1
NCLEX-RN 2026 Actual Exam with
Correct Questions and Answers | 100%
Accurate Grade A+ NGN NCLEX RN Test
This 200-question practice exam is designed to simulate the content, format, and cognitive
complexity of the actual 2026 NCLEX-RN. It includes traditional multiple-choice questions as
well as NGN-style unfolding case studies and item types such as Matrix Multiple Response,
Bowtie, and Cloze.
Domain 1: Safe and Effective Care Environment (Questions 1–35)
This domain covers the largest portion of the exam and focuses on management of care, safety,
and infection control.
1. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of
the following tasks is appropriate for the nurse to delegate?
A. Assessing a newly admitted client's pain level.
B. Teaching a client how to use an incentive spirometer.
C. Ambulating a stable client who had a stroke 3 days ago.
D. Evaluating a client's response to a diuretic medication.
Answer: C
Rationale: Delegation requires the nurse to assign tasks that are routine, have a predictable
outcome, and do not require nursing judgment. Ambulating a stable client is a standard task
that can be delegated to an AP. Assessment (A), teaching (B), and evaluation (D) are core
components of the nursing process that require the clinical judgment and knowledge of a
licensed nurse and cannot be delegated.
2. A nurse is caring for a client who has a chest tube following a thoracotomy. The
nurse notes continuous bubbling in the water seal chamber. What is the priority
nursing action?
A. Clamp the chest tube near the insertion site.
B. Notify the healthcare provider.
C. Assess the chest tube system for an air leak.
D. Increase the wall suction to -40 cm H₂O.
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak somewhere in
the system. The nurse's first action should be to systematically assess for the source of the leak
by checking all connections and the insertion site dressing. Clamping a chest tube is a dangerous
,2
action that can cause a tension pneumothorax. Notifying the provider is important but comes
after assessment.
3. A nurse is caring for a client who is on airborne precautions for active
pulmonary tuberculosis. The client needs to be transported to the radiology
department for a chest x-ray. Which of the following actions should the nurse
take?
A. Have the client wear a surgical mask during transport.
B. Notify the radiology department that the client is coming.
C. Place a surgical mask on the client during transport.
D. Ensure the transporter wears an N95 respirator.
Answer: C
Rationale: When a client on airborne precautions must leave their negative-pressure room, the
client should wear a surgical mask to contain infectious droplet nuclei and prevent transmission
to others. The radiology department should be notified, but the direct action to prevent
transmission during transport is masking the client. The transporter does not need an N95
respirator during transport unless they are within the client's room.
4. A nurse is preparing to administer medications to a client. The client states,
"I've never seen that yellow pill before." What is the nurse's priority action?
A. Reassure the client that the medication is correct.
B. Verify the medication order against the Medication Administration Record (MAR).
C. Explain the purpose of the medication to the client.
D. Document the client's statement and administer the medication.
Answer: B
Rationale: A client's statement that a medication is unfamiliar is a critical safety cue. The
nurse's immediate priority is to stop and verify the "Six Rights" of medication administration,
specifically the right medication. This involves checking the original order against the MAR and
the medication label. Never administer a medication if the client questions it without first
verifying its accuracy.
5. A nurse on a medical-surgical unit is receiving a handoff report on four clients.
Which client should the nurse assess first?
A. A client with pneumonia who has an oxygen saturation of 94% on room air.
B. A client with a new diagnosis of diabetes mellitus who has a blood glucose of 220 mg/dL.
C. A client with a chest tube who reports a sudden onset of severe pain at the insertion site.
D. A client who is postoperative day 2 and has not had a bowel movement.
Answer: C
,3
Rationale: Using the ABC (Airway, Breathing, Circulation) and urgent vs. non-urgent
frameworks, the client with a chest tube and new, severe pain is the priority. This could indicate
a complication such as tube dislodgement, a developing pneumothorax, or infection, all of which
can rapidly compromise breathing. The other findings require assessment and intervention but
are less acute.
6. A nurse is providing discharge teaching to a client who has a new colostomy.
Which of the following statements by the client indicates a need for further
teaching?
A. "I will avoid foods that cause gas, like cabbage and onions."
B. "I should change my pouching system when it is about one-third full."
C. "I need to irrigate my colostomy every day at the same time."
D. "I can use an ostomy deodorant in the pouch if I am concerned about odor."
Answer: C
Rationale: Colostomy irrigation is not a routine requirement for all clients. It is an optional
method of bowel management primarily used for descending or sigmoid colostomies. Many
clients manage their colostomy without irrigation. The other statements reflect correct
understanding of colostomy care.
7. A nurse is documenting in a client's medical record. Which of the following
entries is most appropriate?
A. "Client seems to be in a lot of pain today."
B. "Client is angry with their family."
C. "Incision site is red, warm to the touch, and has purulent drainage."
D. "Client's husband is being difficult and won't help with care."
Answer: C
Rationale: Documentation must be objective, factual, and specific. "Red, warm to the touch,
and has purulent drainage" are objective and measurable assessments. The other options
contain subjective language ("seems to be"), judgments ("angry"), or labeling ("being difficult"),
which are not appropriate in a legal medical record.
8. A nurse is planning care for a client who has a new diagnosis of
thrombocytopenia with a platelet count of 30,000/mm³. Which of the following
interventions should the nurse include in the plan of care?
A. Encourage the client to floss their teeth daily.
B. Insert a rectal suppository for constipation.
C. Instruct the client to use an electric razor for shaving.
D. Administer intramuscular (IM) injections for pain management.
Answer: C
, 4
Rationale: A platelet count of 30,000/mm³ indicates severe thrombocytopenia and a high risk
for bleeding. Nursing care focuses on preventing injury. An electric razor prevents skin nicks.
Flossing, rectal suppositories, and IM injections are invasive procedures that can cause bleeding
and should be avoided.
9. A charge nurse is making assignments for the upcoming shift. Which client
should be assigned to the most experienced nurse?
A. A client who is 24 hours postoperative following an appendectomy.
B. A client who has a new diagnosis of hypertension.
C. A client who is receiving chemotherapy for the first time.
D. A client who has stable angina and is awaiting discharge.
Answer: C
Rationale: A client receiving chemotherapy for the first time requires extensive teaching, close
monitoring for hypersensitivity reactions, and potential management of life-threatening adverse
effects. This complex care requires a nurse with experience and strong clinical judgment. The
other clients have more predictable, lower-acuity needs.
10. A nurse is preparing to perform hand hygiene. Which of the following actions
demonstrates proper technique for using an alcohol-based hand rub?
A. Apply a dime-sized amount of product to the palm of one hand.
B. Rub the product over all surfaces of the hands and fingers until dry.
C. Rinse hands with water after applying the product.
D. Dry hands with a paper towel after applying the product.
Answer: B
Rationale: The proper technique for alcohol-based hand rub is to apply the recommended
amount to the palm and then rub the product over all surfaces of the hands and fingers until
they are completely dry. The friction and drying time are what kill microorganisms. Do not rinse
with water or towel dry unless hands are visibly soiled, in which case soap and water should be
used.
11. A nurse is caring for a client who has Clostridium difficile (C. diff) infection.
Which of the following actions should the nurse take?
A. Use an alcohol-based hand sanitizer after removing gloves.
B. Place the client in a private room with negative-pressure airflow.
C. Wear a surgical mask when entering the client's room.
D. Use soap and water for hand hygiene after providing care.
Answer: D
Rationale: C. diff is a spore-forming bacterium. The spores are not killed by alcohol-based
hand sanitizers. Therefore, the nurse must use soap and water for hand hygiene after caring for
NCLEX-RN 2026 Actual Exam with
Correct Questions and Answers | 100%
Accurate Grade A+ NGN NCLEX RN Test
This 200-question practice exam is designed to simulate the content, format, and cognitive
complexity of the actual 2026 NCLEX-RN. It includes traditional multiple-choice questions as
well as NGN-style unfolding case studies and item types such as Matrix Multiple Response,
Bowtie, and Cloze.
Domain 1: Safe and Effective Care Environment (Questions 1–35)
This domain covers the largest portion of the exam and focuses on management of care, safety,
and infection control.
1. A nurse is preparing to delegate tasks to an assistive personnel (AP). Which of
the following tasks is appropriate for the nurse to delegate?
A. Assessing a newly admitted client's pain level.
B. Teaching a client how to use an incentive spirometer.
C. Ambulating a stable client who had a stroke 3 days ago.
D. Evaluating a client's response to a diuretic medication.
Answer: C
Rationale: Delegation requires the nurse to assign tasks that are routine, have a predictable
outcome, and do not require nursing judgment. Ambulating a stable client is a standard task
that can be delegated to an AP. Assessment (A), teaching (B), and evaluation (D) are core
components of the nursing process that require the clinical judgment and knowledge of a
licensed nurse and cannot be delegated.
2. A nurse is caring for a client who has a chest tube following a thoracotomy. The
nurse notes continuous bubbling in the water seal chamber. What is the priority
nursing action?
A. Clamp the chest tube near the insertion site.
B. Notify the healthcare provider.
C. Assess the chest tube system for an air leak.
D. Increase the wall suction to -40 cm H₂O.
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak somewhere in
the system. The nurse's first action should be to systematically assess for the source of the leak
by checking all connections and the insertion site dressing. Clamping a chest tube is a dangerous
,2
action that can cause a tension pneumothorax. Notifying the provider is important but comes
after assessment.
3. A nurse is caring for a client who is on airborne precautions for active
pulmonary tuberculosis. The client needs to be transported to the radiology
department for a chest x-ray. Which of the following actions should the nurse
take?
A. Have the client wear a surgical mask during transport.
B. Notify the radiology department that the client is coming.
C. Place a surgical mask on the client during transport.
D. Ensure the transporter wears an N95 respirator.
Answer: C
Rationale: When a client on airborne precautions must leave their negative-pressure room, the
client should wear a surgical mask to contain infectious droplet nuclei and prevent transmission
to others. The radiology department should be notified, but the direct action to prevent
transmission during transport is masking the client. The transporter does not need an N95
respirator during transport unless they are within the client's room.
4. A nurse is preparing to administer medications to a client. The client states,
"I've never seen that yellow pill before." What is the nurse's priority action?
A. Reassure the client that the medication is correct.
B. Verify the medication order against the Medication Administration Record (MAR).
C. Explain the purpose of the medication to the client.
D. Document the client's statement and administer the medication.
Answer: B
Rationale: A client's statement that a medication is unfamiliar is a critical safety cue. The
nurse's immediate priority is to stop and verify the "Six Rights" of medication administration,
specifically the right medication. This involves checking the original order against the MAR and
the medication label. Never administer a medication if the client questions it without first
verifying its accuracy.
5. A nurse on a medical-surgical unit is receiving a handoff report on four clients.
Which client should the nurse assess first?
A. A client with pneumonia who has an oxygen saturation of 94% on room air.
B. A client with a new diagnosis of diabetes mellitus who has a blood glucose of 220 mg/dL.
C. A client with a chest tube who reports a sudden onset of severe pain at the insertion site.
D. A client who is postoperative day 2 and has not had a bowel movement.
Answer: C
,3
Rationale: Using the ABC (Airway, Breathing, Circulation) and urgent vs. non-urgent
frameworks, the client with a chest tube and new, severe pain is the priority. This could indicate
a complication such as tube dislodgement, a developing pneumothorax, or infection, all of which
can rapidly compromise breathing. The other findings require assessment and intervention but
are less acute.
6. A nurse is providing discharge teaching to a client who has a new colostomy.
Which of the following statements by the client indicates a need for further
teaching?
A. "I will avoid foods that cause gas, like cabbage and onions."
B. "I should change my pouching system when it is about one-third full."
C. "I need to irrigate my colostomy every day at the same time."
D. "I can use an ostomy deodorant in the pouch if I am concerned about odor."
Answer: C
Rationale: Colostomy irrigation is not a routine requirement for all clients. It is an optional
method of bowel management primarily used for descending or sigmoid colostomies. Many
clients manage their colostomy without irrigation. The other statements reflect correct
understanding of colostomy care.
7. A nurse is documenting in a client's medical record. Which of the following
entries is most appropriate?
A. "Client seems to be in a lot of pain today."
B. "Client is angry with their family."
C. "Incision site is red, warm to the touch, and has purulent drainage."
D. "Client's husband is being difficult and won't help with care."
Answer: C
Rationale: Documentation must be objective, factual, and specific. "Red, warm to the touch,
and has purulent drainage" are objective and measurable assessments. The other options
contain subjective language ("seems to be"), judgments ("angry"), or labeling ("being difficult"),
which are not appropriate in a legal medical record.
8. A nurse is planning care for a client who has a new diagnosis of
thrombocytopenia with a platelet count of 30,000/mm³. Which of the following
interventions should the nurse include in the plan of care?
A. Encourage the client to floss their teeth daily.
B. Insert a rectal suppository for constipation.
C. Instruct the client to use an electric razor for shaving.
D. Administer intramuscular (IM) injections for pain management.
Answer: C
, 4
Rationale: A platelet count of 30,000/mm³ indicates severe thrombocytopenia and a high risk
for bleeding. Nursing care focuses on preventing injury. An electric razor prevents skin nicks.
Flossing, rectal suppositories, and IM injections are invasive procedures that can cause bleeding
and should be avoided.
9. A charge nurse is making assignments for the upcoming shift. Which client
should be assigned to the most experienced nurse?
A. A client who is 24 hours postoperative following an appendectomy.
B. A client who has a new diagnosis of hypertension.
C. A client who is receiving chemotherapy for the first time.
D. A client who has stable angina and is awaiting discharge.
Answer: C
Rationale: A client receiving chemotherapy for the first time requires extensive teaching, close
monitoring for hypersensitivity reactions, and potential management of life-threatening adverse
effects. This complex care requires a nurse with experience and strong clinical judgment. The
other clients have more predictable, lower-acuity needs.
10. A nurse is preparing to perform hand hygiene. Which of the following actions
demonstrates proper technique for using an alcohol-based hand rub?
A. Apply a dime-sized amount of product to the palm of one hand.
B. Rub the product over all surfaces of the hands and fingers until dry.
C. Rinse hands with water after applying the product.
D. Dry hands with a paper towel after applying the product.
Answer: B
Rationale: The proper technique for alcohol-based hand rub is to apply the recommended
amount to the palm and then rub the product over all surfaces of the hands and fingers until
they are completely dry. The friction and drying time are what kill microorganisms. Do not rinse
with water or towel dry unless hands are visibly soiled, in which case soap and water should be
used.
11. A nurse is caring for a client who has Clostridium difficile (C. diff) infection.
Which of the following actions should the nurse take?
A. Use an alcohol-based hand sanitizer after removing gloves.
B. Place the client in a private room with negative-pressure airflow.
C. Wear a surgical mask when entering the client's room.
D. Use soap and water for hand hygiene after providing care.
Answer: D
Rationale: C. diff is a spore-forming bacterium. The spores are not killed by alcohol-based
hand sanitizers. Therefore, the nurse must use soap and water for hand hygiene after caring for
