NCLEX-RN 2026 Practice Questions and Answers with
Detailed Rationales – Next Generation NCLEX Review
1. Priority Assessment
A nurse receives report on four clients. Which client should the nurse assess first?
A. A client with pneumonia whose oxygen saturation is 91% on 2 L/min oxygen
B. A client with diabetes whose blood glucose is 68 mg/dL (3.8 mmol/L)
C. A client with heart failure who gained 1 kg overnight
D. A client 2 days postoperative who reports pain of 7/10
Answer: B
Rationale: A blood glucose of 68 mg/dL indicates hypoglycemia, which can rapidly
progress to neurological deterioration, seizures, and loss of consciousness. The nurse
should assess and treat the hypoglycemia promptly.
2. Infection Control
Which action is most appropriate when caring for a client with Clostridioides difficile
infection?
A. Use alcohol-based hand sanitizer after removing gloves
B. Place the client in a negative-pressure room
C. Wash hands with soap and water after client contact
D. Wear an N95 respirator when entering the room
Answer: C
Rationale: C. Difficile produces spores that are not reliably removed by alcohol-based
hand sanitizer. Soap-and-water hand hygiene is required after caring for the client.
3. Pharmacology
A client receiving digoxin has an apical pulse of 52/min. What should the nurse do?
A. Administer the medication as prescribed
B. Give the medication with food
C. Hold the medication and notify the provider
D. Administer half the prescribed dose
,Answer: C
Rationale: Digoxin can cause bradycardia. An apical pulse below 60/min in an adult is
generally a reason to withhold digoxin and notify the provider.
4. Electrolytes
Which finding is most concerning in a client with hyperkalemia?
A. Muscle weakness
B. Nausea
C. Peaked T waves
D. Abdominal cramping
Answer: C
Rationale: Hyperkalemia can cause potentially fatal cardiac dysrhythmias. Peaked T
waves are a classic ECG manifestation and require prompt intervention.
5. Delegation
Which task can the RN delegate to an experienced unlicensed assistive personnel
(UAP)?
A. Assessing a client’s new onset of confusion
B. Teaching a client how to use an incentive spirometer
C. Measuring vital signs for a stable client
D. Evaluating a client’s response to pain medication
Answer: C
Rationale: Measuring routine vital signs for a stable client is within the UAP’s scope
when the RN provides appropriate direction. Assessment, teaching, and evaluation
remain RN responsibilities.
6. Respiratory
A client with asthma develops severe shortness of breath and has difficulty speaking.
Which finding requires immediate action?
A. Expiratory wheezing
B. Respiratory rate of 28/min
C. Absence of wheezing with severe respiratory distress
,D. Productive cough
Answer: C
Rationale: A previously wheezing client who develops a “silent chest” may have critically
reduced airflow. This can indicate severe airway obstruction and impending respiratory
failure.
7. Medication Safety
Which prescription should the nurse question?
A. Potassium chloride 10 mEq IV diluted in 100 mL saline
B. Acetaminophen 650 mg orally
C. Furosemide 40 mg IV
D. Morphine 2 mg IV for severe pain
Answer: A
Rationale: IV potassium must be appropriately diluted and administered using controlled
infusion. IV potassium chloride should never be administered by IV push because it can
cause fatal cardiac dysrhythmias.
8. Postoperative Care
A client suddenly becomes restless and reports difficulty breathing 24 hours after
surgery. What is the nurse’s priority action?
A. Administer prescribed opioid medication
B. Assess oxygen saturation and respiratory status
C. Encourage oral fluids
D. Place the client in a supine position
Answer: B
Rationale: Sudden respiratory difficulty may indicate a serious complication such as
pulmonary embolism or atelectasis. Airway and breathing must be assessed
immediately.
9. Diabetes
Which finding indicates that a client with diabetes is experiencing hypoglycemia?
A. Fruity breath
, B. Deep, rapid respirations
C. Diaphoresis and tremors
D. Polyuria and polydipsia
Answer: C
Rationale: Adrenergic manifestations of hypoglycemia include sweating, tremors,
palpitations, anxiety, and hunger.
10. Therapeutic Communication
A client says, “I’m terrified that my cancer is going to kill me.” Which response is best?
A. “You shouldn’t think negatively.”
B. “Everything will be fine.”
C. “Tell me more about what concerns you.”
D. “The healthcare team is doing everything possible.”
Answer: C
Rationale: This response encourages the client to express feelings and concerns
without providing false reassurance or minimizing the client’s fears.
11. Blood Transfusion
Fifteen minutes after a blood transfusion begins, the client develops chills and back
pain. What is the nurse’s first action?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain another unit of blood
Answer: B
Rationale: Chills and back pain can indicate an acute transfusion reaction. The nurse
should immediately stop the transfusion and maintain IV access with appropriate normal
saline according to facility protocol.
12. Stroke
A client arrives with sudden facial drooping and weakness of the right arm. What is the
priority?
Detailed Rationales – Next Generation NCLEX Review
1. Priority Assessment
A nurse receives report on four clients. Which client should the nurse assess first?
A. A client with pneumonia whose oxygen saturation is 91% on 2 L/min oxygen
B. A client with diabetes whose blood glucose is 68 mg/dL (3.8 mmol/L)
C. A client with heart failure who gained 1 kg overnight
D. A client 2 days postoperative who reports pain of 7/10
Answer: B
Rationale: A blood glucose of 68 mg/dL indicates hypoglycemia, which can rapidly
progress to neurological deterioration, seizures, and loss of consciousness. The nurse
should assess and treat the hypoglycemia promptly.
2. Infection Control
Which action is most appropriate when caring for a client with Clostridioides difficile
infection?
A. Use alcohol-based hand sanitizer after removing gloves
B. Place the client in a negative-pressure room
C. Wash hands with soap and water after client contact
D. Wear an N95 respirator when entering the room
Answer: C
Rationale: C. Difficile produces spores that are not reliably removed by alcohol-based
hand sanitizer. Soap-and-water hand hygiene is required after caring for the client.
3. Pharmacology
A client receiving digoxin has an apical pulse of 52/min. What should the nurse do?
A. Administer the medication as prescribed
B. Give the medication with food
C. Hold the medication and notify the provider
D. Administer half the prescribed dose
,Answer: C
Rationale: Digoxin can cause bradycardia. An apical pulse below 60/min in an adult is
generally a reason to withhold digoxin and notify the provider.
4. Electrolytes
Which finding is most concerning in a client with hyperkalemia?
A. Muscle weakness
B. Nausea
C. Peaked T waves
D. Abdominal cramping
Answer: C
Rationale: Hyperkalemia can cause potentially fatal cardiac dysrhythmias. Peaked T
waves are a classic ECG manifestation and require prompt intervention.
5. Delegation
Which task can the RN delegate to an experienced unlicensed assistive personnel
(UAP)?
A. Assessing a client’s new onset of confusion
B. Teaching a client how to use an incentive spirometer
C. Measuring vital signs for a stable client
D. Evaluating a client’s response to pain medication
Answer: C
Rationale: Measuring routine vital signs for a stable client is within the UAP’s scope
when the RN provides appropriate direction. Assessment, teaching, and evaluation
remain RN responsibilities.
6. Respiratory
A client with asthma develops severe shortness of breath and has difficulty speaking.
Which finding requires immediate action?
A. Expiratory wheezing
B. Respiratory rate of 28/min
C. Absence of wheezing with severe respiratory distress
,D. Productive cough
Answer: C
Rationale: A previously wheezing client who develops a “silent chest” may have critically
reduced airflow. This can indicate severe airway obstruction and impending respiratory
failure.
7. Medication Safety
Which prescription should the nurse question?
A. Potassium chloride 10 mEq IV diluted in 100 mL saline
B. Acetaminophen 650 mg orally
C. Furosemide 40 mg IV
D. Morphine 2 mg IV for severe pain
Answer: A
Rationale: IV potassium must be appropriately diluted and administered using controlled
infusion. IV potassium chloride should never be administered by IV push because it can
cause fatal cardiac dysrhythmias.
8. Postoperative Care
A client suddenly becomes restless and reports difficulty breathing 24 hours after
surgery. What is the nurse’s priority action?
A. Administer prescribed opioid medication
B. Assess oxygen saturation and respiratory status
C. Encourage oral fluids
D. Place the client in a supine position
Answer: B
Rationale: Sudden respiratory difficulty may indicate a serious complication such as
pulmonary embolism or atelectasis. Airway and breathing must be assessed
immediately.
9. Diabetes
Which finding indicates that a client with diabetes is experiencing hypoglycemia?
A. Fruity breath
, B. Deep, rapid respirations
C. Diaphoresis and tremors
D. Polyuria and polydipsia
Answer: C
Rationale: Adrenergic manifestations of hypoglycemia include sweating, tremors,
palpitations, anxiety, and hunger.
10. Therapeutic Communication
A client says, “I’m terrified that my cancer is going to kill me.” Which response is best?
A. “You shouldn’t think negatively.”
B. “Everything will be fine.”
C. “Tell me more about what concerns you.”
D. “The healthcare team is doing everything possible.”
Answer: C
Rationale: This response encourages the client to express feelings and concerns
without providing false reassurance or minimizing the client’s fears.
11. Blood Transfusion
Fifteen minutes after a blood transfusion begins, the client develops chills and back
pain. What is the nurse’s first action?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain another unit of blood
Answer: B
Rationale: Chills and back pain can indicate an acute transfusion reaction. The nurse
should immediately stop the transfusion and maintain IV access with appropriate normal
saline according to facility protocol.
12. Stroke
A client arrives with sudden facial drooping and weakness of the right arm. What is the
priority?
