Kaplan Readiness Test v3.1:
Comprehensive NCLEX-RN Practice
Examination Advanced Practice
Question Bank graded A+ 2025/2026
Advanced Clinical Judgment and Complex
Decision-Making Assessment for
Professional Nursing Licensure: 150 High-
Level Evidence-Based Multiple-Choice
Questions Integrating Pathophysiology,
Pharmacology, Patient Safety, Ethical
Dilemmas, and Multisystem Care
Management Across the Lifespan with
Detailed Rationales
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT
(Questions 1–25)
1. The charge nurse is evaluating the assignments on a busy medical-surgical unit.
Which client assignment represents the BEST use of nursing resources and patient
safety principles?
,A. An experienced RN caring for four stable post-operative clients while a new graduate
cares for one unstable client
B. The most experienced RN caring for the client with active gastrointestinal bleeding
while an LPN cares for three stable diabetic clients
C. An LPN caring for a client with a chest tube while an RN supervises from the nurses'
station
D. A float RN from the psychiatric unit caring for a client with acute confusion and
restraints
Correct Answer: B
Rationale: The most experienced RN should care for the client with active
gastrointestinal bleeding, which requires complex assessment, hemodynamic
monitoring, and potential rapid deterioration. LPNs can safely care for stable diabetic
clients. Assigning an unstable client to a new graduate (A) compromises patient safety.
LPNs cannot independently manage chest tubes in most settings (C). Float nurses
should be assigned to stable, predictable patients in their area of competency (D).
2. The nurse is caring for a client with end-stage liver disease who develops acute
confusion, asterixis, and a serum ammonia level of 185 mcg/dL (normal 15–60).
The healthcare provider orders lactulose 30 mL orally every 6 hours. The client
refuses the medication, stating "It makes me have diarrhea and I hate it." What is
the nurse's BEST response?
A. "You must take this medication to prevent further liver damage"
B. "I understand you dislike the side effects. Let me explain why this medication is crucial
for your care"
C. "I will contact your provider to see if we can change the medication"
D. "If you don't take this medication, you may go into a coma"
Correct Answer: B
Rationale: The nurse should acknowledge the client's concerns and provide education
about the purpose of lactulose (reducing ammonia levels to prevent hepatic
encephalopathy). Threatening the client (A, D) is nontherapeutic and coercive. While
contacting the provider (C) may be appropriate after education, the priority is to address
the client's understanding and concerns first. Lactulose has no direct alternative for
ammonia reduction.
,3. The nurse is preparing to administer IV potassium chloride 40 mEq in 250 mL of
0.9% normal saline to a client with hypokalemia. Which action is ESSENTIAL for
safe administration?
A. Administer the infusion via IV push over 5 minutes
B. Infuse the medication through a central line at 30 mEq/hour
C. Administer through a peripheral IV at 20 mEq/hour with continuous cardiac
monitoring
D. Mix the potassium with lactated Ringer's solution for better compatibility
Correct Answer: C
Rationale: IV potassium should be infused at a maximum rate of 10–20 mEq/hour
through a peripheral line with cardiac monitoring. IV push administration (A) can cause
fatal hyperkalemia and cardiac arrest. Central line administration (B) requires a maximum
rate of 40 mEq/hour, not 30, and the question doesn't specify central access. Potassium
should not be mixed with lactated Ringer's (D) as both contain potassium, increasing the
risk of hyperkalemia.
4. The nurse is caring for four clients on a telemetry unit. The telemetry monitor
alarms for ventricular tachycardia in one client who is asymptomatic with a pulse.
What is the nurse's priority action?
A. Prepare for synchronized cardioversion
B. Administer amiodarone IV push immediately
C. Assess the client's airway, breathing, circulation, and level of consciousness
D. Call a code blue and begin CPR
Correct Answer: C
Rationale: The priority is to assess the client's clinical status. Ventricular tachycardia
with a pulse and no symptoms may be treated with antiarrhythmics, but immediate
synchronized cardioversion (A) is indicated only for unstable VT. Amiodarone (B) may be
given after assessment, but not as the first action. Calling a code (D) is premature as the
client has a pulse and is stable.
, 5. A client with a new ileostomy has a stoma that appears dark purple and is not
producing output. The client reports severe abdominal pain. What is the nurse's
priority action?
A. Apply a warm compress to the stoma
B. Notify the healthcare provider immediately
C. Massage the stoma to promote output
D. Document the finding and reassess in 1 hour
Correct Answer: B
Rationale: A dark purple stoma indicates ischemia or necrosis, a surgical emergency
requiring immediate provider notification. Applying warm compresses (A) or massaging
(C) could cause further damage. Delaying intervention (D) could result in bowel necrosis
and perforation.
6. The nurse is preparing a client for a percutaneous coronary intervention (PCI).
The client asks, "Why do I have to take aspirin and clopidogrel before this
procedure?" What is the nurse's BEST response?
A. "These medications will help prevent blood clots from forming on the stent"
B. "These medications will thin your blood to make the procedure easier"
C. "These medications will prevent bleeding during the procedure"
D. "These medications will reduce your risk of infection after the procedure"
Correct Answer: A
Rationale: Dual antiplatelet therapy (aspirin and clopidogrel) is given before and after
PCI to prevent stent thrombosis by inhibiting platelet aggregation. The medications do
not "thin" the blood in the traditional sense (B) nor prevent bleeding (C). They do not
prevent infection (D).
Comprehensive NCLEX-RN Practice
Examination Advanced Practice
Question Bank graded A+ 2025/2026
Advanced Clinical Judgment and Complex
Decision-Making Assessment for
Professional Nursing Licensure: 150 High-
Level Evidence-Based Multiple-Choice
Questions Integrating Pathophysiology,
Pharmacology, Patient Safety, Ethical
Dilemmas, and Multisystem Care
Management Across the Lifespan with
Detailed Rationales
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT
(Questions 1–25)
1. The charge nurse is evaluating the assignments on a busy medical-surgical unit.
Which client assignment represents the BEST use of nursing resources and patient
safety principles?
,A. An experienced RN caring for four stable post-operative clients while a new graduate
cares for one unstable client
B. The most experienced RN caring for the client with active gastrointestinal bleeding
while an LPN cares for three stable diabetic clients
C. An LPN caring for a client with a chest tube while an RN supervises from the nurses'
station
D. A float RN from the psychiatric unit caring for a client with acute confusion and
restraints
Correct Answer: B
Rationale: The most experienced RN should care for the client with active
gastrointestinal bleeding, which requires complex assessment, hemodynamic
monitoring, and potential rapid deterioration. LPNs can safely care for stable diabetic
clients. Assigning an unstable client to a new graduate (A) compromises patient safety.
LPNs cannot independently manage chest tubes in most settings (C). Float nurses
should be assigned to stable, predictable patients in their area of competency (D).
2. The nurse is caring for a client with end-stage liver disease who develops acute
confusion, asterixis, and a serum ammonia level of 185 mcg/dL (normal 15–60).
The healthcare provider orders lactulose 30 mL orally every 6 hours. The client
refuses the medication, stating "It makes me have diarrhea and I hate it." What is
the nurse's BEST response?
A. "You must take this medication to prevent further liver damage"
B. "I understand you dislike the side effects. Let me explain why this medication is crucial
for your care"
C. "I will contact your provider to see if we can change the medication"
D. "If you don't take this medication, you may go into a coma"
Correct Answer: B
Rationale: The nurse should acknowledge the client's concerns and provide education
about the purpose of lactulose (reducing ammonia levels to prevent hepatic
encephalopathy). Threatening the client (A, D) is nontherapeutic and coercive. While
contacting the provider (C) may be appropriate after education, the priority is to address
the client's understanding and concerns first. Lactulose has no direct alternative for
ammonia reduction.
,3. The nurse is preparing to administer IV potassium chloride 40 mEq in 250 mL of
0.9% normal saline to a client with hypokalemia. Which action is ESSENTIAL for
safe administration?
A. Administer the infusion via IV push over 5 minutes
B. Infuse the medication through a central line at 30 mEq/hour
C. Administer through a peripheral IV at 20 mEq/hour with continuous cardiac
monitoring
D. Mix the potassium with lactated Ringer's solution for better compatibility
Correct Answer: C
Rationale: IV potassium should be infused at a maximum rate of 10–20 mEq/hour
through a peripheral line with cardiac monitoring. IV push administration (A) can cause
fatal hyperkalemia and cardiac arrest. Central line administration (B) requires a maximum
rate of 40 mEq/hour, not 30, and the question doesn't specify central access. Potassium
should not be mixed with lactated Ringer's (D) as both contain potassium, increasing the
risk of hyperkalemia.
4. The nurse is caring for four clients on a telemetry unit. The telemetry monitor
alarms for ventricular tachycardia in one client who is asymptomatic with a pulse.
What is the nurse's priority action?
A. Prepare for synchronized cardioversion
B. Administer amiodarone IV push immediately
C. Assess the client's airway, breathing, circulation, and level of consciousness
D. Call a code blue and begin CPR
Correct Answer: C
Rationale: The priority is to assess the client's clinical status. Ventricular tachycardia
with a pulse and no symptoms may be treated with antiarrhythmics, but immediate
synchronized cardioversion (A) is indicated only for unstable VT. Amiodarone (B) may be
given after assessment, but not as the first action. Calling a code (D) is premature as the
client has a pulse and is stable.
, 5. A client with a new ileostomy has a stoma that appears dark purple and is not
producing output. The client reports severe abdominal pain. What is the nurse's
priority action?
A. Apply a warm compress to the stoma
B. Notify the healthcare provider immediately
C. Massage the stoma to promote output
D. Document the finding and reassess in 1 hour
Correct Answer: B
Rationale: A dark purple stoma indicates ischemia or necrosis, a surgical emergency
requiring immediate provider notification. Applying warm compresses (A) or massaging
(C) could cause further damage. Delaying intervention (D) could result in bowel necrosis
and perforation.
6. The nurse is preparing a client for a percutaneous coronary intervention (PCI).
The client asks, "Why do I have to take aspirin and clopidogrel before this
procedure?" What is the nurse's BEST response?
A. "These medications will help prevent blood clots from forming on the stent"
B. "These medications will thin your blood to make the procedure easier"
C. "These medications will prevent bleeding during the procedure"
D. "These medications will reduce your risk of infection after the procedure"
Correct Answer: A
Rationale: Dual antiplatelet therapy (aspirin and clopidogrel) is given before and after
PCI to prevent stent thrombosis by inhibiting platelet aggregation. The medications do
not "thin" the blood in the traditional sense (B) nor prevent bleeding (C). They do not
prevent infection (D).
