NCLEX RN Exam Test Bank 2026/2027
NCLEX RN ACTUAL EXAM TEST BANK
Real and Exact Exam Questions and Answers
NCLEX 2026/2027 | Updated Edition
Aligned with NCSBN 2026-2027 NCLEX-RN Test Plan
225 Comprehensive Questions with Detailed Rationales
Including Next Generation NCLEX (NGN) Clinical Judgment Questions
Safe and Effective Care Environment | Health Promotion and Maintenance
Psychosocial Integrity | Basic Care and Comfort | Pharmacological Therapies
Reduction of Risk Potential | Physiological Adaptation | NGN Clinical Judgment
Page 1
, NCLEX RN Exam Test Bank 2026/2027
Section 1: Safe and Effective Care Environment - Management of Care (Q1-Q40)
Q1: A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The client is fully alert and
oriented. Which action should the nurse take first?
A. Notify the healthcare provider to obtain a court order for the transfusion
B. Document the client's refusal and ensure informed consent is documented
C. Explain the consequences of refusing the blood transfusion to the client [CORRECT]
D. Ask the client's family to persuade the client to accept the transfusion
Correct Answer: C
Rationale: The correct answer is C. The nurse must first ensure the client has adequate information to make an informed decision,
which aligns with the ethical principle of autonomy and the legal requirement for informed consent. The nurse should explain the
risks, benefits, and consequences of refusing the transfusion, including potential death, so the client can make a fully informed
choice. Option A is incorrect because a court order should not be sought for a competent adult making an informed refusal. Option B
is important but should occur after ensuring the client understands the consequences. Option D violates client autonomy by involving
family to pressure the client.
Q2: The charge nurse is making client assignments for the shift. Which client is most appropriate to assign to a licensed
practical nurse (LPN)?
A. A client with a new diagnosis of heart failure who requires discharge teaching
B. A client who is 2 hours postoperative following a cholecystectomy with a T-tube [CORRECT]
C. A client with a chest tube who has new-onset subcutaneous emphysema
D. A client admitted with diabetic ketoacidosis who has a potassium level of 3.1 mEq/L
Correct Answer: B
Rationale: The correct answer is B. An LPN can care for a stable postoperative client with a T-tube under RN supervision, as this
involves monitoring and basic care within the LPN scope of practice. Option A requires complex teaching and assessment that is
within the RN scope. Option C requires immediate assessment of a new complication (subcutaneous emphysema) that demands
RN-level critical thinking. Option D involves a critically ill client with an unstable electrolyte imbalance requiring continuous
assessment, IV management, and frequent medication adjustments, all RN responsibilities.
Q3: A nurse is supervising a nursing assistant (UAP) who is caring for a client with Clostridioides difficile infection.
Which action by the UAP requires immediate intervention by the nurse?
A. The UAP wears a gown and gloves when entering the client's room
B. The UAP uses an alcohol-based hand rub after removing gloves [CORRECT]
C. The UAP places the client's used linens in a designated laundry bag
D. The UAP keeps the door to the client's room closed at all times
Correct Answer: B
Rationale: The correct answer is B. The UAP must perform hand hygiene with soap and water after caring for a client with C.
difficile because alcohol-based hand rubs do not effectively kill C. difficile spores. This is a critical safety issue requiring immediate
intervention. Option A is correct because contact precautions require gown and gloves. Option C is appropriate for contaminated
linens. Option D is appropriate as the client is on contact precautions, though closing the door is more commonly associated with
airborne precautions.
Q4: A nurse is reviewing the medical record of a client who has an advance directive stating the client does not want
CPR. Which action should the nurse take?
A. Remove the code status from the client's medical record per facility policy
B. Verify that the advance directive is current and properly documented in the chart [CORRECT]
C. Discuss with the family whether they agree with the client's decision
D. Request that the healthcare provider rewrite the order to include full resuscitation
Correct Answer: B
Page 2
, NCLEX RN Exam Test Bank 2026/2027
Rationale: The correct answer is B. The nurse should verify that the advance directive is current and properly documented to ensure
the client's wishes are honored. This reflects the ethical principles of autonomy and veracity. Option A is incorrect because the DNR
should remain in the chart. Option C is inappropriate because the client's autonomous decision should be respected regardless of
family opinion. Option D directly contradicts the client's expressed wishes and violates legal and ethical standards.
Q5: A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by the
client indicates an understanding of the teaching?
A. I should increase my intake of dark green leafy vegetables
B. I will have my INR checked regularly as scheduled [CORRECT]
C. I can take ibuprofen for my occasional headaches
D. I should take this medication with antacids to reduce stomach upset
Correct Answer: B
Rationale: The correct answer is B. Regular INR monitoring is essential for clients on warfarin to ensure therapeutic anticoagulation
and prevent bleeding or thrombotic complications. Option A is incorrect because increasing vitamin K intake from leafy greens can
decrease warfarin effectiveness. Option C is incorrect because NSAIDs like ibuprofen increase bleeding risk when combined with
warfarin. Option D is incorrect because antacids can interfere with warfarin absorption.
Q6: A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with type 2 diabetes who has a blood glucose of 210 mg/dL
B. A client with heart failure who reports a 2 kg weight gain over 2 days
C. A client with pneumonia who has a temperature of 38.4 degrees C (101.1 degrees F)
D. A client who is 1 day postoperative with new-onset confusion and restlessness [CORRECT]
Correct Answer: D
Rationale: The correct answer is D. New-onset confusion and restlessness in a postoperative client is an early sign of hypoxia, a
life-threatening emergency requiring immediate assessment using the ABC priority framework. This takes priority over the other
clients whose conditions, while needing attention, are not immediately life-threatening. Option A shows elevated glucose but is not an
acute emergency. Option B indicates fluid retention but is not immediately critical. Option C shows a low-grade fever expected with
pneumonia.
Q7: A nurse manager is implementing a quality improvement project to reduce medication errors. Which strategy is
most effective for promoting a culture of safety?
A. Disciplining nurses who make medication errors
B. Implementing a nonpunitive reporting system for near misses and errors [CORRECT]
C. Requiring nurses to work double shifts to improve staffing ratios
D. Limiting medication administration to only experienced nurses
Correct Answer: B
Rationale: The correct answer is B. A nonpunitive reporting system encourages staff to report errors and near misses without fear of
punishment, a fundamental component of a just culture that promotes system-level improvements. Option A is counterproductive
because punishment discourages reporting and does not address root causes. Option C increases fatigue-related errors. Option D is
impractical and limits the development of all nursing staff.
Q8: A nurse is delegating tasks to an experienced nursing assistant (UAP). Which task is most appropriate to delegate?
A. Performing the initial admission assessment of a new client
B. Ambulating a stable client who had a knee replacement yesterday [CORRECT]
C. Evaluating the effectiveness of a new pain management plan
D. Teaching a client how to perform self-catheterization
Correct Answer: B
Rationale: The correct answer is B. Ambulating a stable postoperative client is within the UAP scope of practice and involves routine
care that does not require nursing judgment. Option A requires assessment skills exclusive to the RN. Option C involves evaluation, a
component of the nursing process exclusive to the RN. Option D requires teaching, an RN responsibility under the Nurse Practice
Act.
Page 3
, NCLEX RN Exam Test Bank 2026/2027
Q9: A client tells the nurse, "I do not want the surgeon to know about my history of substance abuse." How should the
nurse respond?
A. "I will keep your information confidential as you request."
B. "The surgeon needs this information to plan your anesthesia care safely." [CORRECT]
C. "Let me ask the social worker to discuss this with you."
D. "I understand your concern, but I must report this to the surgeon."
Correct Answer: B
Rationale: The correct answer is B. The nurse should explain why the information is necessary for safe care, encouraging voluntary
disclosure. The client has a right to confidentiality, but healthcare providers involved in the client's care have a need to know
relevant information that affects treatment decisions, including anesthesia management. Option A withholds critical safety
information. Option C inappropriately defers without addressing the concern. Option D uses an authoritarian approach that may
damage the therapeutic relationship without first educating the client.
Q10: A nurse is receiving a report using the SBAR format. Which information should the nurse include in the
"Background" section?
A. The client's current blood pressure and heart rate readings
B. The client's recent surgical history and current treatment plan [CORRECT]
C. What the nurse thinks the problem might be
D. What the nurse is requesting the provider to do
Correct Answer: B
Rationale: The correct answer is B. In SBAR, the "Background" includes relevant clinical context such as medical history, current
treatment, and pertinent events leading up to the current situation. Option A belongs in "Situation" (current status). Option C belongs
in "Assessment" (clinical judgment). Option D belongs in "Recommendation" (suggested actions). Understanding SBAR ensures
clear, structured communication that reduces errors during handoffs and provider notifications.
Q11: A nurse is caring for a client who is being discharged home with a new ostomy. Which member of the
interdisciplinary team should the nurse consult to provide the most comprehensive discharge planning?
A. A physical therapist for ambulation training
B. A wound ostomy continence (WOC) nurse for ostomy care teaching [CORRECT]
C. A social worker for financial counseling
D. A chaplain for spiritual support
Correct Answer: B
Rationale: The correct answer is B. The WOC nurse specializes in ostomy care and is the best resource for comprehensive ostomy
education, including stoma care, appliance management, and skin assessment. While physical therapy, social work, and chaplaincy
are valuable team members, the WOC nurse provides the most relevant expertise for this client's primary discharge need. Effective
interdisciplinary collaboration ensures the right specialist addresses each client need.
Q12: A nurse is reviewing the laboratory results for a client scheduled for surgery. The client's hemoglobin is 8.5 g/dL.
Which action should the nurse take first?
A. Administer a unit of packed red blood cells
B. Notify the surgeon and document the findings [CORRECT]
C. Encourage the client to eat iron-rich foods
D. Proceed with the scheduled surgery as planned
Correct Answer: B
Rationale: The correct answer is B. A hemoglobin of 8.5 g/dL is below normal and increases surgical risk due to decreased
oxygen-carrying capacity. The nurse should notify the surgeon immediately so the decision to proceed, delay, or treat can be made.
Option A is premature without a provider order. Option C is insufficient for the acute surgical timeframe. Option D is unsafe without
addressing the anemia risk.
Q13: A nurse is providing care for a client who is participating in a clinical research trial. Which action by the nurse
protects the client's rights?
Page 4
NCLEX RN ACTUAL EXAM TEST BANK
Real and Exact Exam Questions and Answers
NCLEX 2026/2027 | Updated Edition
Aligned with NCSBN 2026-2027 NCLEX-RN Test Plan
225 Comprehensive Questions with Detailed Rationales
Including Next Generation NCLEX (NGN) Clinical Judgment Questions
Safe and Effective Care Environment | Health Promotion and Maintenance
Psychosocial Integrity | Basic Care and Comfort | Pharmacological Therapies
Reduction of Risk Potential | Physiological Adaptation | NGN Clinical Judgment
Page 1
, NCLEX RN Exam Test Bank 2026/2027
Section 1: Safe and Effective Care Environment - Management of Care (Q1-Q40)
Q1: A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The client is fully alert and
oriented. Which action should the nurse take first?
A. Notify the healthcare provider to obtain a court order for the transfusion
B. Document the client's refusal and ensure informed consent is documented
C. Explain the consequences of refusing the blood transfusion to the client [CORRECT]
D. Ask the client's family to persuade the client to accept the transfusion
Correct Answer: C
Rationale: The correct answer is C. The nurse must first ensure the client has adequate information to make an informed decision,
which aligns with the ethical principle of autonomy and the legal requirement for informed consent. The nurse should explain the
risks, benefits, and consequences of refusing the transfusion, including potential death, so the client can make a fully informed
choice. Option A is incorrect because a court order should not be sought for a competent adult making an informed refusal. Option B
is important but should occur after ensuring the client understands the consequences. Option D violates client autonomy by involving
family to pressure the client.
Q2: The charge nurse is making client assignments for the shift. Which client is most appropriate to assign to a licensed
practical nurse (LPN)?
A. A client with a new diagnosis of heart failure who requires discharge teaching
B. A client who is 2 hours postoperative following a cholecystectomy with a T-tube [CORRECT]
C. A client with a chest tube who has new-onset subcutaneous emphysema
D. A client admitted with diabetic ketoacidosis who has a potassium level of 3.1 mEq/L
Correct Answer: B
Rationale: The correct answer is B. An LPN can care for a stable postoperative client with a T-tube under RN supervision, as this
involves monitoring and basic care within the LPN scope of practice. Option A requires complex teaching and assessment that is
within the RN scope. Option C requires immediate assessment of a new complication (subcutaneous emphysema) that demands
RN-level critical thinking. Option D involves a critically ill client with an unstable electrolyte imbalance requiring continuous
assessment, IV management, and frequent medication adjustments, all RN responsibilities.
Q3: A nurse is supervising a nursing assistant (UAP) who is caring for a client with Clostridioides difficile infection.
Which action by the UAP requires immediate intervention by the nurse?
A. The UAP wears a gown and gloves when entering the client's room
B. The UAP uses an alcohol-based hand rub after removing gloves [CORRECT]
C. The UAP places the client's used linens in a designated laundry bag
D. The UAP keeps the door to the client's room closed at all times
Correct Answer: B
Rationale: The correct answer is B. The UAP must perform hand hygiene with soap and water after caring for a client with C.
difficile because alcohol-based hand rubs do not effectively kill C. difficile spores. This is a critical safety issue requiring immediate
intervention. Option A is correct because contact precautions require gown and gloves. Option C is appropriate for contaminated
linens. Option D is appropriate as the client is on contact precautions, though closing the door is more commonly associated with
airborne precautions.
Q4: A nurse is reviewing the medical record of a client who has an advance directive stating the client does not want
CPR. Which action should the nurse take?
A. Remove the code status from the client's medical record per facility policy
B. Verify that the advance directive is current and properly documented in the chart [CORRECT]
C. Discuss with the family whether they agree with the client's decision
D. Request that the healthcare provider rewrite the order to include full resuscitation
Correct Answer: B
Page 2
, NCLEX RN Exam Test Bank 2026/2027
Rationale: The correct answer is B. The nurse should verify that the advance directive is current and properly documented to ensure
the client's wishes are honored. This reflects the ethical principles of autonomy and veracity. Option A is incorrect because the DNR
should remain in the chart. Option C is inappropriate because the client's autonomous decision should be respected regardless of
family opinion. Option D directly contradicts the client's expressed wishes and violates legal and ethical standards.
Q5: A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by the
client indicates an understanding of the teaching?
A. I should increase my intake of dark green leafy vegetables
B. I will have my INR checked regularly as scheduled [CORRECT]
C. I can take ibuprofen for my occasional headaches
D. I should take this medication with antacids to reduce stomach upset
Correct Answer: B
Rationale: The correct answer is B. Regular INR monitoring is essential for clients on warfarin to ensure therapeutic anticoagulation
and prevent bleeding or thrombotic complications. Option A is incorrect because increasing vitamin K intake from leafy greens can
decrease warfarin effectiveness. Option C is incorrect because NSAIDs like ibuprofen increase bleeding risk when combined with
warfarin. Option D is incorrect because antacids can interfere with warfarin absorption.
Q6: A nurse is caring for four clients. Which client should the nurse assess first?
A. A client with type 2 diabetes who has a blood glucose of 210 mg/dL
B. A client with heart failure who reports a 2 kg weight gain over 2 days
C. A client with pneumonia who has a temperature of 38.4 degrees C (101.1 degrees F)
D. A client who is 1 day postoperative with new-onset confusion and restlessness [CORRECT]
Correct Answer: D
Rationale: The correct answer is D. New-onset confusion and restlessness in a postoperative client is an early sign of hypoxia, a
life-threatening emergency requiring immediate assessment using the ABC priority framework. This takes priority over the other
clients whose conditions, while needing attention, are not immediately life-threatening. Option A shows elevated glucose but is not an
acute emergency. Option B indicates fluid retention but is not immediately critical. Option C shows a low-grade fever expected with
pneumonia.
Q7: A nurse manager is implementing a quality improvement project to reduce medication errors. Which strategy is
most effective for promoting a culture of safety?
A. Disciplining nurses who make medication errors
B. Implementing a nonpunitive reporting system for near misses and errors [CORRECT]
C. Requiring nurses to work double shifts to improve staffing ratios
D. Limiting medication administration to only experienced nurses
Correct Answer: B
Rationale: The correct answer is B. A nonpunitive reporting system encourages staff to report errors and near misses without fear of
punishment, a fundamental component of a just culture that promotes system-level improvements. Option A is counterproductive
because punishment discourages reporting and does not address root causes. Option C increases fatigue-related errors. Option D is
impractical and limits the development of all nursing staff.
Q8: A nurse is delegating tasks to an experienced nursing assistant (UAP). Which task is most appropriate to delegate?
A. Performing the initial admission assessment of a new client
B. Ambulating a stable client who had a knee replacement yesterday [CORRECT]
C. Evaluating the effectiveness of a new pain management plan
D. Teaching a client how to perform self-catheterization
Correct Answer: B
Rationale: The correct answer is B. Ambulating a stable postoperative client is within the UAP scope of practice and involves routine
care that does not require nursing judgment. Option A requires assessment skills exclusive to the RN. Option C involves evaluation, a
component of the nursing process exclusive to the RN. Option D requires teaching, an RN responsibility under the Nurse Practice
Act.
Page 3
, NCLEX RN Exam Test Bank 2026/2027
Q9: A client tells the nurse, "I do not want the surgeon to know about my history of substance abuse." How should the
nurse respond?
A. "I will keep your information confidential as you request."
B. "The surgeon needs this information to plan your anesthesia care safely." [CORRECT]
C. "Let me ask the social worker to discuss this with you."
D. "I understand your concern, but I must report this to the surgeon."
Correct Answer: B
Rationale: The correct answer is B. The nurse should explain why the information is necessary for safe care, encouraging voluntary
disclosure. The client has a right to confidentiality, but healthcare providers involved in the client's care have a need to know
relevant information that affects treatment decisions, including anesthesia management. Option A withholds critical safety
information. Option C inappropriately defers without addressing the concern. Option D uses an authoritarian approach that may
damage the therapeutic relationship without first educating the client.
Q10: A nurse is receiving a report using the SBAR format. Which information should the nurse include in the
"Background" section?
A. The client's current blood pressure and heart rate readings
B. The client's recent surgical history and current treatment plan [CORRECT]
C. What the nurse thinks the problem might be
D. What the nurse is requesting the provider to do
Correct Answer: B
Rationale: The correct answer is B. In SBAR, the "Background" includes relevant clinical context such as medical history, current
treatment, and pertinent events leading up to the current situation. Option A belongs in "Situation" (current status). Option C belongs
in "Assessment" (clinical judgment). Option D belongs in "Recommendation" (suggested actions). Understanding SBAR ensures
clear, structured communication that reduces errors during handoffs and provider notifications.
Q11: A nurse is caring for a client who is being discharged home with a new ostomy. Which member of the
interdisciplinary team should the nurse consult to provide the most comprehensive discharge planning?
A. A physical therapist for ambulation training
B. A wound ostomy continence (WOC) nurse for ostomy care teaching [CORRECT]
C. A social worker for financial counseling
D. A chaplain for spiritual support
Correct Answer: B
Rationale: The correct answer is B. The WOC nurse specializes in ostomy care and is the best resource for comprehensive ostomy
education, including stoma care, appliance management, and skin assessment. While physical therapy, social work, and chaplaincy
are valuable team members, the WOC nurse provides the most relevant expertise for this client's primary discharge need. Effective
interdisciplinary collaboration ensures the right specialist addresses each client need.
Q12: A nurse is reviewing the laboratory results for a client scheduled for surgery. The client's hemoglobin is 8.5 g/dL.
Which action should the nurse take first?
A. Administer a unit of packed red blood cells
B. Notify the surgeon and document the findings [CORRECT]
C. Encourage the client to eat iron-rich foods
D. Proceed with the scheduled surgery as planned
Correct Answer: B
Rationale: The correct answer is B. A hemoglobin of 8.5 g/dL is below normal and increases surgical risk due to decreased
oxygen-carrying capacity. The nurse should notify the surgeon immediately so the decision to proceed, delay, or treat can be made.
Option A is premature without a provider order. Option C is insufficient for the acute surgical timeframe. Option D is unsafe without
addressing the anemia risk.
Q13: A nurse is providing care for a client who is participating in a clinical research trial. Which action by the nurse
protects the client's rights?
Page 4
