NCLEX-RN COMPREHENSIVE EXAM BANK EDITION | 200+ High-Yield Practice Questions with Correct Answers & Rationales | Next Generation NCLEX (NGN) Prep | Guaranteed A+ Pass

This is a BRAND NEW, UPDATED comprehensive exam study guide for the NCLEX-RN Exam. This document contains 200+ high-yield practice questions with correct answers and rationales – designed to guarantee an A+ pass on your first attempt. Key topics covered (complete 233-page study guide): Psychiatric/Mental Health Nursing: Antisocial personality disorder: uses others for personal gain; poor impulse control Schizophrenia: word salad speech, blunt affect, delusions, poor problem-solving ability, auditory hallucinations (priority when becoming agitated) Clozapine (schizophrenia): highest priority to report = FEVER (agranulocytosis risk) Haloperidol long-term side effect: tardive dyskinesia – lip smacking Bipolar disorder (mania): provide high-calorie nutritional supplements; relaxation exercises; client who knocked over game → "Come outside with me for a walk" Depression: sertraline adverse effect = excessive sweating; difficulty sleeping; when client refuses medication → first identify reason for refusal Electroconvulsive therapy (ECT): client can refuse at any time ("You don't have to go through with the treatment") Alcohol withdrawal: provide frequent orientation to time and place Opioid intoxication: constricted pupils (meiosis/miosis), delayed reflexes, decreased blood pressure, hyperreflexia (withdrawal) Gambling disorder: 12-step program; medication = sertraline Obsessive-compulsive disorder (OCD): gradually decrease time allowed for ritualistic behavior Laissez-faire leadership in group therapy: leader allows group to discuss whatever they want Medical-Surgical Nursing: Water intoxication in infant: generalized edema Enteral feedings (gastrostomy tube): fluid overload finding = BOUNDING PULSES Open colectomy: hyperemesis places client at risk for delayed wound healing Diabetes management long-term test: HbA1c Neutropenia (HIV): use dedicated stethoscope Delirium due to febrile illness: HALLUCINATIONS Heart failure + loop diuretic adverse effect: decreased reflexes (hypokalemia/hyponatremia) Chest pain priority (cardiac unit): indigestion (possible angina/MI) Bronchoscopy post-procedure: AP offering oral fluids requires intervention (NPO until gag reflex returns) Blood draw allergy indicator for latex allergy: AVOCADOS (also bananas, kiwi, chestnuts) Informed consent: client statement "I am thankful there are no serious complications" requires contacting surgeon (lack of informed consent) Digoxin teaching: report muscle weakness (toxicity sign) Osteoporosis: perform weight-bearing exercises to prevent injury Magnesium 4.4 mEq/L (hypermagnesemia): HYPOTENSION Gentamicin ototoxicity risk: concurrent use with FUROSEMIDE Chest tube tidaling: system is working properly (water seal chamber should have at least 2 cm water – 1 cm requires intervention) C. difficile: place client in PRIVATE ROOM (contact precautions – not negative pressure; alcohol-based hand rub not effective – use soap and water) Chronic kidney disease with cloudy dialysate outflow: prioritize (peritonitis sign) Hypothyroidism (stuporous): priority to assess Post-thyroidectomy: fullness in back of throat (hematoma/bleeding) – priority Thyroidectomy complication: tingling in fingers (hypocalcemia) – priority Hypervolemia: urine specific gravity 1.001 (dilute) Pneumococcal pneumonia: tachypnea expected Hepatic encephalopathy diet: rice with black beans (low protein) Preeclampsia with postpartum hemorrhage: methylergonovine CONTRAINDICATED (hypertension) DVT: elevate affected extremity; heparin infusion – withhold if PTT 30-40 seconds (should be 1.5-2x control) Enoxaparin administration: inject into lateral abdominal wall (do NOT expel air bubble) Chronic emphysema ABG: PaCO2 55 mm Hg (hypercapnia – needs treatment) Percutaneous central line (subclavian): review chest x-ray BEFORE infusion (confirm placement) Atrial fibrillation (hemodynamically unstable): cardioversion TB employee screening: Mantoux test (PPD) Radiation implant (sealed): maintain bed rest for 72 hours; visitors limited to 30 min/day; wear dosimeter badge Maternal-Newborn Nursing: Amniocentesis at 33 weeks complication to monitor: CONTRACTIONS 16 weeks gestation screening: maternal serum alpha-fetoprotein (MSAFP) Danger sign at 14 weeks: swelling of the face (pre-eclampsia) Fetal heart tones at 12 weeks: position ultrasound stethoscope above symphysis pubis Nonstress test teaching: Doppler transducer applied to abdomen False labor: intermittent, PAINLESS contractions Postpartum 4 days: lochia serosa, fundus 4 cm below umbilicus (descends 1 cm/day) Methylergonovine contraindication: HYPERTENSION Mastitis while breastfeeding: continue nursing from both breasts; have baby empty breasts with each feeding Newborn genetic screening: after 24 hours old Newborn circumcision care: apply petroleum jelly to glans with diaper changes Neonatal abstinence syndrome (NAS): minimize noise, swaddle with legs flexed NAS withdrawal finding: HYPERTONICITY Coarctation of aorta: weak femoral pulses Newborn anterior fontanelle at 8 months: STILL OPEN (closes 12-18 months) Cleft lip/palate feeding: burp infant frequently Plagiocephaly helmet therapy: keep helmet on for 23 hours/day Fetal bradycardia (100/min for 15 min): possible cause = MATERNAL HYPOGLYCEMIA Epidural management: reposition client side-to-side each hour Rh immune globulin: administer within 72 hours of delivery for Rh-negative mother with Rh-positive baby Preterm labor magnesium sulfate toxicity: urine output 20 mL/hr Oxytocin augmentation: decrease infusion if contractions last 80 seconds (tachysystole) Newborn dry first (immediate post-birth): dry newborn FIRST Newborn under phototherapy: eye shield covering eyes Cold stress in newborn: jitteriness of hands Engorgement (bottle-feeding): do NOT manually express breastmilk (stimulates production) Hyperemesis gravidarum: risk for metabolic alkalosis Placenta previa: BRIGHT red vaginal bleeding Pediatric Nursing: Float nurse assignment (pediatric unit): 10-year-old with pneumonia receiving respiratory treatments (stable, medical condition) Water intoxication infant: generalized edema Increased ICP with decreased LOC: pad side rails (seizure precautions) Scabies permethrin cream adverse effect: BURNING Car seat safety: rolled blanket along each side of baby's head Cystic fibrosis high-frequency chest compressions effective: increased sputum production Retinoblastoma finding: HYPHEMA Legg-Calve-Perthes disease: child should continue to attend school Severe dehydration 7-year-old: heart rate 152/min 8-month-old fontanelle: anterior fontanelle still open 3-year-old development: ride a tricycle Toddler with short-leg plaster cast: support affected leg on a pillow Developmental dysplasia of hip (Pavlik harness): gently massage skin under straps once per day Post-clip palate repair: remove elbow splints periodically for ROM School-age child growth: weight should NOT increase only 2 lb (normal is 4-7 lb/year) 4-month-old vision screening: infant closes eyes when light shone (protective reflex) Droplet precautions: PERTUSSIS, meningitis Respiratory syncytial virus (RSV): use designated stethoscope Pharmacology & Medication Administration: Z-track administration of hydroxyzine: decreases risk of subcutaneous infiltration Digoxin teaching: report muscle weakness (toxicity); withhold if potassium 3.0 mEq/L with digoxin order Insulin glargine (Lantus): do NOT mix with other insulins Clozapine contraindication: fever (agranulocytosis) Sertraline adverse effects: excessive sweating, difficulty sleeping Methadone teaching: further teaching needed if client says "I understand methadone may cause me to have difficulty sleeping" (it causes sedation) Propofol contraindication: allergy to EGGS Atropine 0.4 mg IV stat – correct documentation (leading zero NOT used for numbers 1? Actually 0.4 is correct with leading zero to avoid error – per ISMP, use leading zero before decimal) Metformin: discontinue 48 hours prior to arteriogram (risk of lactic acidosis) Alendronate (osteoporosis): take with 8 ounces of water Ferrous sulfate in pregnancy: take with fluids other than coffee/tea Chemotherapy (breast cancer): report WBC 3,000/mm3 (neutropenia) Gentamicin adverse effects: ototoxicity (tinnitus) Vancomycin trough level: draw 1 hour prior to next dose Phenytoin (seizure disorder): teratogenic – contraindicated in pregnancy if possible Allopurinol effectiveness: monitor uric acid level Lithium carbonate prior to first dose: evaluate thyroid hormones Propranolol withhold indication: pulse 54/min (bradycardia) Spironolactone with potassium 5.2 mEq/L: WITHHOLD Methylergonovine contraindications: hypertension, preeclampsia Magnesium sulfate toxicity: administer calcium gluconate IV Midazolam (conscious sedation) respiratory depression: administer FLUMAZENIL Metoclopramide prior to chemotherapy: also administer diphenhydramine Delegation, Prioritization & Leadership: Antisocial personality disorder client assignment priority Time management: completing activities for one client before moving to next (effective) LPN delegation: insert indwelling catheter if not voided in 3 hours (acute liver failure) AP delegation: performing postmortem care, collecting urine sample, transporting child to x-ray, applying condom catheter, reminding to use incentive spirometer, helping with toileting Charge nurse role: first action when nurses viewing unauthorized records – instruct them to close record Incident report documentation: client found lying on floor near bedside table (objective, no blame) Restraints: provider renew prescription every 24 hours (not 48); pad bony prominences; remove every 2 hours; type of restraint must be specified; remove when client follows simple instructions Fire extinguisher sequence: pull pin → point at base → squeeze handle → sweep Disaster triage priority: traumatic arm amputation (highest) vs. agonal respirations (lowest – expectant) Elder abuse: report to Adult Protective Services (visible contusions on all extremities) Chemical impairment of coworker: report to nurse manager Emergency/Critical Care & Triage: Triage after natural disaster: traumatic arm amputation (highest priority) Chest pain after large meal (ED triage): priority to see first (possible MI) Stroke symptoms (slurred speech, disoriented, headache): priority Decreased fetal movement for 2 days (36 weeks): priority Gastroenteritis + lethargic/confused: priority (dehydration/electrolyte imbalance) Smallpox clinical manifestation: rash in the mouth Anthrax exposure: prophylactic ciprofloxacin Carbon monoxide poisoning (kerosene heater, headache, confused, drowsy): take client outdoors FIRST Legal & Ethical Issues: Ethical principle of justice: spending equal time with each client regardless of crimes Veracity (wrong medication given): tell truth Battery: administering injection against client's wishes Advance directives: client statements "I have the right to refuse treatment" and "My health care proxy can make medical decisions for me" indicate understanding Client leaving AMA (against medical advice): inform client of risks involved if she leaves Living will: communicates wishes for end-of-life care Infection Control & Safety: Contact precautions: herpes simplex (not varicella – airborne; not strep pharyngitis – droplet) Blood spill cleanup: CHLORINE BLEACH C. difficile: private room; soap and water hand hygiene (NOT alcohol-based) MRSA history: client can still transmit infection HIV confidentiality breech: AP discussing client in lobby – first action = tell AP to discontinue conversation Latex allergy: banana, avocado, kiwi, chestnut cross-reactivity Perfect for: NCLEX-RN candidates, nursing students (BSN/ADN), graduate nurses preparing for licensure, international nurses (CGFNS), and anyone preparing for the Next Generation NCLEX (NGN).