NCLEX-RN COMPREHENSIVE PRACTICE
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for candidates preparing for
the NCLEX-RN® examination, including the Next Generation NCLEX (NGN) items
that emphasize clinical judgment and decision-making. The exam integrates all
major content areas: medical-surgical nursing, pharmacology, maternal-newborn
and pediatric nursing, psychiatric-mental health nursing, and professional issues.
Each question is crafted at the advanced level expected of a registered nurse,
combining theoretical knowledge with practical clinical scenarios, client safety,
and evidence-based practice. The 100 multiple-choice and alternate-format items
challenge your ability to analyze complex patient situations, prioritize care,
evaluate outcomes, and apply critical thinking under pressure. Detailed rationales
accompany every answer, explaining why the correct choice is best and why
alternatives fall short. Use this exam to assess your readiness, identify knowledge
gaps, and strengthen the clinical reasoning skills essential for success on the
NCLEX-RN and for safe, effective nursing practice.
Table of Contents
1. Medical-Surgical Nursing
2. Pharmacology and Medication Administration
3. Maternal-Newborn and Women’s Health
4. Pediatric Nursing
5. Psychiatric-Mental Health Nursing
6. Fundamentals and Professional Issues
7. Critical Care and Emergency Nursing
8. Community Health and Leadership
, 1. The nurse is caring for a client 24 hours after a total thyroidectomy. The
client reports tingling around the mouth and muscle cramps. The nurse
should first:
A) Administer the prescribed oral calcium supplement.
B) Check the client’s serum calcium level.
C) Assess for Chvostek’s and Trousseau’s signs.
D) Notify the health care provider.
Correct Answer: C
Tingling around the mouth and muscle cramps suggest hypocalcemia due to
inadvertent removal of parathyroid glands. The nurse should first assess for
Chvostek’s and Trousseau’s signs to confirm the suspicion. While checking the
calcium level (B) and administering calcium (A) are appropriate, assessment
precedes intervention. Notifying the provider (D) should occur after a focused
assessment.
2. A client with a history of chronic obstructive pulmonary disease (COPD) is
admitted with increasing shortness of breath. The nurse initiates oxygen at
2 L/min via nasal cannula. Which finding indicates a need to immediately
reduce the oxygen flow rate?
A) The client’s respiratory rate decreases from 28 to 22 breaths/min.
B) The client becomes confused and has a decreased level of consciousness.
C) The client’s SpO₂ increases from 86% to 92%.
D) The client states they feel less short of breath.
Correct Answer: B
Clients with long-standing COPD may retain CO₂ and rely on hypoxic drive to
breathe. If oxygen is administered at a rate that suppresses this drive, the client
may develop CO₂ narcosis, leading to confusion and decreased consciousness. The
other options indicate expected or positive responses to oxygen therapy.
3. The nurse is preparing to administer digoxin to a client with heart failure.
The client’s apical pulse is 58 beats/min. What should the nurse do first?
A) Administer the digoxin as prescribed.
B) Hold the digoxin and notify the health care provider.
, C) Recheck the pulse in 30 minutes.
D) Administer half of the prescribed dose.
Correct Answer: B
Digoxin is a cardiac glycoside that slows the heart rate. A pulse below 60
beats/min is a standard parameter for withholding the drug. The nurse should
hold the medication and notify the provider. Administering the drug (A) could
cause severe bradycardia. Rechecking (C) delays needed action; altering the dose
(D) is outside nursing scope.
4. A client is receiving warfarin for atrial fibrillation. The international
normalized ratio (INR) is 4.5. The nurse anticipates an order for which
medication?
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma
D) Aspirin
Correct Answer: B
Warfarin works by inhibiting vitamin K-dependent clotting factors. An elevated INR
indicates excessive anticoagulation; vitamin K is the antidote. Protamine sulfate
(A) reverses heparin, not warfarin. Fresh frozen plasma (C) may be used in severe
bleeding but not first-line. Aspirin (D) would increase bleeding risk.
5. The nurse is caring for a client in the immediate postoperative period after a
total hip arthroplasty. Which client position is most appropriate to prevent
dislocation?
A) Abduction of the operative hip with a wedge pillow
B) Adduction of the operative hip with the leg crossed over the other
C) Internal rotation of the operative leg
D) Flexion of the hip beyond 90 degrees
Correct Answer: A
After hip replacement, the hip should be maintained in abduction to keep the
, prosthesis in the socket. Adduction (B), internal rotation (C), and flexion beyond 90
degrees (D) increase the risk of dislocation.
6. A client with Type 1 diabetes mellitus has an insulin pump that malfunctions
and stops delivering insulin. The client is at risk for developing:
A) Hypoglycemia
B) Diabetic ketoacidosis (DKA)
C) Hyperosmolar hyperglycemic state (HHS)
D) Metabolic alkalosis
Correct Answer: B
Without insulin, glucose cannot enter cells, leading to fat breakdown and ketone
production, causing DKA. Hypoglycemia (A) is caused by too much insulin. HHS (C)
occurs more commonly in Type 2 diabetes. Metabolic alkalosis (D) is not directly
caused by lack of insulin.
7. A client diagnosed with major depressive disorder is started on fluoxetine.
Which statement by the client indicates a need for further teaching?
A) “I will take this medication at bedtime.”
B) “It may take 2 to 4 weeks before I notice improvement.”
C) “I will stop taking this medication if I experience sexual side effects.”
D) “I should avoid alcohol while taking this medication.”
Correct Answer: C
Clients should be taught to report side effects rather than abruptly stopping the
medication, as sudden discontinuation can cause withdrawal symptoms or relapse.
Fluoxetine is usually taken in the morning (A) to prevent insomnia; response may
take weeks (B); alcohol should be avoided (D).
8. The nurse is assessing a client who has increased intracranial pressure (ICP).
Which finding is an early sign of increased ICP?
A) Cushing’s triad (bradycardia, hypertension, irregular respirations)
B) Fixed, dilated pupils
C) Change in level of consciousness
D) Decerebrate posturing
EXAMINATION – STUDY GUIDE | LATEST UPDATE
2026/2027 | ACTUAL EXAM | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for candidates preparing for
the NCLEX-RN® examination, including the Next Generation NCLEX (NGN) items
that emphasize clinical judgment and decision-making. The exam integrates all
major content areas: medical-surgical nursing, pharmacology, maternal-newborn
and pediatric nursing, psychiatric-mental health nursing, and professional issues.
Each question is crafted at the advanced level expected of a registered nurse,
combining theoretical knowledge with practical clinical scenarios, client safety,
and evidence-based practice. The 100 multiple-choice and alternate-format items
challenge your ability to analyze complex patient situations, prioritize care,
evaluate outcomes, and apply critical thinking under pressure. Detailed rationales
accompany every answer, explaining why the correct choice is best and why
alternatives fall short. Use this exam to assess your readiness, identify knowledge
gaps, and strengthen the clinical reasoning skills essential for success on the
NCLEX-RN and for safe, effective nursing practice.
Table of Contents
1. Medical-Surgical Nursing
2. Pharmacology and Medication Administration
3. Maternal-Newborn and Women’s Health
4. Pediatric Nursing
5. Psychiatric-Mental Health Nursing
6. Fundamentals and Professional Issues
7. Critical Care and Emergency Nursing
8. Community Health and Leadership
, 1. The nurse is caring for a client 24 hours after a total thyroidectomy. The
client reports tingling around the mouth and muscle cramps. The nurse
should first:
A) Administer the prescribed oral calcium supplement.
B) Check the client’s serum calcium level.
C) Assess for Chvostek’s and Trousseau’s signs.
D) Notify the health care provider.
Correct Answer: C
Tingling around the mouth and muscle cramps suggest hypocalcemia due to
inadvertent removal of parathyroid glands. The nurse should first assess for
Chvostek’s and Trousseau’s signs to confirm the suspicion. While checking the
calcium level (B) and administering calcium (A) are appropriate, assessment
precedes intervention. Notifying the provider (D) should occur after a focused
assessment.
2. A client with a history of chronic obstructive pulmonary disease (COPD) is
admitted with increasing shortness of breath. The nurse initiates oxygen at
2 L/min via nasal cannula. Which finding indicates a need to immediately
reduce the oxygen flow rate?
A) The client’s respiratory rate decreases from 28 to 22 breaths/min.
B) The client becomes confused and has a decreased level of consciousness.
C) The client’s SpO₂ increases from 86% to 92%.
D) The client states they feel less short of breath.
Correct Answer: B
Clients with long-standing COPD may retain CO₂ and rely on hypoxic drive to
breathe. If oxygen is administered at a rate that suppresses this drive, the client
may develop CO₂ narcosis, leading to confusion and decreased consciousness. The
other options indicate expected or positive responses to oxygen therapy.
3. The nurse is preparing to administer digoxin to a client with heart failure.
The client’s apical pulse is 58 beats/min. What should the nurse do first?
A) Administer the digoxin as prescribed.
B) Hold the digoxin and notify the health care provider.
, C) Recheck the pulse in 30 minutes.
D) Administer half of the prescribed dose.
Correct Answer: B
Digoxin is a cardiac glycoside that slows the heart rate. A pulse below 60
beats/min is a standard parameter for withholding the drug. The nurse should
hold the medication and notify the provider. Administering the drug (A) could
cause severe bradycardia. Rechecking (C) delays needed action; altering the dose
(D) is outside nursing scope.
4. A client is receiving warfarin for atrial fibrillation. The international
normalized ratio (INR) is 4.5. The nurse anticipates an order for which
medication?
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma
D) Aspirin
Correct Answer: B
Warfarin works by inhibiting vitamin K-dependent clotting factors. An elevated INR
indicates excessive anticoagulation; vitamin K is the antidote. Protamine sulfate
(A) reverses heparin, not warfarin. Fresh frozen plasma (C) may be used in severe
bleeding but not first-line. Aspirin (D) would increase bleeding risk.
5. The nurse is caring for a client in the immediate postoperative period after a
total hip arthroplasty. Which client position is most appropriate to prevent
dislocation?
A) Abduction of the operative hip with a wedge pillow
B) Adduction of the operative hip with the leg crossed over the other
C) Internal rotation of the operative leg
D) Flexion of the hip beyond 90 degrees
Correct Answer: A
After hip replacement, the hip should be maintained in abduction to keep the
, prosthesis in the socket. Adduction (B), internal rotation (C), and flexion beyond 90
degrees (D) increase the risk of dislocation.
6. A client with Type 1 diabetes mellitus has an insulin pump that malfunctions
and stops delivering insulin. The client is at risk for developing:
A) Hypoglycemia
B) Diabetic ketoacidosis (DKA)
C) Hyperosmolar hyperglycemic state (HHS)
D) Metabolic alkalosis
Correct Answer: B
Without insulin, glucose cannot enter cells, leading to fat breakdown and ketone
production, causing DKA. Hypoglycemia (A) is caused by too much insulin. HHS (C)
occurs more commonly in Type 2 diabetes. Metabolic alkalosis (D) is not directly
caused by lack of insulin.
7. A client diagnosed with major depressive disorder is started on fluoxetine.
Which statement by the client indicates a need for further teaching?
A) “I will take this medication at bedtime.”
B) “It may take 2 to 4 weeks before I notice improvement.”
C) “I will stop taking this medication if I experience sexual side effects.”
D) “I should avoid alcohol while taking this medication.”
Correct Answer: C
Clients should be taught to report side effects rather than abruptly stopping the
medication, as sudden discontinuation can cause withdrawal symptoms or relapse.
Fluoxetine is usually taken in the morning (A) to prevent insomnia; response may
take weeks (B); alcohol should be avoided (D).
8. The nurse is assessing a client who has increased intracranial pressure (ICP).
Which finding is an early sign of increased ICP?
A) Cushing’s triad (bradycardia, hypertension, irregular respirations)
B) Fixed, dilated pupils
C) Change in level of consciousness
D) Decerebrate posturing
