COMPREHENSIVE ONLINE PRACTICE
2026 A & B
(NGN-STYLE QUESTIONS & CASE SCENARIOS)
Answers with detailed Rationale
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,Table of Contents
RN Comprehensive Online Practice 2026 A.......................... 2
RN Comprehensive Online Practice 2026 B ........................ 85
RN Comprehensive Online Practice 2026 A
Question 1
When caring for a child, a nurse plans to use nonpharmacological interventions
to enhance the effectiveness of pain medication. Which of the following
strategies incorporates visualization techniques to help decrease the child's
discomfort?
A. Blowing bubbles with liquid soap to "blow the hurt away"
B. Using a weighted blanket for comfort
C. Applying a cold pack to the affected area
D. Playing the child's favorite music
Correct Answer: A. Blowing bubbles with liquid soap to "blow the hurt away"
This technique uses visualization and distraction by encouraging the child to imagine
"blowing the hurt away" with the bubbles. This combines deep breathing (physiological
benefit) with imagery (psychological benefit) to reduce pain perception.
Question 2
A nurse is providing education to a client who expresses a desire to lose weight.
Which of the following recommendations should the nurse make?
A. "Follow a high-protein, low-carbohydrate diet."
B. "Follow the MyPlate plan."
,C. "Skip breakfast to reduce daily calories."
D. "Use meal replacement shakes for all meals."
Correct Answer: B. "Follow the MyPlate plan."
The MyPlate plan is the USDA's evidence-based guideline for balanced nutrition,
emphasizing fruits, vegetables, grains, protein, and dairy in appropriate portions. It
promotes sustainable, healthy eating habits rather than restrictive fad diets.
Question 3
A nurse is assigning task roles for a group of clients in a community mental
health clinic. Which of the following tasks should the nurse assign to the member
of the group functioning as the orienter?
A. Mediating disagreements between group members
B. Noting the progress of the group toward assigned goals
C. Encouraging quiet members to participate
D. Summarizing the group's discussion
Correct Answer: B. Noting the progress of the group toward assigned goals
The orienter role keeps the group focused on its goals and objectives, tracking
progress and redirecting when the group strays off-topic. This differs from other roles:
the gatekeeper encourages participation, the compromiser mediates conflicts, and the
summarizer recaps discussions.
Question 4 (Next Generation NCLEX - Ordered Response)
A nurse is caring for a client who has a leg cast and is returning a demonstration
on the proper use of crutches while climbing stairs. Identify the sequence the
client should follow:
Move the steps into the box on the right, placing them in the order of
performance:
Available Steps:
, • Stand in the tripod position
• Place body weight on the crutches
• Place the unaffected leg on the stair
• Move the affected leg and the crutches up to the stair
Correct Order:
1. Stand in the tripod position (crutches slightly forward and to the sides, forming
a tripod base)
2. Place body weight on the crutches
3. Place the unaffected leg on the stair ("Good leg goes to heaven")
4. Move the affected leg and the crutches up to the stair ("Bad leg goes to hell")
Memory Aid: "Up with the good, down with the bad" — when going up stairs, the
unaffected leg leads; when going down, the affected leg leads.
Question 5
A nurse is assessing for correct placement of a client's NG feeding tube prior to
administering a bolus feeding. Which of the following actions should the nurse
take?
A. Aspirate contents from the tube and verify the pH level
B. Inject 30 mL of air and auscultate over the epigastrium
C. Place the end of the tube in water and observe for bubbling
D. Obtain a chest x-ray
Correct Answer: A. Aspirate contents from the tube and verify the pH level
Gastric pH is the most reliable bedside method for verifying NG tube placement (pH ≤
5.5 indicates gastric placement). While chest x-ray is the gold standard for initial
placement confirmation, pH testing is appropriate for ongoing verification before
feedings. The air insufflation method is no longer recommended due to unreliability.
,Question 6
A nurse is admitting a client to the mental health unit following a suicide attempt.
The client states, "My family does not care whether I live or die." Which of the
following responses should the nurse make?
A. "Your family visited you in the emergency department."
B. "How does this make you feel?"
C. "I'm sure your family cares about you."
D. "You should talk to your family about this."
Correct Answer: B. "How does this make you feel?"
This therapeutic communication technique uses an open-ended question to
encourage the client to express emotions and explore their perceptions. It validates the
client's feelings without being defensive or dismissive. Avoid arguing with the client's
perceptions or offering false reassurance.
Question 7
A nurse is caring for a client who is immediately postoperative following a total
vaginal hysterectomy. Which of the following actions should the nurse take first?
A. Assess the client's pain level
B. Measure the client's vital signs
C. Check the perineal pad for bleeding
D. Encourage deep breathing and coughing
Correct Answer: B. Measure the client's vital signs
Using the airway, breathing, circulation (ABC) and safety priority frameworks, the
nurse should first obtain baseline vital signs to detect hemorrhage, shock, or
respiratory complications. This provides essential data for comparison and identifies
immediate life threats.
,Question 8
A nurse is caring for a 4-year-old preschooler in an emergency department (ED).
After completing the assessment and reviewing the preschooler's medical record,
which of the following actions should the nurse plan to take?
A. Administer supplemental oxygen, place the preschooler on the affected side, and
administer an antipyretic
B. Place the child in a supine position and apply a cooling blanket
C. Administer IV fluids rapidly and prepare for intubation
D. Provide oral rehydration and discharge home
Correct Answer: A. Administer supplemental oxygen, place the preschooler on
the affected side, and administer an antipyretic
This answer suggests the child has pneumonia or respiratory infection with fever.
Placing the child on the affected side (good lung down) improves ventilation-perfusion
matching and oxygenation. Supplemental oxygen addresses hypoxemia, and
antipyretics reduce fever discomfort.
Question 9
A nurse is caring for a client who has fluid volume overload. Which of the
following tasks should the delegate to an assistive personnel (AP)?
A. Measure the client's daily weight
B. Assess the client's lung sounds
C. Administer diuretic medication
D. Evaluate the client's edema
Correct Answer: A. Measure the client's daily weight
Measuring daily weight is an appropriate task to delegate to AP. It provides objective
data about fluid status (1 kg weight gain ≈ 1 L fluid retention). Assessment tasks (lung
sounds, edema evaluation) and medication administration require nursing judgment and
cannot be delegated.
,Question 10
A nurse is caring for a group of clients. Which of the following clients should the
nurse attend to first?
A. A client who is anxious and attempting to pull out an IV line
B. A client who requests pain medication
C. A client who needs discharge teaching
D. A client who wants to ambulate to the bathroom
Correct Answer: A. A client who is anxious and attempting to pull out an IV line
Using the safety/risk reduction priority framework, the nurse should first attend to the
client at immediate risk for injury. Pulling out an IV line can cause bleeding, air
embolism, or loss of venous access for critical medications. This requires immediate
intervention to prevent harm.
Question 11
A nurse is providing discharge teaching about the use of car seats to the
guardian of a newborn. Which of the following statements by one of the
guardians indicates an understanding of the teaching?
A. "I should place the car seat in the front seat for easy access."
B. "I should ensure that the harness is snug around my baby's body."
C. "I can add a padded insert for my baby's comfort."
D. "I should position the car seat at a 45-degree angle facing forward."
Correct Answer: B. "I should ensure that the harness is snug around my baby's
body."
A snug harness (unable to pinch excess webbing at the shoulders) prevents the
newborn from being ejected or injured during a collision. The car seat should be in the
rear seat, rear-facing, at the appropriate angle (30-45 degrees), without aftermarket
inserts that haven't been crash-tested.
,Question 12
A nurse is reviewing the laboratory results of a toddler who has hemophilia A.
Which of the following aPTT (30 to 40 seconds) values should the nurse expect?
A. 25 seconds
B. 32 seconds
C. 45 seconds
D. 60 seconds
Correct Answer: C. 45 seconds
Hemophilia A is a deficiency of Factor VIII, which affects the intrinsic pathway of
coagulation. This results in a prolonged aPTT (normal: 30-40 seconds). A value of 45
seconds indicates prolonged clotting time consistent with hemophilia.
Question 13
A nurse manager is planning to make changes to the current scheduling system
on the unit. To facilitate the staff's acceptance of this change, which of the
following actions should the nurse manager take first?
A. Implement the new schedule on a trial basis
B. Provide information about scheduling issues to the staff
C. Ask for staff volunteers to create the new schedule
D. Announce the new schedule at the next staff meeting
Correct Answer: B. Provide information about scheduling issues to the staff
The first step in change management is communication and education. Providing
information about why change is needed (scheduling issues) helps staff understand the
rationale and reduces resistance. This follows Lewin's change theory: unfreezing
(preparing for change) comes before moving (implementing change).
Question 14 (Cloze)
, A nurse is caring for a client admitted with profuse vomiting and abdominal pain.
The client is at risk for developing _________ due to _________.
Options: Peritonitis / Dehydration / Electrolyte imbalance / Bowel obstruction / Gastric
ulcer / Appendicitis
Correct Answers: Peritonitis due to bowel obstruction
Profuse vomiting with abdominal pain suggests a bowel obstruction. If the obstruction
is not relieved, intestinal contents can leak into the peritoneal cavity, causing peritonitis
— a life-threatening inflammation of the peritoneum requiring emergency intervention.
Question 15 (Select Two)
The client is one day postoperative following a thyroidectomy. Select the 2
findings the nurse should report to the provider:
[ ] Heart rate of 45/min
[ ] Dressing dry and intact
[ ] Calcium level 8.2 mg/dL
[ ] Hoarse voice
[ ] Pain rated 3/10
Correct Answers:
• Heart rate (bradycardia of 45/min — possible hypocalcemia affecting cardiac
function)
• Dressing (if bloody or swollen — could indicate hemorrhage/hematoma)
After thyroidectomy, critical complications include:
• Hemorrhage/hematoma (check dressing and neck for swelling)
• Hypocalcemia from parathyroid damage (causes bradycardia, tetany, seizures)
• Recurrent laryngeal nerve damage (hoarseness — expected to some degree)