COMPREHENSIVE NCLEX-RN
READINESS EXAMINATION
2026/2027
### Question 1
A charge nurse on a medical-surgical unit is making patient assignments for the upcoming shift. Which
patient should the charge nurse assign to the most experienced registered nurse?
A. A 45-year-old patient with diabetes mellitus who requires insulin administration before meals
B. A 68-year-old patient with chronic obstructive pulmonary disease who needs oxygen therapy and
bronchodilator treatments
C. A 72-year-old patient who is 24 hours post-operative from a hip replacement and requires hourly
neurovascular assessments
D. A 38-year-old patient with acute pancreatitis who is receiving total parenteral nutrition and has
unstable vital signs
💫RATIONALE✔️✔️: The patient with acute pancreatitis receiving TPN and exhibiting unstable vital
signs requires the most experienced nurse due to the complexity of care, need for close monitoring, and
potential for rapid deterioration. This assignment demands advanced clinical judgment and prioritization
skills.
,💫ANSWER✔️✔️: D. A 38-year-old patient with acute pancreatitis who is receiving total parenteral
nutrition and has unstable vital signs
---
### Question 2
The nurse is preparing to administer a blood transfusion to a patient with anemia. Which action should
the nurse prioritize to ensure patient safety?
A. Verify the patient's identity using two identifiers and confirm the blood product with another licensed
nurse
B. Pre-medicate the patient with diphenhydramine and acetaminophen to prevent transfusion reactions
C. Initiate the transfusion using a 20-gauge or larger intravenous catheter
D. Assess the patient's vital signs every 15 minutes during the first hour of the transfusion
💫RATIONALE✔️✔️: Verifying patient identity using two identifiers and confirming the blood product
with another licensed nurse is the priority action to prevent transfusion errors, which are life-
threatening. While the other options are important, verification is the critical first step in transfusion
safety protocols.
💫ANSWER✔️✔️: A. Verify the patient's identity using two identifiers and confirm the blood product
with another licensed nurse
---
### Question 3
,A nurse manager is implementing a new evidence-based practice protocol for fall prevention on the
unit. Which approach is most likely to promote successful adoption of the new protocol?
A. Distributing written copies of the protocol to all staff members and posting it in the break room
B. Requiring staff to attend a mandatory training session and signing an acknowledgment of receipt
C. Involving staff nurses in the development and implementation process and providing ongoing support
D. Announcing the new protocol during a staff meeting and offering incentives for compliance
💫RATIONALE✔️✔️: Involving staff nurses in the development and implementation of evidence-
based practice changes promotes buy-in, ownership, and sustainability. Staff engagement leads to
better understanding, acceptance, and adherence to new protocols.
💫ANSWER✔️✔️: C. Involving staff nurses in the development and implementation process and
providing ongoing support
---
### Question 4
The nurse is caring for a patient who is receiving continuous enteral tube feeding. Which assessment
finding requires immediate intervention?
A. Gastric residual volume of 250 mL after 4 hours
B. Blood glucose level of 140 mg/dL
C. Patient reports mild abdominal cramping
D. Tube feeding formula appears slightly discolored
, 💫RATIONALE✔️✔️: A gastric residual volume of 250 mL after 4 hours is above the recommended
threshold (typically 200-250 mL) and indicates delayed gastric emptying, which increases the risk for
aspiration. The nurse should hold the feeding, assess for abdominal distension, and notify the
healthcare provider.
💫ANSWER✔️✔️: A. Gastric residual volume of 250 mL after 4 hours
---
### Question 5
A newly licensed nurse is caring for a patient with a chest tube drainage system. Which action by the
newly licensed nurse indicates a need for additional teaching?
A. Keeping the drainage system below the level of the patient's chest
B. Taping the connections between the chest tube and drainage system
C. Clamping the chest tube when repositioning the patient
D. Observing for continuous bubbling in the water seal chamber
💫RATIONALE✔️✔️: Chest tubes should never be clamped except for specific situations such as
changing the drainage system or assessing for air leaks, as clamping can lead to tension pneumothorax.
Continuous bubbling in the water seal chamber indicates an air leak, which should be reported.
💫ANSWER✔️✔️: C. Clamping the chest tube when repositioning the patient
---
### Question 6
READINESS EXAMINATION
2026/2027
### Question 1
A charge nurse on a medical-surgical unit is making patient assignments for the upcoming shift. Which
patient should the charge nurse assign to the most experienced registered nurse?
A. A 45-year-old patient with diabetes mellitus who requires insulin administration before meals
B. A 68-year-old patient with chronic obstructive pulmonary disease who needs oxygen therapy and
bronchodilator treatments
C. A 72-year-old patient who is 24 hours post-operative from a hip replacement and requires hourly
neurovascular assessments
D. A 38-year-old patient with acute pancreatitis who is receiving total parenteral nutrition and has
unstable vital signs
💫RATIONALE✔️✔️: The patient with acute pancreatitis receiving TPN and exhibiting unstable vital
signs requires the most experienced nurse due to the complexity of care, need for close monitoring, and
potential for rapid deterioration. This assignment demands advanced clinical judgment and prioritization
skills.
,💫ANSWER✔️✔️: D. A 38-year-old patient with acute pancreatitis who is receiving total parenteral
nutrition and has unstable vital signs
---
### Question 2
The nurse is preparing to administer a blood transfusion to a patient with anemia. Which action should
the nurse prioritize to ensure patient safety?
A. Verify the patient's identity using two identifiers and confirm the blood product with another licensed
nurse
B. Pre-medicate the patient with diphenhydramine and acetaminophen to prevent transfusion reactions
C. Initiate the transfusion using a 20-gauge or larger intravenous catheter
D. Assess the patient's vital signs every 15 minutes during the first hour of the transfusion
💫RATIONALE✔️✔️: Verifying patient identity using two identifiers and confirming the blood product
with another licensed nurse is the priority action to prevent transfusion errors, which are life-
threatening. While the other options are important, verification is the critical first step in transfusion
safety protocols.
💫ANSWER✔️✔️: A. Verify the patient's identity using two identifiers and confirm the blood product
with another licensed nurse
---
### Question 3
,A nurse manager is implementing a new evidence-based practice protocol for fall prevention on the
unit. Which approach is most likely to promote successful adoption of the new protocol?
A. Distributing written copies of the protocol to all staff members and posting it in the break room
B. Requiring staff to attend a mandatory training session and signing an acknowledgment of receipt
C. Involving staff nurses in the development and implementation process and providing ongoing support
D. Announcing the new protocol during a staff meeting and offering incentives for compliance
💫RATIONALE✔️✔️: Involving staff nurses in the development and implementation of evidence-
based practice changes promotes buy-in, ownership, and sustainability. Staff engagement leads to
better understanding, acceptance, and adherence to new protocols.
💫ANSWER✔️✔️: C. Involving staff nurses in the development and implementation process and
providing ongoing support
---
### Question 4
The nurse is caring for a patient who is receiving continuous enteral tube feeding. Which assessment
finding requires immediate intervention?
A. Gastric residual volume of 250 mL after 4 hours
B. Blood glucose level of 140 mg/dL
C. Patient reports mild abdominal cramping
D. Tube feeding formula appears slightly discolored
, 💫RATIONALE✔️✔️: A gastric residual volume of 250 mL after 4 hours is above the recommended
threshold (typically 200-250 mL) and indicates delayed gastric emptying, which increases the risk for
aspiration. The nurse should hold the feeding, assess for abdominal distension, and notify the
healthcare provider.
💫ANSWER✔️✔️: A. Gastric residual volume of 250 mL after 4 hours
---
### Question 5
A newly licensed nurse is caring for a patient with a chest tube drainage system. Which action by the
newly licensed nurse indicates a need for additional teaching?
A. Keeping the drainage system below the level of the patient's chest
B. Taping the connections between the chest tube and drainage system
C. Clamping the chest tube when repositioning the patient
D. Observing for continuous bubbling in the water seal chamber
💫RATIONALE✔️✔️: Chest tubes should never be clamped except for specific situations such as
changing the drainage system or assessing for air leaks, as clamping can lead to tension pneumothorax.
Continuous bubbling in the water seal chamber indicates an air leak, which should be reported.
💫ANSWER✔️✔️: C. Clamping the chest tube when repositioning the patient
---
### Question 6
