RN Comprehensive Practice Exam 450 Questions with
Bold Rationales and answer 2026 2027
This second volume of our high-yield study series provides 50 additional
multiple-choice questions focusing on Pediatrics, Maternity, and Advanced Med-
Surg nursing. Every question features the correct answer and a bolded, italicized
rationale to help students master complex clinical judgment and NGN-style
prioritization.
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 Rationale: Hyperkalemia (high potassium) causes rapid repolarization of the
heart, manifested as peaked T-waves; if untreated, it can lead to lethal
arrhythmias like V-fib.
o D. Shortened PR interval
2. A client's ABG results are: 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 too much CO2.
o B. Metabolic Acidosis
o C. Respiratory Alkalosis
o D. Metabolic Alkalosis
3. Which IV fluid is most appropriate for a client in hypovolemic shock?
o A. 0.9% Sodium Chloride
o Rationale: Normal Saline is an isotonic crystalloid that expands the extracellular
fluid volume without shifting water into or out of the cells.
o B. 0.45% Sodium Chloride
o C. Dextrose 5% in Water
o D. 3% Sodium Chloride
4. A nurse notes a "positive Chvostek's sign." Which electrolyte imbalance is the cause?
,o A. Hyperkalemia
o B. Hypocalcemia
o Rationale: Chvostek’s sign (facial twitching) is a classic sign of neuromuscular
irritability caused by low serum calcium levels.
o C. Hyponatremia
o D. Hypermagnesemia
5. A client with a sodium level of 118 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, which poses a massive
risk for seizures, coma, and brain herniation.
o C. Administer a high-ceiling diuretic
o D. Monitor for peripheral edema
Section 2: Cardiovascular & Respiratory
6. A client taking Digoxin reports seeing yellow halos. What is the nurse's first action?
o A. Check the 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 clinical assessment and a blood draw.
o C. Increase potassium intake
o D. Administer the medication as scheduled
7. What is the "window" for administering tPA to an ischemic stroke client?
o A. 12 hours
o B. 3 to 4.5 hours from symptom onset
o Rationale: Thrombolytic therapy must be started within this tight timeframe to
restore blood flow before permanent brain tissue necrosis occurs.
o C. 24 hours
o D. 1 hour
8. A client with Heart Failure has a BNP level of 900 pg/mL. The nurse should prioritize:
o A. Daily weights
o B. Assessment of lung sounds and O2 saturation
o Rationale: High BNP indicates fluid overload; the nurse must prioritize the
assessment of life-threatening pulmonary edema (Airway/Breathing).
o C. Intake and output
o D. Low-sodium diet teaching
9. A nurse notes constant bubbling in the water seal chamber of a chest tube. This
indicates:
o A. The lung has fully re-expanded
o B. An air leak in the system
,o Rationale: Constant bubbling in the water seal chamber (rather than intermittent
tidaling) indicates that air is leaking into the system from the patient or the
tubing.
o C. Normal suctioning pressure
o D. A blockage in the tube
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: Deep Vein Thrombosis carries a high risk of the clot breaking loose
and traveling to the pulmonary vasculature, causing a life-threatening PE.
o C. Panic Attack
o D. Pneumothorax
Section 3: Pharmacology & Safety
11. What is the specific 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 (low WBC), which can
lead to fatal infections; strict monitoring of the ANC is required.
o C. Liver enzymes
o D. Platelet count
13. A client on an MAOI (Phenelzine) should avoid which food?
o A. Fresh chicken
o B. Aged salami and red wine
o Rationale: Tyramine-rich foods (aged, fermented, or cured) can cause a life-
threatening hypertensive crisis when mixed with MAOIs.
o C. Whole grain bread
o D. Leafy greens
14. Before giving Furosemide, the nurse must assess which lab?
o A. Potassium level
o Rationale: Furosemide is a loop diuretic that causes significant potassium loss,
potentially leading to dangerous hypokalemia.
o B. Sodium level
o C. Blood Glucose
, o D. Hemoglobin
15. In fire safety (RACE), what does the "C" stand for?
o A. Call for help
o B. Carry the client
o C. Confine/Contain the fire
o Rationale: Closing doors and windows prevents the spread of smoke and fire to
other areas of the building.
o D. Clear the hallway
Section 4: Mental Health & Ethics
16. A client in the manic phase of Bipolar Disorder is yelling. The nurse should:
o A. Use seclusion immediately
o B. Guide the client to a quiet area with low stimulation
o Rationale: Reducing environmental stimuli is the first-line intervention to
decrease agitation and hyperactivity in manic patients.
o C. Encourage a group game
o D. Explain unit rules in detail
17. A client with Schizophrenia says, "The spiders are on my skin." This is:
o A. A delusion
o B. A hallucination
o Rationale: A hallucination is a sensory perception (tactile in this case) that occurs
without an external stimulus.
o C. An illusion
o D. Neologism
18. Which personality disorder is characterized by "splitting" and self-harm?
o A. Narcissistic
o B. Borderline
o Rationale: Borderline Personality Disorder involves emotional instability, intense
relationships, and a high risk for self-destructive behavior.
o C. Antisocial
o D. Avoidant
19. A client with Anorexia Nervosa should be weighed:
o A. Daily, in the morning, facing away from the scale
o Rationale: Facing away reduces the client's anxiety regarding the specific
number, while morning weighs ensure consistency.
o B. Once a week after lunch
o C. Monthly
o D. Only when they request it
20. "Waxy flexibility" is associated with which condition?
o A. Catatonic Schizophrenia
o Rationale: Waxy flexibility is a psychomotor symptom where the client remains in
whatever physical position they are placed by others for long periods.
Bold Rationales and answer 2026 2027
This second volume of our high-yield study series provides 50 additional
multiple-choice questions focusing on Pediatrics, Maternity, and Advanced Med-
Surg nursing. Every question features the correct answer and a bolded, italicized
rationale to help students master complex clinical judgment and NGN-style
prioritization.
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 Rationale: Hyperkalemia (high potassium) causes rapid repolarization of the
heart, manifested as peaked T-waves; if untreated, it can lead to lethal
arrhythmias like V-fib.
o D. Shortened PR interval
2. A client's ABG results are: 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 too much CO2.
o B. Metabolic Acidosis
o C. Respiratory Alkalosis
o D. Metabolic Alkalosis
3. Which IV fluid is most appropriate for a client in hypovolemic shock?
o A. 0.9% Sodium Chloride
o Rationale: Normal Saline is an isotonic crystalloid that expands the extracellular
fluid volume without shifting water into or out of the cells.
o B. 0.45% Sodium Chloride
o C. Dextrose 5% in Water
o D. 3% Sodium Chloride
4. A nurse notes a "positive Chvostek's sign." Which electrolyte imbalance is the cause?
,o A. Hyperkalemia
o B. Hypocalcemia
o Rationale: Chvostek’s sign (facial twitching) is a classic sign of neuromuscular
irritability caused by low serum calcium levels.
o C. Hyponatremia
o D. Hypermagnesemia
5. A client with a sodium level of 118 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, which poses a massive
risk for seizures, coma, and brain herniation.
o C. Administer a high-ceiling diuretic
o D. Monitor for peripheral edema
Section 2: Cardiovascular & Respiratory
6. A client taking Digoxin reports seeing yellow halos. What is the nurse's first action?
o A. Check the 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 clinical assessment and a blood draw.
o C. Increase potassium intake
o D. Administer the medication as scheduled
7. What is the "window" for administering tPA to an ischemic stroke client?
o A. 12 hours
o B. 3 to 4.5 hours from symptom onset
o Rationale: Thrombolytic therapy must be started within this tight timeframe to
restore blood flow before permanent brain tissue necrosis occurs.
o C. 24 hours
o D. 1 hour
8. A client with Heart Failure has a BNP level of 900 pg/mL. The nurse should prioritize:
o A. Daily weights
o B. Assessment of lung sounds and O2 saturation
o Rationale: High BNP indicates fluid overload; the nurse must prioritize the
assessment of life-threatening pulmonary edema (Airway/Breathing).
o C. Intake and output
o D. Low-sodium diet teaching
9. A nurse notes constant bubbling in the water seal chamber of a chest tube. This
indicates:
o A. The lung has fully re-expanded
o B. An air leak in the system
,o Rationale: Constant bubbling in the water seal chamber (rather than intermittent
tidaling) indicates that air is leaking into the system from the patient or the
tubing.
o C. Normal suctioning pressure
o D. A blockage in the tube
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: Deep Vein Thrombosis carries a high risk of the clot breaking loose
and traveling to the pulmonary vasculature, causing a life-threatening PE.
o C. Panic Attack
o D. Pneumothorax
Section 3: Pharmacology & Safety
11. What is the specific 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 (low WBC), which can
lead to fatal infections; strict monitoring of the ANC is required.
o C. Liver enzymes
o D. Platelet count
13. A client on an MAOI (Phenelzine) should avoid which food?
o A. Fresh chicken
o B. Aged salami and red wine
o Rationale: Tyramine-rich foods (aged, fermented, or cured) can cause a life-
threatening hypertensive crisis when mixed with MAOIs.
o C. Whole grain bread
o D. Leafy greens
14. Before giving Furosemide, the nurse must assess which lab?
o A. Potassium level
o Rationale: Furosemide is a loop diuretic that causes significant potassium loss,
potentially leading to dangerous hypokalemia.
o B. Sodium level
o C. Blood Glucose
, o D. Hemoglobin
15. In fire safety (RACE), what does the "C" stand for?
o A. Call for help
o B. Carry the client
o C. Confine/Contain the fire
o Rationale: Closing doors and windows prevents the spread of smoke and fire to
other areas of the building.
o D. Clear the hallway
Section 4: Mental Health & Ethics
16. A client in the manic phase of Bipolar Disorder is yelling. The nurse should:
o A. Use seclusion immediately
o B. Guide the client to a quiet area with low stimulation
o Rationale: Reducing environmental stimuli is the first-line intervention to
decrease agitation and hyperactivity in manic patients.
o C. Encourage a group game
o D. Explain unit rules in detail
17. A client with Schizophrenia says, "The spiders are on my skin." This is:
o A. A delusion
o B. A hallucination
o Rationale: A hallucination is a sensory perception (tactile in this case) that occurs
without an external stimulus.
o C. An illusion
o D. Neologism
18. Which personality disorder is characterized by "splitting" and self-harm?
o A. Narcissistic
o B. Borderline
o Rationale: Borderline Personality Disorder involves emotional instability, intense
relationships, and a high risk for self-destructive behavior.
o C. Antisocial
o D. Avoidant
19. A client with Anorexia Nervosa should be weighed:
o A. Daily, in the morning, facing away from the scale
o Rationale: Facing away reduces the client's anxiety regarding the specific
number, while morning weighs ensure consistency.
o B. Once a week after lunch
o C. Monthly
o D. Only when they request it
20. "Waxy flexibility" is associated with which condition?
o A. Catatonic Schizophrenia
o Rationale: Waxy flexibility is a psychomotor symptom where the client remains in
whatever physical position they are placed by others for long periods.
