RN Comprehensive Exam Review 2026 380 NGN Practice Questions & Bold Rationales
2026 2027
This essential study resource provides 380 high-yield, multiple-choice questions
designed to mirror the difficulty and scope of the ATI Comprehensive Predictor
and the HESI Exit Exam. Covering high-frequency topics such as Pediatrics,
Maternity, Pharmacology, and Advanced Med-Surg, each question features a
correct answer in bold italics followed by a detailed clinical rationale. This
document is a powerful tool for nursing students aiming for a Level 3 score and
seeking to master Next Generation NCLEX (NGN) prioritization and risk reduction
strategies.
1. A nurse is assessing a 4-month-old infant. Which reflex should the nurse expect to have
disappeared?
o A. Moro reflex
o Rationale: The Moro (startle) reflex typically disappears by 3 to 4 months. Continued
presence beyond 4 months may indicate neurological delay.
o B. Babinski reflex
o C. Palmar grasp
o D. Stepping reflex
2. A client at 32 weeks gestation reports a sudden gush of bright red vaginal bleeding
without pain. The nurse suspects:
o A. Abruptio Placentae
o B. Placenta Previa
o Rationale: Painless, bright red bleeding in the third trimester is the classic presentation
of placenta previa, where the placenta covers the cervical os.
o C. Preterm labor
o D. Ruptured uterus
3. What is the priority intervention for a client experiencing postpartum hemorrhage?
o A. Perform firm fundal massage.
o Rationale: Uterine atony is the most common cause of postpartum hemorrhage;
massage stimulates the muscle to contract and stop the bleeding.
o B. Check the blood pressure.
o C. Administer oxygen.
o D. Increase IV fluid rate.
4. A toddler is hospitalized with croup. Which finding is the priority to report to the
provider?
o A. Barking cough
,o B. Inspiratory stridor at rest
o Rationale: Stridor at rest indicates significant airway narrowing and impending
respiratory failure, requiring immediate intervention.
o C. Irritability
o D. Temperature of 100.2°F
5. A client taking Warfarin (Coumadin) has an INR of 5.5. The nurse anticipates
administering:
o A. Protamine Sulfate
o B. Vitamin K
o Rationale: Vitamin K is the specific antidote for Warfarin; an INR of 5.5 is well above the
therapeutic range (2.0–3.0) and poses a high bleeding risk.
o C. Heparin
o D. Enoxaparin
6. Which medication is contraindicated for a client with a history of a Sulfa allergy?
o A. Acetaminophen
o B. Hydrochlorothiazide
o Rationale: Many diuretics, such as thiazides and loops, have cross-sensitivity with
sulfonamides.
o C. Penicillin
o D. Ibuprofen
7. A nurse is caring for a child with Tetralogy of Fallot who is having a "Tet spell." What is
the first action?
o A. Place the child in the knee-chest position.
o Rationale: This position increases systemic vascular resistance, which forces more
blood into the lungs and improves oxygenation.
o B. Administer morphine.
o C. Give 100% oxygen via mask.
o D. Call for the Rapid Response Team.
8. A client has a total calcium level of 12.5 mg/dL. The nurse should monitor for:
o A. Positive Chvostek's sign
o B. Cardiac dysrhythmias and lethargy
o Rationale: Hypercalcemia (normal 8.5–10.5 mg/dL) acts as a sedative on the
neuromuscular system, leading to muscle weakness and dangerous heart rhythms.
o C. Muscle tremors
o D. Hyperactive bowel sounds
9. Which lab value is most important to monitor in a client with Acute Pancreatitis?
o A. Serum Amylase and Lipase
o Rationale: These enzymes are the hallmark indicators of pancreatic inflammation;
Lipase is generally considered more specific to the pancreas.
o B. Serum Sodium
o C. Platelet count
o D. Hemoglobin
10. A client is starting Clozapine. Which lab result is a mandatory baseline and weekly
requirement?
o A. ALT/AST
o B. Absolute Neutrophil Count (ANC)
,o Rationale: Clozapine carries a high risk for agranulocytosis (dangerously low WBC);
monitoring ANC is strictly regulated to prevent fatal infections.
o C. Fasting glucose
o D. Blood Urea Nitrogen (BUN)
11. A nurse is assessing a Stage 2 pressure injury. What is the expected appearance?
o A. Non-blanchable redness
o B. Partial-thickness skin loss with a shallow open ulcer or blister
o Rationale: Stage 2 involves the epidermis and dermis but does not extend into the
subcutaneous tissue.
o C. Visible subcutaneous fat
o D. Exposed bone and tendon
12. Before administering a Beta-Blocker, which vital sign must the nurse assess?
o A. Temperature
o B. Heart rate and Blood Pressure
o Rationale: Beta-blockers lower both heart rate and BP; the dose is usually held if HR is
<60 bpm or Systolic BP is <90 mmHg.
o C. Respiratory rate
o D. Oxygen saturation
13. A client has a "pulsatile mass" in the periumbilical area. The nurse should:
o A. Avoid palpation and notify the provider.
o Rationale: This is a classic sign of an Abdominal Aortic Aneurysm (AAA); palpation
could cause the aneurysm to rupture.
o B. Palpate deeply to determine the size.
o C. Auscultate for a bruit.
o D. Document as a normal finding in thin adults.
14. The "Cushing’s Triad" (Bradycardia, Hypertension, and Irregular Respirations) indicates:
o A. Septic shock
o B. Increased Intracranial Pressure (ICP)
o Rationale: These three signs are late indicators of severe brain stem compression and
impending brain herniation.
o C. Myocardial Infarction
o D. Hypoglycemic crisis
15. What is the goal of "Palliative Care"?
o A. To provide a cure for chronic illness.
o B. To provide symptom relief and improve quality of life.
o Rationale: Palliative care focuses on comfort and holistic support during a serious or
terminal illness, regardless of the stage.
o C. To hasten the dying process.
o D. To replace standard medical treatments.
16. A client in "Atrial Fibrillation" is at the highest risk for:
o A. Ventricular fibrillation
o B. Ischemic Stroke
o Rationale: Stasis of blood in the atria allows clots to form, which can travel to the brain.
o C. Pulmonary edema
o D. Kidney stones
17. After a Liver Biopsy, the client should be positioned:
, o A. High-Fowler's
o B. Right-side lying
o Rationale: Positioning on the right side applies pressure to the biopsy site, acting as a
pressure dressing to prevent hemorrhage.
o C. Left-side lying
o D. Supine
18. A "Positive Brudzinski’s sign" indicates:
o A. Deep Vein Thrombosis
o B. Meningeal irritation (Meningitis)
o Rationale: This is when the hips and knees flex involuntarily when the neck is flexed, a
sign of spinal cord/meningeal inflammation.
o C. Appendicitis
o D. Cholecystitis
19. A client has "Pernicious Anemia." The nurse expects the client to need:
o A. Iron supplements
o B. Vitamin B12 injections
o Rationale: Pernicious anemia is caused by a lack of Intrinsic Factor, meaning oral B12
cannot be absorbed; injections are required for life.
o C. Folic acid
o D. Blood transfusions only
20. What is the priority assessment for a client receiving Magnesium Sulfate for
preeclampsia?
o A. Blood glucose
o B. Deep tendon reflexes and respiratory rate
o Rationale: Loss of reflexes and a drop in respirations are early signs of Magnesium
toxicity, which can lead to cardiac arrest.
o C. Temperature
o D. Bowel sounds
21. A client with "SIADH" (Syndrome of Inappropriate Antidiuretic Hormone) will likely have:
o A. High serum sodium
o B. Low serum sodium (Hyponatremia)
o Rationale: SIADH causes excessive water retention, which dilutes the sodium in the
blood.
o C. High urine output
o D. Weight loss
22. Before a "Paracentesis," the nurse must ensure the client:
o A. Voids to empty the bladder.
o Rationale: An empty bladder reduces the risk of accidental puncture by the needle
during the procedure.
o B. Remains NPO for 12 hours.
o C. Drinks 1 liter of water.
o D. Exercises for 30 minutes.
23. Which insulin is the only one that can be given Intravenously (IV)?
o A. NPH
o B. Regular Insulin
2026 2027
This essential study resource provides 380 high-yield, multiple-choice questions
designed to mirror the difficulty and scope of the ATI Comprehensive Predictor
and the HESI Exit Exam. Covering high-frequency topics such as Pediatrics,
Maternity, Pharmacology, and Advanced Med-Surg, each question features a
correct answer in bold italics followed by a detailed clinical rationale. This
document is a powerful tool for nursing students aiming for a Level 3 score and
seeking to master Next Generation NCLEX (NGN) prioritization and risk reduction
strategies.
1. A nurse is assessing a 4-month-old infant. Which reflex should the nurse expect to have
disappeared?
o A. Moro reflex
o Rationale: The Moro (startle) reflex typically disappears by 3 to 4 months. Continued
presence beyond 4 months may indicate neurological delay.
o B. Babinski reflex
o C. Palmar grasp
o D. Stepping reflex
2. A client at 32 weeks gestation reports a sudden gush of bright red vaginal bleeding
without pain. The nurse suspects:
o A. Abruptio Placentae
o B. Placenta Previa
o Rationale: Painless, bright red bleeding in the third trimester is the classic presentation
of placenta previa, where the placenta covers the cervical os.
o C. Preterm labor
o D. Ruptured uterus
3. What is the priority intervention for a client experiencing postpartum hemorrhage?
o A. Perform firm fundal massage.
o Rationale: Uterine atony is the most common cause of postpartum hemorrhage;
massage stimulates the muscle to contract and stop the bleeding.
o B. Check the blood pressure.
o C. Administer oxygen.
o D. Increase IV fluid rate.
4. A toddler is hospitalized with croup. Which finding is the priority to report to the
provider?
o A. Barking cough
,o B. Inspiratory stridor at rest
o Rationale: Stridor at rest indicates significant airway narrowing and impending
respiratory failure, requiring immediate intervention.
o C. Irritability
o D. Temperature of 100.2°F
5. A client taking Warfarin (Coumadin) has an INR of 5.5. The nurse anticipates
administering:
o A. Protamine Sulfate
o B. Vitamin K
o Rationale: Vitamin K is the specific antidote for Warfarin; an INR of 5.5 is well above the
therapeutic range (2.0–3.0) and poses a high bleeding risk.
o C. Heparin
o D. Enoxaparin
6. Which medication is contraindicated for a client with a history of a Sulfa allergy?
o A. Acetaminophen
o B. Hydrochlorothiazide
o Rationale: Many diuretics, such as thiazides and loops, have cross-sensitivity with
sulfonamides.
o C. Penicillin
o D. Ibuprofen
7. A nurse is caring for a child with Tetralogy of Fallot who is having a "Tet spell." What is
the first action?
o A. Place the child in the knee-chest position.
o Rationale: This position increases systemic vascular resistance, which forces more
blood into the lungs and improves oxygenation.
o B. Administer morphine.
o C. Give 100% oxygen via mask.
o D. Call for the Rapid Response Team.
8. A client has a total calcium level of 12.5 mg/dL. The nurse should monitor for:
o A. Positive Chvostek's sign
o B. Cardiac dysrhythmias and lethargy
o Rationale: Hypercalcemia (normal 8.5–10.5 mg/dL) acts as a sedative on the
neuromuscular system, leading to muscle weakness and dangerous heart rhythms.
o C. Muscle tremors
o D. Hyperactive bowel sounds
9. Which lab value is most important to monitor in a client with Acute Pancreatitis?
o A. Serum Amylase and Lipase
o Rationale: These enzymes are the hallmark indicators of pancreatic inflammation;
Lipase is generally considered more specific to the pancreas.
o B. Serum Sodium
o C. Platelet count
o D. Hemoglobin
10. A client is starting Clozapine. Which lab result is a mandatory baseline and weekly
requirement?
o A. ALT/AST
o B. Absolute Neutrophil Count (ANC)
,o Rationale: Clozapine carries a high risk for agranulocytosis (dangerously low WBC);
monitoring ANC is strictly regulated to prevent fatal infections.
o C. Fasting glucose
o D. Blood Urea Nitrogen (BUN)
11. A nurse is assessing a Stage 2 pressure injury. What is the expected appearance?
o A. Non-blanchable redness
o B. Partial-thickness skin loss with a shallow open ulcer or blister
o Rationale: Stage 2 involves the epidermis and dermis but does not extend into the
subcutaneous tissue.
o C. Visible subcutaneous fat
o D. Exposed bone and tendon
12. Before administering a Beta-Blocker, which vital sign must the nurse assess?
o A. Temperature
o B. Heart rate and Blood Pressure
o Rationale: Beta-blockers lower both heart rate and BP; the dose is usually held if HR is
<60 bpm or Systolic BP is <90 mmHg.
o C. Respiratory rate
o D. Oxygen saturation
13. A client has a "pulsatile mass" in the periumbilical area. The nurse should:
o A. Avoid palpation and notify the provider.
o Rationale: This is a classic sign of an Abdominal Aortic Aneurysm (AAA); palpation
could cause the aneurysm to rupture.
o B. Palpate deeply to determine the size.
o C. Auscultate for a bruit.
o D. Document as a normal finding in thin adults.
14. The "Cushing’s Triad" (Bradycardia, Hypertension, and Irregular Respirations) indicates:
o A. Septic shock
o B. Increased Intracranial Pressure (ICP)
o Rationale: These three signs are late indicators of severe brain stem compression and
impending brain herniation.
o C. Myocardial Infarction
o D. Hypoglycemic crisis
15. What is the goal of "Palliative Care"?
o A. To provide a cure for chronic illness.
o B. To provide symptom relief and improve quality of life.
o Rationale: Palliative care focuses on comfort and holistic support during a serious or
terminal illness, regardless of the stage.
o C. To hasten the dying process.
o D. To replace standard medical treatments.
16. A client in "Atrial Fibrillation" is at the highest risk for:
o A. Ventricular fibrillation
o B. Ischemic Stroke
o Rationale: Stasis of blood in the atria allows clots to form, which can travel to the brain.
o C. Pulmonary edema
o D. Kidney stones
17. After a Liver Biopsy, the client should be positioned:
, o A. High-Fowler's
o B. Right-side lying
o Rationale: Positioning on the right side applies pressure to the biopsy site, acting as a
pressure dressing to prevent hemorrhage.
o C. Left-side lying
o D. Supine
18. A "Positive Brudzinski’s sign" indicates:
o A. Deep Vein Thrombosis
o B. Meningeal irritation (Meningitis)
o Rationale: This is when the hips and knees flex involuntarily when the neck is flexed, a
sign of spinal cord/meningeal inflammation.
o C. Appendicitis
o D. Cholecystitis
19. A client has "Pernicious Anemia." The nurse expects the client to need:
o A. Iron supplements
o B. Vitamin B12 injections
o Rationale: Pernicious anemia is caused by a lack of Intrinsic Factor, meaning oral B12
cannot be absorbed; injections are required for life.
o C. Folic acid
o D. Blood transfusions only
20. What is the priority assessment for a client receiving Magnesium Sulfate for
preeclampsia?
o A. Blood glucose
o B. Deep tendon reflexes and respiratory rate
o Rationale: Loss of reflexes and a drop in respirations are early signs of Magnesium
toxicity, which can lead to cardiac arrest.
o C. Temperature
o D. Bowel sounds
21. A client with "SIADH" (Syndrome of Inappropriate Antidiuretic Hormone) will likely have:
o A. High serum sodium
o B. Low serum sodium (Hyponatremia)
o Rationale: SIADH causes excessive water retention, which dilutes the sodium in the
blood.
o C. High urine output
o D. Weight loss
22. Before a "Paracentesis," the nurse must ensure the client:
o A. Voids to empty the bladder.
o Rationale: An empty bladder reduces the risk of accidental puncture by the needle
during the procedure.
o B. Remains NPO for 12 hours.
o C. Drinks 1 liter of water.
o D. Exercises for 30 minutes.
23. Which insulin is the only one that can be given Intravenously (IV)?
o A. NPH
o B. Regular Insulin
