Nursing Capstone Comprehensive
Pre-Test Exam: 200 NCLEX-RN®
Style Questions with Verified
Answers & Clinical Rationales
QUESTION 1
A nurse is caring for multiple clients on a medical-surgical unit. Which client is at the
highest risk for developing a nosocomial infection?
A. Client with alcohol use disorder admitted for detoxification
B. Client with Type 1 diabetes mellitus and peripheral neuropathy
C. Client recovering from a laparoscopic cholecystectomy
D. Client with full-thickness burns, NG tube, and Foley catheter
Correct Answer: D
Rationale: Patients with extensive burns have a severely compromised skin barrier,
making them highly susceptible to infection. The presence of invasive devices such as
an NG tube and Foley catheter further increases infection risk by providing entry
points for microorganisms .
QUESTION 2
Which client should the nurse prioritize for transfer from the ICU to a step-down
neurological unit?
A. Client with acute head injury and seizures
B. Client with ischemic stroke 4 days ago and mild confusion
,C. Client 1-day post-transsphenoidal craniotomy with CSF leak
D. Client with bacterial meningitis and Glasgow Coma Scale of 7
Correct Answer: B
Rationale: The most stable client is the one with an ischemic stroke who is several
days post-event and only mildly confused. The other clients are unstable due to CSF
leak, decreased level of consciousness, or active neurological compromise .
QUESTION 3
A nurse is caring for multiple clients on a medical-surgical unit. After receiving shift
report, which client should the nurse assess first?
A. Ventilated client requiring sputum culture collection
B. COPD client with oxygen saturation of 90% from previous shift
C. Pneumonia client awaiting IV antibiotics
D. Asthma client reporting shortness of breath after bronchodilator use
Correct Answer: D
Rationale: Shortness of breath after bronchodilator use suggests worsening
bronchospasm or treatment failure. This is an airway priority (ABCs). The other clients
are either stable or receiving routine care .
QUESTION 4
Which postoperative client should the nurse assess first?
A. Client scheduled for laparoscopic cholecystectomy
B. Multiple trauma client from motor vehicle collision
C. Client scheduled for thyroidectomy
D. Client awaiting discharge after appendectomy
,Correct Answer: B
Rationale: Trauma patients are the most unstable and require immediate assessment
due to risk of internal injuries, hemorrhage, and airway compromise .
QUESTION 5
During a disaster triage, which client can be safely discharged first?
A. 24-hour post-hysterectomy client
B. 5-day post-total hip replacement client
C. 12-hour pyelonephritis admission
D. 5-day stage III pressure ulcer patient
Correct Answer: B
Rationale: This client is the most stable and least dependent on acute care services
compared to infection or surgical complications .
QUESTION 6
Which client requires immediate assessment after shift change?
A. BP 90/60 with hot, dry skin
B. Sleeping client with stable vital signs
C. Fruity breath, polydipsia, and polyphagia
D. Irritable client with tremors
Correct Answer: C
Rationale: These are classic signs of diabetic ketoacidosis (DKA), a life-threatening
metabolic emergency .
, QUESTION 7
A practical nurse (PN) is caring for a patient with a nasogastric (NG) tube to low
intermittent suction. The patient reports nausea and abdominal distension. Which
action should the PN take first?
A. Irrigate the NG tube with 30 mL of water
B. Check tube placement and assess residual volume
C. Remove the NG tube immediately
D. Administer an antiemetic
Correct Answer: B
Rationale: First assess tube patency and residual volume. High residual may indicate
gastric retention, which could lead to nausea and distension. Never remove an NG
tube without an order. Irrigation may be needed but only after assessment confirms
the tube is correctly placed .
QUESTION 8
A nurse is planning to collect a stool specimen for ova and parasites from a client
who has diarrhea. Which instruction is correct?
A. Collect the specimen from the toilet bowl
B. Refrigerate the specimen immediately after collection
C. Instruct the client to defecate into a clean, dry container
D. Collect three separate specimens over 5 days
Correct Answer: C
Rationale: Specimens for ova and parasite testing should be collected in a clean, dry
container and delivered to the lab while still warm. Refrigeration is not indicated, and
toilet water can contaminate the specimen .
Pre-Test Exam: 200 NCLEX-RN®
Style Questions with Verified
Answers & Clinical Rationales
QUESTION 1
A nurse is caring for multiple clients on a medical-surgical unit. Which client is at the
highest risk for developing a nosocomial infection?
A. Client with alcohol use disorder admitted for detoxification
B. Client with Type 1 diabetes mellitus and peripheral neuropathy
C. Client recovering from a laparoscopic cholecystectomy
D. Client with full-thickness burns, NG tube, and Foley catheter
Correct Answer: D
Rationale: Patients with extensive burns have a severely compromised skin barrier,
making them highly susceptible to infection. The presence of invasive devices such as
an NG tube and Foley catheter further increases infection risk by providing entry
points for microorganisms .
QUESTION 2
Which client should the nurse prioritize for transfer from the ICU to a step-down
neurological unit?
A. Client with acute head injury and seizures
B. Client with ischemic stroke 4 days ago and mild confusion
,C. Client 1-day post-transsphenoidal craniotomy with CSF leak
D. Client with bacterial meningitis and Glasgow Coma Scale of 7
Correct Answer: B
Rationale: The most stable client is the one with an ischemic stroke who is several
days post-event and only mildly confused. The other clients are unstable due to CSF
leak, decreased level of consciousness, or active neurological compromise .
QUESTION 3
A nurse is caring for multiple clients on a medical-surgical unit. After receiving shift
report, which client should the nurse assess first?
A. Ventilated client requiring sputum culture collection
B. COPD client with oxygen saturation of 90% from previous shift
C. Pneumonia client awaiting IV antibiotics
D. Asthma client reporting shortness of breath after bronchodilator use
Correct Answer: D
Rationale: Shortness of breath after bronchodilator use suggests worsening
bronchospasm or treatment failure. This is an airway priority (ABCs). The other clients
are either stable or receiving routine care .
QUESTION 4
Which postoperative client should the nurse assess first?
A. Client scheduled for laparoscopic cholecystectomy
B. Multiple trauma client from motor vehicle collision
C. Client scheduled for thyroidectomy
D. Client awaiting discharge after appendectomy
,Correct Answer: B
Rationale: Trauma patients are the most unstable and require immediate assessment
due to risk of internal injuries, hemorrhage, and airway compromise .
QUESTION 5
During a disaster triage, which client can be safely discharged first?
A. 24-hour post-hysterectomy client
B. 5-day post-total hip replacement client
C. 12-hour pyelonephritis admission
D. 5-day stage III pressure ulcer patient
Correct Answer: B
Rationale: This client is the most stable and least dependent on acute care services
compared to infection or surgical complications .
QUESTION 6
Which client requires immediate assessment after shift change?
A. BP 90/60 with hot, dry skin
B. Sleeping client with stable vital signs
C. Fruity breath, polydipsia, and polyphagia
D. Irritable client with tremors
Correct Answer: C
Rationale: These are classic signs of diabetic ketoacidosis (DKA), a life-threatening
metabolic emergency .
, QUESTION 7
A practical nurse (PN) is caring for a patient with a nasogastric (NG) tube to low
intermittent suction. The patient reports nausea and abdominal distension. Which
action should the PN take first?
A. Irrigate the NG tube with 30 mL of water
B. Check tube placement and assess residual volume
C. Remove the NG tube immediately
D. Administer an antiemetic
Correct Answer: B
Rationale: First assess tube patency and residual volume. High residual may indicate
gastric retention, which could lead to nausea and distension. Never remove an NG
tube without an order. Irrigation may be needed but only after assessment confirms
the tube is correctly placed .
QUESTION 8
A nurse is planning to collect a stool specimen for ova and parasites from a client
who has diarrhea. Which instruction is correct?
A. Collect the specimen from the toilet bowl
B. Refrigerate the specimen immediately after collection
C. Instruct the client to defecate into a clean, dry container
D. Collect three separate specimens over 5 days
Correct Answer: C
Rationale: Specimens for ova and parasite testing should be collected in a clean, dry
container and delivered to the lab while still warm. Refrigeration is not indicated, and
toilet water can contaminate the specimen .
