Comprehensive RN Practice Exam 2026 2027 350
NGN Questions & Bold Rationales
Description;
This high-yield study resource features 350 comprehensive multiple-choice
questions designed to mirror the ATI RN Predictor and HESI Med-Surg exit
exams. Covering essential topics such as Pharmacology, Mental Health,
Fundamentals, and Medical-Surgical nursing, each question includes the correct
answer in bold italics followed by a detailed clinical rationale. This guide is an
essential tool for nursing students seeking to master Next Generation NCLEX
(NGN) priorities, enhance clinical judgment, and achieve a Grade A on their final
proctored assessments.
1. A nurse is caring for a client with a potassium level of 6.5 mEq/L. Which EKG change is
the priority?
o A. Prominent U-waves
o B. ST-segment depression
o C. Tall, peaked T-waves
o D. Shortened PR interval
o *Rationale: Hyperkalemia (high potassium) causes rapid repolarization of the
heart, manifested as peaked T-waves; if untreated, it can lead to ventricular
fibrillation. *
2. A client with Schizophrenia says, "The silver men are coming to take me through the
vents." How should the nurse respond?
o A. "There are no silver men here."
o B. "I don't see silver men, but it sounds like you are feeling afraid."
o C. "Why do you think they are coming for you?"
o D. "Let's go to your room to hide."
o *Rationale: The nurse should acknowledge the client's feelings (fear) without
validating the hallucination, presenting reality calmly. *
,3. Which medication is the priority for a client in a suspected Opioid overdose with a
respiratory rate of 6/min?
o A. Methadone
o B. Lorazepam
o C. Naloxone
o D. Epinephrine
o *Rationale: Naloxone is an opioid antagonist used to reverse life-threatening
respiratory depression caused by opioids. *
4. A nurse is assessing a client for a "positive Trousseau's sign." This indicates:
o A. Hyperkalemia
o B. Hypocalcemia
o C. Hyponatremia
o D. Hypermagnesemia
o *Rationale: Trousseau's sign (carpal spasm induced by a BP cuff) is a classic
sign of neuromuscular irritability due to low calcium. *
5. A client on Lithium Carbonate reports vomiting and blurred vision. What is the nurse's
first action?
o A. Withhold the medication and notify the provider.
o B. Check the client's temperature.
o C. Administer an antiemetic.
o D. Encourage fluid intake.
o *Rationale: These are classic signs of Lithium toxicity. The priority is to stop the
drug and assess serum levels. *
6. Which ethical principle is involved when a nurse tells a client the truth about their
diagnosis?
o A. Fidelity
o B. Beneficence
o C. Veracity
o D. Autonomy
o *Rationale: Veracity is the duty to tell the truth and not mislead or deceive clients.
*
7. A client with a BMI of 16 and lanugo is likely experiencing:
o A. Anorexia Nervosa
o B. Bulimia Nervosa
o C. Binge Eating Disorder
o D. Obesity
o *Rationale: Lanugo (fine hair) and low BMI are hallmark physical findings of
severe malnutrition in Anorexia. *
8. What is the priority intervention for a client with a Glasgow Coma Scale (GCS) of 7?
o A. Perform a skin assessment.
o B. Prepare for intubation (Protect the airway).
o C. Monitor urine output.
o D. Assess for pain.
o *Rationale: A GCS of 8 or less indicates a client cannot maintain their own airway;
"Less than 8, intubate." *
9. Which finding is a hallmark sign of a Tension Pneumothorax?
, o A. Productive cough
o B. Flat neck veins
o C. Tracheal deviation to the unaffected side
o D. Bilateral breath sounds
o *Rationale: A tension pneumothorax causes a mediastinal shift, pushing the
trachea away from the side of the collapse. *
10. A client is prescribed an MAOI. Which snack requires nurse intervention?
o A. Sliced apples
o B. Pepperoni and aged cheese
o C. Hard-boiled eggs
o D. Carrot sticks
o *Rationale: High-tyramine foods (aged cheese/meats) can cause a hypertensive
crisis when mixed with MAOIs. *
11. A nurse uses a blood pressure cuff that is too large. The result will be:
o A. Falsely high
o B. Falsely low
o C. Accurate
o D. Fluctuating
o *Rationale: A cuff that is too large will provide a falsely low reading; one that is
too small gives a falsely high reading. *
12. A client with Borderline Personality Disorder is "splitting" the staff. The nurse should:
o A. Allow the client to work with only one nurse.
o B. Hold a staff meeting to ensure a consistent approach.
o C. Ignore the behavior.
o D. Confront the client.
o *Rationale: Consistency and firm boundaries among all staff are essential to
manage splitting and manipulation. *
13. What is the antidote for Heparin?
o A. Vitamin K
o B. Protamine Sulfate
o C. Acetylcysteine
o D. Flumazenil
o *Rationale: Protamine sulfate is the specific antagonist used to neutralize the
effects of Heparin. *
14. A client reports the "worst headache of my life." The nurse suspects:
o A. Migraine
o B. Cluster headache
o C. Subarachnoid hemorrhage
o D. Tension headache
o *Rationale: This classic description indicates a ruptured aneurysm or bleed,
which is a medical emergency. *
15. "Sundowning" is most commonly associated with:
o A. Depression
o B. Bipolar Disorder
o C. Alzheimer's Dementia
o D. Anxiety
NGN Questions & Bold Rationales
Description;
This high-yield study resource features 350 comprehensive multiple-choice
questions designed to mirror the ATI RN Predictor and HESI Med-Surg exit
exams. Covering essential topics such as Pharmacology, Mental Health,
Fundamentals, and Medical-Surgical nursing, each question includes the correct
answer in bold italics followed by a detailed clinical rationale. This guide is an
essential tool for nursing students seeking to master Next Generation NCLEX
(NGN) priorities, enhance clinical judgment, and achieve a Grade A on their final
proctored assessments.
1. A nurse is caring for a client with a potassium level of 6.5 mEq/L. Which EKG change is
the priority?
o A. Prominent U-waves
o B. ST-segment depression
o C. Tall, peaked T-waves
o D. Shortened PR interval
o *Rationale: Hyperkalemia (high potassium) causes rapid repolarization of the
heart, manifested as peaked T-waves; if untreated, it can lead to ventricular
fibrillation. *
2. A client with Schizophrenia says, "The silver men are coming to take me through the
vents." How should the nurse respond?
o A. "There are no silver men here."
o B. "I don't see silver men, but it sounds like you are feeling afraid."
o C. "Why do you think they are coming for you?"
o D. "Let's go to your room to hide."
o *Rationale: The nurse should acknowledge the client's feelings (fear) without
validating the hallucination, presenting reality calmly. *
,3. Which medication is the priority for a client in a suspected Opioid overdose with a
respiratory rate of 6/min?
o A. Methadone
o B. Lorazepam
o C. Naloxone
o D. Epinephrine
o *Rationale: Naloxone is an opioid antagonist used to reverse life-threatening
respiratory depression caused by opioids. *
4. A nurse is assessing a client for a "positive Trousseau's sign." This indicates:
o A. Hyperkalemia
o B. Hypocalcemia
o C. Hyponatremia
o D. Hypermagnesemia
o *Rationale: Trousseau's sign (carpal spasm induced by a BP cuff) is a classic
sign of neuromuscular irritability due to low calcium. *
5. A client on Lithium Carbonate reports vomiting and blurred vision. What is the nurse's
first action?
o A. Withhold the medication and notify the provider.
o B. Check the client's temperature.
o C. Administer an antiemetic.
o D. Encourage fluid intake.
o *Rationale: These are classic signs of Lithium toxicity. The priority is to stop the
drug and assess serum levels. *
6. Which ethical principle is involved when a nurse tells a client the truth about their
diagnosis?
o A. Fidelity
o B. Beneficence
o C. Veracity
o D. Autonomy
o *Rationale: Veracity is the duty to tell the truth and not mislead or deceive clients.
*
7. A client with a BMI of 16 and lanugo is likely experiencing:
o A. Anorexia Nervosa
o B. Bulimia Nervosa
o C. Binge Eating Disorder
o D. Obesity
o *Rationale: Lanugo (fine hair) and low BMI are hallmark physical findings of
severe malnutrition in Anorexia. *
8. What is the priority intervention for a client with a Glasgow Coma Scale (GCS) of 7?
o A. Perform a skin assessment.
o B. Prepare for intubation (Protect the airway).
o C. Monitor urine output.
o D. Assess for pain.
o *Rationale: A GCS of 8 or less indicates a client cannot maintain their own airway;
"Less than 8, intubate." *
9. Which finding is a hallmark sign of a Tension Pneumothorax?
, o A. Productive cough
o B. Flat neck veins
o C. Tracheal deviation to the unaffected side
o D. Bilateral breath sounds
o *Rationale: A tension pneumothorax causes a mediastinal shift, pushing the
trachea away from the side of the collapse. *
10. A client is prescribed an MAOI. Which snack requires nurse intervention?
o A. Sliced apples
o B. Pepperoni and aged cheese
o C. Hard-boiled eggs
o D. Carrot sticks
o *Rationale: High-tyramine foods (aged cheese/meats) can cause a hypertensive
crisis when mixed with MAOIs. *
11. A nurse uses a blood pressure cuff that is too large. The result will be:
o A. Falsely high
o B. Falsely low
o C. Accurate
o D. Fluctuating
o *Rationale: A cuff that is too large will provide a falsely low reading; one that is
too small gives a falsely high reading. *
12. A client with Borderline Personality Disorder is "splitting" the staff. The nurse should:
o A. Allow the client to work with only one nurse.
o B. Hold a staff meeting to ensure a consistent approach.
o C. Ignore the behavior.
o D. Confront the client.
o *Rationale: Consistency and firm boundaries among all staff are essential to
manage splitting and manipulation. *
13. What is the antidote for Heparin?
o A. Vitamin K
o B. Protamine Sulfate
o C. Acetylcysteine
o D. Flumazenil
o *Rationale: Protamine sulfate is the specific antagonist used to neutralize the
effects of Heparin. *
14. A client reports the "worst headache of my life." The nurse suspects:
o A. Migraine
o B. Cluster headache
o C. Subarachnoid hemorrhage
o D. Tension headache
o *Rationale: This classic description indicates a ruptured aneurysm or bleed,
which is a medical emergency. *
15. "Sundowning" is most commonly associated with:
o A. Depression
o B. Bipolar Disorder
o C. Alzheimer's Dementia
o D. Anxiety
