RN COMPREHENSIVE NURSING
Practice Examination
Comprehensive Predictor Review | 2026
Management of Care | Safety | Health Promotion | Psychosocial Integrity |
Basic Care & Comfort | Pharmacology | Risk Reduction | Physiological Adaptation
IMPORTANT NOTICE
This is an original educational practice resource created for nursing students preparing for
comprehensive examinations. It is not affiliated with, endorsed by, or copied from ATI, VATI,
NCLEX, or any specific testing organization. All questions are independently authored to reinforce
general nursing knowledge and critical thinking skills. Use alongside your textbooks, coursework, and
official study materials.
Total Questions: 150 | All 8 NCLEX Client Need Categories | Includes Rationales
,SECTION 1: MANAGEMENT OF CARE (20 Questions)
1. A nurse on a medical-surgical unit receives report on four clients. Which client should the nurse
assess first?
A. A client 2 hours post-op appendectomy with a blood pressure of 110/68 mmHg
B. A client with pneumonia whose oxygen saturation dropped from 96% to 88% on room air
C. A client with heart failure reporting increased ankle edema over the past 3 days
D. A client with diabetes requesting a snack before bedtime
Rationale: Airway and breathing are the highest priorities (ABCs). A drop in SpO2 to 88% indicates potential respiratory
compromise requiring immediate assessment and intervention.
2. The charge nurse is delegating tasks on a busy unit. Which task is most appropriate to delegate
to a licensed practical nurse (LPN)?
A. Performing the initial assessment on a newly admitted client
B. Administering oral medications to stable clients
C. Developing the plan of care for a client with complex needs
D. Teaching a client about insulin self-administration
Rationale: LPNs can administer oral medications to stable clients. Initial assessments, care planning, and client
education requiring teaching and evaluation are within the RN scope of practice.
3. A nurse manager notices an increase in medication errors on the unit. Which quality improvement
action should be taken first?
A. Terminate the nurses involved in the errors
B. Conduct a root cause analysis to identify system issues
C. Increase the nurse-to-client ratio immediately
D. Implement a new documentation system without staff input
Rationale: Root cause analysis identifies underlying system issues rather than blaming individuals. Most errors result
from system failures, not individual negligence.
4. A client is scheduled for surgery and asks the nurse to witness their advance directive. What is
the nurse's best action?
A. Refuse because nurses cannot witness legal documents
B. Witness the signature if the client is alert and oriented
C. Tell the client to have a family member witness it instead
D. Contact the surgeon to witness the document
Rationale: Nurses can witness advance directives if the client is competent and understands the document. The nurse is
attesting to the client's identity and capacity, not the content.
5. During a code blue, the nurse notes that the defibrillator pads are expired. What should the nurse
do?
A. Use the expired pads because an emergency takes priority
B. Obtain unexpired pads from another unit before shocking
C. Use manual paddles if available while someone retrieves new pads
, D. Delay defibrillation until new pads are located
Rationale: In a code situation, the nurse should use available resources (manual paddles) while ensuring proper
equipment is obtained. Delaying defibrillation is not appropriate, but expired pads may not adhere properly.
6. A new graduate nurse is struggling with time management. Which strategy should the preceptor
recommend?
A. Complete all documentation at the end of the shift
B. Prioritize tasks based on client acuity and safety needs
C. Delegate all medication administration to the LPN
D. Avoid taking breaks to finish all tasks on time
Rationale: Effective time management involves prioritizing by acuity and safety (Maslow's hierarchy, ABCs). Delayed
documentation is unsafe; inappropriate delegation and skipping breaks are not sustainable.
7. A client with a do-not-resuscitate (DNR) order develops cardiac arrest. What is the nurse's priority
action?
A. Begin CPR immediately regardless of the DNR order
B. Verify the DNR order is current and notify the provider
C. Ask the family what they want done in the moment
D. Transfer the client to the ICU for advanced care
Rationale: The nurse must verify the DNR order is current and valid. If confirmed, comfort measures are provided.
Initiating CPR would violate the client's wishes and constitute battery.
8. A nurse is caring for a client whose family insists on aggressive treatment the client previously
refused. What is the nurse's best response?
A. Follow the family's wishes to maintain good relations
B. Honor the client's previously expressed wishes and advocate for them
C. Ask the ethics committee to make the decision
D. Provide the treatment and document the family's request
Rationale: Client autonomy takes precedence. The nurse advocates for the client's wishes, which may involve reviewing
advance directives and facilitating family communication, not unilateral family decisions.
9. Which action by the nurse demonstrates appropriate use of informed consent?
A. Having the client sign the consent form after sedation is administered
B. Ensuring the client understands the procedure, risks, benefits, and alternatives before signing
C. Explaining the procedure quickly because the surgeon will answer questions
D. Obtaining consent from the client's spouse because the client is anxious
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives
voluntarily. Consent must be obtained before sedation and from the client directly if competent.
10. A nurse discovers that a colleague is documenting assessments that were not performed. What
is the nurse's first action?
A. Report the colleague to the state board of nursing immediately
B. Confront the colleague privately and report to the charge nurse if it continues
, C. Ignore the behavior to avoid conflict with a coworker
D. Document the observations in the client's chart
Rationale: Falsification of documentation is serious. The nurse should first address it with the colleague (professional
accountability) and escalate to the charge nurse or manager if the behavior continues, following chain of command.
11. A client is being transferred from the ICU to a medical-surgical unit. What is the nurse's priority
during handoff communication?
A. Provide a detailed social history of the client
B. Use a standardized tool (SBAR) to communicate critical information
C. Focus primarily on the client's dietary preferences
D. Delay the report until all documentation is complete
Rationale: Standardized handoff tools like SBAR (Situation, Background, Assessment, Recommendation) ensure
consistent, complete communication of critical information and reduce errors during transitions of care.
12. The nurse is leading a team response to a mass casualty incident. Which triage category should
receive care first?
A. Clients with minor injuries who can walk
B. Clients with life-threatening injuries who are likely to survive with immediate care
C. Clients with severe injuries who are unlikely to survive even with care
D. Clients who are already deceased
Rationale: In mass casualty triage (START system), immediate (red tag) clients have life-threatening injuries but high
survivability with prompt intervention. This maximizes the number of lives saved.
13. A nurse is reviewing staffing assignments. Which factor is most important when making
assignments?
A. Assigning the same number of clients to each nurse
B. Matching nurse competency and experience to client acuity and needs
C. Assigning clients based on which nurse has been on the unit longest
D. Giving the most complex clients to the newest nurses for learning opportunities
Rationale: Safe staffing matches nurse competency to client acuity. Equal numbers do not ensure safety; experience
and skill level must align with client complexity.
14. A client expresses dissatisfaction with their care and requests to speak with a patient advocate.
What is the nurse's best response?
A. Tell the client that advocates are only for serious complaints
B. Provide the client with contact information for the patient advocate office
C. Ask the client to first discuss the issue with the physician
D. Discourage the client from filing a complaint to protect the unit's reputation
Rationale: Clients have the right to voice concerns and access patient advocacy services. The nurse facilitates this
process without judgment or barriers.
15. A nurse is preparing to discharge a client who will need home health services. What is the
nurse's priority?
A. Ensure the client has a follow-up appointment scheduled
Practice Examination
Comprehensive Predictor Review | 2026
Management of Care | Safety | Health Promotion | Psychosocial Integrity |
Basic Care & Comfort | Pharmacology | Risk Reduction | Physiological Adaptation
IMPORTANT NOTICE
This is an original educational practice resource created for nursing students preparing for
comprehensive examinations. It is not affiliated with, endorsed by, or copied from ATI, VATI,
NCLEX, or any specific testing organization. All questions are independently authored to reinforce
general nursing knowledge and critical thinking skills. Use alongside your textbooks, coursework, and
official study materials.
Total Questions: 150 | All 8 NCLEX Client Need Categories | Includes Rationales
,SECTION 1: MANAGEMENT OF CARE (20 Questions)
1. A nurse on a medical-surgical unit receives report on four clients. Which client should the nurse
assess first?
A. A client 2 hours post-op appendectomy with a blood pressure of 110/68 mmHg
B. A client with pneumonia whose oxygen saturation dropped from 96% to 88% on room air
C. A client with heart failure reporting increased ankle edema over the past 3 days
D. A client with diabetes requesting a snack before bedtime
Rationale: Airway and breathing are the highest priorities (ABCs). A drop in SpO2 to 88% indicates potential respiratory
compromise requiring immediate assessment and intervention.
2. The charge nurse is delegating tasks on a busy unit. Which task is most appropriate to delegate
to a licensed practical nurse (LPN)?
A. Performing the initial assessment on a newly admitted client
B. Administering oral medications to stable clients
C. Developing the plan of care for a client with complex needs
D. Teaching a client about insulin self-administration
Rationale: LPNs can administer oral medications to stable clients. Initial assessments, care planning, and client
education requiring teaching and evaluation are within the RN scope of practice.
3. A nurse manager notices an increase in medication errors on the unit. Which quality improvement
action should be taken first?
A. Terminate the nurses involved in the errors
B. Conduct a root cause analysis to identify system issues
C. Increase the nurse-to-client ratio immediately
D. Implement a new documentation system without staff input
Rationale: Root cause analysis identifies underlying system issues rather than blaming individuals. Most errors result
from system failures, not individual negligence.
4. A client is scheduled for surgery and asks the nurse to witness their advance directive. What is
the nurse's best action?
A. Refuse because nurses cannot witness legal documents
B. Witness the signature if the client is alert and oriented
C. Tell the client to have a family member witness it instead
D. Contact the surgeon to witness the document
Rationale: Nurses can witness advance directives if the client is competent and understands the document. The nurse is
attesting to the client's identity and capacity, not the content.
5. During a code blue, the nurse notes that the defibrillator pads are expired. What should the nurse
do?
A. Use the expired pads because an emergency takes priority
B. Obtain unexpired pads from another unit before shocking
C. Use manual paddles if available while someone retrieves new pads
, D. Delay defibrillation until new pads are located
Rationale: In a code situation, the nurse should use available resources (manual paddles) while ensuring proper
equipment is obtained. Delaying defibrillation is not appropriate, but expired pads may not adhere properly.
6. A new graduate nurse is struggling with time management. Which strategy should the preceptor
recommend?
A. Complete all documentation at the end of the shift
B. Prioritize tasks based on client acuity and safety needs
C. Delegate all medication administration to the LPN
D. Avoid taking breaks to finish all tasks on time
Rationale: Effective time management involves prioritizing by acuity and safety (Maslow's hierarchy, ABCs). Delayed
documentation is unsafe; inappropriate delegation and skipping breaks are not sustainable.
7. A client with a do-not-resuscitate (DNR) order develops cardiac arrest. What is the nurse's priority
action?
A. Begin CPR immediately regardless of the DNR order
B. Verify the DNR order is current and notify the provider
C. Ask the family what they want done in the moment
D. Transfer the client to the ICU for advanced care
Rationale: The nurse must verify the DNR order is current and valid. If confirmed, comfort measures are provided.
Initiating CPR would violate the client's wishes and constitute battery.
8. A nurse is caring for a client whose family insists on aggressive treatment the client previously
refused. What is the nurse's best response?
A. Follow the family's wishes to maintain good relations
B. Honor the client's previously expressed wishes and advocate for them
C. Ask the ethics committee to make the decision
D. Provide the treatment and document the family's request
Rationale: Client autonomy takes precedence. The nurse advocates for the client's wishes, which may involve reviewing
advance directives and facilitating family communication, not unilateral family decisions.
9. Which action by the nurse demonstrates appropriate use of informed consent?
A. Having the client sign the consent form after sedation is administered
B. Ensuring the client understands the procedure, risks, benefits, and alternatives before signing
C. Explaining the procedure quickly because the surgeon will answer questions
D. Obtaining consent from the client's spouse because the client is anxious
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives
voluntarily. Consent must be obtained before sedation and from the client directly if competent.
10. A nurse discovers that a colleague is documenting assessments that were not performed. What
is the nurse's first action?
A. Report the colleague to the state board of nursing immediately
B. Confront the colleague privately and report to the charge nurse if it continues
, C. Ignore the behavior to avoid conflict with a coworker
D. Document the observations in the client's chart
Rationale: Falsification of documentation is serious. The nurse should first address it with the colleague (professional
accountability) and escalate to the charge nurse or manager if the behavior continues, following chain of command.
11. A client is being transferred from the ICU to a medical-surgical unit. What is the nurse's priority
during handoff communication?
A. Provide a detailed social history of the client
B. Use a standardized tool (SBAR) to communicate critical information
C. Focus primarily on the client's dietary preferences
D. Delay the report until all documentation is complete
Rationale: Standardized handoff tools like SBAR (Situation, Background, Assessment, Recommendation) ensure
consistent, complete communication of critical information and reduce errors during transitions of care.
12. The nurse is leading a team response to a mass casualty incident. Which triage category should
receive care first?
A. Clients with minor injuries who can walk
B. Clients with life-threatening injuries who are likely to survive with immediate care
C. Clients with severe injuries who are unlikely to survive even with care
D. Clients who are already deceased
Rationale: In mass casualty triage (START system), immediate (red tag) clients have life-threatening injuries but high
survivability with prompt intervention. This maximizes the number of lives saved.
13. A nurse is reviewing staffing assignments. Which factor is most important when making
assignments?
A. Assigning the same number of clients to each nurse
B. Matching nurse competency and experience to client acuity and needs
C. Assigning clients based on which nurse has been on the unit longest
D. Giving the most complex clients to the newest nurses for learning opportunities
Rationale: Safe staffing matches nurse competency to client acuity. Equal numbers do not ensure safety; experience
and skill level must align with client complexity.
14. A client expresses dissatisfaction with their care and requests to speak with a patient advocate.
What is the nurse's best response?
A. Tell the client that advocates are only for serious complaints
B. Provide the client with contact information for the patient advocate office
C. Ask the client to first discuss the issue with the physician
D. Discourage the client from filing a complaint to protect the unit's reputation
Rationale: Clients have the right to voice concerns and access patient advocacy services. The nurse facilitates this
process without judgment or barriers.
15. A nurse is preparing to discharge a client who will need home health services. What is the
nurse's priority?
A. Ensure the client has a follow-up appointment scheduled
