2026 NCLEX-RN Next Generation
(NGN) Practice Exam: Questions &
Rationales Across All Client Need
Categories
Safe and Effective Care Environment (Questions 1–20)
Question 1
A nurse is preparing to administer morning medications to a client with
hypertension. Which action should the nurse take FIRST to ensure client
safety?
A. Check the client's blood pressure reading
B. Review the medication administration record (MAR)
C. Verify the client's identity using two identifiers
D. Explain the purpose of each medication to the client
Correct Answer: C
Rationale: Client safety begins with accurate identification using two
unique identifiers (e.g., name and date of birth) before any intervention, per
National Patient Safety Goals. While checking BP, reviewing the MAR, and
providing education are important, they occur AFTER confirming the right
client. This prevents medication errors and aligns with the "Right Patient"
principle of medication safety.
,Question 2
A client is at risk for falls. Which interventions should the practical nurse
include in the plan of care? Select all that apply.
☐ Keep the bed in the lowest position
☐ Place frequently used items within easy reach
☐ Use a bed alarm as a restraint alternative
☐ Encourage the client to call for assistance before ambulating
☐ Leave the side rails up at all times
Correct Answers: Keep the bed in the lowest position; Place frequently
used items within easy reach; Use a bed alarm as a restraint alternative;
Encourage the client to call for assistance before ambulating
Rationale: Evidence-based fall prevention includes environmental
modifications (low bed, accessible items), assistive devices (bed alarms),
and promoting client participation in safety (calling for assistance). Leaving
all side rails up at all times is considered a restraint and requires a provider
order; it is not a standard fall prevention intervention.
Question 3
A charge nurse is assigning clients to a licensed practical nurse (LPN).
Which client should the charge nurse assign to the LPN?
A. A client with a new tracheostomy requiring frequent suctioning
B. A client with unstable angina requiring telemetry monitoring
C. A client with diabetic ketoacidosis receiving an insulin drip
D. A client with pneumonia requiring an initial respiratory assessment
,Correct Answer: A
Rationale: LPNs can perform stable, predictable tasks like suctioning a
stable client with an established tracheostomy. Options B and C require RN
assessment and titration of drips. Option D requires initial assessment by an
RN.
Question 4
A nurse is preparing to administer a blood transfusion. Which of the
following actions is most important to prevent a hemolytic
reaction? Select all that apply.
☐ Use a 20-gauge or larger IV catheter
☐ Obtain baseline vital signs
☐ Verify the client's identity using two identifiers
☐ Check the blood product expiration date
☐ Remain with the client for the first 15 minutes
Correct Answers: Verify the client's identity using two identifiers; Check the
blood product expiration date
Rationale: Preventing a hemolytic reaction hinges on correct patient-blood
product matching. Verifying identity and checking the expiration date are
critical safety checks. The other options are important for general
transfusion safety but do not directly prevent hemolytic reactions.
Question 5
A nurse observes an unlicensed assistive personnel (UAP) positioning a
, newly admitted client who has a seizure disorder. The client is supine, and
the UAP is placing soft pillows along the side rails. Which action should the
nurse take?
A. Compliment the UAP on the proper positioning
B. Remove the pillows and instruct the UAP to use padded side rails
C. Allow the UAP to continue with the positioning
D. Document the UAP's actions in the client's chart
Correct Answer: B
Rationale: For clients with seizure disorders, pillows can obstruct the airway
and pose a suffocation risk. Padded side rails should be used instead. The
nurse must provide corrective instruction to ensure client safety.
Question 6
A nurse is caring for a client who has a new prescription for a patient-
controlled analgesia (PCA) pump. Which of the following actions should the
nurse take first?
A. Explain the use of the PCA pump to the client and family
B. Assess the client's pain level using a 0–10 scale
C. Verify the client's allergy status
D. Demonstrate how to use the PCA button
Correct Answer: C
Rationale: Safety is the priority. Verifying allergy status prevents a potential
anaphylactic reaction. The nursing process begins with assessment (B), but
verifying allergies is a specific safety check before administering any
medication via PCA.
(NGN) Practice Exam: Questions &
Rationales Across All Client Need
Categories
Safe and Effective Care Environment (Questions 1–20)
Question 1
A nurse is preparing to administer morning medications to a client with
hypertension. Which action should the nurse take FIRST to ensure client
safety?
A. Check the client's blood pressure reading
B. Review the medication administration record (MAR)
C. Verify the client's identity using two identifiers
D. Explain the purpose of each medication to the client
Correct Answer: C
Rationale: Client safety begins with accurate identification using two
unique identifiers (e.g., name and date of birth) before any intervention, per
National Patient Safety Goals. While checking BP, reviewing the MAR, and
providing education are important, they occur AFTER confirming the right
client. This prevents medication errors and aligns with the "Right Patient"
principle of medication safety.
,Question 2
A client is at risk for falls. Which interventions should the practical nurse
include in the plan of care? Select all that apply.
☐ Keep the bed in the lowest position
☐ Place frequently used items within easy reach
☐ Use a bed alarm as a restraint alternative
☐ Encourage the client to call for assistance before ambulating
☐ Leave the side rails up at all times
Correct Answers: Keep the bed in the lowest position; Place frequently
used items within easy reach; Use a bed alarm as a restraint alternative;
Encourage the client to call for assistance before ambulating
Rationale: Evidence-based fall prevention includes environmental
modifications (low bed, accessible items), assistive devices (bed alarms),
and promoting client participation in safety (calling for assistance). Leaving
all side rails up at all times is considered a restraint and requires a provider
order; it is not a standard fall prevention intervention.
Question 3
A charge nurse is assigning clients to a licensed practical nurse (LPN).
Which client should the charge nurse assign to the LPN?
A. A client with a new tracheostomy requiring frequent suctioning
B. A client with unstable angina requiring telemetry monitoring
C. A client with diabetic ketoacidosis receiving an insulin drip
D. A client with pneumonia requiring an initial respiratory assessment
,Correct Answer: A
Rationale: LPNs can perform stable, predictable tasks like suctioning a
stable client with an established tracheostomy. Options B and C require RN
assessment and titration of drips. Option D requires initial assessment by an
RN.
Question 4
A nurse is preparing to administer a blood transfusion. Which of the
following actions is most important to prevent a hemolytic
reaction? Select all that apply.
☐ Use a 20-gauge or larger IV catheter
☐ Obtain baseline vital signs
☐ Verify the client's identity using two identifiers
☐ Check the blood product expiration date
☐ Remain with the client for the first 15 minutes
Correct Answers: Verify the client's identity using two identifiers; Check the
blood product expiration date
Rationale: Preventing a hemolytic reaction hinges on correct patient-blood
product matching. Verifying identity and checking the expiration date are
critical safety checks. The other options are important for general
transfusion safety but do not directly prevent hemolytic reactions.
Question 5
A nurse observes an unlicensed assistive personnel (UAP) positioning a
, newly admitted client who has a seizure disorder. The client is supine, and
the UAP is placing soft pillows along the side rails. Which action should the
nurse take?
A. Compliment the UAP on the proper positioning
B. Remove the pillows and instruct the UAP to use padded side rails
C. Allow the UAP to continue with the positioning
D. Document the UAP's actions in the client's chart
Correct Answer: B
Rationale: For clients with seizure disorders, pillows can obstruct the airway
and pose a suffocation risk. Padded side rails should be used instead. The
nurse must provide corrective instruction to ensure client safety.
Question 6
A nurse is caring for a client who has a new prescription for a patient-
controlled analgesia (PCA) pump. Which of the following actions should the
nurse take first?
A. Explain the use of the PCA pump to the client and family
B. Assess the client's pain level using a 0–10 scale
C. Verify the client's allergy status
D. Demonstrate how to use the PCA button
Correct Answer: C
Rationale: Safety is the priority. Verifying allergy status prevents a potential
anaphylactic reaction. The nursing process begins with assessment (B), but
verifying allergies is a specific safety check before administering any
medication via PCA.
