NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
NCLEX-RN Practice Test Questions
2026/2027 Edition
NCLEX RN Review Book with Actual Exam Questions for the NCLEX Nursing Examination
2026/2027
200 Practice Questions | 10 NCLEX Test Plan Sections | Detailed Rationale for Every Answer | NGN
Clinical Judgment Scenarios
This comprehensive practice examination contains exactly 200 multiple-choice questions organized into ten
sections that mirror the current NCSBN NCLEX-RN test plan, from Safe and Effective Care Environment
through Critical Thinking and Clinical Judgment. Each question supplies one correct answer, clearly marked,
together with an NCLEX-specific rationale that explains why the correct option is right and why each
distractor is wrong. The items are weighted for cognitive demand at approximately 20 percent recall, 50
percent application, and 30 percent analysis, with three of every four questions presented as clinical
scenarios. As you work, apply the prioritization frameworks the examination rewards: the ABCs (airway,
breathing, circulation), Maslow's hierarchy, assessment-before-implementation, and the
least-restrictive-intervention rule. Study the rationale after answering every item, because the explanation,
not the letter, is what transfers to the testing center.
Section 1: Safe and Effective Care Environment
Questions 1-40 | Management of Care, Client Rights, Advocacy, Delegation, Legal and Ethical Issues, and Quality
Improvement
Q1. The nurse is assigning care for a group of postoperative clients on a medical-surgical unit.
Which task is appropriate to delegate to the unlicensed assistive personnel (UAP)?
A. Assessing the surgical dressing for drainage
B. Teaching the client coughing and deep-breathing exercises
C. Ambulating a stable client who required minimal assistance yesterday [CORRECT]
D. Administering oral analgesics 30 minutes before ambulation
Correct Answer: C
Rationale: The UAP may ambulate a stable client because the RN has already evaluated the client's
condition and the task requires no clinical judgment; ambulation data must still be reported back to the
nurse. Assessment (option A) is a nondelegable RN responsibility, and client teaching (option B)
requires the comprehensive knowledge of an RN. Administering medications (option D) is never
within UAP scope. This reflects the delegation principles in the NCLEX-RN test plan: delegate the
right task to the right person with the right supervision.
Practice Examination with Detailed Answer Rationales 1
,NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q2. A client scheduled for a total knee arthroplasty tells the nurse, 'I have questions about the
risks before I sign this consent form.' Which action should the nurse take first?
A. Explain the most common risks of the procedure to the client
B. Ask the client to sign the form so that the surgery is not delayed
C. Notify the anesthesia provider to clarify the surgical risks
D. Withhold the consent form and contact the surgeon to answer the client's questions
[CORRECT]
Correct Answer: D
Rationale: The provider performing the procedure is legally responsible for disclosing the nature,
risks, benefits, and alternatives; the nurse's role is to witness the signature and advocate when questions
remain unanswered. Withholding the form and notifying the surgeon preserves informed consent.
Explaining risks herself (option B) exceeds nursing scope, and pressuring the client to sign (option C)
violates informed consent principles. The anesthesia provider (option D) is not responsible for surgical
consent.
Q3. Which client situation indicates that a signed informed consent form is INVALID?
A. The nurse signed the form as a witness after the provider explained the procedure
B. The client received an opioid analgesic that caused drowsiness before signing
[CORRECT]
C. The surgeon explained the procedure the evening before surgery
D. The client's spouse was present during the explanation of the procedure
Correct Answer: B
Rationale: Informed consent requires decision-making capacity, voluntary agreement, and adequate
disclosure; preoperative sedation impairs cognitive function, making the consent invalid. Witnessing
(option A), timing of the explanation (option B), and family presence (option C) do not invalidate
consent. This is a legal-recall item testing the three elements of valid consent: capacity, voluntariness,
and disclosure.
Q4. A competent adult client who is a Jehovah's Witness refuses an ordered blood transfusion
that the provider believes is lifesaving. Which nursing action reflects client advocacy?
A. Support the client's decision and ensure the refusal is documented and communicated
to the provider [CORRECT]
B. Prepare to administer the transfusion after a court order is obtained
C. Obtain transfusion consent from the client's closest adult relative
D. Ask the hospital chaplain to persuade the client to accept the transfusion
Correct Answer: A
Rationale: A competent adult has the absolute right to refuse treatment based on the ethical principle
of autonomy, even when refusal may result in death; advocacy means honoring the decision and
documenting it. Administering blood over objection (option A) constitutes battery, and a relative
cannot consent for a competent adult (option C). Persuasion campaigns (option D) violate
voluntariness. The nursing process step is implementation of the client's right to self-determination.
Practice Examination with Detailed Answer Rationales 2
,NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q5. A visitor approaches the nurses' station and asks the nurse for an update on a friend who
was admitted overnight. Which response is most appropriate?
A. Verify that the visitor is on the client's authorized disclosure list before sharing
information [CORRECT]
B. Provide only routine status information to avoid appearing unhelpful
C. Confirm the friend's room number so the visitor can go to the bedside
D. Direct the visitor to the health information management department for records
Correct Answer: A
Rationale: HIPAA requires the nurse to verify identity and authorization before disclosing protected
health information to anyone, including friends and family. Offering routine updates (option A) or a
room number (option B) breaches confidentiality for an unauthorized visitor. Records departments
(option D) release information only through formal authorization processes, not to walk-in visitors.
Q6. A nurse discovers that a laptop containing unencrypted protected health information has
been stolen from a client care area. Which action should the nurse take FIRST?
A. Notify each affected client of the potential breach by telephone
B. Wait 24 hours to determine whether the device can be recovered
C. Document the loss only in the medical records of the affected clients
D. Report the loss immediately to the facility privacy officer according to policy
[CORRECT]
Correct Answer: D
Rationale: Suspected breaches of protected health information must be escalated immediately to the
privacy officer, who performs the formal risk assessment and coordinates HIPAA-required
notifications. Client notification (option A) occurs only after the formal assessment determines breach
probability, and delay (option C) can violate reporting timelines. Incident documentation belongs in the
facility event system, not scattered in client records (option D).
Q7. A client in full cardiac arrest has no DNR order documented in the chart, but the spouse
states the client 'never wanted to be kept alive by machines.' Which action should the nurse
take?
A. Honor the spouse's verbal request and withhold resuscitation
B. Delay resuscitation while the code status is verified with the provider
C. Begin resuscitation until a valid DNR order is confirmed [CORRECT]
D. Contact the hospital attorney before initiating any interventions
Correct Answer: C
Rationale: In the absence of a valid written DNR order, the nurse must initiate resuscitation; verbal
recollection, even from a spouse, is not a legal substitute for an order. Withholding or delaying (options
B and C) exposes the client to harm and the nurse to liability, and an attorney (option D) has no role in
a code. This analysis item applies the legal standard that ambiguity in code status always resolves
toward providing care.
Practice Examination with Detailed Answer Rationales 3
, NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q8. The nurse notes bruising in various stages of healing on the torso of a 4-year-old, and the
caregiver's explanation is inconsistent with the injuries. Which action is the nurse's
PRIORITY?
A. Confront the caregiver directly about the suspected abuse
B. Report the findings to child protective services as required by state law [CORRECT]
C. Document the findings and plan to assess the child at the next visit
D. Discharge the child home with a written community referral
Correct Answer: B
Rationale: Nurses are mandated reporters; when abuse is suspected, the legal duty is to report to child
protective services immediately, and the nurse does not need proof, only reasonable suspicion.
Confrontation (option A) may endanger the child or the family-nurse relationship, and deferring
(options B and C) abandons the duty to protect. After reporting, the nurse documents objective
findings and maintains a safe, nonjudgmental environment.
Q9. Which client finding must the nurse report to an EXTERNAL authority under mandatory
reporting laws?
A. A fall that occurred while the client was in soft wrist restraints
B. A stage 2 pressure injury that was documented on hospital admission
C. An intentional overdose that requires psychiatric consultation
D. A stab wound sustained by a client during an assault [CORRECT]
Correct Answer: D
Rationale: Stab and gunshot wounds are legally mandated reports to law enforcement in every U.S.
jurisdiction, independent of client consent. A restrained fall (option A) and an admission pressure
injury (option B) are internal safety events managed through incident reporting and quality processes,
not external reporting. An overdose (option D) requires mental health evaluation but is not universally a
mandated external report.
Q10. A confused adult client is restrained after less-restrictive measures failed to prevent
pulling at invasive lines. How often must the restraint order be renewed for this adult client?
A. Once per nursing shift for as long as the behavior continues
B. Every 4 hours, with a maximum of 24 consecutive hours [CORRECT]
C. Every 24 hours as long as the provider reassesses the client
D. Every 48 hours after the initial order is written
Correct Answer: B
Rationale: Adult restraint orders must be renewed at least every 4 hours and cannot exceed 24
consecutive hours without a new order and reevaluation; this protects the client's safety and dignity.
Shift-based renewal (option B) and daily renewal (option C) exceed the regulatory time limit, and
48-hour orders (option D) are never permissible. The nurse must also document ongoing behavior,
circulation checks, range of motion, and releases per facility policy.
Practice Examination with Detailed Answer Rationales 4
NCLEX-RN Practice Test Questions
2026/2027 Edition
NCLEX RN Review Book with Actual Exam Questions for the NCLEX Nursing Examination
2026/2027
200 Practice Questions | 10 NCLEX Test Plan Sections | Detailed Rationale for Every Answer | NGN
Clinical Judgment Scenarios
This comprehensive practice examination contains exactly 200 multiple-choice questions organized into ten
sections that mirror the current NCSBN NCLEX-RN test plan, from Safe and Effective Care Environment
through Critical Thinking and Clinical Judgment. Each question supplies one correct answer, clearly marked,
together with an NCLEX-specific rationale that explains why the correct option is right and why each
distractor is wrong. The items are weighted for cognitive demand at approximately 20 percent recall, 50
percent application, and 30 percent analysis, with three of every four questions presented as clinical
scenarios. As you work, apply the prioritization frameworks the examination rewards: the ABCs (airway,
breathing, circulation), Maslow's hierarchy, assessment-before-implementation, and the
least-restrictive-intervention rule. Study the rationale after answering every item, because the explanation,
not the letter, is what transfers to the testing center.
Section 1: Safe and Effective Care Environment
Questions 1-40 | Management of Care, Client Rights, Advocacy, Delegation, Legal and Ethical Issues, and Quality
Improvement
Q1. The nurse is assigning care for a group of postoperative clients on a medical-surgical unit.
Which task is appropriate to delegate to the unlicensed assistive personnel (UAP)?
A. Assessing the surgical dressing for drainage
B. Teaching the client coughing and deep-breathing exercises
C. Ambulating a stable client who required minimal assistance yesterday [CORRECT]
D. Administering oral analgesics 30 minutes before ambulation
Correct Answer: C
Rationale: The UAP may ambulate a stable client because the RN has already evaluated the client's
condition and the task requires no clinical judgment; ambulation data must still be reported back to the
nurse. Assessment (option A) is a nondelegable RN responsibility, and client teaching (option B)
requires the comprehensive knowledge of an RN. Administering medications (option D) is never
within UAP scope. This reflects the delegation principles in the NCLEX-RN test plan: delegate the
right task to the right person with the right supervision.
Practice Examination with Detailed Answer Rationales 1
,NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q2. A client scheduled for a total knee arthroplasty tells the nurse, 'I have questions about the
risks before I sign this consent form.' Which action should the nurse take first?
A. Explain the most common risks of the procedure to the client
B. Ask the client to sign the form so that the surgery is not delayed
C. Notify the anesthesia provider to clarify the surgical risks
D. Withhold the consent form and contact the surgeon to answer the client's questions
[CORRECT]
Correct Answer: D
Rationale: The provider performing the procedure is legally responsible for disclosing the nature,
risks, benefits, and alternatives; the nurse's role is to witness the signature and advocate when questions
remain unanswered. Withholding the form and notifying the surgeon preserves informed consent.
Explaining risks herself (option B) exceeds nursing scope, and pressuring the client to sign (option C)
violates informed consent principles. The anesthesia provider (option D) is not responsible for surgical
consent.
Q3. Which client situation indicates that a signed informed consent form is INVALID?
A. The nurse signed the form as a witness after the provider explained the procedure
B. The client received an opioid analgesic that caused drowsiness before signing
[CORRECT]
C. The surgeon explained the procedure the evening before surgery
D. The client's spouse was present during the explanation of the procedure
Correct Answer: B
Rationale: Informed consent requires decision-making capacity, voluntary agreement, and adequate
disclosure; preoperative sedation impairs cognitive function, making the consent invalid. Witnessing
(option A), timing of the explanation (option B), and family presence (option C) do not invalidate
consent. This is a legal-recall item testing the three elements of valid consent: capacity, voluntariness,
and disclosure.
Q4. A competent adult client who is a Jehovah's Witness refuses an ordered blood transfusion
that the provider believes is lifesaving. Which nursing action reflects client advocacy?
A. Support the client's decision and ensure the refusal is documented and communicated
to the provider [CORRECT]
B. Prepare to administer the transfusion after a court order is obtained
C. Obtain transfusion consent from the client's closest adult relative
D. Ask the hospital chaplain to persuade the client to accept the transfusion
Correct Answer: A
Rationale: A competent adult has the absolute right to refuse treatment based on the ethical principle
of autonomy, even when refusal may result in death; advocacy means honoring the decision and
documenting it. Administering blood over objection (option A) constitutes battery, and a relative
cannot consent for a competent adult (option C). Persuasion campaigns (option D) violate
voluntariness. The nursing process step is implementation of the client's right to self-determination.
Practice Examination with Detailed Answer Rationales 2
,NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q5. A visitor approaches the nurses' station and asks the nurse for an update on a friend who
was admitted overnight. Which response is most appropriate?
A. Verify that the visitor is on the client's authorized disclosure list before sharing
information [CORRECT]
B. Provide only routine status information to avoid appearing unhelpful
C. Confirm the friend's room number so the visitor can go to the bedside
D. Direct the visitor to the health information management department for records
Correct Answer: A
Rationale: HIPAA requires the nurse to verify identity and authorization before disclosing protected
health information to anyone, including friends and family. Offering routine updates (option A) or a
room number (option B) breaches confidentiality for an unauthorized visitor. Records departments
(option D) release information only through formal authorization processes, not to walk-in visitors.
Q6. A nurse discovers that a laptop containing unencrypted protected health information has
been stolen from a client care area. Which action should the nurse take FIRST?
A. Notify each affected client of the potential breach by telephone
B. Wait 24 hours to determine whether the device can be recovered
C. Document the loss only in the medical records of the affected clients
D. Report the loss immediately to the facility privacy officer according to policy
[CORRECT]
Correct Answer: D
Rationale: Suspected breaches of protected health information must be escalated immediately to the
privacy officer, who performs the formal risk assessment and coordinates HIPAA-required
notifications. Client notification (option A) occurs only after the formal assessment determines breach
probability, and delay (option C) can violate reporting timelines. Incident documentation belongs in the
facility event system, not scattered in client records (option D).
Q7. A client in full cardiac arrest has no DNR order documented in the chart, but the spouse
states the client 'never wanted to be kept alive by machines.' Which action should the nurse
take?
A. Honor the spouse's verbal request and withhold resuscitation
B. Delay resuscitation while the code status is verified with the provider
C. Begin resuscitation until a valid DNR order is confirmed [CORRECT]
D. Contact the hospital attorney before initiating any interventions
Correct Answer: C
Rationale: In the absence of a valid written DNR order, the nurse must initiate resuscitation; verbal
recollection, even from a spouse, is not a legal substitute for an order. Withholding or delaying (options
B and C) exposes the client to harm and the nurse to liability, and an attorney (option D) has no role in
a code. This analysis item applies the legal standard that ambiguity in code status always resolves
toward providing care.
Practice Examination with Detailed Answer Rationales 3
, NCLEX-RN Practice Test Questions 2026/2027 | NCLEX RN Review Book
Q8. The nurse notes bruising in various stages of healing on the torso of a 4-year-old, and the
caregiver's explanation is inconsistent with the injuries. Which action is the nurse's
PRIORITY?
A. Confront the caregiver directly about the suspected abuse
B. Report the findings to child protective services as required by state law [CORRECT]
C. Document the findings and plan to assess the child at the next visit
D. Discharge the child home with a written community referral
Correct Answer: B
Rationale: Nurses are mandated reporters; when abuse is suspected, the legal duty is to report to child
protective services immediately, and the nurse does not need proof, only reasonable suspicion.
Confrontation (option A) may endanger the child or the family-nurse relationship, and deferring
(options B and C) abandons the duty to protect. After reporting, the nurse documents objective
findings and maintains a safe, nonjudgmental environment.
Q9. Which client finding must the nurse report to an EXTERNAL authority under mandatory
reporting laws?
A. A fall that occurred while the client was in soft wrist restraints
B. A stage 2 pressure injury that was documented on hospital admission
C. An intentional overdose that requires psychiatric consultation
D. A stab wound sustained by a client during an assault [CORRECT]
Correct Answer: D
Rationale: Stab and gunshot wounds are legally mandated reports to law enforcement in every U.S.
jurisdiction, independent of client consent. A restrained fall (option A) and an admission pressure
injury (option B) are internal safety events managed through incident reporting and quality processes,
not external reporting. An overdose (option D) requires mental health evaluation but is not universally a
mandated external report.
Q10. A confused adult client is restrained after less-restrictive measures failed to prevent
pulling at invasive lines. How often must the restraint order be renewed for this adult client?
A. Once per nursing shift for as long as the behavior continues
B. Every 4 hours, with a maximum of 24 consecutive hours [CORRECT]
C. Every 24 hours as long as the provider reassesses the client
D. Every 48 hours after the initial order is written
Correct Answer: B
Rationale: Adult restraint orders must be renewed at least every 4 hours and cannot exceed 24
consecutive hours without a new order and reevaluation; this protects the client's safety and dignity.
Shift-based renewal (option B) and daily renewal (option C) exceed the regulatory time limit, and
48-hour orders (option D) are never permissible. The nurse must also document ongoing behavior,
circulation checks, range of motion, and releases per facility policy.
Practice Examination with Detailed Answer Rationales 4
