COMPREHENSIVE NURSING
EXAM REVIEW
NCLEX-RN READINESS & INSTITUTIONAL
FINAL ASSESSMENT | 2026/2027
75 Questions and Correct Answers with Rationales
Comprehensive Competency Assessment | Pre-Licensure BSN/ADN Program
Already Graded A+ | 100% Verified
IMPORTANT CLARIFICATION: This document is a study review resource prepared for educational purposes
only. It is not an official NCLEX-RN examination or affiliated with the NCSBN or any nursing regulatory body.
Questions are designed to reinforce nursing knowledge and clinical judgment skills aligned with current NCLEX-
RN test plan frameworks.
Introduction
This Comprehensive Nursing Exam Review contains 75 carefully crafted, NCLEX-style questions
covering all NCSBN NCLEX-RN Client Needs domains. The review is designed to assess your
readiness for the NCLEX-RN licensure examination and institutional final assessments within pre-
licensure BSN and ADN nursing programs. Each question is accompanied by a detailed rationale
explaining the correct answer and why the distractors are incorrect. The questions integrate the
Clinical Judgment Measurement Model (CJMM) framework — Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Actions, and Evaluate Outcomes — and include
Next Generation NCLEX (NGN) item-type formats such as bowtie analyses, trend items, and
priority-ranking matrices. Domains covered include Safe and Effective Care Environment
(Management of Care and Safety/Infection Control), Health Promotion and Maintenance,
Psychosocial Integrity, Physiological Integrity (Basic Care and Comfort, Pharmacological and
Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation), and Clinical
Judgment/NGN Integration.
Answer Format:
,Each question includes four answer options (A, B, C, D). The correct answer is highlighted in bold
cyan with a green background. A detailed rationale follows each question explaining the clinical
reasoning behind the correct response and why each distractor is inappropriate. An answer key
table is provided at the end of the document for quick reference.
Domain 1: Safe and Effective Care Environment — Management of
Care
1. A charge nurse on a medical-surgical unit is making shift assignments. Which task is most
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Administering oral medications to stable patients
B. Performing initial admission assessments on new patients
C. Assisting a postoperative patient with ambulation using a walker
D. Evaluating the effectiveness of a patient's pain management plan
Rationale: Assisting with ambulation using a walker is within the UAP's scope of practice because it involves
routine, repetitive tasks that do not require nursing judgment. The Five Rights of Delegation — Right Task, Right
Circumstance, Right Person, Right Direction, and Right Supervision — guide this decision. Administering
medications (A) and performing admission assessments (B) require RN-level education and licensure. Evaluating
the effectiveness of interventions (D) is a nursing judgment activity that cannot be delegated.
2. A nurse receives the morning report on four patients. Which patient should the nurse
assess first?
A. A patient with type 2 diabetes requesting a snack between meals
B. A patient who is 1 day post-appendectomy with stable vital signs
C. A patient with chronic obstructive pulmonary disease (COPD) who has oxygen
saturation of 88%
D. A patient with a fractured femur scheduled for physical therapy at 1000
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework and Maslow's hierarchy of
physiological needs, the patient with COPD and an oxygen saturation of 88% requires immediate assessment.
Normal SpO2 is 95-100%, and 88% indicates significant hypoxemia requiring prompt intervention. The other
patients have needs that are less urgent — a snack can wait (A), a stable postoperative patient can be assessed
after the critical patient (B), and physical therapy can be rescheduled (D).
3. A nurse is calling the healthcare provider about a patient who has developed new-onset
atrial fibrillation with a heart rate of 150 bpm. Which communication format should the
nurse use?
A. Read the patient's entire medical history to the provider
B. Use SBAR: Situation, Background, Assessment, Recommendation
C. Text the provider a brief summary of the vital signs
D. Document the findings in the chart and wait for rounds
Rationale: SBAR (Situation, Background, Assessment, Recommendation) is the standard communication tool
recommended by The Joint Commission and the World Health Organization for handoff and escalation
,communications. It provides a concise, structured format that reduces communication errors. Reading the entire
history (A) is inefficient and may cause the provider to miss critical information. Texting (C) is not appropriate
for urgent clinical situations. Waiting for rounds (D) delays necessary treatment for a patient with a
dangerously elevated heart rate.
4. A nurse communicates a concern about a patient's deteriorating condition to the primary
healthcare provider, who dismisses the concern. The patient continues to decline. What is
the nurse's next appropriate action?
A. Document the provider's response and take no further action
B. Follow the chain of command and notify the charge nurse or supervisor
C. Ask another nurse to call the provider a second time
D. Transfer the patient to another unit for observation
Rationale: When a healthcare provider dismisses a legitimate patient safety concern and the patient continues
to decline, the nurse must follow the chain of command to escalate the concern to the charge nurse, nursing
supervisor, or next-level provider. This is a professional and legal obligation under the nurse practice act.
Documenting only (A) fails to protect the patient. Asking another nurse to call (C) circumvents proper channels.
Transferring without authorization (D) is inappropriate. The chain of command exists specifically to protect
patients when communication barriers arise.
5. A nurse is planning discharge teaching for a patient with heart failure. Which is the most
important instruction to include?
A. Weigh yourself weekly and report gains of more than 5 pounds
B. Weigh yourself daily and report a weight gain of more than 2 pounds in one day or 3-
5 pounds in one week
C. Restrict fluid intake to 8 ounces per day
D. Exercise vigorously for at least 60 minutes daily
Rationale: Daily weight monitoring is the gold standard for monitoring fluid retention in heart failure patients.
A weight gain of more than 2 pounds in one day or 3-5 pounds in one week indicates fluid retention requiring
medical intervention. Weekly weighing (A) is insufficient because it delays detection of fluid overload. Restricting
fluids to 8 ounces per day (C) is too extreme and can cause dehydration. Vigorous exercise (D) is contraindicated
for heart failure patients without provider clearance and cardiac rehabilitation guidance.
6. A patient scheduled for a colonoscopy states, "I don't really understand what they're going
to do." What is the nurse's best action?
A. Explain the procedure in detail using medical terminology
B. Notify the healthcare provider performing the procedure that the patient needs
further explanation
C. Have the patient sign the consent form and proceed with the procedure
D. Tell the patient that the doctor will explain it after the procedure begins
Rationale: Informed consent requires that the patient understands the procedure, risks, benefits, and
alternatives. The person performing the procedure is responsible for obtaining informed consent. The nurse's
role is to witness the signing and ensure the patient appears to understand. If the patient expresses lack of
understanding, the nurse must notify the provider. Explaining the procedure in detail (A) exceeds the nurse's
, scope — nurses can reinforce teaching but should not provide the primary consent explanation. Proceeding
without understanding (C) violates patient rights. Delaying explanation (D) is unethical and illegal.
7. A patient with terminal cancer has a Do-Not-Resuscitate (DNR) order. The patient's family
demands that "everything possible" be done. What is the nurse's best response?
A. Honor the family's request and ignore the DNR order
B. Explain that the DNR reflects the patient's wishes and facilitate a conversation with
the healthcare team and family
C. Tell the family they have no say in the patient's care
D. Cancel the DNR order per the family's request
Rationale: A DNR order is a legal document that reflects the competent patient's autonomous wishes regarding
resuscitation. The nurse must advocate for the patient's expressed wishes while facilitating a therapeutic
conversation with the family and healthcare team. Ignoring the DNR (A) or canceling it (D) violates the patient's
autonomy and is legally indefensible. Telling the family they have no say (C) is confrontational and non-
therapeutic. The nurse should serve as a mediator, providing emotional support and ensuring the patient's voice
is heard.
Domain 1: Safe and Effective Care Environment — Safety/Infection
Control
8. Which action by a nurse demonstrates compliance with standard precautions?
A. Wearing gloves only when touching blood or body fluids
B. Using hand sanitizer instead of washing hands after removing gloves
C. Wearing gloves whenever anticipating contact with blood, body fluids, secretions,
excretions, mucous membranes, and non-intact skin
D. Removing gloves and immediately answering a phone without hand hygiene
Rationale: Standard precautions apply to all patients and involve wearing gloves whenever there is anticipated
contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. Gloves are
required for more than just blood and body fluids (A is incorrect). Hand hygiene with soap and water or alcohol-
based sanitizer must be performed after glove removal — sanitizer alone is not sufficient in all situations (B).
Failing to perform hand hygiene after glove removal (D) is a critical infection control breach that contributes to
healthcare-associated infections (HAIs).
9. A patient is admitted with suspected tuberculosis (TB). Which type of transmission-based
precautions is required?
A. Contact precautions with a private room
B. Droplet precautions with a surgical mask within 3 feet
C. Airborne precautions with a negative-pressure room and N95 respirator
D. Standard precautions only, since TB is not transmissible in healthcare settings
Rationale: Tuberculosis is transmitted via airborne droplet nuclei that remain suspended in the air and can
travel long distances. Airborne precautions require a negative-pressure airborne infection isolation room (AIIR)
and the use of an N95 respirator or powered air-purifying respirator (PAPR) by healthcare personnel. Contact
precautions (A) are for diseases spread by direct or indirect contact. Droplet precautions (B) are for large
EXAM REVIEW
NCLEX-RN READINESS & INSTITUTIONAL
FINAL ASSESSMENT | 2026/2027
75 Questions and Correct Answers with Rationales
Comprehensive Competency Assessment | Pre-Licensure BSN/ADN Program
Already Graded A+ | 100% Verified
IMPORTANT CLARIFICATION: This document is a study review resource prepared for educational purposes
only. It is not an official NCLEX-RN examination or affiliated with the NCSBN or any nursing regulatory body.
Questions are designed to reinforce nursing knowledge and clinical judgment skills aligned with current NCLEX-
RN test plan frameworks.
Introduction
This Comprehensive Nursing Exam Review contains 75 carefully crafted, NCLEX-style questions
covering all NCSBN NCLEX-RN Client Needs domains. The review is designed to assess your
readiness for the NCLEX-RN licensure examination and institutional final assessments within pre-
licensure BSN and ADN nursing programs. Each question is accompanied by a detailed rationale
explaining the correct answer and why the distractors are incorrect. The questions integrate the
Clinical Judgment Measurement Model (CJMM) framework — Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Actions, and Evaluate Outcomes — and include
Next Generation NCLEX (NGN) item-type formats such as bowtie analyses, trend items, and
priority-ranking matrices. Domains covered include Safe and Effective Care Environment
(Management of Care and Safety/Infection Control), Health Promotion and Maintenance,
Psychosocial Integrity, Physiological Integrity (Basic Care and Comfort, Pharmacological and
Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation), and Clinical
Judgment/NGN Integration.
Answer Format:
,Each question includes four answer options (A, B, C, D). The correct answer is highlighted in bold
cyan with a green background. A detailed rationale follows each question explaining the clinical
reasoning behind the correct response and why each distractor is inappropriate. An answer key
table is provided at the end of the document for quick reference.
Domain 1: Safe and Effective Care Environment — Management of
Care
1. A charge nurse on a medical-surgical unit is making shift assignments. Which task is most
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Administering oral medications to stable patients
B. Performing initial admission assessments on new patients
C. Assisting a postoperative patient with ambulation using a walker
D. Evaluating the effectiveness of a patient's pain management plan
Rationale: Assisting with ambulation using a walker is within the UAP's scope of practice because it involves
routine, repetitive tasks that do not require nursing judgment. The Five Rights of Delegation — Right Task, Right
Circumstance, Right Person, Right Direction, and Right Supervision — guide this decision. Administering
medications (A) and performing admission assessments (B) require RN-level education and licensure. Evaluating
the effectiveness of interventions (D) is a nursing judgment activity that cannot be delegated.
2. A nurse receives the morning report on four patients. Which patient should the nurse
assess first?
A. A patient with type 2 diabetes requesting a snack between meals
B. A patient who is 1 day post-appendectomy with stable vital signs
C. A patient with chronic obstructive pulmonary disease (COPD) who has oxygen
saturation of 88%
D. A patient with a fractured femur scheduled for physical therapy at 1000
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework and Maslow's hierarchy of
physiological needs, the patient with COPD and an oxygen saturation of 88% requires immediate assessment.
Normal SpO2 is 95-100%, and 88% indicates significant hypoxemia requiring prompt intervention. The other
patients have needs that are less urgent — a snack can wait (A), a stable postoperative patient can be assessed
after the critical patient (B), and physical therapy can be rescheduled (D).
3. A nurse is calling the healthcare provider about a patient who has developed new-onset
atrial fibrillation with a heart rate of 150 bpm. Which communication format should the
nurse use?
A. Read the patient's entire medical history to the provider
B. Use SBAR: Situation, Background, Assessment, Recommendation
C. Text the provider a brief summary of the vital signs
D. Document the findings in the chart and wait for rounds
Rationale: SBAR (Situation, Background, Assessment, Recommendation) is the standard communication tool
recommended by The Joint Commission and the World Health Organization for handoff and escalation
,communications. It provides a concise, structured format that reduces communication errors. Reading the entire
history (A) is inefficient and may cause the provider to miss critical information. Texting (C) is not appropriate
for urgent clinical situations. Waiting for rounds (D) delays necessary treatment for a patient with a
dangerously elevated heart rate.
4. A nurse communicates a concern about a patient's deteriorating condition to the primary
healthcare provider, who dismisses the concern. The patient continues to decline. What is
the nurse's next appropriate action?
A. Document the provider's response and take no further action
B. Follow the chain of command and notify the charge nurse or supervisor
C. Ask another nurse to call the provider a second time
D. Transfer the patient to another unit for observation
Rationale: When a healthcare provider dismisses a legitimate patient safety concern and the patient continues
to decline, the nurse must follow the chain of command to escalate the concern to the charge nurse, nursing
supervisor, or next-level provider. This is a professional and legal obligation under the nurse practice act.
Documenting only (A) fails to protect the patient. Asking another nurse to call (C) circumvents proper channels.
Transferring without authorization (D) is inappropriate. The chain of command exists specifically to protect
patients when communication barriers arise.
5. A nurse is planning discharge teaching for a patient with heart failure. Which is the most
important instruction to include?
A. Weigh yourself weekly and report gains of more than 5 pounds
B. Weigh yourself daily and report a weight gain of more than 2 pounds in one day or 3-
5 pounds in one week
C. Restrict fluid intake to 8 ounces per day
D. Exercise vigorously for at least 60 minutes daily
Rationale: Daily weight monitoring is the gold standard for monitoring fluid retention in heart failure patients.
A weight gain of more than 2 pounds in one day or 3-5 pounds in one week indicates fluid retention requiring
medical intervention. Weekly weighing (A) is insufficient because it delays detection of fluid overload. Restricting
fluids to 8 ounces per day (C) is too extreme and can cause dehydration. Vigorous exercise (D) is contraindicated
for heart failure patients without provider clearance and cardiac rehabilitation guidance.
6. A patient scheduled for a colonoscopy states, "I don't really understand what they're going
to do." What is the nurse's best action?
A. Explain the procedure in detail using medical terminology
B. Notify the healthcare provider performing the procedure that the patient needs
further explanation
C. Have the patient sign the consent form and proceed with the procedure
D. Tell the patient that the doctor will explain it after the procedure begins
Rationale: Informed consent requires that the patient understands the procedure, risks, benefits, and
alternatives. The person performing the procedure is responsible for obtaining informed consent. The nurse's
role is to witness the signing and ensure the patient appears to understand. If the patient expresses lack of
understanding, the nurse must notify the provider. Explaining the procedure in detail (A) exceeds the nurse's
, scope — nurses can reinforce teaching but should not provide the primary consent explanation. Proceeding
without understanding (C) violates patient rights. Delaying explanation (D) is unethical and illegal.
7. A patient with terminal cancer has a Do-Not-Resuscitate (DNR) order. The patient's family
demands that "everything possible" be done. What is the nurse's best response?
A. Honor the family's request and ignore the DNR order
B. Explain that the DNR reflects the patient's wishes and facilitate a conversation with
the healthcare team and family
C. Tell the family they have no say in the patient's care
D. Cancel the DNR order per the family's request
Rationale: A DNR order is a legal document that reflects the competent patient's autonomous wishes regarding
resuscitation. The nurse must advocate for the patient's expressed wishes while facilitating a therapeutic
conversation with the family and healthcare team. Ignoring the DNR (A) or canceling it (D) violates the patient's
autonomy and is legally indefensible. Telling the family they have no say (C) is confrontational and non-
therapeutic. The nurse should serve as a mediator, providing emotional support and ensuring the patient's voice
is heard.
Domain 1: Safe and Effective Care Environment — Safety/Infection
Control
8. Which action by a nurse demonstrates compliance with standard precautions?
A. Wearing gloves only when touching blood or body fluids
B. Using hand sanitizer instead of washing hands after removing gloves
C. Wearing gloves whenever anticipating contact with blood, body fluids, secretions,
excretions, mucous membranes, and non-intact skin
D. Removing gloves and immediately answering a phone without hand hygiene
Rationale: Standard precautions apply to all patients and involve wearing gloves whenever there is anticipated
contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. Gloves are
required for more than just blood and body fluids (A is incorrect). Hand hygiene with soap and water or alcohol-
based sanitizer must be performed after glove removal — sanitizer alone is not sufficient in all situations (B).
Failing to perform hand hygiene after glove removal (D) is a critical infection control breach that contributes to
healthcare-associated infections (HAIs).
9. A patient is admitted with suspected tuberculosis (TB). Which type of transmission-based
precautions is required?
A. Contact precautions with a private room
B. Droplet precautions with a surgical mask within 3 feet
C. Airborne precautions with a negative-pressure room and N95 respirator
D. Standard precautions only, since TB is not transmissible in healthcare settings
Rationale: Tuberculosis is transmitted via airborne droplet nuclei that remain suspended in the air and can
travel long distances. Airborne precautions require a negative-pressure airborne infection isolation room (AIIR)
and the use of an N95 respirator or powered air-purifying respirator (PAPR) by healthcare personnel. Contact
precautions (A) are for diseases spread by direct or indirect contact. Droplet precautions (B) are for large
