NGN Comprehensive RN Practice Test 2026 – Updated Clinical Judgment Exam with
Detailed Rationales Next Generation RN Comprehensive Predictor Study Guide – 50 High-
Level NCLEX Questions
Med-Surg & Fundamentals
Question 1 – Respiratory (Med-Surg)
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who reports increased
shortness of breath. Which nursing action should the nurse take first?
A. Administer prescribed bronchodilator
B. Assess oxygen saturation
C. Encourage pursed-lip breathing
D. Notify the provider
✅ Correct Answer: B. Assess oxygen saturation
Rationale: The nurse should assess oxygenation first to determine the client’s current status before
intervening. This follows the nursing process—assessment before action.
Question 2 – Fluid & Electrolytes
A client with heart failure is taking furosemide. Which finding should the nurse report immediately?
A. Weight loss of 1 kg in 1 day
B. Serum potassium 2.9 mEq/L
C. Urine output 2000 mL/24 hr
D. Mild dizziness when standing
✅ Correct Answer: B. Serum potassium 2.9 mEq/L
Rationale: Hypokalemia can lead to cardiac dysrhythmias. This is a critical lab value that requires
immediate intervention.
Question 3 – Infection Control
Which client should be placed in contact precautions?
A. A client with measles
B. A client with tuberculosis
C. A client with C. difficile infection
D. A client with influenza
,✅ Correct Answer: C. A client with Clostridioides difficile
Rationale: C. difficile requires contact precautions (gown and gloves). Alcohol-based sanitizers do not
kill spores—handwashing with soap and water is required.
Question 4 – Safety
A nurse finds a client with dementia wandering the hallway, confused and attempting to leave. What is
the priority action?
A. Reorient the client and escort them back to their room
B. Call security immediately
C. Apply wrist restraints
D. Notify the provider
✅ Correct Answer: A. Reorient and redirect
Rationale: The safest and least restrictive intervention is used first. Reorientation helps reduce
confusion and maintains client dignity.
Question 5 – Nutrition
A nurse is teaching a client recovering from surgery about protein intake. Which food selection indicates
understanding?
A. Oatmeal and fruit
B. Chicken breast and lentils
C. Toast with jam
D. Mashed potatoes
✅ Correct Answer: B. Chicken breast and lentils
Rationale: Protein promotes tissue healing. Both chicken and lentils are high in protein, suitable for
post-surgical recovery.
Question 6 – Pain Management (NGN-style select all that apply)
A client reports pain rated 8/10 after abdominal surgery. Which actions should the nurse implement?
(Select all that apply)
A. Reposition the client
B. Encourage deep breathing and relaxation
C. Administer prescribed analgesic
D. Delay medication to assess tolerance
E. Evaluate pain relief after medication
✅ Correct Answers: A, B, C, E
Rationale: Effective pain management includes nonpharmacologic and pharmacologic interventions and
reassessment. Delaying medication is inappropriate.
, Question 7 – Oxygen Therapy
A client with COPD is receiving 4 L/min oxygen via nasal cannula. The client’s SpO₂ is 98%. What should
the nurse do?
A. Continue oxygen as ordered
B. Decrease oxygen flow to 2 L/min
C. Switch to a nonrebreather mask
D. Notify provider of low oxygen level
✅ Correct Answer: B. Decrease oxygen flow to 2 L/min
Rationale: COPD clients rely on hypoxic drive; excessive oxygen can suppress respirations. Maintain
SpO₂ 88–92%.
Question 8 – Postoperative Care
A client is 4 hours postoperative following abdominal surgery. Which finding requires immediate
intervention?
A. Hypoactive bowel sounds
B. Moderate serosanguinous drainage at incision
C. Restlessness and anxiety
D. Pain rated 6/10
✅ Correct Answer: C. Restlessness and anxiety
Rationale: These may indicate hypoxia or internal bleeding—priority assessment needed.
Question 9 – Medication Administration
A nurse prepares to administer digoxin 0.125 mg. The apical pulse is 52 bpm. What should the nurse do?
A. Administer the dose
B. Recheck the pulse in 15 minutes
C. Hold the dose and notify the provider
D. Give half the prescribed dose
✅ Correct Answer: C. Hold the dose and notify the provider
Rationale: Digoxin can cause bradycardia; withhold medication if HR < 60 bpm and report findings.
Question 10 – Prioritization
Which client should the nurse assess first?
A. Client with pneumonia and O₂ saturation 88%
B. Client reporting chronic back pain
Detailed Rationales Next Generation RN Comprehensive Predictor Study Guide – 50 High-
Level NCLEX Questions
Med-Surg & Fundamentals
Question 1 – Respiratory (Med-Surg)
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who reports increased
shortness of breath. Which nursing action should the nurse take first?
A. Administer prescribed bronchodilator
B. Assess oxygen saturation
C. Encourage pursed-lip breathing
D. Notify the provider
✅ Correct Answer: B. Assess oxygen saturation
Rationale: The nurse should assess oxygenation first to determine the client’s current status before
intervening. This follows the nursing process—assessment before action.
Question 2 – Fluid & Electrolytes
A client with heart failure is taking furosemide. Which finding should the nurse report immediately?
A. Weight loss of 1 kg in 1 day
B. Serum potassium 2.9 mEq/L
C. Urine output 2000 mL/24 hr
D. Mild dizziness when standing
✅ Correct Answer: B. Serum potassium 2.9 mEq/L
Rationale: Hypokalemia can lead to cardiac dysrhythmias. This is a critical lab value that requires
immediate intervention.
Question 3 – Infection Control
Which client should be placed in contact precautions?
A. A client with measles
B. A client with tuberculosis
C. A client with C. difficile infection
D. A client with influenza
,✅ Correct Answer: C. A client with Clostridioides difficile
Rationale: C. difficile requires contact precautions (gown and gloves). Alcohol-based sanitizers do not
kill spores—handwashing with soap and water is required.
Question 4 – Safety
A nurse finds a client with dementia wandering the hallway, confused and attempting to leave. What is
the priority action?
A. Reorient the client and escort them back to their room
B. Call security immediately
C. Apply wrist restraints
D. Notify the provider
✅ Correct Answer: A. Reorient and redirect
Rationale: The safest and least restrictive intervention is used first. Reorientation helps reduce
confusion and maintains client dignity.
Question 5 – Nutrition
A nurse is teaching a client recovering from surgery about protein intake. Which food selection indicates
understanding?
A. Oatmeal and fruit
B. Chicken breast and lentils
C. Toast with jam
D. Mashed potatoes
✅ Correct Answer: B. Chicken breast and lentils
Rationale: Protein promotes tissue healing. Both chicken and lentils are high in protein, suitable for
post-surgical recovery.
Question 6 – Pain Management (NGN-style select all that apply)
A client reports pain rated 8/10 after abdominal surgery. Which actions should the nurse implement?
(Select all that apply)
A. Reposition the client
B. Encourage deep breathing and relaxation
C. Administer prescribed analgesic
D. Delay medication to assess tolerance
E. Evaluate pain relief after medication
✅ Correct Answers: A, B, C, E
Rationale: Effective pain management includes nonpharmacologic and pharmacologic interventions and
reassessment. Delaying medication is inappropriate.
, Question 7 – Oxygen Therapy
A client with COPD is receiving 4 L/min oxygen via nasal cannula. The client’s SpO₂ is 98%. What should
the nurse do?
A. Continue oxygen as ordered
B. Decrease oxygen flow to 2 L/min
C. Switch to a nonrebreather mask
D. Notify provider of low oxygen level
✅ Correct Answer: B. Decrease oxygen flow to 2 L/min
Rationale: COPD clients rely on hypoxic drive; excessive oxygen can suppress respirations. Maintain
SpO₂ 88–92%.
Question 8 – Postoperative Care
A client is 4 hours postoperative following abdominal surgery. Which finding requires immediate
intervention?
A. Hypoactive bowel sounds
B. Moderate serosanguinous drainage at incision
C. Restlessness and anxiety
D. Pain rated 6/10
✅ Correct Answer: C. Restlessness and anxiety
Rationale: These may indicate hypoxia or internal bleeding—priority assessment needed.
Question 9 – Medication Administration
A nurse prepares to administer digoxin 0.125 mg. The apical pulse is 52 bpm. What should the nurse do?
A. Administer the dose
B. Recheck the pulse in 15 minutes
C. Hold the dose and notify the provider
D. Give half the prescribed dose
✅ Correct Answer: C. Hold the dose and notify the provider
Rationale: Digoxin can cause bradycardia; withhold medication if HR < 60 bpm and report findings.
Question 10 – Prioritization
Which client should the nurse assess first?
A. Client with pneumonia and O₂ saturation 88%
B. Client reporting chronic back pain
