NCLEX- PNAdvanced Practice Examination
Comprehensive-Question
150 Review for the 2026 Test
Plan Incorporating Clinical Judgment, Prioritization,
Delegation, and Client Needs Across the aLifespan
well detailed one written and graded A
upgraded
INSTRUCTIONS
This examination contains 150 multiple-choice questions designed to assess advanced practical
nursing knowledge aligned with the 2026 NCLEX-PN® Test Plan. Questions are organized by the
four Client Needs categories as outlined by the NCSBN: Safe and Effective Care Environment
(Coordinated Care 18–24%; Safety and Infection Prevention and Control 10–16%), Health
Promotion and Maintenance (6–12%), Psychosocial Integrity (9–15%), and Physiological
Integrity (Basic Care and Comfort 7–13%; Pharmacological Therapies 10–16%; Reduction of Risk
Potential 9–15%; Physiological Adaptation 7–13%). Select the single best answer for each
question. Each question includes a detailed rationale for the correct answer.
SECTION A: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE (Questions 1–
36)
1. A practical nurse is caring for a client who has been prescribed warfarin for atrial
fibrillation. Which of the following statements by the client indicates a need for further
teaching?
,A. "I will take my medication at the same time every day."
B. "I will avoid eating large amounts of green leafy vegetables."
C. "I will use a soft-bristled toothbrush to prevent gum bleeding."
D. "I will take ibuprofen for my headaches instead of acetaminophen."
Correct Answer: D
Rationale: Warfarin is an anticoagulant that increases bleeding risk. Ibuprofen (an NSAID)
further increases bleeding risk when combined with warfarin and should be avoided.
Acetaminophen is the preferred analgesic for clients on warfarin. Taking warfarin at the same
time daily (A) promotes consistent therapeutic levels. Avoiding large amounts of vitamin K-rich
green leafy vegetables (B) prevents INR fluctuations. Using a soft-bristled toothbrush (C)
minimizes bleeding risk from gum trauma.
2. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate for the nurse to delegate to the UAP?
A. Assessing a client's surgical incision for signs of infection
B. Administering oral medications to a stable client
C. Measuring and recording a client's vital signs
D. Developing a client's plan of care
Correct Answer: C
Rationale: The LPN/VN can delegate routine, stable tasks such as measuring vital signs to UAP.
Assessment (A) and plan of care development (D) require nursing judgment and cannot be
delegated. Medication administration (B) requires licensed personnel and is not within UAP
scope of practice. Delegation decisions must consider the task complexity, client stability, and
the delegatee's competency.
3. A client is being discharged with a new diagnosis of heart failure. Which of the following
actions should the practical nurse prioritize when coordinating discharge teaching?
A. Provide written instructions and schedule a follow-up appointment
B. Assess the client's understanding of medication regimen and dietary restrictions
C. Arrange for home health services without consulting the client
D. Focus solely on medication teaching and omit dietary education
Correct Answer: B
,Rationale: Coordinated care emphasizes client education and self-management. Assessing the
client's understanding of both medications and dietary restrictions (B) is essential for safe
discharge. While written instructions and follow-up (A) are important, they should
complement—not replace—teaching. Arranging services without client input (C) violates client
autonomy. Comprehensive teaching must include both medications and lifestyle modifications
(D is incomplete).
4. A practical nurse is working on a medical-surgical unit. Which of the following clients
should the nurse assess first?
A. A client with pneumonia who has an oxygen saturation of 94% on room air
B. A client with diabetes who has a blood glucose of 180 mg/dL
C. A client with chest pain who is diaphoretic and reporting nausea
D. A client with a urinary tract infection who has a temperature of 100.4°F (38°C)
Correct Answer: C
Rationale: Prioritization requires identifying the client with the most acute or life-threatening
condition. The client with chest pain, diaphoresis, and nausea (C) is exhibiting signs of possible
myocardial infarction and requires immediate assessment. Oxygen saturation of 94% (A) is
acceptable. Blood glucose of 180 mg/dL (B) is elevated but not immediately life-threatening. A
temperature of 100.4°F (D) indicates infection but is not the priority over potential cardiac
compromise.
5. A client with a do-not-resuscitate (DNR) order experiences respiratory arrest. Which of the
following actions should the practical nurse take?
A. Initiate CPR immediately
B. Call the provider for clarification of the DNR order
C. Provide comfort measures and notify the provider
D. Transfer the client to the intensive care unit
Correct Answer: C
Rationale: A valid DNR order indicates that CPR should not be initiated. The nurse should
provide comfort measures and notify the provider (C) of the client's condition. Initiating CPR (A)
would violate the DNR order. Calling for clarification (B) delays appropriate care during an
emergency. Transfer to ICU (D) is not indicated for a client with a DNR order.
, 6. A practical nurse is preparing to transfer a client from a bed to a wheelchair. Which of the
following actions demonstrates safe client handling?
A. Position the wheelchair on the client's weak side
B. Lock the wheelchair brakes before beginning the transfer
C. Use a gait belt only if the client is cooperative
D. Allow the client to hold onto the nurse's neck for support
Correct Answer: B
Rationale: Locking wheelchair brakes (B) is a critical safety measure that prevents the
wheelchair from moving during transfer. The wheelchair should be positioned on the client's
strong side, not weak side (A). A gait belt should be used for all clients requiring transfer
assistance, regardless of cooperation level (C). Clients should never hold onto the nurse's neck
(D) as this can cause injury to both the client and the nurse.
7. A nurse is caring for a client who is post-operative day one following a total hip
replacement. The client reports sudden shortness of breath and chest pain. What is the
nurse's priority action?
A. Administer prescribed pain medication
B. Elevate the head of the bed and apply oxygen
C. Encourage deep breathing exercises
D. Notify the provider after completing a full assessment
Correct Answer: B
Rationale: Sudden shortness of breath and chest pain in a post-operative client suggest possible
pulmonary embolism (PE). The priority action is to elevate the head of the bed and apply
oxygen (B) to optimize oxygenation. Administering pain medication (A) without further
assessment could mask symptoms. Deep breathing exercises (C) are not sufficient for acute
respiratory distress. The provider should be notified immediately, not after a full assessment
(D).
8. A practical nurse is participating in a client care conference. Which of the following
statements reflects appropriate collaborative practice?
A. "I will implement the care plan independently without consulting the RN."
B. "I will share my observations about the client's response to treatment with the team."
Comprehensive-Question
150 Review for the 2026 Test
Plan Incorporating Clinical Judgment, Prioritization,
Delegation, and Client Needs Across the aLifespan
well detailed one written and graded A
upgraded
INSTRUCTIONS
This examination contains 150 multiple-choice questions designed to assess advanced practical
nursing knowledge aligned with the 2026 NCLEX-PN® Test Plan. Questions are organized by the
four Client Needs categories as outlined by the NCSBN: Safe and Effective Care Environment
(Coordinated Care 18–24%; Safety and Infection Prevention and Control 10–16%), Health
Promotion and Maintenance (6–12%), Psychosocial Integrity (9–15%), and Physiological
Integrity (Basic Care and Comfort 7–13%; Pharmacological Therapies 10–16%; Reduction of Risk
Potential 9–15%; Physiological Adaptation 7–13%). Select the single best answer for each
question. Each question includes a detailed rationale for the correct answer.
SECTION A: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE (Questions 1–
36)
1. A practical nurse is caring for a client who has been prescribed warfarin for atrial
fibrillation. Which of the following statements by the client indicates a need for further
teaching?
,A. "I will take my medication at the same time every day."
B. "I will avoid eating large amounts of green leafy vegetables."
C. "I will use a soft-bristled toothbrush to prevent gum bleeding."
D. "I will take ibuprofen for my headaches instead of acetaminophen."
Correct Answer: D
Rationale: Warfarin is an anticoagulant that increases bleeding risk. Ibuprofen (an NSAID)
further increases bleeding risk when combined with warfarin and should be avoided.
Acetaminophen is the preferred analgesic for clients on warfarin. Taking warfarin at the same
time daily (A) promotes consistent therapeutic levels. Avoiding large amounts of vitamin K-rich
green leafy vegetables (B) prevents INR fluctuations. Using a soft-bristled toothbrush (C)
minimizes bleeding risk from gum trauma.
2. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which of the
following tasks is appropriate for the nurse to delegate to the UAP?
A. Assessing a client's surgical incision for signs of infection
B. Administering oral medications to a stable client
C. Measuring and recording a client's vital signs
D. Developing a client's plan of care
Correct Answer: C
Rationale: The LPN/VN can delegate routine, stable tasks such as measuring vital signs to UAP.
Assessment (A) and plan of care development (D) require nursing judgment and cannot be
delegated. Medication administration (B) requires licensed personnel and is not within UAP
scope of practice. Delegation decisions must consider the task complexity, client stability, and
the delegatee's competency.
3. A client is being discharged with a new diagnosis of heart failure. Which of the following
actions should the practical nurse prioritize when coordinating discharge teaching?
A. Provide written instructions and schedule a follow-up appointment
B. Assess the client's understanding of medication regimen and dietary restrictions
C. Arrange for home health services without consulting the client
D. Focus solely on medication teaching and omit dietary education
Correct Answer: B
,Rationale: Coordinated care emphasizes client education and self-management. Assessing the
client's understanding of both medications and dietary restrictions (B) is essential for safe
discharge. While written instructions and follow-up (A) are important, they should
complement—not replace—teaching. Arranging services without client input (C) violates client
autonomy. Comprehensive teaching must include both medications and lifestyle modifications
(D is incomplete).
4. A practical nurse is working on a medical-surgical unit. Which of the following clients
should the nurse assess first?
A. A client with pneumonia who has an oxygen saturation of 94% on room air
B. A client with diabetes who has a blood glucose of 180 mg/dL
C. A client with chest pain who is diaphoretic and reporting nausea
D. A client with a urinary tract infection who has a temperature of 100.4°F (38°C)
Correct Answer: C
Rationale: Prioritization requires identifying the client with the most acute or life-threatening
condition. The client with chest pain, diaphoresis, and nausea (C) is exhibiting signs of possible
myocardial infarction and requires immediate assessment. Oxygen saturation of 94% (A) is
acceptable. Blood glucose of 180 mg/dL (B) is elevated but not immediately life-threatening. A
temperature of 100.4°F (D) indicates infection but is not the priority over potential cardiac
compromise.
5. A client with a do-not-resuscitate (DNR) order experiences respiratory arrest. Which of the
following actions should the practical nurse take?
A. Initiate CPR immediately
B. Call the provider for clarification of the DNR order
C. Provide comfort measures and notify the provider
D. Transfer the client to the intensive care unit
Correct Answer: C
Rationale: A valid DNR order indicates that CPR should not be initiated. The nurse should
provide comfort measures and notify the provider (C) of the client's condition. Initiating CPR (A)
would violate the DNR order. Calling for clarification (B) delays appropriate care during an
emergency. Transfer to ICU (D) is not indicated for a client with a DNR order.
, 6. A practical nurse is preparing to transfer a client from a bed to a wheelchair. Which of the
following actions demonstrates safe client handling?
A. Position the wheelchair on the client's weak side
B. Lock the wheelchair brakes before beginning the transfer
C. Use a gait belt only if the client is cooperative
D. Allow the client to hold onto the nurse's neck for support
Correct Answer: B
Rationale: Locking wheelchair brakes (B) is a critical safety measure that prevents the
wheelchair from moving during transfer. The wheelchair should be positioned on the client's
strong side, not weak side (A). A gait belt should be used for all clients requiring transfer
assistance, regardless of cooperation level (C). Clients should never hold onto the nurse's neck
(D) as this can cause injury to both the client and the nurse.
7. A nurse is caring for a client who is post-operative day one following a total hip
replacement. The client reports sudden shortness of breath and chest pain. What is the
nurse's priority action?
A. Administer prescribed pain medication
B. Elevate the head of the bed and apply oxygen
C. Encourage deep breathing exercises
D. Notify the provider after completing a full assessment
Correct Answer: B
Rationale: Sudden shortness of breath and chest pain in a post-operative client suggest possible
pulmonary embolism (PE). The priority action is to elevate the head of the bed and apply
oxygen (B) to optimize oxygenation. Administering pain medication (A) without further
assessment could mask symptoms. Deep breathing exercises (C) are not sufficient for acute
respiratory distress. The provider should be notified immediately, not after a full assessment
(D).
8. A practical nurse is participating in a client care conference. Which of the following
statements reflects appropriate collaborative practice?
A. "I will implement the care plan independently without consulting the RN."
B. "I will share my observations about the client's response to treatment with the team."
