COMPREHENSIVE NURSING LICENSURE
E X A M I N AT I O N P R E PA R AT I O N
NCLEX-RN
Actual Exam 2026
150 evidence-based practice questions covering all Next
Generation NCLEX item types: Multiple Choice, SATA,
Matrix, Bowtie, Cloze, Case Studies, Sequencing, Drag
and Drop, and Hot Spot questions aligned with the 2026
test blueprint.
Updated with NGN Clinical Judgment Measurement Model
150 Questions | MC, SATA, Matrix, Bowtie, Cloze, Case Studies
and More
N C L E X - R N 2 0 2 6 E X A M I N AT I O N P R E PA R AT I O N
, Section 1: Multiple Choice
Questions 1–30 — Select one best answer. Client Needs: Safe and Effective Care, Health Promotion, Psychosocial
Integrity, Physiological Integrity.
Q1: A charge nurse on a medical-surgical unit is delegating tasks to an LPN and a nursing
assistant. Which of the following tasks should the charge nurse assign to the LPN rather than the
nursing assistant?
A. Recording intake and output from the shift
B. Applying sequential compression devices to a postoperative patient
C. Ambulating a stable patient who had a knee replacement yesterday
D. Administering oral medications to a patient with hypertension [CORRECT]
Correct Answer: D
Administering oral medications is within the LPN scope of practice under RN supervision, while the nursing assistant
can record intake/output, apply sequential compression devices, and ambulate stable patients. Delegation requires the
RN to match the task complexity to the delegatee’s licensure level and demonstrated competency. The RN retains
accountability for the overall plan of care (NCSBN Delegation Guidelines, 2024).
Q2: A nurse is caring for a patient with active pulmonary tuberculosis (TB). Which
transmission-based precaution is MOST appropriate?
A. Contact precautions with private room
B. Droplet precautions with surgical mask within 3 feet
C. Airborne precautions with negative-pressure room and N95 respirator [CORRECT]
D. Standard precautions with hand hygiene only
Correct Answer: C
Pulmonary TB is transmitted via airborne droplet nuclei that remain suspended in the air, requiring airborne
precautions including a negative-pressure isolation room and N95 respirator use. Contact precautions are used for
pathogens spread by direct or indirect contact, and droplet precautions are for pathogens spread through large
respiratory droplets within 3 feet. Standard precautions alone are insufficient for airborne pathogens (CDC
Guidelines for Preventing TB, 2024).
Q3: A nurse receives morning report on four patients. Which patient should the nurse assess
FIRST?
A. A patient with type 2 diabetes requesting a snack before lunch
B. A patient 2 days post-cholecystectomy with a temperature of 38.9°C (102°F) [CORRECT]
C. A patient with heart failure who gained 1 kg overnight
D. A patient with a pressure injury on the sacrum needing a dressing change
Correct Answer: B
The post-cholecystectomy patient with a fever of 38.9°C should be assessed first because an elevated temperature at
2 days post-surgery may indicate a surgical site infection or abscess, which is a potentially life-threatening
complication requiring immediate intervention. The other patients have needs that, while important, are not as
urgent. Using the ABCs and Maslow’s hierarchy, physiological emergencies take priority over comfort or routine
care requests.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 1
, Q4: A nurse is preparing to administer digoxin (Lanoxin) 0.25 mg IV to a patient with heart
failure. Which assessment is MOST critical before administering this medication?
A. Checking the patient's blood pressure
B. Auscultating the apical pulse for a full 60 seconds [CORRECT]
C. Assessing the patient's respiratory rate
D. Checking the patient's serum potassium level
Correct Answer: B
The most critical pre-administration assessment for digoxin is auscultating the apical pulse for 60 seconds. Digoxin
slows cardiac conduction, and the medication should be held if the apical rate is below 60 bpm to avoid severe
bradycardia and potential heart block. While checking serum potassium is also important (hypokalemia increases
digoxin toxicity risk), the immediate bedside safety check is the heart rate assessment. Blood pressure and respiratory
rate are less specific to digoxin’s primary mechanism of action.
Q5: A nurse is caring for a patient scheduled for an elective colonoscopy. The patient tells the
nurse, "I don’t understand why I need this procedure." What is the nurse’s BEST action?
A. Tell the patient the physician already explained the procedure
B. Document the patient’s statement and proceed with preparation
C. Notify the physician that the patient needs further explanation [CORRECT]
D. Provide the patient with a brochure about colonoscopy
Correct Answer: C
The nurse’s best action is to notify the physician that the patient needs further explanation. Informed consent
requires that the patient understands the purpose, risks, benefits, and alternatives of the procedure. If the patient
expresses lack of understanding, the nurse cannot simply proceed—the person performing the procedure (or
someone qualified) must clarify. Telling the patient the physician already explained is dismissive and does not
address the knowledge deficit. While providing a brochure is supportive, it does not replace the need for direct
physician communication.
Q6: A nurse is completing a fall-risk assessment on an 82-year-old patient admitted for
pneumonia. Which finding places this patient at GREATEST risk for falls?
A. The patient uses a walker for ambulation
B. The patient takes furosemide (Lasix) twice daily [CORRECT]
C. The patient has a history of osteoarthritis
D. The patient is oriented to person and place
Correct Answer: B
Furosemide is a loop diuretic that increases urine output and can cause orthostatic hypotension, placing the patient at
greatest risk for falls due to dizziness and syncope upon standing. While using a walker indicates mobility
impairment, it also represents a compensatory safety measure. Osteoarthritis causes joint stiffness but not acute fall
risk. Being oriented to person and place is actually a protective factor against falls. The nurse should implement fall
precautions including assisted ambulation, call light within reach, and adequate lighting.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 2
, Q7: A nurse is planning discharge teaching for a patient with newly diagnosed chronic obstructive
pulmonary disease (COPD). Which instruction is MOST important to include?
A. Avoid extreme hot and cold weather
B. Use pursed-lip breathing during periods of dyspnea [CORRECT]
C. Limit fluid intake to 1,000 mL per day
D. Exercise only during the morning hours
Correct Answer: B
Pursed-lip breathing is the most critical instruction because it prolongs exhalation, prevents air trapping in alveoli,
and improves gas exchange—directly addressing the primary COPD pathophysiology of expiratory airflow
limitation. While avoiding extreme temperatures is helpful, it is secondary to the breathing technique. Fluids should
actually be encouraged (not limited) to thin secretions in COPD. Exercise timing should be flexible based on the
patient’s energy level and environmental factors, not restricted to morning only.
Q8: A nurse is caring for a patient with Clostridioides difficile infection. Which action is MOST
effective in preventing transmission?
A. Wearing a gown and gloves when entering the room [CORRECT]
B. Placing the patient in a negative-pressure room
C. Wearing an N95 respirator during patient contact
D. Assigning the patient to a room with a HEPA filter
Correct Answer: A
C. difficile is transmitted via the fecal-oral route and spores persist on environmental surfaces. The most effective
prevention is contact precautions: gown and gloves for all patient contact and room entry. Hand hygiene with soap
and water is essential because alcohol-based hand rubs do not kill C. difficile spores. Negative-pressure rooms and
N95 respirators are for airborne precautions, and HEPA filters are not required for C. difficile. The single most
important intervention is consistent use of contact precautions and proper handwashing with soap and water (APIC
Guidelines, 2024).
Q9: A pregnant woman at 28 weeks gestation asks the nurse about fetal development. Which
statement by the nurse is MOST accurate?
A. Your baby can now open and close its eyes [CORRECT]
B. Your baby's lungs are fully mature
C. Your baby weighs approximately 1 pound
D. Your baby's brain is completely developed
Correct Answer: A
At 28 weeks gestation, the fetus can open and close its eyes, and rapid brain development continues. Lung maturity is
not complete until approximately 34-36 weeks when surfactant production is sufficient. At 28 weeks, the fetus
weighs approximately 2.2 pounds (1,000 grams), not 1 pound (which occurs around 24 weeks). Brain development
continues through the third trimester and after birth. Accurate developmental milestones help parents understand
fetal growth and participate in prenatal care.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 3
E X A M I N AT I O N P R E PA R AT I O N
NCLEX-RN
Actual Exam 2026
150 evidence-based practice questions covering all Next
Generation NCLEX item types: Multiple Choice, SATA,
Matrix, Bowtie, Cloze, Case Studies, Sequencing, Drag
and Drop, and Hot Spot questions aligned with the 2026
test blueprint.
Updated with NGN Clinical Judgment Measurement Model
150 Questions | MC, SATA, Matrix, Bowtie, Cloze, Case Studies
and More
N C L E X - R N 2 0 2 6 E X A M I N AT I O N P R E PA R AT I O N
, Section 1: Multiple Choice
Questions 1–30 — Select one best answer. Client Needs: Safe and Effective Care, Health Promotion, Psychosocial
Integrity, Physiological Integrity.
Q1: A charge nurse on a medical-surgical unit is delegating tasks to an LPN and a nursing
assistant. Which of the following tasks should the charge nurse assign to the LPN rather than the
nursing assistant?
A. Recording intake and output from the shift
B. Applying sequential compression devices to a postoperative patient
C. Ambulating a stable patient who had a knee replacement yesterday
D. Administering oral medications to a patient with hypertension [CORRECT]
Correct Answer: D
Administering oral medications is within the LPN scope of practice under RN supervision, while the nursing assistant
can record intake/output, apply sequential compression devices, and ambulate stable patients. Delegation requires the
RN to match the task complexity to the delegatee’s licensure level and demonstrated competency. The RN retains
accountability for the overall plan of care (NCSBN Delegation Guidelines, 2024).
Q2: A nurse is caring for a patient with active pulmonary tuberculosis (TB). Which
transmission-based precaution is MOST appropriate?
A. Contact precautions with private room
B. Droplet precautions with surgical mask within 3 feet
C. Airborne precautions with negative-pressure room and N95 respirator [CORRECT]
D. Standard precautions with hand hygiene only
Correct Answer: C
Pulmonary TB is transmitted via airborne droplet nuclei that remain suspended in the air, requiring airborne
precautions including a negative-pressure isolation room and N95 respirator use. Contact precautions are used for
pathogens spread by direct or indirect contact, and droplet precautions are for pathogens spread through large
respiratory droplets within 3 feet. Standard precautions alone are insufficient for airborne pathogens (CDC
Guidelines for Preventing TB, 2024).
Q3: A nurse receives morning report on four patients. Which patient should the nurse assess
FIRST?
A. A patient with type 2 diabetes requesting a snack before lunch
B. A patient 2 days post-cholecystectomy with a temperature of 38.9°C (102°F) [CORRECT]
C. A patient with heart failure who gained 1 kg overnight
D. A patient with a pressure injury on the sacrum needing a dressing change
Correct Answer: B
The post-cholecystectomy patient with a fever of 38.9°C should be assessed first because an elevated temperature at
2 days post-surgery may indicate a surgical site infection or abscess, which is a potentially life-threatening
complication requiring immediate intervention. The other patients have needs that, while important, are not as
urgent. Using the ABCs and Maslow’s hierarchy, physiological emergencies take priority over comfort or routine
care requests.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 1
, Q4: A nurse is preparing to administer digoxin (Lanoxin) 0.25 mg IV to a patient with heart
failure. Which assessment is MOST critical before administering this medication?
A. Checking the patient's blood pressure
B. Auscultating the apical pulse for a full 60 seconds [CORRECT]
C. Assessing the patient's respiratory rate
D. Checking the patient's serum potassium level
Correct Answer: B
The most critical pre-administration assessment for digoxin is auscultating the apical pulse for 60 seconds. Digoxin
slows cardiac conduction, and the medication should be held if the apical rate is below 60 bpm to avoid severe
bradycardia and potential heart block. While checking serum potassium is also important (hypokalemia increases
digoxin toxicity risk), the immediate bedside safety check is the heart rate assessment. Blood pressure and respiratory
rate are less specific to digoxin’s primary mechanism of action.
Q5: A nurse is caring for a patient scheduled for an elective colonoscopy. The patient tells the
nurse, "I don’t understand why I need this procedure." What is the nurse’s BEST action?
A. Tell the patient the physician already explained the procedure
B. Document the patient’s statement and proceed with preparation
C. Notify the physician that the patient needs further explanation [CORRECT]
D. Provide the patient with a brochure about colonoscopy
Correct Answer: C
The nurse’s best action is to notify the physician that the patient needs further explanation. Informed consent
requires that the patient understands the purpose, risks, benefits, and alternatives of the procedure. If the patient
expresses lack of understanding, the nurse cannot simply proceed—the person performing the procedure (or
someone qualified) must clarify. Telling the patient the physician already explained is dismissive and does not
address the knowledge deficit. While providing a brochure is supportive, it does not replace the need for direct
physician communication.
Q6: A nurse is completing a fall-risk assessment on an 82-year-old patient admitted for
pneumonia. Which finding places this patient at GREATEST risk for falls?
A. The patient uses a walker for ambulation
B. The patient takes furosemide (Lasix) twice daily [CORRECT]
C. The patient has a history of osteoarthritis
D. The patient is oriented to person and place
Correct Answer: B
Furosemide is a loop diuretic that increases urine output and can cause orthostatic hypotension, placing the patient at
greatest risk for falls due to dizziness and syncope upon standing. While using a walker indicates mobility
impairment, it also represents a compensatory safety measure. Osteoarthritis causes joint stiffness but not acute fall
risk. Being oriented to person and place is actually a protective factor against falls. The nurse should implement fall
precautions including assisted ambulation, call light within reach, and adequate lighting.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 2
, Q7: A nurse is planning discharge teaching for a patient with newly diagnosed chronic obstructive
pulmonary disease (COPD). Which instruction is MOST important to include?
A. Avoid extreme hot and cold weather
B. Use pursed-lip breathing during periods of dyspnea [CORRECT]
C. Limit fluid intake to 1,000 mL per day
D. Exercise only during the morning hours
Correct Answer: B
Pursed-lip breathing is the most critical instruction because it prolongs exhalation, prevents air trapping in alveoli,
and improves gas exchange—directly addressing the primary COPD pathophysiology of expiratory airflow
limitation. While avoiding extreme temperatures is helpful, it is secondary to the breathing technique. Fluids should
actually be encouraged (not limited) to thin secretions in COPD. Exercise timing should be flexible based on the
patient’s energy level and environmental factors, not restricted to morning only.
Q8: A nurse is caring for a patient with Clostridioides difficile infection. Which action is MOST
effective in preventing transmission?
A. Wearing a gown and gloves when entering the room [CORRECT]
B. Placing the patient in a negative-pressure room
C. Wearing an N95 respirator during patient contact
D. Assigning the patient to a room with a HEPA filter
Correct Answer: A
C. difficile is transmitted via the fecal-oral route and spores persist on environmental surfaces. The most effective
prevention is contact precautions: gown and gloves for all patient contact and room entry. Hand hygiene with soap
and water is essential because alcohol-based hand rubs do not kill C. difficile spores. Negative-pressure rooms and
N95 respirators are for airborne precautions, and HEPA filters are not required for C. difficile. The single most
important intervention is consistent use of contact precautions and proper handwashing with soap and water (APIC
Guidelines, 2024).
Q9: A pregnant woman at 28 weeks gestation asks the nurse about fetal development. Which
statement by the nurse is MOST accurate?
A. Your baby can now open and close its eyes [CORRECT]
B. Your baby's lungs are fully mature
C. Your baby weighs approximately 1 pound
D. Your baby's brain is completely developed
Correct Answer: A
At 28 weeks gestation, the fetus can open and close its eyes, and rapid brain development continues. Lung maturity is
not complete until approximately 34-36 weeks when surfactant production is sufficient. At 28 weeks, the fetus
weighs approximately 2.2 pounds (1,000 grams), not 1 pound (which occurs around 24 weeks). Brain development
continues through the third trimester and after birth. Accurate developmental milestones help parents understand
fetal growth and participate in prenatal care.
NCLEX-RN Practice Exam — Part 1: Q1–Q75 Page 3
