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NCSBN-STYLE NCLEX-RN EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
NCSBN-STYLE NCLEX-RN PRACTICE EXAM (250 Questions with Detailed
Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
C. A client with heart failure who has crackles in the lung bases and is short of breath.
D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
Answer: C. Rationale: The client with heart failure who has crackles and is short of breath is
experiencing acute respiratory distress, which could indicate pulmonary edema—a life-
threatening emergency. This client should be assessed first. The potassium level of 5.2
mEq/L (D) is elevated but not critical (critical is >6.5). The blood glucose of 180 (A) is
elevated but not immediately life-threatening. The fever (B) is concerning but not the
priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
A. Administering a scheduled dose of oral metoprolol.
B. Assessing a client's surgical wound for signs of infection.
C. Assisting a client with a bed bath and providing oral care.
D. Interpreting a client's telemetry rhythm strip.
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Answer: C. Rationale: Assisting with a bed bath and providing oral care are tasks within the
scope of UAP. Administration of medications (A), wound assessment (B), and rhythm
interpretation (D) require the knowledge and judgment of a licensed nurse and cannot be
delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
A. Tremors and diaphoresis.
B. Nausea and vomiting.
C. Seizure activity and autonomic hyperactivity.
D. Insomnia and anxiety.
Answer: C. Rationale: Alcohol withdrawal can lead to seizures and autonomic hyperactivity
(tachycardia, hypertension, hyperthermia), which are life-threatening. Monitoring for these
signs is the highest priority. While tremors (A), nausea (B), and insomnia (D) are common
withdrawal symptoms, they are not as immediately life-threatening as seizures.
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Elevate the head of the bed to a high-Fowler's position.
C. Notify the healthcare provider immediately.
D. Assess the client's vital signs and oxygen saturation.
Answer: C. Rationale: Sudden shortness of breath and chest pain are classic symptoms of a
pulmonary embolism (PE), a life-threatening complication. The nurse should notify the
healthcare provider immediately while simultaneously initiating other interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
A. An Ambu bag and a suction catheter.
B. An obturator and a spare tracheostomy tube.
C. A sterile tracheostomy dressing and cleaning supplies.
D. A pulse oximeter and an oxygen saturation monitor.
Answer: B. Rationale: An obturator and a spare tracheostomy tube of the same size (or one
size smaller) must be kept at the bedside at all times to allow for immediate replacement if
the tube is accidentally dislodged—a life-threatening airway emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
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A. The client's serum potassium level increases to 4.5 mEq/L.
B. The client's urine output increases to 1,500 mL per 24 hours.
C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
D. The client's heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Furosemide is a loop diuretic that reduces fluid volume, which
subsequently decreases blood pressure and reduces the workload on the heart. A decrease in
blood pressure indicates a positive therapeutic response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Warfarin is an anticoagulant. Ibuprofen (an NSAID) increases the risk
of bleeding and should be avoided. Clients should use acetaminophen for pain instead.
Regular INR monitoring (A) is required. Vitamin K-rich foods (B) can interfere with
warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
A. Continue to monitor the client's vital signs.
B. Notify the healthcare provider immediately.
C. Administer a bolus of magnesium sulfate.
D. Document the finding as a normal response.
Answer: B. Rationale: Absent DTRs is a sign of magnesium toxicity. The antidote is calcium
gluconate. The nurse must notify the healthcare provider immediately so that the magnesium
sulfate can be discontinued and calcium gluconate can be administered.
9. The nurse is caring for a client who is receiving a blood transfusion. The client
complains of chills and lower back pain. What is the nurse's priority action?
A. Slow the rate of the transfusion.
B. Stop the transfusion and hang normal saline.
C. Administer an antihistamine.
D. Document the findings.
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Answer: B. Rationale: Chills and lower back pain are classic signs of a hemolytic transfusion
reaction. The priority is to stop the transfusion immediately to prevent further reaction,
maintain IV access with normal saline, and notify the provider.
10. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: The standard protocol is to hold digoxin and notify the healthcare
provider if the apical pulse is below 60 beats per minute (or per facility policy). Bradycardia
can be a sign of digoxin toxicity.
11. The charge nurse is making assignments for the shift. Which client should be
assigned to the most experienced registered nurse on the team?
A. A client with diabetes mellitus requiring daily insulin injections.
B. A client with pneumonia who needs IV antibiotics every 6 hours.
C. A client with a new tracheostomy who is unstable and requires frequent suctioning.
D. A client with a urinary tract infection who needs teaching about antibiotic therapy.
Answer: C. Rationale: The client with a new tracheostomy who is unstable requires the
highest level of nursing judgment and skill. The most unstable and complex client should be
assigned to the most experienced RN.
12. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client's oxygen saturation is 90%, but they appear
drowsy. What is the most important action for the nurse to take?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
C. Assess the client's arterial blood gases (ABGs).
D. Notify the healthcare provider immediately.
Answer: C. Rationale: In clients with COPD, the respiratory drive can be hypoxic.
Drowsiness can indicate carbon dioxide retention (hypercapnia). The priority is to assess the
client's ABGs before making changes to oxygen therapy.
NCSBN-STYLE NCLEX-RN EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
NCSBN-STYLE NCLEX-RN PRACTICE EXAM (250 Questions with Detailed
Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
C. A client with heart failure who has crackles in the lung bases and is short of breath.
D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
Answer: C. Rationale: The client with heart failure who has crackles and is short of breath is
experiencing acute respiratory distress, which could indicate pulmonary edema—a life-
threatening emergency. This client should be assessed first. The potassium level of 5.2
mEq/L (D) is elevated but not critical (critical is >6.5). The blood glucose of 180 (A) is
elevated but not immediately life-threatening. The fever (B) is concerning but not the
priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
A. Administering a scheduled dose of oral metoprolol.
B. Assessing a client's surgical wound for signs of infection.
C. Assisting a client with a bed bath and providing oral care.
D. Interpreting a client's telemetry rhythm strip.
, Page 2 of 58
Answer: C. Rationale: Assisting with a bed bath and providing oral care are tasks within the
scope of UAP. Administration of medications (A), wound assessment (B), and rhythm
interpretation (D) require the knowledge and judgment of a licensed nurse and cannot be
delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
A. Tremors and diaphoresis.
B. Nausea and vomiting.
C. Seizure activity and autonomic hyperactivity.
D. Insomnia and anxiety.
Answer: C. Rationale: Alcohol withdrawal can lead to seizures and autonomic hyperactivity
(tachycardia, hypertension, hyperthermia), which are life-threatening. Monitoring for these
signs is the highest priority. While tremors (A), nausea (B), and insomnia (D) are common
withdrawal symptoms, they are not as immediately life-threatening as seizures.
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Elevate the head of the bed to a high-Fowler's position.
C. Notify the healthcare provider immediately.
D. Assess the client's vital signs and oxygen saturation.
Answer: C. Rationale: Sudden shortness of breath and chest pain are classic symptoms of a
pulmonary embolism (PE), a life-threatening complication. The nurse should notify the
healthcare provider immediately while simultaneously initiating other interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
A. An Ambu bag and a suction catheter.
B. An obturator and a spare tracheostomy tube.
C. A sterile tracheostomy dressing and cleaning supplies.
D. A pulse oximeter and an oxygen saturation monitor.
Answer: B. Rationale: An obturator and a spare tracheostomy tube of the same size (or one
size smaller) must be kept at the bedside at all times to allow for immediate replacement if
the tube is accidentally dislodged—a life-threatening airway emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
, Page 3 of 58
A. The client's serum potassium level increases to 4.5 mEq/L.
B. The client's urine output increases to 1,500 mL per 24 hours.
C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
D. The client's heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Furosemide is a loop diuretic that reduces fluid volume, which
subsequently decreases blood pressure and reduces the workload on the heart. A decrease in
blood pressure indicates a positive therapeutic response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Warfarin is an anticoagulant. Ibuprofen (an NSAID) increases the risk
of bleeding and should be avoided. Clients should use acetaminophen for pain instead.
Regular INR monitoring (A) is required. Vitamin K-rich foods (B) can interfere with
warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
A. Continue to monitor the client's vital signs.
B. Notify the healthcare provider immediately.
C. Administer a bolus of magnesium sulfate.
D. Document the finding as a normal response.
Answer: B. Rationale: Absent DTRs is a sign of magnesium toxicity. The antidote is calcium
gluconate. The nurse must notify the healthcare provider immediately so that the magnesium
sulfate can be discontinued and calcium gluconate can be administered.
9. The nurse is caring for a client who is receiving a blood transfusion. The client
complains of chills and lower back pain. What is the nurse's priority action?
A. Slow the rate of the transfusion.
B. Stop the transfusion and hang normal saline.
C. Administer an antihistamine.
D. Document the findings.
, Page 4 of 58
Answer: B. Rationale: Chills and lower back pain are classic signs of a hemolytic transfusion
reaction. The priority is to stop the transfusion immediately to prevent further reaction,
maintain IV access with normal saline, and notify the provider.
10. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: The standard protocol is to hold digoxin and notify the healthcare
provider if the apical pulse is below 60 beats per minute (or per facility policy). Bradycardia
can be a sign of digoxin toxicity.
11. The charge nurse is making assignments for the shift. Which client should be
assigned to the most experienced registered nurse on the team?
A. A client with diabetes mellitus requiring daily insulin injections.
B. A client with pneumonia who needs IV antibiotics every 6 hours.
C. A client with a new tracheostomy who is unstable and requires frequent suctioning.
D. A client with a urinary tract infection who needs teaching about antibiotic therapy.
Answer: C. Rationale: The client with a new tracheostomy who is unstable requires the
highest level of nursing judgment and skill. The most unstable and complex client should be
assigned to the most experienced RN.
12. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client's oxygen saturation is 90%, but they appear
drowsy. What is the most important action for the nurse to take?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
C. Assess the client's arterial blood gases (ABGs).
D. Notify the healthcare provider immediately.
Answer: C. Rationale: In clients with COPD, the respiratory drive can be hypoxic.
Drowsiness can indicate carbon dioxide retention (hypercapnia). The priority is to assess the
client's ABGs before making changes to oxygen therapy.
