NCLEX-RN 2026 Practice Exam | New Generation NCLEX
Questions with Verified Answers & Rationales | INSTANT PDF
DOWNLOAD
Welcome to this comprehensive NCLEX-RN 2026 practice exam. This resource includes 200 questions
designed to mirror the Next Generation NCLEX (NGN) format, featuring standalone multiple-choice items as
well as case study–inspired questions that test clinical judgment, prioritization, delegation and the latest
nursing competencies. Each question is followed by the correct answer (presented with the full answer
choice text) and a concise rationale of no more than three lines. Use this exam to assess your readiness, build
endurance, and deepen your understanding of key nursing concepts.
Key Topics Covered
• NGN Case Studies – Clinical judgment, unfolding scenarios, and recognizing cues
• Prioritization & Delegation – Maslow, ABCs, safety, scope of practice, assignment
• Pharmacology – Mechanism of action, side effects, nursing considerations, antidotes
• Maternal Newborn – Antepartum, intrapartum, postpartum, newborn assessment, complications
• Med-Surg Nursing – Cardiovascular, respiratory, endocrine, GI, renal, infectious disease
• Mental Health Nursing – Therapeutic communication, psychopharmacology, crisis intervention, defense
mechanisms
Questions 1–200
1. A nurse is caring for a client who presents with sudden chest pain, dyspnea, and hypotension
following a total knee replacement surgery two days ago. Which action should the nurse take first?
A) Administer oxygen at 2 L/min via nasal cannula
B) Prepare for thrombolytic therapy
C) Place the client in a high-Fowler’s position
D) Obtain a STAT spiral CT scan
Answer C: Place the client in a high-Fowler’s position
Rationale: High-Fowler’s position optimizes ventilation and reduces venous return, which can be life-saving
in suspected pulmonary embolism. Oxygen administration is important but positioning is the immediate
priority to maximize oxygenation and perfusion. Obtaining a CT scan requires time and should not delay
positioning and oxygen.
,2. A charge nurse is delegating tasks to a licensed practical nurse (LPN) and a certified nursing
assistant (CNA). Which task is most appropriate for the LPN?
A) Obtain a clean-catch urine specimen from a stable client
B) Administer a scheduled subcutaneous insulin injection
C) Initiate teaching on post-operative deep breathing exercises
D) Perform the initial admission assessment on a new client
Answer B: Administer a scheduled subcutaneous insulin injection
Rationale: LPNs can administer subcutaneous medications to stable clients under the supervision of an RN.
Initial assessment and client teaching are within the RN scope; CNA can obtain urine specimens. Insulin
administration by LPN is within their scope in most jurisdictions when client is stable.
3. A nurse on a mental health unit is assessing a client with major depressive disorder who started
sertraline 10 days ago. Which finding requires immediate notification of the provider?
A) The client reports persistent dry mouth
B) The client states, “I feel more energy but still very sad”
C) The client reports a decrease in appetite
D) The client sleeps 12 hours per day
Answer B: The client states, “I feel more energy but still very sad”
Rationale: Increased energy combined with persistent sadness raises suicide risk as the client may act on
plans. Serotonin reuptake inhibitors initially improve energy before mood, requiring close monitoring for
self-harm. Dry mouth and appetite changes are common side effects but not immediately life-threatening.
4. A primigravida at 38 weeks gestation is admitted with contractions every 3-5 minutes, lasting 60
seconds. Cervical examination reveals 5 cm dilation, 90% effaced, and 0 station. Which fetal
monitoring finding would be most concerning?
A) Variability of 6 bpm
B) Early decelerations to 100 bpm
C) Recurrent late decelerations
D) Accelerations with fetal movement
Answer C: Recurrent late decelerations
Rationale: Late decelerations indicate uteroplacental insufficiency and can lead to fetal acidosis and hypoxic
injury. Early decelerations are benign and caused by fetal head compression during contractions. Moderate
variability and accelerations are reassuring signs of fetal well-being.
,5. A nurse is preparing to administer digoxin 0.25 mg orally. The client’s apical pulse is 54 bpm and
irregular. Which action should the nurse take?
A) Administer the dose as ordered
B) Hold the dose and document the pulse only
C) Hold the dose and reassess the pulse in 30 minutes
D) Hold the dose and notify the healthcare provider
Answer D: Hold the dose and notify the healthcare provider
Rationale: Digoxin is typically held for an apical pulse below 60 bpm in adults due to risk of toxicity and
bradycardia. The provider must be notified for further orders such as ECG or dose adjustment. Reassessment
without notification could delay necessary intervention.
6. A client with cirrhosis develops asterixis, confusion, and a serum ammonia level of 120 mcg/dL.
Which dietary modification is most appropriate?
A) High-protein, low-carbohydrate
B) Low-sodium, fluid-restricted
C) Low-protein, high-calorie
D) High-fat, low-fiber
Answer C: Low-protein, high-calorie
Rationale: Hepatic encephalopathy requires reduced protein intake to decrease ammonia production while
maintaining calories. High-calorie carbohydrates help preserve muscle mass without worsening ammonia
levels. Protein restriction is temporary; once encephalopathy resolves, protein is gradually reintroduced.
7. A nurse in the postpartum unit is assessing a client who delivered 6 hours ago. The client reports
heavy lochia with large clots and a boggy fundus displaced to the right. What is the priority nursing
action?
A) Assist the client to void
B) Administer methylergonovine as ordered
C) Increase the IV oxytocin infusion rate
D) Perform fundal massage
Answer A: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder preventing uterine contraction;
voiding restores tone. Fundal massage is done after ensuring bladder is empty to avoid incomplete
, contraction. Methylergonovine and oxytocin are secondary if massage after voiding does not control
bleeding.
8. A client receiving IV vancomycin reports flushing of the face and neck, and a pruritic rash on the
chest. The infusion was started 10 minutes ago. What should the nurse do first?
A) Slow the infusion rate
B) Administer diphenhydramine as a PRN order
C) Stop the infusion
D) Document the reaction as an expected side effect
Answer C: Stop the infusion
Rationale: The symptoms describe “Red Man Syndrome,” but stopping the infusion is the first action to
prevent worsening reaction. After stopping, the nurse can slow the rate upon provider order or give
antihistamines for mild reactions. Documentation occurs after immediate patient safety interventions.
9. A nurse is caring for a client with bipolar I disorder who is experiencing acute mania. Which goal
should take priority during the first 24 hours of hospitalization?
A) The client will attend group therapy sessions
B) The client will sleep at least 6 hours per night
C) The client will remain free from injury
D) The client will verbalize three coping strategies
Answer C: The client will remain free from injury
Rationale: Safety is always the priority; manic clients may engage in reckless behavior causing harm to self
or others. Sleep and therapy are important but secondary to preventing physical injury. Coping strategies
require stable mood and insight not present in acute mania.
10. A client with chronic heart failure has an ejection fraction of 35%. The nurse notes new-onset
paroxysmal nocturnal dyspnea (PND). Which medication should the nurse anticipate being added to
the regimen?
A) Furosemide IV push
B) Metoprolol succinate
C) Digoxin 0.125 mg daily
D) Spironolactone
Answer A: Furosemide IV push
Questions with Verified Answers & Rationales | INSTANT PDF
DOWNLOAD
Welcome to this comprehensive NCLEX-RN 2026 practice exam. This resource includes 200 questions
designed to mirror the Next Generation NCLEX (NGN) format, featuring standalone multiple-choice items as
well as case study–inspired questions that test clinical judgment, prioritization, delegation and the latest
nursing competencies. Each question is followed by the correct answer (presented with the full answer
choice text) and a concise rationale of no more than three lines. Use this exam to assess your readiness, build
endurance, and deepen your understanding of key nursing concepts.
Key Topics Covered
• NGN Case Studies – Clinical judgment, unfolding scenarios, and recognizing cues
• Prioritization & Delegation – Maslow, ABCs, safety, scope of practice, assignment
• Pharmacology – Mechanism of action, side effects, nursing considerations, antidotes
• Maternal Newborn – Antepartum, intrapartum, postpartum, newborn assessment, complications
• Med-Surg Nursing – Cardiovascular, respiratory, endocrine, GI, renal, infectious disease
• Mental Health Nursing – Therapeutic communication, psychopharmacology, crisis intervention, defense
mechanisms
Questions 1–200
1. A nurse is caring for a client who presents with sudden chest pain, dyspnea, and hypotension
following a total knee replacement surgery two days ago. Which action should the nurse take first?
A) Administer oxygen at 2 L/min via nasal cannula
B) Prepare for thrombolytic therapy
C) Place the client in a high-Fowler’s position
D) Obtain a STAT spiral CT scan
Answer C: Place the client in a high-Fowler’s position
Rationale: High-Fowler’s position optimizes ventilation and reduces venous return, which can be life-saving
in suspected pulmonary embolism. Oxygen administration is important but positioning is the immediate
priority to maximize oxygenation and perfusion. Obtaining a CT scan requires time and should not delay
positioning and oxygen.
,2. A charge nurse is delegating tasks to a licensed practical nurse (LPN) and a certified nursing
assistant (CNA). Which task is most appropriate for the LPN?
A) Obtain a clean-catch urine specimen from a stable client
B) Administer a scheduled subcutaneous insulin injection
C) Initiate teaching on post-operative deep breathing exercises
D) Perform the initial admission assessment on a new client
Answer B: Administer a scheduled subcutaneous insulin injection
Rationale: LPNs can administer subcutaneous medications to stable clients under the supervision of an RN.
Initial assessment and client teaching are within the RN scope; CNA can obtain urine specimens. Insulin
administration by LPN is within their scope in most jurisdictions when client is stable.
3. A nurse on a mental health unit is assessing a client with major depressive disorder who started
sertraline 10 days ago. Which finding requires immediate notification of the provider?
A) The client reports persistent dry mouth
B) The client states, “I feel more energy but still very sad”
C) The client reports a decrease in appetite
D) The client sleeps 12 hours per day
Answer B: The client states, “I feel more energy but still very sad”
Rationale: Increased energy combined with persistent sadness raises suicide risk as the client may act on
plans. Serotonin reuptake inhibitors initially improve energy before mood, requiring close monitoring for
self-harm. Dry mouth and appetite changes are common side effects but not immediately life-threatening.
4. A primigravida at 38 weeks gestation is admitted with contractions every 3-5 minutes, lasting 60
seconds. Cervical examination reveals 5 cm dilation, 90% effaced, and 0 station. Which fetal
monitoring finding would be most concerning?
A) Variability of 6 bpm
B) Early decelerations to 100 bpm
C) Recurrent late decelerations
D) Accelerations with fetal movement
Answer C: Recurrent late decelerations
Rationale: Late decelerations indicate uteroplacental insufficiency and can lead to fetal acidosis and hypoxic
injury. Early decelerations are benign and caused by fetal head compression during contractions. Moderate
variability and accelerations are reassuring signs of fetal well-being.
,5. A nurse is preparing to administer digoxin 0.25 mg orally. The client’s apical pulse is 54 bpm and
irregular. Which action should the nurse take?
A) Administer the dose as ordered
B) Hold the dose and document the pulse only
C) Hold the dose and reassess the pulse in 30 minutes
D) Hold the dose and notify the healthcare provider
Answer D: Hold the dose and notify the healthcare provider
Rationale: Digoxin is typically held for an apical pulse below 60 bpm in adults due to risk of toxicity and
bradycardia. The provider must be notified for further orders such as ECG or dose adjustment. Reassessment
without notification could delay necessary intervention.
6. A client with cirrhosis develops asterixis, confusion, and a serum ammonia level of 120 mcg/dL.
Which dietary modification is most appropriate?
A) High-protein, low-carbohydrate
B) Low-sodium, fluid-restricted
C) Low-protein, high-calorie
D) High-fat, low-fiber
Answer C: Low-protein, high-calorie
Rationale: Hepatic encephalopathy requires reduced protein intake to decrease ammonia production while
maintaining calories. High-calorie carbohydrates help preserve muscle mass without worsening ammonia
levels. Protein restriction is temporary; once encephalopathy resolves, protein is gradually reintroduced.
7. A nurse in the postpartum unit is assessing a client who delivered 6 hours ago. The client reports
heavy lochia with large clots and a boggy fundus displaced to the right. What is the priority nursing
action?
A) Assist the client to void
B) Administer methylergonovine as ordered
C) Increase the IV oxytocin infusion rate
D) Perform fundal massage
Answer A: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder preventing uterine contraction;
voiding restores tone. Fundal massage is done after ensuring bladder is empty to avoid incomplete
, contraction. Methylergonovine and oxytocin are secondary if massage after voiding does not control
bleeding.
8. A client receiving IV vancomycin reports flushing of the face and neck, and a pruritic rash on the
chest. The infusion was started 10 minutes ago. What should the nurse do first?
A) Slow the infusion rate
B) Administer diphenhydramine as a PRN order
C) Stop the infusion
D) Document the reaction as an expected side effect
Answer C: Stop the infusion
Rationale: The symptoms describe “Red Man Syndrome,” but stopping the infusion is the first action to
prevent worsening reaction. After stopping, the nurse can slow the rate upon provider order or give
antihistamines for mild reactions. Documentation occurs after immediate patient safety interventions.
9. A nurse is caring for a client with bipolar I disorder who is experiencing acute mania. Which goal
should take priority during the first 24 hours of hospitalization?
A) The client will attend group therapy sessions
B) The client will sleep at least 6 hours per night
C) The client will remain free from injury
D) The client will verbalize three coping strategies
Answer C: The client will remain free from injury
Rationale: Safety is always the priority; manic clients may engage in reckless behavior causing harm to self
or others. Sleep and therapy are important but secondary to preventing physical injury. Coping strategies
require stable mood and insight not present in acute mania.
10. A client with chronic heart failure has an ejection fraction of 35%. The nurse notes new-onset
paroxysmal nocturnal dyspnea (PND). Which medication should the nurse anticipate being added to
the regimen?
A) Furosemide IV push
B) Metoprolol succinate
C) Digoxin 0.125 mg daily
D) Spironolactone
Answer A: Furosemide IV push
