Saunders NCLEX-RN Test Bank
Comprehensive Nursing Examination Review
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A charge nurse on a busy medical-surgical unit is delegating tasks to a team that includes
assistive personnel (AP) and licensed practical nurses. Which task is most appropriate to
delegate to the AP?
A. Administering an oral antihypertensive medication to a stable patient
B. Assessing a postoperative wound for early signs of infection
C. Ambulating a stable patient on the second postoperative day ✓ CORRECT
D. Teaching a newly diagnosed diabetic patient about foot care
Correct Answer: C
Rationale: Delegating ambulation to AP is appropriate because it is a routine task for a stable
patient and does not require clinical judgment or assessment. Administering oral
antihypertensives, assessing wounds, and providing patient education are within the scope of
the licensed nurse and should not be delegated to unlicensed assistive personnel. On the
NCLEX, remember that the RN retains accountability for assessments, teaching, and clinical
decisions.
Question 2 of 50
A nurse enters a patient's room and finds an 82-year-old client on the floor next to the bed.
The client is alert and states, "I just slipped getting up to use the bathroom." What is the
nurse's priority action?
A. Complete an incident report before leaving the unit
,B. Perform a focused neurological assessment and vital signs ✓ CORRECT
C. Call the provider to report the incident before examining the client
D. Assist the client back to bed immediately
Correct Answer: B
Rationale: After a fall, the nurse must first assess for injuries using a focused neurological
exam and vital signs before moving the client or completing documentation. Assisting the
client back to bed immediately could worsen an undetected spinal or hip fracture. The NCLEX
prioritizes patient assessment over documentation or notification when an acute change in
status occurs.
Question 3 of 50
During a fire drill on a busy oncology unit, a nurse smells smoke coming from a storage
room. The nurse's first action should be to:
A. Evacuate all patients immediately to the nearest stairwell
B. Call the hospital operator to announce the code overhead
C. Close the door to the storage room and activate the nearest fire alarm ✓ CORRECT
D. Search the storage room to locate the exact source of the fire
Correct Answer: C
Rationale: The nurse should follow the RACE protocol by closing the door to confine the fire
and activating the nearest alarm before attempting rescue or evacuation. Searching the room
or delaying the alarm wastes critical time and places staff and patients at risk. Remember
that confining the fire and alarming are the immediate priorities when a fire is discovered.
Question 4 of 50
A nurse is caring for a 34-year-old client who refuses a blood transfusion based on religious
beliefs. The client's hemoglobin is 6.8 g/dL, and the provider has ordered two units of packed
red blood cells. What is the nurse's most appropriate action?
A. Explain that the transfusion is necessary to save the client's life
B. Obtain a court order to administer the blood products
C. Ask the family to convince the client to accept the treatment
D. Notify the provider and document the client's refusal in the medical record ✓ CORRECT
Correct Answer: D
Rationale: The nurse must respect the client's autonomy by notifying the provider of the
refusal and documenting it thoroughly in the medical record. Obtaining a court order or
coercing the client violates the ethical principle of autonomy and the client's right to refuse
treatment. The NCLEX frequently tests your ability to balance advocacy with legal and ethical
boundaries.
, Question 5 of 50
A nurse is supervising a newly licensed nurse who is preparing to insert an indwelling urinary
catheter using sterile technique. The nurse observes the new graduate place the sterile drape
below the patient after opening the kit. What action should the supervising nurse take?
A. Instruct the new nurse to apply a new sterile drape before proceeding ✓ CORRECT
B. Allow the procedure to continue since the drape is still sterile on one side
C. Complete the procedure herself to ensure patient safety
D. Document the breach in sterile technique after the procedure is finished
Correct Answer: A
Rationale: The sterile field was breached when the drape contacted the non-sterile patient
surface, so the nurse must instruct the new graduate to apply a new sterile drape before
continuing. Allowing the procedure to continue would expose the patient to infection risk.
The NCLEX emphasizes that the nurse supervising a new graduate is responsible for
correcting errors in real time.
Question 6 of 50
A nurse on a busy pediatric unit is assigned four patients. Which patient should the nurse
assess first?
A. A 4-year-old with asthma whose parents request a second pillow
B. A 6-month-old with bronchiolitis who has nasal flaring and intercostal retractions ✓
CORRECT
C. A 10-year-old with appendicitis who is requesting pain medication
D. An 8-year-old with a fractured arm whose cast was just applied
Correct Answer: B
Rationale: The infant with nasal flaring and intercostal retractions is exhibiting signs of
respiratory distress and requires immediate assessment to protect the airway and breathing.
Pain medication and comfort requests are important but do not take priority over
physiological stability. Use the ABC framework to prioritize care when multiple patients need
attention.
Question 7 of 50
A nurse is reviewing the medication administration record for a patient with a known
penicillin allergy. The provider has ordered cefazolin preoperatively. What is the nurse's
priority action?
A. Administer the cefazolin and monitor closely for rash
B. Ask the pharmacist to substitute vancomycin independently
Comprehensive Nursing Examination Review
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A charge nurse on a busy medical-surgical unit is delegating tasks to a team that includes
assistive personnel (AP) and licensed practical nurses. Which task is most appropriate to
delegate to the AP?
A. Administering an oral antihypertensive medication to a stable patient
B. Assessing a postoperative wound for early signs of infection
C. Ambulating a stable patient on the second postoperative day ✓ CORRECT
D. Teaching a newly diagnosed diabetic patient about foot care
Correct Answer: C
Rationale: Delegating ambulation to AP is appropriate because it is a routine task for a stable
patient and does not require clinical judgment or assessment. Administering oral
antihypertensives, assessing wounds, and providing patient education are within the scope of
the licensed nurse and should not be delegated to unlicensed assistive personnel. On the
NCLEX, remember that the RN retains accountability for assessments, teaching, and clinical
decisions.
Question 2 of 50
A nurse enters a patient's room and finds an 82-year-old client on the floor next to the bed.
The client is alert and states, "I just slipped getting up to use the bathroom." What is the
nurse's priority action?
A. Complete an incident report before leaving the unit
,B. Perform a focused neurological assessment and vital signs ✓ CORRECT
C. Call the provider to report the incident before examining the client
D. Assist the client back to bed immediately
Correct Answer: B
Rationale: After a fall, the nurse must first assess for injuries using a focused neurological
exam and vital signs before moving the client or completing documentation. Assisting the
client back to bed immediately could worsen an undetected spinal or hip fracture. The NCLEX
prioritizes patient assessment over documentation or notification when an acute change in
status occurs.
Question 3 of 50
During a fire drill on a busy oncology unit, a nurse smells smoke coming from a storage
room. The nurse's first action should be to:
A. Evacuate all patients immediately to the nearest stairwell
B. Call the hospital operator to announce the code overhead
C. Close the door to the storage room and activate the nearest fire alarm ✓ CORRECT
D. Search the storage room to locate the exact source of the fire
Correct Answer: C
Rationale: The nurse should follow the RACE protocol by closing the door to confine the fire
and activating the nearest alarm before attempting rescue or evacuation. Searching the room
or delaying the alarm wastes critical time and places staff and patients at risk. Remember
that confining the fire and alarming are the immediate priorities when a fire is discovered.
Question 4 of 50
A nurse is caring for a 34-year-old client who refuses a blood transfusion based on religious
beliefs. The client's hemoglobin is 6.8 g/dL, and the provider has ordered two units of packed
red blood cells. What is the nurse's most appropriate action?
A. Explain that the transfusion is necessary to save the client's life
B. Obtain a court order to administer the blood products
C. Ask the family to convince the client to accept the treatment
D. Notify the provider and document the client's refusal in the medical record ✓ CORRECT
Correct Answer: D
Rationale: The nurse must respect the client's autonomy by notifying the provider of the
refusal and documenting it thoroughly in the medical record. Obtaining a court order or
coercing the client violates the ethical principle of autonomy and the client's right to refuse
treatment. The NCLEX frequently tests your ability to balance advocacy with legal and ethical
boundaries.
, Question 5 of 50
A nurse is supervising a newly licensed nurse who is preparing to insert an indwelling urinary
catheter using sterile technique. The nurse observes the new graduate place the sterile drape
below the patient after opening the kit. What action should the supervising nurse take?
A. Instruct the new nurse to apply a new sterile drape before proceeding ✓ CORRECT
B. Allow the procedure to continue since the drape is still sterile on one side
C. Complete the procedure herself to ensure patient safety
D. Document the breach in sterile technique after the procedure is finished
Correct Answer: A
Rationale: The sterile field was breached when the drape contacted the non-sterile patient
surface, so the nurse must instruct the new graduate to apply a new sterile drape before
continuing. Allowing the procedure to continue would expose the patient to infection risk.
The NCLEX emphasizes that the nurse supervising a new graduate is responsible for
correcting errors in real time.
Question 6 of 50
A nurse on a busy pediatric unit is assigned four patients. Which patient should the nurse
assess first?
A. A 4-year-old with asthma whose parents request a second pillow
B. A 6-month-old with bronchiolitis who has nasal flaring and intercostal retractions ✓
CORRECT
C. A 10-year-old with appendicitis who is requesting pain medication
D. An 8-year-old with a fractured arm whose cast was just applied
Correct Answer: B
Rationale: The infant with nasal flaring and intercostal retractions is exhibiting signs of
respiratory distress and requires immediate assessment to protect the airway and breathing.
Pain medication and comfort requests are important but do not take priority over
physiological stability. Use the ABC framework to prioritize care when multiple patients need
attention.
Question 7 of 50
A nurse is reviewing the medication administration record for a patient with a known
penicillin allergy. The provider has ordered cefazolin preoperatively. What is the nurse's
priority action?
A. Administer the cefazolin and monitor closely for rash
B. Ask the pharmacist to substitute vancomycin independently
