RN Comprehensive Predictor–Style Practice Exam
100 Original Questions • NGN-Style • Case Scenarios
For NCLEX-RN/exit-exam preparation. These are original practice questions and are not actual ATI
secure/proctored exam items.
Instructions: Choose the best answer unless the question says “Select all that apply.”
CASE STUDY 1 — SEPSIS
A 68-year-old client is admitted with pneumonia. The client becomes increasingly confused and weak.
Assessment: T 39.2°C; HR 126/min; RR 32/min; BP 86/50 mmHg; SpO■ 89% on room air; urine output 15
mL/hr; WBC 19,000/mm³; lactate 4.8 mmol/L.
1. Which finding is the highest priority?
A. Temperature 39.2°C
B. WBC 19,000/mm³
C. BP 86/50 mmHg
D. HR 126/min
2. Which condition should the nurse suspect?
A. Hypoglycemia
B. Septic shock
C. Cardiogenic shock
D. Pulmonary edema
3. Which prescription should the nurse implement first?
A. Administer IV isotonic fluid
B. Obtain a stool specimen
C. Give oral acetaminophen
D. Encourage oral fluids
4. Which findings indicate impaired tissue perfusion? Select all that apply.
■ A. Hypotension
■ B. Oliguria
■ C. Elevated lactate
■ D. Confusion
■ E. Warm hands only
5. After treatment begins, which finding best indicates improvement?
A. Lactate decreases
B. Temperature remains 39°C
C. Urine output decreases
D. BP falls further
CASE STUDY 2 — ACUTE CORONARY SYNDROME
A 59-year-old client reports crushing substernal chest pain radiating to the left arm. The client is pale and
diaphoretic.
BP 154/92 mmHg; HR 104/min; SpO■ 91%.
6. What is the nurse's priority?
A. Obtain a 12-lead ECG
B. Ask about bowel movements
,C. Give a full meal
D. Encourage ambulation
7. Which medication should the nurse anticipate?
A. Aspirin
B. Vitamin K
C. Lactulose
D. Insulin
8. Which laboratory test is most specific for myocardial injury?
A. Troponin
B. Hemoglobin
C. Sodium
D. INR
9. Which finding requires immediate intervention?
A. Chest pain decreases
B. New ventricular dysrhythmia
C. HR 78/min
D. SpO■ 96%
CASE STUDY 3 — STROKE
A 71-year-old client suddenly develops right-sided weakness and difficulty speaking while eating breakfast.
10. Which information is most important?
A. The client's favorite food
B. Time the symptoms began
C. Last bowel movement
D. History of allergies
11. Before giving anything orally, the nurse should:
A. Perform a swallowing assessment
B. Give water
C. Give aspirin
D. Encourage eating
12. Which finding indicates possible increased intracranial pressure?
A. Decreasing level of consciousness
B. Increased appetite
C. Mild thirst
D. Warm hands
13. Which positioning is generally appropriate for a client with increased intracranial pressure?
A. Head elevated with neck in neutral alignment
B. Flat with legs elevated
C. Trendelenburg
D. Prone
CASE STUDY 4 — DKA
A 22-year-old client with type 1 diabetes has vomiting, abdominal pain and excessive thirst.
Glucose: 520 mg/dL; pH: 7.19; Positive ketones; K■: 5.6 mEq/L.
14. Which condition is most likely?
A. DKA
, B. Hypoglycemia
C. Diabetes insipidus
D. SIADH
15. What is the initial priority?
A. IV isotonic fluids
B. Oral glucose
C. Fluid restriction
D. Exercise
16. Why must potassium be monitored closely?
A. Insulin shifts potassium into cells
B. Insulin always increases serum potassium
C. Potassium has no relationship to insulin
D. Potassium prevents ketone formation
17. Which finding suggests improvement?
A. Glucose decreases and acidosis resolves
B. Ketones increase
C. Respirations become more labored
D. BP decreases
PHARMACOLOGY
18. A client receiving heparin develops bleeding. Which medication reverses heparin?
A. Protamine sulfate
B. Vitamin K
C. Naloxone
D. Atropine
19. A client taking warfarin has an INR of 6.5. What should the nurse do?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Encourage vigorous exercise
D. Give aspirin
20. A client receiving morphine has a respiratory rate of 6/min. Which medication is anticipated?
A. Naloxone
B. Flumazenil
C. Protamine
D. Calcium gluconate
21. Which finding suggests lithium toxicity?
A. Severe diarrhea and tremors
B. Increased appetite
C. Mild thirst
D. Bradycardia only
22. A client taking an ACE inhibitor develops swelling of the tongue. What is the priority?
A. Administer the next dose
B. Protect the airway and seek emergency treatment
C. Encourage exercise
D. Give oral fluids
23. Which medication requires monitoring for ototoxicity and nephrotoxicity?
A. Gentamicin
100 Original Questions • NGN-Style • Case Scenarios
For NCLEX-RN/exit-exam preparation. These are original practice questions and are not actual ATI
secure/proctored exam items.
Instructions: Choose the best answer unless the question says “Select all that apply.”
CASE STUDY 1 — SEPSIS
A 68-year-old client is admitted with pneumonia. The client becomes increasingly confused and weak.
Assessment: T 39.2°C; HR 126/min; RR 32/min; BP 86/50 mmHg; SpO■ 89% on room air; urine output 15
mL/hr; WBC 19,000/mm³; lactate 4.8 mmol/L.
1. Which finding is the highest priority?
A. Temperature 39.2°C
B. WBC 19,000/mm³
C. BP 86/50 mmHg
D. HR 126/min
2. Which condition should the nurse suspect?
A. Hypoglycemia
B. Septic shock
C. Cardiogenic shock
D. Pulmonary edema
3. Which prescription should the nurse implement first?
A. Administer IV isotonic fluid
B. Obtain a stool specimen
C. Give oral acetaminophen
D. Encourage oral fluids
4. Which findings indicate impaired tissue perfusion? Select all that apply.
■ A. Hypotension
■ B. Oliguria
■ C. Elevated lactate
■ D. Confusion
■ E. Warm hands only
5. After treatment begins, which finding best indicates improvement?
A. Lactate decreases
B. Temperature remains 39°C
C. Urine output decreases
D. BP falls further
CASE STUDY 2 — ACUTE CORONARY SYNDROME
A 59-year-old client reports crushing substernal chest pain radiating to the left arm. The client is pale and
diaphoretic.
BP 154/92 mmHg; HR 104/min; SpO■ 91%.
6. What is the nurse's priority?
A. Obtain a 12-lead ECG
B. Ask about bowel movements
,C. Give a full meal
D. Encourage ambulation
7. Which medication should the nurse anticipate?
A. Aspirin
B. Vitamin K
C. Lactulose
D. Insulin
8. Which laboratory test is most specific for myocardial injury?
A. Troponin
B. Hemoglobin
C. Sodium
D. INR
9. Which finding requires immediate intervention?
A. Chest pain decreases
B. New ventricular dysrhythmia
C. HR 78/min
D. SpO■ 96%
CASE STUDY 3 — STROKE
A 71-year-old client suddenly develops right-sided weakness and difficulty speaking while eating breakfast.
10. Which information is most important?
A. The client's favorite food
B. Time the symptoms began
C. Last bowel movement
D. History of allergies
11. Before giving anything orally, the nurse should:
A. Perform a swallowing assessment
B. Give water
C. Give aspirin
D. Encourage eating
12. Which finding indicates possible increased intracranial pressure?
A. Decreasing level of consciousness
B. Increased appetite
C. Mild thirst
D. Warm hands
13. Which positioning is generally appropriate for a client with increased intracranial pressure?
A. Head elevated with neck in neutral alignment
B. Flat with legs elevated
C. Trendelenburg
D. Prone
CASE STUDY 4 — DKA
A 22-year-old client with type 1 diabetes has vomiting, abdominal pain and excessive thirst.
Glucose: 520 mg/dL; pH: 7.19; Positive ketones; K■: 5.6 mEq/L.
14. Which condition is most likely?
A. DKA
, B. Hypoglycemia
C. Diabetes insipidus
D. SIADH
15. What is the initial priority?
A. IV isotonic fluids
B. Oral glucose
C. Fluid restriction
D. Exercise
16. Why must potassium be monitored closely?
A. Insulin shifts potassium into cells
B. Insulin always increases serum potassium
C. Potassium has no relationship to insulin
D. Potassium prevents ketone formation
17. Which finding suggests improvement?
A. Glucose decreases and acidosis resolves
B. Ketones increase
C. Respirations become more labored
D. BP decreases
PHARMACOLOGY
18. A client receiving heparin develops bleeding. Which medication reverses heparin?
A. Protamine sulfate
B. Vitamin K
C. Naloxone
D. Atropine
19. A client taking warfarin has an INR of 6.5. What should the nurse do?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Encourage vigorous exercise
D. Give aspirin
20. A client receiving morphine has a respiratory rate of 6/min. Which medication is anticipated?
A. Naloxone
B. Flumazenil
C. Protamine
D. Calcium gluconate
21. Which finding suggests lithium toxicity?
A. Severe diarrhea and tremors
B. Increased appetite
C. Mild thirst
D. Bradycardia only
22. A client taking an ACE inhibitor develops swelling of the tongue. What is the priority?
A. Administer the next dose
B. Protect the airway and seek emergency treatment
C. Encourage exercise
D. Give oral fluids
23. Which medication requires monitoring for ototoxicity and nephrotoxicity?
A. Gentamicin
