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HURST-STYLE NCLEX-PN EXAM 2026 QUESTIONS 2026 –
2027 LATEST VERSION SOLVED QUESTIONS &
ANSWERS
HURST-STYLE NCLEX-PN PRACTICE EXAM (250 Questions with Rationales)
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
• Answer: C. Rationale: The nursing process consists of Assessment, Diagnosis,
Planning, Implementation, and Evaluation. Assessment is the critical first step.
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.
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
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• 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 patient with chronic obstructive pulmonary disease (COPD) is experiencing
dyspnea. Which position should the nurse encourage to ease breathing?
• A. Supine
• B. High Fowler's
• C. Trendelenburg
• D. Prone
• Answer: B. Rationale: High Fowler's position allows maximum lung expansion
and eases breathing by using gravity to lower the diaphragm. Supine,
Trendelenburg, and prone positions would all impede diaphragm movement and
worsen dyspnea.
5. A client is prescribed digoxin. Which vital sign is most important to assess before
administration?
• A. Blood pressure
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• B. Temperature
• C. Apical pulse
• D. Respiratory rate
• Answer: C. Rationale: Digoxin can cause bradycardia. Assessing the apical
pulse for a full minute ensures the heart rate is safe for administration (typically
hold if <60 bpm). Blood pressure is also important but not the priority before
each dose.
6. Which lab value indicates an increased risk for bleeding in a patient taking
warfarin?
• A. INR 1.0
• B. INR 2.5
• C. INR 4.0
• D. INR 1.5
• Answer: C. Rationale: The therapeutic INR for most indications is 2–3. An INR of
4.0 indicates elevated bleeding risk and requires immediate intervention. An INR
of 1.0 or 1.5 is subtherapeutic.
7. A nurse is caring for a client with type 1 diabetes. Which sign indicates
hypoglycemia?
• A. Polyuria
• B. Tremors
• C. Hot, dry skin
• D. Fruity breath odor
• Answer: B. Rationale: Tremors, sweating, and confusion are classic signs of
hypoglycemia. Polyuria, hot/dry skin, and fruity breath (acetone) are signs of
hyperglycemia.
8. Which of the following is the priority nursing diagnosis for a patient with an acute
asthma attack?
• A. Risk for infection
• B. Impaired gas exchange
• C. Anxiety
• D. Activity intolerance
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• Answer: B. Rationale: During an acute asthma attack, the primary concern is
oxygenation and ventilation. Impaired gas exchange is the priority because it
addresses the life-threatening physiological need (ABCs) before psychosocial or
activity concerns.
9. Which nursing intervention is appropriate for a patient with a C. difficile
infection?
• A. Standard precautions
• B. Droplet precautions
• C. Contact precautions
• D. Airborne precautions
• Answer: C. Rationale: C. difficile spores are transmitted via contact with
contaminated surfaces or hands. Contact precautions (gown and gloves) and
strict hand hygiene with soap and water (not alcohol-based sanitizer) prevent
spread.
10. A patient is taking lithium. Which symptom indicates lithium toxicity?
• A. Polyuria
• B. Fine tremor
• C. Polydipsia
• D. Weight gain
• Answer: B. Rationale: Fine tremor is an early sign of lithium toxicity. Polyuria and
polydipsia are common side effects at therapeutic levels. Weight gain is also a
side effect but not indicative of toxicity. Severe toxicity presents with confusion,
ataxia, and seizures.
11. The nurse is caring for a client with heart failure. Which finding is the earliest
sign of left-sided heart failure?
• A. Peripheral edema
• B. Jugular venous distension
• C. Dyspnea on exertion
• D. Hepatomegaly
• Answer: C. Rationale: Left-sided heart failure causes pulmonary congestion.
Dyspnea on exertion is often the earliest symptom. Peripheral edema, JVD, and
hepatomegaly are signs of right-sided heart failure.
HURST-STYLE NCLEX-PN EXAM 2026 QUESTIONS 2026 –
2027 LATEST VERSION SOLVED QUESTIONS &
ANSWERS
HURST-STYLE NCLEX-PN PRACTICE EXAM (250 Questions with Rationales)
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
• Answer: C. Rationale: The nursing process consists of Assessment, Diagnosis,
Planning, Implementation, and Evaluation. Assessment is the critical first step.
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.
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
, Page 2 of 71
• 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 patient with chronic obstructive pulmonary disease (COPD) is experiencing
dyspnea. Which position should the nurse encourage to ease breathing?
• A. Supine
• B. High Fowler's
• C. Trendelenburg
• D. Prone
• Answer: B. Rationale: High Fowler's position allows maximum lung expansion
and eases breathing by using gravity to lower the diaphragm. Supine,
Trendelenburg, and prone positions would all impede diaphragm movement and
worsen dyspnea.
5. A client is prescribed digoxin. Which vital sign is most important to assess before
administration?
• A. Blood pressure
, Page 3 of 71
• B. Temperature
• C. Apical pulse
• D. Respiratory rate
• Answer: C. Rationale: Digoxin can cause bradycardia. Assessing the apical
pulse for a full minute ensures the heart rate is safe for administration (typically
hold if <60 bpm). Blood pressure is also important but not the priority before
each dose.
6. Which lab value indicates an increased risk for bleeding in a patient taking
warfarin?
• A. INR 1.0
• B. INR 2.5
• C. INR 4.0
• D. INR 1.5
• Answer: C. Rationale: The therapeutic INR for most indications is 2–3. An INR of
4.0 indicates elevated bleeding risk and requires immediate intervention. An INR
of 1.0 or 1.5 is subtherapeutic.
7. A nurse is caring for a client with type 1 diabetes. Which sign indicates
hypoglycemia?
• A. Polyuria
• B. Tremors
• C. Hot, dry skin
• D. Fruity breath odor
• Answer: B. Rationale: Tremors, sweating, and confusion are classic signs of
hypoglycemia. Polyuria, hot/dry skin, and fruity breath (acetone) are signs of
hyperglycemia.
8. Which of the following is the priority nursing diagnosis for a patient with an acute
asthma attack?
• A. Risk for infection
• B. Impaired gas exchange
• C. Anxiety
• D. Activity intolerance
, Page 4 of 71
• Answer: B. Rationale: During an acute asthma attack, the primary concern is
oxygenation and ventilation. Impaired gas exchange is the priority because it
addresses the life-threatening physiological need (ABCs) before psychosocial or
activity concerns.
9. Which nursing intervention is appropriate for a patient with a C. difficile
infection?
• A. Standard precautions
• B. Droplet precautions
• C. Contact precautions
• D. Airborne precautions
• Answer: C. Rationale: C. difficile spores are transmitted via contact with
contaminated surfaces or hands. Contact precautions (gown and gloves) and
strict hand hygiene with soap and water (not alcohol-based sanitizer) prevent
spread.
10. A patient is taking lithium. Which symptom indicates lithium toxicity?
• A. Polyuria
• B. Fine tremor
• C. Polydipsia
• D. Weight gain
• Answer: B. Rationale: Fine tremor is an early sign of lithium toxicity. Polyuria and
polydipsia are common side effects at therapeutic levels. Weight gain is also a
side effect but not indicative of toxicity. Severe toxicity presents with confusion,
ataxia, and seizures.
11. The nurse is caring for a client with heart failure. Which finding is the earliest
sign of left-sided heart failure?
• A. Peripheral edema
• B. Jugular venous distension
• C. Dyspnea on exertion
• D. Hepatomegaly
• Answer: C. Rationale: Left-sided heart failure causes pulmonary congestion.
Dyspnea on exertion is often the earliest symptom. Peripheral edema, JVD, and
hepatomegaly are signs of right-sided heart failure.
