1
NCLEX-RN Practice Exam | 200 NGN-Aligned
Questions with Verified Answers & Detailed
Rationales | Complete Review for Next Generation
NCLEX Success
SECTION 1: MANAGEMENT OF CARE (Questions 1–35)
1. A nurse is prioritizing care for four clients. Which client should the nurse assess FIRST?
A. A client with a new prescription for antihypertensives
B. A client with stable vital signs post-surgery
C. A client reporting chest pain rated 8/10
D. A client being discharged with home health care instructions
Correct Answer: C
Rationale: Chest pain rated 8/10 indicates a potential cardiac emergency requiring immediate
assessment. Using the ABC (Airway, Breathing, Circulation) priority framework, cardiac
compromise takes precedence over stable postoperative clients, medication administration, and
discharge planning .
2. A charge nurse is delegating tasks to a licensed practical nurse (LPN) and a certified nursing
assistant (CNA). Which task is most appropriate for the LPN?
A. Obtain a clean-catch urine specimen from a stable client
B. Administer a scheduled subcutaneous insulin injection
C. Initiate teaching on post-operative deep breathing exercises
D. Perform the initial admission assessment on a new client
Correct Answer: B
Rationale: LPNs can administer subcutaneous medications to stable clients under RN
supervision. Initial assessment and client teaching are RN scope of practice. CNAs can obtain
urine specimens but cannot administer medications .
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3. A nurse is caring for a client who has a new prescription for warfarin. Which statement by
the client indicates a need for further teaching?
A. "I will avoid eating large amounts of green leafy vegetables."
B. "I will report any unusual bleeding or bruising to my provider."
C. "I will take ibuprofen for headaches instead of acetaminophen."
D. "I will have my blood drawn regularly to check my INR."
Correct Answer: C
Rationale: Ibuprofen is an NSAID that increases bleeding risk when taken with warfarin. Clients
should use acetaminophen for pain and avoid NSAIDs. The other statements are correct .
4. A nurse is caring for a client who is leaving against medical advice (AMA). Which action
should the nurse take?
A. Restrain the client to prevent leaving
B. Notify the provider and have the client sign the AMA form
C. Discuss the risks of leaving with the client
D. Both B and C
Correct Answer: D
Rationale: The nurse should discuss risks and consequences of leaving AMA and document the
discussion. If the client still wishes to leave, notify the provider and have the client sign the AMA
form .
5. A nurse is preparing to administer a blood transfusion. Which action should the nurse take
to prevent transfusion-associated circulatory overload (TACO)?
A. Administer the transfusion over 4 hours
B. Use a leukocyte-reduced blood product
C. Assess baseline vital signs and cardiac status
D. Premedicate with an antihistamine
Correct Answer: C
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Rationale: TACO results from volume overload, especially in patients with compromised cardiac
or renal function. Assessing baseline vital signs and cardiac status helps identify at-risk patients
and guides the rate of transfusion .
6. A nurse is teaching a client about fall prevention. Which action should the nurse prioritize?
A. Encouraging the client to walk without assistance
B. Ensuring the client uses a walker and removes tripping hazards
C. Advising the client to increase activity without supervision
D. Suggesting the client rely on family for all mobility
Correct Answer: B
Rationale: Using a walker and removing hazards aligns with The Joint Commission standards for
fall prevention. This addresses both personal safety equipment and environmental factors that
contribute to falls .
7. A nurse is preparing to care for a client diagnosed with active pulmonary tuberculosis.
Which action is most appropriate before entering the room?
A. Apply a surgical mask
B. Apply an N95 respirator
C. Wear a face shield only
D. Wear sterile gloves only
Correct Answer: B
Rationale: Tuberculosis is airborne transmitted; therefore, an N95 respirator is required for
respiratory protection. Surgical masks do not filter airborne particles. Face shields protect
against splashes, not airborne pathogens .
8. A nurse is reviewing laboratory results for a client receiving heparin infusion. Which value
indicates a therapeutic response?
A. aPTT of 45 seconds
B. aPTT of 70 seconds
C. PT/INR of 2.5
D. Platelet count of 100,000/mm³
, 4
Correct Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5-2.5 times the
control value, or approximately 60-80 seconds. A PT/INR of 2.5 indicates warfarin therapy, not
heparin .
9. A nurse is providing discharge teaching to a client who has a new prescription for
enoxaparin. Which statement indicates understanding?
A. "I will take ibuprofen for pain."
B. "I will inject the medication into my abdomen."
C. "I will massage the injection site after giving the medication."
D. "I will take this medication with food."
Correct Answer: B
Rationale: Enoxaparin is administered subcutaneously in the abdomen. The injection site should
not be massaged. Ibuprofen increases bleeding risk and should be avoided. Enoxaparin is not
taken orally .
10. A nurse is caring for a client who requires a sterile dressing change. Which action
demonstrates proper sterile technique?
A. Keeping sterile items below waist level
B. Reaching over the sterile field to obtain supplies
C. Opening sterile packages away from the body
D. Using the same gloves for multiple wound care tasks
Correct Answer: C
Rationale: Sterile packages should be opened away from the body to maintain sterility. Sterile
items must remain above waist level. Reaching over the sterile field contaminates it. Gloves
should be changed between tasks .
11. A nurse is assessing a client who has been receiving furosemide. Which finding requires
immediate intervention?
A. Urine output of 50 mL/hr
B. Serum potassium of 2.8 mEq/L
NCLEX-RN Practice Exam | 200 NGN-Aligned
Questions with Verified Answers & Detailed
Rationales | Complete Review for Next Generation
NCLEX Success
SECTION 1: MANAGEMENT OF CARE (Questions 1–35)
1. A nurse is prioritizing care for four clients. Which client should the nurse assess FIRST?
A. A client with a new prescription for antihypertensives
B. A client with stable vital signs post-surgery
C. A client reporting chest pain rated 8/10
D. A client being discharged with home health care instructions
Correct Answer: C
Rationale: Chest pain rated 8/10 indicates a potential cardiac emergency requiring immediate
assessment. Using the ABC (Airway, Breathing, Circulation) priority framework, cardiac
compromise takes precedence over stable postoperative clients, medication administration, and
discharge planning .
2. A charge nurse is delegating tasks to a licensed practical nurse (LPN) and a certified nursing
assistant (CNA). Which task is most appropriate for the LPN?
A. Obtain a clean-catch urine specimen from a stable client
B. Administer a scheduled subcutaneous insulin injection
C. Initiate teaching on post-operative deep breathing exercises
D. Perform the initial admission assessment on a new client
Correct Answer: B
Rationale: LPNs can administer subcutaneous medications to stable clients under RN
supervision. Initial assessment and client teaching are RN scope of practice. CNAs can obtain
urine specimens but cannot administer medications .
,2
3. A nurse is caring for a client who has a new prescription for warfarin. Which statement by
the client indicates a need for further teaching?
A. "I will avoid eating large amounts of green leafy vegetables."
B. "I will report any unusual bleeding or bruising to my provider."
C. "I will take ibuprofen for headaches instead of acetaminophen."
D. "I will have my blood drawn regularly to check my INR."
Correct Answer: C
Rationale: Ibuprofen is an NSAID that increases bleeding risk when taken with warfarin. Clients
should use acetaminophen for pain and avoid NSAIDs. The other statements are correct .
4. A nurse is caring for a client who is leaving against medical advice (AMA). Which action
should the nurse take?
A. Restrain the client to prevent leaving
B. Notify the provider and have the client sign the AMA form
C. Discuss the risks of leaving with the client
D. Both B and C
Correct Answer: D
Rationale: The nurse should discuss risks and consequences of leaving AMA and document the
discussion. If the client still wishes to leave, notify the provider and have the client sign the AMA
form .
5. A nurse is preparing to administer a blood transfusion. Which action should the nurse take
to prevent transfusion-associated circulatory overload (TACO)?
A. Administer the transfusion over 4 hours
B. Use a leukocyte-reduced blood product
C. Assess baseline vital signs and cardiac status
D. Premedicate with an antihistamine
Correct Answer: C
,3
Rationale: TACO results from volume overload, especially in patients with compromised cardiac
or renal function. Assessing baseline vital signs and cardiac status helps identify at-risk patients
and guides the rate of transfusion .
6. A nurse is teaching a client about fall prevention. Which action should the nurse prioritize?
A. Encouraging the client to walk without assistance
B. Ensuring the client uses a walker and removes tripping hazards
C. Advising the client to increase activity without supervision
D. Suggesting the client rely on family for all mobility
Correct Answer: B
Rationale: Using a walker and removing hazards aligns with The Joint Commission standards for
fall prevention. This addresses both personal safety equipment and environmental factors that
contribute to falls .
7. A nurse is preparing to care for a client diagnosed with active pulmonary tuberculosis.
Which action is most appropriate before entering the room?
A. Apply a surgical mask
B. Apply an N95 respirator
C. Wear a face shield only
D. Wear sterile gloves only
Correct Answer: B
Rationale: Tuberculosis is airborne transmitted; therefore, an N95 respirator is required for
respiratory protection. Surgical masks do not filter airborne particles. Face shields protect
against splashes, not airborne pathogens .
8. A nurse is reviewing laboratory results for a client receiving heparin infusion. Which value
indicates a therapeutic response?
A. aPTT of 45 seconds
B. aPTT of 70 seconds
C. PT/INR of 2.5
D. Platelet count of 100,000/mm³
, 4
Correct Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5-2.5 times the
control value, or approximately 60-80 seconds. A PT/INR of 2.5 indicates warfarin therapy, not
heparin .
9. A nurse is providing discharge teaching to a client who has a new prescription for
enoxaparin. Which statement indicates understanding?
A. "I will take ibuprofen for pain."
B. "I will inject the medication into my abdomen."
C. "I will massage the injection site after giving the medication."
D. "I will take this medication with food."
Correct Answer: B
Rationale: Enoxaparin is administered subcutaneously in the abdomen. The injection site should
not be massaged. Ibuprofen increases bleeding risk and should be avoided. Enoxaparin is not
taken orally .
10. A nurse is caring for a client who requires a sterile dressing change. Which action
demonstrates proper sterile technique?
A. Keeping sterile items below waist level
B. Reaching over the sterile field to obtain supplies
C. Opening sterile packages away from the body
D. Using the same gloves for multiple wound care tasks
Correct Answer: C
Rationale: Sterile packages should be opened away from the body to maintain sterility. Sterile
items must remain above waist level. Reaching over the sterile field contaminates it. Gloves
should be changed between tasks .
11. A nurse is assessing a client who has been receiving furosemide. Which finding requires
immediate intervention?
A. Urine output of 50 mL/hr
B. Serum potassium of 2.8 mEq/L
