NGN NCLEX-RN Comprehensive Review Exam
2026 Questions and 100% Correct
Answers 2025/26 Update
1. A nurse on a medical – surgical unit is caring for a client
who has just returned from the operating room after an open
cholecystectomy. The client states, “I’m in so much pain. Can’t
you give me something for the pain?” The nurse looks at the
medication administration record (MAR) and notes that the
prescription “hydromorphone 1 mg IV push every 2 h PRN
pain” was written 2 days ago. Which action should the nurse
take first?
A. Ask the client to rate the pain severity on a 0-to-10 scale.
B. Compare the MAR with the admission medication orders.
C. Call the health-care provider (HCP) to renew the prescription.
D. Administer the hydromorphone as listed on the MAR.
Answer: A
Rationale: Using the nursing process, assessment is always the
first step. The nurse must quantify the pain severity to determine
whether the existing order is appropriate. Comparing the MAR
with admission orders (B) might reveal discrepancies, but that
,does not address the client’s immediate pain. Calling the HCP to
renew a prescription (C) would be premature because the order
has not yet expired. Administering the medication (D) without first
assessing the pain is unsafe.
2. The nurse manager is planning a staff in-service about the
National Council of State Boards of Nursing (NCSBN) Clinical
Judgment Measurement Model (NCJMM). Which action best
reflects the step of “Analyze Cues”?
A. The nurse considers that the older adult client with confusion is
at risk for falls.
B. The nurse clusters assessment findings of hypotension,
tachycardia, and flat neck veins to identify deficient fluid volume.
C. The nurse decides to raise the head of the bed and apply
oxygen for a client who is short of breath.
D. The nurse teaches a client the proper technique for using a
metered-dose inhaler.
Answer: A
Rationale: “Analyze Cues” involves distinguishing relevant from
irrelevant data and determining whether the cues suggest a
concern. Recognizing that confusion in an older adult increases
fall risk is an example of analyzing cues. Clustering findings to
identify a problem (B) is “Analyze Cues” and “Prioritize
Hypotheses.” Raising the head of the bed (C) represents “Take
,Actions.” Teaching a client (D) is “Generate Solutions” and “Take
Actions.”
3. The charge nurse is making client assignments for a
medical-surgical unit. Which client should be assigned to the
registered nurse (RN) who was floated from the pediatric
unit?
A. A 45-year-old client with a new diagnosis of diabetes mellitus
who requires medication teaching.
B. A 72-year-old client with chronic obstructive pulmonary disease
(COPD) who needs a scheduled albuterol nebulizer treatment.
C. A 38-year-old client with hypothyroidism who has a
thyroid-stimulating hormone (TSH) level of 4.5 mIU/L.
D. A 52-year-old client with a hemorrhagic stroke who has
new-onset confusion and declining level of consciousness.
Answer: D
Rationale: The client with a hemorrhagic stroke and deteriorating
level of consciousness is unstable and requires an RN with
advanced assessment skills. The float RN from pediatrics might
not be familiar with complex neurological changes. Clients in A, B,
and C are relatively stable, and the float RN can safely care for
them with appropriate support. Assigning an unstable client (D) to
a float nurse increases the risk of missing subtle changes in
condition.
, 4. A client with end-stage renal disease (ESRD) tells the nurse,
“I do not want any more dialysis. I know I will die, but I have
accepted that.” The client’s family insists that dialysis be
continued. Which action should the nurse take?
A. Continue dialysis because the family has the legal right to make
decisions.
B. Notify the hospital ethics committee to mediate the
disagreement.
C. Respect the client’s decision because the client is competent
and has decision-making capacity.
D. Request a psychiatric consultation to evaluate the client for
depression.
Answer: C
Rationale: A competent adult client has the right to refuse
treatment even if that refusal leads to death. The nurse must
honor the client’s wishes and support the client’s autonomy.
Continuing dialysis against the client’s wishes (A) would violate
the client’s right to self-determination. Although an ethics
committee (B) can be helpful, it is not the first step when the
client is clearly competent. A psychiatric consultation (D) is
unnecessary unless there is evidence that the client lacks
decision-making capacity.
2026 Questions and 100% Correct
Answers 2025/26 Update
1. A nurse on a medical – surgical unit is caring for a client
who has just returned from the operating room after an open
cholecystectomy. The client states, “I’m in so much pain. Can’t
you give me something for the pain?” The nurse looks at the
medication administration record (MAR) and notes that the
prescription “hydromorphone 1 mg IV push every 2 h PRN
pain” was written 2 days ago. Which action should the nurse
take first?
A. Ask the client to rate the pain severity on a 0-to-10 scale.
B. Compare the MAR with the admission medication orders.
C. Call the health-care provider (HCP) to renew the prescription.
D. Administer the hydromorphone as listed on the MAR.
Answer: A
Rationale: Using the nursing process, assessment is always the
first step. The nurse must quantify the pain severity to determine
whether the existing order is appropriate. Comparing the MAR
with admission orders (B) might reveal discrepancies, but that
,does not address the client’s immediate pain. Calling the HCP to
renew a prescription (C) would be premature because the order
has not yet expired. Administering the medication (D) without first
assessing the pain is unsafe.
2. The nurse manager is planning a staff in-service about the
National Council of State Boards of Nursing (NCSBN) Clinical
Judgment Measurement Model (NCJMM). Which action best
reflects the step of “Analyze Cues”?
A. The nurse considers that the older adult client with confusion is
at risk for falls.
B. The nurse clusters assessment findings of hypotension,
tachycardia, and flat neck veins to identify deficient fluid volume.
C. The nurse decides to raise the head of the bed and apply
oxygen for a client who is short of breath.
D. The nurse teaches a client the proper technique for using a
metered-dose inhaler.
Answer: A
Rationale: “Analyze Cues” involves distinguishing relevant from
irrelevant data and determining whether the cues suggest a
concern. Recognizing that confusion in an older adult increases
fall risk is an example of analyzing cues. Clustering findings to
identify a problem (B) is “Analyze Cues” and “Prioritize
Hypotheses.” Raising the head of the bed (C) represents “Take
,Actions.” Teaching a client (D) is “Generate Solutions” and “Take
Actions.”
3. The charge nurse is making client assignments for a
medical-surgical unit. Which client should be assigned to the
registered nurse (RN) who was floated from the pediatric
unit?
A. A 45-year-old client with a new diagnosis of diabetes mellitus
who requires medication teaching.
B. A 72-year-old client with chronic obstructive pulmonary disease
(COPD) who needs a scheduled albuterol nebulizer treatment.
C. A 38-year-old client with hypothyroidism who has a
thyroid-stimulating hormone (TSH) level of 4.5 mIU/L.
D. A 52-year-old client with a hemorrhagic stroke who has
new-onset confusion and declining level of consciousness.
Answer: D
Rationale: The client with a hemorrhagic stroke and deteriorating
level of consciousness is unstable and requires an RN with
advanced assessment skills. The float RN from pediatrics might
not be familiar with complex neurological changes. Clients in A, B,
and C are relatively stable, and the float RN can safely care for
them with appropriate support. Assigning an unstable client (D) to
a float nurse increases the risk of missing subtle changes in
condition.
, 4. A client with end-stage renal disease (ESRD) tells the nurse,
“I do not want any more dialysis. I know I will die, but I have
accepted that.” The client’s family insists that dialysis be
continued. Which action should the nurse take?
A. Continue dialysis because the family has the legal right to make
decisions.
B. Notify the hospital ethics committee to mediate the
disagreement.
C. Respect the client’s decision because the client is competent
and has decision-making capacity.
D. Request a psychiatric consultation to evaluate the client for
depression.
Answer: C
Rationale: A competent adult client has the right to refuse
treatment even if that refusal leads to death. The nurse must
honor the client’s wishes and support the client’s autonomy.
Continuing dialysis against the client’s wishes (A) would violate
the client’s right to self-determination. Although an ethics
committee (B) can be helpful, it is not the first step when the
client is clearly competent. A psychiatric consultation (D) is
unnecessary unless there is evidence that the client lacks
decision-making capacity.
