Kaplan Readiness Test: Comprehensive NCLEX-RN
Practice Examination Advanced Practice
Question Bank graded A+ 2025/2026
Comprehensive Readiness Assessment for
Professional Nursing Licensure Success: 150
Advanced Multiple-Choice Questions Covering
Clinical Judgment, Pharmacology, Patient
Safety, Ethical Practice, and Evidence-Based
Care Across the Lifespan
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1–25)
1. The charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to the most experienced RN?
A. A client with pneumonia requiring IV antibiotics every 6 hours
B. A client with a fractured hip who is 1 day post-operative
C. A client with end-stage renal disease exhibiting confusion and twitching
D. A client with a new diagnosis of hypertension requiring dietary teaching
Correct Answer: C
Rationale: The client with ESRD exhibiting confusion and twitching is displaying signs of severe
uremia or electrolyte imbalances (such as hyperkalemia or hypocalcemia), which can rapidly
progress to seizures or cardiac arrest. This client requires the most experienced RN for complex
assessment and intervention. The other options are stable and can be delegated to less
experienced nurses or LPNs.
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A. A client with an NG tube who has vomited 50 mL of greenish fluid
B. A client with a new colostomy who is reporting abdominal cramping
,C. A client with a hip replacement who is reporting incisional pain of 6/10
D. A client with a chest tube who has continuous bubbling in the water seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which can lead
to pneumothorax or loss of chest tube function. This is a life-threatening complication requiring
immediate assessment and intervention. The other clients have stable conditions that can be
addressed after the chest tube issue.
3. A nurse in the emergency department is assessing a client who reports chest pain and
shortness of breath. Which finding is the highest priority?
A. Heart rate 110/min
B. Oxygen saturation 88% on room air
C. Respiratory rate 22/min
D. Blood pressure 140/90 mm Hg
Correct Answer: B
Rationale: Oxygen saturation of 88% indicates hypoxemia, which poses an immediate threat to
tissue perfusion and life. Airway and breathing take priority over circulation (heart rate) and
blood pressure in the primary survey. The nurse must intervene immediately to improve
oxygenation.
4. A nurse discovers a fire in a patient's trash can. What is the nurse's priority action?
A. Activate the fire alarm
B. Attempt to extinguish the fire
C. Remove the patient from the room
D. Close all doors and windows
Correct Answer: C
Rationale: In a fire emergency, the priority is the safety of the patient (RACE: Rescue, Alarm,
Contain, Extinguish). The nurse must first remove the patient from immediate danger before
activating the alarm, containing the fire, or attempting to extinguish it.
,5. A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP). Which
task is appropriate for the nurse to delegate?
A. Administering oral medications
B. Assessing a patient's postoperative wound
C. Performing routine vital signs on stable patients
D. Evaluating the effectiveness of pain management
Correct Answer: C
Rationale: Routine vital signs on stable patients fall within the scope of practice for UAPs.
Assessment, medication administration, and evaluation of care outcomes require the clinical
judgment of a licensed nurse and cannot be delegated.
6. A client with a history of falls is placed on fall precautions. Which intervention should the
nurse implement first?
A. Place the client in a room near the nurses' station
B. Apply a bed alarm
C. Conduct a comprehensive fall risk assessment
D. Keep the bed in the lowest position with side rails up
Correct Answer: C
Rationale: Assessment precedes intervention. The nurse must first conduct a comprehensive
fall risk assessment to identify specific risk factors and develop an individualized plan of care.
While the other options are appropriate interventions, they should be implemented based on
the assessment findings.
7. The nurse is caring for a client with a new tracheostomy. Which action is essential to
maintain airway patency?
A. Suction the tracheostomy every 2 hours
B. Change the inner cannula daily
C. Keep suction equipment at the bedside
D. Deflate the cuff for 5 minutes every hour
Correct Answer: C
, Rationale: Keeping suction equipment at the bedside ensures immediate availability in case of
airway obstruction, which is the most critical complication of tracheostomy. Suctioning should
be performed PRN, not on a fixed schedule, to prevent mucosal damage.
8. A nurse is providing discharge instructions to a client with a new colostomy. Which
statement indicates the client needs further teaching?
A. "I will clean the skin around the stoma with warm water and dry it thoroughly"
B. "I will continue to take my daily multi-vitamin"
C. "I should take polyethylene glycol (MiraLax) with a large glass of water"
D. "The appliance should fit snugly around the colostomy opening"
Correct Answer: C
Rationale: Polyethylene glycol (MiraLax) is an osmotic laxative that can cause increased output
and dehydration in clients with an ostomy. Clients with colostomies should avoid laxatives
unless specifically prescribed. The other statements reflect correct understanding of ostomy
care.
9. A charge nurse is observing a new graduate nurse perform a sterile dressing change. Which
action requires immediate intervention?
A. Opening the sterile package away from the body
B. Pouring sterile solution into a sterile container on the sterile field
C. Reaching over the sterile field to obtain additional supplies
D. Donning sterile gloves after opening the sterile package
Correct Answer: C
Rationale: Reaching over the sterile field contaminates the field due to non-sterile particles
falling from the arm. The nurse should reach around the edges of the sterile field or ask an
assistant to add supplies. The other actions are appropriate sterile technique.
10. A client who is postoperative day 2 following abdominal surgery develops a temperature
of 101.2°F (38.4°C), tachycardia, and reports chest pain. What is the nurse's priority action?
A. Administer prescribed antipyretic
B. Notify the healthcare provider
Practice Examination Advanced Practice
Question Bank graded A+ 2025/2026
Comprehensive Readiness Assessment for
Professional Nursing Licensure Success: 150
Advanced Multiple-Choice Questions Covering
Clinical Judgment, Pharmacology, Patient
Safety, Ethical Practice, and Evidence-Based
Care Across the Lifespan
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1–25)
1. The charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to the most experienced RN?
A. A client with pneumonia requiring IV antibiotics every 6 hours
B. A client with a fractured hip who is 1 day post-operative
C. A client with end-stage renal disease exhibiting confusion and twitching
D. A client with a new diagnosis of hypertension requiring dietary teaching
Correct Answer: C
Rationale: The client with ESRD exhibiting confusion and twitching is displaying signs of severe
uremia or electrolyte imbalances (such as hyperkalemia or hypocalcemia), which can rapidly
progress to seizures or cardiac arrest. This client requires the most experienced RN for complex
assessment and intervention. The other options are stable and can be delegated to less
experienced nurses or LPNs.
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A. A client with an NG tube who has vomited 50 mL of greenish fluid
B. A client with a new colostomy who is reporting abdominal cramping
,C. A client with a hip replacement who is reporting incisional pain of 6/10
D. A client with a chest tube who has continuous bubbling in the water seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which can lead
to pneumothorax or loss of chest tube function. This is a life-threatening complication requiring
immediate assessment and intervention. The other clients have stable conditions that can be
addressed after the chest tube issue.
3. A nurse in the emergency department is assessing a client who reports chest pain and
shortness of breath. Which finding is the highest priority?
A. Heart rate 110/min
B. Oxygen saturation 88% on room air
C. Respiratory rate 22/min
D. Blood pressure 140/90 mm Hg
Correct Answer: B
Rationale: Oxygen saturation of 88% indicates hypoxemia, which poses an immediate threat to
tissue perfusion and life. Airway and breathing take priority over circulation (heart rate) and
blood pressure in the primary survey. The nurse must intervene immediately to improve
oxygenation.
4. A nurse discovers a fire in a patient's trash can. What is the nurse's priority action?
A. Activate the fire alarm
B. Attempt to extinguish the fire
C. Remove the patient from the room
D. Close all doors and windows
Correct Answer: C
Rationale: In a fire emergency, the priority is the safety of the patient (RACE: Rescue, Alarm,
Contain, Extinguish). The nurse must first remove the patient from immediate danger before
activating the alarm, containing the fire, or attempting to extinguish it.
,5. A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP). Which
task is appropriate for the nurse to delegate?
A. Administering oral medications
B. Assessing a patient's postoperative wound
C. Performing routine vital signs on stable patients
D. Evaluating the effectiveness of pain management
Correct Answer: C
Rationale: Routine vital signs on stable patients fall within the scope of practice for UAPs.
Assessment, medication administration, and evaluation of care outcomes require the clinical
judgment of a licensed nurse and cannot be delegated.
6. A client with a history of falls is placed on fall precautions. Which intervention should the
nurse implement first?
A. Place the client in a room near the nurses' station
B. Apply a bed alarm
C. Conduct a comprehensive fall risk assessment
D. Keep the bed in the lowest position with side rails up
Correct Answer: C
Rationale: Assessment precedes intervention. The nurse must first conduct a comprehensive
fall risk assessment to identify specific risk factors and develop an individualized plan of care.
While the other options are appropriate interventions, they should be implemented based on
the assessment findings.
7. The nurse is caring for a client with a new tracheostomy. Which action is essential to
maintain airway patency?
A. Suction the tracheostomy every 2 hours
B. Change the inner cannula daily
C. Keep suction equipment at the bedside
D. Deflate the cuff for 5 minutes every hour
Correct Answer: C
, Rationale: Keeping suction equipment at the bedside ensures immediate availability in case of
airway obstruction, which is the most critical complication of tracheostomy. Suctioning should
be performed PRN, not on a fixed schedule, to prevent mucosal damage.
8. A nurse is providing discharge instructions to a client with a new colostomy. Which
statement indicates the client needs further teaching?
A. "I will clean the skin around the stoma with warm water and dry it thoroughly"
B. "I will continue to take my daily multi-vitamin"
C. "I should take polyethylene glycol (MiraLax) with a large glass of water"
D. "The appliance should fit snugly around the colostomy opening"
Correct Answer: C
Rationale: Polyethylene glycol (MiraLax) is an osmotic laxative that can cause increased output
and dehydration in clients with an ostomy. Clients with colostomies should avoid laxatives
unless specifically prescribed. The other statements reflect correct understanding of ostomy
care.
9. A charge nurse is observing a new graduate nurse perform a sterile dressing change. Which
action requires immediate intervention?
A. Opening the sterile package away from the body
B. Pouring sterile solution into a sterile container on the sterile field
C. Reaching over the sterile field to obtain additional supplies
D. Donning sterile gloves after opening the sterile package
Correct Answer: C
Rationale: Reaching over the sterile field contaminates the field due to non-sterile particles
falling from the arm. The nurse should reach around the edges of the sterile field or ask an
assistant to add supplies. The other actions are appropriate sterile technique.
10. A client who is postoperative day 2 following abdominal surgery develops a temperature
of 101.2°F (38.4°C), tachycardia, and reports chest pain. What is the nurse's priority action?
A. Administer prescribed antipyretic
B. Notify the healthcare provider
