VATI PN COMPREHENSIVE PREDICTOR RETAKE
2026
Actual Exam with 180 Next Generation NCLEX (NGN) Questions & Verified Answers — A+
Graded
Aligned to 2026 NCLEX-PN Test Plan & NGN Item Format Standards
NGN Item Format Distribution: Extended Multiple Response (EMR) = 30 · Matrix/Grid = 20 ·
Drag-and-Drop = 20 · Cloze/Drop-Down = 20 · Highlight/Select Text = 15 · Bowtie/Trend Analysis = 15 ·
Traditional MC = 60
Cognitive levels: 25% recall · 55% application · 20% analysis · Question style: 80% scenario-based, 20%
direct recall
SECTION 1 — Management of Care (Advocacy, Delegation, Prioritization,
Continuity of Care, & Legal/Ethical Issues)
Q1: [MC] A practical nurse (PN) is caring for four clients. Which client should the PN
assess FIRST after receiving shift handoff?
A. A client with chronic back pain requesting PRN analgesic
B. A client 2 hours post-coronary angiogram with femoral arterial sheath reporting groin
pressure [CORRECT]
C. A client with type 2 diabetes awaiting breakfast trays
D. A client with a stage 2 sacral pressure injury scheduled for dressing change
Correct Answer: B
Rationale: The post-angiogram client with femoral arterial sheath and new groin pressure is at
highest risk for active arterial bleeding or hematoma formation — an ABCs/safety prioritization.
The other clients are stable with needs that can wait 30–60 minutes. NGN strategy: use the ABC +
acute-vs-chronic + unstable-first framework to rank risk.
Q2: [EMR] A PN is delegating tasks. Which client assignment is MOST appropriate to
delegate to a UAP?
A. A client 4 hours post-thoracentesis with new dyspnea
B. A client receiving the first 15 minutes of a packed RBC transfusion
C. A stable post-op client needing ambulation after voiding without dizziness [CORRECT]
D. A client with new-onset confusion and agitation requiring restraints
Correct Answer: C
Rationale: Ambulation of a stable post-op client who has already voided without dizziness is
within UAP scope. New dyspnea post-thoracentesis requires PN/RN assessment, the first 15
minutes of a transfusion must be monitored by the nurse per AABB standards, and applying
restraints requires nursing assessment and provider order. NGN strategy: delegate only stable
clients with predictable outcomes.
,Q3: [Matrix] For each task below, identify whether it can be delegated to a UAP, must be
performed by a PN, or requires an RN. (Matrix item — choose the BEST single correct
statement below.)
A. Initial post-operative assessment must be performed by a UAP
B. Reinforcement of teaching initiated by an RN can be performed by a PN [CORRECT]
C. Insertion of a central line can be delegated to a UAP
D. Evaluation of a new plan of care can be performed by a UAP
Correct Answer: B
Rationale: PNs can reinforce teaching already initiated by an RN but cannot perform initial
teaching or evaluate outcomes. Initial post-op assessment, central line insertion, and care plan
evaluation all require RN-level judgment. NGN strategy: 5 rights of delegation — right task, right
circumstance, right person, right communication, right supervision.
Q4: [DragDrop] Order the following clients from HIGHEST to LOWEST priority for
assessment (1 = assess first). Drag-and-drop ordered response.
A. (1) Client with respiratory rate 28 and SpO2 88% on room air; (2) client with chronic
knee pain; (3) client 2 hr post-op voiding 30 mL/hr; (4) client requesting PRN stool
softener
B. (1) Client requesting PRN stool softener; (2) client with chronic knee pain; (3) client 2
hr post-op voiding 30 mL/hr; (4) client with respiratory rate 28 and SpO2 88%
C. (1) Client with respiratory rate 28 and SpO2 88%; (2) client 2 hr post-op voiding 30
mL/hr; (3) client with chronic knee pain; (4) client requesting PRN stool softener
[CORRECT]
D. (1) Client 2 hr post-op voiding 30 mL/hr; (2) client with respiratory rate 28 and SpO2
88%; (3) client with chronic knee pain; (4) client requesting PRN stool softener
Correct Answer: C
Rationale: Use ABCs first (respiratory compromise with SpO2 88% — acute), then evaluate for
acute post-op complication (oliguria 30 mL/hr suggests retention/hypovolemia — acute), then
stable chronic pain, then routine comfort need (stool softener). NGN strategy: DragDrop items
require sequential clinical judgment using ABC + acute/unstable first.
Q5: [Cloze] Drop-down completion: The legal principle that requires a nurse to perform at
the level of a reasonably prudent nurse with similar education and experience is called
[Select the correct term].
A. beneficence
B. nonmaleficence
C. standard of care [CORRECT]
D. informed consent
Correct Answer: C
Rationale: Standard of care is the legal benchmark — what a reasonably prudent nurse with
similar education and experience would do in the same situation. Beneficence/nonmaleficence are
ethical principles, and informed consent is a separate legal doctrine requiring provider disclosure
of risks/benefits. NGN strategy: Cloze items test precise terminology — distinguish ethical vs. legal
principles.
,Q6: [Highlight] Highlight-Select: A 78-year-old client is admitted with dehydration. The
nurse reviews the following assessment findings: HR 102, BP 88/52, RR 20, temp 37.0°C,
mucous membranes dry, capillary refill 4 seconds, oriented x3. Which findings require
IMMEDIATE follow-up? (Select the most concerning pair.)
A. BP 88/52 and HR 102 [CORRECT]
B. RR 20 and temp 37.0°C
C. Capillary refill 4 seconds and oriented x3
D. Mucous membranes dry and capillary refill 4 seconds
Correct Answer: A
Rationale: BP 88/52 with HR 102 reflects hypovolemic shock physiology from dehydration and
requires immediate fluid resuscitation and provider notification. The other findings are either
normal or non-urgent in isolation. NGN strategy: Highlight items ask you to identify the cluster of
concerning cues that indicate clinical deterioration.
Q7: [Bowtie] BOWTIE item: A client with heart failure develops sudden shortness of
breath with pink frothy sputum. Identify the priority nursing action, the suspected
complication, and the parameter to monitor.
A. Action: Place supine flat; Complication: Pneumonia; Monitor: Temp
B. Action: Place in high-Fowler's with oxygen; Complication: Pulmonary edema; Monitor:
SpO2 and respiratory status [CORRECT]
C. Action: Ambulate to chair; Complication: DVT; Monitor: Calf circumference
D. Action: Withhold fluids; Complication: Dehydration; Monitor: Urine output
Correct Answer: B
Rationale: Pink frothy sputum plus acute dyspnea in heart failure indicates acute pulmonary
edema — high-Fowler's positioning and supplemental oxygen are the immediate priority to
optimize ventilation, with close SpO2 and respiratory monitoring while awaiting diuretics. NGN
strategy: Bowtie items require linking action + complication + evaluation parameter in one clinical
judgment cycle.
Q8: [MC] A PN discovers a client's advance directive states 'no CPR' but the provider's
order does not reflect this. The FIRST action is to:
A. Notify the provider and request the order be updated to reflect the advance directive
[CORRECT]
B. Initiate CPR if the client codes until clarification is obtained
C. Place the document in the client's chart and take no further action
D. Notify the family and request they decide
Correct Answer: A
Rationale: The advance directive is a legally binding document that must be honored; the PN's
role is to notify the provider so orders can be reconciled. Initiating CPR against a valid DNR could
constitute battery. NGN strategy: legal/ethical items require knowing the hierarchy: directive >
provider orders > family preference.
, Q9: [EMR] Which of the following tasks CANNOT be delegated to a UAP? (Select all that
apply.)
A. Initial admission assessment of a new client
B. Feeding a stable client who can swallow
C. Teaching a client about a newly prescribed diabetic diet [CORRECT]
D. Ambulating a stable client to the bathroom
E. Obtaining routine vital signs on a stable client
Correct Answer: C
Rationale: Initial admission assessment and any client teaching require a licensed nurse and
cannot be delegated to UAP. Feeding, ambulating, and routine vitals on stable clients are
appropriate UAP tasks. NGN strategy: the PN retains initial assessment, teaching, evaluation, and
unstable client care.
Q10: [MC] A PN is supervising a UAP who reports that a client's BP is 80/40. The PN should:
A. Tell the UAP to recheck in 1 hour
B. Immediately assess the client and notify the provider [CORRECT]
C. Document the finding and continue with other tasks
D. Have the UAP reposition the client and recheck
Correct Answer: B
Rationale: A BP of 80/40 is critically low and may indicate shock; the PN must immediately assess
the client and notify the provider. Delaying assessment or delegating repositioning to UAP is
unsafe. NGN strategy: when a UAP reports abnormal findings, the nurse must personally assess
and act — never delegate judgment.
Q11: [MC] A client is scheduled for surgery but refuses to sign the consent after the
surgeon has explained the procedure. The most appropriate nursing action is to:
A. Notify the surgeon of the client's refusal [CORRECT]
B. Encourage the client to sign since the surgeon has already explained everything
C. Explain the procedure again and ask the client to sign
D. Document the refusal and proceed with preoperative preparation
Correct Answer: A
Rationale: The client has the right to refuse treatment; the nurse must notify the surgeon of the
refusal and document the discussion. Pressuring the client or proceeding without consent could
constitute battery. NGN strategy: autonomy and informed consent require respect for refusal.
Q12: [MC] Which client assignment is INAPPROPRIATE to delegate to a PN working on a
medical unit?
A. A client with pneumonia requiring IV antibiotic administration
B. A client 6 hours post-thyroidectomy requiring calcium monitoring
C. A newly admitted client with chest pain requiring initial assessment [CORRECT]
D. A client with a foley catheter requiring routine irrigation
Correct Answer: C
Rationale: A client with new-onset chest pain requires RN-level initial assessment and continuous
cardiac monitoring; this client is unstable and unpredictable. IV antibiotics, post-thyroidectomy
monitoring (once stable), and routine catheter irrigation are within PN scope. NGN strategy: initial
assessments of potentially unstable clients stay with the RN.
2026
Actual Exam with 180 Next Generation NCLEX (NGN) Questions & Verified Answers — A+
Graded
Aligned to 2026 NCLEX-PN Test Plan & NGN Item Format Standards
NGN Item Format Distribution: Extended Multiple Response (EMR) = 30 · Matrix/Grid = 20 ·
Drag-and-Drop = 20 · Cloze/Drop-Down = 20 · Highlight/Select Text = 15 · Bowtie/Trend Analysis = 15 ·
Traditional MC = 60
Cognitive levels: 25% recall · 55% application · 20% analysis · Question style: 80% scenario-based, 20%
direct recall
SECTION 1 — Management of Care (Advocacy, Delegation, Prioritization,
Continuity of Care, & Legal/Ethical Issues)
Q1: [MC] A practical nurse (PN) is caring for four clients. Which client should the PN
assess FIRST after receiving shift handoff?
A. A client with chronic back pain requesting PRN analgesic
B. A client 2 hours post-coronary angiogram with femoral arterial sheath reporting groin
pressure [CORRECT]
C. A client with type 2 diabetes awaiting breakfast trays
D. A client with a stage 2 sacral pressure injury scheduled for dressing change
Correct Answer: B
Rationale: The post-angiogram client with femoral arterial sheath and new groin pressure is at
highest risk for active arterial bleeding or hematoma formation — an ABCs/safety prioritization.
The other clients are stable with needs that can wait 30–60 minutes. NGN strategy: use the ABC +
acute-vs-chronic + unstable-first framework to rank risk.
Q2: [EMR] A PN is delegating tasks. Which client assignment is MOST appropriate to
delegate to a UAP?
A. A client 4 hours post-thoracentesis with new dyspnea
B. A client receiving the first 15 minutes of a packed RBC transfusion
C. A stable post-op client needing ambulation after voiding without dizziness [CORRECT]
D. A client with new-onset confusion and agitation requiring restraints
Correct Answer: C
Rationale: Ambulation of a stable post-op client who has already voided without dizziness is
within UAP scope. New dyspnea post-thoracentesis requires PN/RN assessment, the first 15
minutes of a transfusion must be monitored by the nurse per AABB standards, and applying
restraints requires nursing assessment and provider order. NGN strategy: delegate only stable
clients with predictable outcomes.
,Q3: [Matrix] For each task below, identify whether it can be delegated to a UAP, must be
performed by a PN, or requires an RN. (Matrix item — choose the BEST single correct
statement below.)
A. Initial post-operative assessment must be performed by a UAP
B. Reinforcement of teaching initiated by an RN can be performed by a PN [CORRECT]
C. Insertion of a central line can be delegated to a UAP
D. Evaluation of a new plan of care can be performed by a UAP
Correct Answer: B
Rationale: PNs can reinforce teaching already initiated by an RN but cannot perform initial
teaching or evaluate outcomes. Initial post-op assessment, central line insertion, and care plan
evaluation all require RN-level judgment. NGN strategy: 5 rights of delegation — right task, right
circumstance, right person, right communication, right supervision.
Q4: [DragDrop] Order the following clients from HIGHEST to LOWEST priority for
assessment (1 = assess first). Drag-and-drop ordered response.
A. (1) Client with respiratory rate 28 and SpO2 88% on room air; (2) client with chronic
knee pain; (3) client 2 hr post-op voiding 30 mL/hr; (4) client requesting PRN stool
softener
B. (1) Client requesting PRN stool softener; (2) client with chronic knee pain; (3) client 2
hr post-op voiding 30 mL/hr; (4) client with respiratory rate 28 and SpO2 88%
C. (1) Client with respiratory rate 28 and SpO2 88%; (2) client 2 hr post-op voiding 30
mL/hr; (3) client with chronic knee pain; (4) client requesting PRN stool softener
[CORRECT]
D. (1) Client 2 hr post-op voiding 30 mL/hr; (2) client with respiratory rate 28 and SpO2
88%; (3) client with chronic knee pain; (4) client requesting PRN stool softener
Correct Answer: C
Rationale: Use ABCs first (respiratory compromise with SpO2 88% — acute), then evaluate for
acute post-op complication (oliguria 30 mL/hr suggests retention/hypovolemia — acute), then
stable chronic pain, then routine comfort need (stool softener). NGN strategy: DragDrop items
require sequential clinical judgment using ABC + acute/unstable first.
Q5: [Cloze] Drop-down completion: The legal principle that requires a nurse to perform at
the level of a reasonably prudent nurse with similar education and experience is called
[Select the correct term].
A. beneficence
B. nonmaleficence
C. standard of care [CORRECT]
D. informed consent
Correct Answer: C
Rationale: Standard of care is the legal benchmark — what a reasonably prudent nurse with
similar education and experience would do in the same situation. Beneficence/nonmaleficence are
ethical principles, and informed consent is a separate legal doctrine requiring provider disclosure
of risks/benefits. NGN strategy: Cloze items test precise terminology — distinguish ethical vs. legal
principles.
,Q6: [Highlight] Highlight-Select: A 78-year-old client is admitted with dehydration. The
nurse reviews the following assessment findings: HR 102, BP 88/52, RR 20, temp 37.0°C,
mucous membranes dry, capillary refill 4 seconds, oriented x3. Which findings require
IMMEDIATE follow-up? (Select the most concerning pair.)
A. BP 88/52 and HR 102 [CORRECT]
B. RR 20 and temp 37.0°C
C. Capillary refill 4 seconds and oriented x3
D. Mucous membranes dry and capillary refill 4 seconds
Correct Answer: A
Rationale: BP 88/52 with HR 102 reflects hypovolemic shock physiology from dehydration and
requires immediate fluid resuscitation and provider notification. The other findings are either
normal or non-urgent in isolation. NGN strategy: Highlight items ask you to identify the cluster of
concerning cues that indicate clinical deterioration.
Q7: [Bowtie] BOWTIE item: A client with heart failure develops sudden shortness of
breath with pink frothy sputum. Identify the priority nursing action, the suspected
complication, and the parameter to monitor.
A. Action: Place supine flat; Complication: Pneumonia; Monitor: Temp
B. Action: Place in high-Fowler's with oxygen; Complication: Pulmonary edema; Monitor:
SpO2 and respiratory status [CORRECT]
C. Action: Ambulate to chair; Complication: DVT; Monitor: Calf circumference
D. Action: Withhold fluids; Complication: Dehydration; Monitor: Urine output
Correct Answer: B
Rationale: Pink frothy sputum plus acute dyspnea in heart failure indicates acute pulmonary
edema — high-Fowler's positioning and supplemental oxygen are the immediate priority to
optimize ventilation, with close SpO2 and respiratory monitoring while awaiting diuretics. NGN
strategy: Bowtie items require linking action + complication + evaluation parameter in one clinical
judgment cycle.
Q8: [MC] A PN discovers a client's advance directive states 'no CPR' but the provider's
order does not reflect this. The FIRST action is to:
A. Notify the provider and request the order be updated to reflect the advance directive
[CORRECT]
B. Initiate CPR if the client codes until clarification is obtained
C. Place the document in the client's chart and take no further action
D. Notify the family and request they decide
Correct Answer: A
Rationale: The advance directive is a legally binding document that must be honored; the PN's
role is to notify the provider so orders can be reconciled. Initiating CPR against a valid DNR could
constitute battery. NGN strategy: legal/ethical items require knowing the hierarchy: directive >
provider orders > family preference.
, Q9: [EMR] Which of the following tasks CANNOT be delegated to a UAP? (Select all that
apply.)
A. Initial admission assessment of a new client
B. Feeding a stable client who can swallow
C. Teaching a client about a newly prescribed diabetic diet [CORRECT]
D. Ambulating a stable client to the bathroom
E. Obtaining routine vital signs on a stable client
Correct Answer: C
Rationale: Initial admission assessment and any client teaching require a licensed nurse and
cannot be delegated to UAP. Feeding, ambulating, and routine vitals on stable clients are
appropriate UAP tasks. NGN strategy: the PN retains initial assessment, teaching, evaluation, and
unstable client care.
Q10: [MC] A PN is supervising a UAP who reports that a client's BP is 80/40. The PN should:
A. Tell the UAP to recheck in 1 hour
B. Immediately assess the client and notify the provider [CORRECT]
C. Document the finding and continue with other tasks
D. Have the UAP reposition the client and recheck
Correct Answer: B
Rationale: A BP of 80/40 is critically low and may indicate shock; the PN must immediately assess
the client and notify the provider. Delaying assessment or delegating repositioning to UAP is
unsafe. NGN strategy: when a UAP reports abnormal findings, the nurse must personally assess
and act — never delegate judgment.
Q11: [MC] A client is scheduled for surgery but refuses to sign the consent after the
surgeon has explained the procedure. The most appropriate nursing action is to:
A. Notify the surgeon of the client's refusal [CORRECT]
B. Encourage the client to sign since the surgeon has already explained everything
C. Explain the procedure again and ask the client to sign
D. Document the refusal and proceed with preoperative preparation
Correct Answer: A
Rationale: The client has the right to refuse treatment; the nurse must notify the surgeon of the
refusal and document the discussion. Pressuring the client or proceeding without consent could
constitute battery. NGN strategy: autonomy and informed consent require respect for refusal.
Q12: [MC] Which client assignment is INAPPROPRIATE to delegate to a PN working on a
medical unit?
A. A client with pneumonia requiring IV antibiotic administration
B. A client 6 hours post-thyroidectomy requiring calcium monitoring
C. A newly admitted client with chest pain requiring initial assessment [CORRECT]
D. A client with a foley catheter requiring routine irrigation
Correct Answer: C
Rationale: A client with new-onset chest pain requires RN-level initial assessment and continuous
cardiac monitoring; this client is unstable and unpredictable. IV antibiotics, post-thyroidectomy
monitoring (once stable), and routine catheter irrigation are within PN scope. NGN strategy: initial
assessments of potentially unstable clients stay with the RN.
