NCLEX-RN UWorld Comprehensive Study Guide & Practice Q Bank Actual Exam
2026/2027 – Complete Exam-Style Questions with Detailed Rationales | 100%
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Section A: Safe and Effective Care Environment — Management of
Care (20 Questions)
Q1: A nurse on a busy medical-surgical unit receives a new admission from the
emergency department while simultaneously managing a patient who is becoming
hemodynamically unstable. Which action demonstrates the nurse's role as a client
advocate?
A. Delegating the new admission assessment to the charge nurse so the nurse can
focus on the unstable patient
B. Requesting additional staffing assistance and prioritizing care for the unstable
patient while ensuring the new admission receives a timely assessment [CORRECT]
C. Completing the new admission paperwork first because it is time-sensitive
D. Asking the unstable patient's family to monitor vital signs while the nurse admits the
new patient
Correct Answer: B
Rationale: Client advocacy requires ensuring each patient receives safe, appropriate
care based on acuity. Requesting help and prioritizing the unstable patient aligns with
the NCJMM cognitive process of prioritization. Delegating an admission assessment to
the charge nurse is inappropriate (admission requires RN assessment), completing
paperwork first ignores the unstable patient, and asking family to monitor vitals is
unsafe and outside their scope.
,Q2: A nurse is caring for a client who was admitted for elective surgery. The client
states, "I changed my mind. I don't want the surgery." Which action by the nurse is MOST
appropriate?
A. Explain that the client cannot withdraw consent once preoperative medications have
been administered
B. Notify the surgeon immediately and document the client's refusal in the medical
record [CORRECT]
C. Convince the client to proceed by explaining the risks of not having the surgery
D. Have the client's family sign a new consent form on the client's behalf
Correct Answer: B
Rationale: Clients have the legal right to withdraw informed consent at any time before a
procedure. The nurse must immediately notify the surgeon and document the refusal
without attempting to coerce the client. Preoperative medication does not eliminate the
right to refuse, and family members cannot override a competent adult's decision.
Q3: A registered nurse is delegating tasks to a licensed practical nurse (LPN) and an
unlicensed assistive personnel (UAP). Which task is MOST appropriate to delegate to
the LPN?
A. Developing the initial plan of care for a newly admitted client with heart failure
B. Administering an oral antibiotic to a stable client with a urinary tract infection
[CORRECT]
C. Assessing a postoperative client for signs of hemorrhage
D. Counseling a client newly diagnosed with diabetes about insulin administration
Correct Answer: B
Rationale: LPNs can administer oral medications to stable clients within their scope of
practice. Developing the initial plan of care, assessing for postoperative complications,
and providing diabetic counseling are RN-level responsibilities that require clinical
,judgment, assessment, and teaching. The NCJMM cognitive process of delegation
requires matching task complexity to licensure level.
Q4: A nurse is reviewing advance directives with a client admitted for a chronic
condition. The client has a living will and a durable power of attorney for healthcare
(DPOA-HC). Which statement by the nurse is MOST accurate?
A. "The living will appoints a specific person to make decisions if you become
incapacitated."
B. "The DPOA-HC names a surrogate decision-maker, while the living will documents
your specific treatment preferences." [CORRECT]
C. "Both documents are only valid if signed by two physicians."
D. "The living will overrides the DPOA-HC if there is a conflict between the two."
Correct Answer: B
Rationale: A living will specifies the client's wishes regarding life-sustaining treatments,
while a DPOA-HC designates a surrogate to make healthcare decisions when the client
cannot. Advance directives typically require witness signatures (not necessarily
physicians), and neither document inherently overrides the other—conflicts are resolved
through clinical ethics consultation.
Q5: A client is being discharged home after a total hip replacement. Which action by the
nurse demonstrates continuity of care?
A. Providing the client with a generic brochure about joint replacement
B. Coordinating home health services, reviewing medications, and scheduling follow-up
appointments before discharge [CORRECT]
C. Telling the client to call the office if they have any questions after leaving
D. Completing discharge documentation after the client has already left the facility
Correct Answer: B
, Rationale: Continuity of care requires seamless transitions between care settings
through coordinated discharge planning, including home health referrals, medication
reconciliation, and follow-up scheduling. Generic brochures lack personalization, vague
instructions place burden on the client, and post-departure documentation fails to
ensure safe transition.
Q6: A nurse observes a colleague documenting vital signs that were not actually
obtained. Which action by the nurse demonstrates professional accountability and
ethical responsibility?
A. Ignore the behavior because confronting a colleague could damage team cohesion
B. Report the observation to the nurse manager and follow institutional policy for
addressing falsified documentation [CORRECT]
C. Confront the colleague publicly at the nurses' station to deter future behavior
D. Document the vital signs correctly in the nurse's own notes without addressing the
colleague's actions
Correct Answer: B
Rationale: Falsified documentation constitutes professional misconduct that
jeopardizes patient safety. The nurse must follow the chain of command and
institutional policy for reporting. Ignoring the behavior violates ethical obligations,
public confrontation is unprofessional, and silently correcting notes does not address
the systemic issue or colleague accountability.
Q7: A client is scheduled for a blood transfusion. The nurse checks the blood product
against the client's identification band and medical record. Which client right is the
nurse primarily protecting?
A. The right to refuse treatment
B. The right to safety and error prevention [CORRECT]
2026/2027 – Complete Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Safe and Effective Care Environment — Management of
Care (20 Questions)
Q1: A nurse on a busy medical-surgical unit receives a new admission from the
emergency department while simultaneously managing a patient who is becoming
hemodynamically unstable. Which action demonstrates the nurse's role as a client
advocate?
A. Delegating the new admission assessment to the charge nurse so the nurse can
focus on the unstable patient
B. Requesting additional staffing assistance and prioritizing care for the unstable
patient while ensuring the new admission receives a timely assessment [CORRECT]
C. Completing the new admission paperwork first because it is time-sensitive
D. Asking the unstable patient's family to monitor vital signs while the nurse admits the
new patient
Correct Answer: B
Rationale: Client advocacy requires ensuring each patient receives safe, appropriate
care based on acuity. Requesting help and prioritizing the unstable patient aligns with
the NCJMM cognitive process of prioritization. Delegating an admission assessment to
the charge nurse is inappropriate (admission requires RN assessment), completing
paperwork first ignores the unstable patient, and asking family to monitor vitals is
unsafe and outside their scope.
,Q2: A nurse is caring for a client who was admitted for elective surgery. The client
states, "I changed my mind. I don't want the surgery." Which action by the nurse is MOST
appropriate?
A. Explain that the client cannot withdraw consent once preoperative medications have
been administered
B. Notify the surgeon immediately and document the client's refusal in the medical
record [CORRECT]
C. Convince the client to proceed by explaining the risks of not having the surgery
D. Have the client's family sign a new consent form on the client's behalf
Correct Answer: B
Rationale: Clients have the legal right to withdraw informed consent at any time before a
procedure. The nurse must immediately notify the surgeon and document the refusal
without attempting to coerce the client. Preoperative medication does not eliminate the
right to refuse, and family members cannot override a competent adult's decision.
Q3: A registered nurse is delegating tasks to a licensed practical nurse (LPN) and an
unlicensed assistive personnel (UAP). Which task is MOST appropriate to delegate to
the LPN?
A. Developing the initial plan of care for a newly admitted client with heart failure
B. Administering an oral antibiotic to a stable client with a urinary tract infection
[CORRECT]
C. Assessing a postoperative client for signs of hemorrhage
D. Counseling a client newly diagnosed with diabetes about insulin administration
Correct Answer: B
Rationale: LPNs can administer oral medications to stable clients within their scope of
practice. Developing the initial plan of care, assessing for postoperative complications,
and providing diabetic counseling are RN-level responsibilities that require clinical
,judgment, assessment, and teaching. The NCJMM cognitive process of delegation
requires matching task complexity to licensure level.
Q4: A nurse is reviewing advance directives with a client admitted for a chronic
condition. The client has a living will and a durable power of attorney for healthcare
(DPOA-HC). Which statement by the nurse is MOST accurate?
A. "The living will appoints a specific person to make decisions if you become
incapacitated."
B. "The DPOA-HC names a surrogate decision-maker, while the living will documents
your specific treatment preferences." [CORRECT]
C. "Both documents are only valid if signed by two physicians."
D. "The living will overrides the DPOA-HC if there is a conflict between the two."
Correct Answer: B
Rationale: A living will specifies the client's wishes regarding life-sustaining treatments,
while a DPOA-HC designates a surrogate to make healthcare decisions when the client
cannot. Advance directives typically require witness signatures (not necessarily
physicians), and neither document inherently overrides the other—conflicts are resolved
through clinical ethics consultation.
Q5: A client is being discharged home after a total hip replacement. Which action by the
nurse demonstrates continuity of care?
A. Providing the client with a generic brochure about joint replacement
B. Coordinating home health services, reviewing medications, and scheduling follow-up
appointments before discharge [CORRECT]
C. Telling the client to call the office if they have any questions after leaving
D. Completing discharge documentation after the client has already left the facility
Correct Answer: B
, Rationale: Continuity of care requires seamless transitions between care settings
through coordinated discharge planning, including home health referrals, medication
reconciliation, and follow-up scheduling. Generic brochures lack personalization, vague
instructions place burden on the client, and post-departure documentation fails to
ensure safe transition.
Q6: A nurse observes a colleague documenting vital signs that were not actually
obtained. Which action by the nurse demonstrates professional accountability and
ethical responsibility?
A. Ignore the behavior because confronting a colleague could damage team cohesion
B. Report the observation to the nurse manager and follow institutional policy for
addressing falsified documentation [CORRECT]
C. Confront the colleague publicly at the nurses' station to deter future behavior
D. Document the vital signs correctly in the nurse's own notes without addressing the
colleague's actions
Correct Answer: B
Rationale: Falsified documentation constitutes professional misconduct that
jeopardizes patient safety. The nurse must follow the chain of command and
institutional policy for reporting. Ignoring the behavior violates ethical obligations,
public confrontation is unprofessional, and silently correcting notes does not address
the systemic issue or colleague accountability.
Q7: A client is scheduled for a blood transfusion. The nurse checks the blood product
against the client's identification band and medical record. Which client right is the
nurse primarily protecting?
A. The right to refuse treatment
B. The right to safety and error prevention [CORRECT]
