NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
1. A nurse receives change-of-shift report for four clients. Which client should the
nurse assess first?
• A) A client with type 2 diabetes mellitus requesting a bedtime snack
• B) A client with chronic heart failure reporting mild bilateral ankle edema
• C) A client who underwent a coronary artery bypass graft (CABG) 4 hours
ago with a chest tube drainage of 120 mL/hour for the past 2 consecutive
hours
• D) A client with pneumonia who has a temperature of 38.1°C (100.6°F)
Answer: C — Chest tube drainage exceeding 100 mL/hour for two or more
consecutive hours indicates potential postoperative hemorrhage, requiring
immediate intervention.
2. The nurse is caring for four clients on a medical-surgical unit. Which client
requires the immediate attention of the nurse?
• A) A client with chronic obstructive pulmonary disease (COPD) with an
oxygen saturation of 91% on room air
• B) A client with a new onset of sudden confusion, right-sided facial
drooping, and slurred speech
• C) A client with osteomyelitis scheduled for intravenous antibiotic therapy
in 30 minutes
• D) A client with rheumatoid arthritis requesting assistance to ambulate to
the bathroom
Answer: B — Sudden neurological deficits indicate an acute cerebrovascular
accident (stroke), which is a medical emergency requiring rapid evaluation for
thrombolytic therapy.
3. Four clients present to the emergency department. Which client should the
triage nurse prioritize for immediate physician evaluation?
,NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• A) A 24-year-old client with a minor laceration to the forearm who is
bleeding moderately
• B) A 50-year-old client complaining of acute, crushing substernal chest pain
radiating to the left arm
• C) A 35-year-old client with a closed ankle sprain sustained while playing
soccer
• D) A 60-year-old client with chronic low back pain reporting mild discomfort
Answer: B — Crushing substernal chest pain suggests acute myocardial infarction
(heart attack), which is life-threatening and requires immediate cardiac triage.
4. The nurse is caring for a group of postoperative clients. Which client should the
nurse assess first?
• A) A client post-appendectomy reporting moderate incisional pain rated 5
out of 10
• B) A client post-thyroidectomy who exhibits audible inspiratory stridor and
throat tightness
• C) A client post-total knee replacement who refuses to use the incentive
spirometer
• D) A client post-cholecystectomy who has hypoactive bowel sounds in all
four quadrants
Answer: B — Stridor and throat tightness after thyroid surgery indicate acute
airway obstruction caused by hematoma or edema, representing a critical airway
emergency.
5. A nurse is reviewing morning laboratory results. Which result requires
immediate notification of the healthcare provider?
• A) Serum potassium level of 3.6 mEq/L for a client on a regular diet
• B) International Normalized Ratio (INR) of 5.8 for a client receiving warfarin
• C) Fasting blood glucose of 110 mg/dL for a client without diabetes
,NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• D) Hemoglobin level of 12.5 g/dL for a client post-hemorrhoidectomy
Answer: B — An INR of 5.8 is significantly elevated and places the client at severe
risk for spontaneous hemorrhage, requiring urgent intervention and potential
vitamin K administration.
6. The nurse is monitoring a client receiving an intravenous infusion of regular
insulin for diabetic ketoacidosis (DKA). Which laboratory value should the nurse
monitor most closely to prevent a life-threatening complication?
• A) Serum sodium
• B) Serum potassium
• C) Serum calcium
• D) Blood urea nitrogen (BUN)
Answer: B — Insulin drives glucose and potassium into cells, which can precipitate
rapid and severe hypokalemia, leading to lethal cardiac dysrhythmias.
7. The nurse receives report on four clients. Which client should the nurse assess
first?
• A) A client with chronic kidney disease reporting generalized fatigue
• B) A client with asthma experiencing acute expiratory wheezing and
dyspnea
• C) A client with peptic ulcer disease reporting mild epigastric discomfort
after eating
• D) A client with hypertension whose blood pressure is 138/84 mmHg
Answer: B — Acute bronchospasm and dyspnea compromise airway and gas
exchange, requiring immediate respiratory assessment and bronchodilator
therapy.
8. The nurse is prioritizing care for clients on a telemetry unit. Which client should
be evaluated first?
, NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• A) A client with first-degree AV block and a heart rate of 72 beats per
minute
• B) A client in atrial fibrillation with a controlled ventricular rate of 88 beats
per minute
• C) A client with frequent multifocal premature ventricular contractions
(PVCs) complaining of palpitations
• D) A client with a normal sinus rhythm and a pulse of 76 beats per minute
Answer: C — Multifocal PVCs indicate ventricular irritability and can rapidly
deteriorate into ventricular tachycardia or ventricular fibrillation, requiring prompt
evaluation.
9. A nurse is caring for a client with a closed head injury and increased intracranial
pressure (ICP). Which finding indicates a critical, life-threatening deterioration in
neurological status?
• A) A gradual increase in Glasgow Coma Scale score from 12 to 14
• B) Equal and reactive pupils measuring 3 mm in diameter
• C) Development of a widening pulse pressure, bradycardia, and irregular
respirations
• D) A mild, transient headache rated 2 out of 10
Answer: C — Cushing's triad (widening pulse pressure, bradycardia, irregular
respirations) signals severe brainstem compression and impending herniation.
10. The nurse is assigned to care for four postpartum clients. Which client should
the nurse assess first?
• A) A client 2 hours post-delivery with a boggy uterus and heavy vaginal
bleeding
• B) A client 12 hours post-delivery reporting mild afterpains during
breastfeeding
• C) A client 24 hours post-delivery with moderate lochia rubra
well detailed answers
1. A nurse receives change-of-shift report for four clients. Which client should the
nurse assess first?
• A) A client with type 2 diabetes mellitus requesting a bedtime snack
• B) A client with chronic heart failure reporting mild bilateral ankle edema
• C) A client who underwent a coronary artery bypass graft (CABG) 4 hours
ago with a chest tube drainage of 120 mL/hour for the past 2 consecutive
hours
• D) A client with pneumonia who has a temperature of 38.1°C (100.6°F)
Answer: C — Chest tube drainage exceeding 100 mL/hour for two or more
consecutive hours indicates potential postoperative hemorrhage, requiring
immediate intervention.
2. The nurse is caring for four clients on a medical-surgical unit. Which client
requires the immediate attention of the nurse?
• A) A client with chronic obstructive pulmonary disease (COPD) with an
oxygen saturation of 91% on room air
• B) A client with a new onset of sudden confusion, right-sided facial
drooping, and slurred speech
• C) A client with osteomyelitis scheduled for intravenous antibiotic therapy
in 30 minutes
• D) A client with rheumatoid arthritis requesting assistance to ambulate to
the bathroom
Answer: B — Sudden neurological deficits indicate an acute cerebrovascular
accident (stroke), which is a medical emergency requiring rapid evaluation for
thrombolytic therapy.
3. Four clients present to the emergency department. Which client should the
triage nurse prioritize for immediate physician evaluation?
,NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• A) A 24-year-old client with a minor laceration to the forearm who is
bleeding moderately
• B) A 50-year-old client complaining of acute, crushing substernal chest pain
radiating to the left arm
• C) A 35-year-old client with a closed ankle sprain sustained while playing
soccer
• D) A 60-year-old client with chronic low back pain reporting mild discomfort
Answer: B — Crushing substernal chest pain suggests acute myocardial infarction
(heart attack), which is life-threatening and requires immediate cardiac triage.
4. The nurse is caring for a group of postoperative clients. Which client should the
nurse assess first?
• A) A client post-appendectomy reporting moderate incisional pain rated 5
out of 10
• B) A client post-thyroidectomy who exhibits audible inspiratory stridor and
throat tightness
• C) A client post-total knee replacement who refuses to use the incentive
spirometer
• D) A client post-cholecystectomy who has hypoactive bowel sounds in all
four quadrants
Answer: B — Stridor and throat tightness after thyroid surgery indicate acute
airway obstruction caused by hematoma or edema, representing a critical airway
emergency.
5. A nurse is reviewing morning laboratory results. Which result requires
immediate notification of the healthcare provider?
• A) Serum potassium level of 3.6 mEq/L for a client on a regular diet
• B) International Normalized Ratio (INR) of 5.8 for a client receiving warfarin
• C) Fasting blood glucose of 110 mg/dL for a client without diabetes
,NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• D) Hemoglobin level of 12.5 g/dL for a client post-hemorrhoidectomy
Answer: B — An INR of 5.8 is significantly elevated and places the client at severe
risk for spontaneous hemorrhage, requiring urgent intervention and potential
vitamin K administration.
6. The nurse is monitoring a client receiving an intravenous infusion of regular
insulin for diabetic ketoacidosis (DKA). Which laboratory value should the nurse
monitor most closely to prevent a life-threatening complication?
• A) Serum sodium
• B) Serum potassium
• C) Serum calcium
• D) Blood urea nitrogen (BUN)
Answer: B — Insulin drives glucose and potassium into cells, which can precipitate
rapid and severe hypokalemia, leading to lethal cardiac dysrhythmias.
7. The nurse receives report on four clients. Which client should the nurse assess
first?
• A) A client with chronic kidney disease reporting generalized fatigue
• B) A client with asthma experiencing acute expiratory wheezing and
dyspnea
• C) A client with peptic ulcer disease reporting mild epigastric discomfort
after eating
• D) A client with hypertension whose blood pressure is 138/84 mmHg
Answer: B — Acute bronchospasm and dyspnea compromise airway and gas
exchange, requiring immediate respiratory assessment and bronchodilator
therapy.
8. The nurse is prioritizing care for clients on a telemetry unit. Which client should
be evaluated first?
, NCLEX-PN Next Generation Practice Exam 2026 Exam questions and
well detailed answers
• A) A client with first-degree AV block and a heart rate of 72 beats per
minute
• B) A client in atrial fibrillation with a controlled ventricular rate of 88 beats
per minute
• C) A client with frequent multifocal premature ventricular contractions
(PVCs) complaining of palpitations
• D) A client with a normal sinus rhythm and a pulse of 76 beats per minute
Answer: C — Multifocal PVCs indicate ventricular irritability and can rapidly
deteriorate into ventricular tachycardia or ventricular fibrillation, requiring prompt
evaluation.
9. A nurse is caring for a client with a closed head injury and increased intracranial
pressure (ICP). Which finding indicates a critical, life-threatening deterioration in
neurological status?
• A) A gradual increase in Glasgow Coma Scale score from 12 to 14
• B) Equal and reactive pupils measuring 3 mm in diameter
• C) Development of a widening pulse pressure, bradycardia, and irregular
respirations
• D) A mild, transient headache rated 2 out of 10
Answer: C — Cushing's triad (widening pulse pressure, bradycardia, irregular
respirations) signals severe brainstem compression and impending herniation.
10. The nurse is assigned to care for four postpartum clients. Which client should
the nurse assess first?
• A) A client 2 hours post-delivery with a boggy uterus and heavy vaginal
bleeding
• B) A client 12 hours post-delivery reporting mild afterpains during
breastfeeding
• C) A client 24 hours post-delivery with moderate lochia rubra
