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Next Generation NCLEX (NGN) 2026 Comprehensive Exam
Bank: 220 Multiple-Choice Questions Across All Client Need
Categories with Expert Rationales
SECTION I: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1–50)
Management of Care (Questions 1–25)
Question 1
A charge nurse is assigning patient care assignments for a medical-surgical unit. The unit has
four RNs, two LPNs/LVNs, and two nursing assistants. Which patient should the charge nurse
assign to the LPN/LVN?
A) A patient with a new tracheostomy requiring frequent suctioning
B) A patient with type 2 diabetes mellitus requiring insulin administration
C) A patient with a chest tube connected to continuous suction
D) A patient with a percutaneous endoscopic gastrostomy (PEG) tube for feedings
E) A patient with a newly placed central line requiring dressing change
CorreCt Answer: B
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Rationale: LPNs/LVNs can administer insulin and other medications to stable patients under the
supervision of an RN. Tracheostomy suctioning (A) and chest tube management (C) are higher-
acuity skills requiring RN assessment. PEG tube feedings (D) can be delegated but require RN
assessment of placement. Central line dressing changes (E) require RN-level assessment and
sterile technique.
Question 2
A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to a UAP?
A) Assessing a patient's surgical incision for signs of infection
B) Administering a subcutaneous injection of heparin
C) Obtaining a patient's blood pressure and pulse
D) Performing a sterile dressing change
E) Teaching a patient about insulin self-administration
CorreCt Answer: C
Rationale: UAPs can perform vital signs and basic hygiene tasks. Assessment (A) requires RN-
level clinical judgment. Medication administration (B) is outside the scope of UAP practice.
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Sterile dressing changes (D) require RN or LPN/LVN scope. Patient teaching (E) requires RN-level
education and evaluation.
Question 3
A nurse is caring for a patient who is scheduled for surgery. The patient asks, "Do I really need
this surgery? I'm not sure I want to go through with it." Which action should the nurse take
first?
A) Encourage the patient to express their concerns
B) Tell the patient that surgery is the best option
C) Contact the surgeon to come speak with the patient
D) Ask the patient to sign the consent form
E) Document the patient's statement in the chart
CorreCt Answer: A
Rationale: The nurse should first encourage the patient to express their concerns and explore
the reasons for their reluctance. This aligns with the ethical principle of autonomy and the
nurse's role as a patient advocate. The nurse should not coerce the patient (B). The surgeon
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should be notified (C) to provide additional information, but the nurse should first assess the
patient's concerns.
Question 4
A nurse is caring for a patient who is being discharged with a new colostomy. Which action
demonstrates that the nurse is effectively preparing the patient for self-care?
A) Providing written instructions about colostomy care
B) Demonstrating the colostomy bag change procedure and observing the patient perform a
return demonstration
C) Telling the patient to call the home health agency if there are any problems
D) Administering the patient's scheduled medications
E) Requesting a social work consult for home care
CorreCt Answer: B
Rationale: Effective patient education requires demonstration and return demonstration to
ensure the patient can perform the skill independently. Written instructions (A) are helpful but
not sufficient for skill acquisition. Telling the patient to call for help (C) does not ensure self-care
readiness. Medication administration (D) is not patient education.
Next Generation NCLEX (NGN) 2026 Comprehensive Exam
Bank: 220 Multiple-Choice Questions Across All Client Need
Categories with Expert Rationales
SECTION I: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1–50)
Management of Care (Questions 1–25)
Question 1
A charge nurse is assigning patient care assignments for a medical-surgical unit. The unit has
four RNs, two LPNs/LVNs, and two nursing assistants. Which patient should the charge nurse
assign to the LPN/LVN?
A) A patient with a new tracheostomy requiring frequent suctioning
B) A patient with type 2 diabetes mellitus requiring insulin administration
C) A patient with a chest tube connected to continuous suction
D) A patient with a percutaneous endoscopic gastrostomy (PEG) tube for feedings
E) A patient with a newly placed central line requiring dressing change
CorreCt Answer: B
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Rationale: LPNs/LVNs can administer insulin and other medications to stable patients under the
supervision of an RN. Tracheostomy suctioning (A) and chest tube management (C) are higher-
acuity skills requiring RN assessment. PEG tube feedings (D) can be delegated but require RN
assessment of placement. Central line dressing changes (E) require RN-level assessment and
sterile technique.
Question 2
A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to a UAP?
A) Assessing a patient's surgical incision for signs of infection
B) Administering a subcutaneous injection of heparin
C) Obtaining a patient's blood pressure and pulse
D) Performing a sterile dressing change
E) Teaching a patient about insulin self-administration
CorreCt Answer: C
Rationale: UAPs can perform vital signs and basic hygiene tasks. Assessment (A) requires RN-
level clinical judgment. Medication administration (B) is outside the scope of UAP practice.
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Sterile dressing changes (D) require RN or LPN/LVN scope. Patient teaching (E) requires RN-level
education and evaluation.
Question 3
A nurse is caring for a patient who is scheduled for surgery. The patient asks, "Do I really need
this surgery? I'm not sure I want to go through with it." Which action should the nurse take
first?
A) Encourage the patient to express their concerns
B) Tell the patient that surgery is the best option
C) Contact the surgeon to come speak with the patient
D) Ask the patient to sign the consent form
E) Document the patient's statement in the chart
CorreCt Answer: A
Rationale: The nurse should first encourage the patient to express their concerns and explore
the reasons for their reluctance. This aligns with the ethical principle of autonomy and the
nurse's role as a patient advocate. The nurse should not coerce the patient (B). The surgeon
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should be notified (C) to provide additional information, but the nurse should first assess the
patient's concerns.
Question 4
A nurse is caring for a patient who is being discharged with a new colostomy. Which action
demonstrates that the nurse is effectively preparing the patient for self-care?
A) Providing written instructions about colostomy care
B) Demonstrating the colostomy bag change procedure and observing the patient perform a
return demonstration
C) Telling the patient to call the home health agency if there are any problems
D) Administering the patient's scheduled medications
E) Requesting a social work consult for home care
CorreCt Answer: B
Rationale: Effective patient education requires demonstration and return demonstration to
ensure the patient can perform the skill independently. Written instructions (A) are helpful but
not sufficient for skill acquisition. Telling the patient to call for help (C) does not ensure self-care
readiness. Medication administration (D) is not patient education.
