N AT I O N A L C O U N C I L O F S TAT E B OA R D S O F N U R S I N G
NCSBN
NCLEX-RN (NGN) TEST BANK
NCLEX-RN (NGN)
2026/2027 Edition
Verified 265 Questions and Answers
with Rationales
A + G R A D E D · N E XT G E N E R AT I O N N C L E X
E XA M I N AT I O N C O D E NCSBN-NCLEX-RN-NGN-2026
T O TA L Q U E S T I O N S 265 Multiple Choice + Multi-Response
SECTIONS 9 (Sections 1–9)
ED ITION
S TA N D A R D S NCSBN NCLEX-RN Test Plan (2026)
MOD EL NGN Clinical Judgment Measurement
Aligned with NCSBN NCLEX-RN Test Plan, Next Generation NCLEX (NGN) Measurement Model,
and Clinical Judgment Competency Standards (2026/2027 Edition).
N C S B N C E R T I F I C AT I O N · R E G I S T E R E D N U R S E L I C E N S U R E
,NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027
EDITION
Verified 265 Questions and Answers with Rationales - A+ Graded
Aligned with NCSBN NCLEX-RN Test Plan, Next Generation NCLEX (NGN) Measurement Model, and Clinical Judgment
Competency Standards (2026/2027 Edition).
Section 1: Management of Care
40 Questions · Question Range Q1–Q40
Q1: An RN on a med-surg unit is assigned four patients at the start of the shift. Using the NCSBN
priority-setting framework (ABC + Maslow + Acute/Chronic + Patient Safety), which patient should the RN
assess FIRST?
A. Patient who is 3 days post-op with an oral temperature of 100.4 F
B. Patient with chronic COPD reporting increased dyspnea and an SpO2 of 88% on room air *[CORRECT]*
C. Patient receiving IV antibiotics who is asking for pain medication
D. Patient who was admitted 2 hours ago with a femur fracture complaining of hunger
Correct Answer: B
Rationale: The ABC framework prioritizes airway and breathing above all other concerns. Per NCSBN NCLEX-RN Test Plan
(2026/2027 edition), the patient with SpO2 of 88% and dyspnea represents an acute respiratory compromise requiring immediate
intervention. Choice A is a low-grade postoperative fever (common in first 48 hours); Choice C, while important, is not
life-threatening; Choice D is a comfort need (Maslow's physiological but lower acuity). The NCSBN priority-setting framework uses
acute vs. chronic, then ABC, then Maslow, then patient safety to triage multiple patients.
Q2: A charge nurse is delegating care tasks to a licensed practical nurse (LPN) and an unlicensed assistive
personnel (UAP). Which task is MOST appropriate to delegate to the LPN according to the NCSBN
delegation framework (5 Rights of Delegation)?
A. Ambulating a patient who is 2 days post-op from a total knee replacement for the first time
B. Reinforcing patient teaching for a newly diagnosed diabetic patient about insulin injection sites
*[CORRECT]*
C. Administering IV push morphine to a patient with acute pain from sickle cell crisis
D. Admitting a new patient transferred from the ICU with multiple chest tubes and a central line
Correct Answer: B
Rationale: The NCSBN 5 Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right
Supervision/Evaluation) permit LPNs to reinforce teaching for stable patients with established plans. Choice A involves first-time
post-op ambulation, requiring RN assessment; Choice C involves IV push narcotics, which is outside LPN scope in most states; Choice
D requires comprehensive initial RN assessment for an unstable patient. LPNs work under RN direction and cannot perform initial
assessments, IV push meds, or care for unstable patients.
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 1
,NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
Q3: An 82-year-old patient with stage IV dementia is admitted with pneumonia. The patient's daughter
presents a valid durable power of attorney for healthcare and requests that antibiotics be withheld. The
patient's spouse disagrees and wants full treatment. What is the nurse's BEST action based on ethical
principles?
A. Follow the spouse's wishes as next of kin
B. Administer antibiotics until the ethics committee convenes
C. Honor the durable power of attorney and notify the provider of the daughter's request *[CORRECT]*
D. Refuse to participate in the patient's care due to moral conflict
Correct Answer: C
Rationale: A durable power of attorney for healthcare (DPOA-HC) is a legal advance directive that authorizes the designated agent
to make healthcare decisions when the patient lacks capacity. Per the Patient Self-Determination Act (PSDA) and ANA Code of
Ethics, the designated DPOA-HC supersedes next-of-kin hierarchy. Choice A ignores the legal authority of the DPOA; Choice B
delays care but violates the principle of autonomy; Choice D is abandonment (nurses must provide care unless proper conscientious
objection procedures are followed). The nurse must advocate for the patient's previously expressed wishes through the legally
designated agent.
Q4: A patient is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the patient signs the consent form. Thirty minutes later, the patient tells the nurse, 'I'm not
sure what I signed. The doctor spoke so fast and used medical terms I didn't understand.' What is the nurse's
priority action?
A. Document the patient's statement and continue pre-operative preparation
B. Notify the surgeon that the patient has questions about the procedure before it begins *[CORRECT]*
C. Re-explain the procedure in layperson terms and ask the patient to re-sign the consent
D. Cancel the surgery and notify the anesthesiologist
Correct Answer: B
Rationale: Informed consent requires that the patient understands the procedure, risks, benefits, and alternatives. The nurse's role is
to witness the consent and notify the provider if the patient has questions or does not understand. Per NCSBN NCLEX standards, only
the provider performing the procedure can legally obtain informed consent. Choice A is neglect; Choice C oversteps nursing scope
(nurses cannot obtain consent); Choice D is excessive - the nurse should not unilaterally cancel surgery. The nurse advocates for the
patient by ensuring the provider addresses the patient's understanding.
Q5: A nurse manager is investigating a medication error. A nurse administered 10 units of regular insulin
instead of the prescribed 5 units. The patient became hypoglycemic but recovered with treatment. Which
action by the nurse manager demonstrates Just Culture principles?
A. Immediately terminate the nurse for the medication error
B. Conduct a root cause analysis to identify system factors while holding the nurse accountable for at-risk
behavior *[CORRECT]*
C. Document the error in the nurse's file without further action since the patient recovered
D. Reassign the nurse to a different unit to prevent future errors
Correct Answer: B
Rationale: The Just Culture model distinguishes between human error (system improvements needed), at-risk behavior (coaching
needed), and reckless behavior (disciplinary action). The nurse manager should investigate system factors (e.g., look-alike vials,
similar labeling) while addressing the individual's behavior. Per the ANA and NCSBN position on Just Culture, blame-free reporting
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 2
, NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
improves patient safety. Choice A is excessive without determining intent; Choice C ignores patient safety responsibilities; Choice D
does not address root causes and transfers the problem.
Q6: An RN is caring for a patient who is HIV positive. The patient's family is unaware of the diagnosis. The
patient's spouse approaches the nurse and asks, 'Is my spouse HIV positive? I think I have the right to know.'
What is the nurse's BEST response based on HIPAA and ethical principles?
A. Disclose the diagnosis because spouses have a right to know their risk of exposure
B. Tell the spouse that the information is confidential and cannot be shared without the patient's permission
C. Suggest the spouse discuss their concerns directly with the patient
D. Both B and C - maintain confidentiality and encourage direct communication *[CORRECT]*
Correct Answer: D
Rationale: HIPAA protects the confidentiality of the patient's HIV status. The nurse cannot disclose without the patient's consent. Per
ethical principles (autonomy, confidentiality), the nurse should both refuse to disclose AND encourage direct communication between
spouses. Choice A violates HIPAA; Choice B alone is correct but lacks the proactive advocacy of encouraging patient-to-spouse
communication; Choice C alone does not address the spouse's direct inquiry to the nurse. The combined response B and C is most
therapeutic and legally sound. NCSBN NCLEX tests knowledge of both legal duties and therapeutic communication.
Q7: A patient with end-stage heart failure has a signed DNR (Do Not Resuscitate) order. The patient goes into
cardiac arrest and the patient's adult child, who is present, says, 'Please save my parent! Do CPR!' What is
the nurse's priority action?
A. Begin CPR immediately; the family's wishes override the DNR
B. Verify the DNR order is current and valid, then do not initiate CPR *[CORRECT]*
C. Call the provider for clarification before initiating any action
D. Begin CPR while another nurse verifies the DNR documentation
Correct Answer: B
Rationale: A valid, current DNR order represents the patient's autonomous decision and must be honored regardless of family wishes.
Per the Patient Self-Determination Act and ANA Code of Ethics, the nurse should verify the DNR is current and valid (e.g., signed, in
the chart, not revoked) and refrain from initiating CPR. Choice A violates the patient's autonomy; Choice C delays appropriate
end-of-life care; Choice D initiates inappropriate CPR. The nurse provides emotional support to the family while respecting the
patient's wishes.
Q8: A new graduate nurse is preparing to administer IV morphine to a post-operative patient for the first
time. The patient's respiratory rate is 10 breaths/minute. What is the nurse's BEST action based on the
NCSBN clinical judgment model?
A. Administer the morphine as ordered; respiratory rate of 10 is within normal limits
B. Hold the morphine, notify the provider, and assess the patient's pain level and sedation status
*[CORRECT]*
C. Administer half the dose of morphine and reassess in 30 minutes
D. Administer naloxone immediately to reverse potential opioid toxicity
Correct Answer: B
Rationale: Using the NGN Clinical Judgment Measurement Model (recognize cues, analyze cues, prioritize hypotheses, generate
solutions, take action, evaluate outcomes), the nurse recognizes that a respiratory rate of 10 is bradypneic and concerning for
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 3
NCSBN
NCLEX-RN (NGN) TEST BANK
NCLEX-RN (NGN)
2026/2027 Edition
Verified 265 Questions and Answers
with Rationales
A + G R A D E D · N E XT G E N E R AT I O N N C L E X
E XA M I N AT I O N C O D E NCSBN-NCLEX-RN-NGN-2026
T O TA L Q U E S T I O N S 265 Multiple Choice + Multi-Response
SECTIONS 9 (Sections 1–9)
ED ITION
S TA N D A R D S NCSBN NCLEX-RN Test Plan (2026)
MOD EL NGN Clinical Judgment Measurement
Aligned with NCSBN NCLEX-RN Test Plan, Next Generation NCLEX (NGN) Measurement Model,
and Clinical Judgment Competency Standards (2026/2027 Edition).
N C S B N C E R T I F I C AT I O N · R E G I S T E R E D N U R S E L I C E N S U R E
,NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027
EDITION
Verified 265 Questions and Answers with Rationales - A+ Graded
Aligned with NCSBN NCLEX-RN Test Plan, Next Generation NCLEX (NGN) Measurement Model, and Clinical Judgment
Competency Standards (2026/2027 Edition).
Section 1: Management of Care
40 Questions · Question Range Q1–Q40
Q1: An RN on a med-surg unit is assigned four patients at the start of the shift. Using the NCSBN
priority-setting framework (ABC + Maslow + Acute/Chronic + Patient Safety), which patient should the RN
assess FIRST?
A. Patient who is 3 days post-op with an oral temperature of 100.4 F
B. Patient with chronic COPD reporting increased dyspnea and an SpO2 of 88% on room air *[CORRECT]*
C. Patient receiving IV antibiotics who is asking for pain medication
D. Patient who was admitted 2 hours ago with a femur fracture complaining of hunger
Correct Answer: B
Rationale: The ABC framework prioritizes airway and breathing above all other concerns. Per NCSBN NCLEX-RN Test Plan
(2026/2027 edition), the patient with SpO2 of 88% and dyspnea represents an acute respiratory compromise requiring immediate
intervention. Choice A is a low-grade postoperative fever (common in first 48 hours); Choice C, while important, is not
life-threatening; Choice D is a comfort need (Maslow's physiological but lower acuity). The NCSBN priority-setting framework uses
acute vs. chronic, then ABC, then Maslow, then patient safety to triage multiple patients.
Q2: A charge nurse is delegating care tasks to a licensed practical nurse (LPN) and an unlicensed assistive
personnel (UAP). Which task is MOST appropriate to delegate to the LPN according to the NCSBN
delegation framework (5 Rights of Delegation)?
A. Ambulating a patient who is 2 days post-op from a total knee replacement for the first time
B. Reinforcing patient teaching for a newly diagnosed diabetic patient about insulin injection sites
*[CORRECT]*
C. Administering IV push morphine to a patient with acute pain from sickle cell crisis
D. Admitting a new patient transferred from the ICU with multiple chest tubes and a central line
Correct Answer: B
Rationale: The NCSBN 5 Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right
Supervision/Evaluation) permit LPNs to reinforce teaching for stable patients with established plans. Choice A involves first-time
post-op ambulation, requiring RN assessment; Choice C involves IV push narcotics, which is outside LPN scope in most states; Choice
D requires comprehensive initial RN assessment for an unstable patient. LPNs work under RN direction and cannot perform initial
assessments, IV push meds, or care for unstable patients.
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 1
,NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
Q3: An 82-year-old patient with stage IV dementia is admitted with pneumonia. The patient's daughter
presents a valid durable power of attorney for healthcare and requests that antibiotics be withheld. The
patient's spouse disagrees and wants full treatment. What is the nurse's BEST action based on ethical
principles?
A. Follow the spouse's wishes as next of kin
B. Administer antibiotics until the ethics committee convenes
C. Honor the durable power of attorney and notify the provider of the daughter's request *[CORRECT]*
D. Refuse to participate in the patient's care due to moral conflict
Correct Answer: C
Rationale: A durable power of attorney for healthcare (DPOA-HC) is a legal advance directive that authorizes the designated agent
to make healthcare decisions when the patient lacks capacity. Per the Patient Self-Determination Act (PSDA) and ANA Code of
Ethics, the designated DPOA-HC supersedes next-of-kin hierarchy. Choice A ignores the legal authority of the DPOA; Choice B
delays care but violates the principle of autonomy; Choice D is abandonment (nurses must provide care unless proper conscientious
objection procedures are followed). The nurse must advocate for the patient's previously expressed wishes through the legally
designated agent.
Q4: A patient is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the patient signs the consent form. Thirty minutes later, the patient tells the nurse, 'I'm not
sure what I signed. The doctor spoke so fast and used medical terms I didn't understand.' What is the nurse's
priority action?
A. Document the patient's statement and continue pre-operative preparation
B. Notify the surgeon that the patient has questions about the procedure before it begins *[CORRECT]*
C. Re-explain the procedure in layperson terms and ask the patient to re-sign the consent
D. Cancel the surgery and notify the anesthesiologist
Correct Answer: B
Rationale: Informed consent requires that the patient understands the procedure, risks, benefits, and alternatives. The nurse's role is
to witness the consent and notify the provider if the patient has questions or does not understand. Per NCSBN NCLEX standards, only
the provider performing the procedure can legally obtain informed consent. Choice A is neglect; Choice C oversteps nursing scope
(nurses cannot obtain consent); Choice D is excessive - the nurse should not unilaterally cancel surgery. The nurse advocates for the
patient by ensuring the provider addresses the patient's understanding.
Q5: A nurse manager is investigating a medication error. A nurse administered 10 units of regular insulin
instead of the prescribed 5 units. The patient became hypoglycemic but recovered with treatment. Which
action by the nurse manager demonstrates Just Culture principles?
A. Immediately terminate the nurse for the medication error
B. Conduct a root cause analysis to identify system factors while holding the nurse accountable for at-risk
behavior *[CORRECT]*
C. Document the error in the nurse's file without further action since the patient recovered
D. Reassign the nurse to a different unit to prevent future errors
Correct Answer: B
Rationale: The Just Culture model distinguishes between human error (system improvements needed), at-risk behavior (coaching
needed), and reckless behavior (disciplinary action). The nurse manager should investigate system factors (e.g., look-alike vials,
similar labeling) while addressing the individual's behavior. Per the ANA and NCSBN position on Just Culture, blame-free reporting
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 2
, NCSBN TEST BANK - NCLEX-RN (NGN) 2026/2027 EDITION 265 Questions | A+ Graded
improves patient safety. Choice A is excessive without determining intent; Choice C ignores patient safety responsibilities; Choice D
does not address root causes and transfers the problem.
Q6: An RN is caring for a patient who is HIV positive. The patient's family is unaware of the diagnosis. The
patient's spouse approaches the nurse and asks, 'Is my spouse HIV positive? I think I have the right to know.'
What is the nurse's BEST response based on HIPAA and ethical principles?
A. Disclose the diagnosis because spouses have a right to know their risk of exposure
B. Tell the spouse that the information is confidential and cannot be shared without the patient's permission
C. Suggest the spouse discuss their concerns directly with the patient
D. Both B and C - maintain confidentiality and encourage direct communication *[CORRECT]*
Correct Answer: D
Rationale: HIPAA protects the confidentiality of the patient's HIV status. The nurse cannot disclose without the patient's consent. Per
ethical principles (autonomy, confidentiality), the nurse should both refuse to disclose AND encourage direct communication between
spouses. Choice A violates HIPAA; Choice B alone is correct but lacks the proactive advocacy of encouraging patient-to-spouse
communication; Choice C alone does not address the spouse's direct inquiry to the nurse. The combined response B and C is most
therapeutic and legally sound. NCSBN NCLEX tests knowledge of both legal duties and therapeutic communication.
Q7: A patient with end-stage heart failure has a signed DNR (Do Not Resuscitate) order. The patient goes into
cardiac arrest and the patient's adult child, who is present, says, 'Please save my parent! Do CPR!' What is
the nurse's priority action?
A. Begin CPR immediately; the family's wishes override the DNR
B. Verify the DNR order is current and valid, then do not initiate CPR *[CORRECT]*
C. Call the provider for clarification before initiating any action
D. Begin CPR while another nurse verifies the DNR documentation
Correct Answer: B
Rationale: A valid, current DNR order represents the patient's autonomous decision and must be honored regardless of family wishes.
Per the Patient Self-Determination Act and ANA Code of Ethics, the nurse should verify the DNR is current and valid (e.g., signed, in
the chart, not revoked) and refrain from initiating CPR. Choice A violates the patient's autonomy; Choice C delays appropriate
end-of-life care; Choice D initiates inappropriate CPR. The nurse provides emotional support to the family while respecting the
patient's wishes.
Q8: A new graduate nurse is preparing to administer IV morphine to a post-operative patient for the first
time. The patient's respiratory rate is 10 breaths/minute. What is the nurse's BEST action based on the
NCSBN clinical judgment model?
A. Administer the morphine as ordered; respiratory rate of 10 is within normal limits
B. Hold the morphine, notify the provider, and assess the patient's pain level and sedation status
*[CORRECT]*
C. Administer half the dose of morphine and reassess in 30 minutes
D. Administer naloxone immediately to reverse potential opioid toxicity
Correct Answer: B
Rationale: Using the NGN Clinical Judgment Measurement Model (recognize cues, analyze cues, prioritize hypotheses, generate
solutions, take action, evaluate outcomes), the nurse recognizes that a respiratory rate of 10 is bradypneic and concerning for
NCSBN NCLEX-RN Test Bank | Aligned with NGN Clinical Judgment Measurement Model Page 3
