NCLEX NEXT GEN PRACTICE EXAM 1 – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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CORE DOMAINS
Management of CareSafety and Infection ControlHealth Promotion and MaintenancePsychosocial IntegrityBasic Care and ComfortPharmacological and Parenteral
TherapiesReduction of Risk PotentialPhysiological Adaptation
INTRODUCTION
This comprehensive practice assessment is designed to prepare nursing candidates for the rigors of the Next Generation NCLEX licensure examination. The exam evaluates
clinical judgment through a blend of foundational nursing knowledge and complex scenario-based inquiries. Candidates are assessed on their ability to prioritize patient needs,
manage acute and chronic conditions, and maintain safety standards within various healthcare environments. By emphasizing real-world application and ethical decision-
making, this exam mirrors the multi-dimensional nature of modern nursing practice. Success requires not only memorization of medical facts but also the critical thinking skills
necessary to ensure optimal patient outcomes and professional accountability.
1. A nurse is caring for a client with a chest tube. If the chest tube becomes accidentally disconnected from the drainage system, which action should the nurse take first?
A. Apply a sterile occlusive dressing to the site.
B. Instruct the client to perform a Valsalva maneuver.
🟢 C. Submerge the end of the tube in a bottle of sterile water.
D. Clamp the chest tube close to the insertion site.
🔴 RATIONALE: Submerging the end of the tube in sterile water creates a temporary water seal, preventing air from entering the pleural space while a new drainage system is
prepared.
2. Which laboratory value should the nurse prioritize monitoring for a client receiving a heparin infusion for a pulmonary embolism?
A. Prothrombin time (PT)
🟢 B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
🔴 RATIONALE: The aPTT is the standard laboratory test used to monitor the effectiveness and safety of unfractionated heparin therapy.
3. A client is admitted with a diagnosis of rule-out active tuberculosis (TB). Which precaution should the nurse implement?
🟢 A. Place the client in a negative-pressure airflow room.
B. Wear a surgical mask when entering the room.
C. Keep the door open to monitor the client’s respiratory effort.
D. Initiate contact precautions for all bedside care.
🔴 RATIONALE: Active TB requires airborne precautions, which include a negative-pressure room and the use of an N95 respirator mask for healthcare workers.
4. A nurse is assessing a client with suspected digitalis toxicity. Which clinical manifestation is most indicative of this condition?
,A. Persistent dry cough
🟢 B. Visual disturbances such as seeing yellow halos
C. Significant peripheral edema
D. Increased appetite and thirst
🔴 RATIONALE: Visual changes, particularly yellow-green halos around lights, are a classic and specific sign of digoxin (digitalis) toxicity.
5. Which intervention is the priority for a client experiencing an acute manic episode of bipolar disorder?
A. Encouraging the client to join a group therapy session.
B. Providing a high-calorie, finger-food diet.
🟢 C. Maintaining a quiet, low-stimulus environment.
D. Setting strict limits on all verbal outbursts.
🔴 RATIONALE: Reducing environmental stimuli is essential to prevent further escalation of manic behavior and ensure client safety.
6. A nurse is preparing to administer an intramuscular injection to an infant. Which site is the most appropriate?
🟢 A. Vastus lateralis
B. Ventrogluteal
C. Deltoid
D. Dorsogluteal
🔴 RATIONALE: The vastus lateralis is the preferred site for IM injections in infants because it is the most developed muscle mass at that age.
7. A client with type 1 diabetes mellitus is found unconscious and clammy. What is the nurse’s immediate priority action?
A. Obtain a blood glucose reading.
🟢 B. Administer glucagon subcutaneously or IM.
C. Provide 4 ounces of orange juice.
D. Start an intravenous line for normal saline.
🔴 RATIONALE: In an unconscious client suspected of hypoglycemia, immediate administration of glucagon is necessary to raise blood glucose levels when the client cannot
safely swallow.
8. When assessing a client with a fractured hip, which finding should the nurse expect?
🟢 A. Shortening of the affected extremity
B. Internal rotation of the affected leg
C. Bounding pedal pulses
D. Absence of pain when moving the limb
🔴 RATIONALE: Classic signs of a hip fracture include external rotation and shortening of the affected limb compared to the unaffected side.
9. A nurse is teaching a client about a newly prescribed low-sodium diet. Which food choice indicates the client understands the teaching?
, A. Canned vegetable soup
B. Deli turkey breast slices
🟢 C. Fresh steamed broccoli
D. Cottage cheese
🔴 RATIONALE: Fresh vegetables are naturally low in sodium, whereas canned soups, processed meats, and dairy products often contain high levels of added salt.
10. Which vital sign change is most characteristic of late-stage increased intracranial pressure (Cushing's Triad)?
🟢 A. Increased systolic blood pressure with a widening pulse pressure
B. Tachycardia and tachypnea
C. Decreased systolic blood pressure and bradycardia
D. Hypotension and irregular respirations
🔴 RATIONALE: Cushing's Triad consists of bradycardia, irregular respirations, and a widening pulse pressure (increased systolic BP).
11. A nurse is caring for a client with end-stage renal disease. Which electrolyte imbalance is most likely to occur?
A. Hypokalemia
B. Hypomagnesemia
🟢 C. Hyperkalemia
D. Hypercalcemia
🔴 RATIONALE: The kidneys are responsible for excreting potassium; in renal failure, potassium is retained, leading to potentially lethal hyperkalemia.
12. A client is prescribed spironolactone. Which dietary instruction is most important for the nurse to provide?
🟢 A. Avoid salt substitutes containing potassium.
B. Increase intake of bananas and oranges.
C. Limit intake of dark leafy green vegetables.
D. Drink at least 3 liters of water daily.
🔴 RATIONALE: Spironolactone is a potassium-sparing diuretic; using potassium-based salt substitutes can lead to hyperkalemia.
13. Which assessment finding should the nurse report immediately for a client who just underwent a thyroidectomy?
A. Soreness when swallowing
🟢 B. Laryngeal stridor
C. Slight hoarseness
D. Small amount of serosanguinous drainage on the dressing
🔴 RATIONALE: Stridor indicates airway obstruction or laryngeal nerve damage and requires emergency intervention.
14. A nurse is assessing a client with right-sided heart failure. Which finding should be expected?
DOWNLOAD PDF.
CORE DOMAINS
Management of CareSafety and Infection ControlHealth Promotion and MaintenancePsychosocial IntegrityBasic Care and ComfortPharmacological and Parenteral
TherapiesReduction of Risk PotentialPhysiological Adaptation
INTRODUCTION
This comprehensive practice assessment is designed to prepare nursing candidates for the rigors of the Next Generation NCLEX licensure examination. The exam evaluates
clinical judgment through a blend of foundational nursing knowledge and complex scenario-based inquiries. Candidates are assessed on their ability to prioritize patient needs,
manage acute and chronic conditions, and maintain safety standards within various healthcare environments. By emphasizing real-world application and ethical decision-
making, this exam mirrors the multi-dimensional nature of modern nursing practice. Success requires not only memorization of medical facts but also the critical thinking skills
necessary to ensure optimal patient outcomes and professional accountability.
1. A nurse is caring for a client with a chest tube. If the chest tube becomes accidentally disconnected from the drainage system, which action should the nurse take first?
A. Apply a sterile occlusive dressing to the site.
B. Instruct the client to perform a Valsalva maneuver.
🟢 C. Submerge the end of the tube in a bottle of sterile water.
D. Clamp the chest tube close to the insertion site.
🔴 RATIONALE: Submerging the end of the tube in sterile water creates a temporary water seal, preventing air from entering the pleural space while a new drainage system is
prepared.
2. Which laboratory value should the nurse prioritize monitoring for a client receiving a heparin infusion for a pulmonary embolism?
A. Prothrombin time (PT)
🟢 B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
🔴 RATIONALE: The aPTT is the standard laboratory test used to monitor the effectiveness and safety of unfractionated heparin therapy.
3. A client is admitted with a diagnosis of rule-out active tuberculosis (TB). Which precaution should the nurse implement?
🟢 A. Place the client in a negative-pressure airflow room.
B. Wear a surgical mask when entering the room.
C. Keep the door open to monitor the client’s respiratory effort.
D. Initiate contact precautions for all bedside care.
🔴 RATIONALE: Active TB requires airborne precautions, which include a negative-pressure room and the use of an N95 respirator mask for healthcare workers.
4. A nurse is assessing a client with suspected digitalis toxicity. Which clinical manifestation is most indicative of this condition?
,A. Persistent dry cough
🟢 B. Visual disturbances such as seeing yellow halos
C. Significant peripheral edema
D. Increased appetite and thirst
🔴 RATIONALE: Visual changes, particularly yellow-green halos around lights, are a classic and specific sign of digoxin (digitalis) toxicity.
5. Which intervention is the priority for a client experiencing an acute manic episode of bipolar disorder?
A. Encouraging the client to join a group therapy session.
B. Providing a high-calorie, finger-food diet.
🟢 C. Maintaining a quiet, low-stimulus environment.
D. Setting strict limits on all verbal outbursts.
🔴 RATIONALE: Reducing environmental stimuli is essential to prevent further escalation of manic behavior and ensure client safety.
6. A nurse is preparing to administer an intramuscular injection to an infant. Which site is the most appropriate?
🟢 A. Vastus lateralis
B. Ventrogluteal
C. Deltoid
D. Dorsogluteal
🔴 RATIONALE: The vastus lateralis is the preferred site for IM injections in infants because it is the most developed muscle mass at that age.
7. A client with type 1 diabetes mellitus is found unconscious and clammy. What is the nurse’s immediate priority action?
A. Obtain a blood glucose reading.
🟢 B. Administer glucagon subcutaneously or IM.
C. Provide 4 ounces of orange juice.
D. Start an intravenous line for normal saline.
🔴 RATIONALE: In an unconscious client suspected of hypoglycemia, immediate administration of glucagon is necessary to raise blood glucose levels when the client cannot
safely swallow.
8. When assessing a client with a fractured hip, which finding should the nurse expect?
🟢 A. Shortening of the affected extremity
B. Internal rotation of the affected leg
C. Bounding pedal pulses
D. Absence of pain when moving the limb
🔴 RATIONALE: Classic signs of a hip fracture include external rotation and shortening of the affected limb compared to the unaffected side.
9. A nurse is teaching a client about a newly prescribed low-sodium diet. Which food choice indicates the client understands the teaching?
, A. Canned vegetable soup
B. Deli turkey breast slices
🟢 C. Fresh steamed broccoli
D. Cottage cheese
🔴 RATIONALE: Fresh vegetables are naturally low in sodium, whereas canned soups, processed meats, and dairy products often contain high levels of added salt.
10. Which vital sign change is most characteristic of late-stage increased intracranial pressure (Cushing's Triad)?
🟢 A. Increased systolic blood pressure with a widening pulse pressure
B. Tachycardia and tachypnea
C. Decreased systolic blood pressure and bradycardia
D. Hypotension and irregular respirations
🔴 RATIONALE: Cushing's Triad consists of bradycardia, irregular respirations, and a widening pulse pressure (increased systolic BP).
11. A nurse is caring for a client with end-stage renal disease. Which electrolyte imbalance is most likely to occur?
A. Hypokalemia
B. Hypomagnesemia
🟢 C. Hyperkalemia
D. Hypercalcemia
🔴 RATIONALE: The kidneys are responsible for excreting potassium; in renal failure, potassium is retained, leading to potentially lethal hyperkalemia.
12. A client is prescribed spironolactone. Which dietary instruction is most important for the nurse to provide?
🟢 A. Avoid salt substitutes containing potassium.
B. Increase intake of bananas and oranges.
C. Limit intake of dark leafy green vegetables.
D. Drink at least 3 liters of water daily.
🔴 RATIONALE: Spironolactone is a potassium-sparing diuretic; using potassium-based salt substitutes can lead to hyperkalemia.
13. Which assessment finding should the nurse report immediately for a client who just underwent a thyroidectomy?
A. Soreness when swallowing
🟢 B. Laryngeal stridor
C. Slight hoarseness
D. Small amount of serosanguinous drainage on the dressing
🔴 RATIONALE: Stridor indicates airway obstruction or laryngeal nerve damage and requires emergency intervention.
14. A nurse is assessing a client with right-sided heart failure. Which finding should be expected?
