NCLEX-RN COMPREHENSIVE EXAMINATION - NATIONAL COUNCIL OF
STATE BOARDS OF NURSING (NCSBN) - 2026/2027 ACADEMIC YEAR -
QUESTIONS AND ANSWERS COVERING FIVE CORE DOMAINS
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply critical thinking to prioritize patient-centered care across diverse clinical situations
2 Integrate evidence-based practice and current guidelines into nursing interventions
3 Demonstrate proficiency in interpreting diagnostic data and adjusting care plans
4 Exhibit ethical and legal decision-making in complex healthcare environments
5 Synthesize knowledge across physiological and psychosocial domains to optimize patient outcomes
6 NCLEX
7 RN Comprehensive Examination
8 National Council of State Boards of Nursing
9 NCSBN
10 2026
11 2027 Academic Year
12 Questions and Answers Covering Five Core Domains
13 Foundations of Nursing (NCLEX-RN Comprehensive)
14 Applied Nursing (NCLEX-RN Comprehensive)
15 Advanced Nursing (NCLEX-RN Comprehensive)
16 Nursing (NCLEX-RN Comprehensive) Review
ABSTRACT
Page 1
,This study document brings together 150 carefully worded exam questions drawn from NCLEX-RN
Comprehensive Examination - National Council of State Boards of Nursing (NCSBN) - 2026/2027
Academic Year - Questions and Answers Covering Five Core Domains, with the strongest
emphasis placed on Apply critical thinking to prioritize patient-centered care across diverse clinical
situations, Integrate evidence-based practice and current guidelines into nursing interventions and
Demonstrate proficiency in interpreting diagnostic data and adjusting care plans. Every item
follows the wording style and level of reasoning you meet in the real paper, and each one is paired
with a clear rationale so the correct choice is never a guess. Work through the set at your own
pace, mark the questions that slow you down, then come back to them until the reasoning feels
automatic. Learners who revise this way walk into the exam room recognising the pattern behind
the questions instead of meeting them for the first time. Keep going - steady, honest practice is
what turns a difficult paper into a comfortable pass.
Q1 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
In a patient with septic shock, which hemodynamic profile indicates the transition
from the hyperdynamic (warm) phase to the hypodynamic (cold) phase?
A. Increased cardiac output, decreased systemic vascular resistance, warm extremities
B. Decreased cardiac output, increased systemic vascular resistance, cool extremities
CORRECT
C. Increased cardiac output, increased systemic vascular resistance, bounding pulses
D. Decreased cardiac output, decreased systemic vascular resistance, flushed skin
RATIONALE: The hyperdynamic phase of septic shock presents with high cardiac output and low
SVR (warm shock). As shock progresses, myocardial depression leads to decreased cardiac
output and compensatory vasoconstriction (increased SVR), resulting in cool extremities. Option
B correctly identifies this transition. Options A and C describe earlier phases; D is incorrect
because SVR is typically elevated in cold shock.
Page 2
,Q2 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates that the lung has re-expanded and the chest tube
can be considered for removal?
A. Continuous bubbling in the water-seal chamber during inspiration and expiration
B. Absence of bubbling in the water-seal chamber and no fluctuation with respiration
CORRECT
C. Fluctuation (tidaling) in the water-seal chamber that stops during inspiration
D. Intermittent bubbling in the water-seal chamber with coughing
RATIONALE: When the lung re-expands, the pleural space is sealed, so there is no air leak (no
bubbling) and no pressure changes to cause tidaling. Option B is correct. Continuous bubbling
indicates an air leak; intermittent bubbling with cough may be normal but does not confirm full
expansion. Tidaling without air leak is expected while the lung is not fully expanded.
Q3 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A client is receiving a continuous infusion of heparin for the treatment of deep
vein thrombosis. The current aPTT is 120 seconds (therapeutic range 60-80
seconds). What is the nurse's priority action?
A. Continue the infusion at the same rate and recheck aPTT in 6 hours
B. Stop the infusion and administer protamine sulfate
C. Decrease the infusion rate according to the titration protocol CORRECT
D. Increase the infusion rate to achieve therapeutic anticoagulation
RATIONALE: An aPTT of 120 seconds is above the therapeutic range, indicating an increased
bleeding risk. The standard of care is to reduce the heparin infusion per protocol, not to stop it
unless there is active bleeding. Protamine sulfate is reserved for severe bleeding. Continuing or
increasing would worsen the risk. Option C is the correct priority.
Page 3
, Q4 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
Which of the following best describes the mechanism of action of naloxone in the
management of opioid overdose?
A. It inhibits the reuptake of dopamine, increasing its availability at the synapse
B. It binds to opioid receptors as an antagonist, displacing opioids and reversing their effects
CORRECT
C. It enhances GABA-mediated inhibition in the central nervous system
D. It stimulates the respiratory center directly, independent of opioid receptors
RATIONALE: Naloxone is a competitive opioid antagonist that binds to mu, delta, and kappa
receptors, displacing opioids and reversing respiratory depression. Option A describes
cocaine-like action, C describes benzodiazepines, and D is incorrect because naloxone requires
opioid receptor occupancy to be effective.
Q5 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion-associated circulatory overload (TACO)?
A. Administer the blood over 4 hours as per protocol
B. Assess the client's baseline respiratory status and cardiac history CORRECT
C. Obtain informed consent before the transfusion
D. Verify the client's identification with two identifiers
RATIONALE: TACO is caused by rapid transfusion overwhelming the circulatory system. Patients
at risk include those with heart failure or renal insufficiency. Assessing baseline respiratory status
and cardiac history helps identify those at risk and guides infusion rate. Option A (too slow) can
cause bacterial growth; C and D are important but not specifically for TACO prevention.
Page 4
STATE BOARDS OF NURSING (NCSBN) - 2026/2027 ACADEMIC YEAR -
QUESTIONS AND ANSWERS COVERING FIVE CORE DOMAINS
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply critical thinking to prioritize patient-centered care across diverse clinical situations
2 Integrate evidence-based practice and current guidelines into nursing interventions
3 Demonstrate proficiency in interpreting diagnostic data and adjusting care plans
4 Exhibit ethical and legal decision-making in complex healthcare environments
5 Synthesize knowledge across physiological and psychosocial domains to optimize patient outcomes
6 NCLEX
7 RN Comprehensive Examination
8 National Council of State Boards of Nursing
9 NCSBN
10 2026
11 2027 Academic Year
12 Questions and Answers Covering Five Core Domains
13 Foundations of Nursing (NCLEX-RN Comprehensive)
14 Applied Nursing (NCLEX-RN Comprehensive)
15 Advanced Nursing (NCLEX-RN Comprehensive)
16 Nursing (NCLEX-RN Comprehensive) Review
ABSTRACT
Page 1
,This study document brings together 150 carefully worded exam questions drawn from NCLEX-RN
Comprehensive Examination - National Council of State Boards of Nursing (NCSBN) - 2026/2027
Academic Year - Questions and Answers Covering Five Core Domains, with the strongest
emphasis placed on Apply critical thinking to prioritize patient-centered care across diverse clinical
situations, Integrate evidence-based practice and current guidelines into nursing interventions and
Demonstrate proficiency in interpreting diagnostic data and adjusting care plans. Every item
follows the wording style and level of reasoning you meet in the real paper, and each one is paired
with a clear rationale so the correct choice is never a guess. Work through the set at your own
pace, mark the questions that slow you down, then come back to them until the reasoning feels
automatic. Learners who revise this way walk into the exam room recognising the pattern behind
the questions instead of meeting them for the first time. Keep going - steady, honest practice is
what turns a difficult paper into a comfortable pass.
Q1 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
In a patient with septic shock, which hemodynamic profile indicates the transition
from the hyperdynamic (warm) phase to the hypodynamic (cold) phase?
A. Increased cardiac output, decreased systemic vascular resistance, warm extremities
B. Decreased cardiac output, increased systemic vascular resistance, cool extremities
CORRECT
C. Increased cardiac output, increased systemic vascular resistance, bounding pulses
D. Decreased cardiac output, decreased systemic vascular resistance, flushed skin
RATIONALE: The hyperdynamic phase of septic shock presents with high cardiac output and low
SVR (warm shock). As shock progresses, myocardial depression leads to decreased cardiac
output and compensatory vasoconstriction (increased SVR), resulting in cool extremities. Option
B correctly identifies this transition. Options A and C describe earlier phases; D is incorrect
because SVR is typically elevated in cold shock.
Page 2
,Q2 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates that the lung has re-expanded and the chest tube
can be considered for removal?
A. Continuous bubbling in the water-seal chamber during inspiration and expiration
B. Absence of bubbling in the water-seal chamber and no fluctuation with respiration
CORRECT
C. Fluctuation (tidaling) in the water-seal chamber that stops during inspiration
D. Intermittent bubbling in the water-seal chamber with coughing
RATIONALE: When the lung re-expands, the pleural space is sealed, so there is no air leak (no
bubbling) and no pressure changes to cause tidaling. Option B is correct. Continuous bubbling
indicates an air leak; intermittent bubbling with cough may be normal but does not confirm full
expansion. Tidaling without air leak is expected while the lung is not fully expanded.
Q3 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A client is receiving a continuous infusion of heparin for the treatment of deep
vein thrombosis. The current aPTT is 120 seconds (therapeutic range 60-80
seconds). What is the nurse's priority action?
A. Continue the infusion at the same rate and recheck aPTT in 6 hours
B. Stop the infusion and administer protamine sulfate
C. Decrease the infusion rate according to the titration protocol CORRECT
D. Increase the infusion rate to achieve therapeutic anticoagulation
RATIONALE: An aPTT of 120 seconds is above the therapeutic range, indicating an increased
bleeding risk. The standard of care is to reduce the heparin infusion per protocol, not to stop it
unless there is active bleeding. Protamine sulfate is reserved for severe bleeding. Continuing or
increasing would worsen the risk. Option C is the correct priority.
Page 3
, Q4 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
Which of the following best describes the mechanism of action of naloxone in the
management of opioid overdose?
A. It inhibits the reuptake of dopamine, increasing its availability at the synapse
B. It binds to opioid receptors as an antagonist, displacing opioids and reversing their effects
CORRECT
C. It enhances GABA-mediated inhibition in the central nervous system
D. It stimulates the respiratory center directly, independent of opioid receptors
RATIONALE: Naloxone is a competitive opioid antagonist that binds to mu, delta, and kappa
receptors, displacing opioids and reversing respiratory depression. Option A describes
cocaine-like action, C describes benzodiazepines, and D is incorrect because naloxone requires
opioid receptor occupancy to be effective.
Q5 APPLY CRITICAL THINKING TO PRIORITIZE PATIENT-CENTERED CARE ACROSS
DIVERSE CLINICAL SITUATIONS
A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion-associated circulatory overload (TACO)?
A. Administer the blood over 4 hours as per protocol
B. Assess the client's baseline respiratory status and cardiac history CORRECT
C. Obtain informed consent before the transfusion
D. Verify the client's identification with two identifiers
RATIONALE: TACO is caused by rapid transfusion overwhelming the circulatory system. Patients
at risk include those with heart failure or renal insufficiency. Assessing baseline respiratory status
and cardiac history helps identify those at risk and guides infusion rate. Option A (too slow) can
cause bacterial growth; C and D are important but not specifically for TACO prevention.
Page 4
