PN COMPREHENSIVE PREDICTOR EXAM WITH NGN |
2026/2027 Edition | 250 Verified Questions
PN Comprehensive Predictor Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest NGN Guidelines | Graded A+
This comprehensive predictor exam is designed for practical nursing (PN) students preparing for the
NCLEX-PN. It includes 250 verified questions with detailed solutions, covering all major content
areas. The exam reflects the latest Next Generation NCLEX (NGN) format and clinical judgment
framework. Ideal for final exam review and self-assessment.
Key Features:
Safe and Effective Care Environment
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity: Basic Care and Comfort
Physiological Integrity: Pharmacological and Parenteral Therapies
Physiological Integrity: Reduction of Risk Potential and Physiological Adaptation
Updates for 2026:
- Integrated NGN-style case studies and unfolding scenarios
- Updated rationales with evidence-based practice references
- Added clinical judgment measurement model (CJMM) cues
- Revised distractors to reflect current NCLEX-PN test plan
- Enhanced answer explanations with step-by-step clinical reasoning
Abstract:
The PN Comprehensive Predictor Exam with NGN is a high-stakes assessment tool for practical nursing students.
This document contains 250 questions that mirror the NCLEX-PN blueprint, emphasizing clinical judgment and
decision-making. Each question includes a detailed solution with rationale, correct answer, and distractor
analysis. The exam covers six major client needs categories: safe and effective care environment, health
promotion, psychosocial integrity, and physiological integrity subcategories. Questions are formatted as
multiple-choice, select-all-that-apply, ordered response, and fill-in-the-blank, aligned with NGN guidelines. This
resource is essential for students aiming to achieve a passing score on the predictor exam and ultimately the
NCLEX-PN. The content has been rigorously reviewed for accuracy and relevance to the 2026-2027 academic
year.
Keywords:
PN Comprehensive Predictor, NCLEX-PN, NGN, Clinical Judgment, Practical Nursing, Exam Prep, 250
Questions, 2026-2027
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct. Incorrect
options are analyzed with explanations of why they are wrong. Rationales include references to nursing concepts,
guidelines, and evidence-based practice. For NGN items, clinical judgment steps are highlighted.
Compliance Checklist:
Aligned with NCLEX-PN 2026-2027 test plan
Incorporates NGN clinical judgment framework
All questions verified for accuracy
Page 1
, Rationales cite current nursing standards
Distractors reflect common student errors
Suitable for self-assessment and review
Content Area Overview:
Content Area Questions Key Topics Weight
Safe and Effective Care 1-45 Management of Care, Safety and Infection 18%
Environment Control, Coordinated Care
Health Promotion and 46-85 Growth and Development, Prevention and 16%
Maintenance Early Detection, Health Screening
Psychosocial Integrity 86-125 Coping Mechanisms, Mental Health 16%
Disorders, Therapeutic Communication
Physiological Integrity: Basic 126-160 Mobility, Nutrition, Elimination, Comfort 14%
Care and Comfort Measures
Physiological Integrity: 161-200 Medication Administration, IV Therapy, 18%
Pharmacological and Parenteral Blood Products, Adverse Effects
Therapies
Physiological Integrity: 201-250 Diagnostic Tests, Complications, 18%
Reduction of Risk Potential and Emergency Care, Pathophysiology
Physiological Adaptation
Page 2
,Q1. A client with a history of chronic heart failure is admitted with acute dyspnea and bilateral
crackles. The nurse notes a urine output of 20 mL over the past hour. Which intervention should the
nurse prioritize?
A. Administer furosemide 40 mg IV push over 2 minutes
B. Administer metoprolol 25 mg orally
C. Increase IV fluids to 150 mL/hr
D. Administer digoxin 0.25 mg IV push
Correct Answer: A. Administer furosemide 40 mg IV push over 2 minutes
Rationale: The client is experiencing fluid overload (pulmonary edema) with acute decompensated heart
failure and oliguria. Furosemide IV is indicated to promote diuresis and reduce preload. Metoprolol may
worsen acute failure, IV fluids would exacerbate overload, and digoxin is for chronic management, not
acute decompensation.
Why Wrong:
B - Beta-blockers are contraindicated in acute decompensated heart failure due to negative inotropic
effects.
C - Increasing IV fluids would worsen pulmonary congestion and decrease urine output further.
D - Digoxin has a slow onset and is not indicated for acute diuresis or managing acute
decompensation.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 24
Q2. A client with type 2 diabetes is admitted with a blood glucose of 480 mg/dL, serum potassium
5.8 mEq/L, and arterial pH 7.18. Which finding indicates that the client is experiencing
hyperosmolar hyperglycemic state (HHS) rather than diabetic ketoacidosis (DKA)?
A. Serum ketones large
B. Serum osmolality 340 mOsm/kg
C. Anion gap 16 mEq/L
D. Bicarbonate 14 mEq/L
Correct Answer: B. Serum osmolality 340 mOsm/kg
Rationale: HHS is characterized by severe hyperglycemia, hyperosmolality (>320 mOsm/kg), and
minimal ketosis. An osmolality of 340 mOsm/kg points to HHS. DKA typically presents with ketosis, wide
anion gap, and low bicarbonate. The potassium of 5.8 is common in both due to acidosis shifting K+ out
of cells.
Why Wrong:
A - Large ketones are typical in DKA, not HHS, where ketone production is minimal.
C - An elevated anion gap is more characteristic of DKA due to ketoacid accumulation.
D - Low bicarbonate is seen in both DKA and HHS, but is not specific to HHS.
Reference: Ignatavicius, D.D., Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 48
Page 3
, Q3. A client receiving continuous IV heparin for a pulmonary embolism has an aPTT of 90 seconds
(therapeutic range 45-70 seconds). What is the nurse's priority action?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Administer protamine sulfate 50 mg IV
C. Stop the heparin infusion for 1 hour and reassess aPTT
D. Continue the current infusion and monitor for bleeding
Correct Answer: C. Stop the heparin infusion for 1 hour and reassess aPTT
Rationale: An aPTT of 90 seconds is supratherapeutic, indicating increased bleeding risk. The protocol
typically requires holding the infusion and reassessing aPTT after 1 hour. Increasing the rate would
worsen the risk. Protamine is reserved for severe bleeding or reversal, not for routine management.
Continuing the infusion is unsafe.
Why Wrong:
A - Increasing the rate would further elevate aPTT and increase bleeding risk.
B - Protamine is used for emergency reversal, not for routine supratherapeutic aPTT without active
bleeding.
D - Continuing the infusion at a supratherapeutic level places the client at high risk of hemorrhage.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34
Q4. A nurse is assessing a client who is 2 hours post-cesarean delivery. The client's fundus is firm at
the umbilicus, but the nurse notes a steady trickle of bright red blood from the vagina. What is the
most likely cause?
A. Uterine atony
B. Laceration of the genital tract
C. Retained placental fragments
D. Disseminated intravascular coagulation
Correct Answer: B. Laceration of the genital tract
Rationale: A firm fundus rules out uterine atony as the cause of bleeding. A steady trickle of bright red
blood despite a firm uterus suggests a lower genital tract laceration (e.g., cervical or vaginal tear).
Retained fragments typically cause uterine atony. DIC would present with oozing from multiple sites and
abnormal labs.
Why Wrong:
A - Uterine atony would present with a boggy, relaxed fundus, which is not the case here.
C - Retained fragments usually lead to uterine atony and intermittent bleeding, not a steady trickle
with a firm fundus.
D - DIC is a systemic coagulopathy with widespread bleeding, not isolated vaginal trickle with a
firm fundus.
Reference: Perry, S.E., et al. (2026). Maternal-Newborn Nursing, 10th Ed., Ch. 19
Page 4
2026/2027 Edition | 250 Verified Questions
PN Comprehensive Predictor Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest NGN Guidelines | Graded A+
This comprehensive predictor exam is designed for practical nursing (PN) students preparing for the
NCLEX-PN. It includes 250 verified questions with detailed solutions, covering all major content
areas. The exam reflects the latest Next Generation NCLEX (NGN) format and clinical judgment
framework. Ideal for final exam review and self-assessment.
Key Features:
Safe and Effective Care Environment
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity: Basic Care and Comfort
Physiological Integrity: Pharmacological and Parenteral Therapies
Physiological Integrity: Reduction of Risk Potential and Physiological Adaptation
Updates for 2026:
- Integrated NGN-style case studies and unfolding scenarios
- Updated rationales with evidence-based practice references
- Added clinical judgment measurement model (CJMM) cues
- Revised distractors to reflect current NCLEX-PN test plan
- Enhanced answer explanations with step-by-step clinical reasoning
Abstract:
The PN Comprehensive Predictor Exam with NGN is a high-stakes assessment tool for practical nursing students.
This document contains 250 questions that mirror the NCLEX-PN blueprint, emphasizing clinical judgment and
decision-making. Each question includes a detailed solution with rationale, correct answer, and distractor
analysis. The exam covers six major client needs categories: safe and effective care environment, health
promotion, psychosocial integrity, and physiological integrity subcategories. Questions are formatted as
multiple-choice, select-all-that-apply, ordered response, and fill-in-the-blank, aligned with NGN guidelines. This
resource is essential for students aiming to achieve a passing score on the predictor exam and ultimately the
NCLEX-PN. The content has been rigorously reviewed for accuracy and relevance to the 2026-2027 academic
year.
Keywords:
PN Comprehensive Predictor, NCLEX-PN, NGN, Clinical Judgment, Practical Nursing, Exam Prep, 250
Questions, 2026-2027
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct. Incorrect
options are analyzed with explanations of why they are wrong. Rationales include references to nursing concepts,
guidelines, and evidence-based practice. For NGN items, clinical judgment steps are highlighted.
Compliance Checklist:
Aligned with NCLEX-PN 2026-2027 test plan
Incorporates NGN clinical judgment framework
All questions verified for accuracy
Page 1
, Rationales cite current nursing standards
Distractors reflect common student errors
Suitable for self-assessment and review
Content Area Overview:
Content Area Questions Key Topics Weight
Safe and Effective Care 1-45 Management of Care, Safety and Infection 18%
Environment Control, Coordinated Care
Health Promotion and 46-85 Growth and Development, Prevention and 16%
Maintenance Early Detection, Health Screening
Psychosocial Integrity 86-125 Coping Mechanisms, Mental Health 16%
Disorders, Therapeutic Communication
Physiological Integrity: Basic 126-160 Mobility, Nutrition, Elimination, Comfort 14%
Care and Comfort Measures
Physiological Integrity: 161-200 Medication Administration, IV Therapy, 18%
Pharmacological and Parenteral Blood Products, Adverse Effects
Therapies
Physiological Integrity: 201-250 Diagnostic Tests, Complications, 18%
Reduction of Risk Potential and Emergency Care, Pathophysiology
Physiological Adaptation
Page 2
,Q1. A client with a history of chronic heart failure is admitted with acute dyspnea and bilateral
crackles. The nurse notes a urine output of 20 mL over the past hour. Which intervention should the
nurse prioritize?
A. Administer furosemide 40 mg IV push over 2 minutes
B. Administer metoprolol 25 mg orally
C. Increase IV fluids to 150 mL/hr
D. Administer digoxin 0.25 mg IV push
Correct Answer: A. Administer furosemide 40 mg IV push over 2 minutes
Rationale: The client is experiencing fluid overload (pulmonary edema) with acute decompensated heart
failure and oliguria. Furosemide IV is indicated to promote diuresis and reduce preload. Metoprolol may
worsen acute failure, IV fluids would exacerbate overload, and digoxin is for chronic management, not
acute decompensation.
Why Wrong:
B - Beta-blockers are contraindicated in acute decompensated heart failure due to negative inotropic
effects.
C - Increasing IV fluids would worsen pulmonary congestion and decrease urine output further.
D - Digoxin has a slow onset and is not indicated for acute diuresis or managing acute
decompensation.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 24
Q2. A client with type 2 diabetes is admitted with a blood glucose of 480 mg/dL, serum potassium
5.8 mEq/L, and arterial pH 7.18. Which finding indicates that the client is experiencing
hyperosmolar hyperglycemic state (HHS) rather than diabetic ketoacidosis (DKA)?
A. Serum ketones large
B. Serum osmolality 340 mOsm/kg
C. Anion gap 16 mEq/L
D. Bicarbonate 14 mEq/L
Correct Answer: B. Serum osmolality 340 mOsm/kg
Rationale: HHS is characterized by severe hyperglycemia, hyperosmolality (>320 mOsm/kg), and
minimal ketosis. An osmolality of 340 mOsm/kg points to HHS. DKA typically presents with ketosis, wide
anion gap, and low bicarbonate. The potassium of 5.8 is common in both due to acidosis shifting K+ out
of cells.
Why Wrong:
A - Large ketones are typical in DKA, not HHS, where ketone production is minimal.
C - An elevated anion gap is more characteristic of DKA due to ketoacid accumulation.
D - Low bicarbonate is seen in both DKA and HHS, but is not specific to HHS.
Reference: Ignatavicius, D.D., Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 48
Page 3
, Q3. A client receiving continuous IV heparin for a pulmonary embolism has an aPTT of 90 seconds
(therapeutic range 45-70 seconds). What is the nurse's priority action?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Administer protamine sulfate 50 mg IV
C. Stop the heparin infusion for 1 hour and reassess aPTT
D. Continue the current infusion and monitor for bleeding
Correct Answer: C. Stop the heparin infusion for 1 hour and reassess aPTT
Rationale: An aPTT of 90 seconds is supratherapeutic, indicating increased bleeding risk. The protocol
typically requires holding the infusion and reassessing aPTT after 1 hour. Increasing the rate would
worsen the risk. Protamine is reserved for severe bleeding or reversal, not for routine management.
Continuing the infusion is unsafe.
Why Wrong:
A - Increasing the rate would further elevate aPTT and increase bleeding risk.
B - Protamine is used for emergency reversal, not for routine supratherapeutic aPTT without active
bleeding.
D - Continuing the infusion at a supratherapeutic level places the client at high risk of hemorrhage.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34
Q4. A nurse is assessing a client who is 2 hours post-cesarean delivery. The client's fundus is firm at
the umbilicus, but the nurse notes a steady trickle of bright red blood from the vagina. What is the
most likely cause?
A. Uterine atony
B. Laceration of the genital tract
C. Retained placental fragments
D. Disseminated intravascular coagulation
Correct Answer: B. Laceration of the genital tract
Rationale: A firm fundus rules out uterine atony as the cause of bleeding. A steady trickle of bright red
blood despite a firm uterus suggests a lower genital tract laceration (e.g., cervical or vaginal tear).
Retained fragments typically cause uterine atony. DIC would present with oozing from multiple sites and
abnormal labs.
Why Wrong:
A - Uterine atony would present with a boggy, relaxed fundus, which is not the case here.
C - Retained fragments usually lead to uterine atony and intermittent bleeding, not a steady trickle
with a firm fundus.
D - DIC is a systemic coagulopathy with widespread bleeding, not isolated vaginal trickle with a
firm fundus.
Reference: Perry, S.E., et al. (2026). Maternal-Newborn Nursing, 10th Ed., Ch. 19
Page 4
