Prioritize Hypotheses
6. The nurse is teaching a client about fall prevention at home. Which recommendation is MOST
important?
A. Remove throw rugs and clutter from walkways
B. Install grab bars in the shower
C. Keep a nightlight on in the bedroom and hallway
D. Wear non-skid slippers at all times
Rationale: While all options reduce fall risk, improved visibility (nightlight) addresses the most common
cause of falls: poor lighting, especially at night. This is a high-impact, low-cost intervention. Other
options are also important but secondary to environmental visibility.
Difficulty: ★ | Content: Safety/Education
7. A client with dysphagia is prescribed thickened liquids. Which observation indicates the teaching
was effective?
A. Client drinks thin apple juice without coughing
B. Client uses a spoon to drink water thickened to honey consistency
C. Client tilts head back when swallowing pills
D. Client finishes entire meal in <15 minutes
Rationale: Thickened liquids reduce aspiration risk. Using a spoon for honey-thick liquids is correct
technique. Thin liquids (A) increase aspiration risk. Tilting head back (C) opens airway and increases
aspiration risk. Rushing meals (D) increases choking risk.
Difficulty: ★★ | Content: Nutrition/Safety
8. [NGN: Highlight] Read the nurse's note. HIGHLIGHT the sentence indicating a need for immediate
intervention.
, "Client post-op hip replacement, day 1. Ambulated 10 feet with walker. Reports pain 4/10. Incision
dressing dry and intact. Client states, 'I feel like something is tearing in my leg.' Vital signs stable. Pedal
pulses +2 bilaterally."
Rationale: "Feeling of tearing" could indicate wound dehiscence, hematoma, or vascular compromise –
requires immediate assessment. Other findings are expected post-op. This tests cue recognition for
escalation.
Difficulty: ★★★ | NGN Skill: Recognize Cues
9. Which action by the nurse demonstrates proper body mechanics when lifting a client?
A. Bend at the waist to reach the client
B. Keep feet shoulder-width apart and bend knees
C. Twist the torso while moving the client
D. Hold the client away from the body for leverage
Rationale: Wide base of support + bending knees (not waist) uses leg muscles and protects the nurse's
back. Twisting (C) or holding client away (D) increases injury risk. Bending at waist (A) strains lumbar
spine.
Difficulty: ★ | Content: Safety/Ergonomics
10. A client is prescribed warfarin. Which statement by the client requires FOLLOW-UP teaching?
A. "I will have my INR checked regularly."
B. "I will use a soft toothbrush to prevent bleeding."
C. "I can take ibuprofen for headache if needed."
D. "I will report unusual bruising or bleeding."
Rationale: NSAIDs like ibuprofen increase bleeding risk with warfarin. Acetaminophen is preferred for
pain. Options A, B, D reflect correct understanding. This tests identification of knowledge gaps.
Difficulty: ★★ | Content: Pharmacology/Patient Education
11. [NGN: Extended Multiple Response] Which findings indicate a client is experiencing hypoglycemia?
Select all that apply.
☐ Diaphoresis
☐ Tremors
☐ Polyuria
