Mark Klimek NCLEX Review 2026/2027 100+
Practice Questions with Correct Answers and
Rationales
SECTION 1: PRIORITIZATION & DELEGATION
Question 1
A nurse is caring for four patients at the start of the shift.
Which patient should the nurse assess FIRST?
A) A 45-year-old post-operative day 2 with pain rated 4/10
B) A 68-year-old newly admitted with pneumonia and O2 sat
89%
C) A 30-year-old NPO patient requesting ice chips
D) A 55-year-old with a colostomy asking for a bag change
Correct Answer: B
Rationale: An O2 saturation of 89% indicates hypoxemia,
which is a life-threatening airway and breathing problem.
According to Klimek's prioritization rules, ABCs (Airway,
Breathing, Circulation) always take priority. The pneumonia
patient is unstable and requires immediate intervention. Pain,
,NPO status, and colostomy care are important but non-urgent
issues .
Question 2
Which task can be appropriately delegated to an LPN/LVN?
A) Initial assessment of a newly admitted patient
B) Teaching a diabetic patient about insulin injection
technique
C) Administering a scheduled IM antibiotic to a stable patient
D) Evaluating a patient's response to pain medication
Correct Answer: C
Rationale: LPNs/LVNs can administer stable, scheduled
medications including IM antibiotics. Initial assessments,
patient teaching, and evaluation of patient response require
RN scope of practice. As Klimek teaches, LPNs cannot do the
"first of anything," cannot perform initial assessments, cannot
do admissions/discharges, and cannot perform IV push
medications .
Question 3
,A charge nurse must assign a patient with active tuberculosis
on airborne precautions to one of four staff members. Who is
the BEST assignment?
A) Pregnant LPN with 10 years of experience
B) RN with a history of positive PPD and negative chest x-ray
C) New graduate RN just off orientation
D) Unlicensed assistive personnel
Correct Answer: B
Rationale: The RN with past positive PPD (now latent TB)
already has immunity and is immune-competent. Pregnant staff
should avoid airborne infection rooms when possible. UAP
cannot care for airborne isolation patients independently. The
new graduate may lack experience with complex airborne
isolation precautions .
Question 4
A patient on a heparin drip has an aPTT of 110 seconds (normal
~30 seconds). No bleeding is noted. What should the nurse do
FIRST?
A) Turn off the heparin drip
B) Administer protamine sulfate
, C) Notify the provider
D) Recheck the aPTT in 1 hour
Correct Answer: A
Rationale: Therapeutic aPTT on heparin is approximately 1.5-
2.5 times normal (about 60-80 seconds). An aPTT of 110
seconds is supratherapeutic. The FIRST step is to stop the
infusion, then notify the provider. Protamine sulfate is
reserved for severe bleeding, not for asymptomatic elevated
aPTT. Klimek's default order for abnormal lab values: Hold the
med, Assess, Prepare correction, Call/Notify .
Question 5
A confused patient is trying to remove their IV line. Which
action by the nurse requires CORRECTION?
A) Applying wrist restraints and checking every 2 hours
B) Offering a family member to sit with the patient
C) Using a mitt restraint and removing it every hour
D) Trying a bed alarm and diversion activities first
Correct Answer: A
Rationale: Restraints require a provider order, face-to-face
evaluation within 1 hour, and checks every 15-30 minutes
(NOT every 2 hours). Least restrictive measures must be
Practice Questions with Correct Answers and
Rationales
SECTION 1: PRIORITIZATION & DELEGATION
Question 1
A nurse is caring for four patients at the start of the shift.
Which patient should the nurse assess FIRST?
A) A 45-year-old post-operative day 2 with pain rated 4/10
B) A 68-year-old newly admitted with pneumonia and O2 sat
89%
C) A 30-year-old NPO patient requesting ice chips
D) A 55-year-old with a colostomy asking for a bag change
Correct Answer: B
Rationale: An O2 saturation of 89% indicates hypoxemia,
which is a life-threatening airway and breathing problem.
According to Klimek's prioritization rules, ABCs (Airway,
Breathing, Circulation) always take priority. The pneumonia
patient is unstable and requires immediate intervention. Pain,
,NPO status, and colostomy care are important but non-urgent
issues .
Question 2
Which task can be appropriately delegated to an LPN/LVN?
A) Initial assessment of a newly admitted patient
B) Teaching a diabetic patient about insulin injection
technique
C) Administering a scheduled IM antibiotic to a stable patient
D) Evaluating a patient's response to pain medication
Correct Answer: C
Rationale: LPNs/LVNs can administer stable, scheduled
medications including IM antibiotics. Initial assessments,
patient teaching, and evaluation of patient response require
RN scope of practice. As Klimek teaches, LPNs cannot do the
"first of anything," cannot perform initial assessments, cannot
do admissions/discharges, and cannot perform IV push
medications .
Question 3
,A charge nurse must assign a patient with active tuberculosis
on airborne precautions to one of four staff members. Who is
the BEST assignment?
A) Pregnant LPN with 10 years of experience
B) RN with a history of positive PPD and negative chest x-ray
C) New graduate RN just off orientation
D) Unlicensed assistive personnel
Correct Answer: B
Rationale: The RN with past positive PPD (now latent TB)
already has immunity and is immune-competent. Pregnant staff
should avoid airborne infection rooms when possible. UAP
cannot care for airborne isolation patients independently. The
new graduate may lack experience with complex airborne
isolation precautions .
Question 4
A patient on a heparin drip has an aPTT of 110 seconds (normal
~30 seconds). No bleeding is noted. What should the nurse do
FIRST?
A) Turn off the heparin drip
B) Administer protamine sulfate
, C) Notify the provider
D) Recheck the aPTT in 1 hour
Correct Answer: A
Rationale: Therapeutic aPTT on heparin is approximately 1.5-
2.5 times normal (about 60-80 seconds). An aPTT of 110
seconds is supratherapeutic. The FIRST step is to stop the
infusion, then notify the provider. Protamine sulfate is
reserved for severe bleeding, not for asymptomatic elevated
aPTT. Klimek's default order for abnormal lab values: Hold the
med, Assess, Prepare correction, Call/Notify .
Question 5
A confused patient is trying to remove their IV line. Which
action by the nurse requires CORRECTION?
A) Applying wrist restraints and checking every 2 hours
B) Offering a family member to sit with the patient
C) Using a mitt restraint and removing it every hour
D) Trying a bed alarm and diversion activities first
Correct Answer: A
Rationale: Restraints require a provider order, face-to-face
evaluation within 1 hour, and checks every 15-30 minutes
(NOT every 2 hours). Least restrictive measures must be
