NCLEX-RN Exam Preparation – Comprehensive Nursing Review & Practice
Questions (2025_2026)
SECTION I: SAFE AND EFFECTIVE CARE ENVIRONMENT (47
Questions)
Management of Care (26 Questions - 17%)
Question 1
A 72-year-old client with a history of chronic obstructive pulmonary disease (COPD) is
admitted with pneumonia. The client is dyspneic, using accessory muscles, and states,
"I can't catch my breath." The nurse receives new orders including: oxygen at 2 L/min via
nasal cannula, IV antibiotics, and a STAT chest x-ray. What is the nurse's first priority
action?
A. Obtain the STAT chest x-ray
B. Administer the IV antibiotics
C. Apply oxygen at 2 L/min via nasal cannula
D. Complete the full physical assessment
Correct Answer: C
Explanation: The nurse's first priority is to apply oxygen at 2 L/min via nasal cannula.
This client presents with acute respiratory distress, evidenced by dyspnea and use of
accessory muscles. Following the ABCs (Airway, Breathing, Circulation) priority
framework, addressing the compromised breathing status takes precedence over all
other interventions. The oxygen therapy directly treats the hypoxemia that is likely
,present. Option A (obtaining chest x-ray) is important for diagnosis but does not
address the immediate life-threatening respiratory compromise. Option B (administering
antibiotics) treats the underlying infection but will not provide immediate relief of
respiratory distress. Option D (completing full physical assessment) should be done but
not at the expense of addressing the immediate airway/breathing concern; a focused
respiratory assessment can occur while implementing oxygen therapy.
Question 2
The nurse is caring for four clients on a medical-surgical unit. Which client should the
nurse assess first?
A. A 45-year-old client with appendicitis who rates pain 6/10 and is scheduled for
surgery in 2 hours
B. A 68-year-old client with heart failure who has new-onset confusion and restlessness
C. A 32-year-old client with gastroenteritis who reports three episodes of diarrhea in the
past hour
D. A 55-year-old client with diabetes who is due for a routine blood glucose check before
lunch
Correct Answer: B
Explanation: The nurse should assess the 68-year-old client with heart failure who has
new-onset confusion and restlessness first. New confusion in a client with heart failure
is a red flag for cerebral hypoxia due to inadequate cardiac output or impending
pulmonary edema, representing a potential life-threatening deterioration. This requires
immediate assessment using the ABCs framework. Option A (appendicitis client) has
stable pain before scheduled surgery. Option C (gastroenteritis client) has expected
,symptoms that, while uncomfortable, are not immediately life-threatening. Option D
(diabetes client) needs routine monitoring but is not urgent. The change in mental
status always takes priority over stable or expected conditions.
Question 3
A registered nurse (RN) is working with a licensed practical nurse (LPN) and a certified
nursing assistant (CNA) on a busy medical-surgical unit. Which task is most appropriate
for the RN to delegate to the LPN?
A. Administering a blood transfusion to a client with anemia
B. Performing sterile dressing changes on a postoperative wound
C. Developing the plan of care for a newly admitted client
D. Assessing a client with chest pain who just returned from cardiac catheterization
Correct Answer: B
Explanation: Performing sterile dressing changes on a postoperative wound is the most
appropriate task to delegate to the LPN. According to delegation principles, LPNs can
perform sterile procedures, administer medications (except IV push in most states), and
provide direct care for stable clients with predictable outcomes. Option A (administering
blood transfusion) typically requires RN level due to the need for assessment during
transfusion and management of potential reactions. Option C (developing the plan of
care) is an RN responsibility involving clinical judgment and critical thinking that cannot
be delegated. Option D (assessing a client with chest pain post-catheterization) requires
RN-level assessment skills due to the risk of complications including bleeding,
hematoma, or vessel occlusion.
, Question 4
A client with terminal cancer tells the nurse, "I've decided to stop chemotherapy. I want
to focus on quality of life rather than quantity." The client's family insists the nurse
convince the client to continue treatment. What is the nurse's most appropriate
response?
A. "I'll talk to your doctor about other treatment options that might be less aggressive"
B. "Your family wants what's best for you. Have you considered their feelings?"
C. "You have the right to make decisions about your own care. Let's discuss what quality
of life means to you"
D. "Stopping treatment now would mean giving up. There are still options we haven't
tried"
Correct Answer: C
Explanation: The nurse's response must prioritize client autonomy, a fundamental
ethical principle in nursing. Stating "You have the right to make decisions about your
own care" affirms the client's right to self-determination, while offering to discuss quality
of life opens therapeutic communication about the client's values and goals. Option A
undermines the client's decision by suggesting alternative treatments when the client
has clearly stated their wishes. Option B creates guilt and places family wishes above
client autonomy. Option D is paternalistic, dismisses the client's informed decision, and
imposes the nurse's values. The nurse's role is to advocate for the client's expressed
wishes while ensuring the decision is informed.
Question 5
Questions (2025_2026)
SECTION I: SAFE AND EFFECTIVE CARE ENVIRONMENT (47
Questions)
Management of Care (26 Questions - 17%)
Question 1
A 72-year-old client with a history of chronic obstructive pulmonary disease (COPD) is
admitted with pneumonia. The client is dyspneic, using accessory muscles, and states,
"I can't catch my breath." The nurse receives new orders including: oxygen at 2 L/min via
nasal cannula, IV antibiotics, and a STAT chest x-ray. What is the nurse's first priority
action?
A. Obtain the STAT chest x-ray
B. Administer the IV antibiotics
C. Apply oxygen at 2 L/min via nasal cannula
D. Complete the full physical assessment
Correct Answer: C
Explanation: The nurse's first priority is to apply oxygen at 2 L/min via nasal cannula.
This client presents with acute respiratory distress, evidenced by dyspnea and use of
accessory muscles. Following the ABCs (Airway, Breathing, Circulation) priority
framework, addressing the compromised breathing status takes precedence over all
other interventions. The oxygen therapy directly treats the hypoxemia that is likely
,present. Option A (obtaining chest x-ray) is important for diagnosis but does not
address the immediate life-threatening respiratory compromise. Option B (administering
antibiotics) treats the underlying infection but will not provide immediate relief of
respiratory distress. Option D (completing full physical assessment) should be done but
not at the expense of addressing the immediate airway/breathing concern; a focused
respiratory assessment can occur while implementing oxygen therapy.
Question 2
The nurse is caring for four clients on a medical-surgical unit. Which client should the
nurse assess first?
A. A 45-year-old client with appendicitis who rates pain 6/10 and is scheduled for
surgery in 2 hours
B. A 68-year-old client with heart failure who has new-onset confusion and restlessness
C. A 32-year-old client with gastroenteritis who reports three episodes of diarrhea in the
past hour
D. A 55-year-old client with diabetes who is due for a routine blood glucose check before
lunch
Correct Answer: B
Explanation: The nurse should assess the 68-year-old client with heart failure who has
new-onset confusion and restlessness first. New confusion in a client with heart failure
is a red flag for cerebral hypoxia due to inadequate cardiac output or impending
pulmonary edema, representing a potential life-threatening deterioration. This requires
immediate assessment using the ABCs framework. Option A (appendicitis client) has
stable pain before scheduled surgery. Option C (gastroenteritis client) has expected
,symptoms that, while uncomfortable, are not immediately life-threatening. Option D
(diabetes client) needs routine monitoring but is not urgent. The change in mental
status always takes priority over stable or expected conditions.
Question 3
A registered nurse (RN) is working with a licensed practical nurse (LPN) and a certified
nursing assistant (CNA) on a busy medical-surgical unit. Which task is most appropriate
for the RN to delegate to the LPN?
A. Administering a blood transfusion to a client with anemia
B. Performing sterile dressing changes on a postoperative wound
C. Developing the plan of care for a newly admitted client
D. Assessing a client with chest pain who just returned from cardiac catheterization
Correct Answer: B
Explanation: Performing sterile dressing changes on a postoperative wound is the most
appropriate task to delegate to the LPN. According to delegation principles, LPNs can
perform sterile procedures, administer medications (except IV push in most states), and
provide direct care for stable clients with predictable outcomes. Option A (administering
blood transfusion) typically requires RN level due to the need for assessment during
transfusion and management of potential reactions. Option C (developing the plan of
care) is an RN responsibility involving clinical judgment and critical thinking that cannot
be delegated. Option D (assessing a client with chest pain post-catheterization) requires
RN-level assessment skills due to the risk of complications including bleeding,
hematoma, or vessel occlusion.
, Question 4
A client with terminal cancer tells the nurse, "I've decided to stop chemotherapy. I want
to focus on quality of life rather than quantity." The client's family insists the nurse
convince the client to continue treatment. What is the nurse's most appropriate
response?
A. "I'll talk to your doctor about other treatment options that might be less aggressive"
B. "Your family wants what's best for you. Have you considered their feelings?"
C. "You have the right to make decisions about your own care. Let's discuss what quality
of life means to you"
D. "Stopping treatment now would mean giving up. There are still options we haven't
tried"
Correct Answer: C
Explanation: The nurse's response must prioritize client autonomy, a fundamental
ethical principle in nursing. Stating "You have the right to make decisions about your
own care" affirms the client's right to self-determination, while offering to discuss quality
of life opens therapeutic communication about the client's values and goals. Option A
undermines the client's decision by suggesting alternative treatments when the client
has clearly stated their wishes. Option B creates guilt and places family wishes above
client autonomy. Option D is paternalistic, dismisses the client's informed decision, and
imposes the nurse's values. The nurse's role is to advocate for the client's expressed
wishes while ensuring the decision is informed.
Question 5
