NCLEX-RN COMPREHENSIVE PRACTICE
EXAMINATION 2026–2027 — NGN & CLINICAL
JUDGMENT 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 with emphasis on the Next
Generation NCLEX (NGN) clinical judgment model and integrated nursing content.
The 100-question test reflects the current NCLEX-RN test plan, including safe and
effective care environment, health promotion, psychosocial integrity, and
physiological integrity. Questions are written at the application, analysis, and
evaluation levels, requiring recognition of cues, analysis of data, hypothesis
generation, prioritization, delegation, and evaluation of outcomes. The 2026–2027
edition incorporates unfolding case studies, laboratory interpretation, medication
safety, and patient-centered care scenarios across the lifespan. Use this review to
assess readiness, identify knowledge gaps, and strengthen critical thinking for
first-attempt success on the NCLEX-RN. Detailed rationales clarify correct answers
and distractors. This practice tool is intended for self-assessment and review, not
as a substitute for official NCLEX resources.
Table of Contents
I. Safe and Effective Care Environment
II. Health Promotion and Maintenance
III. Psychosocial Integrity and Coping
IV. Basic Care and Comfort
V. Pharmacological and Parenteral Therapies
VI. Reduction of Risk Potential
VII. Physiological Adaptation and Complex Care
VIII. Next Generation NCLEX Clinical Judgment Scenarios
, 1. A nurse is reviewing the laboratory results for a client with chronic kidney
disease. Which finding requires immediate intervention?
A) Serum creatinine 2.5 mg/dL
B) Serum potassium 6.8 mEq/L
C) Serum calcium 8.5 mg/dL
D) Hemoglobin 10 g/dL
Correct Answer: B
A serum potassium of 6.8 mEq/L indicates severe hyperkalemia, which can cause
life-threatening cardiac dysrhythmias. The nurse should immediately notify the
provider and prepare for treatment. The other values are abnormal but not
immediately life-threatening.
2. A client with acute pancreatitis is NPO and receiving IV fluids. Which
laboratory finding is the best indicator of improving nutritional status over
the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a level of 22
mg/dL indicates adequate protein synthesis. Amylase and lipase are pancreatic
enzymes reflecting inflammation, not nutrition. Blood glucose indicates glucose
control, not overall nutrition.
3. A nurse is caring for a client with a traumatic brain injury. The client's
intracranial pressure (ICP) is 22 mm Hg and cerebral perfusion pressure
(CPP) is 58 mm Hg. What is the priority action?
A) Elevate the head of the bed to 60 degrees
B) Notify the provider and prepare to administer mannitol
C) Suction the client vigorously
D) Place the client in a supine position
,Correct Answer: B
ICP >20 mm Hg and CPP <60 mm Hg indicate inadequate cerebral perfusion and
increased intracranial pressure. The provider must be notified, and mannitol may
be ordered to reduce ICP. Head of bed should be elevated 30 degrees, not 60.
Suctioning and supine positioning increase ICP.
4. A client receiving a continuous heparin infusion has an aPTT of 105 seconds
(therapeutic range 60–80 seconds). The client has no bleeding. What should
the nurse do?
A) Stop the infusion and administer protamine sulfate
B) Continue the current rate and recheck aPTT in 6 hours
C) Decrease the infusion rate per protocol and recheck aPTT in 6 hours
D) Administer vitamin K subcutaneously
Correct Answer: C
A supratherapeutic aPTT without bleeding requires a rate reduction per protocol.
Protamine is reserved for severe bleeding. Vitamin K reverses warfarin, not
heparin. Continuing the current rate increases bleeding risk.
5. A client with major depressive disorder suddenly becomes more energetic,
gives away possessions, and states, “I have a plan to end my pain.” What is
the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; ensuring safety through continuous observation is the
immediate priority. A no-suicide contract does not replace direct supervision.
Group therapy and anxiolytics do not address acute risk.
6. A nurse is teaching a client with Ménière’s disease about dietary
modifications. Which statement indicates a need for further teaching?
, A) “I will distribute my fluid intake evenly throughout the day.”
B) “I will limit my intake of canned soups and processed meats.”
C) “I can drink coffee in the morning as long as I reduce salt.”
D) “I need to avoid alcohol and tobacco to help reduce vertigo attacks.”
Correct Answer: C
Caffeine is a stimulant that can exacerbate tinnitus and vertigo in Ménière’s
disease and should be avoided, not compensated by salt reduction. Even fluid
distribution, low-sodium diet, and avoiding alcohol/tobacco are appropriate
recommendations.
7. A nurse is caring for a client 12 hours after a laparoscopic cholecystectomy.
The client reports sudden, severe right shoulder pain rated 8/10. Vital signs
are stable, and the abdomen is soft and non-distended. What is the priority
nursing action?
A) Notify the surgeon immediately for suspected bile leak
B) Administer the prescribed opioid analgesic
C) Apply a heating pad and reposition the client
D) Explain that referred phrenic nerve irritation from CO₂ insufflation is
likely
Correct Answer: D
Post-laparoscopic shoulder pain is most often due to diaphragmatic irritation from
residual carbon dioxide, referring pain via the phrenic nerve. Explanation and
repositioning are appropriate first actions. A bile leak would present with
abdominal pain and peritonitis, not isolated shoulder pain with a benign
abdominal exam.
8. A client with chronic kidney disease stage 4 has a serum potassium of 6.8
mEq/L. The nurse administers intravenous calcium gluconate as prescribed.
What is the primary rationale?
A) Shift potassium intracellularly
B) Prevent ventricular dysrhythmias by antagonizing cardiac membrane
effects
EXAMINATION 2026–2027 — NGN & CLINICAL
JUDGMENT 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 with emphasis on the Next
Generation NCLEX (NGN) clinical judgment model and integrated nursing content.
The 100-question test reflects the current NCLEX-RN test plan, including safe and
effective care environment, health promotion, psychosocial integrity, and
physiological integrity. Questions are written at the application, analysis, and
evaluation levels, requiring recognition of cues, analysis of data, hypothesis
generation, prioritization, delegation, and evaluation of outcomes. The 2026–2027
edition incorporates unfolding case studies, laboratory interpretation, medication
safety, and patient-centered care scenarios across the lifespan. Use this review to
assess readiness, identify knowledge gaps, and strengthen critical thinking for
first-attempt success on the NCLEX-RN. Detailed rationales clarify correct answers
and distractors. This practice tool is intended for self-assessment and review, not
as a substitute for official NCLEX resources.
Table of Contents
I. Safe and Effective Care Environment
II. Health Promotion and Maintenance
III. Psychosocial Integrity and Coping
IV. Basic Care and Comfort
V. Pharmacological and Parenteral Therapies
VI. Reduction of Risk Potential
VII. Physiological Adaptation and Complex Care
VIII. Next Generation NCLEX Clinical Judgment Scenarios
, 1. A nurse is reviewing the laboratory results for a client with chronic kidney
disease. Which finding requires immediate intervention?
A) Serum creatinine 2.5 mg/dL
B) Serum potassium 6.8 mEq/L
C) Serum calcium 8.5 mg/dL
D) Hemoglobin 10 g/dL
Correct Answer: B
A serum potassium of 6.8 mEq/L indicates severe hyperkalemia, which can cause
life-threatening cardiac dysrhythmias. The nurse should immediately notify the
provider and prepare for treatment. The other values are abnormal but not
immediately life-threatening.
2. A client with acute pancreatitis is NPO and receiving IV fluids. Which
laboratory finding is the best indicator of improving nutritional status over
the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a level of 22
mg/dL indicates adequate protein synthesis. Amylase and lipase are pancreatic
enzymes reflecting inflammation, not nutrition. Blood glucose indicates glucose
control, not overall nutrition.
3. A nurse is caring for a client with a traumatic brain injury. The client's
intracranial pressure (ICP) is 22 mm Hg and cerebral perfusion pressure
(CPP) is 58 mm Hg. What is the priority action?
A) Elevate the head of the bed to 60 degrees
B) Notify the provider and prepare to administer mannitol
C) Suction the client vigorously
D) Place the client in a supine position
,Correct Answer: B
ICP >20 mm Hg and CPP <60 mm Hg indicate inadequate cerebral perfusion and
increased intracranial pressure. The provider must be notified, and mannitol may
be ordered to reduce ICP. Head of bed should be elevated 30 degrees, not 60.
Suctioning and supine positioning increase ICP.
4. A client receiving a continuous heparin infusion has an aPTT of 105 seconds
(therapeutic range 60–80 seconds). The client has no bleeding. What should
the nurse do?
A) Stop the infusion and administer protamine sulfate
B) Continue the current rate and recheck aPTT in 6 hours
C) Decrease the infusion rate per protocol and recheck aPTT in 6 hours
D) Administer vitamin K subcutaneously
Correct Answer: C
A supratherapeutic aPTT without bleeding requires a rate reduction per protocol.
Protamine is reserved for severe bleeding. Vitamin K reverses warfarin, not
heparin. Continuing the current rate increases bleeding risk.
5. A client with major depressive disorder suddenly becomes more energetic,
gives away possessions, and states, “I have a plan to end my pain.” What is
the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; ensuring safety through continuous observation is the
immediate priority. A no-suicide contract does not replace direct supervision.
Group therapy and anxiolytics do not address acute risk.
6. A nurse is teaching a client with Ménière’s disease about dietary
modifications. Which statement indicates a need for further teaching?
, A) “I will distribute my fluid intake evenly throughout the day.”
B) “I will limit my intake of canned soups and processed meats.”
C) “I can drink coffee in the morning as long as I reduce salt.”
D) “I need to avoid alcohol and tobacco to help reduce vertigo attacks.”
Correct Answer: C
Caffeine is a stimulant that can exacerbate tinnitus and vertigo in Ménière’s
disease and should be avoided, not compensated by salt reduction. Even fluid
distribution, low-sodium diet, and avoiding alcohol/tobacco are appropriate
recommendations.
7. A nurse is caring for a client 12 hours after a laparoscopic cholecystectomy.
The client reports sudden, severe right shoulder pain rated 8/10. Vital signs
are stable, and the abdomen is soft and non-distended. What is the priority
nursing action?
A) Notify the surgeon immediately for suspected bile leak
B) Administer the prescribed opioid analgesic
C) Apply a heating pad and reposition the client
D) Explain that referred phrenic nerve irritation from CO₂ insufflation is
likely
Correct Answer: D
Post-laparoscopic shoulder pain is most often due to diaphragmatic irritation from
residual carbon dioxide, referring pain via the phrenic nerve. Explanation and
repositioning are appropriate first actions. A bile leak would present with
abdominal pain and peritonitis, not isolated shoulder pain with a benign
abdominal exam.
8. A client with chronic kidney disease stage 4 has a serum potassium of 6.8
mEq/L. The nurse administers intravenous calcium gluconate as prescribed.
What is the primary rationale?
A) Shift potassium intracellularly
B) Prevent ventricular dysrhythmias by antagonizing cardiac membrane
effects
