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RN Comprehensive
Predictor 2026 v
Here is a for the RN Comprehensive Predictor 2026 v2. This guide is built from sample questions and rationales found in official test‑bank documents, structured using the SOAP framework— Situation, Objective Data, Analysis/Assessment, and Plan—to help you master clinical judgment for the Next Generation NCLEX (NGN) format. All questions are representative of what you will face on the actual exam.
ComponentMeaning in This Guide
S – SituationThe patient scenario, including chief complaint and relevant history.
O – Objective DataKey assessment findings, vital signs, lab results, and other measurable data.
A – Analysis/AssessmentYour analysis: identify the problem, recognize clinical manifestations, and prioritize the immediate threat.
P – PlanThe specific, most appropriate nursing action to take first or prioritize.
🩺 Cardiology Questions
Question 1: Heart Failure & Furosemide
- S – Situation: A client with heart failure is prescribed furosemide 40 mg IV.
- O – Objective Data: The nurse assesses for signs of medication effectiveness.
- A – Analysis/Assessment: Furosemide is a loop diuretic that reduces fluid overload in heart failure. Effective treatment is indicated by a reduction in fluid volume and improvement in symptoms of congestion.
- P – Plan: Which assessment finding indicates the medication is effective? Correct Answer: Decreased ankle edema and urine output of 200 mL/hr Rationale: Decreased peripheral edema and increased urine output (diuresis) are direct signs of effective diuretic therapy. Weight gain indicates fluid retention, and hypokalemia is an adverse effect, not a therapeutic goal.
Question 2: Post‑Cardiac Catheterization Care
- S – Situation: A client returns to the unit after a cardiac catheterization via the right femoral artery.
- O – Objective Data: The client has a sheath or dressing in place over the right femoral artery.
- A – Analysis/Assessment: The priority is to prevent bleeding and hematoma formation at the arterial puncture site. Early ambulation or improper positioning increases the risk of severe bleeding.
- P – Plan: Which action should the nurse prioritize? Correct Answer: Maintain the client on bed rest with the leg extended for 4‑6 hours Rationale: Bed rest with the affected leg extended is required to prevent bleeding and hematoma formation. Pedal pulse assessment is important but secondary; early ambulation and heat increase bleeding risk.
Question 3: Atrial Fibrillation & Warfarin Monitoring
- S – Situation: A client is prescribed warfarin for atrial fibrillation.
- New‑onset heart failure, SpO₂ 94% on 2L NC
- Hypertension, BP 160/92, asymptomatic
- A – Analysis/Assessment: The client 2 hours post‑MI with severe chest pain is at highest risk for life‑threatening complications (e.g., extension of infarction, arrhythmias). This is an unstable, high‑acuity patient.
- P – Plan: Which client should the nurse assess first? Correct Answer: Client 2 hours post‑MI with chest pain 8/10 Rationale: This client has the most acute, unstable condition. Airway and circulation are intact, but severe pain indicates ongoing cardiac ischemia and requires immediate intervention.
🩺 Medical‑Surgical Questions
Question 6: Type 1 Diabetes & DKA Risk
- S – Situation: A nurse is caring for a client with a new diagnosis of type 1 diabetes mellitus.
- O – Objective Data: Available findings: blood glucose 180 mg/dL, presence of ketones in urine, client reports thirst and frequent urination, hemoglobin A1c 8.5%.
- A – Analysis/Assessment: Ketones in urine indicate the body is breaking down fat for energy due to insufficient insulin, which can rapidly progress to diabetic ketoacidosis (DKA)—a life‑threatening emergency.
- P – Plan: Which finding requires immediate intervention? Correct Answer: Presence of ketones in urine Rationale: Ketones signal DKA risk and require immediate intervention with insulin and IV fluids. Blood glucose 180 mg/dL is elevated but not immediately critical; thirst and frequent urination are expected symptoms of hyperglycemia; HbA1c reflects average glucose over 3 months and is not an acute finding.
Question 7: Blood Transfusion Hemolytic Reaction
- S – Situation: A nurse is assessing a client receiving a blood transfusion.
- O – Objective Data: The client develops new symptoms.
- A – Analysis/Assessment: Hemolytic transfusion reaction occurs when recipient antibodies attack donor RBCs. Classic signs include low back pain (due to hemolysis in kidneys) and dark urine (hemoglobinuria). This is a medical emergency.
- P – Plan: Which finding indicates a hemolytic reaction? Correct Answer: Low back pain and dark urine Rationale: These are classic signs. Stop transfusion, maintain IV line with saline, notify provider, and send blood bag and client sample to lab. Urticaria indicates allergic reaction; fever/chills may be febrile non‑hemolytic; dyspnea/crackles suggest fluid overload or TRALI.
Question 8: Blood Transfusion – Priority Action
- S – Situation: A nurse is caring for a client receiving a blood transfusion who develops chills and fever within 15 minutes.
- O – Objective Data: Chills and fever within 15 minutes of starting transfusion.
- A – Analysis/Assessment: This indicates a possible transfusion reaction. Immediate cessation prevents further complications and allows for proper evaluation.
- P – Plan: Which action should the nurse take first? Correct Answer: Stop the transfusion and maintain IV line with normal saline Rationale: Signs of a transfusion reaction require immediate cessation of the transfusion to prevent further complications. Antipyretics and provider notification follow the initial emergency response.
Question 9: Asthma Exacerbation – First Medication
- S – Situation: A nurse is caring for a client with an acute asthma exacerbation.
- O – Objective Data: SpO₂ 89% indicates hypoxemia. Pneumonia compromises gas exchange.
- A – Analysis/Assessment: ABCs (Airway, Breathing, Circulation) guide prioritization. Hypoxemia is a breathing problem that must be addressed immediately.
- P – Plan: Which client should be assessed FIRST? Correct Answer: Client with pneumonia, SpO₂ 89% on 2 L nasal cannula Rationale: ABCs – Airway/Breathing priority. SpO₂ 89% indicates hypoxemia. Pneumonia compromises gas exchange. Priority is oxygenation. Hypoglycemia is next but stable; pain and urinary retention are lower priority.
Question 12: ARDS – Next Step
- S – Situation: A patient with acute respiratory distress syndrome (ARDS) is receiving oxygen by a non‑rebreather mask, but arterial blood gas measurements still show poor oxygenation.
- O – Objective Data: Refractory hypoxemia despite high‑flow oxygen.
- A – Analysis/Assessment: A non‑rebreather mask can deliver nearly 100% oxygen. When oxygenation does not improve, refractory hypoxemia is present. The patient is at risk for respiratory arrest and requires more aggressive support.
- P – Plan: Which action should the nurse anticipate? Correct Answer: Perform endotracheal intubation and initiate mechanical ventilation Rationale: Intubation and mechanical ventilation are required to decrease the patient’s work of breathing and improve oxygenation. CPAP is insufficient at this stage.
👶 Pediatrics Questions
Question 13: Kawasaki Disease – Acute Phase Care
- S – Situation: A nurse is planning care for a preschool‑age child in the acute phase of Kawasaki disease.
- O – Objective Data: Acute phase with fever, rash, mucous membrane changes.
- A – Analysis/Assessment: Kawasaki disease causes inflammation of medium‑sized arteries, including coronary arteries. Cardiac complications (myocarditis, coronary artery aneurysms) are the most serious.
- P – Plan: Which intervention should the nurse include in the plan of care? Correct Answer: Monitor the client’s cardiac status Rationale: Cardiac monitoring is essential to detect complications such as myocarditis or coronary artery aneurysms. Fever control (acetaminophen) is supportive but not the priority. Antibiotics are not indicated; Kawasaki disease is not bacterial. The child should be protected from infection, not exposed to other children.
Question 14: Lyme Disease – Reportable Illness
- S – Situation: A home health nurse is caring for a child who has Lyme disease.
- O – Objective Data: Child diagnosed with Lyme disease after tick bite.
- A – Analysis/Assessment: Lyme disease is a reportable communicable disease in most states. Public health authorities must be notified for tracking and prevention.
- P – Plan: Which action should the nurse take? Correct Answer: Ensure the state health department has been notified Rationale: Lyme disease is reportable. Antitoxin is not used; antibiotics are. Skin necrosis is not characteristic; erythema migrans is the classic rash.
🩺 Maternal‑Newborn Questions
Question 15: Newborn & Sibling Jealousy
- S – Situation: A nurse is preparing to administer IV potassium.
- O – Objective Data: Potassium is prescribed IV.
- A – Analysis/Assessment: IV potassium is a high‑risk medication. It must be diluted and administered slowly to prevent cardiac arrhythmias. Undiluted or rapid infusion can be fatal.
- P – Plan: Which action is appropriate when administering potassium IV? Correct Answer: Dilute in appropriate IV fluid and infuse slowly via infusion pump Rationale: Potassium must be diluted to prevent cardiac complications. It should never be given as a bolus or undiluted. An infusion pump ensures accurate rate control.
🩺⚕️ Mental Health Questions
Question 18: Command Hallucinations
- S – Situation: A nurse observes a client on the psychiatric unit muttering and standing near a window. The client states, “The voices are telling me to jump.”
- O – Objective Data: Client is at a window, voices command self‑harm.
- A – Analysis/Assessment: Command hallucinations to harm oneself indicate an immediate safety risk. The nurse must validate the client’s experience while maintaining a non‑judgmental stance and not reinforcing the delusion.
- P – Plan: Which response by the nurse is appropriate? Correct Answer: “I understand the voices are frightening you, but I do not hear any voices.” Rationale: This response validates the client’s feeling (“frightening”) while gently reality‑testing (“I do not hear any voices”). It does not argue with the client’s perception but offers support.
👥 Leadership & Delegation Questions
Question 19: Assigning to the Most Experienced RN
- S – Situation: A charge nurse is making assignments for a shift.
- O – Objective Data: Options include a client 2 days post‑appendectomy ready for discharge, a client with new‑onset confusion and fluctuating level of consciousness, a client with stable COPD requesting pain medication, and a client with a UTI needing IV antibiotics.
- A – Analysis/Assessment: New‑onset confusion with fluctuating level of consciousness indicates an unstable, unpredictable patient. This patient requires the most experienced RN for frequent reassessment and rapid intervention.
- P – Plan: Which client should be assigned to the most experienced RN? Correct Answer: Client with new‑onset confusion and fluctuating level of consciousness Rationale: Unstable, unpredictable, or complex patients require the most experienced RN. Stable post‑op and chronic care patients can be assigned to other staff.
Question 20: Tasks Delegable to LPN (Select All That Apply)
- S – Situation: A charge nurse is delegating tasks to a Licensed Practical Nurse (LPN).
- O – Objective Data: Several tasks are available for delegation.
- A – Analysis/Assessment: LPNs can perform stable, predictable tasks and monitor for complications under RN supervision. They cannot perform initial assessments, teaching, or evaluation.
- P – Plan: Which tasks can be delegated to an LPN? (Select All That Apply) Correct Answer: Administer a tube feeding to a stable patient; Monitor for complications in a stable patient Rationale: LPNs can perform stable, predictable tasks and monitor for complications. RNs are responsible for initial assessment, teaching, and evaluation.
🏥 NGN Case Study Example
| Differentiate Unstable vs. Stable | Unstable patients (new‑onset confusion, chest pain, severe respiratory distress) always take priority over stable, predictable patients. An LPN can care for stable patients; an RN must manage unstable patients. | | Know the 5 Rights of Delegation | Right Task, Right Circumstances, Right Person, Right Direction/Communication, Right Supervision/Evaluation. | | Master Scope of Practice | – UAP: Routine tasks (bathing, ambulation, I&Os, specimen collection)
- LPN: Stable patients, predictable outcomes, can administer medications (not IV push in some states), monitor, suction, catheterize. Cannot do initial assessments, create care plans, or teach.
- RN: Unstable patients, initial assessments, teaching, complex clinical judgment. | | Watch for Absolute Language | Words like “always,” “never,” “all,” “none,” “every,” “only” often signal incorrect answers. In nursing, few things are absolute. | | Prioritize Using the “Gold Standard” Question | An RN would delegate applying a condom catheter to an AP but would never delegate feeding a patient with aspiration precautions. |
📌 Final Notes
- This study guide is derived from official test‑bank documents for the RN Comprehensive Predictor 2026 v2 and covers the types of questions you will encounter.
- Use it alongside your ATI textbooks, online practice assessments, and focused review modules.
- Pay special attention to prioritization, delegation, and clinical judgment—these are consistently the most heavily weighted areas on the exam.
- If you need additional practice on a specific topic, open‑ended study questions, or a downloadable PDF version, just ask.
Good luck on your exam – you will pass!
