[NCLEX-RN PRACTICE EXAM 1] – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
• Management of Care
• Safety and Infection Control
• Health Promotion and Maintenance
• Psychosocial Integrity
• Basic Care and Comfort
• Pharmacological and Parenteral Therapies
• Reduction of Risk Potential
• Physiological Adaptation
INTRODUCTION
The purpose of this practice exam is to provide a comprehensive evaluation of the clinical judgment and nursing knowledge required for entry-level licensure. This assessment focuses
on the application of essential nursing principles across diverse patient populations and healthcare settings. The exam utilizes multiple-choice and scenario-based questions to mirror
the complexity of the actual licensing environment. Candidates are assessed on their ability to integrate theoretical foundations with practical decision-making and ethical standards.
There is a strong emphasis on real-world application, prioritizing patient safety, and demonstrating the critical thinking skills necessary for effective and safe nursing practice.
1. A nurse is caring for a client with a suspected deep vein thrombosis (DVT). Which of the following provider orders should the nurse clarify?
A. Elevate the affected extremity above the heart level.
B. Apply sequential compression devices (SCDs) to both legs.
C. Administer subcutaneous enoxaparin as prescribed.
D. Maintain the client on bed rest with bathroom privileges.
🟢 B. Apply sequential compression devices (SCDs) to both legs.
🔴 RATIONALE: SCDs are used for prophylaxis to prevent DVT. If a DVT is already suspected or confirmed, using SCDs is contraindicated as the mechanical squeezing could
dislodge the clot and cause a pulmonary embolism.
2. A client is admitted with a diagnosis of pheochromocytoma. Which vital sign should the nurse prioritize for frequent monitoring?
A. Temperature
B. Oxygen saturation
C. Blood pressure
D. Heart rate
🟢 C. Blood pressure
,🔴 RATIONALE: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla, which leads to severe, episodic hypertension. Monitoring for hypertensive crisis
is the priority intervention.
3. Which of the following actions by a newly licensed nurse indicates a need for further instruction regarding sterile technique?
A. Opening the top flap of a sterile kit away from the body.
B. Keeping sterile gloved hands above the waist level at all times.
C. Reaching over the sterile field to pick up a discarded gauze pad.
D. Maintaining a 1-inch border around the edge of the sterile field.
🟢 C. Reaching over the sterile field to pick up a discarded gauze pad.
🔴 RATIONALE: Reaching over a sterile field contaminates it because microorganisms can fall from the nurse's sleeves or arms onto the sterile surface.
4. A nurse is preparing to administer digoxin to a client with heart failure. Which laboratory value should the nurse check before administration?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum glucose
🟢 B. Serum potassium
🔴 RATIONALE: Hypokalemia increases the risk of digoxin toxicity. The nurse must ensure potassium levels are within the normal range before administering the medication.
5. A client who is 24 hours postoperative following an abdominal hysterectomy complains of severe abdominal pain and bloating. Which action should the nurse take first?
A. Administer the PRN morphine sulfate.
B. Auscultate for bowel sounds in all four quadrants.
C. Encourage the client to ambulate in the hallway.
D. Provide a warm heating pad for the abdomen.
🟢 B. Auscultate for bowel sounds in all four quadrants.
🔴 RATIONALE: The nurse should first assess for the presence of bowel sounds to rule out a paralytic ileus, which is a common complication after abdominal surgery, before
implementing interventions.
6. Which task is most appropriate for the RN to delegate to an unlicensed assistive personnel (UAP)?
A. Assisting a stable client with their first walk after surgery.
B. Changing a sterile dressing on a central venous line.
C. Feeding a client who was recently diagnosed with dysphagia.
D. Checking the blood pressure of a client receiving a blood transfusion.
, 🟢 A. Assisting a stable client with their first walk after surgery.
🔴 RATIONALE: UAPs can assist stable clients with activities of daily living and ambulation. Sterile dressing changes, feeding clients at risk for aspiration, and monitoring during
blood transfusions require nursing judgment.
7. A client with type 1 diabetes mellitus presents with a blood glucose of 600 mg/dL and fruity-smelling breath. Which acid-base imbalance does the nurse anticipate?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
🟢 D. Metabolic acidosis
🔴 RATIONALE: These findings are classic for Diabetic Ketoacidosis (DKA). In DKA, the breakdown of fats for energy produces ketones, which are acidic, leading to metabolic
acidosis.
8. A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which statement by the client indicates understanding?
A. "I will increase my intake of spinach and kale to stay healthy."
B. "I should use a soft-bristled toothbrush for oral care."
C. "I can take aspirin if I develop a headache."
D. "I will stop taking the medication if I see a small bruise."
🟢 B. "I should use a soft-bristled toothbrush for oral care."
🔴 RATIONALE: Warfarin is an anticoagulant that increases the risk of bleeding. Using a soft-bristled toothbrush helps prevent gingival bleeding.
9. An older adult client is brought to the emergency department with confusion and a high fever. The nurse suspects urosepsis. Which diagnostic test should be prioritized?
A. Chest X-ray
B. Urinalysis and culture
C. Electrocardiogram (ECG)
D. Serum electrolytes
🟢 B. Urinalysis and culture
🔴 RATIONALE: In older adults, urinary tract infections often present with confusion (delirium). A urinalysis and culture are essential to confirm the source of infection in
suspected urosepsis.
10. A nurse is caring for a client in the manic phase of bipolar disorder. Which meal choice is most appropriate?
CORE DOMAINS
• Management of Care
• Safety and Infection Control
• Health Promotion and Maintenance
• Psychosocial Integrity
• Basic Care and Comfort
• Pharmacological and Parenteral Therapies
• Reduction of Risk Potential
• Physiological Adaptation
INTRODUCTION
The purpose of this practice exam is to provide a comprehensive evaluation of the clinical judgment and nursing knowledge required for entry-level licensure. This assessment focuses
on the application of essential nursing principles across diverse patient populations and healthcare settings. The exam utilizes multiple-choice and scenario-based questions to mirror
the complexity of the actual licensing environment. Candidates are assessed on their ability to integrate theoretical foundations with practical decision-making and ethical standards.
There is a strong emphasis on real-world application, prioritizing patient safety, and demonstrating the critical thinking skills necessary for effective and safe nursing practice.
1. A nurse is caring for a client with a suspected deep vein thrombosis (DVT). Which of the following provider orders should the nurse clarify?
A. Elevate the affected extremity above the heart level.
B. Apply sequential compression devices (SCDs) to both legs.
C. Administer subcutaneous enoxaparin as prescribed.
D. Maintain the client on bed rest with bathroom privileges.
🟢 B. Apply sequential compression devices (SCDs) to both legs.
🔴 RATIONALE: SCDs are used for prophylaxis to prevent DVT. If a DVT is already suspected or confirmed, using SCDs is contraindicated as the mechanical squeezing could
dislodge the clot and cause a pulmonary embolism.
2. A client is admitted with a diagnosis of pheochromocytoma. Which vital sign should the nurse prioritize for frequent monitoring?
A. Temperature
B. Oxygen saturation
C. Blood pressure
D. Heart rate
🟢 C. Blood pressure
,🔴 RATIONALE: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla, which leads to severe, episodic hypertension. Monitoring for hypertensive crisis
is the priority intervention.
3. Which of the following actions by a newly licensed nurse indicates a need for further instruction regarding sterile technique?
A. Opening the top flap of a sterile kit away from the body.
B. Keeping sterile gloved hands above the waist level at all times.
C. Reaching over the sterile field to pick up a discarded gauze pad.
D. Maintaining a 1-inch border around the edge of the sterile field.
🟢 C. Reaching over the sterile field to pick up a discarded gauze pad.
🔴 RATIONALE: Reaching over a sterile field contaminates it because microorganisms can fall from the nurse's sleeves or arms onto the sterile surface.
4. A nurse is preparing to administer digoxin to a client with heart failure. Which laboratory value should the nurse check before administration?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum glucose
🟢 B. Serum potassium
🔴 RATIONALE: Hypokalemia increases the risk of digoxin toxicity. The nurse must ensure potassium levels are within the normal range before administering the medication.
5. A client who is 24 hours postoperative following an abdominal hysterectomy complains of severe abdominal pain and bloating. Which action should the nurse take first?
A. Administer the PRN morphine sulfate.
B. Auscultate for bowel sounds in all four quadrants.
C. Encourage the client to ambulate in the hallway.
D. Provide a warm heating pad for the abdomen.
🟢 B. Auscultate for bowel sounds in all four quadrants.
🔴 RATIONALE: The nurse should first assess for the presence of bowel sounds to rule out a paralytic ileus, which is a common complication after abdominal surgery, before
implementing interventions.
6. Which task is most appropriate for the RN to delegate to an unlicensed assistive personnel (UAP)?
A. Assisting a stable client with their first walk after surgery.
B. Changing a sterile dressing on a central venous line.
C. Feeding a client who was recently diagnosed with dysphagia.
D. Checking the blood pressure of a client receiving a blood transfusion.
, 🟢 A. Assisting a stable client with their first walk after surgery.
🔴 RATIONALE: UAPs can assist stable clients with activities of daily living and ambulation. Sterile dressing changes, feeding clients at risk for aspiration, and monitoring during
blood transfusions require nursing judgment.
7. A client with type 1 diabetes mellitus presents with a blood glucose of 600 mg/dL and fruity-smelling breath. Which acid-base imbalance does the nurse anticipate?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
🟢 D. Metabolic acidosis
🔴 RATIONALE: These findings are classic for Diabetic Ketoacidosis (DKA). In DKA, the breakdown of fats for energy produces ketones, which are acidic, leading to metabolic
acidosis.
8. A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which statement by the client indicates understanding?
A. "I will increase my intake of spinach and kale to stay healthy."
B. "I should use a soft-bristled toothbrush for oral care."
C. "I can take aspirin if I develop a headache."
D. "I will stop taking the medication if I see a small bruise."
🟢 B. "I should use a soft-bristled toothbrush for oral care."
🔴 RATIONALE: Warfarin is an anticoagulant that increases the risk of bleeding. Using a soft-bristled toothbrush helps prevent gingival bleeding.
9. An older adult client is brought to the emergency department with confusion and a high fever. The nurse suspects urosepsis. Which diagnostic test should be prioritized?
A. Chest X-ray
B. Urinalysis and culture
C. Electrocardiogram (ECG)
D. Serum electrolytes
🟢 B. Urinalysis and culture
🔴 RATIONALE: In older adults, urinary tract infections often present with confusion (delirium). A urinalysis and culture are essential to confirm the source of infection in
suspected urosepsis.
10. A nurse is caring for a client in the manic phase of bipolar disorder. Which meal choice is most appropriate?
