NCLEX RN ACTUAL EX AM 2026
Registered Nursing Licensure Test Paper | Questions & Solutions
Next Generation NCLEX (NGN) Aligned | Clinical Judgment Measurement Model
Student Name: ________________________ Date: _______________ Score: _______ / 100
This NCLEX RN Actual Exam provides 100 multiple-choice questions covering all four Client Needs categories: Safe &
Effective Care Environment (Management of Care, Safety & Infection Control), Health Promotion & Maintenance,
Psychosocial Integrity, and Physiological Integrity (Basic Care & Comfort, Pharmacological & Parenteral Therapies,
Reduction of Risk Potential, Physiological Adaptation) with NGN-style clinical judgment questions aligned to the
CJMM framework.
Safe & Eff ective Car e En vir on m ent — Man agem ent of Car e
1. A charge nurse is making assignments for the upcoming shift. Which client should be assigned to the
licensed practical nurse (LPN)?
Answer: A. A client who is 2 days post-appendectomy with a stable abdominal incision
Rationale: The LPN can care for a stable postoperative client with predictable outcomes. Clients who require
complex assessments, new teaching, or continuous monitoring should be assigned to RNs, whose scope includes
comprehensive evaluation and education.
A) A client who is 2 days post-appendectomy with a stable abdominal incision
B) A client who is 1 day postoperative after a thoracotomy with a chest tube
C) A client newly diagnosed with type 2 diabetes mellitus who needs discharge teaching
D) A client admitted with acute respiratory failure requiring continuous arterial blood gas
monitoring
2. A nurse is caring for a client who is scheduled for an invasive cardiac procedure. The client states, "I do
not want this procedure done." What is the nurse's best action?
Answer: D. Document the client's refusal and notify the health care provider
Rationale: Every competent adult has the right to refuse treatment. The nurse must respect client autonomy,
document the refusal, and inform the health care provider so that alternative plans can be discussed.
A) Explain the benefits of the procedure and encourage the client to proceed
B) Ask the client's family to persuade the client to accept the procedure
C) Tell the client that the provider has already signed the consent form
D) Document the client's refusal and notify the health care provider
3. A nurse receives a telephone call from a person who identifies himself as a family member and asks
about a client's condition. What is the nurse's best response?
Answer: A. Verify the client's chart to confirm the caller is listed before sharing any information
Rationale: HIPAA requires verification of the caller's identity and confirmation that the person is authorized to
receive information before disclosing any protected health information. The nurse should check the chart for an
approved contact list.
A) Verify the client's chart to confirm the caller is listed before sharing any information
, B) Provide the information since the caller identified himself as family
C) Tell the caller that no information can be given over the phone under any circumstances
D) Transfer the call directly to the client's room so the client can decide what to share
4. A nurse is reviewing the medical record of a client who has a Do-Not-Resuscitate (DNR) order. The
client's family insists that "everything possible" be done if the client's heart stops. What is the nurse's
priority action?
Answer: D. Ask the health care provider to discuss the DNR order with the family
Rationale: The nurse should notify the health care provider so that clarification and discussion with the family can
occur. The DNR reflects the client's wishes; however, facilitating provider-family communication is the appropriate
priority nursing action.
A) Honor the family's request because they know what is best for the client
B) Follow the DNR order as documented in the client's record
C) Call the ethics committee to resolve the dispute before any emergency arises
D) Ask the health care provider to discuss the DNR order with the family
5. Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
Answer: A. Measuring and recording the intake and output for a client with heart failure
Rationale: Measuring and recording intake and output is a standardized, repetitive task within the UAP's scope of
practice. Assessment, teaching, and evaluation require registered nurse licensure and critical thinking.
A) Measuring and recording the intake and output for a client with heart failure
B) Assessing a postoperative client's wound for signs of infection
C) Teaching a client how to use an incentive spirometer
D) Evaluating the effectiveness of a new pain management regimen
6. A client is being discharged from the hospital after a total hip replacement. The case manager's
primary role in the discharge process is to:
Answer: A. Coordinate services and resources to ensure continuity of care after discharge
Rationale: The case manager coordinates care across settings, arranging resources such as home health services,
equipment, and follow-up appointments to promote safe continuity of care after hospitalization.
A) Coordinate services and resources to ensure continuity of care after discharge
B) Perform the client's final physical assessment before discharge
C) Prescribe the home physical therapy regimen for the client
D) Provide the client with all discharge medications from the pharmacy
7. A nurse is providing preoperative teaching to a client scheduled for a cholecystectomy. The client signs
the informed consent form. Which of the following is true about informed consent?
Answer: C. The client can sign the consent form and still withdraw consent at any time before the
procedure
Rationale: Informed consent is an ongoing process, and a competent client has the right to withdraw consent at any
time, even after signing the form. The surgeon or provider is responsible for obtaining informed consent.
, A) The nurse's signature on the form indicates the client understands the procedure
B) The informed consent should be obtained by the performing surgeon, not the nurse
C) The client can sign the consent form and still withdraw consent at any time before the
procedure
D) A family member can provide informed consent if the client is only mildly confused
8. Four clients arrive at the emergency department at the same time. The triage nurse should prioritize
which client first?
Answer: B. A client reporting chest pain rated 8/10 with diaphoresis and shortness of breath
Rationale: Chest pain with diaphoresis and dyspnea suggests a potentially life-threatening condition such as acute
myocardial infarction. Using the emergency severity index, this client requires the highest priority for immediate
assessment and intervention.
A) A client with a 3-inch laceration to the forearm from a kitchen knife
B) A client reporting chest pain rated 8/10 with diaphoresis and shortness of breath
C) A client with a temperature of 101.2°F (38.4°C) and a productive cough for 3 days
D) A client with a sprained ankle sustained during a basketball game 2 hours ago
9. A nurse discovers that a colleague has been diverting narcotic medications from the medication
dispensing system. What is the nurse's most appropriate action?
Answer: B. Report the suspicion to the charge nurse and follow the chain of command
Rationale: The nurse has a legal and ethical obligation to report suspected diversion through the proper channels.
Reporting to the charge nurse and following the chain of command protects client safety and fulfills professional
responsibility.
A) Confront the colleague directly and ask them to stop
B) Report the suspicion to the charge nurse and follow the chain of command
C) Ignore the situation because it is not the nurse's responsibility
D) Document the incident in the colleague's personnel file
10. A nurse is caring for several clients on a medical-surgical unit. Which client should the nurse assess
first after receiving the shift report?
Answer: C. A client with heart failure who reports new-onset dyspnea at rest
Rationale: New-onset dyspnea at rest in a client with heart failure may indicate worsening fluid overload or
pulmonary edema, requiring immediate assessment. This is the most unstable and potentially life-threatening
finding.
A) A client who is scheduled for a computed tomography (CT) scan at 1000
B) A client who was admitted 2 days ago with pneumonia and has a temperature of 100.4°F (38°C)
C) A client with heart failure who reports new-onset dyspnea at rest
D) A client who is requesting pain medication for chronic knee pain rated 4/10
11. A client with a terminal illness tells the nurse, "I am tired of suffering. I want to discuss ending my
life." What is the nurse's best response?
Answer: A. Listen therapeutically, explore the client's concerns, and notify the health care provider
Registered Nursing Licensure Test Paper | Questions & Solutions
Next Generation NCLEX (NGN) Aligned | Clinical Judgment Measurement Model
Student Name: ________________________ Date: _______________ Score: _______ / 100
This NCLEX RN Actual Exam provides 100 multiple-choice questions covering all four Client Needs categories: Safe &
Effective Care Environment (Management of Care, Safety & Infection Control), Health Promotion & Maintenance,
Psychosocial Integrity, and Physiological Integrity (Basic Care & Comfort, Pharmacological & Parenteral Therapies,
Reduction of Risk Potential, Physiological Adaptation) with NGN-style clinical judgment questions aligned to the
CJMM framework.
Safe & Eff ective Car e En vir on m ent — Man agem ent of Car e
1. A charge nurse is making assignments for the upcoming shift. Which client should be assigned to the
licensed practical nurse (LPN)?
Answer: A. A client who is 2 days post-appendectomy with a stable abdominal incision
Rationale: The LPN can care for a stable postoperative client with predictable outcomes. Clients who require
complex assessments, new teaching, or continuous monitoring should be assigned to RNs, whose scope includes
comprehensive evaluation and education.
A) A client who is 2 days post-appendectomy with a stable abdominal incision
B) A client who is 1 day postoperative after a thoracotomy with a chest tube
C) A client newly diagnosed with type 2 diabetes mellitus who needs discharge teaching
D) A client admitted with acute respiratory failure requiring continuous arterial blood gas
monitoring
2. A nurse is caring for a client who is scheduled for an invasive cardiac procedure. The client states, "I do
not want this procedure done." What is the nurse's best action?
Answer: D. Document the client's refusal and notify the health care provider
Rationale: Every competent adult has the right to refuse treatment. The nurse must respect client autonomy,
document the refusal, and inform the health care provider so that alternative plans can be discussed.
A) Explain the benefits of the procedure and encourage the client to proceed
B) Ask the client's family to persuade the client to accept the procedure
C) Tell the client that the provider has already signed the consent form
D) Document the client's refusal and notify the health care provider
3. A nurse receives a telephone call from a person who identifies himself as a family member and asks
about a client's condition. What is the nurse's best response?
Answer: A. Verify the client's chart to confirm the caller is listed before sharing any information
Rationale: HIPAA requires verification of the caller's identity and confirmation that the person is authorized to
receive information before disclosing any protected health information. The nurse should check the chart for an
approved contact list.
A) Verify the client's chart to confirm the caller is listed before sharing any information
, B) Provide the information since the caller identified himself as family
C) Tell the caller that no information can be given over the phone under any circumstances
D) Transfer the call directly to the client's room so the client can decide what to share
4. A nurse is reviewing the medical record of a client who has a Do-Not-Resuscitate (DNR) order. The
client's family insists that "everything possible" be done if the client's heart stops. What is the nurse's
priority action?
Answer: D. Ask the health care provider to discuss the DNR order with the family
Rationale: The nurse should notify the health care provider so that clarification and discussion with the family can
occur. The DNR reflects the client's wishes; however, facilitating provider-family communication is the appropriate
priority nursing action.
A) Honor the family's request because they know what is best for the client
B) Follow the DNR order as documented in the client's record
C) Call the ethics committee to resolve the dispute before any emergency arises
D) Ask the health care provider to discuss the DNR order with the family
5. Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
Answer: A. Measuring and recording the intake and output for a client with heart failure
Rationale: Measuring and recording intake and output is a standardized, repetitive task within the UAP's scope of
practice. Assessment, teaching, and evaluation require registered nurse licensure and critical thinking.
A) Measuring and recording the intake and output for a client with heart failure
B) Assessing a postoperative client's wound for signs of infection
C) Teaching a client how to use an incentive spirometer
D) Evaluating the effectiveness of a new pain management regimen
6. A client is being discharged from the hospital after a total hip replacement. The case manager's
primary role in the discharge process is to:
Answer: A. Coordinate services and resources to ensure continuity of care after discharge
Rationale: The case manager coordinates care across settings, arranging resources such as home health services,
equipment, and follow-up appointments to promote safe continuity of care after hospitalization.
A) Coordinate services and resources to ensure continuity of care after discharge
B) Perform the client's final physical assessment before discharge
C) Prescribe the home physical therapy regimen for the client
D) Provide the client with all discharge medications from the pharmacy
7. A nurse is providing preoperative teaching to a client scheduled for a cholecystectomy. The client signs
the informed consent form. Which of the following is true about informed consent?
Answer: C. The client can sign the consent form and still withdraw consent at any time before the
procedure
Rationale: Informed consent is an ongoing process, and a competent client has the right to withdraw consent at any
time, even after signing the form. The surgeon or provider is responsible for obtaining informed consent.
, A) The nurse's signature on the form indicates the client understands the procedure
B) The informed consent should be obtained by the performing surgeon, not the nurse
C) The client can sign the consent form and still withdraw consent at any time before the
procedure
D) A family member can provide informed consent if the client is only mildly confused
8. Four clients arrive at the emergency department at the same time. The triage nurse should prioritize
which client first?
Answer: B. A client reporting chest pain rated 8/10 with diaphoresis and shortness of breath
Rationale: Chest pain with diaphoresis and dyspnea suggests a potentially life-threatening condition such as acute
myocardial infarction. Using the emergency severity index, this client requires the highest priority for immediate
assessment and intervention.
A) A client with a 3-inch laceration to the forearm from a kitchen knife
B) A client reporting chest pain rated 8/10 with diaphoresis and shortness of breath
C) A client with a temperature of 101.2°F (38.4°C) and a productive cough for 3 days
D) A client with a sprained ankle sustained during a basketball game 2 hours ago
9. A nurse discovers that a colleague has been diverting narcotic medications from the medication
dispensing system. What is the nurse's most appropriate action?
Answer: B. Report the suspicion to the charge nurse and follow the chain of command
Rationale: The nurse has a legal and ethical obligation to report suspected diversion through the proper channels.
Reporting to the charge nurse and following the chain of command protects client safety and fulfills professional
responsibility.
A) Confront the colleague directly and ask them to stop
B) Report the suspicion to the charge nurse and follow the chain of command
C) Ignore the situation because it is not the nurse's responsibility
D) Document the incident in the colleague's personnel file
10. A nurse is caring for several clients on a medical-surgical unit. Which client should the nurse assess
first after receiving the shift report?
Answer: C. A client with heart failure who reports new-onset dyspnea at rest
Rationale: New-onset dyspnea at rest in a client with heart failure may indicate worsening fluid overload or
pulmonary edema, requiring immediate assessment. This is the most unstable and potentially life-threatening
finding.
A) A client who is scheduled for a computed tomography (CT) scan at 1000
B) A client who was admitted 2 days ago with pneumonia and has a temperature of 100.4°F (38°C)
C) A client with heart failure who reports new-onset dyspnea at rest
D) A client who is requesting pain medication for chronic knee pain rated 4/10
11. A client with a terminal illness tells the nurse, "I am tired of suffering. I want to discuss ending my
life." What is the nurse's best response?
Answer: A. Listen therapeutically, explore the client's concerns, and notify the health care provider
