RN Comprehensive Practice Exam 350 NGN Questions & correct answers 2026
2027
This high-yield study resource features 50 comprehensive multiple-choice
questions designed to mirror the ATI RN Comprehensive Predictor and HESI Med-
Surg exit exams. Each question includes the correct answer in bold italics
followed by a detailed clinical rationale to help nursing students master core
concepts in pharmacology, mental health, and medical-surgical nursing. It is the
perfect tool for students at WCU, Chamberlain, and GCU seeking to achieve a
Grade A on their final proctored exams and prepare for the Next Generation
NCLEX (NGN).
1. A client presents with a serum potassium level of 6.2 mEq/L. Which EKG finding is the
priority?
o A. Prominent U waves
o B. ST-segment depression
o C. Tall, peaked T waves
o Rationale: Hyperkalemia causes rapid repolarization of the heart, manifested as
peaked T waves; this can progress to lethal arrhythmias.
o D. Prolonged QT interval
2. A client has the following ABG results: pH 7.30, PaCO2 55, HCO3 26. How does the
nurse interpret this?
o A. Respiratory Acidosis
o Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 (respiratory
cause), indicating the lungs are retaining CO2.
o B. Metabolic Acidosis
,o C. Respiratory Alkalosis
o D. Metabolic Alkalosis
3. A client with a sodium level of 115 mEq/L is admitted. Which intervention is the priority?
o A. Encourage oral water intake
o B. Implement seizure precautions
o Rationale: Severe hyponatremia causes cerebral edema, significantly increasing
the risk for seizures and coma.
o C. Administer a high-ceiling diuretic
o D. Monitor for peripheral edema
4. A nurse notes a positive Chvostek's sign in a post-thyroidectomy client. Which lab does
the nurse check?
o A. Potassium
o B. Sodium
o C. Calcium
o Rationale: Facial twitching (Chvostek's) is a classic sign of hypocalcemia,
common if the parathyroid glands were accidentally damaged.
o D. Magnesium
5. Which IV fluid is appropriate for a client in hypovolemic shock?
o A. 0.9% Sodium Chloride
o Rationale: Isotonic solutions like Normal Saline expand the extracellular fluid
volume without shifting fluid into or out of cells.
o B. 0.45% Sodium Chloride
o C. Dextrose 5% in Water
o D. 3% Sodium Chloride
Section 2: Cardiovascular & Respiratory
6. A client taking Digoxin reports seeing yellow halos around lights. What is the nurse's
first action?
o A. Check the client's blood pressure
o B. Hold the dose and assess for toxicity
o Rationale: Yellow-green visual disturbances are a hallmark sign of Digoxin
toxicity and require immediate intervention.
o C. Increase the client's potassium intake
o D. Document the finding as an expected side effect
7. What is the "window" for administering tPA to a client with an ischemic stroke?
o A. 12 hours
o B. 3 to 4.5 hours from symptom onset
o Rationale: Thrombolytic therapy must be started quickly to restore blood flow to
the brain before permanent necrosis occurs.
o C. 24 hours
o D. 1 hour
8. A client with Heart Failure has a BNP level of 1,200 pg/mL. The nurse should prioritize:
o A. Checking for pedal edema
, o B. Assessing lung sounds and oxygen saturation
o Rationale: High BNP indicates fluid overload; the priority is assessing for life-
threatening pulmonary edema (Airway/Breathing).
o C. Measuring daily weight
o D. Encouraging a low-sodium diet
9. A nurse notes constant bubbling in the water seal chamber of a chest tube. This
indicates:
o A. The lung is fully re-expanded
o B. An air leak in the system
o Rationale: Constant bubbling in the water seal chamber suggests air is leaking
into the system from the tubing or the pleural space.
o C. Normal suctioning pressure
o D. The system is clogged
10. A client with a DVT reports sudden chest pain and shortness of breath. The nurse
suspects:
o A. Myocardial Infarction
o B. Pulmonary Embolism
o Rationale: DVT puts a client at high risk for a clot breaking loose and traveling to
the pulmonary vasculature.
o C. Panic Attack
o D. Pneumothorax
Section 3: Pharmacology & Safety
11. What is the antidote for Heparin?
o A. Vitamin K
o B. Protamine Sulfate
o Rationale: Protamine Sulfate is the specific chemical antagonist used to
neutralize the anticoagulant effects of heparin.
o C. Acetylcysteine
o D. Flumazenil
12. A client is starting Clozapine. Which lab test is mandatory every week?
o A. Serum glucose
o B. Absolute Neutrophil Count (ANC)
o Rationale: Clozapine carries a high risk for agranulocytosis (dangerously low
WBC), which can lead to fatal infections.
o C. Liver enzymes
o D. Platelet count
13. A client on Phenelzine (MAOI) should avoid which food?
o A. Fresh chicken
o B. Aged salami and wine
o Rationale: Tyramine-rich foods combined with MAOIs can trigger a life-
threatening hypertensive crisis.
o C. Leafy greens
2027
This high-yield study resource features 50 comprehensive multiple-choice
questions designed to mirror the ATI RN Comprehensive Predictor and HESI Med-
Surg exit exams. Each question includes the correct answer in bold italics
followed by a detailed clinical rationale to help nursing students master core
concepts in pharmacology, mental health, and medical-surgical nursing. It is the
perfect tool for students at WCU, Chamberlain, and GCU seeking to achieve a
Grade A on their final proctored exams and prepare for the Next Generation
NCLEX (NGN).
1. A client presents with a serum potassium level of 6.2 mEq/L. Which EKG finding is the
priority?
o A. Prominent U waves
o B. ST-segment depression
o C. Tall, peaked T waves
o Rationale: Hyperkalemia causes rapid repolarization of the heart, manifested as
peaked T waves; this can progress to lethal arrhythmias.
o D. Prolonged QT interval
2. A client has the following ABG results: pH 7.30, PaCO2 55, HCO3 26. How does the
nurse interpret this?
o A. Respiratory Acidosis
o Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 (respiratory
cause), indicating the lungs are retaining CO2.
o B. Metabolic Acidosis
,o C. Respiratory Alkalosis
o D. Metabolic Alkalosis
3. A client with a sodium level of 115 mEq/L is admitted. Which intervention is the priority?
o A. Encourage oral water intake
o B. Implement seizure precautions
o Rationale: Severe hyponatremia causes cerebral edema, significantly increasing
the risk for seizures and coma.
o C. Administer a high-ceiling diuretic
o D. Monitor for peripheral edema
4. A nurse notes a positive Chvostek's sign in a post-thyroidectomy client. Which lab does
the nurse check?
o A. Potassium
o B. Sodium
o C. Calcium
o Rationale: Facial twitching (Chvostek's) is a classic sign of hypocalcemia,
common if the parathyroid glands were accidentally damaged.
o D. Magnesium
5. Which IV fluid is appropriate for a client in hypovolemic shock?
o A. 0.9% Sodium Chloride
o Rationale: Isotonic solutions like Normal Saline expand the extracellular fluid
volume without shifting fluid into or out of cells.
o B. 0.45% Sodium Chloride
o C. Dextrose 5% in Water
o D. 3% Sodium Chloride
Section 2: Cardiovascular & Respiratory
6. A client taking Digoxin reports seeing yellow halos around lights. What is the nurse's
first action?
o A. Check the client's blood pressure
o B. Hold the dose and assess for toxicity
o Rationale: Yellow-green visual disturbances are a hallmark sign of Digoxin
toxicity and require immediate intervention.
o C. Increase the client's potassium intake
o D. Document the finding as an expected side effect
7. What is the "window" for administering tPA to a client with an ischemic stroke?
o A. 12 hours
o B. 3 to 4.5 hours from symptom onset
o Rationale: Thrombolytic therapy must be started quickly to restore blood flow to
the brain before permanent necrosis occurs.
o C. 24 hours
o D. 1 hour
8. A client with Heart Failure has a BNP level of 1,200 pg/mL. The nurse should prioritize:
o A. Checking for pedal edema
, o B. Assessing lung sounds and oxygen saturation
o Rationale: High BNP indicates fluid overload; the priority is assessing for life-
threatening pulmonary edema (Airway/Breathing).
o C. Measuring daily weight
o D. Encouraging a low-sodium diet
9. A nurse notes constant bubbling in the water seal chamber of a chest tube. This
indicates:
o A. The lung is fully re-expanded
o B. An air leak in the system
o Rationale: Constant bubbling in the water seal chamber suggests air is leaking
into the system from the tubing or the pleural space.
o C. Normal suctioning pressure
o D. The system is clogged
10. A client with a DVT reports sudden chest pain and shortness of breath. The nurse
suspects:
o A. Myocardial Infarction
o B. Pulmonary Embolism
o Rationale: DVT puts a client at high risk for a clot breaking loose and traveling to
the pulmonary vasculature.
o C. Panic Attack
o D. Pneumothorax
Section 3: Pharmacology & Safety
11. What is the antidote for Heparin?
o A. Vitamin K
o B. Protamine Sulfate
o Rationale: Protamine Sulfate is the specific chemical antagonist used to
neutralize the anticoagulant effects of heparin.
o C. Acetylcysteine
o D. Flumazenil
12. A client is starting Clozapine. Which lab test is mandatory every week?
o A. Serum glucose
o B. Absolute Neutrophil Count (ANC)
o Rationale: Clozapine carries a high risk for agranulocytosis (dangerously low
WBC), which can lead to fatal infections.
o C. Liver enzymes
o D. Platelet count
13. A client on Phenelzine (MAOI) should avoid which food?
o A. Fresh chicken
o B. Aged salami and wine
o Rationale: Tyramine-rich foods combined with MAOIs can trigger a life-
threatening hypertensive crisis.
o C. Leafy greens
