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RN Comprehensive Predictor 2026 Exit Ultimate
Study Guide and Practice Test: Advanced
Nursing Competency Assessment with Next
Generation NCLEX-Style Clinical Judgment
Questions for Licensure Readiness
SECTION 1: MANAGEMENT OF CARE (Questions 1-25)
1. A charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to a float nurse from the postpartum unit?
A) A client with unstable angina on a nitroglycerin drip
B) A client with pneumonia requiring chest tube monitoring
C) A stable client with a urinary tract infection receiving oral antibiotics
D) A client one hour post-cardiac catheterization with a femoral sheath
Correct Answer: C
Rationale: The float nurse requires the most stable, predictable assignment. The UTI client is
stable and does not require specialized cardiac or respiratory skills. The other options require
specialized cardiac or respiratory expertise that a float nurse from a different specialty may not
possess .
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2. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of the following
tasks is appropriate to delegate?
A) Assessing a client's post-operative incision
B) Teaching a client how to use an inhaler
C) Measuring a client's urinary output from a Foley catheter
D) Evaluating the effectiveness of pain medication
Correct Answer: C
Rationale: Delegation involves routine tasks with predictable outcomes, such as measurement,
ambulation, and hygiene. Assessment, teaching, and evaluation are nursing responsibilities that
cannot be delegated to APs .
3. A nurse is receiving change-of-shift report on four clients. Which client should the nurse
assess first?
A) A client with a dressing that needs reinforcement
B) A client reporting pain rated 6/10
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C) A client whose urinary output was 100 mL in 12 hours
D) A client scheduled for discharge
Correct Answer: C
Rationale: Low urine output (100 mL in 12 hours) is only 8.3 mL/hour, far below the minimum
of 30 mL/hour. This indicates potential renal failure or severe hypovolemia, which is a life-
threatening issue that must be addressed immediately .
4. A nurse enters a client's room and sees smoke coming from a wastebasket. What action
should the nurse take first?
A) Pull the fire alarm
B) Extinguish the fire
C) Assist the client to a nearby waiting area
D) Close the client's door
Correct Answer: C
Rationale: The mnemonic is RACE (Rescue, Alarm, Contain, Extinguish). The immediate priority
is to move the client to safety ("Rescue") before pulling the alarm or fighting the fire .
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5. A charge nurse is implementing a new fall prevention protocol. Which action demonstrates
effective leadership?
A) Mandating the change without staff input
B) Providing education and asking staff for feedback on implementation
C) Ignoring staff concerns about increased workload
D) Implementing the protocol only on day shift
Correct Answer: B
Rationale: Effective leadership includes collaboration, education, and addressing staff concerns.
Change is more successful when staff are involved in the process .
6. A client refuses a scheduled blood transfusion after receiving education about the risks and
benefits. What should the nurse do?
A) Begin the transfusion because it is prescribed
B) Respect the client's decision and notify the healthcare provider
RN Comprehensive Predictor 2026 Exit Ultimate
Study Guide and Practice Test: Advanced
Nursing Competency Assessment with Next
Generation NCLEX-Style Clinical Judgment
Questions for Licensure Readiness
SECTION 1: MANAGEMENT OF CARE (Questions 1-25)
1. A charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to a float nurse from the postpartum unit?
A) A client with unstable angina on a nitroglycerin drip
B) A client with pneumonia requiring chest tube monitoring
C) A stable client with a urinary tract infection receiving oral antibiotics
D) A client one hour post-cardiac catheterization with a femoral sheath
Correct Answer: C
Rationale: The float nurse requires the most stable, predictable assignment. The UTI client is
stable and does not require specialized cardiac or respiratory skills. The other options require
specialized cardiac or respiratory expertise that a float nurse from a different specialty may not
possess .
, 2
2. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of the following
tasks is appropriate to delegate?
A) Assessing a client's post-operative incision
B) Teaching a client how to use an inhaler
C) Measuring a client's urinary output from a Foley catheter
D) Evaluating the effectiveness of pain medication
Correct Answer: C
Rationale: Delegation involves routine tasks with predictable outcomes, such as measurement,
ambulation, and hygiene. Assessment, teaching, and evaluation are nursing responsibilities that
cannot be delegated to APs .
3. A nurse is receiving change-of-shift report on four clients. Which client should the nurse
assess first?
A) A client with a dressing that needs reinforcement
B) A client reporting pain rated 6/10
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C) A client whose urinary output was 100 mL in 12 hours
D) A client scheduled for discharge
Correct Answer: C
Rationale: Low urine output (100 mL in 12 hours) is only 8.3 mL/hour, far below the minimum
of 30 mL/hour. This indicates potential renal failure or severe hypovolemia, which is a life-
threatening issue that must be addressed immediately .
4. A nurse enters a client's room and sees smoke coming from a wastebasket. What action
should the nurse take first?
A) Pull the fire alarm
B) Extinguish the fire
C) Assist the client to a nearby waiting area
D) Close the client's door
Correct Answer: C
Rationale: The mnemonic is RACE (Rescue, Alarm, Contain, Extinguish). The immediate priority
is to move the client to safety ("Rescue") before pulling the alarm or fighting the fire .
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5. A charge nurse is implementing a new fall prevention protocol. Which action demonstrates
effective leadership?
A) Mandating the change without staff input
B) Providing education and asking staff for feedback on implementation
C) Ignoring staff concerns about increased workload
D) Implementing the protocol only on day shift
Correct Answer: B
Rationale: Effective leadership includes collaboration, education, and addressing staff concerns.
Change is more successful when staff are involved in the process .
6. A client refuses a scheduled blood transfusion after receiving education about the risks and
benefits. What should the nurse do?
A) Begin the transfusion because it is prescribed
B) Respect the client's decision and notify the healthcare provider
