NURS 4426: NCLEX Comprehensive Predictor Prep
with Detailed Rationales
Course Code: NURS 4426
Course Name: Advanced Clinical Judgment and Licensure Readiness
Topic: High-Yield NCLEX Concepts, Safety, Critical Care, Clinical Delegation
and Mixed Specialties (Pediatrics, Maternity, Mental Health, Med-Surg)
Academic Year: 2026/2027
Question 1
A charge nurse is planning care for a medical-surgical unit. Which of the following
tasks should the nurse plan to perform rather than delegating to assistive
personnel (AP)?
A. Measuring the intake and output of a client receiving continuous bladder
irrigation.
B. Evaluating a client’s understanding of a new low-sodium diet.
C. Applying a moisturizing lotion to the intact skin of a client who has a stage 1
pressure injury.
D. Transporting a stable client via wheelchair to the radiology department.
CORRECT ANSWER: B
RATIONALE: The nurse cannot delegate any part of the nursing process,
which includes evaluation, assessment, and teaching (EAT). Evaluating a client's
understanding of dietary restrictions requires clinical judgment and nursing
knowledge, making it inappropriate for delegation to AP. Measuring intake and
output, applying lotion to intact skin, and transporting stable clients are standard
tasks within the scope of practice of assistive personnel.
Question 2
A nurse is assessing a client who has Addison's disease. Which of the following
clinical findings should the nurse expect?
A. Hypernatremia
B. Hyponatremia
,C. Hypertension
D. Hyperglycemia
CORRECT ANSWER: B
RATIONALE: Addison's disease is characterized by hyposecretion of adrenal
corticoids (aldosterone and cortisol), leading to a down-regulation of electrolyte
and metabolic values. This results in hyponatremia, hypotension, decreased blood
volume, hypoglycemia, and hyperkalemia. Hypernatremia, hypertension, and
hyperglycemia are characteristic findings of Cushing's syndrome, where cortisol
levels are elevated.
Question 3
A nurse is caring for a client who has Cushing's syndrome. Which of the
following laboratory or clinical findings should the nurse anticipate?
A. Hypoglycemia
B. Decreased blood volume
C. Hypernatremia
D. Hypotension
CORRECT ANSWER: C
RATIONALE: Cushing's syndrome results from an overproduction of
glucocorticoids and mineralocorticoids. The clinical presentation includes elevated
electrolyte and metabolic values such as hypernatremia, hypertension,
hypervolemia, hyperglycemia, and hypokalemia. Hypoglycemia, low blood
volume, and hypotension are clinical manifestations of adrenal insufficiency, or
Addison's disease.
Question 4
A nurse is planning interventions to optimize peripheral perfusion for a client
who has severe peripheral venous insufficiency. Which of the following actions
should the nurse take?
A. Dangle the client's lower extremities over the edge of the bed.
B. Elevate the client's lower extremities above the level of the heart.
C. Instruct the client to cross their legs at the knees while sitting.
D. Apply cold compresses to the client's calves bilaterally.
, CORRECT ANSWER: B
RATIONALE: To promote peripheral venous perfusion and return, the nurse
should elevate the veins. Elevating the legs uses gravity to reduce venous
congestion and edema. Dangling the extremities is an intervention used for arterial
insufficiency to facilitate blood flow down into the tissues (dangle arteries).
Crossing the legs compresses blood vessels and worsens venous congestion, while
cold compresses cause vasoconstriction and impair perfusion.
Question 5
A nurse is evaluating a newborn at 1 min after birth. The newborn has a pink body
with blue extremities, a heart rate of 110/min, a weak cry with grimacing when the
soles of the feet are flicked, and some flexion of the extremities. The nurse should
document an APGAR score of which of the following?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER: B
RATIONALE: The APGAR score is calculated as follows: Appearance: 1
point for a pink body with blue extremities (acrocyanosis). Pulse: 2 points for a
heart rate greater than 100/min. Grimace: 1 point for a weak cry and grimace
during stimulation. Activity: 1 point for some flexion of extremities. Respirations:
1 point for a weak cry/slow respirations. Totaling these values (1 + 2 + 1 + 1 + 1)
equals 6.
Question 6
A nurse is preparing to admit a client who has disseminated herpes zoster. Which
of the following isolation precautions should the nurse implement?
A. Airborne and Contact precautions
B. Droplet precautions only
C. Airborne precautions only
D. Contact precautions only
, CORRECT ANSWER: A
RATIONALE: Disseminated herpes zoster requires both airborne and
contact precautions because the virus can be transmitted via small-particle
aerosols as well as direct contact with fluid from the lesions. Localized herpes
zoster requires only contact precautions, provided the lesions are covered and the
client is not immunocompromised. Droplet precautions are insufficient because
they do not protect against micro-aerosols that remain suspended in the air.
Question 7
A nurse is caring for a client who requires airborne precautions for a suspected
tuberculosis (TB) infection. Which of the following engineering controls or
personal protective equipment (PPE) must be utilized?
A. A private room with positive airflow pressure.
B. An N95 respirator mask worn by the nurse during care.
C. A standard surgical mask worn by the nurse at all times.
D. A room with a minimum of 4 air exchanges per hour.
CORRECT ANSWER: B
RATIONALE: Tuberculosis requires airborne precautions, which mandate
that healthcare providers wear an N95 respirator mask to filter out the
microscopic droplet nuclei. The client requires a private room with negative
airflow pressure (not positive) and 6 to 12 air exchanges per hour to prevent
contaminated air from escaping into the hallway. A surgical mask does not provide
adequate filtration against airborne pathogens.
Question 8
A nurse is caring for a client who has pertussis. Which of the following
transmission-based precautions should the nurse initiate?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions
D. Protective environment
with Detailed Rationales
Course Code: NURS 4426
Course Name: Advanced Clinical Judgment and Licensure Readiness
Topic: High-Yield NCLEX Concepts, Safety, Critical Care, Clinical Delegation
and Mixed Specialties (Pediatrics, Maternity, Mental Health, Med-Surg)
Academic Year: 2026/2027
Question 1
A charge nurse is planning care for a medical-surgical unit. Which of the following
tasks should the nurse plan to perform rather than delegating to assistive
personnel (AP)?
A. Measuring the intake and output of a client receiving continuous bladder
irrigation.
B. Evaluating a client’s understanding of a new low-sodium diet.
C. Applying a moisturizing lotion to the intact skin of a client who has a stage 1
pressure injury.
D. Transporting a stable client via wheelchair to the radiology department.
CORRECT ANSWER: B
RATIONALE: The nurse cannot delegate any part of the nursing process,
which includes evaluation, assessment, and teaching (EAT). Evaluating a client's
understanding of dietary restrictions requires clinical judgment and nursing
knowledge, making it inappropriate for delegation to AP. Measuring intake and
output, applying lotion to intact skin, and transporting stable clients are standard
tasks within the scope of practice of assistive personnel.
Question 2
A nurse is assessing a client who has Addison's disease. Which of the following
clinical findings should the nurse expect?
A. Hypernatremia
B. Hyponatremia
,C. Hypertension
D. Hyperglycemia
CORRECT ANSWER: B
RATIONALE: Addison's disease is characterized by hyposecretion of adrenal
corticoids (aldosterone and cortisol), leading to a down-regulation of electrolyte
and metabolic values. This results in hyponatremia, hypotension, decreased blood
volume, hypoglycemia, and hyperkalemia. Hypernatremia, hypertension, and
hyperglycemia are characteristic findings of Cushing's syndrome, where cortisol
levels are elevated.
Question 3
A nurse is caring for a client who has Cushing's syndrome. Which of the
following laboratory or clinical findings should the nurse anticipate?
A. Hypoglycemia
B. Decreased blood volume
C. Hypernatremia
D. Hypotension
CORRECT ANSWER: C
RATIONALE: Cushing's syndrome results from an overproduction of
glucocorticoids and mineralocorticoids. The clinical presentation includes elevated
electrolyte and metabolic values such as hypernatremia, hypertension,
hypervolemia, hyperglycemia, and hypokalemia. Hypoglycemia, low blood
volume, and hypotension are clinical manifestations of adrenal insufficiency, or
Addison's disease.
Question 4
A nurse is planning interventions to optimize peripheral perfusion for a client
who has severe peripheral venous insufficiency. Which of the following actions
should the nurse take?
A. Dangle the client's lower extremities over the edge of the bed.
B. Elevate the client's lower extremities above the level of the heart.
C. Instruct the client to cross their legs at the knees while sitting.
D. Apply cold compresses to the client's calves bilaterally.
, CORRECT ANSWER: B
RATIONALE: To promote peripheral venous perfusion and return, the nurse
should elevate the veins. Elevating the legs uses gravity to reduce venous
congestion and edema. Dangling the extremities is an intervention used for arterial
insufficiency to facilitate blood flow down into the tissues (dangle arteries).
Crossing the legs compresses blood vessels and worsens venous congestion, while
cold compresses cause vasoconstriction and impair perfusion.
Question 5
A nurse is evaluating a newborn at 1 min after birth. The newborn has a pink body
with blue extremities, a heart rate of 110/min, a weak cry with grimacing when the
soles of the feet are flicked, and some flexion of the extremities. The nurse should
document an APGAR score of which of the following?
A. 5
B. 6
C. 7
D. 8
CORRECT ANSWER: B
RATIONALE: The APGAR score is calculated as follows: Appearance: 1
point for a pink body with blue extremities (acrocyanosis). Pulse: 2 points for a
heart rate greater than 100/min. Grimace: 1 point for a weak cry and grimace
during stimulation. Activity: 1 point for some flexion of extremities. Respirations:
1 point for a weak cry/slow respirations. Totaling these values (1 + 2 + 1 + 1 + 1)
equals 6.
Question 6
A nurse is preparing to admit a client who has disseminated herpes zoster. Which
of the following isolation precautions should the nurse implement?
A. Airborne and Contact precautions
B. Droplet precautions only
C. Airborne precautions only
D. Contact precautions only
, CORRECT ANSWER: A
RATIONALE: Disseminated herpes zoster requires both airborne and
contact precautions because the virus can be transmitted via small-particle
aerosols as well as direct contact with fluid from the lesions. Localized herpes
zoster requires only contact precautions, provided the lesions are covered and the
client is not immunocompromised. Droplet precautions are insufficient because
they do not protect against micro-aerosols that remain suspended in the air.
Question 7
A nurse is caring for a client who requires airborne precautions for a suspected
tuberculosis (TB) infection. Which of the following engineering controls or
personal protective equipment (PPE) must be utilized?
A. A private room with positive airflow pressure.
B. An N95 respirator mask worn by the nurse during care.
C. A standard surgical mask worn by the nurse at all times.
D. A room with a minimum of 4 air exchanges per hour.
CORRECT ANSWER: B
RATIONALE: Tuberculosis requires airborne precautions, which mandate
that healthcare providers wear an N95 respirator mask to filter out the
microscopic droplet nuclei. The client requires a private room with negative
airflow pressure (not positive) and 6 to 12 air exchanges per hour to prevent
contaminated air from escaping into the hallway. A surgical mask does not provide
adequate filtration against airborne pathogens.
Question 8
A nurse is caring for a client who has pertussis. Which of the following
transmission-based precautions should the nurse initiate?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions
D. Protective environment
