NCLEX COMPREHENSIVE PRACTICE EXAM –
2026 NGN FORMAT, 400+ QUESTIONS
Next Generation NCLEX-Style Comprehensive
Examination
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT – MANAGEMENT OF CARE
1. A nurse is caring for a group of patients. Which patient should the nurse assess first?
A) A patient with pneumonia who has a fever of 38.5°C (101.3°F) and is diaphoretic
B) A patient with heart failure who has 3+ pitting edema and crackles in the lungs
C) A patient with diabetes who has a blood glucose of 220 mg/dL and is lethargic
D) A patient with chronic kidney disease who has a potassium level of 6.2 mEq/L and ECG
changes
Answer: D) A patient with chronic kidney disease who has a potassium level of 6.2 mEq/L and ECG
changes
Rationale: A potassium level of 6.2 mEq/L with ECG changes indicates hyperkalemia, a life-threatening
condition that can cause cardiac arrhythmias and cardiac arrest. This is the priority patient. The patient
with heart failure has significant findings but is stable, the patient with pneumonia has fever which is
expected, and the patient with diabetes has hyperglycemia which requires intervention but is not
immediately life-threatening.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task should the nurse
delegate to the UAP?
A) Administering oral medications
B) Assisting a patient with ambulation
C) Assessing a patient's surgical wound
D) Developing a patient's plan of care
Answer: B) Assisting a patient with ambulation
Rationale: UAP can assist with activities of daily living (bathing, feeding, ambulation, toileting).
Administering medications (A) and assessment (C) require nursing judgment and cannot be delegated.
Developing a plan of care (D) is an RN responsibility that requires clinical judgment.
,3. A nurse is providing discharge teaching to a patient with a new colostomy. Which statement by the
patient indicates the need for further teaching?
A) "I should change my pouch every 3-5 days or when it leaks."
B) "I can take a shower with the pouch on or off."
C) "I should restrict my fluid intake to prevent leakage."
D) "I should avoid gas-forming foods like beans and cabbage."
Answer: C) "I should restrict my fluid intake to prevent leakage."
Rationale: Patients with colostomies should maintain adequate fluid intake (at least 8 glasses per day) to
prevent dehydration and ensure proper stoma function. Restricting fluids is incorrect and could lead to
dehydration and constipation. The other statements are correct: pouches should be changed every 3-5
days, showering is allowed, and gas-forming foods should be limited.
4. A nurse is caring for a patient who is postoperative day 1 after a total hip replacement. Which
action should the nurse take to prevent dislocation?
A) Place a pillow between the legs when the patient is in bed
B) Keep the patient's hips in adduction
C) Allow the patient to cross their legs at the ankles
D) Position the patient in a low Fowler's position
Answer: A) Place a pillow between the legs when the patient is in bed
Rationale: After total hip replacement, the hip should be kept in abduction (not adduction) to prevent
dislocation. A pillow between the legs maintains abduction. Crossing legs (C) can cause dislocation, and a
low Fowler's position does not specifically prevent dislocation. The correct answer is A.
5. A nurse is caring for a patient with a tracheostomy. Which finding indicates that the tracheostomy
tube is obstructed?
A) Oxygen saturation of 88% on room air
B) Increased coughing and difficulty speaking
C) Decreased respiratory rate
D) Crackles on auscultation
Answer: B) Increased coughing and difficulty speaking
Rationale: Tracheostomy tube obstruction presents with difficulty breathing, increased coughing, and
difficulty speaking. The patient may also have stridor, cyanosis, and decreased oxygen saturation.
,Decreased respiratory rate (C) is a sign of respiratory depression or failure, not obstruction. The nurse
should suction the tracheostomy and assess the tube. Increased coughing may indicate the need for
suctioning.
6. A nurse is caring for a patient receiving continuous enteral tube feeding. Which position should the
nurse maintain during the feeding?
A) Supine
B) Left lateral
C) Semi-Fowler's
D) Trendelenburg
Answer: C) Semi-Fowler's
Rationale: The head of the bed should be elevated at least 30-45 degrees (Semi-Fowler's) during enteral
tube feeding to prevent aspiration. Supine (A) and Trendelenburg (D) positions increase the risk of
aspiration. Left lateral (B) may be used for other purposes but is not the standard for tube feeding.
7. A nurse is caring for a patient with a chest tube. Which finding indicates that the chest tube system
is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) No fluctuation in the water seal chamber
Answer: C) Tidaling in the water seal chamber
Rationale: Tidaling (fluctuation) in the water seal chamber with respiration indicates that the chest tube
is patent and functioning properly. Continuous bubbling in the water seal chamber (A) indicates a leak.
Bubbling in the suction control chamber (B) is normal when suction is applied. No fluctuation (D) may
indicate occlusion or the lung has re-expanded.
8. A nurse is caring for a patient with a patient-controlled analgesia (PCA) pump. The patient's family
member asks to press the button for the patient. The nurse should:
A) Allow the family member to press the button
B) Instruct the family member that only the patient should press the button
C) Press the button for the patient
D) Increase the PCA dose
, Answer: B) Instruct the family member that only the patient should press the button
Rationale: Only the patient should press the PCA button to prevent accidental overdose and respiratory
depression. The nurse should educate the family member about the purpose of PCA and the importance
of patient-controlled dosing. The nurse should not press the button for the patient or increase the dose
without an order.
9. A nurse is caring for a patient who is being transferred to a long-term care facility. The nurse should
ensure that:
A) The patient's family signs the transfer form
B) The patient's medical records are sent with the patient
C) The patient has a signed consent for transfer
D) The receiving facility has been notified
Answer: D) The receiving facility has been notified
Rationale: The nurse should ensure that the receiving facility has been notified of the transfer and that a
complete report is provided. Medical records should be transferred with the patient or sent separately.
Informed consent is required for transfer, and the patient or family should be involved. The receiving
facility should be informed to ensure continuity of care.
10. A nurse is caring for a patient who is being discharged with a new prescription for warfarin. Which
patient statement indicates understanding of the medication teaching?
A) "I should take aspirin if I have a headache."
B) "I should avoid eating leafy green vegetables."
C) "I should have my blood levels checked regularly."
D) "I can stop taking the medication if I feel better."
Answer: C) "I should have my blood levels checked regularly."
Rationale: Warfarin requires regular monitoring of INR levels to ensure therapeutic effect and prevent
bleeding. Patients should not take aspirin with warfarin (A) due to bleeding risk. Patients should
maintain consistent vitamin K intake (leafy greens) rather than avoiding them. Patients should not stop
warfarin without healthcare provider guidance.
SECTION 2: SAFE AND EFFECTIVE CARE ENVIRONMENT – SAFETY AND INFECTION CONTROL
11. A nurse is preparing to care for a patient with active pulmonary tuberculosis. Which personal
protective equipment should the nurse use?
A) Surgical mask and gown
2026 NGN FORMAT, 400+ QUESTIONS
Next Generation NCLEX-Style Comprehensive
Examination
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT – MANAGEMENT OF CARE
1. A nurse is caring for a group of patients. Which patient should the nurse assess first?
A) A patient with pneumonia who has a fever of 38.5°C (101.3°F) and is diaphoretic
B) A patient with heart failure who has 3+ pitting edema and crackles in the lungs
C) A patient with diabetes who has a blood glucose of 220 mg/dL and is lethargic
D) A patient with chronic kidney disease who has a potassium level of 6.2 mEq/L and ECG
changes
Answer: D) A patient with chronic kidney disease who has a potassium level of 6.2 mEq/L and ECG
changes
Rationale: A potassium level of 6.2 mEq/L with ECG changes indicates hyperkalemia, a life-threatening
condition that can cause cardiac arrhythmias and cardiac arrest. This is the priority patient. The patient
with heart failure has significant findings but is stable, the patient with pneumonia has fever which is
expected, and the patient with diabetes has hyperglycemia which requires intervention but is not
immediately life-threatening.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task should the nurse
delegate to the UAP?
A) Administering oral medications
B) Assisting a patient with ambulation
C) Assessing a patient's surgical wound
D) Developing a patient's plan of care
Answer: B) Assisting a patient with ambulation
Rationale: UAP can assist with activities of daily living (bathing, feeding, ambulation, toileting).
Administering medications (A) and assessment (C) require nursing judgment and cannot be delegated.
Developing a plan of care (D) is an RN responsibility that requires clinical judgment.
,3. A nurse is providing discharge teaching to a patient with a new colostomy. Which statement by the
patient indicates the need for further teaching?
A) "I should change my pouch every 3-5 days or when it leaks."
B) "I can take a shower with the pouch on or off."
C) "I should restrict my fluid intake to prevent leakage."
D) "I should avoid gas-forming foods like beans and cabbage."
Answer: C) "I should restrict my fluid intake to prevent leakage."
Rationale: Patients with colostomies should maintain adequate fluid intake (at least 8 glasses per day) to
prevent dehydration and ensure proper stoma function. Restricting fluids is incorrect and could lead to
dehydration and constipation. The other statements are correct: pouches should be changed every 3-5
days, showering is allowed, and gas-forming foods should be limited.
4. A nurse is caring for a patient who is postoperative day 1 after a total hip replacement. Which
action should the nurse take to prevent dislocation?
A) Place a pillow between the legs when the patient is in bed
B) Keep the patient's hips in adduction
C) Allow the patient to cross their legs at the ankles
D) Position the patient in a low Fowler's position
Answer: A) Place a pillow between the legs when the patient is in bed
Rationale: After total hip replacement, the hip should be kept in abduction (not adduction) to prevent
dislocation. A pillow between the legs maintains abduction. Crossing legs (C) can cause dislocation, and a
low Fowler's position does not specifically prevent dislocation. The correct answer is A.
5. A nurse is caring for a patient with a tracheostomy. Which finding indicates that the tracheostomy
tube is obstructed?
A) Oxygen saturation of 88% on room air
B) Increased coughing and difficulty speaking
C) Decreased respiratory rate
D) Crackles on auscultation
Answer: B) Increased coughing and difficulty speaking
Rationale: Tracheostomy tube obstruction presents with difficulty breathing, increased coughing, and
difficulty speaking. The patient may also have stridor, cyanosis, and decreased oxygen saturation.
,Decreased respiratory rate (C) is a sign of respiratory depression or failure, not obstruction. The nurse
should suction the tracheostomy and assess the tube. Increased coughing may indicate the need for
suctioning.
6. A nurse is caring for a patient receiving continuous enteral tube feeding. Which position should the
nurse maintain during the feeding?
A) Supine
B) Left lateral
C) Semi-Fowler's
D) Trendelenburg
Answer: C) Semi-Fowler's
Rationale: The head of the bed should be elevated at least 30-45 degrees (Semi-Fowler's) during enteral
tube feeding to prevent aspiration. Supine (A) and Trendelenburg (D) positions increase the risk of
aspiration. Left lateral (B) may be used for other purposes but is not the standard for tube feeding.
7. A nurse is caring for a patient with a chest tube. Which finding indicates that the chest tube system
is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) No fluctuation in the water seal chamber
Answer: C) Tidaling in the water seal chamber
Rationale: Tidaling (fluctuation) in the water seal chamber with respiration indicates that the chest tube
is patent and functioning properly. Continuous bubbling in the water seal chamber (A) indicates a leak.
Bubbling in the suction control chamber (B) is normal when suction is applied. No fluctuation (D) may
indicate occlusion or the lung has re-expanded.
8. A nurse is caring for a patient with a patient-controlled analgesia (PCA) pump. The patient's family
member asks to press the button for the patient. The nurse should:
A) Allow the family member to press the button
B) Instruct the family member that only the patient should press the button
C) Press the button for the patient
D) Increase the PCA dose
, Answer: B) Instruct the family member that only the patient should press the button
Rationale: Only the patient should press the PCA button to prevent accidental overdose and respiratory
depression. The nurse should educate the family member about the purpose of PCA and the importance
of patient-controlled dosing. The nurse should not press the button for the patient or increase the dose
without an order.
9. A nurse is caring for a patient who is being transferred to a long-term care facility. The nurse should
ensure that:
A) The patient's family signs the transfer form
B) The patient's medical records are sent with the patient
C) The patient has a signed consent for transfer
D) The receiving facility has been notified
Answer: D) The receiving facility has been notified
Rationale: The nurse should ensure that the receiving facility has been notified of the transfer and that a
complete report is provided. Medical records should be transferred with the patient or sent separately.
Informed consent is required for transfer, and the patient or family should be involved. The receiving
facility should be informed to ensure continuity of care.
10. A nurse is caring for a patient who is being discharged with a new prescription for warfarin. Which
patient statement indicates understanding of the medication teaching?
A) "I should take aspirin if I have a headache."
B) "I should avoid eating leafy green vegetables."
C) "I should have my blood levels checked regularly."
D) "I can stop taking the medication if I feel better."
Answer: C) "I should have my blood levels checked regularly."
Rationale: Warfarin requires regular monitoring of INR levels to ensure therapeutic effect and prevent
bleeding. Patients should not take aspirin with warfarin (A) due to bleeding risk. Patients should
maintain consistent vitamin K intake (leafy greens) rather than avoiding them. Patients should not stop
warfarin without healthcare provider guidance.
SECTION 2: SAFE AND EFFECTIVE CARE ENVIRONMENT – SAFETY AND INFECTION CONTROL
11. A nurse is preparing to care for a patient with active pulmonary tuberculosis. Which personal
protective equipment should the nurse use?
A) Surgical mask and gown
