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KAPLAN-STYLE NCLEX-RN EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
Decision Tree Strategy: A systematic approach to answering NCLEX questions
"Who is the client?" — Identifying the client at risk
"What is the problem?" — Pinpointing the core issue
"What are the options?" — Evaluating each answer choice
"Does it address the problem?" — Selecting the best intervention
Focus on "First, Best, Most" — Prioritization questions
KAPLAN-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: Decision Tree: Who is the client? The client with heart
failure. What is the problem? Acute respiratory distress (crackles and shortness of
breath). Does it address the problem? This is a life-threatening emergency (pulmonary
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edema). The client with a potassium of 5.2 (D) is elevated but not critical (>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.
Answer: C. Rationale: Decision Tree: Who is the client? The client requiring basic
care. What is the problem? Need for hygiene assistance. Does it address the
problem? Assisting with a bed bath and oral care are within the UAP scope of practice.
Administration of medications (A), wound assessment (B), and rhythm interpretation (D)
require nursing judgment.
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: Decision Tree: Who is the client? The client in alcohol
withdrawal. What is the problem? Risk of seizures and autonomic hyperactivity. Does it
address the problem? Seizures are life-threatening. Tremors (A), nausea (B), and insomnia
(D) are common but not immediately life-threatening.
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.
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Answer: C. Rationale: Decision Tree: Who is the client? A post-operative client. What is
the problem? Sudden SOB and chest pain. Does it address the problem? These are classic
signs of a pulmonary embolism. The provider must be notified immediately for diagnosis and
treatment.
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: Decision Tree: Who is the client? A client with a new
tracheostomy. What is the problem? Risk of accidental decannulation. Does it address the
problem? An obturator and spare tracheostomy tube allow immediate replacement if the tube
is dislodged.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
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: Decision Tree: Who is the client? A client with heart failure. What
is the problem? Fluid overload. Does it address the problem? Furosemide reduces fluid
volume, decreasing blood pressure and workload on the heart.
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: Decision Tree: Who is the client? A client on warfarin. What is the
problem? Risk of bleeding. Does it address the problem? Ibuprofen (NSAID) increases
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bleeding risk and should be avoided. Regular INR (A), consistent vitamin K intake (B), and
reporting bleeding (D) are correct.
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: Decision Tree: Who is the client? A client with preeclampsia on
magnesium sulfate. What is the problem? Absent DTRs indicate magnesium toxicity. Does
it address the problem? The provider must be notified immediately so magnesium can be
discontinued and calcium gluconate 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.
Answer: B. Rationale: Decision Tree: Who is the client? A client receiving a blood
transfusion. What is the problem? Chills and back pain indicate a hemolytic transfusion
reaction. Does it address the problem? The transfusion must be stopped immediately to
prevent further reaction.
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.
KAPLAN-STYLE NCLEX-RN EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
Decision Tree Strategy: A systematic approach to answering NCLEX questions
"Who is the client?" — Identifying the client at risk
"What is the problem?" — Pinpointing the core issue
"What are the options?" — Evaluating each answer choice
"Does it address the problem?" — Selecting the best intervention
Focus on "First, Best, Most" — Prioritization questions
KAPLAN-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: Decision Tree: Who is the client? The client with heart
failure. What is the problem? Acute respiratory distress (crackles and shortness of
breath). Does it address the problem? This is a life-threatening emergency (pulmonary
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edema). The client with a potassium of 5.2 (D) is elevated but not critical (>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.
Answer: C. Rationale: Decision Tree: Who is the client? The client requiring basic
care. What is the problem? Need for hygiene assistance. Does it address the
problem? Assisting with a bed bath and oral care are within the UAP scope of practice.
Administration of medications (A), wound assessment (B), and rhythm interpretation (D)
require nursing judgment.
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: Decision Tree: Who is the client? The client in alcohol
withdrawal. What is the problem? Risk of seizures and autonomic hyperactivity. Does it
address the problem? Seizures are life-threatening. Tremors (A), nausea (B), and insomnia
(D) are common but not immediately life-threatening.
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.
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Answer: C. Rationale: Decision Tree: Who is the client? A post-operative client. What is
the problem? Sudden SOB and chest pain. Does it address the problem? These are classic
signs of a pulmonary embolism. The provider must be notified immediately for diagnosis and
treatment.
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: Decision Tree: Who is the client? A client with a new
tracheostomy. What is the problem? Risk of accidental decannulation. Does it address the
problem? An obturator and spare tracheostomy tube allow immediate replacement if the tube
is dislodged.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
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: Decision Tree: Who is the client? A client with heart failure. What
is the problem? Fluid overload. Does it address the problem? Furosemide reduces fluid
volume, decreasing blood pressure and workload on the heart.
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: Decision Tree: Who is the client? A client on warfarin. What is the
problem? Risk of bleeding. Does it address the problem? Ibuprofen (NSAID) increases
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bleeding risk and should be avoided. Regular INR (A), consistent vitamin K intake (B), and
reporting bleeding (D) are correct.
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: Decision Tree: Who is the client? A client with preeclampsia on
magnesium sulfate. What is the problem? Absent DTRs indicate magnesium toxicity. Does
it address the problem? The provider must be notified immediately so magnesium can be
discontinued and calcium gluconate 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.
Answer: B. Rationale: Decision Tree: Who is the client? A client receiving a blood
transfusion. What is the problem? Chills and back pain indicate a hemolytic transfusion
reaction. Does it address the problem? The transfusion must be stopped immediately to
prevent further reaction.
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.
