Page 1 of 70
HURST-STYLE NCLEX-RN PRACTICE EXAM 2026
QUESTIONS 2026 – 2027 LATEST VERSION SOLVED
QUESTIONS & ANSWERS
HURST REVIEW PHILOSOPHY
The Hurst Review emphasizes:
• "What the NCLEX Lady Thinks" — understanding the motivation behind
questions
• Critical thinking over cramming — working with the NCLEX's "think-on-your-
feet" philosophy
• The nursing process as the foundation for clinical decision-making
• Prioritization using Maslow's hierarchy and the ABCs
• Application of knowledge to real-world nursing scenarios
10-Point Summary of Hurst-Style NCLEX-RN Exam Coverage
1. The Nursing Process & Critical Thinking: Assessment, Diagnosis, Planning,
Implementation, Evaluation—knowing which step is priority and how to apply it
in complex scenarios.
2. Prioritization & Delegation: Maslow's hierarchy, ABCs (Airway, Breathing,
Circulation), acute vs. chronic, and knowing which tasks can be delegated to
UAP, LPN, and which are RN-only.
3. Pharmacology & Medication Administration: Mechanism of action, side
effects, adverse reactions, contraindications, interactions, and client teaching
for major drug classes.
4. Fluid & Electrolyte Balance: Recognizing imbalances, interpreting lab values,
implementing interventions, and monitoring for complications.
, Page 2 of 70
5. Cardiovascular & Respiratory Disorders: Heart failure, MI, hypertension,
dysrhythmias, COPD, asthma, pneumonia, TB—pathophysiology, assessment,
interventions, and complications.
6. Endocrine & Metabolic Disorders: Diabetes (DKA, HHS, hypoglycemia), thyroid
disorders, adrenal disorders—signs, symptoms, management, and client
education.
7. Gastrointestinal & Renal Disorders: Liver disease, pancreatitis, diverticulitis,
kidney disease, dialysis—assessment, interventions, and dietary management.
8. Neurological & Musculoskeletal Disorders: Stroke, seizures, head injuries,
meningitis, fractures, joint replacements—assessment, interventions, and
complications.
9. Maternal-Newborn, Pediatric, & Mental Health: Labor and delivery,
postpartum, newborn assessment, growth and development, common pediatric
conditions, therapeutic communication, psychopharmacology, and crisis
intervention.
10. Infection Control, Safety, & Emergency Preparedness: Transmission-based
precautions, sterile technique, fall prevention, disaster planning, and emergency
response.
HURST-STYLE NCLEX-RN PRACTICE EXAM (250 Questions with Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. A nurse is caring for a patient with chronic heart failure who is very ill. The patient
has a documented "do not resuscitate" (DNR) order. The patient goes into
ventricular fibrillation and the nurse defibrillates the patient, stating she was
unaware of the DNR order. What part of the nursing process did the nurse fail to
perform?
• A. Planning
• B. Evaluation
• C. Assessment
• D. Implementation
, Page 3 of 70
• Answer: C. Rationale: Assessment is the critical first step of the nursing
process. The nurse failed to assess the patient's chart for code status before the
patient arrested. Proper assessment would have revealed the DNR order and
prevented the unwanted resuscitation. This question highlights the priority of
assessment before action—a key Hurst principle.
2. On the morning laboratory report, a patient's potassium is noted to be 2.5 mEq/L
(critical low). The nurse does not want to "bother the physician this early." During
the change-of-shift report, the patient develops ventricular tachycardia and has to
be resuscitated. What part of the nursing process did the nurse fail to perform?
• A. Evaluation
• B. Implementation
• C. Assessment
• D. Planning
• Answer: B. Rationale: Implementation is the phase where the nurse carries out
planned interventions. After assessing the critical lab value (hypokalemia), the
nurse should have implemented the plan of care by notifying the healthcare
provider. Failure to implement this action led to a negative patient outcome.
3. A patient in the critical care unit has an order to be transported off the unit for a
diagnostic procedure. The nurse fails to ensure the patient is properly monitored
during transport, and the patient experiences a cardiac arrest. Which action did the
nurse fail to adequately perform?
• A. Make the proper nursing diagnosis.
• B. Assess and analyze the level of care needed by the patient.
• C. Act as a patient advocate to postpone the examination.
• D. Communicate findings in a timely manner.
• Answer: B. Rationale: The nurse's primary duty is to ensure patient safety. This
requires assessing the patient's stability and analyzing the level of care (e.g.,
need for monitoring, oxygen, a nurse versus a tech) required during transport.
The failure was in this critical assessment and analysis step.
4. A charge nurse is assigning client care 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.
, Page 4 of 70
• 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. According to the
principles of delegation and prioritization, the most unstable and complex client
should be assigned to the most experienced RN.
5. A 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 medication.
• B. Assessing a client's surgical wound for signs of infection.
• C. Assisting a client with ambulation and providing a bedpan.
• D. Interpreting a client's cardiac rhythm strip.
• Answer: C. Rationale: Assisting with ambulation and providing a bedpan are
tasks within the scope of UAP. Administration of medications, wound
assessment, and rhythm interpretation require the knowledge and judgment of a
licensed nurse and cannot be delegated.
6. A nurse is preparing to administer a blood transfusion to a client. The client's
identification band is missing. What is the most appropriate nursing action?
• A. Ask the client to state their name and date of birth to verify identity.
• B. Use the client's room number and bed number as identification.
• C. Request a new identification band from the admitting office before
proceeding.
• D. Proceed with the transfusion using the client's chart for identification.
• Answer: C. Rationale: Patient safety is paramount. The two-patient identifier
policy requires matching the blood product to the client's identification band. If
the band is missing, a new one must be obtained before the transfusion. This
prevents the potentially fatal error of transfusing the wrong blood type.
7. A nurse is caring for a client who has a continuous epidural infusion for
postoperative pain management. What is the most important piece of emergency
equipment the nurse should have available at the client's bedside?
• A. A pulse oximeter and oxygen saturation monitor.
HURST-STYLE NCLEX-RN PRACTICE EXAM 2026
QUESTIONS 2026 – 2027 LATEST VERSION SOLVED
QUESTIONS & ANSWERS
HURST REVIEW PHILOSOPHY
The Hurst Review emphasizes:
• "What the NCLEX Lady Thinks" — understanding the motivation behind
questions
• Critical thinking over cramming — working with the NCLEX's "think-on-your-
feet" philosophy
• The nursing process as the foundation for clinical decision-making
• Prioritization using Maslow's hierarchy and the ABCs
• Application of knowledge to real-world nursing scenarios
10-Point Summary of Hurst-Style NCLEX-RN Exam Coverage
1. The Nursing Process & Critical Thinking: Assessment, Diagnosis, Planning,
Implementation, Evaluation—knowing which step is priority and how to apply it
in complex scenarios.
2. Prioritization & Delegation: Maslow's hierarchy, ABCs (Airway, Breathing,
Circulation), acute vs. chronic, and knowing which tasks can be delegated to
UAP, LPN, and which are RN-only.
3. Pharmacology & Medication Administration: Mechanism of action, side
effects, adverse reactions, contraindications, interactions, and client teaching
for major drug classes.
4. Fluid & Electrolyte Balance: Recognizing imbalances, interpreting lab values,
implementing interventions, and monitoring for complications.
, Page 2 of 70
5. Cardiovascular & Respiratory Disorders: Heart failure, MI, hypertension,
dysrhythmias, COPD, asthma, pneumonia, TB—pathophysiology, assessment,
interventions, and complications.
6. Endocrine & Metabolic Disorders: Diabetes (DKA, HHS, hypoglycemia), thyroid
disorders, adrenal disorders—signs, symptoms, management, and client
education.
7. Gastrointestinal & Renal Disorders: Liver disease, pancreatitis, diverticulitis,
kidney disease, dialysis—assessment, interventions, and dietary management.
8. Neurological & Musculoskeletal Disorders: Stroke, seizures, head injuries,
meningitis, fractures, joint replacements—assessment, interventions, and
complications.
9. Maternal-Newborn, Pediatric, & Mental Health: Labor and delivery,
postpartum, newborn assessment, growth and development, common pediatric
conditions, therapeutic communication, psychopharmacology, and crisis
intervention.
10. Infection Control, Safety, & Emergency Preparedness: Transmission-based
precautions, sterile technique, fall prevention, disaster planning, and emergency
response.
HURST-STYLE NCLEX-RN PRACTICE EXAM (250 Questions with Rationales)
Category 1: Safe and Effective Care Environment (Questions 1-25)
1. A nurse is caring for a patient with chronic heart failure who is very ill. The patient
has a documented "do not resuscitate" (DNR) order. The patient goes into
ventricular fibrillation and the nurse defibrillates the patient, stating she was
unaware of the DNR order. What part of the nursing process did the nurse fail to
perform?
• A. Planning
• B. Evaluation
• C. Assessment
• D. Implementation
, Page 3 of 70
• Answer: C. Rationale: Assessment is the critical first step of the nursing
process. The nurse failed to assess the patient's chart for code status before the
patient arrested. Proper assessment would have revealed the DNR order and
prevented the unwanted resuscitation. This question highlights the priority of
assessment before action—a key Hurst principle.
2. On the morning laboratory report, a patient's potassium is noted to be 2.5 mEq/L
(critical low). The nurse does not want to "bother the physician this early." During
the change-of-shift report, the patient develops ventricular tachycardia and has to
be resuscitated. What part of the nursing process did the nurse fail to perform?
• A. Evaluation
• B. Implementation
• C. Assessment
• D. Planning
• Answer: B. Rationale: Implementation is the phase where the nurse carries out
planned interventions. After assessing the critical lab value (hypokalemia), the
nurse should have implemented the plan of care by notifying the healthcare
provider. Failure to implement this action led to a negative patient outcome.
3. A patient in the critical care unit has an order to be transported off the unit for a
diagnostic procedure. The nurse fails to ensure the patient is properly monitored
during transport, and the patient experiences a cardiac arrest. Which action did the
nurse fail to adequately perform?
• A. Make the proper nursing diagnosis.
• B. Assess and analyze the level of care needed by the patient.
• C. Act as a patient advocate to postpone the examination.
• D. Communicate findings in a timely manner.
• Answer: B. Rationale: The nurse's primary duty is to ensure patient safety. This
requires assessing the patient's stability and analyzing the level of care (e.g.,
need for monitoring, oxygen, a nurse versus a tech) required during transport.
The failure was in this critical assessment and analysis step.
4. A charge nurse is assigning client care 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.
, Page 4 of 70
• 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. According to the
principles of delegation and prioritization, the most unstable and complex client
should be assigned to the most experienced RN.
5. A 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 medication.
• B. Assessing a client's surgical wound for signs of infection.
• C. Assisting a client with ambulation and providing a bedpan.
• D. Interpreting a client's cardiac rhythm strip.
• Answer: C. Rationale: Assisting with ambulation and providing a bedpan are
tasks within the scope of UAP. Administration of medications, wound
assessment, and rhythm interpretation require the knowledge and judgment of a
licensed nurse and cannot be delegated.
6. A nurse is preparing to administer a blood transfusion to a client. The client's
identification band is missing. What is the most appropriate nursing action?
• A. Ask the client to state their name and date of birth to verify identity.
• B. Use the client's room number and bed number as identification.
• C. Request a new identification band from the admitting office before
proceeding.
• D. Proceed with the transfusion using the client's chart for identification.
• Answer: C. Rationale: Patient safety is paramount. The two-patient identifier
policy requires matching the blood product to the client's identification band. If
the band is missing, a new one must be obtained before the transfusion. This
prevents the potentially fatal error of transfusing the wrong blood type.
7. A nurse is caring for a client who has a continuous epidural infusion for
postoperative pain management. What is the most important piece of emergency
equipment the nurse should have available at the client's bedside?
• A. A pulse oximeter and oxygen saturation monitor.
