NCLEX RN ACTUAL EXAM 2026
UPDATED WITH NGN QUESTIONS AND ANSWERS
Next Generation NCLEX (NGN) Clinical Judgment Measurement Model
150 Comprehensive Questions with Detailed Rationales
MC | SATA | Matrix | Bowtie | Cloze | Case Studies | Sequencing | Drag & Drop | Hot Spot
Total Questions 150
Item Types MC, SATA, Matrix, Bowtie, Cloze, Case Studies, Sequencing, Drag & Drop, Hot Spot
Alignment 2026 NCLEX-RN Test Blueprint & NGN NCJMM Standards
Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action,
Cognitive Skills
Evaluate Outcomes
Scoring 100% Correct Answers with Comprehensive Rationales
Aligned with 2026 NCLEX-RN Test Plan | NGN Clinical Judgment Measurement Model (NCJMM)
All Six Cognitive Skills Represented | Evidence-Based Practice & Current Standards
NCLEX RN Actual Exam 2026 - Page 1
,NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Section 1: Multiple Choice (MC) - Questions 1-30
Clinical Judgment and Foundational Knowledge | Single Answer Format | Tests knowledge, application, and
clinical reasoning across all Client Needs categories
Q1: The nurse is caring for a client with heart failure who reports shortness of breath and has 2+
pitting edema in the lower extremities. Which finding is most concerning and requires immediate
intervention?
A. Weight gain of 1 kg over the past week
B. Crackles in bilateral lung bases on auscultation [CORRECT]
C. Decreased appetite with early satiety
D. Fatigue reported during ambulation
Correct Answer: B
Rationale: Bilateral crackles indicate pulmonary fluid accumulation secondary to left-sided heart failure, signaling
worsening cardiac output and potential respiratory compromise. This requires immediate intervention such as
administering diuretics and repositioning the client. Weight gain (A) is concerning but not immediately
life-threatening; decreased appetite (C) and fatigue (D) are common symptoms of heart failure but do not indicate
acute decompensation.
Q2: A client with type 2 diabetes mellitus has a blood glucose level of 52 mg/dL. Which action should
the nurse take first?
A. Administer the prescribed regular insulin per sliding scale
B. Provide 15 g of fast-acting carbohydrate, such as 4 oz of juice [CORRECT]
C. Document the finding and reassess in 30 minutes
D. Obtain a repeat blood glucose level to confirm the result
Correct Answer: B
Rationale: A blood glucose of 52 mg/dL is below the normal range and indicates hypoglycemia. The first priority
action per the ABC framework is to provide rapid glucose replacement with 15 g of fast-acting carbohydrate to
prevent seizures and loss of consciousness. Administering insulin (A) would worsen hypoglycemia. While confirming
(D) may seem reasonable, delaying treatment of symptomatic hypoglycemia is dangerous. Documentation (C) does
not address the immediate need.
Q3: The nurse is delegating care to an unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Assessing a postoperative client's incision site for signs of infection
B. Performing initial admission assessment on a newly assigned client
C. Recording intake and output for a stable client with heart failure [CORRECT]
D. Administering oral medications to a client with a complex medication regimen
Correct Answer: C
Rationale: Recording intake and output is a standard UAP function within the scope of practice for stable clients.
Assessment (A, B) and medication administration (D) require nursing education, clinical judgment, and licensure and
cannot be delegated to UAP. The RN must delegate only tasks that do not require nursing judgment and are within the
delegatee's training and competency.
NCLEX RN Actual Exam 2026 - Page 2
,NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Q4: A client receiving heparin infusion has an activated partial thromboplastin time (aPTT) of 98
seconds. Which action should the nurse anticipate?
A. Increase the heparin infusion rate
B. Administer protamine sulfate as prescribed [CORRECT]
C. Continue the current infusion rate unchanged
D. Discontinue heparin and begin warfarin therapy
Correct Answer: B
Rationale: An aPTT of 98 seconds is significantly above the therapeutic range (typically 1.5 to 2.5 times control,
approximately 60 to 80 seconds), indicating over-anticoagulation and increased bleeding risk. The nurse should
anticipate administering protamine sulfate, the antidote for heparin, to reverse the anticoagulant effect. Increasing
the rate (A) would worsen the situation. Continuing unchanged (C) is unsafe. Warfarin (D) is not the antidote for
heparin toxicity.
Q5: The nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease
(COPD). Which statement by the client indicates understanding of oxygen use at home?
A. I should increase my oxygen flow rate to 6 L/min during exertion
B. I will use my oxygen at 2 L/min as prescribed continuously [CORRECT]
C. I only need oxygen when I feel short of breath
D. I should turn off the oxygen while sleeping to conserve the supply
Correct Answer: B
Rationale: Clients with COPD should use oxygen at the lowest flow rate that maintains adequate oxygenation
(typically 1-3 L/min) as prescribed. Using too high a flow rate (A) can suppress the hypoxic drive that stimulates
breathing in COPD patients. Using oxygen only PRN (C) is inadequate for chronic management. Oxygen should not
be discontinued during sleep (D) as desaturation often occurs at night.
Q6: A postoperative client has a platelet count of 45,000/mm3. Which assessment finding should the
nurse report immediately to the healthcare provider?
A. Heart rate of 98 bpm
B. Temperature of 99.2 F (37.3 C)
C. Petechiae and ecchymosis on the arms and legs [CORRECT]
D. White blood cell count of 11,500/mm3
Correct Answer: C
Rationale: A platelet count of 45,000/mm3 indicates thrombocytopenia (normal 150,000-400,000/mm3), placing the
client at risk for bleeding. Petechiae and ecchymosis are signs of active bleeding that require immediate provider
notification. A heart rate of 98 (A) is slightly elevated but not critical. A temperature of 99.2F (B) is within normal
limits. A WBC of 11,500 (D) is mildly elevated but not an immediate priority compared to active bleeding.
Q7: The nurse is caring for a client who is 12 hours postpartum and reports persistent perineal pain.
Assessment reveals a swollen, purple, and ecchymotic perineal area. Which action is the priority?
A. Apply an ice pack to the perineum for 20 minutes [CORRECT]
B. Encourage the client to perform Kegel exercises
C. Prepare the client for an episiotomy repair
D. Administer a stool softener as prescribed
Correct Answer: A
NCLEX RN Actual Exam 2026 - Page 3
, NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Rationale: The findings describe a hematoma or vulvar varicosity. Applying ice causes vasoconstriction, reduces
swelling, and provides analgesia, making it the first-line intervention for perineal swelling and discomfort. Kegel
exercises (B) would increase discomfort and are contraindicated. An episiotomy repair (C) is not indicated for a
hematoma. A stool softener (D) is appropriate for constipation prevention but not the priority for acute perineal
swelling.
Q8: A client with schizophrenia is exhibiting echolalia, flat affect, and social withdrawal. Which
therapeutic communication technique is most appropriate?
A. Why do you keep repeating what I say?
B. I notice you are sitting quietly today. Would you like to talk about anything? [CORRECT]
C. You need to stop repeating words and interact with others
D. If you do not talk to me, I will have to call the doctor
Correct Answer: B
Rationale: Offering to listen and using an open-ended, non-threatening approach respects the client's current state
and promotes therapeutic engagement. Asking 'why' (A) is confrontational and often elicits defensive responses.
Telling the client to stop repeating words (C) is a non-therapeutic approach that fails to acknowledge the symptom as
part of the illness. Using threats (D) damages the therapeutic relationship and violates the principles of
patient-centered care.
Q9: The nurse is reviewing the laboratory results of a client with acute kidney injury (AKI). Which
finding requires the most immediate intervention?
A. Blood urea nitrogen (BUN) of 35 mg/dL
B. Serum potassium of 6.8 mEq/L [CORRECT]
C. Serum creatinine of 3.2 mg/dL
D. Hemoglobin of 10.5 g/dL
Correct Answer: B
Rationale: A serum potassium of 6.8 mEq/L is critically elevated (normal 3.5-5.0 mEq/L) and places the client at
immediate risk for life-threatening cardiac dysrhythmias, including ventricular fibrillation and cardiac arrest. This is
the highest priority finding requiring emergency intervention such as administering calcium gluconate, insulin with
dextrose, or kayexalate. Elevated BUN (A), creatinine (C), and decreased hemoglobin (D) are significant but not
immediately life-threatening.
Q10: A client is receiving total parenteral nutrition (TPN) through a central venous catheter. Which
nursing action is essential to prevent infection?
A. Change the TPN solution bag every 48 hours
B. Use aseptic technique when accessing the central line [CORRECT]
C. Clean the catheter site with hydrogen peroxide daily
D. Flush the catheter with normal saline after each use
Correct Answer: B
Rationale: Aseptic (sterile) technique is the single most critical intervention for preventing central line-associated
bloodstream infections (CLABSIs). The Centers for Disease Control and Prevention (CDC) recommend strict aseptic
technique for all central line access. TPN solution bags should be changed every 24 hours (not 48), making (A)
incorrect. Hydrogen peroxide (C) is cytotoxic and not recommended for catheter site care; chlorhexidine is preferred.
Flushing with saline (D) is appropriate for peripheral lines but the central line for TPN requires specific protocols.
NCLEX RN Actual Exam 2026 - Page 4
UPDATED WITH NGN QUESTIONS AND ANSWERS
Next Generation NCLEX (NGN) Clinical Judgment Measurement Model
150 Comprehensive Questions with Detailed Rationales
MC | SATA | Matrix | Bowtie | Cloze | Case Studies | Sequencing | Drag & Drop | Hot Spot
Total Questions 150
Item Types MC, SATA, Matrix, Bowtie, Cloze, Case Studies, Sequencing, Drag & Drop, Hot Spot
Alignment 2026 NCLEX-RN Test Blueprint & NGN NCJMM Standards
Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action,
Cognitive Skills
Evaluate Outcomes
Scoring 100% Correct Answers with Comprehensive Rationales
Aligned with 2026 NCLEX-RN Test Plan | NGN Clinical Judgment Measurement Model (NCJMM)
All Six Cognitive Skills Represented | Evidence-Based Practice & Current Standards
NCLEX RN Actual Exam 2026 - Page 1
,NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Section 1: Multiple Choice (MC) - Questions 1-30
Clinical Judgment and Foundational Knowledge | Single Answer Format | Tests knowledge, application, and
clinical reasoning across all Client Needs categories
Q1: The nurse is caring for a client with heart failure who reports shortness of breath and has 2+
pitting edema in the lower extremities. Which finding is most concerning and requires immediate
intervention?
A. Weight gain of 1 kg over the past week
B. Crackles in bilateral lung bases on auscultation [CORRECT]
C. Decreased appetite with early satiety
D. Fatigue reported during ambulation
Correct Answer: B
Rationale: Bilateral crackles indicate pulmonary fluid accumulation secondary to left-sided heart failure, signaling
worsening cardiac output and potential respiratory compromise. This requires immediate intervention such as
administering diuretics and repositioning the client. Weight gain (A) is concerning but not immediately
life-threatening; decreased appetite (C) and fatigue (D) are common symptoms of heart failure but do not indicate
acute decompensation.
Q2: A client with type 2 diabetes mellitus has a blood glucose level of 52 mg/dL. Which action should
the nurse take first?
A. Administer the prescribed regular insulin per sliding scale
B. Provide 15 g of fast-acting carbohydrate, such as 4 oz of juice [CORRECT]
C. Document the finding and reassess in 30 minutes
D. Obtain a repeat blood glucose level to confirm the result
Correct Answer: B
Rationale: A blood glucose of 52 mg/dL is below the normal range and indicates hypoglycemia. The first priority
action per the ABC framework is to provide rapid glucose replacement with 15 g of fast-acting carbohydrate to
prevent seizures and loss of consciousness. Administering insulin (A) would worsen hypoglycemia. While confirming
(D) may seem reasonable, delaying treatment of symptomatic hypoglycemia is dangerous. Documentation (C) does
not address the immediate need.
Q3: The nurse is delegating care to an unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
A. Assessing a postoperative client's incision site for signs of infection
B. Performing initial admission assessment on a newly assigned client
C. Recording intake and output for a stable client with heart failure [CORRECT]
D. Administering oral medications to a client with a complex medication regimen
Correct Answer: C
Rationale: Recording intake and output is a standard UAP function within the scope of practice for stable clients.
Assessment (A, B) and medication administration (D) require nursing education, clinical judgment, and licensure and
cannot be delegated to UAP. The RN must delegate only tasks that do not require nursing judgment and are within the
delegatee's training and competency.
NCLEX RN Actual Exam 2026 - Page 2
,NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Q4: A client receiving heparin infusion has an activated partial thromboplastin time (aPTT) of 98
seconds. Which action should the nurse anticipate?
A. Increase the heparin infusion rate
B. Administer protamine sulfate as prescribed [CORRECT]
C. Continue the current infusion rate unchanged
D. Discontinue heparin and begin warfarin therapy
Correct Answer: B
Rationale: An aPTT of 98 seconds is significantly above the therapeutic range (typically 1.5 to 2.5 times control,
approximately 60 to 80 seconds), indicating over-anticoagulation and increased bleeding risk. The nurse should
anticipate administering protamine sulfate, the antidote for heparin, to reverse the anticoagulant effect. Increasing
the rate (A) would worsen the situation. Continuing unchanged (C) is unsafe. Warfarin (D) is not the antidote for
heparin toxicity.
Q5: The nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease
(COPD). Which statement by the client indicates understanding of oxygen use at home?
A. I should increase my oxygen flow rate to 6 L/min during exertion
B. I will use my oxygen at 2 L/min as prescribed continuously [CORRECT]
C. I only need oxygen when I feel short of breath
D. I should turn off the oxygen while sleeping to conserve the supply
Correct Answer: B
Rationale: Clients with COPD should use oxygen at the lowest flow rate that maintains adequate oxygenation
(typically 1-3 L/min) as prescribed. Using too high a flow rate (A) can suppress the hypoxic drive that stimulates
breathing in COPD patients. Using oxygen only PRN (C) is inadequate for chronic management. Oxygen should not
be discontinued during sleep (D) as desaturation often occurs at night.
Q6: A postoperative client has a platelet count of 45,000/mm3. Which assessment finding should the
nurse report immediately to the healthcare provider?
A. Heart rate of 98 bpm
B. Temperature of 99.2 F (37.3 C)
C. Petechiae and ecchymosis on the arms and legs [CORRECT]
D. White blood cell count of 11,500/mm3
Correct Answer: C
Rationale: A platelet count of 45,000/mm3 indicates thrombocytopenia (normal 150,000-400,000/mm3), placing the
client at risk for bleeding. Petechiae and ecchymosis are signs of active bleeding that require immediate provider
notification. A heart rate of 98 (A) is slightly elevated but not critical. A temperature of 99.2F (B) is within normal
limits. A WBC of 11,500 (D) is mildly elevated but not an immediate priority compared to active bleeding.
Q7: The nurse is caring for a client who is 12 hours postpartum and reports persistent perineal pain.
Assessment reveals a swollen, purple, and ecchymotic perineal area. Which action is the priority?
A. Apply an ice pack to the perineum for 20 minutes [CORRECT]
B. Encourage the client to perform Kegel exercises
C. Prepare the client for an episiotomy repair
D. Administer a stool softener as prescribed
Correct Answer: A
NCLEX RN Actual Exam 2026 - Page 3
, NCLEX RN 2026 | NGN Clinical Judgment Measurement Model
Rationale: The findings describe a hematoma or vulvar varicosity. Applying ice causes vasoconstriction, reduces
swelling, and provides analgesia, making it the first-line intervention for perineal swelling and discomfort. Kegel
exercises (B) would increase discomfort and are contraindicated. An episiotomy repair (C) is not indicated for a
hematoma. A stool softener (D) is appropriate for constipation prevention but not the priority for acute perineal
swelling.
Q8: A client with schizophrenia is exhibiting echolalia, flat affect, and social withdrawal. Which
therapeutic communication technique is most appropriate?
A. Why do you keep repeating what I say?
B. I notice you are sitting quietly today. Would you like to talk about anything? [CORRECT]
C. You need to stop repeating words and interact with others
D. If you do not talk to me, I will have to call the doctor
Correct Answer: B
Rationale: Offering to listen and using an open-ended, non-threatening approach respects the client's current state
and promotes therapeutic engagement. Asking 'why' (A) is confrontational and often elicits defensive responses.
Telling the client to stop repeating words (C) is a non-therapeutic approach that fails to acknowledge the symptom as
part of the illness. Using threats (D) damages the therapeutic relationship and violates the principles of
patient-centered care.
Q9: The nurse is reviewing the laboratory results of a client with acute kidney injury (AKI). Which
finding requires the most immediate intervention?
A. Blood urea nitrogen (BUN) of 35 mg/dL
B. Serum potassium of 6.8 mEq/L [CORRECT]
C. Serum creatinine of 3.2 mg/dL
D. Hemoglobin of 10.5 g/dL
Correct Answer: B
Rationale: A serum potassium of 6.8 mEq/L is critically elevated (normal 3.5-5.0 mEq/L) and places the client at
immediate risk for life-threatening cardiac dysrhythmias, including ventricular fibrillation and cardiac arrest. This is
the highest priority finding requiring emergency intervention such as administering calcium gluconate, insulin with
dextrose, or kayexalate. Elevated BUN (A), creatinine (C), and decreased hemoglobin (D) are significant but not
immediately life-threatening.
Q10: A client is receiving total parenteral nutrition (TPN) through a central venous catheter. Which
nursing action is essential to prevent infection?
A. Change the TPN solution bag every 48 hours
B. Use aseptic technique when accessing the central line [CORRECT]
C. Clean the catheter site with hydrogen peroxide daily
D. Flush the catheter with normal saline after each use
Correct Answer: B
Rationale: Aseptic (sterile) technique is the single most critical intervention for preventing central line-associated
bloodstream infections (CLABSIs). The Centers for Disease Control and Prevention (CDC) recommend strict aseptic
technique for all central line access. TPN solution bags should be changed every 24 hours (not 48), making (A)
incorrect. Hydrogen peroxide (C) is cytotoxic and not recommended for catheter site care; chlorhexidine is preferred.
Flushing with saline (D) is appropriate for peripheral lines but the central line for TPN requires specific protocols.
NCLEX RN Actual Exam 2026 - Page 4
