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Advanced NCLEX-RN Comprehensive
Practice Examination 150 Evidence-Based
Multiple-Choice Questions Covering
Prioritization, Pharmacology,
Pathophysiology, Patient Safety, and
Complex Care Management Across Diverse
Healthcare Settings for High-Stakes
Licensure Success a well detailed one 2025
/ 2026 written and graded A+ upgraded
Instructions
This comprehensive practice examination contains 150 multiple-choice questions designed for
advanced NCLEX-RN preparation. Questions range from hard to mixed difficulty levels and cover
critical care, pharmacology, medical-surgical nursing, maternal-newborn, pediatrics, mental
health, leadership, prioritization, and Next Generation NCLEX (NGN)-style clinical judgment
scenarios. Each question includes one correct answer with a detailed rationale explaining both
the correct response and why distractors are incorrect.
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Section 1: Safe and Effective Care Environment – Prioritization, Delegation, and Management
(Questions 1–25)
Question 1
A nurse in the emergency department receives four clients simultaneously. Which client should
be seen first?
A. 45-year-old with chest pain radiating to the jaw, diaphoretic
B. 60-year-old with cough and fever, SpO₂ 91% on room air
C. 30-year-old with ankle swelling after a fall, pain 5/10
D. 72-year-old with confusion and UTI history, afebrile
- detailed answer 100% correct :- A
Rationale: Chest pain radiating to the jaw with diaphoresis indicates acute coronary syndrome
or ST-elevation myocardial infarction (STEMI) until proven otherwise. This client has the highest
mortality risk if care is delayed. While the COPD client with SpO₂ 91% (B) requires attention, it is
not as immediately life-threatening as an evolving MI. The ankle injury (C) and confusion with
UTI history (D) are urgent but lower priority compared to a potential cardiac event.
Question 2
The charge nurse is making assignments for a medical-surgical unit. Which client should be
assigned to the most experienced registered nurse?
A. A client requiring discharge teaching about a new colostomy
B. A client with pancreatitis who is experiencing acute pain
C. A client with acute respiratory distress syndrome on a ventilator
D. A client with a urinary tract infection requiring IV antibiotics
- detailed answer 100% correct :- C
Rationale: The client with ARDS on a ventilator is the most unstable and requires the highest
level of nursing expertise. Ventilator management, hemodynamic monitoring, and complex
assessment skills are required. This client should be assigned to the most experienced RN to
ensure safe and effective care. Discharge teaching (A) and pain management for pancreatitis (B)
can be delegated to less experienced nurses, and IV antibiotics for UTI (D) are routine.
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Question 3
A nurse discovers a client on the floor in the hallway. The client states, "I fell when I was trying
to get to the bathroom." What is the nurse's priority action?
A. Help the client back to bed
B. Assess the client for injuries
C. Notify the healthcare provider
D. Complete an incident report
- detailed answer 100% correct :- B
Rationale: Assessment is the priority. The nurse must first assess the client for injuries, including
head trauma, fractures, or other injuries that may have occurred during the fall. After
assessment, the nurse can then help the client back to bed (A), notify the healthcare provider
(C), and complete an incident report (D). The assessment guides all subsequent actions.
Question 4
The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess FIRST after receiving the shift report?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL
B. A client with COPD who has an oxygen saturation of 89% on 2 L/min oxygen
C. A client with heart failure who has 2+ pitting edema in the lower extremities
D. A client with pneumonia who has a temperature of 101.2°F (38.4°C)
- detailed answer 100% correct :- B
Rationale: The client with COPD and oxygen saturation of 89% despite supplemental oxygen is
experiencing hypoxemia, which poses an immediate threat to tissue perfusion and life. Airway
and breathing take priority over circulation (edema) and other findings. The nurse must assess
this client first to determine the cause of inadequate oxygenation and intervene appropriately.
Question 5
A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate?
A. Administering oral medications
B. Assessing a client's postoperative incision
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C. Assisting a client with ambulation
D. Developing a client's plan of care
- detailed answer 100% correct :- C
Rationale: Assisting with ambulation is within the scope of practice for UAP. The RN cannot
delegate tasks that require nursing judgment, assessment, or evaluation, including medication
administration (A), wound assessment (B), and care planning (D). Delegation must follow the
five rights: right task, right circumstances, right person, right directions/communication, and
right supervision/evaluation.
Question 6
A client is scheduled for surgery and has signed the informed consent. The client now states, "I
don't understand what the surgeon is going to do." What is the nurse's best action?
A. Explain the procedure to the client in simple terms
B. Notify the surgeon immediately
C. Have the client sign the consent form again
D. Document the client's statement and proceed with surgery
- detailed answer 100% correct :- B
Rationale: It is the surgeon's responsibility to obtain informed consent and ensure the client
understands the procedure, risks, benefits, and alternatives. The nurse should notify the
surgeon immediately so that the client's questions can be addressed before proceeding. The
nurse may reinforce teaching but should not provide the primary explanation of the procedure.
Question 7
A client with a do-not-resuscitate (DNR) order experiences cardiac arrest. What is the nurse's
appropriate action?
A. Begin CPR immediately
B. Call a code blue
C. Provide comfort measures only
D. Notify the family before taking any action
- detailed answer 100% correct :- C
Rationale: A valid DNR order means that cardiopulmonary resuscitation should not be initiated.
The nurse should provide comfort measures and support to the client and family. Beginning CPR
Advanced NCLEX-RN Comprehensive
Practice Examination 150 Evidence-Based
Multiple-Choice Questions Covering
Prioritization, Pharmacology,
Pathophysiology, Patient Safety, and
Complex Care Management Across Diverse
Healthcare Settings for High-Stakes
Licensure Success a well detailed one 2025
/ 2026 written and graded A+ upgraded
Instructions
This comprehensive practice examination contains 150 multiple-choice questions designed for
advanced NCLEX-RN preparation. Questions range from hard to mixed difficulty levels and cover
critical care, pharmacology, medical-surgical nursing, maternal-newborn, pediatrics, mental
health, leadership, prioritization, and Next Generation NCLEX (NGN)-style clinical judgment
scenarios. Each question includes one correct answer with a detailed rationale explaining both
the correct response and why distractors are incorrect.
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Section 1: Safe and Effective Care Environment – Prioritization, Delegation, and Management
(Questions 1–25)
Question 1
A nurse in the emergency department receives four clients simultaneously. Which client should
be seen first?
A. 45-year-old with chest pain radiating to the jaw, diaphoretic
B. 60-year-old with cough and fever, SpO₂ 91% on room air
C. 30-year-old with ankle swelling after a fall, pain 5/10
D. 72-year-old with confusion and UTI history, afebrile
- detailed answer 100% correct :- A
Rationale: Chest pain radiating to the jaw with diaphoresis indicates acute coronary syndrome
or ST-elevation myocardial infarction (STEMI) until proven otherwise. This client has the highest
mortality risk if care is delayed. While the COPD client with SpO₂ 91% (B) requires attention, it is
not as immediately life-threatening as an evolving MI. The ankle injury (C) and confusion with
UTI history (D) are urgent but lower priority compared to a potential cardiac event.
Question 2
The charge nurse is making assignments for a medical-surgical unit. Which client should be
assigned to the most experienced registered nurse?
A. A client requiring discharge teaching about a new colostomy
B. A client with pancreatitis who is experiencing acute pain
C. A client with acute respiratory distress syndrome on a ventilator
D. A client with a urinary tract infection requiring IV antibiotics
- detailed answer 100% correct :- C
Rationale: The client with ARDS on a ventilator is the most unstable and requires the highest
level of nursing expertise. Ventilator management, hemodynamic monitoring, and complex
assessment skills are required. This client should be assigned to the most experienced RN to
ensure safe and effective care. Discharge teaching (A) and pain management for pancreatitis (B)
can be delegated to less experienced nurses, and IV antibiotics for UTI (D) are routine.
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Question 3
A nurse discovers a client on the floor in the hallway. The client states, "I fell when I was trying
to get to the bathroom." What is the nurse's priority action?
A. Help the client back to bed
B. Assess the client for injuries
C. Notify the healthcare provider
D. Complete an incident report
- detailed answer 100% correct :- B
Rationale: Assessment is the priority. The nurse must first assess the client for injuries, including
head trauma, fractures, or other injuries that may have occurred during the fall. After
assessment, the nurse can then help the client back to bed (A), notify the healthcare provider
(C), and complete an incident report (D). The assessment guides all subsequent actions.
Question 4
The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess FIRST after receiving the shift report?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL
B. A client with COPD who has an oxygen saturation of 89% on 2 L/min oxygen
C. A client with heart failure who has 2+ pitting edema in the lower extremities
D. A client with pneumonia who has a temperature of 101.2°F (38.4°C)
- detailed answer 100% correct :- B
Rationale: The client with COPD and oxygen saturation of 89% despite supplemental oxygen is
experiencing hypoxemia, which poses an immediate threat to tissue perfusion and life. Airway
and breathing take priority over circulation (edema) and other findings. The nurse must assess
this client first to determine the cause of inadequate oxygenation and intervene appropriately.
Question 5
A nurse is preparing to delegate tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate?
A. Administering oral medications
B. Assessing a client's postoperative incision
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C. Assisting a client with ambulation
D. Developing a client's plan of care
- detailed answer 100% correct :- C
Rationale: Assisting with ambulation is within the scope of practice for UAP. The RN cannot
delegate tasks that require nursing judgment, assessment, or evaluation, including medication
administration (A), wound assessment (B), and care planning (D). Delegation must follow the
five rights: right task, right circumstances, right person, right directions/communication, and
right supervision/evaluation.
Question 6
A client is scheduled for surgery and has signed the informed consent. The client now states, "I
don't understand what the surgeon is going to do." What is the nurse's best action?
A. Explain the procedure to the client in simple terms
B. Notify the surgeon immediately
C. Have the client sign the consent form again
D. Document the client's statement and proceed with surgery
- detailed answer 100% correct :- B
Rationale: It is the surgeon's responsibility to obtain informed consent and ensure the client
understands the procedure, risks, benefits, and alternatives. The nurse should notify the
surgeon immediately so that the client's questions can be addressed before proceeding. The
nurse may reinforce teaching but should not provide the primary explanation of the procedure.
Question 7
A client with a do-not-resuscitate (DNR) order experiences cardiac arrest. What is the nurse's
appropriate action?
A. Begin CPR immediately
B. Call a code blue
C. Provide comfort measures only
D. Notify the family before taking any action
- detailed answer 100% correct :- C
Rationale: A valid DNR order means that cardiopulmonary resuscitation should not be initiated.
The nurse should provide comfort measures and support to the client and family. Beginning CPR
