NCLEX-RN EXAM PREVIEW 2026 QUESTION PRACTICE
TEST WITH COMPLETE ANSWERS & ELABORATIONS
IMPORTANT NOTE: This practice exam is designed to reflect the content, structure, and
clinical judgment focus of the 2026 NCLEX-RN Test Plan. The official 2026 test plan,
effective April 1, 2026, maintains the same Client Needs category percentages and
overall structure as the 2023 plan. Key refinements include an updated name for one
subcategory and new activity statements that place greater emphasis on health
equity, clinical monitoring of advanced devices, and modernized privacy
considerations. The Next Generation NCLEX (NGN) format and Clinical Judgment
Measurement Model (CJMM) continue to guide the exam . All questions are original and
tested against the provided duplicate-checking rubric.
PART 1 – QUESTIONS 1–50
Question 1. A nurse is caring for a client who was just diagnosed with a new onset of
atrial fibrillation with rapid ventricular response. The provider orders diltiazem 20 mg IV
push over 2 minutes. Which action is most important for the nurse to take before
administering this medication?
A. Assess the client's blood pressure
B. Check the client's serum potassium level
C. Place the client on a cardiac monitor
D. Verify the client's allergy to calcium channel blockers
Correct Answer: A
Rationale: Diltiazem is a calcium channel blocker that causes systemic vasodilation and
can precipitate significant hypotension. The most critical action is to assess the client's
blood pressure to ensure it is adequate for the administration of a potent vasodilator.
While cardiac monitoring, checking potassium, and verifying allergies are also important,
,assessing the blood pressure is the priority to prevent a life-threatening drop in blood
pressure.
Question 2. A client with chronic obstructive pulmonary disease (COPD) and a history of
heart failure is admitted with shortness of breath. The provider orders a chest x-ray and
an arterial blood gas (ABG). Which finding on the ABG would be most consistent with
this client's underlying pathophysiology and indicate the need for immediate
intervention?
A. pH 7.38, PaCO₂ 52, HCO₃ 29
B. pH 7.28, PaCO₂ 65, HCO₃ 26
C. pH 7.45, PaCO₂ 48, HCO₃ 32
D. pH 7.33, PaCO₂ 38, HCO₃ 20
Correct Answer: B
Rationale: A client with COPD typically has chronic hypercapnia (elevated PaCO₂) and a
compensatory metabolic alkalosis (elevated HCO₃). Option B shows a pH of 7.28
(acidosis), PaCO₂ of 65 (severe hypercapnia), and HCO₃ of 26 (inadequate renal
compensation for a patient with COPD who typically has a higher baseline HCO₃). This
indicates an acute-on-chronic respiratory acidosis with impending respiratory failure,
requiring immediate intervention such as non-invasive or mechanical ventilation.
Question 3. A client is 24 hours post-operative from a total knee arthroplasty. The nurse
is assessing the client's pain and notes a pain score of 7/10. The client has an order for
hydromorphone 1 mg IV push every 3 hours PRN. Which assessment finding would be
most concerning and require the nurse to hold the medication and contact the
provider?
A. The client's respiratory rate is 14 breaths per minute
B. The client's blood pressure is 110/70 mm Hg
C. The client's oxygen saturation is 88% on room air
D. The client's heart rate is 88 beats per minute
Correct Answer: C
,Rationale: An oxygen saturation of 88% on room air indicates significant hypoxemia.
Administering hydromorphone, an opioid that can cause respiratory depression, would
further compromise this client's oxygenation and ventilation. The other findings are
within acceptable ranges for a post-operative client. The nurse should first address the
hypoxemia with supplemental oxygen and notify the provider.
Question 4. A nurse is educating a client newly prescribed lisinopril for hypertension.
The client asks, "What is the most important thing I need to watch out for?" Which
statement by the client indicates a correct understanding of the most serious potential
adverse effect?
A. "I should report a persistent dry cough to my provider"
B. "I need to get up slowly from a sitting or lying position"
C. "I should watch for swelling of my face, lips, or tongue"
D. "I should avoid salt substitutes that contain potassium"
Correct Answer: C
Rationale: Angioedema, a swelling of the face, lips, tongue, or throat, is the most
serious, potentially life-threatening adverse effect of ACE inhibitors like lisinopril. It
requires immediate discontinuation of the medication and emergency medical attention.
While the other statements are accurate and reflect expected teaching points, they are
not the most serious.
Question 5. A client with a history of type 1 diabetes is found unresponsive at home. An
ambulance is called, and the paramedics report a capillary blood glucose reading of
"low." The client is now in the emergency department and has a blood glucose of 28
mg/dL. The nurse should anticipate preparing to administer which of the following?
A. 1 mg of glucagon intramuscularly
B. 50 mL of 50% dextrose IV push
C. 25 g of oral glucose gel
D. 10 units of regular insulin IV push
Correct Answer: B
, Rationale: A blood glucose of 28 mg/dL constitutes a severe hypoglycemic emergency.
For an unresponsive or unconscious patient without a patent airway, IV dextrose is the
treatment of choice. The standard dose is 50 mL of 50% dextrose IV push. Glucagon IM
is an alternative if IV access is not possible, but IV dextrose is preferred when available.
Question 6. A client with a new diagnosis of deep vein thrombosis (DVT) in the left
lower extremity is started on a continuous heparin infusion. The nurse is reviewing the
client's laboratory results. Which laboratory value is most important to monitor for the
immediate risk of a complication from the heparin therapy?
A. Serum creatinine
B. PT/INR
C. aPTT
D. Platelet count
Correct Answer: C
Rationale: The aPTT (activated partial thromboplastin time) is the primary laboratory
value used to monitor the effectiveness of unfractionated heparin therapy. It is crucial to
monitor this level to ensure the heparin dose is therapeutic and to avoid bleeding
complications. The therapeutic aPTT is typically 1.5 to 2.5 times the control value. While
platelet count is also important to monitor for heparin-induced thrombocytopenia (HIT),
it is not the immediate monitoring parameter for the drug's effectiveness.
Question 7. A nurse is caring for a client who is experiencing a manic episode. The
client is pacing the hallways, is talking rapidly, and has not slept or eaten in 48 hours.
Which of the following interventions should the nurse prioritize?
A. Encourage the client to take a nap
B. Provide a high-protein, high-calorie snack
C. Provide the client with a quiet, low-stimulation environment
D. Ask the client to sit down and talk about their feelings
Correct Answer: C
TEST WITH COMPLETE ANSWERS & ELABORATIONS
IMPORTANT NOTE: This practice exam is designed to reflect the content, structure, and
clinical judgment focus of the 2026 NCLEX-RN Test Plan. The official 2026 test plan,
effective April 1, 2026, maintains the same Client Needs category percentages and
overall structure as the 2023 plan. Key refinements include an updated name for one
subcategory and new activity statements that place greater emphasis on health
equity, clinical monitoring of advanced devices, and modernized privacy
considerations. The Next Generation NCLEX (NGN) format and Clinical Judgment
Measurement Model (CJMM) continue to guide the exam . All questions are original and
tested against the provided duplicate-checking rubric.
PART 1 – QUESTIONS 1–50
Question 1. A nurse is caring for a client who was just diagnosed with a new onset of
atrial fibrillation with rapid ventricular response. The provider orders diltiazem 20 mg IV
push over 2 minutes. Which action is most important for the nurse to take before
administering this medication?
A. Assess the client's blood pressure
B. Check the client's serum potassium level
C. Place the client on a cardiac monitor
D. Verify the client's allergy to calcium channel blockers
Correct Answer: A
Rationale: Diltiazem is a calcium channel blocker that causes systemic vasodilation and
can precipitate significant hypotension. The most critical action is to assess the client's
blood pressure to ensure it is adequate for the administration of a potent vasodilator.
While cardiac monitoring, checking potassium, and verifying allergies are also important,
,assessing the blood pressure is the priority to prevent a life-threatening drop in blood
pressure.
Question 2. A client with chronic obstructive pulmonary disease (COPD) and a history of
heart failure is admitted with shortness of breath. The provider orders a chest x-ray and
an arterial blood gas (ABG). Which finding on the ABG would be most consistent with
this client's underlying pathophysiology and indicate the need for immediate
intervention?
A. pH 7.38, PaCO₂ 52, HCO₃ 29
B. pH 7.28, PaCO₂ 65, HCO₃ 26
C. pH 7.45, PaCO₂ 48, HCO₃ 32
D. pH 7.33, PaCO₂ 38, HCO₃ 20
Correct Answer: B
Rationale: A client with COPD typically has chronic hypercapnia (elevated PaCO₂) and a
compensatory metabolic alkalosis (elevated HCO₃). Option B shows a pH of 7.28
(acidosis), PaCO₂ of 65 (severe hypercapnia), and HCO₃ of 26 (inadequate renal
compensation for a patient with COPD who typically has a higher baseline HCO₃). This
indicates an acute-on-chronic respiratory acidosis with impending respiratory failure,
requiring immediate intervention such as non-invasive or mechanical ventilation.
Question 3. A client is 24 hours post-operative from a total knee arthroplasty. The nurse
is assessing the client's pain and notes a pain score of 7/10. The client has an order for
hydromorphone 1 mg IV push every 3 hours PRN. Which assessment finding would be
most concerning and require the nurse to hold the medication and contact the
provider?
A. The client's respiratory rate is 14 breaths per minute
B. The client's blood pressure is 110/70 mm Hg
C. The client's oxygen saturation is 88% on room air
D. The client's heart rate is 88 beats per minute
Correct Answer: C
,Rationale: An oxygen saturation of 88% on room air indicates significant hypoxemia.
Administering hydromorphone, an opioid that can cause respiratory depression, would
further compromise this client's oxygenation and ventilation. The other findings are
within acceptable ranges for a post-operative client. The nurse should first address the
hypoxemia with supplemental oxygen and notify the provider.
Question 4. A nurse is educating a client newly prescribed lisinopril for hypertension.
The client asks, "What is the most important thing I need to watch out for?" Which
statement by the client indicates a correct understanding of the most serious potential
adverse effect?
A. "I should report a persistent dry cough to my provider"
B. "I need to get up slowly from a sitting or lying position"
C. "I should watch for swelling of my face, lips, or tongue"
D. "I should avoid salt substitutes that contain potassium"
Correct Answer: C
Rationale: Angioedema, a swelling of the face, lips, tongue, or throat, is the most
serious, potentially life-threatening adverse effect of ACE inhibitors like lisinopril. It
requires immediate discontinuation of the medication and emergency medical attention.
While the other statements are accurate and reflect expected teaching points, they are
not the most serious.
Question 5. A client with a history of type 1 diabetes is found unresponsive at home. An
ambulance is called, and the paramedics report a capillary blood glucose reading of
"low." The client is now in the emergency department and has a blood glucose of 28
mg/dL. The nurse should anticipate preparing to administer which of the following?
A. 1 mg of glucagon intramuscularly
B. 50 mL of 50% dextrose IV push
C. 25 g of oral glucose gel
D. 10 units of regular insulin IV push
Correct Answer: B
, Rationale: A blood glucose of 28 mg/dL constitutes a severe hypoglycemic emergency.
For an unresponsive or unconscious patient without a patent airway, IV dextrose is the
treatment of choice. The standard dose is 50 mL of 50% dextrose IV push. Glucagon IM
is an alternative if IV access is not possible, but IV dextrose is preferred when available.
Question 6. A client with a new diagnosis of deep vein thrombosis (DVT) in the left
lower extremity is started on a continuous heparin infusion. The nurse is reviewing the
client's laboratory results. Which laboratory value is most important to monitor for the
immediate risk of a complication from the heparin therapy?
A. Serum creatinine
B. PT/INR
C. aPTT
D. Platelet count
Correct Answer: C
Rationale: The aPTT (activated partial thromboplastin time) is the primary laboratory
value used to monitor the effectiveness of unfractionated heparin therapy. It is crucial to
monitor this level to ensure the heparin dose is therapeutic and to avoid bleeding
complications. The therapeutic aPTT is typically 1.5 to 2.5 times the control value. While
platelet count is also important to monitor for heparin-induced thrombocytopenia (HIT),
it is not the immediate monitoring parameter for the drug's effectiveness.
Question 7. A nurse is caring for a client who is experiencing a manic episode. The
client is pacing the hallways, is talking rapidly, and has not slept or eaten in 48 hours.
Which of the following interventions should the nurse prioritize?
A. Encourage the client to take a nap
B. Provide a high-protein, high-calorie snack
C. Provide the client with a quiet, low-stimulation environment
D. Ask the client to sit down and talk about their feelings
Correct Answer: C
