Chamberlain
NCLEX-RN
Comprehensive
Review Exam
Total Questions: 100 | Recommended Time: 120 minutes
Section 1: Management of Care (Questions 1–15)
1. A nurse is caring for a client with a spinal cord injury at T4 who suddenly
develops a pounding headache, facial flushing, and severe hypertension. Which
action should the nurse take first?
A. Administer prescribed antihypertensive medication
B. Place the client in a high-Fowler's position
C. Increase intravenous fluid administration
D. Encourage the client to lie flat
Rationale: This presentation indicates autonomic dysreflexia, a life-threatening
emergency in clients with spinal cord injuries above T6. The first action is to elevate the
head of the bed to reduce blood pressure, then identify and remove the triggering
stimulus (most commonly bladder distention or fecal impaction).
,2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task
is appropriate to delegate?
A. Administering oral medications
B. Measuring and recording intake and output
C. Assessing a postoperative incision
D. Teaching a client about a new medication
Rationale: Measuring and recording intake and output is a routine, non-invasive task
within UAP scope. Medication administration, assessment, and teaching require RN
judgment.
3. A nurse is caring for a client who has a living will stating no CPR. The client is
found unresponsive and pulseless. Which action should the nurse take?
A. Begin CPR immediately
B. Honor the living will and withhold CPR
C. Call a code blue
D. Administer epinephrine
Rationale: A living will is a legal document expressing the client's wishes. The nurse
must honor it and withhold CPR if the document is valid and applies.
4. A nurse is preparing to administer a blood transfusion. Which action should the
nurse take first?
A. Obtain vital signs
B. Verify client identity and blood product compatibility with a second nurse
C. Prime IV tubing with 0.9% sodium chloride
D. Explain the procedure
Rationale: Verification of client identity and blood product compatibility with a second
licensed nurse is the priority safety measure to prevent hemolytic transfusion reaction.
,5. A nurse is reviewing a client's medication record and notes a discrepancy. Which
action should the nurse take?
A. Administer the medication as written
B. Clarify the order with the prescribing provider
C. Ask another nurse to administer
D. Document and administer
Rationale: Unclear or discrepant medication orders must be clarified with the prescriber
before administration to prevent harm.
6. A nurse is caring for a client with active tuberculosis. Which isolation
precautions should be implemented?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Standard precautions
Rationale: TB is transmitted via airborne droplet nuclei requiring a negative-pressure
room and N95 respirator.
7. A client with COPD has a primary breathing drive based on:
A. High carbon dioxide levels
B. Low oxygen levels
C. High pH levels
D. Low bicarbonate levels
Rationale: In chronic CO₂ retainers, central chemoreceptors become insensitive to CO₂.
The hypoxic drive (low oxygen) becomes the stimulus to breathe.
8. Which laboratory marker is most specific for cardiac muscle damage?
, A. CK-MB
B. Myoglobin
C. Troponin I
D. C-reactive protein
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer
than CK-MB, making it the gold standard for diagnosing MI.
9. A nurse is caring for a client in the manic phase of bipolar disorder. Which
activity is most appropriate?
A. Playing chess with another client
B. Attending a 2-hour group therapy session
C. Walking around the unit with a nurse
D. Reading a long novel
Rationale: Manic clients have high energy and short attention spans. Physical activity
like walking helps channel energy without requiring intense concentration.
10. A client with a history of alcohol abuse is admitted for detoxification. Which
medication is commonly used to prevent seizures during withdrawal?
A. Disulfiram
B. Lorazepam
C. Methadone
D. Naloxone
Rationale: Benzodiazepines like lorazepam are first-line treatment for managing alcohol
withdrawal and preventing seizures/delirium tremens.
11. A client is receiving continuous heparin infusion. The nurse notes aPTT of 110
seconds (normal 25–35). Which action should the nurse take?
NCLEX-RN
Comprehensive
Review Exam
Total Questions: 100 | Recommended Time: 120 minutes
Section 1: Management of Care (Questions 1–15)
1. A nurse is caring for a client with a spinal cord injury at T4 who suddenly
develops a pounding headache, facial flushing, and severe hypertension. Which
action should the nurse take first?
A. Administer prescribed antihypertensive medication
B. Place the client in a high-Fowler's position
C. Increase intravenous fluid administration
D. Encourage the client to lie flat
Rationale: This presentation indicates autonomic dysreflexia, a life-threatening
emergency in clients with spinal cord injuries above T6. The first action is to elevate the
head of the bed to reduce blood pressure, then identify and remove the triggering
stimulus (most commonly bladder distention or fecal impaction).
,2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task
is appropriate to delegate?
A. Administering oral medications
B. Measuring and recording intake and output
C. Assessing a postoperative incision
D. Teaching a client about a new medication
Rationale: Measuring and recording intake and output is a routine, non-invasive task
within UAP scope. Medication administration, assessment, and teaching require RN
judgment.
3. A nurse is caring for a client who has a living will stating no CPR. The client is
found unresponsive and pulseless. Which action should the nurse take?
A. Begin CPR immediately
B. Honor the living will and withhold CPR
C. Call a code blue
D. Administer epinephrine
Rationale: A living will is a legal document expressing the client's wishes. The nurse
must honor it and withhold CPR if the document is valid and applies.
4. A nurse is preparing to administer a blood transfusion. Which action should the
nurse take first?
A. Obtain vital signs
B. Verify client identity and blood product compatibility with a second nurse
C. Prime IV tubing with 0.9% sodium chloride
D. Explain the procedure
Rationale: Verification of client identity and blood product compatibility with a second
licensed nurse is the priority safety measure to prevent hemolytic transfusion reaction.
,5. A nurse is reviewing a client's medication record and notes a discrepancy. Which
action should the nurse take?
A. Administer the medication as written
B. Clarify the order with the prescribing provider
C. Ask another nurse to administer
D. Document and administer
Rationale: Unclear or discrepant medication orders must be clarified with the prescriber
before administration to prevent harm.
6. A nurse is caring for a client with active tuberculosis. Which isolation
precautions should be implemented?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Standard precautions
Rationale: TB is transmitted via airborne droplet nuclei requiring a negative-pressure
room and N95 respirator.
7. A client with COPD has a primary breathing drive based on:
A. High carbon dioxide levels
B. Low oxygen levels
C. High pH levels
D. Low bicarbonate levels
Rationale: In chronic CO₂ retainers, central chemoreceptors become insensitive to CO₂.
The hypoxic drive (low oxygen) becomes the stimulus to breathe.
8. Which laboratory marker is most specific for cardiac muscle damage?
, A. CK-MB
B. Myoglobin
C. Troponin I
D. C-reactive protein
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer
than CK-MB, making it the gold standard for diagnosing MI.
9. A nurse is caring for a client in the manic phase of bipolar disorder. Which
activity is most appropriate?
A. Playing chess with another client
B. Attending a 2-hour group therapy session
C. Walking around the unit with a nurse
D. Reading a long novel
Rationale: Manic clients have high energy and short attention spans. Physical activity
like walking helps channel energy without requiring intense concentration.
10. A client with a history of alcohol abuse is admitted for detoxification. Which
medication is commonly used to prevent seizures during withdrawal?
A. Disulfiram
B. Lorazepam
C. Methadone
D. Naloxone
Rationale: Benzodiazepines like lorazepam are first-line treatment for managing alcohol
withdrawal and preventing seizures/delirium tremens.
11. A client is receiving continuous heparin infusion. The nurse notes aPTT of 110
seconds (normal 25–35). Which action should the nurse take?
