NCLEX-RN Comprehensive Final Exam
2026/2027: 120 NGN Practice Questions with
Answers, Rationales & References – Next
Generation NCLEX Test Bank for
Guaranteed First-Time Pass
Description:
Prepare for the 2026/2027 NCLEX-RN with this comprehensive Next Generation NCLEX
(NGN) practice exam featuring 120 high-yield questions with detailed answers, evidence-based
rationales, and current references. Covering all eight NCSBN Client Need categories—
Management of Care, Safety and Infection Control, Health Promotion, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, and Physiological Adaptation—this test bank includes SATA, matrix/grid, bow-
tie, cloze, highlight, drag-and-drop, trend, and unfolding case study items. Aligned with the
2026 NCSBN Test Plan and Clinical Judgment Measurement Model, it's the ultimate study guide
for nursing students and licensure candidates.
Your first-time pass starts here—download the 2026/2027 NCLEX-RN Comprehensive Final Exam
today and walk into test day fully prepared!
, NCLEX-RN 2026/2027 NGN Practice Test – 120 Questions &
Answers
Test Plan Alignment: National Council of State Boards of Nursing (NCSBN) 2026 NCLEX-
RN® Test Plan, Effective April 1, 2026
Section I: Management of Care (Questions 1–18)
Unfolding Case Study: Postoperative Care Management
Case Introduction: A 68-year-old client is admitted to the medical-surgical unit following an
open reduction and internal fixation (ORIF) of a right hip fracture sustained in a fall at home.
The client has a history of hypertension, type 2 diabetes mellitus, and chronic kidney disease
stage 3. The client is 6 hours postoperative. Current vital signs: T 37.8°C (100.0°F), HR 92, RR
18, BP 148/86 mm Hg, SpO2 94% on room air. Pain is reported as 6/10 at the surgical site.
Question 1 (Matrix/Grid – Recognize Cues)
A nurse is reviewing the client's electronic health record. For each finding, indicate whether it is
a finding that requires follow-up or a finding that is expected in the postoperative period. Select
one option per row.
Finding Requires Follow-Up Expected Finding
Pain rated 6/10 at the surgical site ☐ ☐
Blood pressure 148/86 mm Hg ☐ ☐
SpO2 94% on room air ☐ ☐
Temperature 37.8°C (100.0°F) ☐ ☐
Urine output 20 mL/hr over the past 2 hours ☐ ☐
,Finding Requires Follow-Up Expected Finding
Hemoglobin 10.2 g/dL ☐ ☐
Answer: Requires Follow-Up: Blood pressure 148/86 mm Hg; SpO2 94% on room air; Urine
output 20 mL/hr over the past 2 hours. Expected Finding: Pain rated 6/10 at the surgical site;
Temperature 37.8°C (100.0°F); Hemoglobin 10.2 g/dL.
Explanation: This matrix item requires the nurse to distinguish between expected postoperative
findings and those that demand further investigation. The blood pressure elevation is concerning
given the client's CKD and hypertension, requiring assessment for pain-related sympathetic
response versus inadequate antihypertensive management. The SpO2 of 94% on room air
warrants monitoring and possible intervention, as values below 92–94% may indicate hypoxemia
requiring supplemental oxygen. Urine output below 30 mL/hr in a postoperative client with CKD
raises concern for acute kidney injury or inadequate fluid resuscitation. Fever within the first 48
hours postoperatively is typically non-infectious and related to surgical stress. Mild anemia is
expected following surgical blood loss. Pain is an expected finding that should be addressed
through the prescribed multimodal analgesic regimen. This item assesses the recognize cues
cognitive operation within the NCJMM framework.
Reference: NCSBN. (2026). 2026 NCLEX-RN Test Plan. National Council of State Boards of
Nursing.
Question 2 (Cloze/Drop-Down – Analyze Cues)
A nurse is analyzing the client's postoperative data. Complete the following sentence by
selecting the most appropriate options from the drop-down menus.
The client's blood pressure elevation is most likely related to [pain and sympathetic nervous
system activation / inadequate antihypertensive dosing / fluid overload], while the decreased
urine output is most concerning for [hypovolemia or inadequate renal perfusion / urinary tract
infection / bladder distension from urinary retention]. The SpO2 of 94% is most consistent with
[atelectasis or hypoventilation / pulmonary embolism / pneumonia].
, Answer: The client's blood pressure elevation is most likely related to pain and sympathetic
nervous system activation. The decreased urine output is most concerning for hypovolemia or
inadequate renal perfusion. The SpO2 of 94% is most consistent with atelectasis or
hypoventilation.
Explanation: This cloze item requires the nurse to connect clinical findings to their most likely
underlying causes (analyze cues). Acute postoperative pain triggers sympathetic nervous system
activation, releasing catecholamines that elevate heart rate and blood pressure. While inadequate
antihypertensive dosing could contribute, the acute temporal relationship to surgery and pain
makes sympathetic activation the most likely cause. Decreased urine output in the immediate
postoperative period is most concerning for hypovolemia from blood loss, third-spacing, or
inadequate fluid replacement, particularly in a client with pre-existing CKD. Urinary tract
infection would not typically manifest this acutely with isolated oliguria. Atelectasis and
hypoventilation are common postoperative pulmonary complications resulting from anesthesia
effects, incisional pain limiting deep breathing, and immobility, producing mild hypoxemia that
may present as SpO2 in the 92–94% range. Pulmonary embolism would typically present with
more acute and severe symptoms, while pneumonia would usually present later in the
postoperative course with fever and productive cough.
Reference: Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts,
D. (2023). Medical-surgical nursing: Assessment and management of clinical problems (12th
ed.). Elsevier.
Question 3 (SATA – Prioritize Hypotheses)
A nurse is prioritizing hypotheses for this client. Which of the following are the priority concerns
for this client at this time? Select all that apply.
A. Acute pain
B. Risk for impaired gas exchange
C. Risk for acute kidney injury
D. Risk for infection
2026/2027: 120 NGN Practice Questions with
Answers, Rationales & References – Next
Generation NCLEX Test Bank for
Guaranteed First-Time Pass
Description:
Prepare for the 2026/2027 NCLEX-RN with this comprehensive Next Generation NCLEX
(NGN) practice exam featuring 120 high-yield questions with detailed answers, evidence-based
rationales, and current references. Covering all eight NCSBN Client Need categories—
Management of Care, Safety and Infection Control, Health Promotion, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, and Physiological Adaptation—this test bank includes SATA, matrix/grid, bow-
tie, cloze, highlight, drag-and-drop, trend, and unfolding case study items. Aligned with the
2026 NCSBN Test Plan and Clinical Judgment Measurement Model, it's the ultimate study guide
for nursing students and licensure candidates.
Your first-time pass starts here—download the 2026/2027 NCLEX-RN Comprehensive Final Exam
today and walk into test day fully prepared!
, NCLEX-RN 2026/2027 NGN Practice Test – 120 Questions &
Answers
Test Plan Alignment: National Council of State Boards of Nursing (NCSBN) 2026 NCLEX-
RN® Test Plan, Effective April 1, 2026
Section I: Management of Care (Questions 1–18)
Unfolding Case Study: Postoperative Care Management
Case Introduction: A 68-year-old client is admitted to the medical-surgical unit following an
open reduction and internal fixation (ORIF) of a right hip fracture sustained in a fall at home.
The client has a history of hypertension, type 2 diabetes mellitus, and chronic kidney disease
stage 3. The client is 6 hours postoperative. Current vital signs: T 37.8°C (100.0°F), HR 92, RR
18, BP 148/86 mm Hg, SpO2 94% on room air. Pain is reported as 6/10 at the surgical site.
Question 1 (Matrix/Grid – Recognize Cues)
A nurse is reviewing the client's electronic health record. For each finding, indicate whether it is
a finding that requires follow-up or a finding that is expected in the postoperative period. Select
one option per row.
Finding Requires Follow-Up Expected Finding
Pain rated 6/10 at the surgical site ☐ ☐
Blood pressure 148/86 mm Hg ☐ ☐
SpO2 94% on room air ☐ ☐
Temperature 37.8°C (100.0°F) ☐ ☐
Urine output 20 mL/hr over the past 2 hours ☐ ☐
,Finding Requires Follow-Up Expected Finding
Hemoglobin 10.2 g/dL ☐ ☐
Answer: Requires Follow-Up: Blood pressure 148/86 mm Hg; SpO2 94% on room air; Urine
output 20 mL/hr over the past 2 hours. Expected Finding: Pain rated 6/10 at the surgical site;
Temperature 37.8°C (100.0°F); Hemoglobin 10.2 g/dL.
Explanation: This matrix item requires the nurse to distinguish between expected postoperative
findings and those that demand further investigation. The blood pressure elevation is concerning
given the client's CKD and hypertension, requiring assessment for pain-related sympathetic
response versus inadequate antihypertensive management. The SpO2 of 94% on room air
warrants monitoring and possible intervention, as values below 92–94% may indicate hypoxemia
requiring supplemental oxygen. Urine output below 30 mL/hr in a postoperative client with CKD
raises concern for acute kidney injury or inadequate fluid resuscitation. Fever within the first 48
hours postoperatively is typically non-infectious and related to surgical stress. Mild anemia is
expected following surgical blood loss. Pain is an expected finding that should be addressed
through the prescribed multimodal analgesic regimen. This item assesses the recognize cues
cognitive operation within the NCJMM framework.
Reference: NCSBN. (2026). 2026 NCLEX-RN Test Plan. National Council of State Boards of
Nursing.
Question 2 (Cloze/Drop-Down – Analyze Cues)
A nurse is analyzing the client's postoperative data. Complete the following sentence by
selecting the most appropriate options from the drop-down menus.
The client's blood pressure elevation is most likely related to [pain and sympathetic nervous
system activation / inadequate antihypertensive dosing / fluid overload], while the decreased
urine output is most concerning for [hypovolemia or inadequate renal perfusion / urinary tract
infection / bladder distension from urinary retention]. The SpO2 of 94% is most consistent with
[atelectasis or hypoventilation / pulmonary embolism / pneumonia].
, Answer: The client's blood pressure elevation is most likely related to pain and sympathetic
nervous system activation. The decreased urine output is most concerning for hypovolemia or
inadequate renal perfusion. The SpO2 of 94% is most consistent with atelectasis or
hypoventilation.
Explanation: This cloze item requires the nurse to connect clinical findings to their most likely
underlying causes (analyze cues). Acute postoperative pain triggers sympathetic nervous system
activation, releasing catecholamines that elevate heart rate and blood pressure. While inadequate
antihypertensive dosing could contribute, the acute temporal relationship to surgery and pain
makes sympathetic activation the most likely cause. Decreased urine output in the immediate
postoperative period is most concerning for hypovolemia from blood loss, third-spacing, or
inadequate fluid replacement, particularly in a client with pre-existing CKD. Urinary tract
infection would not typically manifest this acutely with isolated oliguria. Atelectasis and
hypoventilation are common postoperative pulmonary complications resulting from anesthesia
effects, incisional pain limiting deep breathing, and immobility, producing mild hypoxemia that
may present as SpO2 in the 92–94% range. Pulmonary embolism would typically present with
more acute and severe symptoms, while pneumonia would usually present later in the
postoperative course with fever and productive cough.
Reference: Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts,
D. (2023). Medical-surgical nursing: Assessment and management of clinical problems (12th
ed.). Elsevier.
Question 3 (SATA – Prioritize Hypotheses)
A nurse is prioritizing hypotheses for this client. Which of the following are the priority concerns
for this client at this time? Select all that apply.
A. Acute pain
B. Risk for impaired gas exchange
C. Risk for acute kidney injury
D. Risk for infection
