Ace your nursing exams with this comprehensive, NGN-style practice
test covering med-surg, pharmacology, leadership, and fundamentals,
designed to mirror the rigor of ATI, HESI, and NCLEX-RN for
guaranteed success.
2025/2026 | Comprehensive Nursing Exam Prep | Ultimate NGN
Questions & Rationales | Pass on First Attempt – Chamberlain,
Walden, & Grand Canyon Aligned
---
1. A client with chronic obstructive pulmonary disease (COPD) is prescribed a bronchodilator via a
metered-dose inhaler (MDI). Which instruction is most important for the nurse to include in the
teaching?
A. Inhale deeply and quickly while pressing the canister.
B. Wait 5 minutes between puffs of the same medication.
C. Rinse the mouth with water after each use to prevent thrush.
D. Use a spacer device to improve medication delivery to the lungs.
💫ANSWER✔️✔️: D
💫RATIONALE✔️✔️: Using a spacer device with an MDI is crucial for patients with COPD as it allows more
medication to reach the lower airways and reduces oropharyngeal deposition. While rinsing the mouth
(C) is important for corticosteroid inhalers, this is the most critical for efficacy. Deep, slow inhalation (A)
is recommended, not quick, and waiting 1 minute (B) is standard, not 5. This NCLEX prep strategy
emphasizes optimizing drug delivery for respiratory compromise.
2. A nurse is preparing to administer a blood transfusion to a client. The client reports a previous history
of a febrile reaction to transfusions. Which of the following actions should the nurse take?
A. Premedicate the client with an antihistamine as prescribed.
B. Administer the blood product as prescribed, monitoring vital signs closely.
C. Premedicate the client with an antipyretic as prescribed.
D. Obtain a signed informed consent for the blood transfusion.
,💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Premedicating with an antipyretic (e.g., acetaminophen) is an effective measure to
prevent or reduce febrile, non-hemolytic transfusion reactions. Antihistamines (A) are more effective for
allergic reactions. Simply administering without intervention (B) is not proactive. Informed consent (D) is
legally required but does not address the specific history of febrile reactions. This is a key HESI RN
Comprehensive Exit Exam topic for safe blood administration.
3. A client with a diagnosis of major depressive disorder is prescribed phenelzine (Nardil). The nurse's
teaching should emphasize avoiding which of the following foods?
A. Broccoli, spinach, and kale.
B. Aged cheese, smoked meats, and tap beer.
C. Fresh fruits and vegetables.
D. Whole grains and cereals.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Phenelzine is a monoamine oxidase inhibitor (MAOI), which requires a strict
tyramine-restricted diet. Aged cheeses, smoked/cured meats, and fermented alcoholic beverages are
high in tyramine and can precipitate a life-threatening hypertensive crisis. This is a critical point in any
ATI Pharmacology Proctored Exam review.
4. The nurse is caring for a client with heart failure who is receiving furosemide (Lasix). Which of the
following assessment findings indicates the medication is having the desired effect?
A. Increased heart rate.
B. Decreased peripheral edema.
C. Increased jugular venous distention.
D. Adventitious breath sounds in the lung bases.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Furosemide is a loop diuretic used to reduce fluid volume overload. A decrease in
peripheral edema is a positive indicator of reduced fluid volume. An increased heart rate (A) could be a
sign of hypovolemia or electrolyte imbalance, not a desired effect. Jugular venous distention (C) and
adventitious lung sounds (D) are signs of worsening heart failure.
5. An adolescent client is admitted with a traumatic amputation of the lower leg. Which statement by
the parent indicates an understanding of the care needed after the initial surgery?
,A. "We will keep the room lights dim to help him relax."
B. "We should look at the area where the amputation was done to see how it is healing."
C. "We must avoid discussing the amputation as it will only make him more upset."
D. "We will encourage him to stay in bed and not move the stump to prevent pain."
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: It is important for the family to be involved in care and to look at the site with the
healthcare team to promote acceptance and monitor healing. Keeping the room dim (A) is not specific
to this condition. Encouraging discussion (C) is healthier than avoidance. Promoting mobility (D) is
encouraged unless contraindicated.
6. The nurse is preparing a continuous insulin infusion for a client in diabetic ketoacidosis (DKA). The
prescription reads: 100 units of regular insulin in 100 mL of 0.9% NaCl. The infusion rate is to be 10
mL/hr. How many units of insulin per hour is the client receiving?
A. 1 unit/hr
B. 5 units/hr
C. 10 units/hr
D. 100 units/hr
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: The concentration is 1 unit per mL (100 units / 100 mL). At a rate of 10 mL/hr, the
client receives 10 units/hr. This is a fundamental dose calculation for med-surg nursing, often tested on
the ATI RN Comprehensive Predictor.
7. A client is 24 hours post-operative from a total hip arthroplasty. Which of the following positions is
contraindicated for this client?
A. Supine with a pillow between the legs.
B. Side-lying on the non-operative side.
C. High-Fowler's position with knees flexed.
D. Supine with the affected leg abducted.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: High-Fowler's position with knees flexed increases the risk of hip dislocation in a
post-operative hip replacement patient. The hip should be maintained in extension. Pillows between the
legs (A) help maintain abduction, and side-lying on the non-operative side (B) is safe.
, 8. A nurse is performing a neurovascular assessment on a client with a fractured tibia and a cast. Which
finding is the most early indicator of compartment syndrome?
A. Pulselessness.
B. Paresthesia.
C. Pallor.
D. Paralysis.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Paresthesia (tingling, numbness) is often the earliest sign of compartment syndrome
due to nerve ischemia. Pain out of proportion is also an early sign. Pulselessness (A), pallor (C), and
paralysis (D) are late findings, indicating significant compromise and potential tissue necrosis.
9. The nurse is teaching a client with a new diagnosis of seizure disorder who is prescribed phenytoin
(Dilantin). Which of the following instructions is essential?
A. "Take the medication with milk to prevent stomach upset."
B. "If you miss a dose, double the next dose to catch up."
C. "It is important to maintain good oral hygiene and see your dentist regularly."
D. "This medication may turn your urine orange."
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Phenytoin causes gingival hyperplasia (overgrowth of gums). Excellent oral hygiene
and regular dental visits are vital to manage this side effect. It should not be taken with milk (A) as it
may affect absorption. Missing a dose should not be managed by doubling (B). Orange urine (D) is a side
effect of rifampin, not phenytoin.
10. A nurse is caring for a client with a nasogastric tube attached to continuous suction. Which of the
following assessment findings is a sign of a complication?
A. Gastric aspirate with a pH of 4.0.
B. Abdominal distention.
C. Bowel sounds present in all quadrants.
D. The tube is taped securely to the nose.
💫ANSWER✔️✔️: B
test covering med-surg, pharmacology, leadership, and fundamentals,
designed to mirror the rigor of ATI, HESI, and NCLEX-RN for
guaranteed success.
2025/2026 | Comprehensive Nursing Exam Prep | Ultimate NGN
Questions & Rationales | Pass on First Attempt – Chamberlain,
Walden, & Grand Canyon Aligned
---
1. A client with chronic obstructive pulmonary disease (COPD) is prescribed a bronchodilator via a
metered-dose inhaler (MDI). Which instruction is most important for the nurse to include in the
teaching?
A. Inhale deeply and quickly while pressing the canister.
B. Wait 5 minutes between puffs of the same medication.
C. Rinse the mouth with water after each use to prevent thrush.
D. Use a spacer device to improve medication delivery to the lungs.
💫ANSWER✔️✔️: D
💫RATIONALE✔️✔️: Using a spacer device with an MDI is crucial for patients with COPD as it allows more
medication to reach the lower airways and reduces oropharyngeal deposition. While rinsing the mouth
(C) is important for corticosteroid inhalers, this is the most critical for efficacy. Deep, slow inhalation (A)
is recommended, not quick, and waiting 1 minute (B) is standard, not 5. This NCLEX prep strategy
emphasizes optimizing drug delivery for respiratory compromise.
2. A nurse is preparing to administer a blood transfusion to a client. The client reports a previous history
of a febrile reaction to transfusions. Which of the following actions should the nurse take?
A. Premedicate the client with an antihistamine as prescribed.
B. Administer the blood product as prescribed, monitoring vital signs closely.
C. Premedicate the client with an antipyretic as prescribed.
D. Obtain a signed informed consent for the blood transfusion.
,💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Premedicating with an antipyretic (e.g., acetaminophen) is an effective measure to
prevent or reduce febrile, non-hemolytic transfusion reactions. Antihistamines (A) are more effective for
allergic reactions. Simply administering without intervention (B) is not proactive. Informed consent (D) is
legally required but does not address the specific history of febrile reactions. This is a key HESI RN
Comprehensive Exit Exam topic for safe blood administration.
3. A client with a diagnosis of major depressive disorder is prescribed phenelzine (Nardil). The nurse's
teaching should emphasize avoiding which of the following foods?
A. Broccoli, spinach, and kale.
B. Aged cheese, smoked meats, and tap beer.
C. Fresh fruits and vegetables.
D. Whole grains and cereals.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Phenelzine is a monoamine oxidase inhibitor (MAOI), which requires a strict
tyramine-restricted diet. Aged cheeses, smoked/cured meats, and fermented alcoholic beverages are
high in tyramine and can precipitate a life-threatening hypertensive crisis. This is a critical point in any
ATI Pharmacology Proctored Exam review.
4. The nurse is caring for a client with heart failure who is receiving furosemide (Lasix). Which of the
following assessment findings indicates the medication is having the desired effect?
A. Increased heart rate.
B. Decreased peripheral edema.
C. Increased jugular venous distention.
D. Adventitious breath sounds in the lung bases.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Furosemide is a loop diuretic used to reduce fluid volume overload. A decrease in
peripheral edema is a positive indicator of reduced fluid volume. An increased heart rate (A) could be a
sign of hypovolemia or electrolyte imbalance, not a desired effect. Jugular venous distention (C) and
adventitious lung sounds (D) are signs of worsening heart failure.
5. An adolescent client is admitted with a traumatic amputation of the lower leg. Which statement by
the parent indicates an understanding of the care needed after the initial surgery?
,A. "We will keep the room lights dim to help him relax."
B. "We should look at the area where the amputation was done to see how it is healing."
C. "We must avoid discussing the amputation as it will only make him more upset."
D. "We will encourage him to stay in bed and not move the stump to prevent pain."
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: It is important for the family to be involved in care and to look at the site with the
healthcare team to promote acceptance and monitor healing. Keeping the room dim (A) is not specific
to this condition. Encouraging discussion (C) is healthier than avoidance. Promoting mobility (D) is
encouraged unless contraindicated.
6. The nurse is preparing a continuous insulin infusion for a client in diabetic ketoacidosis (DKA). The
prescription reads: 100 units of regular insulin in 100 mL of 0.9% NaCl. The infusion rate is to be 10
mL/hr. How many units of insulin per hour is the client receiving?
A. 1 unit/hr
B. 5 units/hr
C. 10 units/hr
D. 100 units/hr
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: The concentration is 1 unit per mL (100 units / 100 mL). At a rate of 10 mL/hr, the
client receives 10 units/hr. This is a fundamental dose calculation for med-surg nursing, often tested on
the ATI RN Comprehensive Predictor.
7. A client is 24 hours post-operative from a total hip arthroplasty. Which of the following positions is
contraindicated for this client?
A. Supine with a pillow between the legs.
B. Side-lying on the non-operative side.
C. High-Fowler's position with knees flexed.
D. Supine with the affected leg abducted.
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: High-Fowler's position with knees flexed increases the risk of hip dislocation in a
post-operative hip replacement patient. The hip should be maintained in extension. Pillows between the
legs (A) help maintain abduction, and side-lying on the non-operative side (B) is safe.
, 8. A nurse is performing a neurovascular assessment on a client with a fractured tibia and a cast. Which
finding is the most early indicator of compartment syndrome?
A. Pulselessness.
B. Paresthesia.
C. Pallor.
D. Paralysis.
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Paresthesia (tingling, numbness) is often the earliest sign of compartment syndrome
due to nerve ischemia. Pain out of proportion is also an early sign. Pulselessness (A), pallor (C), and
paralysis (D) are late findings, indicating significant compromise and potential tissue necrosis.
9. The nurse is teaching a client with a new diagnosis of seizure disorder who is prescribed phenytoin
(Dilantin). Which of the following instructions is essential?
A. "Take the medication with milk to prevent stomach upset."
B. "If you miss a dose, double the next dose to catch up."
C. "It is important to maintain good oral hygiene and see your dentist regularly."
D. "This medication may turn your urine orange."
💫ANSWER✔️✔️: C
💫RATIONALE✔️✔️: Phenytoin causes gingival hyperplasia (overgrowth of gums). Excellent oral hygiene
and regular dental visits are vital to manage this side effect. It should not be taken with milk (A) as it
may affect absorption. Missing a dose should not be managed by doubling (B). Orange urine (D) is a side
effect of rifampin, not phenytoin.
10. A nurse is caring for a client with a nasogastric tube attached to continuous suction. Which of the
following assessment findings is a sign of a complication?
A. Gastric aspirate with a pH of 4.0.
B. Abdominal distention.
C. Bowel sounds present in all quadrants.
D. The tube is taped securely to the nose.
💫ANSWER✔️✔️: B
