NCLEX-RN® Comprehensive Examination
Practice Questions a well detailed practice
exam 2025/2026 graded A+ well written !!!
Advanced/Hard Difficulty | 150 Multiple-
Choice Questions with Rationales
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT — Management of Care (Questions 1-
25)
The NCLEX-RN Test Plan allocates 15–21% of items to Management of Care, covering
prioritization, delegation, interdisciplinary collaboration, and resource management.
Question 1
A charge nurse is making assignments on a medical-surgical unit. Which patient should be
assigned to the most experienced registered nurse?
A. A 45-year-old patient with diabetes mellitus requiring insulin administration
B. A 68-year-old patient with pneumonia who needs hourly vital signs
C. A 32-year-old patient with acute pancreatitis receiving total parenteral nutrition (TPN)
D. A 72-year-old patient with a urinary tract infection requiring oral antibiotics
Correct Answer: C
Rationale: The patient with acute pancreatitis receiving TPN requires the most experienced RN
due to the complexity of TPN administration, risk of metabolic complications, and need for close
monitoring. TPN is a high-risk therapy requiring advanced assessment skills and knowledge of
potential complications including hyperglycemia, electrolyte imbalances, and catheter-related
,infections. Option A involves routine insulin administration which can be delegated. Option B
involves stable monitoring tasks. Option D involves routine medication administration.
Question 2
A nurse manager is implementing a new evidence-based fall prevention protocol. Which action
demonstrates effective leadership in facilitating staff adoption of the change?
A. Mandating immediate implementation of the protocol without staff input
B. Posting the new protocol on the unit bulletin board for staff to review
C. Conducting staff education sessions, soliciting feedback, and addressing concerns
D. Waiting for staff to ask questions about the new protocol before providing education
Correct Answer: C
Rationale: Effective change management requires staff education, engagement, and addressing
concerns to facilitate adoption. Mandating change without input (A) creates resistance. Simply
posting information (B) does not ensure understanding or buy-in. Waiting for questions (D) is
passive and does not proactively support staff through the change process.
Question 3
A registered nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the RN to delegate?
A. Assessing a patient's lung sounds
B. Evaluating the effectiveness of pain medication
C. Measuring and recording a patient's intake and output
D. Creating a patient's plan of care
Correct Answer: C
Rationale: Measuring and recording intake and output is a routine task that falls within the
scope of practice for UAP. The RN cannot delegate assessment (A), evaluation (B), or planning
(D) as these require clinical judgment and are within the RN's scope of practice. The five rights
of delegation include right task, right circumstance, right person, right
direction/communication, and right supervision/evaluation.
Question 4
,A patient is being discharged with a new colostomy. The nurse notes that the patient is tearful
and states, "I can't go home like this. Everyone will be disgusted by me." What is the nurse's
priority intervention?
A. Reassure the patient that the colostomy will not be noticeable
B. Provide extensive written discharge instructions about ostomy care
C. Allow the patient to express concerns and arrange for a visit from a wound ostomy
continence nurse
D. Tell the patient that many people live successfully with colostomies
Correct Answer: C
Rationale: The priority is to address the patient's psychosocial concerns through therapeutic
communication and arrange for specialized support. Allowing expression of concerns validates
the patient's feelings. A WOCN can provide expert education and support. Option A dismisses
the patient's concerns. Option B does not address the emotional distress. Option D minimizes
the patient's feelings without providing adequate support.
Question 5
A nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's family
member insists that "everything be done" despite the patient's documented wishes. What
should the nurse do?
A. Initiate CPR if the patient arrests to satisfy the family
B. Explain the DNR order and the patient's right to self-determination, and notify the healthcare
provider
C. Ignore the DNR order and follow the family's wishes
D. Ask the family to leave the hospital
Correct Answer: B
Rationale: The nurse must advocate for the patient's autonomy and advance directives. The
patient's documented wishes take precedence. The nurse should explain the DNR order, provide
support to the family, and notify the healthcare provider for additional discussion. Option A and
C violate the patient's rights. Option D is inappropriate and unprofessional.
Question 6
, A charge nurse is evaluating a new graduate nurse's performance. Which action by the new
graduate requires immediate intervention?
A. Documenting vital signs 30 minutes after obtaining them
B. Administering a medication without checking the patient's allergy status
C. Asking a more experienced nurse for assistance with a difficult IV insertion
D. Reporting a change in patient status to the healthcare provider
Correct Answer: B
Rationale: Administering medication without checking allergy status is a serious safety violation
that could result in a life-threatening anaphylactic reaction. This requires immediate
intervention and remediation. Option A, while not ideal, is less critical. Option C demonstrates
appropriate help-seeking behavior. Option D demonstrates appropriate communication.
Question 7
A nurse is preparing to discharge a patient who speaks limited English. What is the most
appropriate action to ensure effective discharge teaching?
A. Provide written instructions in English and ask the patient to have a family member translate
B. Use a certified medical interpreter to provide discharge instructions
C. Speak slowly and loudly to ensure the patient understands
D. Give the patient a video about discharge instructions to watch at home
Correct Answer: B
Rationale: Using a certified medical interpreter is the standard of care for patients with limited
English proficiency to ensure accurate communication. Family members should not be used as
interpreters due to potential errors and confidentiality concerns. Speaking loudly (C) does not
improve understanding. Written materials alone (A) and videos (D) are insufficient without
proper interpretation.
Question 8
A nurse is caring for four patients. Which patient should the nurse assess first?
A. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of
91%
B. A patient with diabetes mellitus with a blood glucose of 180 mg/dL
Practice Questions a well detailed practice
exam 2025/2026 graded A+ well written !!!
Advanced/Hard Difficulty | 150 Multiple-
Choice Questions with Rationales
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT — Management of Care (Questions 1-
25)
The NCLEX-RN Test Plan allocates 15–21% of items to Management of Care, covering
prioritization, delegation, interdisciplinary collaboration, and resource management.
Question 1
A charge nurse is making assignments on a medical-surgical unit. Which patient should be
assigned to the most experienced registered nurse?
A. A 45-year-old patient with diabetes mellitus requiring insulin administration
B. A 68-year-old patient with pneumonia who needs hourly vital signs
C. A 32-year-old patient with acute pancreatitis receiving total parenteral nutrition (TPN)
D. A 72-year-old patient with a urinary tract infection requiring oral antibiotics
Correct Answer: C
Rationale: The patient with acute pancreatitis receiving TPN requires the most experienced RN
due to the complexity of TPN administration, risk of metabolic complications, and need for close
monitoring. TPN is a high-risk therapy requiring advanced assessment skills and knowledge of
potential complications including hyperglycemia, electrolyte imbalances, and catheter-related
,infections. Option A involves routine insulin administration which can be delegated. Option B
involves stable monitoring tasks. Option D involves routine medication administration.
Question 2
A nurse manager is implementing a new evidence-based fall prevention protocol. Which action
demonstrates effective leadership in facilitating staff adoption of the change?
A. Mandating immediate implementation of the protocol without staff input
B. Posting the new protocol on the unit bulletin board for staff to review
C. Conducting staff education sessions, soliciting feedback, and addressing concerns
D. Waiting for staff to ask questions about the new protocol before providing education
Correct Answer: C
Rationale: Effective change management requires staff education, engagement, and addressing
concerns to facilitate adoption. Mandating change without input (A) creates resistance. Simply
posting information (B) does not ensure understanding or buy-in. Waiting for questions (D) is
passive and does not proactively support staff through the change process.
Question 3
A registered nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the RN to delegate?
A. Assessing a patient's lung sounds
B. Evaluating the effectiveness of pain medication
C. Measuring and recording a patient's intake and output
D. Creating a patient's plan of care
Correct Answer: C
Rationale: Measuring and recording intake and output is a routine task that falls within the
scope of practice for UAP. The RN cannot delegate assessment (A), evaluation (B), or planning
(D) as these require clinical judgment and are within the RN's scope of practice. The five rights
of delegation include right task, right circumstance, right person, right
direction/communication, and right supervision/evaluation.
Question 4
,A patient is being discharged with a new colostomy. The nurse notes that the patient is tearful
and states, "I can't go home like this. Everyone will be disgusted by me." What is the nurse's
priority intervention?
A. Reassure the patient that the colostomy will not be noticeable
B. Provide extensive written discharge instructions about ostomy care
C. Allow the patient to express concerns and arrange for a visit from a wound ostomy
continence nurse
D. Tell the patient that many people live successfully with colostomies
Correct Answer: C
Rationale: The priority is to address the patient's psychosocial concerns through therapeutic
communication and arrange for specialized support. Allowing expression of concerns validates
the patient's feelings. A WOCN can provide expert education and support. Option A dismisses
the patient's concerns. Option B does not address the emotional distress. Option D minimizes
the patient's feelings without providing adequate support.
Question 5
A nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's family
member insists that "everything be done" despite the patient's documented wishes. What
should the nurse do?
A. Initiate CPR if the patient arrests to satisfy the family
B. Explain the DNR order and the patient's right to self-determination, and notify the healthcare
provider
C. Ignore the DNR order and follow the family's wishes
D. Ask the family to leave the hospital
Correct Answer: B
Rationale: The nurse must advocate for the patient's autonomy and advance directives. The
patient's documented wishes take precedence. The nurse should explain the DNR order, provide
support to the family, and notify the healthcare provider for additional discussion. Option A and
C violate the patient's rights. Option D is inappropriate and unprofessional.
Question 6
, A charge nurse is evaluating a new graduate nurse's performance. Which action by the new
graduate requires immediate intervention?
A. Documenting vital signs 30 minutes after obtaining them
B. Administering a medication without checking the patient's allergy status
C. Asking a more experienced nurse for assistance with a difficult IV insertion
D. Reporting a change in patient status to the healthcare provider
Correct Answer: B
Rationale: Administering medication without checking allergy status is a serious safety violation
that could result in a life-threatening anaphylactic reaction. This requires immediate
intervention and remediation. Option A, while not ideal, is less critical. Option C demonstrates
appropriate help-seeking behavior. Option D demonstrates appropriate communication.
Question 7
A nurse is preparing to discharge a patient who speaks limited English. What is the most
appropriate action to ensure effective discharge teaching?
A. Provide written instructions in English and ask the patient to have a family member translate
B. Use a certified medical interpreter to provide discharge instructions
C. Speak slowly and loudly to ensure the patient understands
D. Give the patient a video about discharge instructions to watch at home
Correct Answer: B
Rationale: Using a certified medical interpreter is the standard of care for patients with limited
English proficiency to ensure accurate communication. Family members should not be used as
interpreters due to potential errors and confidentiality concerns. Speaking loudly (C) does not
improve understanding. Written materials alone (A) and videos (D) are insufficient without
proper interpretation.
Question 8
A nurse is caring for four patients. Which patient should the nurse assess first?
A. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of
91%
B. A patient with diabetes mellitus with a blood glucose of 180 mg/dL
