NCLEX-RN
Comprehensive
Exam
Total Questions: 75 | Time Allotted: 90 minutes
Section 1: Safe and Effective Care Environment –
Management of Care (Questions 1–12)
1. A nurse is caring for a client who has a new prescription for warfarin. Which of
the following laboratory values should the nurse monitor to evaluate the
effectiveness of the medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
Rationale: Warfarin is an anticoagulant that inhibits vitamin K–dependent clotting
factors. The INR is the standard laboratory test used to monitor warfarin therapy, with a
therapeutic range typically 2.0–3.0. aPTT is used to monitor heparin therapy. Platelet
count and bleeding time do not reflect warfarin's therapeutic effect.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate for the nurse to delegate?
,A. Administering oral medications to a stable client
B. Measuring and recording a client's intake and output
C. Assessing a client's postoperative incision
D. Teaching a client about a new medication
Rationale: Measuring and recording intake and output is a routine, non-invasive task
within the UAP's scope of practice. Medication administration, assessment, and client
teaching require the professional judgment and licensure of a registered nurse and
cannot be delegated to UAP.
3. A nurse is preparing to administer a blood transfusion. Which of the following
actions should the nurse take first?
A. Obtain the client's vital signs
B. Verify the client's identity and blood product compatibility with a second nurse
C. Prime the IV tubing with 0.9% sodium chloride
D. Explain the procedure to the client
Rationale: The priority action before initiating a blood transfusion is to verify client
identity and blood product compatibility with a second licensed nurse to prevent a
hemolytic transfusion reaction. While vital signs, priming with normal saline, and client
education are important, verification is the priority safety measure.
4. A nurse is reviewing a client's advance directive. The client has a living will
stating no cardiopulmonary resuscitation (CPR). The client is found unresponsive
and pulseless. Which of the following actions should the nurse take?
A. Begin CPR immediately
B. Honor the living will and withhold CPR
C. Call a code blue and begin chest compressions
D. Administer epinephrine
Rationale: A living will is a legal document that expresses the client's wishes regarding
life-sustaining treatment. If the document is valid and applies to the current situation,
the nurse must honor it and withhold CPR. Beginning CPR would violate the client's
legal right to refuse treatment.
,5. A nurse is caring for a client who speaks a different language than the nurse.
Which of the following actions should the nurse take to ensure effective
communication?
A. Ask a family member to interpret
B. Use a professional medical interpreter
C. Speak slowly and loudly in English
D. Use hand gestures to communicate
Rationale: Using a professional medical interpreter ensures accurate communication
and maintains confidentiality. Family members may misinterpret medical information or
filter content. Speaking loudly and using gestures do not overcome language barriers
and may lead to misunderstandings.
6. A nurse is participating in a quality improvement (QI) project. Which of the
following is the first step in the QI process?
A. Implementing a change
B. Identifying a problem or area for improvement
C. Evaluating the effectiveness of the change
D. Collecting data
Rationale: The QI process begins with identifying a problem or area needing
improvement. This is followed by data collection, planning and implementing
interventions, and evaluating outcomes. Without identifying the problem first,
subsequent steps cannot be effectively carried out.
7. A nurse is caring for a client who is scheduled for surgery. The client asks the
nurse, "What are the risks of this procedure?" Which of the following actions
should the nurse take?
A. Explain the risks in detail
B. Notify the surgeon to discuss the risks with the client
, C. Provide the client with a brochure about the surgery
D. Tell the client not to worry
Rationale: Informed consent requires that the provider performing the procedure
explain the risks, benefits, and alternatives. The nurse's role is to witness the consent and
ensure the client understands, not to explain the procedure's risks. The nurse should
notify the surgeon to address the client's questions.
8. A nurse is caring for a client who has been admitted with a diagnosis of active
tuberculosis (TB). Which of the following types of isolation precautions should the
nurse implement?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Standard precautions only
Rationale: Tuberculosis is transmitted via airborne droplets (droplet nuclei) that remain
suspended in the air. Airborne precautions require a negative-pressure room, N95
respirator, and door kept closed. Contact and droplet precautions are insufficient for TB.
9. A nurse is reviewing the medical record of a client who has a prescription for
digoxin. Which of the following findings should the nurse report to the provider?
A. Heart rate of 72 beats per minute
B. Serum potassium level of 3.2 mEq/L
C. Blood pressure of 118/76 mm Hg
D. Serum digoxin level of 1.2 ng/mL
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the risk of digoxin toxicity.
The nurse should report this finding. A heart rate of 72, BP of 118/76, and digoxin level
of 1.2 ng/mL (therapeutic range 0.5–2.0 ng/mL) are within normal limits.
Comprehensive
Exam
Total Questions: 75 | Time Allotted: 90 minutes
Section 1: Safe and Effective Care Environment –
Management of Care (Questions 1–12)
1. A nurse is caring for a client who has a new prescription for warfarin. Which of
the following laboratory values should the nurse monitor to evaluate the
effectiveness of the medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
Rationale: Warfarin is an anticoagulant that inhibits vitamin K–dependent clotting
factors. The INR is the standard laboratory test used to monitor warfarin therapy, with a
therapeutic range typically 2.0–3.0. aPTT is used to monitor heparin therapy. Platelet
count and bleeding time do not reflect warfarin's therapeutic effect.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate for the nurse to delegate?
,A. Administering oral medications to a stable client
B. Measuring and recording a client's intake and output
C. Assessing a client's postoperative incision
D. Teaching a client about a new medication
Rationale: Measuring and recording intake and output is a routine, non-invasive task
within the UAP's scope of practice. Medication administration, assessment, and client
teaching require the professional judgment and licensure of a registered nurse and
cannot be delegated to UAP.
3. A nurse is preparing to administer a blood transfusion. Which of the following
actions should the nurse take first?
A. Obtain the client's vital signs
B. Verify the client's identity and blood product compatibility with a second nurse
C. Prime the IV tubing with 0.9% sodium chloride
D. Explain the procedure to the client
Rationale: The priority action before initiating a blood transfusion is to verify client
identity and blood product compatibility with a second licensed nurse to prevent a
hemolytic transfusion reaction. While vital signs, priming with normal saline, and client
education are important, verification is the priority safety measure.
4. A nurse is reviewing a client's advance directive. The client has a living will
stating no cardiopulmonary resuscitation (CPR). The client is found unresponsive
and pulseless. Which of the following actions should the nurse take?
A. Begin CPR immediately
B. Honor the living will and withhold CPR
C. Call a code blue and begin chest compressions
D. Administer epinephrine
Rationale: A living will is a legal document that expresses the client's wishes regarding
life-sustaining treatment. If the document is valid and applies to the current situation,
the nurse must honor it and withhold CPR. Beginning CPR would violate the client's
legal right to refuse treatment.
,5. A nurse is caring for a client who speaks a different language than the nurse.
Which of the following actions should the nurse take to ensure effective
communication?
A. Ask a family member to interpret
B. Use a professional medical interpreter
C. Speak slowly and loudly in English
D. Use hand gestures to communicate
Rationale: Using a professional medical interpreter ensures accurate communication
and maintains confidentiality. Family members may misinterpret medical information or
filter content. Speaking loudly and using gestures do not overcome language barriers
and may lead to misunderstandings.
6. A nurse is participating in a quality improvement (QI) project. Which of the
following is the first step in the QI process?
A. Implementing a change
B. Identifying a problem or area for improvement
C. Evaluating the effectiveness of the change
D. Collecting data
Rationale: The QI process begins with identifying a problem or area needing
improvement. This is followed by data collection, planning and implementing
interventions, and evaluating outcomes. Without identifying the problem first,
subsequent steps cannot be effectively carried out.
7. A nurse is caring for a client who is scheduled for surgery. The client asks the
nurse, "What are the risks of this procedure?" Which of the following actions
should the nurse take?
A. Explain the risks in detail
B. Notify the surgeon to discuss the risks with the client
, C. Provide the client with a brochure about the surgery
D. Tell the client not to worry
Rationale: Informed consent requires that the provider performing the procedure
explain the risks, benefits, and alternatives. The nurse's role is to witness the consent and
ensure the client understands, not to explain the procedure's risks. The nurse should
notify the surgeon to address the client's questions.
8. A nurse is caring for a client who has been admitted with a diagnosis of active
tuberculosis (TB). Which of the following types of isolation precautions should the
nurse implement?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Standard precautions only
Rationale: Tuberculosis is transmitted via airborne droplets (droplet nuclei) that remain
suspended in the air. Airborne precautions require a negative-pressure room, N95
respirator, and door kept closed. Contact and droplet precautions are insufficient for TB.
9. A nurse is reviewing the medical record of a client who has a prescription for
digoxin. Which of the following findings should the nurse report to the provider?
A. Heart rate of 72 beats per minute
B. Serum potassium level of 3.2 mEq/L
C. Blood pressure of 118/76 mm Hg
D. Serum digoxin level of 1.2 ng/mL
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the risk of digoxin toxicity.
The nurse should report this finding. A heart rate of 72, BP of 118/76, and digoxin level
of 1.2 ng/mL (therapeutic range 0.5–2.0 ng/mL) are within normal limits.
