NCLEX COMPREHENSIVE
EXAM PRACTICE
1️⃣ Enalapril Maleate Administration
Question:
Enalapril maleate is prescribed for a hospitalized patient. Which assessment does the nurse
perform as a priority before administering the medication?
A. Checking the patient’s peripheral pulses
✅ B. Checking the patient’s blood pressure
C. Reviewing the patient’s potassium level
D. Monitoring intake and output
Rationale:
Enalapril is an ACE inhibitor used to treat hypertension. One side effect is postural
hypotension; therefore, the nurse must check blood pressure immediately before
administration. Other assessments are important but not the top priority for this drug.
2️⃣ Upper GI Series Preparation
Question:
A patient scheduled for an upper GI series states, “I need to drink citrate of magnesia the night
before and give myself an enema in the morning.” Which statement indicates a need for further
teaching?
✅ A. “I need to drink citrate of magnesia the night before the test and give myself a Fleet
enema on the morning of the test.”
B. “I must remain NPO for 8 hours before the test.”
C. “I’ll swallow a barium mixture during the test.”
D. “I’ll take a laxative after the test.”
Rationale:
An upper GI series involves swallowing barium to visualize the upper GI tract. The patient
1
,must be NPO for 8 hours but does not require laxatives or enemas before the test. After the
procedure, a laxative is given to expel barium and prevent impaction.
3️⃣ Medication Dose Clarification
Question:
A nurse notes that a prescribed medication dose is unusually high and the provider is unavailable
until morning. What should the nurse do?
✅ A. Ask the answering service to contact the on-call health care provider.
B. Wait until morning to clarify.
C. Call the nursing supervisor.
D. Administer the medication as prescribed.
Rationale:
The nurse has a legal and ethical duty to protect the patient from harm. If a dose appears
incorrect, the medication must be withheld and clarified with the on-call provider before
administration.
4️⃣ PVCs in a Patient With MI
Question:
A patient with an acute MI develops premature ventricular contractions (PVCs) with no
perfusion. What is the nurse’s priority action?
✅ A. Ask the ED health care provider to check the patient.
B. Continue to monitor and document.
C. Administer oxygen immediately.
D. Tell the patient the PVCs are expected.
Rationale:
PVCs may indicate ventricular irritability and can precede ventricular tachycardia or
fibrillation. Because there’s no perfusion, this is potentially life-threatening, and the provider
must be notified immediately.
5️⃣ NPO and Morning Antihypertensive Before ECT
2
,Question:
A patient scheduled for electroconvulsive therapy (ECT) is NPO. The patient routinely takes a
morning antihypertensive. What should the nurse do?
✅ A. Administer the antihypertensive with a small sip of water.
B. Withhold until bedtime.
C. Give after ECT.
D. Change the route to IV.
Rationale:
Patients must be NPO before ECT to prevent aspiration, but antihypertensives, cardiac meds,
and H₂ blockers should be given with a small sip of water to prevent complications such as
rebound hypertension.
6️⃣ Depression After Cardiac Surgery
Question:
A patient who recently underwent coronary artery bypass surgery reports feeling depressed.
Which response by the nurse is therapeutic?
✅ A. “Tell me more about what you’re feeling.”
B. “This is normal after surgery.”
C. “You’ll feel better soon.”
D. “Everyone feels that way.”
Rationale:
Therapeutic communication encourages the expression of feelings. Avoid false reassurance or
generalizations, which minimize the patient’s emotions.
7️⃣ Yellow, Foul Amniotic Fluid
Question:
A laboring patient’s amniotic fluid is yellow and foul-smelling after rupture of membranes. What
should the nurse do first?
✅ A. Contact the health care provider.
B. Continue monitoring.
C. Document findings.
D. Check for protein in the fluid.
3
, Rationale:
Normal amniotic fluid is clear and mild in odor. A foul or yellow color suggests
chorioamnionitis, a serious infection requiring immediate provider notification.
8️⃣ Post–Central Venous Catheter Insertion
Question:
After insertion of a central venous catheter for parenteral nutrition (PN), what is the nurse’s
immediate action?
✅ A. Call radiology for a chest X-ray.
B. Start PN infusion.
C. Flush the line with saline.
D. Obtain a blood glucose.
Rationale:
A chest X-ray is required to confirm catheter placement and rule out pneumothorax before
any infusions are started.
9️⃣ Rape Victim and HIV Concern
Question:
A rape victim says, “I’m really worried that I’ve got HIV now.” What is the appropriate nurse
response?
✅ A. “Let’s talk about the information that you need to determine your risk of
contracting HIV.”
B. “You’re more likely to get pregnant than HIV.”
C. “HIV is rarely an issue in rape victims.”
D. “Every rape victim is concerned about HIV.”
Rationale:
The nurse should address the patient’s concern directly, provide accurate information, and
support informed decision-making. Avoid false reassurance or minimizing statements.
10️⃣ Ibuprofen and GI Upset
4
EXAM PRACTICE
1️⃣ Enalapril Maleate Administration
Question:
Enalapril maleate is prescribed for a hospitalized patient. Which assessment does the nurse
perform as a priority before administering the medication?
A. Checking the patient’s peripheral pulses
✅ B. Checking the patient’s blood pressure
C. Reviewing the patient’s potassium level
D. Monitoring intake and output
Rationale:
Enalapril is an ACE inhibitor used to treat hypertension. One side effect is postural
hypotension; therefore, the nurse must check blood pressure immediately before
administration. Other assessments are important but not the top priority for this drug.
2️⃣ Upper GI Series Preparation
Question:
A patient scheduled for an upper GI series states, “I need to drink citrate of magnesia the night
before and give myself an enema in the morning.” Which statement indicates a need for further
teaching?
✅ A. “I need to drink citrate of magnesia the night before the test and give myself a Fleet
enema on the morning of the test.”
B. “I must remain NPO for 8 hours before the test.”
C. “I’ll swallow a barium mixture during the test.”
D. “I’ll take a laxative after the test.”
Rationale:
An upper GI series involves swallowing barium to visualize the upper GI tract. The patient
1
,must be NPO for 8 hours but does not require laxatives or enemas before the test. After the
procedure, a laxative is given to expel barium and prevent impaction.
3️⃣ Medication Dose Clarification
Question:
A nurse notes that a prescribed medication dose is unusually high and the provider is unavailable
until morning. What should the nurse do?
✅ A. Ask the answering service to contact the on-call health care provider.
B. Wait until morning to clarify.
C. Call the nursing supervisor.
D. Administer the medication as prescribed.
Rationale:
The nurse has a legal and ethical duty to protect the patient from harm. If a dose appears
incorrect, the medication must be withheld and clarified with the on-call provider before
administration.
4️⃣ PVCs in a Patient With MI
Question:
A patient with an acute MI develops premature ventricular contractions (PVCs) with no
perfusion. What is the nurse’s priority action?
✅ A. Ask the ED health care provider to check the patient.
B. Continue to monitor and document.
C. Administer oxygen immediately.
D. Tell the patient the PVCs are expected.
Rationale:
PVCs may indicate ventricular irritability and can precede ventricular tachycardia or
fibrillation. Because there’s no perfusion, this is potentially life-threatening, and the provider
must be notified immediately.
5️⃣ NPO and Morning Antihypertensive Before ECT
2
,Question:
A patient scheduled for electroconvulsive therapy (ECT) is NPO. The patient routinely takes a
morning antihypertensive. What should the nurse do?
✅ A. Administer the antihypertensive with a small sip of water.
B. Withhold until bedtime.
C. Give after ECT.
D. Change the route to IV.
Rationale:
Patients must be NPO before ECT to prevent aspiration, but antihypertensives, cardiac meds,
and H₂ blockers should be given with a small sip of water to prevent complications such as
rebound hypertension.
6️⃣ Depression After Cardiac Surgery
Question:
A patient who recently underwent coronary artery bypass surgery reports feeling depressed.
Which response by the nurse is therapeutic?
✅ A. “Tell me more about what you’re feeling.”
B. “This is normal after surgery.”
C. “You’ll feel better soon.”
D. “Everyone feels that way.”
Rationale:
Therapeutic communication encourages the expression of feelings. Avoid false reassurance or
generalizations, which minimize the patient’s emotions.
7️⃣ Yellow, Foul Amniotic Fluid
Question:
A laboring patient’s amniotic fluid is yellow and foul-smelling after rupture of membranes. What
should the nurse do first?
✅ A. Contact the health care provider.
B. Continue monitoring.
C. Document findings.
D. Check for protein in the fluid.
3
, Rationale:
Normal amniotic fluid is clear and mild in odor. A foul or yellow color suggests
chorioamnionitis, a serious infection requiring immediate provider notification.
8️⃣ Post–Central Venous Catheter Insertion
Question:
After insertion of a central venous catheter for parenteral nutrition (PN), what is the nurse’s
immediate action?
✅ A. Call radiology for a chest X-ray.
B. Start PN infusion.
C. Flush the line with saline.
D. Obtain a blood glucose.
Rationale:
A chest X-ray is required to confirm catheter placement and rule out pneumothorax before
any infusions are started.
9️⃣ Rape Victim and HIV Concern
Question:
A rape victim says, “I’m really worried that I’ve got HIV now.” What is the appropriate nurse
response?
✅ A. “Let’s talk about the information that you need to determine your risk of
contracting HIV.”
B. “You’re more likely to get pregnant than HIV.”
C. “HIV is rarely an issue in rape victims.”
D. “Every rape victim is concerned about HIV.”
Rationale:
The nurse should address the patient’s concern directly, provide accurate information, and
support informed decision-making. Avoid false reassurance or minimizing statements.
10️⃣ Ibuprofen and GI Upset
4
