NCLEX-RN COMPREHENSIVE PRACTICE
EXAMINATION 2026–2027 STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing graduates
preparing for the NCLEX-RN® licensure examination and for internationally
educated nurses seeking U.S. licensure. The 100-question test reflects the
integrated content and cognitive complexity of the current NCLEX-RN test plan,
including safe and effective care environment, health promotion and maintenance,
psychosocial integrity, and physiological integrity. Questions incorporate clinical
judgment, prioritization, delegation, pharmacology, management of care, and
patient safety across the lifespan. The 2026–2027 edition integrates the Next
Generation NCLEX (NGN) clinical judgment model, emphasizing recognition of
cues, analysis of data, hypothesis generation, and evaluation of outcomes. Use
this review to assess readiness, identify gaps, and strengthen critical thinking for
first-attempt success on the NCLEX-RN. Detailed rationales reinforce correct
answers and clarify distractors. This practice tool is intended for self-assessment
and review, not as a substitute for official NCLEX resources.
Table of Contents
I. Management of Care and Delegation
II. Safety and Infection Control
III. Health Promotion and Disease Prevention
IV. Psychosocial Integrity and Coping
V. Basic Care and Comfort
VI. Pharmacological and Parenteral Therapies
VII. Reduction of Risk Potential
VIII. Physiological Adaptation
IX. Next Generation NCLEX Clinical Judgment Scenarios
, 1. The nurse is caring for a client with acute pancreatitis who is NPO and
receiving IV fluids. Which laboratory result is the best indicator that the
client’s nutritional status is being maintained during the first 72 hours of
NPO status?
A) Serum prealbumin level
B) Blood glucose level
C) Serum amylase level
D) Serum lipase level
Correct Answer: A
Prealbumin has a short half-life (2–3 days) and reflects recent nutritional status
more accurately than albumin. Blood glucose (B) indicates glucose control, not
overall nutrition. Amylase (C) and lipase (D) are pancreatic enzymes used to
diagnose pancreatitis, not nutritional status.
2. A client is admitted with a diagnosis of bacterial meningitis. The nurse
should implement which type of isolation precautions in addition to
standard precautions?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective isolation
Correct Answer: B
Neisseria meningitidis and other bacterial meningitis pathogens are transmitted
via large respiratory droplets, requiring droplet precautions (mask within 3 feet).
Contact precautions (A) are for MRSA, VRE, and C. difficile. Airborne precautions
(C) are for tuberculosis, measles, and varicella. Protective isolation (D) is for
neutropenic clients.
3. The nurse is caring for a client in the emergency department with acute
chest pain. Which serum cardiac biomarker is most specific for myocardial
infarction within the first 3–6 hours?
A) Myoglobin
B) CK-MB
, C) Troponin I
D) C-reactive protein
Correct Answer: C
Cardiac troponin I is highly specific for myocardial necrosis and rises within 3–6
hours, remaining elevated for up to 10–14 days. Myoglobin (A) rises early but is
nonspecific. CK-MB (B) is less specific and rises within 4–6 hours. C-reactive protein
(D) is a nonspecific inflammatory marker.
4. The nurse is preparing to administer a unit of packed red blood cells to a
client with a hemoglobin of 7.0 g/dL. Which action is essential before
starting the transfusion?
A) Verify the blood product with another licensed nurse at the bedside
B) Administer a test dose of 10 mL and wait 1 hour
C) Premedicate with acetaminophen and diphenhydramine
D) Warm the blood to body temperature in a microwave
Correct Answer: A
Two licensed nurses must verify the blood product, patient identification, and
compatibility at the bedside to prevent transfusion reactions. A test dose (B) is not
required for blood. Premedication (C) may be ordered for prior reactions but not
routine. Blood should never be microwaved (D); only a blood warmer is used if
needed.
5. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L.
The nurse should prepare for which intervention first?
A) Administering sodium polystyrene sulfonate orally
B) Starting a continuous insulin and glucose infusion
C) Administering IV calcium gluconate
D) Preparing the client for hemodialysis
Correct Answer: C
Calcium gluconate is given first to stabilize the myocardium and prevent life-
threatening dysrhythmias, even though it does not lower potassium. Sodium
, polystyrene sulfonate (A) and insulin/glucose (B) lower potassium but take time.
Hemodialysis (D) is definitive but not the first emergency step.
6. The nurse is teaching a client with a new colostomy about skin care. Which
statement by the client indicates a need for further teaching?
A) “I will change the pouch when it is one-third to one-half full.”
B) “I should clean the skin around the stoma with mild soap and water.”
C) “I can apply lotion to the peristomal skin before applying the pouch.”
D) “I will measure the stoma each time I change the pouch.”
Correct Answer: C
Lotions, oils, and powders should not be used on peristomal skin because they
interfere with pouch adhesion. The other statements reflect correct colostomy
care.
7. The nurse is caring for a client receiving mechanical ventilation. The high-
pressure alarm sounds. Which action should the nurse take first?
A) Silence the alarm and call the respiratory therapist
B) Assess the client for breath sounds and suction the airway
C) Check the ventilator circuit for a disconnection
D) Increase the tidal volume setting
Correct Answer: B
The high-pressure alarm indicates increased airway resistance, often due to mucus
plugging, biting the tube, or kinking. The nurse should first assess the client,
auscultate breath sounds, and suction if needed. A disconnection (C) triggers a
low-pressure alarm. The nurse cannot increase tidal volume (D) without an order.
8. A client with a pulmonary embolism is receiving unfractionated heparin
intravenously. The aPTT is 42 seconds (therapeutic range 60–80 seconds).
The client is stable with no bleeding. What should the nurse do?
A) Continue the current rate and recheck aPTT in 6 hours
B) Increase the heparin rate per the nomogram and recheck aPTT
C) Stop the heparin and administer protamine sulfate
D) Administer vitamin K subcutaneously
EXAMINATION 2026–2027 STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing graduates
preparing for the NCLEX-RN® licensure examination and for internationally
educated nurses seeking U.S. licensure. The 100-question test reflects the
integrated content and cognitive complexity of the current NCLEX-RN test plan,
including safe and effective care environment, health promotion and maintenance,
psychosocial integrity, and physiological integrity. Questions incorporate clinical
judgment, prioritization, delegation, pharmacology, management of care, and
patient safety across the lifespan. The 2026–2027 edition integrates the Next
Generation NCLEX (NGN) clinical judgment model, emphasizing recognition of
cues, analysis of data, hypothesis generation, and evaluation of outcomes. Use
this review to assess readiness, identify gaps, and strengthen critical thinking for
first-attempt success on the NCLEX-RN. Detailed rationales reinforce correct
answers and clarify distractors. This practice tool is intended for self-assessment
and review, not as a substitute for official NCLEX resources.
Table of Contents
I. Management of Care and Delegation
II. Safety and Infection Control
III. Health Promotion and Disease Prevention
IV. Psychosocial Integrity and Coping
V. Basic Care and Comfort
VI. Pharmacological and Parenteral Therapies
VII. Reduction of Risk Potential
VIII. Physiological Adaptation
IX. Next Generation NCLEX Clinical Judgment Scenarios
, 1. The nurse is caring for a client with acute pancreatitis who is NPO and
receiving IV fluids. Which laboratory result is the best indicator that the
client’s nutritional status is being maintained during the first 72 hours of
NPO status?
A) Serum prealbumin level
B) Blood glucose level
C) Serum amylase level
D) Serum lipase level
Correct Answer: A
Prealbumin has a short half-life (2–3 days) and reflects recent nutritional status
more accurately than albumin. Blood glucose (B) indicates glucose control, not
overall nutrition. Amylase (C) and lipase (D) are pancreatic enzymes used to
diagnose pancreatitis, not nutritional status.
2. A client is admitted with a diagnosis of bacterial meningitis. The nurse
should implement which type of isolation precautions in addition to
standard precautions?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective isolation
Correct Answer: B
Neisseria meningitidis and other bacterial meningitis pathogens are transmitted
via large respiratory droplets, requiring droplet precautions (mask within 3 feet).
Contact precautions (A) are for MRSA, VRE, and C. difficile. Airborne precautions
(C) are for tuberculosis, measles, and varicella. Protective isolation (D) is for
neutropenic clients.
3. The nurse is caring for a client in the emergency department with acute
chest pain. Which serum cardiac biomarker is most specific for myocardial
infarction within the first 3–6 hours?
A) Myoglobin
B) CK-MB
, C) Troponin I
D) C-reactive protein
Correct Answer: C
Cardiac troponin I is highly specific for myocardial necrosis and rises within 3–6
hours, remaining elevated for up to 10–14 days. Myoglobin (A) rises early but is
nonspecific. CK-MB (B) is less specific and rises within 4–6 hours. C-reactive protein
(D) is a nonspecific inflammatory marker.
4. The nurse is preparing to administer a unit of packed red blood cells to a
client with a hemoglobin of 7.0 g/dL. Which action is essential before
starting the transfusion?
A) Verify the blood product with another licensed nurse at the bedside
B) Administer a test dose of 10 mL and wait 1 hour
C) Premedicate with acetaminophen and diphenhydramine
D) Warm the blood to body temperature in a microwave
Correct Answer: A
Two licensed nurses must verify the blood product, patient identification, and
compatibility at the bedside to prevent transfusion reactions. A test dose (B) is not
required for blood. Premedication (C) may be ordered for prior reactions but not
routine. Blood should never be microwaved (D); only a blood warmer is used if
needed.
5. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L.
The nurse should prepare for which intervention first?
A) Administering sodium polystyrene sulfonate orally
B) Starting a continuous insulin and glucose infusion
C) Administering IV calcium gluconate
D) Preparing the client for hemodialysis
Correct Answer: C
Calcium gluconate is given first to stabilize the myocardium and prevent life-
threatening dysrhythmias, even though it does not lower potassium. Sodium
, polystyrene sulfonate (A) and insulin/glucose (B) lower potassium but take time.
Hemodialysis (D) is definitive but not the first emergency step.
6. The nurse is teaching a client with a new colostomy about skin care. Which
statement by the client indicates a need for further teaching?
A) “I will change the pouch when it is one-third to one-half full.”
B) “I should clean the skin around the stoma with mild soap and water.”
C) “I can apply lotion to the peristomal skin before applying the pouch.”
D) “I will measure the stoma each time I change the pouch.”
Correct Answer: C
Lotions, oils, and powders should not be used on peristomal skin because they
interfere with pouch adhesion. The other statements reflect correct colostomy
care.
7. The nurse is caring for a client receiving mechanical ventilation. The high-
pressure alarm sounds. Which action should the nurse take first?
A) Silence the alarm and call the respiratory therapist
B) Assess the client for breath sounds and suction the airway
C) Check the ventilator circuit for a disconnection
D) Increase the tidal volume setting
Correct Answer: B
The high-pressure alarm indicates increased airway resistance, often due to mucus
plugging, biting the tube, or kinking. The nurse should first assess the client,
auscultate breath sounds, and suction if needed. A disconnection (C) triggers a
low-pressure alarm. The nurse cannot increase tidal volume (D) without an order.
8. A client with a pulmonary embolism is receiving unfractionated heparin
intravenously. The aPTT is 42 seconds (therapeutic range 60–80 seconds).
The client is stable with no bleeding. What should the nurse do?
A) Continue the current rate and recheck aPTT in 6 hours
B) Increase the heparin rate per the nomogram and recheck aPTT
C) Stop the heparin and administer protamine sulfate
D) Administer vitamin K subcutaneously
