RN VATI Comprehensive Predictor 2026 |
Updated Practice Questions, Verified
Answers & Accuracy-Reviewed Rationales |
NCLEX RN Exam Prep Study Guide
• VATI Comprehensive RN Predictor 2026 — A complete practice examination
designed to assess readiness for NCLEX-RN with verified answers and detailed
clinical EXPERT RATIONALE across all major nursing domains.
• Study Strategy — Complete all questions under timed conditions, review
incorrect responses with EXPERT RATIONALE, and identify knowledge gaps for
targeted studying before taking the actual NCLEX exam.
1. A client hospitalized with acute myocardial infarction (AMI) is receiving
heparin therapy. The nurse notices the client's activated partial
thromboplastin time (aPTT) is 28 seconds. What is the nurse's priority action?
A) Document the result and continue current heparin dose
B) Prepare to administer protamine sulfate immediately
C) Notify the provider to increase the heparin dose
D) Administer vitamin K to reverse the heparin effect
E) Discontinue the heparin infusion without provider order
✔ CORRECT ANSWER: C) Notify the provider to increase the heparin dose
EXPERT RATIONALE: The therapeutic range for aPTT on heparin therapy is typically
1.5–2.5 times the control value, or approximately 45–75 seconds. An aPTT of 28
seconds is subtherapeutic, indicating insufficient anticoagulation. The nurse must
notify the provider immediately so the heparin dose can be increased to achieve
therapeutic levels and prevent clot formation. Protamine sulfate reverses excessive
heparin (when aPTT is critically elevated), not low aPTT. Vitamin K reverses warfarin,
not heparin. Continuing the current dose would leave the client at risk. The nurse
cannot independently discontinue medications.
,2. A client with COPD is experiencing acute dyspnea. The nurse observes use
of accessory muscles and a respiratory rate of 32 breaths per minute. Which
nursing intervention takes priority?
A) Position the client supine to facilitate breathing
B) Place the client in high Fowler's position and administer oxygen
C) Administer sedatives to calm the client
D) Encourage deep breathing exercises
E) Apply a non-rebreather mask delivering 100% oxygen
✔ CORRECT ANSWER: B) Place the client in high Fowler's position and
administer oxygen
EXPERT RATIONALE: High Fowler's position (90 degrees) facilitates chest expansion
by using gravity to promote diaphragmatic movement and reduces work of
breathing. Oxygen administration increases oxygen saturation, addressing the
immediate physiological need. Supine positioning worsens dyspnea by restricting
chest expansion. Sedatives can suppress respiratory drive, which is dangerous in
COPD. Deep breathing, while beneficial long-term, is not the priority during acute
distress. A non-rebreather mask is contraindicated in stable COPD patients (risk of
CO2 retention), though this client may need it depending on oxygenation levels—
Fowler's position and oxygen administration are the immediate priority actions.
3. A 68-year-old male client is admitted with a diagnosis of stroke (CVA). The
CT scan shows no evidence of hemorrhage. The nurse anticipates the provider
may order which thrombolytic agent within the 3-hour window?
A) Warfarin (Coumadin)
B) Alteplase (tPA)
C) Enoxaparin (Lovenox)
D) Aspirin
E) Clopidogrel (Plavix)
,✔ CORRECT ANSWER: B) Alteplase (tPA)
EXPERT RATIONALE: Alteplase (tissue plasminogen activator) is the only FDA-
approved thrombolytic agent for acute ischemic stroke and must be administered
within 3 hours of symptom onset (up to 4.5 hours in select cases). tPA dissolves the
clot causing the stroke, restoring cerebral blood flow. The absence of hemorrhage
on CT confirms it is safe to use (rules out hemorrhagic stroke). Warfarin is long-
acting and inappropriate for acute treatment. Enoxaparin and aspirin are
anticoagulants/antiplatelets used after acute phase. Clopidogrel is an antiplatelet
agent, not a thrombolytic. Only thrombolytics dissolve existing clots in the acute
window.
4. A nurse is caring for a client receiving continuous cardiac monitoring. The
monitor shows a rhythm with a rate of 150 bpm, narrow QRS complexes, and
a regular rhythm. P waves are buried in the T waves. What is this rhythm?
A) Atrial flutter with rapid ventricular response
B) Paroxysmal supraventricular tachycardia (PSVT)
C) Atrial fibrillation with rapid ventricular response
D) Sinus tachycardia
E) Ventricular tachycardia
✔ CORRECT ANSWER: B) Paroxysmal supraventricular tachycardia (PSVT)
EXPERT RATIONALE: PSVT presents with a regular, narrow-complex tachycardia at
rates typically 150–250 bpm. P waves are often buried in or immediately after the
QRS complex or T wave because the reentry circuit involves the AV node. The
rhythm is sudden in onset and offset, and the regularity distinguishes it from atrial
fibrillation (which is irregularly irregular). Atrial flutter would show a flutter wave
sawtooth pattern. Sinus tachycardia has visible P waves separate from QRS and
slower rate (<150 bpm). Ventricular tachycardia has wide QRS complexes. This
narrow, regular rhythm with buried P waves is diagnostic of PSVT.
, 5. A client with a urinary tract infection (UTI) is prescribed trimethoprim-
sulfamethoxazole (TMP-SMX). Before administering, which assessment is
most important?
A) Checking liver function tests
B) Asking about history of sulfonamide allergy
C) Verifying blood glucose levels
D) Assessing potassium levels
E) Reviewing recent blood pressure readings
✔ CORRECT ANSWER: B) Asking about history of sulfonamide allergy
EXPERT RATIONALE: TMP-SMX is a sulfonamide antibiotic, and sulfonamide
allergies are among the most common drug allergies (occur in 3–8% of the
population). A history of sulfonamide or sulfite allergy is an absolute
contraindication to administration because cross-sensitivity is high and allergic
reactions can be severe (Stevens-Johnson syndrome, toxic epidermal necrolysis).
While liver function and potassium should be monitored (TMP-SMX can elevate
potassium), allergy assessment must occur first to prevent serious adverse
reactions. Blood glucose and BP are not primary concerns with this medication.
6. A nurse is administering medications to a client with heart failure. The
client takes digoxin and loop diuretics. Which electrolyte imbalance is the
nurse most concerned about related to digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
C) Hypocalcemia
D) Hypernatremia
E) Hypophosphatemia
✔ CORRECT ANSWER: B) Hypokalemia
Updated Practice Questions, Verified
Answers & Accuracy-Reviewed Rationales |
NCLEX RN Exam Prep Study Guide
• VATI Comprehensive RN Predictor 2026 — A complete practice examination
designed to assess readiness for NCLEX-RN with verified answers and detailed
clinical EXPERT RATIONALE across all major nursing domains.
• Study Strategy — Complete all questions under timed conditions, review
incorrect responses with EXPERT RATIONALE, and identify knowledge gaps for
targeted studying before taking the actual NCLEX exam.
1. A client hospitalized with acute myocardial infarction (AMI) is receiving
heparin therapy. The nurse notices the client's activated partial
thromboplastin time (aPTT) is 28 seconds. What is the nurse's priority action?
A) Document the result and continue current heparin dose
B) Prepare to administer protamine sulfate immediately
C) Notify the provider to increase the heparin dose
D) Administer vitamin K to reverse the heparin effect
E) Discontinue the heparin infusion without provider order
✔ CORRECT ANSWER: C) Notify the provider to increase the heparin dose
EXPERT RATIONALE: The therapeutic range for aPTT on heparin therapy is typically
1.5–2.5 times the control value, or approximately 45–75 seconds. An aPTT of 28
seconds is subtherapeutic, indicating insufficient anticoagulation. The nurse must
notify the provider immediately so the heparin dose can be increased to achieve
therapeutic levels and prevent clot formation. Protamine sulfate reverses excessive
heparin (when aPTT is critically elevated), not low aPTT. Vitamin K reverses warfarin,
not heparin. Continuing the current dose would leave the client at risk. The nurse
cannot independently discontinue medications.
,2. A client with COPD is experiencing acute dyspnea. The nurse observes use
of accessory muscles and a respiratory rate of 32 breaths per minute. Which
nursing intervention takes priority?
A) Position the client supine to facilitate breathing
B) Place the client in high Fowler's position and administer oxygen
C) Administer sedatives to calm the client
D) Encourage deep breathing exercises
E) Apply a non-rebreather mask delivering 100% oxygen
✔ CORRECT ANSWER: B) Place the client in high Fowler's position and
administer oxygen
EXPERT RATIONALE: High Fowler's position (90 degrees) facilitates chest expansion
by using gravity to promote diaphragmatic movement and reduces work of
breathing. Oxygen administration increases oxygen saturation, addressing the
immediate physiological need. Supine positioning worsens dyspnea by restricting
chest expansion. Sedatives can suppress respiratory drive, which is dangerous in
COPD. Deep breathing, while beneficial long-term, is not the priority during acute
distress. A non-rebreather mask is contraindicated in stable COPD patients (risk of
CO2 retention), though this client may need it depending on oxygenation levels—
Fowler's position and oxygen administration are the immediate priority actions.
3. A 68-year-old male client is admitted with a diagnosis of stroke (CVA). The
CT scan shows no evidence of hemorrhage. The nurse anticipates the provider
may order which thrombolytic agent within the 3-hour window?
A) Warfarin (Coumadin)
B) Alteplase (tPA)
C) Enoxaparin (Lovenox)
D) Aspirin
E) Clopidogrel (Plavix)
,✔ CORRECT ANSWER: B) Alteplase (tPA)
EXPERT RATIONALE: Alteplase (tissue plasminogen activator) is the only FDA-
approved thrombolytic agent for acute ischemic stroke and must be administered
within 3 hours of symptom onset (up to 4.5 hours in select cases). tPA dissolves the
clot causing the stroke, restoring cerebral blood flow. The absence of hemorrhage
on CT confirms it is safe to use (rules out hemorrhagic stroke). Warfarin is long-
acting and inappropriate for acute treatment. Enoxaparin and aspirin are
anticoagulants/antiplatelets used after acute phase. Clopidogrel is an antiplatelet
agent, not a thrombolytic. Only thrombolytics dissolve existing clots in the acute
window.
4. A nurse is caring for a client receiving continuous cardiac monitoring. The
monitor shows a rhythm with a rate of 150 bpm, narrow QRS complexes, and
a regular rhythm. P waves are buried in the T waves. What is this rhythm?
A) Atrial flutter with rapid ventricular response
B) Paroxysmal supraventricular tachycardia (PSVT)
C) Atrial fibrillation with rapid ventricular response
D) Sinus tachycardia
E) Ventricular tachycardia
✔ CORRECT ANSWER: B) Paroxysmal supraventricular tachycardia (PSVT)
EXPERT RATIONALE: PSVT presents with a regular, narrow-complex tachycardia at
rates typically 150–250 bpm. P waves are often buried in or immediately after the
QRS complex or T wave because the reentry circuit involves the AV node. The
rhythm is sudden in onset and offset, and the regularity distinguishes it from atrial
fibrillation (which is irregularly irregular). Atrial flutter would show a flutter wave
sawtooth pattern. Sinus tachycardia has visible P waves separate from QRS and
slower rate (<150 bpm). Ventricular tachycardia has wide QRS complexes. This
narrow, regular rhythm with buried P waves is diagnostic of PSVT.
, 5. A client with a urinary tract infection (UTI) is prescribed trimethoprim-
sulfamethoxazole (TMP-SMX). Before administering, which assessment is
most important?
A) Checking liver function tests
B) Asking about history of sulfonamide allergy
C) Verifying blood glucose levels
D) Assessing potassium levels
E) Reviewing recent blood pressure readings
✔ CORRECT ANSWER: B) Asking about history of sulfonamide allergy
EXPERT RATIONALE: TMP-SMX is a sulfonamide antibiotic, and sulfonamide
allergies are among the most common drug allergies (occur in 3–8% of the
population). A history of sulfonamide or sulfite allergy is an absolute
contraindication to administration because cross-sensitivity is high and allergic
reactions can be severe (Stevens-Johnson syndrome, toxic epidermal necrolysis).
While liver function and potassium should be monitored (TMP-SMX can elevate
potassium), allergy assessment must occur first to prevent serious adverse
reactions. Blood glucose and BP are not primary concerns with this medication.
6. A nurse is administering medications to a client with heart failure. The
client takes digoxin and loop diuretics. Which electrolyte imbalance is the
nurse most concerned about related to digoxin toxicity?
A) Hyperkalemia
B) Hypokalemia
C) Hypocalcemia
D) Hypernatremia
E) Hypophosphatemia
✔ CORRECT ANSWER: B) Hypokalemia
