NURSING.COM NCLEX-RN
COMPREHENSIVE PRACTICE EXAM
Instructions: Choose the best answer for each question. After submitting your answers,
review the detailed rationales provided.
Question 1
The nurse is caring for a group of clients on a medical-surgical unit. Which client should
the nurse assess FIRST?
1. A 45-year-old with diabetes mellitus who has a blood glucose level of 95 mg/dL and is
requesting breakfast.
2. A 60-year-old with pneumonia who has a pulse oximetry reading of 91% on room air.
3. A 70-year-old with heart failure who has new-onset confusion and respiratory rate of 28
breaths/min.
4. A 55-year-old with a fractured femur who has mild discomfort at the surgical site.
Answer: 3
Rationale:
Correct: The client with new-onset confusion and tachypnea is exhibiting signs of
potential hypoxia and decompensated heart failure. Confusion is a critical indicator of
inadequate cerebral oxygenation. This client is the most unstable and requires
immediate assessment and intervention. This is the only client with a change in level of
consciousness and respiratory distress, making them the priority.
Incorrect 1: A blood glucose of 95 mg/dL is within normal range. This is a stable client
with a routine request.
Incorrect 2: An O2 saturation of 91% is low and requires intervention, but it is not as
acute as a client with new-onset confusion (a sign of end-organ hypoxia). The nurse
would address this client second, likely by initiating supplemental oxygen.
Incorrect 4: Mild post-operative discomfort is expected and is the lowest priority on this
list.
, Question 2
A client is prescribed 500 mg of oral acetaminophen. The medication bottle lists the
concentration as 160 mg/5 mL. How many mL should the nurse administer? (Round to
the nearest whole number).
1. 10 mL
2. 12 mL
3. 15 mL
4. 16 mL
Answer: 4
Rationale:
Correct: To solve this dosage calculation: (Desired dose / Dose on hand) x Volume =
(500 mg / 160 mg) x 5 mL = (3.125) x 5 mL = 15.625 mL. Rounding to the nearest whole
number gives you 16 mL.
Incorrect 1 & 2: These numbers result from an incorrect calculation, such as forgetting
to multiply by the volume or using the wrong ratio.
Incorrect 3: This is the answer before rounding, but the question specifically asks to
round to the nearest whole number. 15.625 rounds up to 16.
Question 3
The nurse is providing discharge teaching to a client who is starting warfarin
(Coumadin). Which statement by the client indicates a need for further teaching?
1. "I will use an electric razor when shaving."
2. "I need to eat a consistent amount of green leafy vegetables each day."
3. "I will take aspirin if I get a headache because it works better with my blood thinner."
4. "I will notify my dentist about this medication before any procedures."
Answer: 3
Rationale:
, Correct: This statement indicates a need for further teaching. Aspirin is an antiplatelet
agent and, when combined with warfarin (an anticoagulant), it significantly increases the
risk of bleeding. The client should avoid aspirin and other NSAIDs unless specifically
prescribed by the provider who knows they are on warfarin.
Incorrect 1: Using an electric razor is a correct safety precaution to prevent cuts and
bleeding.
Incorrect 2: Vitamin K is the antidote to warfarin and is found in green leafy vegetables.
Eating a consistent amount is crucial to maintain stable therapeutic INR levels.
Incorrect 4: Informing all healthcare providers, including the dentist, is essential to
manage bleeding risks during invasive procedures.
Question 4
A client is 2 hours post-operative following a transurethral resection of the prostate
(TURP). The nurse notes that the client's indwelling urinary catheter is draining dark red
urine with multiple large clots. What is the nurse's priority action?
1. Increase the flow rate of the continuous bladder irrigation (CBI).
2. Notify the healthcare provider immediately.
3. Manually irrigate the catheter as prescribed.
4. Document the finding as expected.
Answer: 3
Rationale:
Correct: Dark red urine with clots in the immediate post-TURP period can indicate
catheter obstruction. The priority action is to ensure the catheter remains patent to
prevent bladder spasms and further clot formation. The nurse should first attempt to
manually irrigate the catheter per protocol or as prescribed to clear any obstruction.
Incorrect 1: Increasing the CBI flow rate may help with bloody urine, but if the catheter
is already clogged with clots, the fluid will not be able to drain, potentially leading to
bladder distension. Patency must be established first.
Incorrect 2: The provider should be notified if irrigation is unsuccessful or if bleeding is
excessive, but the first action is to attempt to resolve the obstruction.
Incorrect 4: While some bleeding is expected, dark red urine with large clots is not a
normal finding and requires intervention.
, Question 5
A nurse in the emergency department is assessing a client who reports severe chest pain
unrelieved by rest. Which of the following statements by the client would be most
indicative of an acute myocardial infarction (AMI)?
1. "The pain is a sharp, stabbing sensation that gets worse when I take a deep breath."
2. "It feels like heartburn after I eat a large meal."
3. "The pain is a heavy, squeezing pressure that radiates to my jaw."
4. "The pain is in my left shoulder and goes away when I lift my arm."
Answer: 3
Rationale:
Correct: Classic cardiac chest pain (angina or MI) is often described as pressure,
squeezing, heaviness, or tightness. Radiation to the jaw, neck, back, or left arm is a
common associated symptom.
Incorrect 1: Sharp, stabbing pain that is pleuritic (worse with deep breath) is more
indicative of a pulmonary issue like pericarditis or a pulmonary embolism.
Incorrect 2: While some patients describe MI pain as indigestion, this description alone
is less specific than the classic crushing, radiating pain. It also lacks the severity and
unrelenting nature of an MI.
Incorrect 4: Pain localized to the shoulder that resolves with movement is more
characteristic of a musculoskeletal issue.
Question 6
The nurse is assessing a client with hyperthyroidism. Which of the following findings
requires immediate intervention?
1. Weight loss of 5 lbs over the last month.
2. Heart rate of 110 beats/min and blood pressure of 130/78 mm Hg.
3. Client reports feeling nervous and having difficulty sleeping.
4. Temperature of 101.8°F (38.8°C) and new-onset atrial fibrillation.
COMPREHENSIVE PRACTICE EXAM
Instructions: Choose the best answer for each question. After submitting your answers,
review the detailed rationales provided.
Question 1
The nurse is caring for a group of clients on a medical-surgical unit. Which client should
the nurse assess FIRST?
1. A 45-year-old with diabetes mellitus who has a blood glucose level of 95 mg/dL and is
requesting breakfast.
2. A 60-year-old with pneumonia who has a pulse oximetry reading of 91% on room air.
3. A 70-year-old with heart failure who has new-onset confusion and respiratory rate of 28
breaths/min.
4. A 55-year-old with a fractured femur who has mild discomfort at the surgical site.
Answer: 3
Rationale:
Correct: The client with new-onset confusion and tachypnea is exhibiting signs of
potential hypoxia and decompensated heart failure. Confusion is a critical indicator of
inadequate cerebral oxygenation. This client is the most unstable and requires
immediate assessment and intervention. This is the only client with a change in level of
consciousness and respiratory distress, making them the priority.
Incorrect 1: A blood glucose of 95 mg/dL is within normal range. This is a stable client
with a routine request.
Incorrect 2: An O2 saturation of 91% is low and requires intervention, but it is not as
acute as a client with new-onset confusion (a sign of end-organ hypoxia). The nurse
would address this client second, likely by initiating supplemental oxygen.
Incorrect 4: Mild post-operative discomfort is expected and is the lowest priority on this
list.
, Question 2
A client is prescribed 500 mg of oral acetaminophen. The medication bottle lists the
concentration as 160 mg/5 mL. How many mL should the nurse administer? (Round to
the nearest whole number).
1. 10 mL
2. 12 mL
3. 15 mL
4. 16 mL
Answer: 4
Rationale:
Correct: To solve this dosage calculation: (Desired dose / Dose on hand) x Volume =
(500 mg / 160 mg) x 5 mL = (3.125) x 5 mL = 15.625 mL. Rounding to the nearest whole
number gives you 16 mL.
Incorrect 1 & 2: These numbers result from an incorrect calculation, such as forgetting
to multiply by the volume or using the wrong ratio.
Incorrect 3: This is the answer before rounding, but the question specifically asks to
round to the nearest whole number. 15.625 rounds up to 16.
Question 3
The nurse is providing discharge teaching to a client who is starting warfarin
(Coumadin). Which statement by the client indicates a need for further teaching?
1. "I will use an electric razor when shaving."
2. "I need to eat a consistent amount of green leafy vegetables each day."
3. "I will take aspirin if I get a headache because it works better with my blood thinner."
4. "I will notify my dentist about this medication before any procedures."
Answer: 3
Rationale:
, Correct: This statement indicates a need for further teaching. Aspirin is an antiplatelet
agent and, when combined with warfarin (an anticoagulant), it significantly increases the
risk of bleeding. The client should avoid aspirin and other NSAIDs unless specifically
prescribed by the provider who knows they are on warfarin.
Incorrect 1: Using an electric razor is a correct safety precaution to prevent cuts and
bleeding.
Incorrect 2: Vitamin K is the antidote to warfarin and is found in green leafy vegetables.
Eating a consistent amount is crucial to maintain stable therapeutic INR levels.
Incorrect 4: Informing all healthcare providers, including the dentist, is essential to
manage bleeding risks during invasive procedures.
Question 4
A client is 2 hours post-operative following a transurethral resection of the prostate
(TURP). The nurse notes that the client's indwelling urinary catheter is draining dark red
urine with multiple large clots. What is the nurse's priority action?
1. Increase the flow rate of the continuous bladder irrigation (CBI).
2. Notify the healthcare provider immediately.
3. Manually irrigate the catheter as prescribed.
4. Document the finding as expected.
Answer: 3
Rationale:
Correct: Dark red urine with clots in the immediate post-TURP period can indicate
catheter obstruction. The priority action is to ensure the catheter remains patent to
prevent bladder spasms and further clot formation. The nurse should first attempt to
manually irrigate the catheter per protocol or as prescribed to clear any obstruction.
Incorrect 1: Increasing the CBI flow rate may help with bloody urine, but if the catheter
is already clogged with clots, the fluid will not be able to drain, potentially leading to
bladder distension. Patency must be established first.
Incorrect 2: The provider should be notified if irrigation is unsuccessful or if bleeding is
excessive, but the first action is to attempt to resolve the obstruction.
Incorrect 4: While some bleeding is expected, dark red urine with large clots is not a
normal finding and requires intervention.
, Question 5
A nurse in the emergency department is assessing a client who reports severe chest pain
unrelieved by rest. Which of the following statements by the client would be most
indicative of an acute myocardial infarction (AMI)?
1. "The pain is a sharp, stabbing sensation that gets worse when I take a deep breath."
2. "It feels like heartburn after I eat a large meal."
3. "The pain is a heavy, squeezing pressure that radiates to my jaw."
4. "The pain is in my left shoulder and goes away when I lift my arm."
Answer: 3
Rationale:
Correct: Classic cardiac chest pain (angina or MI) is often described as pressure,
squeezing, heaviness, or tightness. Radiation to the jaw, neck, back, or left arm is a
common associated symptom.
Incorrect 1: Sharp, stabbing pain that is pleuritic (worse with deep breath) is more
indicative of a pulmonary issue like pericarditis or a pulmonary embolism.
Incorrect 2: While some patients describe MI pain as indigestion, this description alone
is less specific than the classic crushing, radiating pain. It also lacks the severity and
unrelenting nature of an MI.
Incorrect 4: Pain localized to the shoulder that resolves with movement is more
characteristic of a musculoskeletal issue.
Question 6
The nurse is assessing a client with hyperthyroidism. Which of the following findings
requires immediate intervention?
1. Weight loss of 5 lbs over the last month.
2. Heart rate of 110 beats/min and blood pressure of 130/78 mm Hg.
3. Client reports feeling nervous and having difficulty sleeping.
4. Temperature of 101.8°F (38.8°C) and new-onset atrial fibrillation.
