Mark Klimek NCLEX Review 2026/2027 | Nursing Exam Prep
& Practice Questions - 150 Questions
This exam assesses advanced knowledge and clinical judgment in the Management of Care domain, including
delegation, prioritization, ethical and legal principles, interdisciplinary collaboration, resource management, and
patient advocacy. Questions reflect the complexity and rigor expected of top-tier US nursing programs and the
current NCLEX-RN test plan. It contains 150 multiple-choice questions, each with four distractors and a fully
worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused sections:
Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity,
Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological Adaptation.
Targeted learning outcomes include: Apply leadership and management principles to coordinate safe, effective
patient care.; Prioritize nursing interventions based on patient acuity, safety, and evidence-based guidelines.;
Integrate ethical and legal standards into clinical decision-making and delegation.. Every item has been reviewed
for clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
with a passing score of 80%. Aligned with Aligns with AACN Essentials and NCSBN NCLEX-RN Test Plan 2023.
Designed to meet the standards of Ivy League and R1 university nursing programs. standards and reflects the
Section 1: Management of Care (Questions 1-19)
1 A charge nurse is assigning care for four patients on a medical-surgical unit.
Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with diabetes mellitus requiring a blood glucose check and
insulin administration before breakfast.
B) A patient with pneumonia who is stable and receiving intravenous
antibiotics every 6 hours.
C) A patient with a new tracheostomy who is being weaned from mechanical
ventilation and has a complex airway management plan.
D) A patient with a urinary tract infection who needs a straight
catheterization for a urine culture.
Answer: C
Rationale: The patient with a new tracheostomy and ventilator weaning is the
most unstable and requires advanced assessment and intervention skills.
Assigning this patient to the most experienced RN ensures safe care. Options
A, B, and D are more stable and can be managed by less experienced RNs or
LPNs.
2 A nurse manager is evaluating the delegation of tasks to unlicensed assistive
personnel (UAP). Which task is appropriate to delegate?
,A) Administering a unit of packed red blood cells to a patient with anemia.
B) Reinforcing teaching about wound care to a patient with a new colostomy.
C) Measuring vital signs on a patient who is 2 hours post-cardiac
catheterization.
D) Assessing the lung sounds of a patient with shortness of breath.
Answer: C
Rationale: Measuring vital signs is a stable, routine task that can be delegated to
UAP. Administering blood (A) and patient teaching (B) require RN licensure.
Assessing lung sounds (D) is a professional assessment that cannot be
delegated.
3 A nurse is triaging patients in the emergency department. Which patient
should be treated first?
A) A patient with a fractured femur and capillary refill of 3 seconds.
B) A patient with chest pain, diaphoresis, and ST-segment elevation on ECG.
C) A patient with a laceration on the forearm that is bleeding slowly.
D) A patient with a temperature of 38.5°C (101.3°F) and a productive cough.
Answer: B
Rationale: Chest pain with ST-segment elevation indicates an acute myocardial
infarction, which is life-threatening and requires immediate intervention. The
fractured femur (A) is urgent but not immediately life-threatening. The
laceration (C) and fever with cough (D) are non-urgent.
4 A nurse is caring for a patient who has a living will that refuses blood
transfusions. The patient is now unconscious and needs emergency surgery
due to trauma. The surgeon orders transfusions. What is the nurse's best
action?
A) Administer the blood transfusions as ordered because the patient is
unconscious.
B) Refuse to administer the blood and notify the ethics committee.
C) Call the patient's family to obtain consent for transfusion.
D) Administer the blood and document the situation.
Answer: B
Rationale: A living will is a legal document that must be honored. The nurse
should advocate for the patient's wishes and refuse to administer blood, then
notify the ethics committee for guidance. Administering blood (A, D) violates
,the patient's autonomy. Family consent (C) is not valid when a living will
exists.
5 A nurse is preparing to delegate a task to a licensed practical nurse (LPN).
Which task is within the LPN's scope of practice?
A) Administering a blood transfusion.
B) Performing a comprehensive admission assessment.
C) Administering oral medications to a stable patient.
D) Creating the nursing care plan for a patient with a new diagnosis.
Answer: C
Rationale: LPNs can administer oral medications to stable patients under the
supervision of an RN. Blood transfusions (A) and admission assessments (B)
require RN-level education and judgment. Creating a nursing care plan (D) is
the responsibility of the RN.
6 A nurse is caring for a patient who has a chest tube connected to a drainage
system. The patient's family member asks why the nurse is not allowing the
patient to take a shower. Which response by the nurse is most appropriate?
A) Showering is not allowed because the chest tube might get wet.
B) The doctor has not ordered a shower for the patient.
C) The chest tube system must remain sealed and intact to prevent air from
entering the pleural space.
D) The patient is too unstable to shower.
Answer: C
Rationale: The priority is maintaining the integrity of the chest tube system to
prevent pneumothorax. The nurse's response should educate the family on the
clinical rationale. Option A is vague; option B is not patient-centered; option D
may not be accurate.
7 A nurse is leading a team of healthcare providers in a code blue situation.
Which action demonstrates effective leadership?
A) The nurse performs chest compressions while directing others.
B) The nurse assigns roles based on team members' competencies and
monitors the code's progress.
C) The nurse documents all interventions during the code.
D) The nurse asks the team what they think should be done next.
, Answer: B
Rationale: Effective leadership involves delegating tasks appropriately,
maintaining situational awareness, and coordinating the team. Performing
compressions (A) may hinder the leader's ability to oversee the code.
Documentation (C) is important but should be done by another team member.
Asking for opinions (D) can cause delays in a time-sensitive situation.
8 A nurse discovers that a colleague has been diverting narcotics for personal
use. What is the nurse's first action?
A) Confront the colleague directly.
B) Report the colleague to the nurse manager.
C) Ignore the situation to avoid conflict.
D) Document the observation in the colleague's personnel file.
Answer: B
Rationale: The nurse has an ethical and legal duty to report suspected diversion
to protect patients and uphold professional standards. Confrontation (A) may
escalate the situation. Ignoring (C) is unethical. Documentation (D) is not the
appropriate first step; reporting to management is required.
9 A nurse is caring for a patient who requires a blood transfusion. The patient
has a history of multiple transfusions and is at risk for a transfusion reaction.
Which action should the nurse take to ensure patient safety?
A) Administer the blood at the fastest rate possible to complete the
transfusion quickly.
B) Obtain and document baseline vital signs before starting the transfusion.
C) Pre-medicate the patient with acetaminophen and diphenhydramine
without an order.
D) Have a second nurse verify the patient's identity and blood product only if
the patient is unconscious.
Answer: B
Rationale: Obtaining baseline vital signs is essential to detect early signs of a
transfusion reaction. Rapid infusion (A) increases risk. Pre-medicating without
an order (C) is beyond the nurse's scope. Verification (D) should be done for all
patients, not just unconscious ones.
& Practice Questions - 150 Questions
This exam assesses advanced knowledge and clinical judgment in the Management of Care domain, including
delegation, prioritization, ethical and legal principles, interdisciplinary collaboration, resource management, and
patient advocacy. Questions reflect the complexity and rigor expected of top-tier US nursing programs and the
current NCLEX-RN test plan. It contains 150 multiple-choice questions, each with four distractors and a fully
worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused sections:
Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity,
Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological Adaptation.
Targeted learning outcomes include: Apply leadership and management principles to coordinate safe, effective
patient care.; Prioritize nursing interventions based on patient acuity, safety, and evidence-based guidelines.;
Integrate ethical and legal standards into clinical decision-making and delegation.. Every item has been reviewed
for clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
with a passing score of 80%. Aligned with Aligns with AACN Essentials and NCSBN NCLEX-RN Test Plan 2023.
Designed to meet the standards of Ivy League and R1 university nursing programs. standards and reflects the
Section 1: Management of Care (Questions 1-19)
1 A charge nurse is assigning care for four patients on a medical-surgical unit.
Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with diabetes mellitus requiring a blood glucose check and
insulin administration before breakfast.
B) A patient with pneumonia who is stable and receiving intravenous
antibiotics every 6 hours.
C) A patient with a new tracheostomy who is being weaned from mechanical
ventilation and has a complex airway management plan.
D) A patient with a urinary tract infection who needs a straight
catheterization for a urine culture.
Answer: C
Rationale: The patient with a new tracheostomy and ventilator weaning is the
most unstable and requires advanced assessment and intervention skills.
Assigning this patient to the most experienced RN ensures safe care. Options
A, B, and D are more stable and can be managed by less experienced RNs or
LPNs.
2 A nurse manager is evaluating the delegation of tasks to unlicensed assistive
personnel (UAP). Which task is appropriate to delegate?
,A) Administering a unit of packed red blood cells to a patient with anemia.
B) Reinforcing teaching about wound care to a patient with a new colostomy.
C) Measuring vital signs on a patient who is 2 hours post-cardiac
catheterization.
D) Assessing the lung sounds of a patient with shortness of breath.
Answer: C
Rationale: Measuring vital signs is a stable, routine task that can be delegated to
UAP. Administering blood (A) and patient teaching (B) require RN licensure.
Assessing lung sounds (D) is a professional assessment that cannot be
delegated.
3 A nurse is triaging patients in the emergency department. Which patient
should be treated first?
A) A patient with a fractured femur and capillary refill of 3 seconds.
B) A patient with chest pain, diaphoresis, and ST-segment elevation on ECG.
C) A patient with a laceration on the forearm that is bleeding slowly.
D) A patient with a temperature of 38.5°C (101.3°F) and a productive cough.
Answer: B
Rationale: Chest pain with ST-segment elevation indicates an acute myocardial
infarction, which is life-threatening and requires immediate intervention. The
fractured femur (A) is urgent but not immediately life-threatening. The
laceration (C) and fever with cough (D) are non-urgent.
4 A nurse is caring for a patient who has a living will that refuses blood
transfusions. The patient is now unconscious and needs emergency surgery
due to trauma. The surgeon orders transfusions. What is the nurse's best
action?
A) Administer the blood transfusions as ordered because the patient is
unconscious.
B) Refuse to administer the blood and notify the ethics committee.
C) Call the patient's family to obtain consent for transfusion.
D) Administer the blood and document the situation.
Answer: B
Rationale: A living will is a legal document that must be honored. The nurse
should advocate for the patient's wishes and refuse to administer blood, then
notify the ethics committee for guidance. Administering blood (A, D) violates
,the patient's autonomy. Family consent (C) is not valid when a living will
exists.
5 A nurse is preparing to delegate a task to a licensed practical nurse (LPN).
Which task is within the LPN's scope of practice?
A) Administering a blood transfusion.
B) Performing a comprehensive admission assessment.
C) Administering oral medications to a stable patient.
D) Creating the nursing care plan for a patient with a new diagnosis.
Answer: C
Rationale: LPNs can administer oral medications to stable patients under the
supervision of an RN. Blood transfusions (A) and admission assessments (B)
require RN-level education and judgment. Creating a nursing care plan (D) is
the responsibility of the RN.
6 A nurse is caring for a patient who has a chest tube connected to a drainage
system. The patient's family member asks why the nurse is not allowing the
patient to take a shower. Which response by the nurse is most appropriate?
A) Showering is not allowed because the chest tube might get wet.
B) The doctor has not ordered a shower for the patient.
C) The chest tube system must remain sealed and intact to prevent air from
entering the pleural space.
D) The patient is too unstable to shower.
Answer: C
Rationale: The priority is maintaining the integrity of the chest tube system to
prevent pneumothorax. The nurse's response should educate the family on the
clinical rationale. Option A is vague; option B is not patient-centered; option D
may not be accurate.
7 A nurse is leading a team of healthcare providers in a code blue situation.
Which action demonstrates effective leadership?
A) The nurse performs chest compressions while directing others.
B) The nurse assigns roles based on team members' competencies and
monitors the code's progress.
C) The nurse documents all interventions during the code.
D) The nurse asks the team what they think should be done next.
, Answer: B
Rationale: Effective leadership involves delegating tasks appropriately,
maintaining situational awareness, and coordinating the team. Performing
compressions (A) may hinder the leader's ability to oversee the code.
Documentation (C) is important but should be done by another team member.
Asking for opinions (D) can cause delays in a time-sensitive situation.
8 A nurse discovers that a colleague has been diverting narcotics for personal
use. What is the nurse's first action?
A) Confront the colleague directly.
B) Report the colleague to the nurse manager.
C) Ignore the situation to avoid conflict.
D) Document the observation in the colleague's personnel file.
Answer: B
Rationale: The nurse has an ethical and legal duty to report suspected diversion
to protect patients and uphold professional standards. Confrontation (A) may
escalate the situation. Ignoring (C) is unethical. Documentation (D) is not the
appropriate first step; reporting to management is required.
9 A nurse is caring for a patient who requires a blood transfusion. The patient
has a history of multiple transfusions and is at risk for a transfusion reaction.
Which action should the nurse take to ensure patient safety?
A) Administer the blood at the fastest rate possible to complete the
transfusion quickly.
B) Obtain and document baseline vital signs before starting the transfusion.
C) Pre-medicate the patient with acetaminophen and diphenhydramine
without an order.
D) Have a second nurse verify the patient's identity and blood product only if
the patient is unconscious.
Answer: B
Rationale: Obtaining baseline vital signs is essential to detect early signs of a
transfusion reaction. Rapid infusion (A) increases risk. Pre-medicating without
an order (C) is beyond the nurse's scope. Verification (D) should be done for all
patients, not just unconscious ones.
