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NCLEX-RN 2026/2027 Next Generation NCLEX
(NGN) Edition | Complete Test Bank with NGN Case
Studies, Standalone Questions & Detailed Rationales |
Updated for Latest NCLEX Test Plan | A+ Graded
SECTION 1: MANAGEMENT OF CARE (Questions 1-20)
Q1: The charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to the most experienced registered nurse (RN)?
A. A 45-year-old with type 2 diabetes requiring blood glucose monitoring and insulin
administration before meals
B. A 62-year-old 3 days post-cholecystectomy with stable vital signs and a Jackson-Pratt drain
C. A 58-year-old with new-onset atrial fibrillation, started on amiodarone IV, with a heart rate of
110-120 bpm. [CORRECT]
D. A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with stable oxygen
saturation
Rationale: The client with new-onset atrial fibrillation on amiodarone IV requires close
monitoring for dysrhythmias, hypotension, and adverse effects, necessitating the clinical
judgment of the most experienced RN. The other clients (A, B, D) are stable with predictable
care needs and could be safely assigned to a less experienced RN or LPN under supervision.
Q2: The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Administering oral medications to a stable client
B. Assessing a postoperative client's incision for signs of infection
C. Measuring and recording intake and output for a client with heart failure [CORRECT]
D. Teaching a newly diagnosed diabetic client about insulin administration
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Rationale: Measuring and recording I&O (C) is a task within the UAP scope of practice.
Administering medications (A) and client teaching (D) require nursing judgment and licensure.
Assessment (B) is an RN responsibility that cannot be delegated.
Q3: A nurse manager is reviewing incident reports. Which situation requires immediate follow-
up to ensure client safety?
A. A client received their routine morning medications 30 minutes late
B. A confused client with a bed alarm was found on the floor beside the bed after the alarm
sounded [CORRECT]
C. A nurse documented vital signs in the electronic health record 15 minutes after obtaining them
D. A client refused their scheduled physical therapy session
Rationale: A fall (B) represents a serious safety event requiring immediate investigation, root
cause analysis, and implementation of preventive measures. The other situations (A, C, D) are
less critical and do not represent immediate safety threats.
Q4: The nurse is supervising a newly licensed nurse (NLN). Which action by the NLN requires
immediate intervention by the supervising nurse?
A. The NLN asks a senior nurse to verify a medication dosage calculation
B. The NLN delegates vital sign measurement to UAP for a stable client
C. The NLN administers morphine 10 mg IV to a client with respiratory rate of 8 breaths/min
[CORRECT]
D. The NLN documents client education provided during the shift
Rationale: Morphine is contraindicated with a respiratory rate of 8/min due to risk of respiratory
depression and arrest. This requires immediate intervention. Asking for verification (A)
demonstrates appropriate judgment, delegating appropriate tasks (B) is correct, and
documentation (D) is standard practice.
Q5: Which action demonstrates the nurse's role as a client advocate?
A. Following the physician's orders exactly as written
B. Supporting a client's decision to refuse chemotherapy despite family opposition [CORRECT]
C. Encouraging a client to follow the treatment plan recommended by the healthcare team
,3
D. Documenting all client care activities accurately
Rationale: Advocacy involves supporting client autonomy and right to self-determination (B).
Following orders (A) and accurate documentation (D) are nursing responsibilities but not
advocacy. Encouraging compliance (C) may conflict with client wishes and does not represent
advocacy.
Q6: The nurse is planning discharge for a client with chronic heart failure. Which action
demonstrates continuity of care?
A. Providing written discharge instructions to the client
B. Scheduling a follow-up appointment with the cardiologist in 2 weeks
C. Contacting the home health agency to arrange for nursing visits and medication reconciliation
[CORRECT]
D. Ensuring the client has transportation to follow-up appointments
Rationale: Continuity of care involves coordinating care across settings (C). Written instructions
(A), follow-up appointments (B), and transportation (D) are important but represent single
aspects of discharge planning rather than coordinated continuity of care.
Q7: A nurse discovers that a colleague has documented vital signs that were not actually
obtained. What is the nurse's first action?
A. Confront the colleague immediately
B. Report the incident to the nurse manager [CORRECT]
C. Document the actual vital signs in the client's record
D. Complete an incident report
Rationale: Falsification of documentation is a serious ethical and legal violation requiring
immediate reporting to management (B) to ensure client safety and appropriate follow-up.
Confrontation (A) may not resolve the systemic issue, and documentation (C) or incident reports
(D) are secondary to immediate reporting.
Q8: Which situation represents a violation of client confidentiality?
A. Discussing a client's condition with the interdisciplinary team during rounds
B. Sharing client information with the client's spouse who is listed as an emergency contact
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C. Discussing a celebrity client's diagnosis with friends outside the hospital [CORRECT]
D. Reporting suspected child abuse to the appropriate authorities
Rationale: Discussing client information in social settings (C) violates HIPAA regardless of the
client's public status. Team discussions (A), sharing with authorized contacts (B), and mandatory
reporting (D) are all appropriate and legally sanctioned.
Q9: The nurse is caring for a client whose religious beliefs prohibit blood transfusions. The
client is hemorrhaging and the physician orders a transfusion. What is the nurse's best action?
A. Administer the transfusion immediately to save the client's life
B. Refuse to participate and request another nurse administer the transfusion
C. Ensure the client has signed informed refusal and notify the physician of the client's wishes
[CORRECT]
D. Contact the hospital ethics committee after administering the transfusion
Rationale: Clients have the right to refuse treatment based on religious beliefs. The nurse must
ensure informed refusal is documented and communicate with the physician (C). Administering
against wishes (A) constitutes battery. Refusing assignment (B) is not appropriate, and contacting
ethics (D) should occur before, not after, treatment decisions.
Q10: A nurse is floating to a pediatric unit for the first time. Which assignment is most
appropriate for this nurse?
A. A newly admitted child with suspected meningitis requiring isolation precautions
B. A stable 8-year-old with asthma awaiting discharge [CORRECT]
C. A 3-year-old with dehydration requiring frequent IV monitoring and fluid calculations
D. A teenager with newly diagnosed type 1 diabetes requiring intensive education
Rationale: A floating nurse should receive an assignment matching their competency level. The
stable child awaiting discharge (B) is most appropriate. Meningitis (A), complex pediatric
calculations (C), and intensive new-onset diabetes education (D) require specialized pediatric
expertise.
Q11: Which statement by a nurse demonstrates understanding of appropriate delegation to a
licensed practical/vocational nurse (LPN/LVN)?
NCLEX-RN 2026/2027 Next Generation NCLEX
(NGN) Edition | Complete Test Bank with NGN Case
Studies, Standalone Questions & Detailed Rationales |
Updated for Latest NCLEX Test Plan | A+ Graded
SECTION 1: MANAGEMENT OF CARE (Questions 1-20)
Q1: The charge nurse is making assignments on a medical-surgical unit. Which client should be
assigned to the most experienced registered nurse (RN)?
A. A 45-year-old with type 2 diabetes requiring blood glucose monitoring and insulin
administration before meals
B. A 62-year-old 3 days post-cholecystectomy with stable vital signs and a Jackson-Pratt drain
C. A 58-year-old with new-onset atrial fibrillation, started on amiodarone IV, with a heart rate of
110-120 bpm. [CORRECT]
D. A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with stable oxygen
saturation
Rationale: The client with new-onset atrial fibrillation on amiodarone IV requires close
monitoring for dysrhythmias, hypotension, and adverse effects, necessitating the clinical
judgment of the most experienced RN. The other clients (A, B, D) are stable with predictable
care needs and could be safely assigned to a less experienced RN or LPN under supervision.
Q2: The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Administering oral medications to a stable client
B. Assessing a postoperative client's incision for signs of infection
C. Measuring and recording intake and output for a client with heart failure [CORRECT]
D. Teaching a newly diagnosed diabetic client about insulin administration
,2
Rationale: Measuring and recording I&O (C) is a task within the UAP scope of practice.
Administering medications (A) and client teaching (D) require nursing judgment and licensure.
Assessment (B) is an RN responsibility that cannot be delegated.
Q3: A nurse manager is reviewing incident reports. Which situation requires immediate follow-
up to ensure client safety?
A. A client received their routine morning medications 30 minutes late
B. A confused client with a bed alarm was found on the floor beside the bed after the alarm
sounded [CORRECT]
C. A nurse documented vital signs in the electronic health record 15 minutes after obtaining them
D. A client refused their scheduled physical therapy session
Rationale: A fall (B) represents a serious safety event requiring immediate investigation, root
cause analysis, and implementation of preventive measures. The other situations (A, C, D) are
less critical and do not represent immediate safety threats.
Q4: The nurse is supervising a newly licensed nurse (NLN). Which action by the NLN requires
immediate intervention by the supervising nurse?
A. The NLN asks a senior nurse to verify a medication dosage calculation
B. The NLN delegates vital sign measurement to UAP for a stable client
C. The NLN administers morphine 10 mg IV to a client with respiratory rate of 8 breaths/min
[CORRECT]
D. The NLN documents client education provided during the shift
Rationale: Morphine is contraindicated with a respiratory rate of 8/min due to risk of respiratory
depression and arrest. This requires immediate intervention. Asking for verification (A)
demonstrates appropriate judgment, delegating appropriate tasks (B) is correct, and
documentation (D) is standard practice.
Q5: Which action demonstrates the nurse's role as a client advocate?
A. Following the physician's orders exactly as written
B. Supporting a client's decision to refuse chemotherapy despite family opposition [CORRECT]
C. Encouraging a client to follow the treatment plan recommended by the healthcare team
,3
D. Documenting all client care activities accurately
Rationale: Advocacy involves supporting client autonomy and right to self-determination (B).
Following orders (A) and accurate documentation (D) are nursing responsibilities but not
advocacy. Encouraging compliance (C) may conflict with client wishes and does not represent
advocacy.
Q6: The nurse is planning discharge for a client with chronic heart failure. Which action
demonstrates continuity of care?
A. Providing written discharge instructions to the client
B. Scheduling a follow-up appointment with the cardiologist in 2 weeks
C. Contacting the home health agency to arrange for nursing visits and medication reconciliation
[CORRECT]
D. Ensuring the client has transportation to follow-up appointments
Rationale: Continuity of care involves coordinating care across settings (C). Written instructions
(A), follow-up appointments (B), and transportation (D) are important but represent single
aspects of discharge planning rather than coordinated continuity of care.
Q7: A nurse discovers that a colleague has documented vital signs that were not actually
obtained. What is the nurse's first action?
A. Confront the colleague immediately
B. Report the incident to the nurse manager [CORRECT]
C. Document the actual vital signs in the client's record
D. Complete an incident report
Rationale: Falsification of documentation is a serious ethical and legal violation requiring
immediate reporting to management (B) to ensure client safety and appropriate follow-up.
Confrontation (A) may not resolve the systemic issue, and documentation (C) or incident reports
(D) are secondary to immediate reporting.
Q8: Which situation represents a violation of client confidentiality?
A. Discussing a client's condition with the interdisciplinary team during rounds
B. Sharing client information with the client's spouse who is listed as an emergency contact
, 4
C. Discussing a celebrity client's diagnosis with friends outside the hospital [CORRECT]
D. Reporting suspected child abuse to the appropriate authorities
Rationale: Discussing client information in social settings (C) violates HIPAA regardless of the
client's public status. Team discussions (A), sharing with authorized contacts (B), and mandatory
reporting (D) are all appropriate and legally sanctioned.
Q9: The nurse is caring for a client whose religious beliefs prohibit blood transfusions. The
client is hemorrhaging and the physician orders a transfusion. What is the nurse's best action?
A. Administer the transfusion immediately to save the client's life
B. Refuse to participate and request another nurse administer the transfusion
C. Ensure the client has signed informed refusal and notify the physician of the client's wishes
[CORRECT]
D. Contact the hospital ethics committee after administering the transfusion
Rationale: Clients have the right to refuse treatment based on religious beliefs. The nurse must
ensure informed refusal is documented and communicate with the physician (C). Administering
against wishes (A) constitutes battery. Refusing assignment (B) is not appropriate, and contacting
ethics (D) should occur before, not after, treatment decisions.
Q10: A nurse is floating to a pediatric unit for the first time. Which assignment is most
appropriate for this nurse?
A. A newly admitted child with suspected meningitis requiring isolation precautions
B. A stable 8-year-old with asthma awaiting discharge [CORRECT]
C. A 3-year-old with dehydration requiring frequent IV monitoring and fluid calculations
D. A teenager with newly diagnosed type 1 diabetes requiring intensive education
Rationale: A floating nurse should receive an assignment matching their competency level. The
stable child awaiting discharge (B) is most appropriate. Meningitis (A), complex pediatric
calculations (C), and intensive new-onset diabetes education (D) require specialized pediatric
expertise.
Q11: Which statement by a nurse demonstrates understanding of appropriate delegation to a
licensed practical/vocational nurse (LPN/LVN)?
