COMPREHENSIVE NURSING LICENSURE EXAMINATION PREPARATION
NCLEX-RN 150 QUESTIONS
Actual Exam 2026
Updated with NGN Questions and Answers
A comprehensive practice examination aligned with the 2026 NCLEX-RN Test Blueprint and
Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM)
standards. Covers all item types: Multiple Choice, Select All That Apply, Matrix/Grid, Bowtie,
Cloze, Case Studies, Sequencing, Drag and Drop, and Hot Spot questions with detailed
rationales.
Item Types: MC, SATA, Matrix, Bowtie, Cloze, Case Studies,
Sequencing, Drag & Drop, Hot Spot
Framework: NGN Clinical Judgment Measurement Model
(NCJMM)
Alignment: 2026 NCLEX-RN Test Blueprint
P RO F E S S I O N A L E X A M P R E PA R AT I O N R E S O U RC E
,Section 1: Multiple Choice - Clinical Judgment and Foundational
Knowledge (Q1-Q30)
Q1: A nurse is assessing a client who is 12 hours postoperative following a total knee arthroplasty. Which finding
requires immediate intervention?
A. Hemoglobin of 10.2 g/dL
B. Pain rating of 6 on a scale of 0 to 10
C. Capillary refill of 4 seconds in the affected extremity [CORRECT]
D. Temperature of 37.8 degrees C (100.0 degrees F)
Correct Answer: C
Rationale: Capillary refill greater than 3 seconds indicates compromised peripheral circulation, which is the priority finding
following orthopedic surgery. This suggests possible vascular compromise or compartment syndrome, both of which require
immediate intervention to prevent tissue necrosis and permanent damage. A hemoglobin of 10.2 g/dL is expected postoperatively due
to blood loss during surgery. Pain of 6/10 is expected after this procedure and requires pharmacological management but is not the
priority. A temperature of 37.8 degrees C is a mild postoperative febrile response and is common within the first 24 hours after
surgery.
Q2: A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by
the client indicates an understanding of the teaching?
A. "I will increase my intake of leafy green vegetables."
B. "I will take an aspirin daily for headaches."
C. "I will have my INR checked regularly." [CORRECT]
D. "I will use a safety razor for shaving."
Correct Answer: C
Rationale: Regular INR monitoring is essential for clients taking warfarin to ensure the therapeutic range (2.0-3.0 for most
indications) is maintained and to prevent bleeding or thrombotic complications. The client should maintain consistent vitamin K
intake rather than increasing it, because vitamin K antagonizes warfarin. Aspirin should be avoided because it increases bleeding
risk when combined with warfarin. A safety razor should be avoided; an electric razor is recommended to prevent cuts and bleeding.
Q3: A nurse is caring for a client who has heart failure and is receiving furosemide. Which laboratory value should the
nurse monitor closely?
A. Sodium 140 mEq/L
B. Potassium 3.0 mEq/L [CORRECT]
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in the distal tubule. A potassium
level of 3.0 mEq/L indicates hypokalemia, which can lead to cardiac dysrhythmias, muscle weakness, and increased risk of digoxin
toxicity if the client is also taking digoxin. Sodium of 140 mEq/L is within the normal range. Calcium of 9.5 mg/dL is normal.
Magnesium of 2.0 mg/dL is within normal limits, though loop diuretics can also cause hypomagnesemia, the potassium value here is
the most critically abnormal and directly life-threatening.
NCLEX-RN 2026 NGN Exam | Page 1
,Q4: A nurse is delegating tasks to an assistive personnel (AP). Which task is most appropriate for the nurse to
delegate?
A. Assessing a client who is reporting chest pain
B. Measuring vital signs for a stable postoperative client [CORRECT]
C. Administering a newly prescribed medication
D. Evaluating the effectiveness of patient education
Correct Answer: B
Rationale: Measuring vital signs for a stable client is within the scope of practice of assistive personnel and does not require nursing
judgment. Assessment, medication administration, and evaluation are all nursing responsibilities that require critical thinking and
clinical judgment and cannot be delegated to AP. The RN must always perform assessment, administer medications (except in some
states where medication aides may give certain medications), and evaluate outcomes of care.
Q5: A nurse is caring for a client who has type 1 diabetes mellitus and reports feeling shaky and diaphoretic. The
client's blood glucose is 58 mg/dL. Which action should the nurse take first?
A. Administer 1 mg of glucagon intramuscularly
B. Provide 4 oz of orange juice [CORRECT]
C. Give the client a sandwich
D. Check the blood glucose again in 15 minutes
Correct Answer: B
Rationale: The client is experiencing mild to moderate hypoglycemia (blood glucose 58 mg/dL). The first action is to provide 15 g of
fast-acting carbohydrates, such as 4 oz of juice or regular soda. Glucagon is reserved for severe hypoglycemia when the client is
unconscious or unable to swallow. A sandwich contains protein and fat which slow glucose absorption and is appropriate as a
follow-up after the fast-acting carbohydrate raises the blood glucose. Waiting 15 minutes to recheck without treating is dangerous
because the blood glucose could drop further, causing seizures or loss of consciousness.
Q6: A nurse on a medical-surgical unit is receiving shift report. Which client should the nurse assess first?
A. A client who is 1 day postoperative with a heart rate of 92/min
B. A client with pneumonia who has a temperature of 38.6 degrees C (101.5 degrees F)
C. A client with heart failure who has gained 2 kg in 2 days
D. A client who has a new tracheostomy with tracheal deviation [CORRECT]
Correct Answer: D
Rationale: Tracheal deviation is a sign of tension pneumothorax, which is a life-threatening emergency that requires immediate
intervention. Using the ABC (Airway, Breathing, Circulation) framework, tracheal deviation indicates compromised airway and
breathing. A heart rate of 92/min is slightly elevated but not critical. A temperature of 38.6 degrees C is expected with pneumonia
and requires intervention but is not immediately life-threatening. A 2 kg weight gain in 2 days for a client with heart failure
indicates fluid retention but is not the most urgent finding compared to tracheal deviation.
Q7: A nurse is reviewing the laboratory results of a client who has chronic kidney disease. Which finding should the
nurse expect?
A. Decreased blood urea nitrogen
B. Increased hemoglobin
C. Increased serum phosphorus [CORRECT]
D. Decreased serum potassium
Correct Answer: C
NCLEX-RN 2026 NGN Exam | Page 2
, Rationale: In chronic kidney disease, the kidneys cannot adequately excrete phosphorus, leading to hyperphosphatemia. This also
contributes to hypocalcemia because phosphorus and calcium have an inverse relationship. Blood urea nitrogen (BUN) increases
because the kidneys cannot excrete nitrogenous waste. Hemoglobin decreases due to decreased erythropoietin production, leading to
anemia. Serum potassium increases (hyperkalemia) due to decreased renal excretion of potassium, which is a potentially
life-threatening complication of CKD.
Q8: A nurse is providing teaching about contraception to a client who has a history of deep vein thrombosis. Which
contraceptive method should the nurse recommend?
A. Combined oral contraceptives
B. Intravenous contraceptive patch
C. Copper intrauterine device [CORRECT]
D. Vaginal contraceptive ring
Correct Answer: C
Rationale: The copper intrauterine device (IUD) does not contain hormones and is the safest option for a client with a history of
deep vein thrombosis (DVT). Combined hormonal contraceptives (pills, patch, and ring) contain estrogen, which increases the risk of
thromboembolic events and are contraindicated for clients with a history of DVT. The copper IUD works primarily by preventing
fertilization and does not carry the thromboembolic risk associated with estrogen-containing methods.
Q9: A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which medication should the
nurse administer first?
A. Fluticasone via metered-dose inhaler
B. Montelukast orally
C. Albuterol via nebulizer [CORRECT]
D. Methylprednisolone intravenously
Correct Answer: C
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid bronchodilation and is the first-line medication for
acute asthma exacerbation. It acts within minutes to relieve bronchospasm. Fluticasone is an inhaled corticosteroid used for
maintenance therapy, not acute relief. Montelukast is a leukotriene receptor antagonist used for prophylaxis, not acute treatment.
Systemic corticosteroids like methylprednisolone are used for moderate-to-severe exacerbations but are not the first immediate
action; bronchodilators should be given first to open the airways.
Q10: A nurse is assessing a client who has suspected appendicitis. Which finding is most important to report to the
provider?
A. Pain in the right lower quadrant
B. Nausea and vomiting
C. Rebound tenderness at McBurney point [CORRECT]
D. White blood cell count of 12,000/mm3
Correct Answer: C
Rationale: Rebound tenderness at McBurney point indicates peritoneal irritation, which suggests the appendix may have perforated
or is at high risk of perforation. This is a surgical emergency requiring immediate intervention. RLQ pain, nausea, and elevated
WBC are all expected findings with appendicitis, but rebound tenderness (a sign of peritonitis) is the most critical finding indicating
potential perforation and the need for emergency surgery.
Q11: A nurse is planning care for a client who has Alzheimer's disease and wanders at night. Which intervention is
most effective?
NCLEX-RN 2026 NGN Exam | Page 3
NCLEX-RN 150 QUESTIONS
Actual Exam 2026
Updated with NGN Questions and Answers
A comprehensive practice examination aligned with the 2026 NCLEX-RN Test Blueprint and
Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM)
standards. Covers all item types: Multiple Choice, Select All That Apply, Matrix/Grid, Bowtie,
Cloze, Case Studies, Sequencing, Drag and Drop, and Hot Spot questions with detailed
rationales.
Item Types: MC, SATA, Matrix, Bowtie, Cloze, Case Studies,
Sequencing, Drag & Drop, Hot Spot
Framework: NGN Clinical Judgment Measurement Model
(NCJMM)
Alignment: 2026 NCLEX-RN Test Blueprint
P RO F E S S I O N A L E X A M P R E PA R AT I O N R E S O U RC E
,Section 1: Multiple Choice - Clinical Judgment and Foundational
Knowledge (Q1-Q30)
Q1: A nurse is assessing a client who is 12 hours postoperative following a total knee arthroplasty. Which finding
requires immediate intervention?
A. Hemoglobin of 10.2 g/dL
B. Pain rating of 6 on a scale of 0 to 10
C. Capillary refill of 4 seconds in the affected extremity [CORRECT]
D. Temperature of 37.8 degrees C (100.0 degrees F)
Correct Answer: C
Rationale: Capillary refill greater than 3 seconds indicates compromised peripheral circulation, which is the priority finding
following orthopedic surgery. This suggests possible vascular compromise or compartment syndrome, both of which require
immediate intervention to prevent tissue necrosis and permanent damage. A hemoglobin of 10.2 g/dL is expected postoperatively due
to blood loss during surgery. Pain of 6/10 is expected after this procedure and requires pharmacological management but is not the
priority. A temperature of 37.8 degrees C is a mild postoperative febrile response and is common within the first 24 hours after
surgery.
Q2: A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which statement by
the client indicates an understanding of the teaching?
A. "I will increase my intake of leafy green vegetables."
B. "I will take an aspirin daily for headaches."
C. "I will have my INR checked regularly." [CORRECT]
D. "I will use a safety razor for shaving."
Correct Answer: C
Rationale: Regular INR monitoring is essential for clients taking warfarin to ensure the therapeutic range (2.0-3.0 for most
indications) is maintained and to prevent bleeding or thrombotic complications. The client should maintain consistent vitamin K
intake rather than increasing it, because vitamin K antagonizes warfarin. Aspirin should be avoided because it increases bleeding
risk when combined with warfarin. A safety razor should be avoided; an electric razor is recommended to prevent cuts and bleeding.
Q3: A nurse is caring for a client who has heart failure and is receiving furosemide. Which laboratory value should the
nurse monitor closely?
A. Sodium 140 mEq/L
B. Potassium 3.0 mEq/L [CORRECT]
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in the distal tubule. A potassium
level of 3.0 mEq/L indicates hypokalemia, which can lead to cardiac dysrhythmias, muscle weakness, and increased risk of digoxin
toxicity if the client is also taking digoxin. Sodium of 140 mEq/L is within the normal range. Calcium of 9.5 mg/dL is normal.
Magnesium of 2.0 mg/dL is within normal limits, though loop diuretics can also cause hypomagnesemia, the potassium value here is
the most critically abnormal and directly life-threatening.
NCLEX-RN 2026 NGN Exam | Page 1
,Q4: A nurse is delegating tasks to an assistive personnel (AP). Which task is most appropriate for the nurse to
delegate?
A. Assessing a client who is reporting chest pain
B. Measuring vital signs for a stable postoperative client [CORRECT]
C. Administering a newly prescribed medication
D. Evaluating the effectiveness of patient education
Correct Answer: B
Rationale: Measuring vital signs for a stable client is within the scope of practice of assistive personnel and does not require nursing
judgment. Assessment, medication administration, and evaluation are all nursing responsibilities that require critical thinking and
clinical judgment and cannot be delegated to AP. The RN must always perform assessment, administer medications (except in some
states where medication aides may give certain medications), and evaluate outcomes of care.
Q5: A nurse is caring for a client who has type 1 diabetes mellitus and reports feeling shaky and diaphoretic. The
client's blood glucose is 58 mg/dL. Which action should the nurse take first?
A. Administer 1 mg of glucagon intramuscularly
B. Provide 4 oz of orange juice [CORRECT]
C. Give the client a sandwich
D. Check the blood glucose again in 15 minutes
Correct Answer: B
Rationale: The client is experiencing mild to moderate hypoglycemia (blood glucose 58 mg/dL). The first action is to provide 15 g of
fast-acting carbohydrates, such as 4 oz of juice or regular soda. Glucagon is reserved for severe hypoglycemia when the client is
unconscious or unable to swallow. A sandwich contains protein and fat which slow glucose absorption and is appropriate as a
follow-up after the fast-acting carbohydrate raises the blood glucose. Waiting 15 minutes to recheck without treating is dangerous
because the blood glucose could drop further, causing seizures or loss of consciousness.
Q6: A nurse on a medical-surgical unit is receiving shift report. Which client should the nurse assess first?
A. A client who is 1 day postoperative with a heart rate of 92/min
B. A client with pneumonia who has a temperature of 38.6 degrees C (101.5 degrees F)
C. A client with heart failure who has gained 2 kg in 2 days
D. A client who has a new tracheostomy with tracheal deviation [CORRECT]
Correct Answer: D
Rationale: Tracheal deviation is a sign of tension pneumothorax, which is a life-threatening emergency that requires immediate
intervention. Using the ABC (Airway, Breathing, Circulation) framework, tracheal deviation indicates compromised airway and
breathing. A heart rate of 92/min is slightly elevated but not critical. A temperature of 38.6 degrees C is expected with pneumonia
and requires intervention but is not immediately life-threatening. A 2 kg weight gain in 2 days for a client with heart failure
indicates fluid retention but is not the most urgent finding compared to tracheal deviation.
Q7: A nurse is reviewing the laboratory results of a client who has chronic kidney disease. Which finding should the
nurse expect?
A. Decreased blood urea nitrogen
B. Increased hemoglobin
C. Increased serum phosphorus [CORRECT]
D. Decreased serum potassium
Correct Answer: C
NCLEX-RN 2026 NGN Exam | Page 2
, Rationale: In chronic kidney disease, the kidneys cannot adequately excrete phosphorus, leading to hyperphosphatemia. This also
contributes to hypocalcemia because phosphorus and calcium have an inverse relationship. Blood urea nitrogen (BUN) increases
because the kidneys cannot excrete nitrogenous waste. Hemoglobin decreases due to decreased erythropoietin production, leading to
anemia. Serum potassium increases (hyperkalemia) due to decreased renal excretion of potassium, which is a potentially
life-threatening complication of CKD.
Q8: A nurse is providing teaching about contraception to a client who has a history of deep vein thrombosis. Which
contraceptive method should the nurse recommend?
A. Combined oral contraceptives
B. Intravenous contraceptive patch
C. Copper intrauterine device [CORRECT]
D. Vaginal contraceptive ring
Correct Answer: C
Rationale: The copper intrauterine device (IUD) does not contain hormones and is the safest option for a client with a history of
deep vein thrombosis (DVT). Combined hormonal contraceptives (pills, patch, and ring) contain estrogen, which increases the risk of
thromboembolic events and are contraindicated for clients with a history of DVT. The copper IUD works primarily by preventing
fertilization and does not carry the thromboembolic risk associated with estrogen-containing methods.
Q9: A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which medication should the
nurse administer first?
A. Fluticasone via metered-dose inhaler
B. Montelukast orally
C. Albuterol via nebulizer [CORRECT]
D. Methylprednisolone intravenously
Correct Answer: C
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid bronchodilation and is the first-line medication for
acute asthma exacerbation. It acts within minutes to relieve bronchospasm. Fluticasone is an inhaled corticosteroid used for
maintenance therapy, not acute relief. Montelukast is a leukotriene receptor antagonist used for prophylaxis, not acute treatment.
Systemic corticosteroids like methylprednisolone are used for moderate-to-severe exacerbations but are not the first immediate
action; bronchodilators should be given first to open the airways.
Q10: A nurse is assessing a client who has suspected appendicitis. Which finding is most important to report to the
provider?
A. Pain in the right lower quadrant
B. Nausea and vomiting
C. Rebound tenderness at McBurney point [CORRECT]
D. White blood cell count of 12,000/mm3
Correct Answer: C
Rationale: Rebound tenderness at McBurney point indicates peritoneal irritation, which suggests the appendix may have perforated
or is at high risk of perforation. This is a surgical emergency requiring immediate intervention. RLQ pain, nausea, and elevated
WBC are all expected findings with appendicitis, but rebound tenderness (a sign of peritonitis) is the most critical finding indicating
potential perforation and the need for emergency surgery.
Q11: A nurse is planning care for a client who has Alzheimer's disease and wanders at night. Which intervention is
most effective?
NCLEX-RN 2026 NGN Exam | Page 3
