NCLEX-RN Exam Prep 2026/2027 | 500+ NGN Practice Questions
& Detailed Rationales
This comprehensive study resource is a premier test bank designed for nursing
graduates preparing for the National Council Licensure Examination for Registered
Nurses (NCLEX-RN). It features 500 high-yield practice questions, 100% verified
correct answers, and thorough clinical rationales meticulously aligned with the
2026/2027 Next Generation NCLEX (NGN) blueprint. Utilizing these premium
assessment materials ensures deep competence across complex unfolding case
studies, prioritization questions, and standalone alternate-format items to maximize
your clinical judgment and guarantee a passing score on your first attempt.
1. A nurse is caring for a client who is 1 day postoperative following a
thyroidectomy. The client reports tingling around the mouth and in the fingertips.
Which of the following actions should the nurse take first?
A. Administer a prescribed analgesic
B. Assess for Chvostek's sign
C. Encourage the client to drink milk
D. Document the finding
Correct Answer: B
Rationale: Tingling around the mouth and fingertips after thyroidectomy suggests
hypocalcemia due to inadvertent parathyroid removal. The nurse should first assess for
Chvostek's sign (facial twitching when tapping the facial nerve) and Trousseau's sign to
confirm hypocalcemia. Administering analgesia (A) does not address the cause. Milk (C) is
not a rapid treatment for hypocalcemia. Documentation (D) is important but comes after
assessment.
2. A nurse is reviewing the laboratory results of a client who has cirrhosis. Which
of the following findings should the nurse report to the provider immediately?
A. Serum albumin 2.8 g/dL
B. Ammonia level 90 mcg/dL
C. Prothrombin time 14 seconds
D. Platelet count 120,000/mm³
Correct Answer: B
,Rationale: An ammonia level of 90 mcg/dL is elevated (normal 15–45 mcg/dL) and
indicates hepatic encephalopathy, a life-threatening complication of cirrhosis. The nurse
should report this immediately. Low albumin (A) is expected in cirrhosis but not
immediately life-threatening. Prolonged PT (C) is common but 14 seconds is only slightly
elevated. Thrombocytopenia (D) is also expected due to splenomegaly but is not the
priority.
3. A nurse is caring for a client who is receiving a blood transfusion. The client
develops fever, chills, and low back pain. Which of the following actions should
the nurse take first?
A. Stop the transfusion
B. Administer antipyretics
C. Notify the provider
D. Obtain a urine specimen
Correct Answer: A
Rationale: Fever, chills, and low back pain during transfusion indicate an acute hemolytic
reaction. The first action is to stop the transfusion immediately to prevent further
hemolysis. Antipyretics (B) and notification (C) follow, but stopping the transfusion is
priority. Urine specimen (D) may be needed but is not the first action.
4. A nurse is teaching a client who has a new prescription for metformin. Which of
the following statements by the client indicates a need for further teaching?
A. "I will take this medication with meals."
B. "I will report any muscle pain or weakness."
C. "I will have my kidney function checked regularly."
D. "I will drink alcohol in moderation while taking this medication."
Correct Answer: D
Rationale: Alcohol should be avoided while taking metformin due to the increased risk of
lactic acidosis. Taking with meals (A), reporting muscle pain (B), and monitoring kidney
function (C) are correct. The client needs further teaching about avoiding alcohol.
,5. A nurse is assessing a client who has suspected meningitis. Which of the
following findings should the nurse expect?
A. Positive Kernig's sign
B. Negative Brudzinski's sign
C. Clear cerebrospinal fluid
D. Bradycardia
Correct Answer: A
Rationale: Kernig's sign (resistance to knee extension when the hip is flexed) is positive in
meningitis. Brudzinski's sign is also positive. Cerebrospinal fluid (C) would show increased
WBCs and protein. Bradycardia (D) is not typical; tachycardia may occur.
6. A nurse is caring for a client who is at 36 weeks gestation and has preeclampsia.
Which of the following findings should the nurse report immediately?
A. Blood pressure 140/90 mm Hg
B. 1+ protein in the urine
C. Severe headache
D. Mild ankle edema
Correct Answer: C
Rationale: A severe headache in a client with preeclampsia may indicate impending
seizure (eclampsia) and should be reported immediately. Blood pressure (A) and
proteinuria (B) are expected with preeclampsia. Mild ankle edema (D) is common in
pregnancy.
7. A nurse is teaching a client who has a new prescription for levothyroxine. Which
of the following instructions should the nurse include?
A. "Take this medication on an empty stomach."
B. "Take this medication with your calcium supplement."
, C. "Stop taking this medication if you feel better."
D. "Double the dose if you miss one."
Correct Answer: A
Rationale: Levothyroxine should be taken on an empty stomach, 30–60 minutes before
breakfast, for optimal absorption. Calcium (B) decreases absorption and should be
separated by at least 4 hours. Stopping (C) or doubling (D) is unsafe.
8. A nurse is caring for a client who has a new prescription for digoxin. The client's
apical pulse is 54 bpm. Which of the following actions should the nurse take?
A. Administer the digoxin as ordered
B. Hold the digoxin and notify the provider
C. Administer the digoxin with food
D. Recheck the pulse in 30 minutes
Correct Answer: B
Rationale: Digoxin is withheld for an apical pulse below 60 bpm in adults because
bradycardia increases the risk of toxicity and dysrhythmias. The nurse should hold the
dose and notify the provider.
9. A nurse is assessing a client who has been diagnosed with heart failure. Which
of the following findings indicates fluid overload?
A. Weight loss
B. Increased urine output
C. Crackles in the lungs
D. Decreased JVD
Correct Answer: C
Rationale: Crackles in the lungs indicate pulmonary congestion and fluid overload. Weight
loss (A) and increased urine output (B) indicate fluid loss. Decreased JVD (D) is not
indicative of fluid overload; increased JVD would be.
& Detailed Rationales
This comprehensive study resource is a premier test bank designed for nursing
graduates preparing for the National Council Licensure Examination for Registered
Nurses (NCLEX-RN). It features 500 high-yield practice questions, 100% verified
correct answers, and thorough clinical rationales meticulously aligned with the
2026/2027 Next Generation NCLEX (NGN) blueprint. Utilizing these premium
assessment materials ensures deep competence across complex unfolding case
studies, prioritization questions, and standalone alternate-format items to maximize
your clinical judgment and guarantee a passing score on your first attempt.
1. A nurse is caring for a client who is 1 day postoperative following a
thyroidectomy. The client reports tingling around the mouth and in the fingertips.
Which of the following actions should the nurse take first?
A. Administer a prescribed analgesic
B. Assess for Chvostek's sign
C. Encourage the client to drink milk
D. Document the finding
Correct Answer: B
Rationale: Tingling around the mouth and fingertips after thyroidectomy suggests
hypocalcemia due to inadvertent parathyroid removal. The nurse should first assess for
Chvostek's sign (facial twitching when tapping the facial nerve) and Trousseau's sign to
confirm hypocalcemia. Administering analgesia (A) does not address the cause. Milk (C) is
not a rapid treatment for hypocalcemia. Documentation (D) is important but comes after
assessment.
2. A nurse is reviewing the laboratory results of a client who has cirrhosis. Which
of the following findings should the nurse report to the provider immediately?
A. Serum albumin 2.8 g/dL
B. Ammonia level 90 mcg/dL
C. Prothrombin time 14 seconds
D. Platelet count 120,000/mm³
Correct Answer: B
,Rationale: An ammonia level of 90 mcg/dL is elevated (normal 15–45 mcg/dL) and
indicates hepatic encephalopathy, a life-threatening complication of cirrhosis. The nurse
should report this immediately. Low albumin (A) is expected in cirrhosis but not
immediately life-threatening. Prolonged PT (C) is common but 14 seconds is only slightly
elevated. Thrombocytopenia (D) is also expected due to splenomegaly but is not the
priority.
3. A nurse is caring for a client who is receiving a blood transfusion. The client
develops fever, chills, and low back pain. Which of the following actions should
the nurse take first?
A. Stop the transfusion
B. Administer antipyretics
C. Notify the provider
D. Obtain a urine specimen
Correct Answer: A
Rationale: Fever, chills, and low back pain during transfusion indicate an acute hemolytic
reaction. The first action is to stop the transfusion immediately to prevent further
hemolysis. Antipyretics (B) and notification (C) follow, but stopping the transfusion is
priority. Urine specimen (D) may be needed but is not the first action.
4. A nurse is teaching a client who has a new prescription for metformin. Which of
the following statements by the client indicates a need for further teaching?
A. "I will take this medication with meals."
B. "I will report any muscle pain or weakness."
C. "I will have my kidney function checked regularly."
D. "I will drink alcohol in moderation while taking this medication."
Correct Answer: D
Rationale: Alcohol should be avoided while taking metformin due to the increased risk of
lactic acidosis. Taking with meals (A), reporting muscle pain (B), and monitoring kidney
function (C) are correct. The client needs further teaching about avoiding alcohol.
,5. A nurse is assessing a client who has suspected meningitis. Which of the
following findings should the nurse expect?
A. Positive Kernig's sign
B. Negative Brudzinski's sign
C. Clear cerebrospinal fluid
D. Bradycardia
Correct Answer: A
Rationale: Kernig's sign (resistance to knee extension when the hip is flexed) is positive in
meningitis. Brudzinski's sign is also positive. Cerebrospinal fluid (C) would show increased
WBCs and protein. Bradycardia (D) is not typical; tachycardia may occur.
6. A nurse is caring for a client who is at 36 weeks gestation and has preeclampsia.
Which of the following findings should the nurse report immediately?
A. Blood pressure 140/90 mm Hg
B. 1+ protein in the urine
C. Severe headache
D. Mild ankle edema
Correct Answer: C
Rationale: A severe headache in a client with preeclampsia may indicate impending
seizure (eclampsia) and should be reported immediately. Blood pressure (A) and
proteinuria (B) are expected with preeclampsia. Mild ankle edema (D) is common in
pregnancy.
7. A nurse is teaching a client who has a new prescription for levothyroxine. Which
of the following instructions should the nurse include?
A. "Take this medication on an empty stomach."
B. "Take this medication with your calcium supplement."
, C. "Stop taking this medication if you feel better."
D. "Double the dose if you miss one."
Correct Answer: A
Rationale: Levothyroxine should be taken on an empty stomach, 30–60 minutes before
breakfast, for optimal absorption. Calcium (B) decreases absorption and should be
separated by at least 4 hours. Stopping (C) or doubling (D) is unsafe.
8. A nurse is caring for a client who has a new prescription for digoxin. The client's
apical pulse is 54 bpm. Which of the following actions should the nurse take?
A. Administer the digoxin as ordered
B. Hold the digoxin and notify the provider
C. Administer the digoxin with food
D. Recheck the pulse in 30 minutes
Correct Answer: B
Rationale: Digoxin is withheld for an apical pulse below 60 bpm in adults because
bradycardia increases the risk of toxicity and dysrhythmias. The nurse should hold the
dose and notify the provider.
9. A nurse is assessing a client who has been diagnosed with heart failure. Which
of the following findings indicates fluid overload?
A. Weight loss
B. Increased urine output
C. Crackles in the lungs
D. Decreased JVD
Correct Answer: C
Rationale: Crackles in the lungs indicate pulmonary congestion and fluid overload. Weight
loss (A) and increased urine output (B) indicate fluid loss. Decreased JVD (D) is not
indicative of fluid overload; increased JVD would be.
