NCLEX-RN Clinical Judgment and Comprehensive
Nursing Practice Exam questions and correct answers–
Updated 2026 (Graded A+) instant download pdf
Subject: Advanced Professional Nursing
Subtopic: Management of Care, Prioritization, and Delegation
Question 1: A charge nurse on a medical-surgical unit is evaluating client assignments for the
upcoming shift. The unit is staffed with an RN, a Licensed Practical Nurse (LPN), and an
Assistive Personnel (AP). Which of the following client assignments represents the most
appropriate delegation of nursing tasks based on safety and scope of practice?
A) Assign the LPN to perform the initial admission assessment and formulate the plan of care
for a client who arrived with stable chronic obstructive pulmonary disease (COPD).
B) Assign the AP to monitor and record the hourly chest tube drainage volume for a client
who is 4 hours postoperative following a left lower lobectomy.
C) Assign the LPN to administer an scheduled subcutaneous dose of insulin glargine and
perform a sterile redressing change on a stage 3 pressure injury.
D) Assign the AP to perform the initial clean intermittent catheterization for a client who has
a new spinal cord injury and neurogenic bladder.
Correct Answer: C - Assign the LPN to administer an scheduled subcutaneous dose of
insulin glargine and perform a sterile redressing change on a stage 3 pressure injury.
Rationale: The scope of practice for an LPN includes the administration of routine
medications (including subcutaneous insulin) and performing sterile wound care or dressing
changes on stable wounds. Option A is incorrect because initial assessments, formulation of
nursing diagnoses, and creating the plan of care require the independent clinical judgment of
an RN and cannot be delegated to an LPN. Option B is incorrect because a client 4 hours
postoperative from a lobectomy is highly unstable and at risk for hemorrhage or respiratory
distress; evaluating chest tube drainage in the immediate postoperative period requires RN
assessment. Option D is incorrect because the initial implementation of a procedure or care
plan component for a client with a new, acute condition requires professional nursing
judgment; subsequent, routine catheterizations for a stable client might be assigned
differently depending on state practice acts, but the initial one is an RN responsibility.
Question 2: An RN is caring for a group of clients and receives the morning laboratory
results. Which of the following clients should the nurse identify as the highest priority for
immediate clinical intervention?
,A) A client receiving digoxin for heart failure who has a digoxin level of 1.4 ng/mL and a
potassium level of 3.6 mEq/L.
B) A client with acute pancreatitis who exhibits a positive Trousseau's sign and has a total
serum calcium level of 7.2 mg/dL.
C) A client receiving a continuous heparin infusion for a deep vein thrombosis who has an
activated partial thromboplastin time (aPTT) of 55 seconds.
D) A client with chronic kidney disease whose serum creatinine is 4.8 mg/dL and who has
missed their last scheduled hemodialysis session.
Correct Answer: B - A client with acute pancreatitis who exhibits a positive Trousseau's
sign and has a total serum calcium level of 7.2 mg/dL.
Rationale: Acute pancreatitis can cause severe hypocalcemia due to fat necrosis and the
precipitation of calcium soaps in the abdominal cavity. A total serum calcium level of 7.2
mg/dL is critically low (normal is 9.0–10.5 mg/dL), and a positive Trousseau's sign (carpal
spasm induced by inflating a blood pressure cuff) indicates severe neuromuscular irritability.
This places the client at immediate risk for laryngospasm, seizures, and fatal cardiac
arrhythmias, making them the highest priority. Option A is incorrect because the digoxin
level is within the therapeutic range (0.5–2.0 ng/mL) and potassium is low-normal, which
warrants monitoring but not immediate emergency action. Option C is incorrect because an
aPTT of 55 seconds is generally within or close to the expected therapeutic target range for
heparin therapy (typically 1.5–2.5 times the normal control value). Option D is incorrect
because while a creatinine of 4.8 mg/dL is high, it is a chronic manifestation of their kidney
disease; although missing dialysis is concerning, the acute neuromuscular risks of severe
hypocalcemia present an more immediate life-threatening crisis.
Question 3: A nurse in the emergency department is triaging four clients who arrived
simultaneously. Using the Emergency Severity Index (ESI) or standard prioritization
frameworks, which client must the nurse bring to the treatment area first?
A) A 45-year-old client reporting sudden-onset, severe epigastric pain that radiates to the
left shoulder, accompanied by diaphoresis and nausea.
B) A 19-year-old client with a closed fractured radius who reports severe pain rated as 9 on a
0-10 scale and whose distal pulse is intact and capillary refill is 2 seconds.
C) A 68-year-old client with a history of type 2 diabetes who presents with a blood glucose
level of 450 mg/dL and a trace amount of ketones in the urine.
D) A 28-year-old client reporting a productive cough with green sputum, a temperature of
38.4°C (101.1°F), and an oxygen saturation of 94% on room air.
Correct Answer: A - A 45-year-old client reporting sudden-onset, severe epigastric pain
that radiates to the left shoulder, accompanied by diaphoresis and nausea.
,Rationale: Sudden-onset epigastric or chest pain radiating to the left shoulder accompanied
by autonomic symptoms like diaphoresis and nausea is a classic presentation of an acute
myocardial infarction (AMI). This represents a life-threatening compromise to the
cardiovascular system, making this client an ESI Level 2 or immediate priority. Option B is
incorrect because while the client has high pain scores, the extremity is neurovascularly
intact (distal pulse intact, good capillary refill), meaning the limb is not immediately
jeopardized. Option C is incorrect because while the glucose is elevated, the presence of only
trace ketones suggests the absence of severe diabetic ketoacidosis (DKA); the client requires
intervention but is less acute than a potential AMI. Option D is incorrect because the client is
displaying signs of a respiratory infection but remains hemodynamically stable with
acceptable oxygenation, placing them in a lower priority tier.
Subtopic: Pharmacological and Parenteral Therapies
Question 4: A nurse is preparing to administer an intravenous bolus of diltiazem to a client
experiencing atrial fibrillation with a rapid ventricular response. Which of the following pre-
administration assessments is mandatory to ensure client safety?
A) Assess the client's deep tendon reflexes and check for a positive Babinski sign.
B) Obtain a continuous electrocardiogram (ECG) strip and measure the client's blood
pressure.
C) Measure the client's daily weight and check for shifting dullness in the abdomen.
D) Assess the client's deep vein areas for asymmetric calf swelling and warmth.
Correct Answer: B - Obtain a continuous electrocardiogram (ECG) strip and measure the
client's blood pressure.
Rationale: Diltiazem is a calcium channel blocker that slows AV node conduction to control
the ventricular rate in atrial fibrillation. It causes negative inotropic and chronotropic effects,
as well as systemic vasodilation. Therefore, it can cause severe hypotension and bradycardia
or heart blocks. The nurse must establish baseline blood pressure and monitor the cardiac
rhythm continuously during administration. Option A is incorrect because deep tendon
reflexes are monitored during magnesium sulfate therapy, not calcium channel blocker
administration. Option C is incorrect because daily weights and shifting dullness relate to
fluid volume overload and ascites, which are not acute pre-administration safety checks for
an emergency antiarrhythmic bolus. Option D is incorrect because while deep vein
thrombosis checks are important in atrial fibrillation due to embolic risk, they do not dictate
the immediate hemodynamic safety of administering intravenous diltiazem.
Question 5: A nurse is monitoring a client who is receiving a continuous intravenous infusion
of magnesium sulfate for preeclampsia. Which of the following clinical findings indicates
early magnesium toxicity and requires the nurse to discontinue the infusion immediately?
, A) A respiratory rate of 14 breaths per minute and a urinary output of 40 mL over the last
hour.
B) A blood pressure reading of 142/92 mm Hg and a mild, generalized headache.
C) Absence of patellar deep tendon reflexes and a respiratory rate of 10 breaths per minute.
D) A serum magnesium level of 5.5 mEq/L and generalized muscle relaxation.
Correct Answer: C - Absence of patellar deep tendon reflexes and a respiratory rate of 10
breaths per minute.
Rationale: Magnesium sulfate is a central nervous system depressant used to prevent
seizures in preeclampsia. Early signs of toxicity occur as serum levels rise and include the loss
or absence of deep tendon reflexes (DTRs), followed by respiratory depression (respiratory
rate less than 12 breaths/min), bradycardia, and cardiac arrest. Discontinuing the infusion
and preparing the antidote (calcium gluconate) is required. Option A is incorrect because a
respiratory rate of 14 and a urine output of 40 mL/hr are within acceptable parameters
(urine output should remain greater than 30 mL/hr to prevent magnesium accumulation, as
it is renally excreted). Option B is incorrect because elevated blood pressure and a mild
headache are manifestations of the underlying preeclampsia rather than magnesium
toxicity. Option D is incorrect because a therapeutic serum magnesium level for preventing
seizures is generally maintained between 4.0 and 7.0 mEq/L; thus, 5.5 mEq/L is within the
therapeutic window.
Question 6: A nurse is caring for a client with a history of chronic alcoholism who is admitted
with severe malnutrition. The provider prescribes an intravenous infusion of 5% dextrose in
0.9% normal saline with vitamins. Which of the following vitamins must be administered
before or concurrently with the glucose infusion to prevent the development of Wernicke's
encephalopathy?
A) Vitamin B12 (Cyanocobalamin)
B) Vitamin B1 (Thiamine)
) Vitamin B6 (Pyridoxine)
D) Vitamin K (Phytonadione)
Correct Answer: B - Vitamin B1 (Thiamine)
Rationale: Individuals with chronic alcohol use disorder are frequently deficient in thiamine
(Vitamin B1) due to poor dietary intake and malabsorption. Thiamine is a vital coenzyme in
glucose metabolism. If a high-glucose load (such as a dextrose infusion) is administered to a
thiamine-deficient client, it rapidly consumes the remaining thiamine stores, precipitating
acute Wernicke's encephalopathy (characterized by ataxia, nystagmus, and confusion).
Therefore, thiamine supplementation must precede or accompany carbohydrate
Nursing Practice Exam questions and correct answers–
Updated 2026 (Graded A+) instant download pdf
Subject: Advanced Professional Nursing
Subtopic: Management of Care, Prioritization, and Delegation
Question 1: A charge nurse on a medical-surgical unit is evaluating client assignments for the
upcoming shift. The unit is staffed with an RN, a Licensed Practical Nurse (LPN), and an
Assistive Personnel (AP). Which of the following client assignments represents the most
appropriate delegation of nursing tasks based on safety and scope of practice?
A) Assign the LPN to perform the initial admission assessment and formulate the plan of care
for a client who arrived with stable chronic obstructive pulmonary disease (COPD).
B) Assign the AP to monitor and record the hourly chest tube drainage volume for a client
who is 4 hours postoperative following a left lower lobectomy.
C) Assign the LPN to administer an scheduled subcutaneous dose of insulin glargine and
perform a sterile redressing change on a stage 3 pressure injury.
D) Assign the AP to perform the initial clean intermittent catheterization for a client who has
a new spinal cord injury and neurogenic bladder.
Correct Answer: C - Assign the LPN to administer an scheduled subcutaneous dose of
insulin glargine and perform a sterile redressing change on a stage 3 pressure injury.
Rationale: The scope of practice for an LPN includes the administration of routine
medications (including subcutaneous insulin) and performing sterile wound care or dressing
changes on stable wounds. Option A is incorrect because initial assessments, formulation of
nursing diagnoses, and creating the plan of care require the independent clinical judgment of
an RN and cannot be delegated to an LPN. Option B is incorrect because a client 4 hours
postoperative from a lobectomy is highly unstable and at risk for hemorrhage or respiratory
distress; evaluating chest tube drainage in the immediate postoperative period requires RN
assessment. Option D is incorrect because the initial implementation of a procedure or care
plan component for a client with a new, acute condition requires professional nursing
judgment; subsequent, routine catheterizations for a stable client might be assigned
differently depending on state practice acts, but the initial one is an RN responsibility.
Question 2: An RN is caring for a group of clients and receives the morning laboratory
results. Which of the following clients should the nurse identify as the highest priority for
immediate clinical intervention?
,A) A client receiving digoxin for heart failure who has a digoxin level of 1.4 ng/mL and a
potassium level of 3.6 mEq/L.
B) A client with acute pancreatitis who exhibits a positive Trousseau's sign and has a total
serum calcium level of 7.2 mg/dL.
C) A client receiving a continuous heparin infusion for a deep vein thrombosis who has an
activated partial thromboplastin time (aPTT) of 55 seconds.
D) A client with chronic kidney disease whose serum creatinine is 4.8 mg/dL and who has
missed their last scheduled hemodialysis session.
Correct Answer: B - A client with acute pancreatitis who exhibits a positive Trousseau's
sign and has a total serum calcium level of 7.2 mg/dL.
Rationale: Acute pancreatitis can cause severe hypocalcemia due to fat necrosis and the
precipitation of calcium soaps in the abdominal cavity. A total serum calcium level of 7.2
mg/dL is critically low (normal is 9.0–10.5 mg/dL), and a positive Trousseau's sign (carpal
spasm induced by inflating a blood pressure cuff) indicates severe neuromuscular irritability.
This places the client at immediate risk for laryngospasm, seizures, and fatal cardiac
arrhythmias, making them the highest priority. Option A is incorrect because the digoxin
level is within the therapeutic range (0.5–2.0 ng/mL) and potassium is low-normal, which
warrants monitoring but not immediate emergency action. Option C is incorrect because an
aPTT of 55 seconds is generally within or close to the expected therapeutic target range for
heparin therapy (typically 1.5–2.5 times the normal control value). Option D is incorrect
because while a creatinine of 4.8 mg/dL is high, it is a chronic manifestation of their kidney
disease; although missing dialysis is concerning, the acute neuromuscular risks of severe
hypocalcemia present an more immediate life-threatening crisis.
Question 3: A nurse in the emergency department is triaging four clients who arrived
simultaneously. Using the Emergency Severity Index (ESI) or standard prioritization
frameworks, which client must the nurse bring to the treatment area first?
A) A 45-year-old client reporting sudden-onset, severe epigastric pain that radiates to the
left shoulder, accompanied by diaphoresis and nausea.
B) A 19-year-old client with a closed fractured radius who reports severe pain rated as 9 on a
0-10 scale and whose distal pulse is intact and capillary refill is 2 seconds.
C) A 68-year-old client with a history of type 2 diabetes who presents with a blood glucose
level of 450 mg/dL and a trace amount of ketones in the urine.
D) A 28-year-old client reporting a productive cough with green sputum, a temperature of
38.4°C (101.1°F), and an oxygen saturation of 94% on room air.
Correct Answer: A - A 45-year-old client reporting sudden-onset, severe epigastric pain
that radiates to the left shoulder, accompanied by diaphoresis and nausea.
,Rationale: Sudden-onset epigastric or chest pain radiating to the left shoulder accompanied
by autonomic symptoms like diaphoresis and nausea is a classic presentation of an acute
myocardial infarction (AMI). This represents a life-threatening compromise to the
cardiovascular system, making this client an ESI Level 2 or immediate priority. Option B is
incorrect because while the client has high pain scores, the extremity is neurovascularly
intact (distal pulse intact, good capillary refill), meaning the limb is not immediately
jeopardized. Option C is incorrect because while the glucose is elevated, the presence of only
trace ketones suggests the absence of severe diabetic ketoacidosis (DKA); the client requires
intervention but is less acute than a potential AMI. Option D is incorrect because the client is
displaying signs of a respiratory infection but remains hemodynamically stable with
acceptable oxygenation, placing them in a lower priority tier.
Subtopic: Pharmacological and Parenteral Therapies
Question 4: A nurse is preparing to administer an intravenous bolus of diltiazem to a client
experiencing atrial fibrillation with a rapid ventricular response. Which of the following pre-
administration assessments is mandatory to ensure client safety?
A) Assess the client's deep tendon reflexes and check for a positive Babinski sign.
B) Obtain a continuous electrocardiogram (ECG) strip and measure the client's blood
pressure.
C) Measure the client's daily weight and check for shifting dullness in the abdomen.
D) Assess the client's deep vein areas for asymmetric calf swelling and warmth.
Correct Answer: B - Obtain a continuous electrocardiogram (ECG) strip and measure the
client's blood pressure.
Rationale: Diltiazem is a calcium channel blocker that slows AV node conduction to control
the ventricular rate in atrial fibrillation. It causes negative inotropic and chronotropic effects,
as well as systemic vasodilation. Therefore, it can cause severe hypotension and bradycardia
or heart blocks. The nurse must establish baseline blood pressure and monitor the cardiac
rhythm continuously during administration. Option A is incorrect because deep tendon
reflexes are monitored during magnesium sulfate therapy, not calcium channel blocker
administration. Option C is incorrect because daily weights and shifting dullness relate to
fluid volume overload and ascites, which are not acute pre-administration safety checks for
an emergency antiarrhythmic bolus. Option D is incorrect because while deep vein
thrombosis checks are important in atrial fibrillation due to embolic risk, they do not dictate
the immediate hemodynamic safety of administering intravenous diltiazem.
Question 5: A nurse is monitoring a client who is receiving a continuous intravenous infusion
of magnesium sulfate for preeclampsia. Which of the following clinical findings indicates
early magnesium toxicity and requires the nurse to discontinue the infusion immediately?
, A) A respiratory rate of 14 breaths per minute and a urinary output of 40 mL over the last
hour.
B) A blood pressure reading of 142/92 mm Hg and a mild, generalized headache.
C) Absence of patellar deep tendon reflexes and a respiratory rate of 10 breaths per minute.
D) A serum magnesium level of 5.5 mEq/L and generalized muscle relaxation.
Correct Answer: C - Absence of patellar deep tendon reflexes and a respiratory rate of 10
breaths per minute.
Rationale: Magnesium sulfate is a central nervous system depressant used to prevent
seizures in preeclampsia. Early signs of toxicity occur as serum levels rise and include the loss
or absence of deep tendon reflexes (DTRs), followed by respiratory depression (respiratory
rate less than 12 breaths/min), bradycardia, and cardiac arrest. Discontinuing the infusion
and preparing the antidote (calcium gluconate) is required. Option A is incorrect because a
respiratory rate of 14 and a urine output of 40 mL/hr are within acceptable parameters
(urine output should remain greater than 30 mL/hr to prevent magnesium accumulation, as
it is renally excreted). Option B is incorrect because elevated blood pressure and a mild
headache are manifestations of the underlying preeclampsia rather than magnesium
toxicity. Option D is incorrect because a therapeutic serum magnesium level for preventing
seizures is generally maintained between 4.0 and 7.0 mEq/L; thus, 5.5 mEq/L is within the
therapeutic window.
Question 6: A nurse is caring for a client with a history of chronic alcoholism who is admitted
with severe malnutrition. The provider prescribes an intravenous infusion of 5% dextrose in
0.9% normal saline with vitamins. Which of the following vitamins must be administered
before or concurrently with the glucose infusion to prevent the development of Wernicke's
encephalopathy?
A) Vitamin B12 (Cyanocobalamin)
B) Vitamin B1 (Thiamine)
) Vitamin B6 (Pyridoxine)
D) Vitamin K (Phytonadione)
Correct Answer: B - Vitamin B1 (Thiamine)
Rationale: Individuals with chronic alcohol use disorder are frequently deficient in thiamine
(Vitamin B1) due to poor dietary intake and malabsorption. Thiamine is a vital coenzyme in
glucose metabolism. If a high-glucose load (such as a dextrose infusion) is administered to a
thiamine-deficient client, it rapidly consumes the remaining thiamine stores, precipitating
acute Wernicke's encephalopathy (characterized by ataxia, nystagmus, and confusion).
Therefore, thiamine supplementation must precede or accompany carbohydrate
