RN Comprehensive Predictor-Style Practice Exam: 150 Questions (NGN Format)
RN Comprehensive Predictor-Style Practice
Exam: 150 Questions (NGN Format)
Original practice questions written for exit-exam preparation. Not affiliated with or taken
from ATI. Answers and short rationales follow each question. Cover the answers and test
yourself.
Section 1: Management of Care and Prioritization (Q1-10)
1. Which client should the nurse assess first? A) COPD, SpO2 90% on 2 L B) Post-
appendectomy, pain 5/10 C) Post-op, HR 130, BP 84/50, new confusion D) Client awaiting
discharge teaching Answer: C. Signs of hypovolemic shock (possible bleeding) are
unstable and life-threatening.
2. Which task can the nurse delegate to unlicensed assistive personnel (UAP)? A) Assess
pain after medication B) Measure vital signs on a stable client C) Teach colostomy care D)
Complete the admission assessment Answer: B. Assessment, teaching, and evaluation
cannot be delegated. Routine vitals on stable clients can.
3. Which task is most appropriate to assign to an LPN/LVN? A) Develop the initial care
plan B) Teach new insulin administration C) Administer IV push blood products D) Give
oral medications to a stable client Answer: D. LPNs provide care for stable clients with
predictable outcomes. Initial plans, new teaching, and blood products stay with the RN.
4. A client signed the surgical consent form but tells the nurse, "I'm not sure I want this
surgery." What should the nurse do? A) Ask the witness to sign anyway B) Cancel the
surgery C) Notify the provider that the client has questions before surgery D) Ask the
family to decide Answer: C. Consent must be informed and voluntary. The provider must
clarify.
5. Two hours after a thyroidectomy, which finding requires immediate intervention? A)
Tingling around the mouth B) Pain 4/10 C) Slight hoarseness D) Neck swelling with stridor
Answer: D. Airway compromise from hematoma or edema takes priority. Tingling suggests
hypocalcemia and is next.
6. A client is found on the floor after a fall. What is the nurse's first action? A) Complete an
incident report B) Assess the client for injury C) Notify the nurse manager D) Document
in the chart Answer: B. Assess the client first, then notify the provider, then document.
Page 1 of 18
,RN Comprehensive Predictor-Style Practice Exam: 150 Questions (NGN Format)
7. During a mass casualty triage (START), which client is tagged red (immediate)? A)
Walking with a laceration B) Closed forearm fracture, alert C) Respiratory rate 34/min D)
Not breathing after the airway is repositioned Answer: C. RR over 30 is red. Not breathing
after repositioning is black (expectant). Walking wounded are green.
8. A nurse suspects a colleague is diverting opioids. What is the best action? A) Confront
the colleague B) Ignore it C) Call the state board first D) Report per facility policy through
the chain of command Answer: D. Follow the facility's reporting policy and protect client
safety.
9. An unresponsive client has an advance directive refusing intubation, but a family
member demands full treatment. What should the nurse do? A) Follow the client's
advance directive B) Follow the family's wishes C) Intubate until the ethics committee
meets D) Ask the family to override Answer: A. The advance directive expresses the
client's autonomous wishes.
10. Which room is appropriate for a client with suspected active tuberculosis? A) Semi-
private room with another respiratory client B) Private negative-pressure room, staff wear
N95 respirators C) Private positive-pressure room D) Any room with a surgical mask on
staff Answer: B. TB requires airborne precautions: negative pressure and an N95.
Section 2: Pharmacology (Q11-25)
11. Which medication reverses warfarin toxicity? A) Protamine sulfate B) Naloxone C)
Vitamin K (phytonadione) D) Flumazenil Answer: C. Protamine reverses heparin.
Naloxone reverses opioids. Flumazenil reverses benzodiazepines.
12. A client on a heparin infusion has an aPTT of 110 seconds (control 30, therapeutic 45-
75). What should the nurse do first? A) Continue the infusion B) Increase the rate C) Give
vitamin K D) Stop the infusion and notify the provider Answer: D. The aPTT is
supratherapeutic, so bleeding risk is high. Protamine may be ordered.
13. Which finding suggests digoxin toxicity? A) Yellow-green visual halos and HR 52 B)
Constipation C) Hypertension D) Weight loss Answer: A. Visual changes, nausea, and
bradycardia are classic. Hypokalemia increases risk.
14. A client taking lisinopril should report which finding immediately? A) Dry cough B)
Mild dizziness C) Headache D) Swelling of the lips and tongue Answer: D. Angioedema
can obstruct the airway. Dry cough is common but not urgent.
Page 2 of 18
, RN Comprehensive Predictor-Style Practice Exam: 150 Questions (NGN Format)
15. Which finding in a client taking furosemide requires intervention? A) Potassium 3.1
mEq/L B) Urine output 60 mL/h C) Weight down 1 kg D) BP 118/76 Answer: A. Loop
diuretics waste potassium. Hypokalemia can cause dysrhythmias.
16. A client taking insulin is alert, diaphoretic, and shaky with a glucose of 52 mg/dL. What
is the best action? A) Give glucagon IM B) Give 4 oz (120 mL) of juice C) Give regular
insulin D) Offer a meat sandwich Answer: B. Alert clients get 15 g of fast-acting
carbohydrate. Glucagon is for unresponsive clients.
17. Metformin combined with IV contrast increases the risk of which complication? A)
Hypoglycemia B) Diabetic ketoacidosis C) Lactic acidosis D) Hyperkalemia Answer: C.
Contrast can injure the kidneys, causing metformin to accumulate. Metformin is held per
order.
18. Which statement shows correct understanding of levothyroxine teaching? A) "I take it
on an empty stomach 30-60 minutes before breakfast." B) "I take it with breakfast." C) "I
take it at bedtime with milk." D) "I take it with my calcium supplement." Answer: A. Food
and calcium reduce absorption.
19. Which teaching is correct for a client taking lithium? A) Restrict sodium B) Use NSAIDs
for pain C) Keep sodium intake and fluids consistent D) Restrict fluids Answer: C. Low
sodium raises lithium levels. NSAIDs also raise levels. Therapeutic range is 0.6-1.2 mEq/L.
20. Which meal choice shows understanding for a client taking phenelzine (MAOI)? A)
Salami pizza B) Red wine C) Soy sauce D) Grilled chicken with rice Answer: D. Avoid
tyramine-rich foods (aged cheese, cured meats, wine, soy) to prevent hypertensive crisis.
21. Which is the antidote for acetaminophen overdose? A) Naloxone B) Acetylcysteine C)
Flumazenil D) Physostigmine Answer: B. Acetylcysteine protects the liver.
22. A client on a morphine PCA has RR 8 and is difficult to arouse. Which medication does
the nurse anticipate? A) Naloxone B) Flumazenil C) Atropine D) Protamine Answer: A.
Naloxone reverses opioid respiratory depression.
23. A client develops facial flushing during a vancomycin infusion. What should the nurse
do? A) Discontinue permanently B) Slow the infusion rate and notify the provider C)
Increase the rate D) Give vitamin K Answer: B. Vancomycin infusion reaction (red man
syndrome) is rate-related.
24. Which laboratory value is most important to monitor for a client on gentamicin? A)
Hemoglobin B) Platelets C) Serum creatinine D) Glucose Answer: C. Aminoglycosides are
nephrotoxic and ototoxic. Peak and trough levels are also monitored.
Page 3 of 18
RN Comprehensive Predictor-Style Practice
Exam: 150 Questions (NGN Format)
Original practice questions written for exit-exam preparation. Not affiliated with or taken
from ATI. Answers and short rationales follow each question. Cover the answers and test
yourself.
Section 1: Management of Care and Prioritization (Q1-10)
1. Which client should the nurse assess first? A) COPD, SpO2 90% on 2 L B) Post-
appendectomy, pain 5/10 C) Post-op, HR 130, BP 84/50, new confusion D) Client awaiting
discharge teaching Answer: C. Signs of hypovolemic shock (possible bleeding) are
unstable and life-threatening.
2. Which task can the nurse delegate to unlicensed assistive personnel (UAP)? A) Assess
pain after medication B) Measure vital signs on a stable client C) Teach colostomy care D)
Complete the admission assessment Answer: B. Assessment, teaching, and evaluation
cannot be delegated. Routine vitals on stable clients can.
3. Which task is most appropriate to assign to an LPN/LVN? A) Develop the initial care
plan B) Teach new insulin administration C) Administer IV push blood products D) Give
oral medications to a stable client Answer: D. LPNs provide care for stable clients with
predictable outcomes. Initial plans, new teaching, and blood products stay with the RN.
4. A client signed the surgical consent form but tells the nurse, "I'm not sure I want this
surgery." What should the nurse do? A) Ask the witness to sign anyway B) Cancel the
surgery C) Notify the provider that the client has questions before surgery D) Ask the
family to decide Answer: C. Consent must be informed and voluntary. The provider must
clarify.
5. Two hours after a thyroidectomy, which finding requires immediate intervention? A)
Tingling around the mouth B) Pain 4/10 C) Slight hoarseness D) Neck swelling with stridor
Answer: D. Airway compromise from hematoma or edema takes priority. Tingling suggests
hypocalcemia and is next.
6. A client is found on the floor after a fall. What is the nurse's first action? A) Complete an
incident report B) Assess the client for injury C) Notify the nurse manager D) Document
in the chart Answer: B. Assess the client first, then notify the provider, then document.
Page 1 of 18
,RN Comprehensive Predictor-Style Practice Exam: 150 Questions (NGN Format)
7. During a mass casualty triage (START), which client is tagged red (immediate)? A)
Walking with a laceration B) Closed forearm fracture, alert C) Respiratory rate 34/min D)
Not breathing after the airway is repositioned Answer: C. RR over 30 is red. Not breathing
after repositioning is black (expectant). Walking wounded are green.
8. A nurse suspects a colleague is diverting opioids. What is the best action? A) Confront
the colleague B) Ignore it C) Call the state board first D) Report per facility policy through
the chain of command Answer: D. Follow the facility's reporting policy and protect client
safety.
9. An unresponsive client has an advance directive refusing intubation, but a family
member demands full treatment. What should the nurse do? A) Follow the client's
advance directive B) Follow the family's wishes C) Intubate until the ethics committee
meets D) Ask the family to override Answer: A. The advance directive expresses the
client's autonomous wishes.
10. Which room is appropriate for a client with suspected active tuberculosis? A) Semi-
private room with another respiratory client B) Private negative-pressure room, staff wear
N95 respirators C) Private positive-pressure room D) Any room with a surgical mask on
staff Answer: B. TB requires airborne precautions: negative pressure and an N95.
Section 2: Pharmacology (Q11-25)
11. Which medication reverses warfarin toxicity? A) Protamine sulfate B) Naloxone C)
Vitamin K (phytonadione) D) Flumazenil Answer: C. Protamine reverses heparin.
Naloxone reverses opioids. Flumazenil reverses benzodiazepines.
12. A client on a heparin infusion has an aPTT of 110 seconds (control 30, therapeutic 45-
75). What should the nurse do first? A) Continue the infusion B) Increase the rate C) Give
vitamin K D) Stop the infusion and notify the provider Answer: D. The aPTT is
supratherapeutic, so bleeding risk is high. Protamine may be ordered.
13. Which finding suggests digoxin toxicity? A) Yellow-green visual halos and HR 52 B)
Constipation C) Hypertension D) Weight loss Answer: A. Visual changes, nausea, and
bradycardia are classic. Hypokalemia increases risk.
14. A client taking lisinopril should report which finding immediately? A) Dry cough B)
Mild dizziness C) Headache D) Swelling of the lips and tongue Answer: D. Angioedema
can obstruct the airway. Dry cough is common but not urgent.
Page 2 of 18
, RN Comprehensive Predictor-Style Practice Exam: 150 Questions (NGN Format)
15. Which finding in a client taking furosemide requires intervention? A) Potassium 3.1
mEq/L B) Urine output 60 mL/h C) Weight down 1 kg D) BP 118/76 Answer: A. Loop
diuretics waste potassium. Hypokalemia can cause dysrhythmias.
16. A client taking insulin is alert, diaphoretic, and shaky with a glucose of 52 mg/dL. What
is the best action? A) Give glucagon IM B) Give 4 oz (120 mL) of juice C) Give regular
insulin D) Offer a meat sandwich Answer: B. Alert clients get 15 g of fast-acting
carbohydrate. Glucagon is for unresponsive clients.
17. Metformin combined with IV contrast increases the risk of which complication? A)
Hypoglycemia B) Diabetic ketoacidosis C) Lactic acidosis D) Hyperkalemia Answer: C.
Contrast can injure the kidneys, causing metformin to accumulate. Metformin is held per
order.
18. Which statement shows correct understanding of levothyroxine teaching? A) "I take it
on an empty stomach 30-60 minutes before breakfast." B) "I take it with breakfast." C) "I
take it at bedtime with milk." D) "I take it with my calcium supplement." Answer: A. Food
and calcium reduce absorption.
19. Which teaching is correct for a client taking lithium? A) Restrict sodium B) Use NSAIDs
for pain C) Keep sodium intake and fluids consistent D) Restrict fluids Answer: C. Low
sodium raises lithium levels. NSAIDs also raise levels. Therapeutic range is 0.6-1.2 mEq/L.
20. Which meal choice shows understanding for a client taking phenelzine (MAOI)? A)
Salami pizza B) Red wine C) Soy sauce D) Grilled chicken with rice Answer: D. Avoid
tyramine-rich foods (aged cheese, cured meats, wine, soy) to prevent hypertensive crisis.
21. Which is the antidote for acetaminophen overdose? A) Naloxone B) Acetylcysteine C)
Flumazenil D) Physostigmine Answer: B. Acetylcysteine protects the liver.
22. A client on a morphine PCA has RR 8 and is difficult to arouse. Which medication does
the nurse anticipate? A) Naloxone B) Flumazenil C) Atropine D) Protamine Answer: A.
Naloxone reverses opioid respiratory depression.
23. A client develops facial flushing during a vancomycin infusion. What should the nurse
do? A) Discontinue permanently B) Slow the infusion rate and notify the provider C)
Increase the rate D) Give vitamin K Answer: B. Vancomycin infusion reaction (red man
syndrome) is rate-related.
24. Which laboratory value is most important to monitor for a client on gentamicin? A)
Hemoglobin B) Platelets C) Serum creatinine D) Glucose Answer: C. Aminoglycosides are
nephrotoxic and ototoxic. Peak and trough levels are also monitored.
Page 3 of 18
