NCLEX-RN Exam 2026 Updated Practice
Questions, Comprehensive Review Guide,
Detailed Rationales, Verified Answers, Complete
Success Study Workbook
1. A nurse is caring for a client who is agitated and attempting to remove their
IV line. The client is not cooperating with care. Which of the following actions
should the nurse take first?
A. Apply soft wrist restraints to prevent the client from removing the IV.
B. Ask the client why they want to remove the IV and address their concerns.
C. Request a prescription for an antipsychotic medication from the provider.
D. Dim the lights in the room to promote a calm environment.
Answer: B. Ask the client why they want to remove the IV and address their
concerns.
Rationale: The least restrictive intervention must be attempted first. The nurse
should attempt to de-escalate the situation by communicating with the client to
understand the cause of their agitation (e.g., pain, discomfort, fear). Restraints (A)
are a last resort and require a prescription. Medications (C) are not the first step.
Environmental changes (D) may help but do not address the root cause of the
behavior, which is the immediate priority.
2. A charge nurse is making assignments for a medical-surgical unit. Which
client should be assigned to the most experienced RN?
A. A client who is 2 days post-operative from a total hip replacement.
B. A client requiring a blood transfusion for symptomatic anemia.
C. A client with new-onset atrial fibrillation who is on a continuous telemetry
monitor.
D. A client being discharged home with a new colostomy.
Answer: C. A client with new-onset atrial fibrillation who is on a continuous
telemetry monitor.
Rationale: This client is the most unstable and at high risk for complications (e.g.,
stroke, hemodynamic instability), requiring advanced assessment skills and clinical
judgment. The client with a hip replacement (A) is a stable post-op client. The
,blood transfusion (B) requires an experienced nurse but is a standard procedure.
The discharge teaching (D) is important but can often be delegated to a licensed
practical nurse (LPN) or well-trained RN.
3. A nurse is preparing to delegate a task to an unlicensed assistive personnel
(UAP). Which of the following tasks is appropriate for the nurse to delegate?
A. Administering a tap-water enema.
B. Assessing a client's skin integrity.
C. Reinforcing teaching about a low-sodium diet.
D. Measuring a client's intake and output (I&O).
Answer: D. Measuring a client's intake and output (I&O).
Rationale: Measuring I&O is a non-invasive, standard task that falls within the
scope of practice for a UAP. Administering an enema (A) is an invasive procedure
typically not delegated to UAPs. Assessment (B) and teaching (C) are the legal
responsibilities of the RN and cannot be delegated.
4. A nurse is caring for a client who is a Jehovah's Witness and is refusing a
prescribed blood transfusion. The client is unconscious, and their spouse is
present. The spouse tells the nurse to "go ahead and give the blood." What
should the nurse do?
A. Administer the blood transfusion as prescribed by the provider.
B. Notify the provider and document the client's wishes and the spouse's request.
C. Contact the hospital ethics committee or legal counsel for guidance.
D. Ask the spouse to sign the informed consent form for the transfusion.
Answer: C. Contact the hospital ethics committee or legal counsel for
guidance.
Rationale: A competent adult has the right to refuse treatment, even life-saving
treatment. If the client has a prior documented advance directive refusing blood,
this must be honored. Without that, and with a surrogate decision-maker (spouse)
disagreeing with the client's known beliefs, the situation is an ethical dilemma
requiring consultation with the ethics committee to determine the best course of
action. The nurse should not administer the blood (A) against the client's known
beliefs. Notifying the provider (B) is part of the process but doesn't resolve the
conflict.
,5. A nurse is providing discharge teaching to a client. The client states, "I
don't understand how I'm supposed to give myself these shots." Which of the
following is the nurse's best response?
A. "Don't worry, you will get the hang of it after a few tries."
B. "I will show you the steps again and watch you do a return demonstration."
C. "I will have the home health nurse do it for you when you get home."
D. "You need to talk to your doctor about this if you are confused."
Answer: B. "I will show you the steps again and watch you do a return
demonstration."
Rationale: The nursing process requires evaluation of learning. A return
demonstration is the best way to confirm the client's understanding and ability to
perform a psychomotor skill. This is the safest and most effective teaching method.
A (false reassurance) and D (dismissing the question) are not therapeutic. C does
not promote client independence and is not appropriate as a first-line response.
6. A nurse receives a change-of-shift report on four clients. Which client
should the nurse assess first?
A. A client with a fractured femur who is reporting pain of 8 on a 0-10 scale.
B. A client with pneumonia who has an oxygen saturation of 91% on room air.
C. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL.
D. A client with an ileal conduit who has bright red urine in the collection bag.
Answer: B. A client with pneumonia who has an oxygen saturation of 91% on
room air.
Rationale: Using the ABCs (Airway, Breathing, Circulation), the client with a low
oxygen saturation (91%) is the most unstable and at immediate risk for respiratory
failure. While pain (A) is important, it is not life-threatening. A blood glucose of
180 mg/dL (C) is elevated but not an emergency. Bright red urine in an ileal
conduit (D) could indicate bleeding but is less immediately life-threatening than
hypoxia.
7. A nurse is caring for a client who is a member of a culture that values
traditional healing practices. The provider prescribes a treatment that
conflicts with the client's cultural beliefs. What is the nurse's best action?
A. Inform the provider of the client's beliefs and advocate for a culturally sensitive
alternative.
, B. Tell the client that the prescribed treatment is the best option for their health.
C. Instruct the client to discuss their concerns with the hospital chaplain.
D. Ask the family to convince the client to accept the treatment.
Answer: A. Inform the provider of the client's beliefs and advocate for a
culturally sensitive alternative.
Rationale: The nurse acts as a client advocate. The best action is to respectfully
communicate the client's cultural beliefs and concerns to the provider and explore
whether there are alternative treatments or a compromise that respects the client's
culture while still providing safe care. B, C, and D are paternalistic and do not
respect client autonomy or cultural values.
8. A nurse is delegating the task of ambulating a client who has a history of
falls to a UAP. Which statement by the nurse is most appropriate?
A. "Please ambulate the client in room 212."
B. "I need you to take the client for a walk down the hall."
C. "Please assist the client in room 212 to ambulate using a gait belt. Ensure the
client wears non-skid footwear, and stay with the client at all times."
D. "Please make sure the client doesn't fall when you take them for a walk."
Answer: C. "Please assist the client in room 212 to ambulate using a gait belt.
Ensure the client wears non-skid footwear, and stay with the client at all
times."
Rationale: This statement provides the "what, how, and why" and is specific,
clear, and includes safety parameters. It effectively communicates the task and the
standard of care. A and B are too vague and lack safety instructions. D is
unprofessional and focuses on the negative outcome without clear instructions.
9. A nurse is caring for a client who has a do-not-resuscitate (DNR) order. The
client's family member tells the nurse, "I want you to do everything you can to
save them." What is the nurse's best response?
A. "I understand you are concerned, but the DNR order means we cannot perform
CPR."
B. "I will call the provider and ask them to speak with you about the DNR order."
C. "You can override the DNR order if you want to."
D. "Don't worry, we will still give the client excellent care."
Questions, Comprehensive Review Guide,
Detailed Rationales, Verified Answers, Complete
Success Study Workbook
1. A nurse is caring for a client who is agitated and attempting to remove their
IV line. The client is not cooperating with care. Which of the following actions
should the nurse take first?
A. Apply soft wrist restraints to prevent the client from removing the IV.
B. Ask the client why they want to remove the IV and address their concerns.
C. Request a prescription for an antipsychotic medication from the provider.
D. Dim the lights in the room to promote a calm environment.
Answer: B. Ask the client why they want to remove the IV and address their
concerns.
Rationale: The least restrictive intervention must be attempted first. The nurse
should attempt to de-escalate the situation by communicating with the client to
understand the cause of their agitation (e.g., pain, discomfort, fear). Restraints (A)
are a last resort and require a prescription. Medications (C) are not the first step.
Environmental changes (D) may help but do not address the root cause of the
behavior, which is the immediate priority.
2. A charge nurse is making assignments for a medical-surgical unit. Which
client should be assigned to the most experienced RN?
A. A client who is 2 days post-operative from a total hip replacement.
B. A client requiring a blood transfusion for symptomatic anemia.
C. A client with new-onset atrial fibrillation who is on a continuous telemetry
monitor.
D. A client being discharged home with a new colostomy.
Answer: C. A client with new-onset atrial fibrillation who is on a continuous
telemetry monitor.
Rationale: This client is the most unstable and at high risk for complications (e.g.,
stroke, hemodynamic instability), requiring advanced assessment skills and clinical
judgment. The client with a hip replacement (A) is a stable post-op client. The
,blood transfusion (B) requires an experienced nurse but is a standard procedure.
The discharge teaching (D) is important but can often be delegated to a licensed
practical nurse (LPN) or well-trained RN.
3. A nurse is preparing to delegate a task to an unlicensed assistive personnel
(UAP). Which of the following tasks is appropriate for the nurse to delegate?
A. Administering a tap-water enema.
B. Assessing a client's skin integrity.
C. Reinforcing teaching about a low-sodium diet.
D. Measuring a client's intake and output (I&O).
Answer: D. Measuring a client's intake and output (I&O).
Rationale: Measuring I&O is a non-invasive, standard task that falls within the
scope of practice for a UAP. Administering an enema (A) is an invasive procedure
typically not delegated to UAPs. Assessment (B) and teaching (C) are the legal
responsibilities of the RN and cannot be delegated.
4. A nurse is caring for a client who is a Jehovah's Witness and is refusing a
prescribed blood transfusion. The client is unconscious, and their spouse is
present. The spouse tells the nurse to "go ahead and give the blood." What
should the nurse do?
A. Administer the blood transfusion as prescribed by the provider.
B. Notify the provider and document the client's wishes and the spouse's request.
C. Contact the hospital ethics committee or legal counsel for guidance.
D. Ask the spouse to sign the informed consent form for the transfusion.
Answer: C. Contact the hospital ethics committee or legal counsel for
guidance.
Rationale: A competent adult has the right to refuse treatment, even life-saving
treatment. If the client has a prior documented advance directive refusing blood,
this must be honored. Without that, and with a surrogate decision-maker (spouse)
disagreeing with the client's known beliefs, the situation is an ethical dilemma
requiring consultation with the ethics committee to determine the best course of
action. The nurse should not administer the blood (A) against the client's known
beliefs. Notifying the provider (B) is part of the process but doesn't resolve the
conflict.
,5. A nurse is providing discharge teaching to a client. The client states, "I
don't understand how I'm supposed to give myself these shots." Which of the
following is the nurse's best response?
A. "Don't worry, you will get the hang of it after a few tries."
B. "I will show you the steps again and watch you do a return demonstration."
C. "I will have the home health nurse do it for you when you get home."
D. "You need to talk to your doctor about this if you are confused."
Answer: B. "I will show you the steps again and watch you do a return
demonstration."
Rationale: The nursing process requires evaluation of learning. A return
demonstration is the best way to confirm the client's understanding and ability to
perform a psychomotor skill. This is the safest and most effective teaching method.
A (false reassurance) and D (dismissing the question) are not therapeutic. C does
not promote client independence and is not appropriate as a first-line response.
6. A nurse receives a change-of-shift report on four clients. Which client
should the nurse assess first?
A. A client with a fractured femur who is reporting pain of 8 on a 0-10 scale.
B. A client with pneumonia who has an oxygen saturation of 91% on room air.
C. A client with diabetes mellitus who has a blood glucose level of 180 mg/dL.
D. A client with an ileal conduit who has bright red urine in the collection bag.
Answer: B. A client with pneumonia who has an oxygen saturation of 91% on
room air.
Rationale: Using the ABCs (Airway, Breathing, Circulation), the client with a low
oxygen saturation (91%) is the most unstable and at immediate risk for respiratory
failure. While pain (A) is important, it is not life-threatening. A blood glucose of
180 mg/dL (C) is elevated but not an emergency. Bright red urine in an ileal
conduit (D) could indicate bleeding but is less immediately life-threatening than
hypoxia.
7. A nurse is caring for a client who is a member of a culture that values
traditional healing practices. The provider prescribes a treatment that
conflicts with the client's cultural beliefs. What is the nurse's best action?
A. Inform the provider of the client's beliefs and advocate for a culturally sensitive
alternative.
, B. Tell the client that the prescribed treatment is the best option for their health.
C. Instruct the client to discuss their concerns with the hospital chaplain.
D. Ask the family to convince the client to accept the treatment.
Answer: A. Inform the provider of the client's beliefs and advocate for a
culturally sensitive alternative.
Rationale: The nurse acts as a client advocate. The best action is to respectfully
communicate the client's cultural beliefs and concerns to the provider and explore
whether there are alternative treatments or a compromise that respects the client's
culture while still providing safe care. B, C, and D are paternalistic and do not
respect client autonomy or cultural values.
8. A nurse is delegating the task of ambulating a client who has a history of
falls to a UAP. Which statement by the nurse is most appropriate?
A. "Please ambulate the client in room 212."
B. "I need you to take the client for a walk down the hall."
C. "Please assist the client in room 212 to ambulate using a gait belt. Ensure the
client wears non-skid footwear, and stay with the client at all times."
D. "Please make sure the client doesn't fall when you take them for a walk."
Answer: C. "Please assist the client in room 212 to ambulate using a gait belt.
Ensure the client wears non-skid footwear, and stay with the client at all
times."
Rationale: This statement provides the "what, how, and why" and is specific,
clear, and includes safety parameters. It effectively communicates the task and the
standard of care. A and B are too vague and lack safety instructions. D is
unprofessional and focuses on the negative outcome without clear instructions.
9. A nurse is caring for a client who has a do-not-resuscitate (DNR) order. The
client's family member tells the nurse, "I want you to do everything you can to
save them." What is the nurse's best response?
A. "I understand you are concerned, but the DNR order means we cannot perform
CPR."
B. "I will call the provider and ask them to speak with you about the DNR order."
C. "You can override the DNR order if you want to."
D. "Don't worry, we will still give the client excellent care."
