NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
NCLEX-RN Actual Exam 2026/2027 with NGN
Updated 2027 | SATA, Bowtie & Case Studies | Verified Q&A | Pass Guaranteed - A+ Graded
Aligned with the 2026-2027 NCSBN NCLEX-RN Test Plan including Next Generation NCLEX (NGN)
Components
Total Questions 185 (including NGN SATA, Bowtie, and Case Studies)
Test Plan NCSBN NCLEX-RN 2026-2027 with NGN Integration
Format Multiple Choice, SATA, Bowtie, Extended Case Studies
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Scoring Standard NCLEX + NGN Partial Credit Scoring
Duration Recommended Practice: 5 hours (1.6 min/question)
Examination Blueprint
Section Content Area Questions
1 Safe & Effective Care - Management of Care Q1-25 (25)
2 Safe & Effective Care - Safety & Infection Control Q26-40 (15)
3 Health Promotion & Maintenance Q41-55 (15)
4 Psychosocial Integrity Q56-70 (15)
5 Basic Care & Comfort Q71-85 (15)
6 Pharmacological & Parenteral Therapies Q86-105 (20)
7 Reduction of Risk Potential Q106-120 (15)
8 Physiological Adaptation Q121-145 (25)
9 NGN Special Formats (SATA, Bowtie, Case Studies) Q146-185 (40)
Examination Instructions
This comprehensive NCLEX-RN practice examination contains 185 questions designed to mirror the structure, content,
and cognitive complexity of the actual NCLEX-RN examination with Next Generation NCLEX (NGN) components.
Sections 1 through 8 use traditional multiple-choice format with four options and a single correct answer. Section 9
features NGN-specific formats including Select All That Apply (SATA) questions with partial-credit scoring, Bowtie
questions requiring identification of a condition, selection of indicated interventions, and recognition of an evaluation
finding, and Extended Case Studies that follow a single client through layered clinical scenarios using the Clinical
Judgment Measurement Model (CJMM). Read each stem carefully, noting keywords such as 'first,' 'next,' 'best,' 'priority,'
and 'initial' that determine the correct action. Apply the nursing process (ADPIE), ABC priority framework, Maslow's
hierarchy, and least-restrictive principle when prioritizing. Rationales follow each question with
NCLEX-RN/NGN-specific clinical reasoning, evidence-based practice, and safety considerations.
A+ Graded - Pass Guaranteed Page 1 Aligned with 2026-2027 NCSBN Test Plan
,NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
Section 1: Safe and Effective Care Environment - Management of Care
(Q1-25)
Client Rights, Advocacy, Delegation, Supervision, Ethics, Legal Issues, Advance Directives, HIPAA, Continuity of
Care, Interdisciplinary Collaboration, and Case Management.
Q1: A registered nurse (RN) on a medical-surgical unit is planning care for four assigned clients. Which client
should the RN assess first?
A. A client who is 2 days postoperative from a hip replacement requesting pain medication.
B. A client with chronic kidney disease whose morning potassium level is 5.2 mEq/L.
C. A client with heart failure whose oxygen saturation has dropped from 96% to 90% on room air over
the past hour. [CORRECT]
D. A client newly admitted with pneumonia who is scheduled for a chest x-ray in 2 hours.
Correct Answer: C
Rationale:
Using the ABC priority framework and acute-versus-chronic distinction, the client with heart failure
demonstrating a dropping oxygen saturation (90% on room air) represents the highest-priority assessment. A
6-point drop in an hour signals possible pulmonary edema or decompensation requiring immediate evaluation.
The postoperative pain request, mildly elevated potassium in chronic kidney disease, and pending chest x-ray
are important but not immediately life-threatening. The nurse should assess this client first, then notify the
provider if findings warrant escalation of care.
Q2: An RN is delegating care for the shift. Which task is most appropriate to assign to the unlicensed assistive
personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about foot care.
B. Measuring vital signs and recording intake and output for stable clients. [CORRECT]
C. Assessing a stage 2 pressure injury for signs of infection.
D. Administering oral acetaminophen to a client with a mild headache.
Correct Answer: B
Rationale:
Delegation follows the Five Rights: right task, right circumstance, right person, right direction, and right
supervision. Measuring vital signs and recording intake/output are routine, noninvasive tasks within the UAP
scope that do not require clinical judgment. Teaching requires RN-level knowledge and is non-delegable.
Assessment (wound evaluation) and medication administration are nursing functions that cannot be delegated to
UAP. The RN retains accountability for the overall plan of care even when tasks are delegated.
Q3: A client scheduled for an elective cholecystectomy tells the nurse, 'I changed my mind. I don't want this surgery.'
What is the nurse's best response?
A. Remind the client that the surgery has already been scheduled and the operating room is booked.
B. Notify the surgeon immediately so the consent can be revoked and the procedure cancelled.
[CORRECT]
C. Explain that the client signed the consent form and is legally bound to proceed.
A+ Graded - Pass Guaranteed Page 2 Aligned with 2026-2027 NCSBN Test Plan
,NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
D. Document the client's statement and continue preoperative preparation as ordered.
Correct Answer: B
Rationale:
The principle of autonomy guarantees the client's right to refuse treatment at any time, even after signing the
informed consent. The nurse's role as advocate is to immediately notify the surgeon so the consent can be
revoked and the procedure cancelled. A signed consent is not an irrevocable contract. Continuing preparation
would constitute battery. The nurse must document the client's decision and the notification of the provider, but
the priority action is to halt the surgical process.
Q4: A client with a terminal illness has a documented Do-Not-Resuscitate (DNR) order. The client goes into cardiac
arrest and the spouse yells, 'Please do something!' What should the nurse do first?
A. Begin cardiopulmonary resuscitation immediately to honor the spouse's request.
B. Verify the DNR order in the medical record and the client's identification before acting. [CORRECT]
C. Call the rapid response team and let them decide whether to resuscitate.
D. Notify the provider and await further orders before taking any action.
Correct Answer: B
Rationale:
A valid DNR order must be honored; however, the nurse must first verify the order is current and applies to this
client to prevent errors. The spouse's distress is understandable, but the client's autonomous decision and
documented order take precedence. Initiating CPR when a valid DNR exists violates the client's wishes and may
constitute unwanted treatment. Calling a rapid response team or provider without first verifying the DNR delays
appropriate action. After verification, the nurse provides supportive care and emotional support to the spouse.
Q5: A nurse overhears a colleague discussing a client's diagnosis in a crowded elevator. Which action should the
nurse take first?
A. Report the colleague to the nursing supervisor immediately.
B. Quietly remind the colleague that client information should not be discussed in public areas.
[CORRECT]
C. Document the incident and file a formal incident report after the shift.
D. File a complaint with the hospital's privacy officer in writing.
Correct Answer: B
Rationale:
HIPAA's Privacy Rule protects protected health information (PHI) from unauthorized disclosure. The first
action is to intervene directly and professionally to stop the breach by reminding the colleague of privacy rules
in a non-confrontational manner. This immediate intervention protects the client and prevents further disclosure.
Afterward, the nurse should document and report the incident through the appropriate channels per facility
policy. Escalation to the supervisor or privacy officer is appropriate if the behavior continues or for formal
follow-up.
Q6: An RN is supervising a licensed practical nurse (LPN) and a UAP. Which client should the RN assign to the
LPN?
A+ Graded - Pass Guaranteed Page 3 Aligned with 2026-2027 NCSBN Test Plan
, NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
A. A stable client requiring routine vital signs and ambulation assistance.
B. A newly admitted client with acute abdominal pain requiring frequent reassessment.
C. A stable client with a complicated medication regimen requiring IV antibiotics through a PICC line.
D. A client with a sterile dressing change to a surgical wound and a foley catheter care. [CORRECT]
Correct Answer: D
Rationale:
The LPN scope includes caring for stable clients with predictable outcomes and performing tasks such as sterile
dressing changes and Foley catheter care. The newly admitted client with acute abdominal pain requires
RN-level assessment and clinical judgment. IV antibiotic administration through a PICC line varies by state and
facility but is often an RN-only skill, especially with complicated regimens. Routine vital signs and ambulation
are appropriately delegated to UAP. The RN retains responsibility for assessment, care planning, and
evaluation.
Q7: A client asks the nurse for a copy of their medical record. What is the nurse's best response?
A. Explain that only the healthcare provider can authorize release of the medical record.
B. Inform the client they have the right to access their record and facilitate the request through health
information management. [CORRECT]
C. Tell the client the record is the property of the hospital and cannot be released.
D. Print a copy of the record from the workstation and give it to the client immediately.
Correct Answer: B
Rationale:
Under HIPAA, clients have a legal right to access and obtain a copy of their medical records. The nurse's role is
to acknowledge this right and direct the client to the appropriate department (Health Information Management
or Medical Records) to formally request the record. The provider's authorization is not required for the client to
access their own record. While the facility owns the physical record, the information belongs to the client.
Direct printing without proper procedure bypasses safeguards and identity verification.
Q8: A nurse is caring for a client whose family insists on withholding a cancer diagnosis from the client. The client
repeatedly asks the nurse, 'What is wrong with me?' What is the most appropriate action?
A. Honor the family's wishes and tell the client the healthcare team is still investigating.
B. Notify the provider and advocate for the client's right to know their diagnosis. [CORRECT]
C. Tell the client the diagnosis to honor the principle of veracity.
D. Refer the family to social services and continue to defer the client's questions.
Correct Answer: B
Rationale:
The ethical principles of autonomy and veracity support the client's right to know their diagnosis. The nurse
should not unilaterally disclose the diagnosis but must notify the provider and advocate for an honest
conversation, exploring the family's cultural concerns. In many cultures, family involvement in disclosure is
significant, and a culturally sensitive approach is needed. The provider ultimately leads the disclosure, but the
nurse advocates for the client. Continuing to defer the client's questions undermines trust and the therapeutic
relationship.
A+ Graded - Pass Guaranteed Page 4 Aligned with 2026-2027 NCSBN Test Plan
NCLEX-RN Actual Exam 2026/2027 with NGN
Updated 2027 | SATA, Bowtie & Case Studies | Verified Q&A | Pass Guaranteed - A+ Graded
Aligned with the 2026-2027 NCSBN NCLEX-RN Test Plan including Next Generation NCLEX (NGN)
Components
Total Questions 185 (including NGN SATA, Bowtie, and Case Studies)
Test Plan NCSBN NCLEX-RN 2026-2027 with NGN Integration
Format Multiple Choice, SATA, Bowtie, Extended Case Studies
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Scoring Standard NCLEX + NGN Partial Credit Scoring
Duration Recommended Practice: 5 hours (1.6 min/question)
Examination Blueprint
Section Content Area Questions
1 Safe & Effective Care - Management of Care Q1-25 (25)
2 Safe & Effective Care - Safety & Infection Control Q26-40 (15)
3 Health Promotion & Maintenance Q41-55 (15)
4 Psychosocial Integrity Q56-70 (15)
5 Basic Care & Comfort Q71-85 (15)
6 Pharmacological & Parenteral Therapies Q86-105 (20)
7 Reduction of Risk Potential Q106-120 (15)
8 Physiological Adaptation Q121-145 (25)
9 NGN Special Formats (SATA, Bowtie, Case Studies) Q146-185 (40)
Examination Instructions
This comprehensive NCLEX-RN practice examination contains 185 questions designed to mirror the structure, content,
and cognitive complexity of the actual NCLEX-RN examination with Next Generation NCLEX (NGN) components.
Sections 1 through 8 use traditional multiple-choice format with four options and a single correct answer. Section 9
features NGN-specific formats including Select All That Apply (SATA) questions with partial-credit scoring, Bowtie
questions requiring identification of a condition, selection of indicated interventions, and recognition of an evaluation
finding, and Extended Case Studies that follow a single client through layered clinical scenarios using the Clinical
Judgment Measurement Model (CJMM). Read each stem carefully, noting keywords such as 'first,' 'next,' 'best,' 'priority,'
and 'initial' that determine the correct action. Apply the nursing process (ADPIE), ABC priority framework, Maslow's
hierarchy, and least-restrictive principle when prioritizing. Rationales follow each question with
NCLEX-RN/NGN-specific clinical reasoning, evidence-based practice, and safety considerations.
A+ Graded - Pass Guaranteed Page 1 Aligned with 2026-2027 NCSBN Test Plan
,NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
Section 1: Safe and Effective Care Environment - Management of Care
(Q1-25)
Client Rights, Advocacy, Delegation, Supervision, Ethics, Legal Issues, Advance Directives, HIPAA, Continuity of
Care, Interdisciplinary Collaboration, and Case Management.
Q1: A registered nurse (RN) on a medical-surgical unit is planning care for four assigned clients. Which client
should the RN assess first?
A. A client who is 2 days postoperative from a hip replacement requesting pain medication.
B. A client with chronic kidney disease whose morning potassium level is 5.2 mEq/L.
C. A client with heart failure whose oxygen saturation has dropped from 96% to 90% on room air over
the past hour. [CORRECT]
D. A client newly admitted with pneumonia who is scheduled for a chest x-ray in 2 hours.
Correct Answer: C
Rationale:
Using the ABC priority framework and acute-versus-chronic distinction, the client with heart failure
demonstrating a dropping oxygen saturation (90% on room air) represents the highest-priority assessment. A
6-point drop in an hour signals possible pulmonary edema or decompensation requiring immediate evaluation.
The postoperative pain request, mildly elevated potassium in chronic kidney disease, and pending chest x-ray
are important but not immediately life-threatening. The nurse should assess this client first, then notify the
provider if findings warrant escalation of care.
Q2: An RN is delegating care for the shift. Which task is most appropriate to assign to the unlicensed assistive
personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about foot care.
B. Measuring vital signs and recording intake and output for stable clients. [CORRECT]
C. Assessing a stage 2 pressure injury for signs of infection.
D. Administering oral acetaminophen to a client with a mild headache.
Correct Answer: B
Rationale:
Delegation follows the Five Rights: right task, right circumstance, right person, right direction, and right
supervision. Measuring vital signs and recording intake/output are routine, noninvasive tasks within the UAP
scope that do not require clinical judgment. Teaching requires RN-level knowledge and is non-delegable.
Assessment (wound evaluation) and medication administration are nursing functions that cannot be delegated to
UAP. The RN retains accountability for the overall plan of care even when tasks are delegated.
Q3: A client scheduled for an elective cholecystectomy tells the nurse, 'I changed my mind. I don't want this surgery.'
What is the nurse's best response?
A. Remind the client that the surgery has already been scheduled and the operating room is booked.
B. Notify the surgeon immediately so the consent can be revoked and the procedure cancelled.
[CORRECT]
C. Explain that the client signed the consent form and is legally bound to proceed.
A+ Graded - Pass Guaranteed Page 2 Aligned with 2026-2027 NCSBN Test Plan
,NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
D. Document the client's statement and continue preoperative preparation as ordered.
Correct Answer: B
Rationale:
The principle of autonomy guarantees the client's right to refuse treatment at any time, even after signing the
informed consent. The nurse's role as advocate is to immediately notify the surgeon so the consent can be
revoked and the procedure cancelled. A signed consent is not an irrevocable contract. Continuing preparation
would constitute battery. The nurse must document the client's decision and the notification of the provider, but
the priority action is to halt the surgical process.
Q4: A client with a terminal illness has a documented Do-Not-Resuscitate (DNR) order. The client goes into cardiac
arrest and the spouse yells, 'Please do something!' What should the nurse do first?
A. Begin cardiopulmonary resuscitation immediately to honor the spouse's request.
B. Verify the DNR order in the medical record and the client's identification before acting. [CORRECT]
C. Call the rapid response team and let them decide whether to resuscitate.
D. Notify the provider and await further orders before taking any action.
Correct Answer: B
Rationale:
A valid DNR order must be honored; however, the nurse must first verify the order is current and applies to this
client to prevent errors. The spouse's distress is understandable, but the client's autonomous decision and
documented order take precedence. Initiating CPR when a valid DNR exists violates the client's wishes and may
constitute unwanted treatment. Calling a rapid response team or provider without first verifying the DNR delays
appropriate action. After verification, the nurse provides supportive care and emotional support to the spouse.
Q5: A nurse overhears a colleague discussing a client's diagnosis in a crowded elevator. Which action should the
nurse take first?
A. Report the colleague to the nursing supervisor immediately.
B. Quietly remind the colleague that client information should not be discussed in public areas.
[CORRECT]
C. Document the incident and file a formal incident report after the shift.
D. File a complaint with the hospital's privacy officer in writing.
Correct Answer: B
Rationale:
HIPAA's Privacy Rule protects protected health information (PHI) from unauthorized disclosure. The first
action is to intervene directly and professionally to stop the breach by reminding the colleague of privacy rules
in a non-confrontational manner. This immediate intervention protects the client and prevents further disclosure.
Afterward, the nurse should document and report the incident through the appropriate channels per facility
policy. Escalation to the supervisor or privacy officer is appropriate if the behavior continues or for formal
follow-up.
Q6: An RN is supervising a licensed practical nurse (LPN) and a UAP. Which client should the RN assign to the
LPN?
A+ Graded - Pass Guaranteed Page 3 Aligned with 2026-2027 NCSBN Test Plan
, NCLEX-RN Actual Exam 2026/2027 with NGN | SATA, Bowtie & Case Studies | Verified Q&A
A. A stable client requiring routine vital signs and ambulation assistance.
B. A newly admitted client with acute abdominal pain requiring frequent reassessment.
C. A stable client with a complicated medication regimen requiring IV antibiotics through a PICC line.
D. A client with a sterile dressing change to a surgical wound and a foley catheter care. [CORRECT]
Correct Answer: D
Rationale:
The LPN scope includes caring for stable clients with predictable outcomes and performing tasks such as sterile
dressing changes and Foley catheter care. The newly admitted client with acute abdominal pain requires
RN-level assessment and clinical judgment. IV antibiotic administration through a PICC line varies by state and
facility but is often an RN-only skill, especially with complicated regimens. Routine vital signs and ambulation
are appropriately delegated to UAP. The RN retains responsibility for assessment, care planning, and
evaluation.
Q7: A client asks the nurse for a copy of their medical record. What is the nurse's best response?
A. Explain that only the healthcare provider can authorize release of the medical record.
B. Inform the client they have the right to access their record and facilitate the request through health
information management. [CORRECT]
C. Tell the client the record is the property of the hospital and cannot be released.
D. Print a copy of the record from the workstation and give it to the client immediately.
Correct Answer: B
Rationale:
Under HIPAA, clients have a legal right to access and obtain a copy of their medical records. The nurse's role is
to acknowledge this right and direct the client to the appropriate department (Health Information Management
or Medical Records) to formally request the record. The provider's authorization is not required for the client to
access their own record. While the facility owns the physical record, the information belongs to the client.
Direct printing without proper procedure bypasses safeguards and identity verification.
Q8: A nurse is caring for a client whose family insists on withholding a cancer diagnosis from the client. The client
repeatedly asks the nurse, 'What is wrong with me?' What is the most appropriate action?
A. Honor the family's wishes and tell the client the healthcare team is still investigating.
B. Notify the provider and advocate for the client's right to know their diagnosis. [CORRECT]
C. Tell the client the diagnosis to honor the principle of veracity.
D. Refer the family to social services and continue to defer the client's questions.
Correct Answer: B
Rationale:
The ethical principles of autonomy and veracity support the client's right to know their diagnosis. The nurse
should not unilaterally disclose the diagnosis but must notify the provider and advocate for an honest
conversation, exploring the family's cultural concerns. In many cultures, family involvement in disclosure is
significant, and a culturally sensitive approach is needed. The provider ultimately leads the disclosure, but the
nurse advocates for the client. Continuing to defer the client's questions undermines trust and the therapeutic
relationship.
A+ Graded - Pass Guaranteed Page 4 Aligned with 2026-2027 NCSBN Test Plan
