RN COMPREHENSIVE PREDICTOR NURSING
EXAM REVIEW
100 High-Yield Questions with In-Depth Explanations (2026-2027 Update Exam)
Exam Blueprints & Overview: This test bank is designed as a professional and high-yield study companion for
nursing students preparing for the RN Comprehensive Predictor Examination. It contains exactly 100 detailed
multiple-choice questions rigorously mapped to the core nursing chapters and clinical concepts. Each question
includes a correct answer key and an in-depth rationale designed to reinforce clinical judgment,
patient-centered care, and evidence-based practice standards for 2026-2027. All questions are fully grounded
in official course materials.
TABLE OF CONTENTS
Chapter 1: Medical-Surgical Nursing — Cardiovascular & Renal Systems (Q1-15) Page 2
Chapter 2: Medical-Surgical Nursing — Respiratory & Thoracic Care (Q16-45) Page 4
Chapter 3: Maternal-Newborn & Pediatric Nursing (Q46-60) Page 9
Chapter 4: Mental Health & Psychiatric Nursing (Q61-75) Page 11
Chapter 5: Pharmacology & Medication Administration (Q76-90) Page 13
Chapter 6: Nursing Leadership, Professional Standards & Patient Safety (Q91-100) Page 16
Page 1
,RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
CHAPTER 1: MEDICAL-SURGICAL NURSING — CARDIOVASCULAR & RENAL
SYSTEMS
Question 1: A nurse is preparing to administer digoxin 0.125 mg PO to an adult client. For which of the
following findings should the nurse withhold the medication and report to the provider?
A. Potassium level of 4.2 mEq/L
B. Apical pulse of 58/min
C. Digoxin level of 1.0 ng/mL
D. Constipation for the past 2 days
ANSWER ■: B — Apical pulse of 58/min
Explanation: Before administering digoxin, the nurse must assess the apical pulse for 1 full minute. For an adult client, the
medication should be withheld and the provider notified if the apical pulse is less than 60/min, as digoxin decreases the heart
rate (negative chronotropic effect) and bradycardia is a classic sign of toxicity. A potassium level of 4.2 mEq/L is within the
normal range (3.5 to 5.0 mEq/L), although hypokalemia increases the risk of digoxin toxicity. A digoxin level of 1.0 ng/mL is
within the therapeutic range (0.5 to 2.0 ng/mL). Constipation is a common side effect of many medications but is not a reason to
withhold digoxin or a priority finding compared to bradycardia.
Question 2: A nurse is caring for a client who is recovering from an acute myocardial infarction (MI) that
occurred 3 days ago. Which of the following interventions should the nurse include in the plan of care?
A. Perform a 12-lead ECG every 12 hours
B. Place the client in a supine position while resting
C. Draw a troponin level every 4 hours
D. Obtain a cardiac rehabilitation consultation
ANSWER ■: D — Obtain a cardiac rehabilitation consultation
Explanation: A client who is 3 days post-MI is stable enough to begin planning for long-term recovery and lifestyle modification.
A cardiac rehabilitation consultation is indicated to help the client safely increase activity, manage risk factors, and promote
recovery. A 12-lead ECG every 12 hours is not routinely indicated for a stable client 3 days post-MI unless they experience new
chest pain. The supine position increases venous return and cardiac workload; the client should be in semi-Fowler's or a
comfortable position of rest. Troponin levels peak within 24 hours of an MI and do not need to be drawn every 4 hours 3 days
after the event unless re-infarction is suspected.
Page 2
,RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
Question 3: A nurse is assessing a client who has left-sided heart failure. Which of the following findings
should the nurse identify as a manifestation of pulmonary congestion?
A. Frothy, pink sputum
B. Jugular vein distention (JVD)
C. Weight gain of 1 kg (2.2 lb) in 24 hours
D. Bradypnea with shallow respirations
ANSWER ■: A — Frothy, pink sputum
Explanation: Left-sided heart failure leads to backup of blood into the pulmonary vasculature, resulting in pulmonary congestion
and increased pulmonary capillary hydrostatic pressure. This causes fluid to leak into the alveoli, manifesting as dyspnea,
crackles, and classic frothy, pink-tinged sputum (a sign of severe pulmonary edema). Jugular vein distention and rapid weight
gain are signs of systemic fluid volume excess, which are characteristic of right-sided heart failure. Clients with pulmonary
congestion typically experience tachypnea (rapid breathing) rather than bradypnea (slow breathing).
Question 4: A nurse is assessing a client who is receiving a transfusion of packed red blood cells (RBCs).
Which of the following findings indicates the client is experiencing fluid overload?
A. Low back pain and dark urine
B. Dyspnea and bilateral crackles
C. Hypotension and a thready pulse
D. Fever and severe muscle chills
ANSWER ■: B — Dyspnea and bilateral crackles
Explanation: Transfusion-associated circulatory overload (TACO) occurs when the volume or rate of the transfusion exceeds
the client's cardiovascular capacity. Manifestations include dyspnea, crackles in the lungs, distended jugular veins, and
tachycardia. Low back pain and dark urine indicate an acute hemolytic transfusion reaction. Hypotension and a thready pulse
indicate septic or anaphylactic reactions, whereas fluid overload typically causes hypertension and a bounding pulse. Fever and
chills are indicative of a febrile non-hemolytic reaction.
Question 5: A nurse is reviewing laboratory data for a client who has chronic kidney disease (CKD). Which of
the following findings should the nurse expect?
A. Decreased creatinine level
B. Increased hemoglobin level
C. Decreased calcium level
D. Increased bicarbonate level
ANSWER ■: C — Decreased calcium level
Explanation: In chronic kidney disease, the kidneys cannot adequately excrete phosphorus, leading to hyperphosphatemia.
High phosphorus levels bind to calcium, causing hypocalcemia (decreased calcium level). Additionally, the kidneys fail to
activate vitamin D, which is necessary for calcium absorption. CKD causes an increase in creatinine due to decreased
glomerular filtration. Hemoglobin is decreased (anemia) due to a deficiency in erythropoietin production. Bicarbonate is
decreased because of the kidneys' inability to excrete hydrogen ions and reabsorb bicarbonate, leading to metabolic acidosis.
Page 3
, RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
Question 6: A nurse is caring for a client who has generalized petechiae and ecchymoses. The nurse should
anticipate a prescription for which of the following laboratory tests?
A. Platelet count
B. Potassium level
C. Creatinine clearance
D. Prealbumin level
ANSWER ■: A — Platelet count
Explanation: Petechiae (small, pinpoint red/purple spots) and ecchymoses (bruising) are clinical manifestations of bleeding
under the skin, which commonly result from thrombocytopenia (low platelet count) or coagulation factor deficiencies. Therefore,
a platelet count is the priority laboratory test to assess the client's clotting ability. Potassium levels, creatinine clearance, and
prealbumin do not assess coagulation or platelet function and are not directly related to petechiae and ecchymoses.
Question 7: A nurse is assessing a client 30 minutes postoperative following an arterial thrombectomy.
Which of the following findings is the priority to report to the provider?
A. Incisional pain rated at 6 on a scale of 0 to 10
B. Muscle spasms in the affected extremity
C. Cool, moist, pale skin in the distal portion of the limb
D. A small area of sanguineous drainage on the surgical dressing
ANSWER ■: C — Cool, moist, pale skin in the distal portion of the limb
Explanation: An arterial thrombectomy is performed to restore blood flow to an extremity. Cool, moist, pale, or cyanotic skin
distal to the surgical site indicates a lack of perfusion, suggesting re-occlusion of the artery or a failing graft, which requires
immediate intervention to save the limb. Incisional pain of 6/10 is expected postoperatively and should be managed with
analgesics but is not the highest priority. Muscle spasms can occur but do not indicate an immediate threat to limb viability. A
small amount of drainage is expected, whereas a loss of perfusion is an emergency.
Question 8: A nurse is caring for a client who is to receive a transfusion of packed RBCs. Which of the
following actions should the nurse plan to take?
A. Prime the IV tubing with 5% dextrose in water (D5W)
B. Administer the transfusion over a period of 6 hours to prevent overload
C. Prime the IV tubing with 0.9% sodium chloride
D. Use a standard non-filtered IV administration set
ANSWER ■: C — Prime the IV tubing with 0.9% sodium chloride
Explanation: Packed RBCs must only be administered with 0.9% sodium chloride (normal saline) to prevent hemolysis of the
red blood cells. Dextrose solutions (like D5W) cause RBCs to clump and hemolyze. Blood transfusions must be completed within
4 hours of removal from the blood bank to prevent bacterial growth and cellular degradation. A specialized blood administration
set with an in-line filter must be used to remove any clots or debris.
Page 4
EXAM REVIEW
100 High-Yield Questions with In-Depth Explanations (2026-2027 Update Exam)
Exam Blueprints & Overview: This test bank is designed as a professional and high-yield study companion for
nursing students preparing for the RN Comprehensive Predictor Examination. It contains exactly 100 detailed
multiple-choice questions rigorously mapped to the core nursing chapters and clinical concepts. Each question
includes a correct answer key and an in-depth rationale designed to reinforce clinical judgment,
patient-centered care, and evidence-based practice standards for 2026-2027. All questions are fully grounded
in official course materials.
TABLE OF CONTENTS
Chapter 1: Medical-Surgical Nursing — Cardiovascular & Renal Systems (Q1-15) Page 2
Chapter 2: Medical-Surgical Nursing — Respiratory & Thoracic Care (Q16-45) Page 4
Chapter 3: Maternal-Newborn & Pediatric Nursing (Q46-60) Page 9
Chapter 4: Mental Health & Psychiatric Nursing (Q61-75) Page 11
Chapter 5: Pharmacology & Medication Administration (Q76-90) Page 13
Chapter 6: Nursing Leadership, Professional Standards & Patient Safety (Q91-100) Page 16
Page 1
,RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
CHAPTER 1: MEDICAL-SURGICAL NURSING — CARDIOVASCULAR & RENAL
SYSTEMS
Question 1: A nurse is preparing to administer digoxin 0.125 mg PO to an adult client. For which of the
following findings should the nurse withhold the medication and report to the provider?
A. Potassium level of 4.2 mEq/L
B. Apical pulse of 58/min
C. Digoxin level of 1.0 ng/mL
D. Constipation for the past 2 days
ANSWER ■: B — Apical pulse of 58/min
Explanation: Before administering digoxin, the nurse must assess the apical pulse for 1 full minute. For an adult client, the
medication should be withheld and the provider notified if the apical pulse is less than 60/min, as digoxin decreases the heart
rate (negative chronotropic effect) and bradycardia is a classic sign of toxicity. A potassium level of 4.2 mEq/L is within the
normal range (3.5 to 5.0 mEq/L), although hypokalemia increases the risk of digoxin toxicity. A digoxin level of 1.0 ng/mL is
within the therapeutic range (0.5 to 2.0 ng/mL). Constipation is a common side effect of many medications but is not a reason to
withhold digoxin or a priority finding compared to bradycardia.
Question 2: A nurse is caring for a client who is recovering from an acute myocardial infarction (MI) that
occurred 3 days ago. Which of the following interventions should the nurse include in the plan of care?
A. Perform a 12-lead ECG every 12 hours
B. Place the client in a supine position while resting
C. Draw a troponin level every 4 hours
D. Obtain a cardiac rehabilitation consultation
ANSWER ■: D — Obtain a cardiac rehabilitation consultation
Explanation: A client who is 3 days post-MI is stable enough to begin planning for long-term recovery and lifestyle modification.
A cardiac rehabilitation consultation is indicated to help the client safely increase activity, manage risk factors, and promote
recovery. A 12-lead ECG every 12 hours is not routinely indicated for a stable client 3 days post-MI unless they experience new
chest pain. The supine position increases venous return and cardiac workload; the client should be in semi-Fowler's or a
comfortable position of rest. Troponin levels peak within 24 hours of an MI and do not need to be drawn every 4 hours 3 days
after the event unless re-infarction is suspected.
Page 2
,RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
Question 3: A nurse is assessing a client who has left-sided heart failure. Which of the following findings
should the nurse identify as a manifestation of pulmonary congestion?
A. Frothy, pink sputum
B. Jugular vein distention (JVD)
C. Weight gain of 1 kg (2.2 lb) in 24 hours
D. Bradypnea with shallow respirations
ANSWER ■: A — Frothy, pink sputum
Explanation: Left-sided heart failure leads to backup of blood into the pulmonary vasculature, resulting in pulmonary congestion
and increased pulmonary capillary hydrostatic pressure. This causes fluid to leak into the alveoli, manifesting as dyspnea,
crackles, and classic frothy, pink-tinged sputum (a sign of severe pulmonary edema). Jugular vein distention and rapid weight
gain are signs of systemic fluid volume excess, which are characteristic of right-sided heart failure. Clients with pulmonary
congestion typically experience tachypnea (rapid breathing) rather than bradypnea (slow breathing).
Question 4: A nurse is assessing a client who is receiving a transfusion of packed red blood cells (RBCs).
Which of the following findings indicates the client is experiencing fluid overload?
A. Low back pain and dark urine
B. Dyspnea and bilateral crackles
C. Hypotension and a thready pulse
D. Fever and severe muscle chills
ANSWER ■: B — Dyspnea and bilateral crackles
Explanation: Transfusion-associated circulatory overload (TACO) occurs when the volume or rate of the transfusion exceeds
the client's cardiovascular capacity. Manifestations include dyspnea, crackles in the lungs, distended jugular veins, and
tachycardia. Low back pain and dark urine indicate an acute hemolytic transfusion reaction. Hypotension and a thready pulse
indicate septic or anaphylactic reactions, whereas fluid overload typically causes hypertension and a bounding pulse. Fever and
chills are indicative of a febrile non-hemolytic reaction.
Question 5: A nurse is reviewing laboratory data for a client who has chronic kidney disease (CKD). Which of
the following findings should the nurse expect?
A. Decreased creatinine level
B. Increased hemoglobin level
C. Decreased calcium level
D. Increased bicarbonate level
ANSWER ■: C — Decreased calcium level
Explanation: In chronic kidney disease, the kidneys cannot adequately excrete phosphorus, leading to hyperphosphatemia.
High phosphorus levels bind to calcium, causing hypocalcemia (decreased calcium level). Additionally, the kidneys fail to
activate vitamin D, which is necessary for calcium absorption. CKD causes an increase in creatinine due to decreased
glomerular filtration. Hemoglobin is decreased (anemia) due to a deficiency in erythropoietin production. Bicarbonate is
decreased because of the kidneys' inability to excrete hydrogen ions and reabsorb bicarbonate, leading to metabolic acidosis.
Page 3
, RN COMPREHENSIVE PREDICTOR NURSING EXAM REVIEW 2026-2027 UPDATE EXAM
Question 6: A nurse is caring for a client who has generalized petechiae and ecchymoses. The nurse should
anticipate a prescription for which of the following laboratory tests?
A. Platelet count
B. Potassium level
C. Creatinine clearance
D. Prealbumin level
ANSWER ■: A — Platelet count
Explanation: Petechiae (small, pinpoint red/purple spots) and ecchymoses (bruising) are clinical manifestations of bleeding
under the skin, which commonly result from thrombocytopenia (low platelet count) or coagulation factor deficiencies. Therefore,
a platelet count is the priority laboratory test to assess the client's clotting ability. Potassium levels, creatinine clearance, and
prealbumin do not assess coagulation or platelet function and are not directly related to petechiae and ecchymoses.
Question 7: A nurse is assessing a client 30 minutes postoperative following an arterial thrombectomy.
Which of the following findings is the priority to report to the provider?
A. Incisional pain rated at 6 on a scale of 0 to 10
B. Muscle spasms in the affected extremity
C. Cool, moist, pale skin in the distal portion of the limb
D. A small area of sanguineous drainage on the surgical dressing
ANSWER ■: C — Cool, moist, pale skin in the distal portion of the limb
Explanation: An arterial thrombectomy is performed to restore blood flow to an extremity. Cool, moist, pale, or cyanotic skin
distal to the surgical site indicates a lack of perfusion, suggesting re-occlusion of the artery or a failing graft, which requires
immediate intervention to save the limb. Incisional pain of 6/10 is expected postoperatively and should be managed with
analgesics but is not the highest priority. Muscle spasms can occur but do not indicate an immediate threat to limb viability. A
small amount of drainage is expected, whereas a loss of perfusion is an emergency.
Question 8: A nurse is caring for a client who is to receive a transfusion of packed RBCs. Which of the
following actions should the nurse plan to take?
A. Prime the IV tubing with 5% dextrose in water (D5W)
B. Administer the transfusion over a period of 6 hours to prevent overload
C. Prime the IV tubing with 0.9% sodium chloride
D. Use a standard non-filtered IV administration set
ANSWER ■: C — Prime the IV tubing with 0.9% sodium chloride
Explanation: Packed RBCs must only be administered with 0.9% sodium chloride (normal saline) to prevent hemolysis of the
red blood cells. Dextrose solutions (like D5W) cause RBCs to clump and hemolyze. Blood transfusions must be completed within
4 hours of removal from the blood bank to prevent bacterial growth and cellular degradation. A specialized blood administration
set with an in-line filter must be used to remove any clots or debris.
Page 4
