**The Synapse Success Predictor: A Comprehensive
Readiness Examination for the Next Generation NCLEX-
RN (2025 Standards)**
1. A nurse in a mental health unit is assessing a client with major depressive disorder who has been
taking phenelzine (Nardil) for 3 days. The client reports a throbbing headache and palpitations. Which
question is the nurse’s priority?
A. “Have you eaten any aged cheese or smoked meat today?”
B. “Did you take your medication with a full glass of water?”
C. “What time did you last check your blood pressure?”
D. “Are you feeling anxious about being in the hospital?”
💫RATIONALE✔️✔️: Phenelzine is an MAOI; ingestion of tyramine-rich foods (aged cheese, smoked
meats) can cause a hypertensive crisis presenting with headache and palpitations. This is a life-
threatening emergency requiring immediate assessment.
💫ANSWER✔️✔️: A. “Have you eaten any aged cheese or smoked meat today?”
---
2. A charge nurse is assigning staff for a medical-surgical unit. Which client should be assigned to the
licensed practical nurse (LPN)?
A. A client 2 hours post-thyroidectomy reporting stridor.
B. A client with new-onset atrial fibrillation and a heart rate of 140.
C. A client with stable diabetes mellitus requiring a dressing change for a foot ulcer.
D. A client just admitted with suspected meningitis needing droplet precautions initiated.
💫RATIONALE✔️✔️: The LPN can perform stable, predictable tasks such as dressing changes for a
chronic wound. The other clients require RN assessment or complex intervention due to acute changes
or high risk for deterioration.
💫ANSWER✔️✔️: C. A client with stable diabetes mellitus requiring a dressing change for a foot ulcer.
---
,3. A nurse is providing discharge teaching to a client with heart failure. Which statement by the client
indicates an understanding of daily weight monitoring?
A. “I will weigh myself each morning after my first cup of coffee.”
B. “I will notify my provider if I gain more than 2-3 lbs in a day.”
C. “I will weigh myself every evening before I go to bed.”
D. “I will wear different clothes each time I weigh myself for accuracy.”
💫RATIONALE✔️✔️: A weight gain of 2-3 lbs (1-1.4 kg) in 24 hours or 5 lbs in a week indicates fluid
retention and worsening heart failure, requiring provider notification.
💫ANSWER✔️✔️: B. “I will notify my provider if I gain more than 2-3 lbs in a day.”
---
4. A nurse is caring for a client receiving a continuous IV heparin infusion. The client’s aPTT is 120
seconds. The nurse should anticipate which order from the provider?
A. Increase the heparin infusion rate.
B. Administer protamine sulfate and hold the infusion.
C. Administer vitamin K and continue the infusion.
D. Decrease the heparin infusion rate by 50%.
💫RATIONALE✔️✔️: An aPTT of 120 seconds is significantly elevated (therapeutic range is typically 60-80
seconds, 1.5-2.5x control). Protamine sulfate is the antidote for heparin to reverse anticoagulation
immediately.
💫ANSWER✔️✔️: B. Administer protamine sulfate and hold the infusion.
---
5. A nurse in a prenatal clinic is reviewing the chart of a client at 36 weeks gestation. Which finding
requires immediate follow-up?
A. Blood pressure 138/88 mm Hg.
B. Report of mild ankle edema in the evening.
C. Report of intermittent low back pain.
D. Weight gain of 4 lbs (1.8 kg) in one week.
, 💫RATIONALE✔️✔️: A sudden weight gain of >2 lbs (1 kg) per week in the third trimester can indicate
fluid retention from preeclampsia, especially when combined with other signs like elevated blood
pressure.
💫ANSWER✔️✔️: D. Weight gain of 4 lbs (1.8 kg) in one week.
---
6. A nurse is preparing to administer enoxaparin (Lovenox) subcutaneously. Which action is correct?
A. Expel the air bubble from the prefilled syringe before injection.
B. Massage the injection site vigorously after administration.
C. Insert the needle at a 90-degree angle into a skin fold.
D. Aspirate for blood return before depressing the plunger.
💫RATIONALE✔️✔️: Enoxaparin is given deep subcutaneously at a 90-degree angle into a pinched skin
fold. The air bubble should NOT be expelled to prevent medication loss, and aspiration is unnecessary.
💫ANSWER✔️✔️: C. Insert the needle at a 90-degree angle into a skin fold.
---
7. A nurse is assessing a client who sustained a blunt chest trauma. Which finding is the earliest sign of a
tension pneumothorax?
A. Cyanosis.
B. Severe respiratory distress.
C. Tracheal deviation.
D. Anxiety and restlessness.
💫RATIONALE✔️✔️: Anxiety and restlessness are early signs of hypoxia. Tracheal deviation and cyanosis
are late, ominous findings. Early recognition is critical for decompression.
💫ANSWER✔️✔️: D. Anxiety and restlessness.
---
8. A nurse is providing dietary teaching to a client with chronic kidney disease (CKD) not on dialysis.
Which food choice indicates correct understanding?
A. A banana with peanut butter.
, B. A baked potato with sour cream.
C. A grilled chicken breast with steamed rice.
D. A large glass of whole milk.
💫RATIONALE✔️✔️: Grilled chicken with rice is lower in potassium and phosphorus compared to
bananas (high K+), potatoes (high K+), and milk (high phosphorus). Protein may be limited but not
eliminated.
💫ANSWER✔️✔️: C. A grilled chicken breast with steamed rice.
---
9. A nurse is caring for a client who is postoperative day 1 following a total hip arthroplasty. Which
action is most important to prevent dislocation?
A. Place a pillow between the client’s legs when turning.
B. Keep the head of the bed flat at all times.
C. Turn the client onto the operative side for comfort.
D. Encourage the client to cross legs at the ankles.
💫RATIONALE✔️✔️: Keeping the hip in adduction or crossing the legs can cause prosthetic dislocation.
An abduction pillow maintains the hip in a neutral or abducted position.
💫ANSWER✔️✔️: A. Place a pillow between the client’s legs when turning.
---
10. A charge nurse is evaluating a new graduate’s performance of a sterile dressing change. Which
action requires immediate intervention?
A. The new graduate opens the sterile kit away from their body.
B. The new graduate dons sterile gloves, then opens the outer wrapper.
C. The new graduate sets up the sterile field 2 inches from the edge of the table.
D. The new graduate holds hands with sterile gloves above the waist.
💫RATIONALE✔️✔️: Sterile gloves must be put on AFTER opening the outer wrapper and preparing the
field. Opening the wrapper after gloving contaminates the gloves.
💫ANSWER✔️✔️: B. The new graduate dons sterile gloves, then opens the outer wrapper.
Readiness Examination for the Next Generation NCLEX-
RN (2025 Standards)**
1. A nurse in a mental health unit is assessing a client with major depressive disorder who has been
taking phenelzine (Nardil) for 3 days. The client reports a throbbing headache and palpitations. Which
question is the nurse’s priority?
A. “Have you eaten any aged cheese or smoked meat today?”
B. “Did you take your medication with a full glass of water?”
C. “What time did you last check your blood pressure?”
D. “Are you feeling anxious about being in the hospital?”
💫RATIONALE✔️✔️: Phenelzine is an MAOI; ingestion of tyramine-rich foods (aged cheese, smoked
meats) can cause a hypertensive crisis presenting with headache and palpitations. This is a life-
threatening emergency requiring immediate assessment.
💫ANSWER✔️✔️: A. “Have you eaten any aged cheese or smoked meat today?”
---
2. A charge nurse is assigning staff for a medical-surgical unit. Which client should be assigned to the
licensed practical nurse (LPN)?
A. A client 2 hours post-thyroidectomy reporting stridor.
B. A client with new-onset atrial fibrillation and a heart rate of 140.
C. A client with stable diabetes mellitus requiring a dressing change for a foot ulcer.
D. A client just admitted with suspected meningitis needing droplet precautions initiated.
💫RATIONALE✔️✔️: The LPN can perform stable, predictable tasks such as dressing changes for a
chronic wound. The other clients require RN assessment or complex intervention due to acute changes
or high risk for deterioration.
💫ANSWER✔️✔️: C. A client with stable diabetes mellitus requiring a dressing change for a foot ulcer.
---
,3. A nurse is providing discharge teaching to a client with heart failure. Which statement by the client
indicates an understanding of daily weight monitoring?
A. “I will weigh myself each morning after my first cup of coffee.”
B. “I will notify my provider if I gain more than 2-3 lbs in a day.”
C. “I will weigh myself every evening before I go to bed.”
D. “I will wear different clothes each time I weigh myself for accuracy.”
💫RATIONALE✔️✔️: A weight gain of 2-3 lbs (1-1.4 kg) in 24 hours or 5 lbs in a week indicates fluid
retention and worsening heart failure, requiring provider notification.
💫ANSWER✔️✔️: B. “I will notify my provider if I gain more than 2-3 lbs in a day.”
---
4. A nurse is caring for a client receiving a continuous IV heparin infusion. The client’s aPTT is 120
seconds. The nurse should anticipate which order from the provider?
A. Increase the heparin infusion rate.
B. Administer protamine sulfate and hold the infusion.
C. Administer vitamin K and continue the infusion.
D. Decrease the heparin infusion rate by 50%.
💫RATIONALE✔️✔️: An aPTT of 120 seconds is significantly elevated (therapeutic range is typically 60-80
seconds, 1.5-2.5x control). Protamine sulfate is the antidote for heparin to reverse anticoagulation
immediately.
💫ANSWER✔️✔️: B. Administer protamine sulfate and hold the infusion.
---
5. A nurse in a prenatal clinic is reviewing the chart of a client at 36 weeks gestation. Which finding
requires immediate follow-up?
A. Blood pressure 138/88 mm Hg.
B. Report of mild ankle edema in the evening.
C. Report of intermittent low back pain.
D. Weight gain of 4 lbs (1.8 kg) in one week.
, 💫RATIONALE✔️✔️: A sudden weight gain of >2 lbs (1 kg) per week in the third trimester can indicate
fluid retention from preeclampsia, especially when combined with other signs like elevated blood
pressure.
💫ANSWER✔️✔️: D. Weight gain of 4 lbs (1.8 kg) in one week.
---
6. A nurse is preparing to administer enoxaparin (Lovenox) subcutaneously. Which action is correct?
A. Expel the air bubble from the prefilled syringe before injection.
B. Massage the injection site vigorously after administration.
C. Insert the needle at a 90-degree angle into a skin fold.
D. Aspirate for blood return before depressing the plunger.
💫RATIONALE✔️✔️: Enoxaparin is given deep subcutaneously at a 90-degree angle into a pinched skin
fold. The air bubble should NOT be expelled to prevent medication loss, and aspiration is unnecessary.
💫ANSWER✔️✔️: C. Insert the needle at a 90-degree angle into a skin fold.
---
7. A nurse is assessing a client who sustained a blunt chest trauma. Which finding is the earliest sign of a
tension pneumothorax?
A. Cyanosis.
B. Severe respiratory distress.
C. Tracheal deviation.
D. Anxiety and restlessness.
💫RATIONALE✔️✔️: Anxiety and restlessness are early signs of hypoxia. Tracheal deviation and cyanosis
are late, ominous findings. Early recognition is critical for decompression.
💫ANSWER✔️✔️: D. Anxiety and restlessness.
---
8. A nurse is providing dietary teaching to a client with chronic kidney disease (CKD) not on dialysis.
Which food choice indicates correct understanding?
A. A banana with peanut butter.
, B. A baked potato with sour cream.
C. A grilled chicken breast with steamed rice.
D. A large glass of whole milk.
💫RATIONALE✔️✔️: Grilled chicken with rice is lower in potassium and phosphorus compared to
bananas (high K+), potatoes (high K+), and milk (high phosphorus). Protein may be limited but not
eliminated.
💫ANSWER✔️✔️: C. A grilled chicken breast with steamed rice.
---
9. A nurse is caring for a client who is postoperative day 1 following a total hip arthroplasty. Which
action is most important to prevent dislocation?
A. Place a pillow between the client’s legs when turning.
B. Keep the head of the bed flat at all times.
C. Turn the client onto the operative side for comfort.
D. Encourage the client to cross legs at the ankles.
💫RATIONALE✔️✔️: Keeping the hip in adduction or crossing the legs can cause prosthetic dislocation.
An abduction pillow maintains the hip in a neutral or abducted position.
💫ANSWER✔️✔️: A. Place a pillow between the client’s legs when turning.
---
10. A charge nurse is evaluating a new graduate’s performance of a sterile dressing change. Which
action requires immediate intervention?
A. The new graduate opens the sterile kit away from their body.
B. The new graduate dons sterile gloves, then opens the outer wrapper.
C. The new graduate sets up the sterile field 2 inches from the edge of the table.
D. The new graduate holds hands with sterile gloves above the waist.
💫RATIONALE✔️✔️: Sterile gloves must be put on AFTER opening the outer wrapper and preparing the
field. Opening the wrapper after gloving contaminates the gloves.
💫ANSWER✔️✔️: B. The new graduate dons sterile gloves, then opens the outer wrapper.
