NCLEX-RN 2026 Comprehensive Prac ce
Exam — 300 Original Ques ons with
Detailed Ra onales & NGN Case Studies
1. The nurse receives reports on four clients. Which client should the nurse assess
first?
A. A client with COPD requesting assistance to the bathroom
B. A postoperative client reporting pain of 7/10
C. A client with a potassium level of 6.2 mEq/L
D. A client scheduled for discharge education
Answer: C
Rationale: A potassium level of 6.2 mEq/L indicates significant hyperkalemia and creates a risk
for life-threatening cardiac dysrhythmias. This client requires immediate assessment and
intervention.
2. Which task is appropriate for the RN to delegate to unlicensed assistive
personnel (UAP)?
A. Assess a client's pain after medication administration
B. Teach a client how to use an incentive spirometer
C. Obtain routine vital signs for a stable client
D. Evaluate a client's response to treatment
Answer: C
Rationale: UAP can perform routine, predictable tasks such as obtaining vital signs for stable
clients. Assessment, teaching, and evaluation remain the responsibility of the RN.
3. Which client assignment is most appropriate for a newly licensed RN?
A. A client receiving titrated vasoactive medication
B. A stable client recovering from an uncomplicated appendectomy
,C. A client experiencing an acute gastrointestinal hemorrhage
D. A client requiring complex ventilator management
Answer: B
Rationale: A newly licensed RN should initially care for stable clients with predictable outcomes.
Clients requiring complex or rapidly changing care should be assigned to experienced nurses.
4. A client refuses a prescribed medication. What is the nurse's priority action?
A. Ask the family to convince the client
B. Document the refusal and notify the provider when appropriate
C. Administer the medication without informing the client
D. Tell the client the medication is mandatory
Answer: B
Rationale: Competent clients have the right to refuse treatment. The nurse should assess the
reason for refusal, provide appropriate information, document the refusal, and notify the
provider as indicated.
5. Which action protects client confidentiality?
A. Discussing client information in the elevator
B. Sharing information with a visitor who asks about the client
C. Accessing a medical record only when involved in the client's care
D. Leaving the electronic health record open during a break
Answer: C
Rationale: Health information should be accessed only when necessary for professional
responsibilities. Discussing information publicly or leaving records accessible violates
confidentiality.
6. Which intervention is most appropriate for a client at high risk for falls?
A. Keep all four side rails raised
B. Place frequently used items within reach
C. Encourage the client to walk independently
D. Keep the room completely dark at night
,Answer: B
Rationale: Keeping needed items within reach reduces unnecessary movement and fall risk. Four
raised side rails may constitute a restraint.
7. The nurse suspects elder abuse. Which action is appropriate?
A. Ignore the concern until the client confirms abuse
B. Document objective findings and follow reporting requirements
C. Confront the suspected abuser immediately
D. Ask the family to investigate
Answer: B
Rationale: The nurse should objectively document findings and follow applicable institutional
and legal reporting procedures for suspected abuse.
8. Which client statement demonstrates understanding of advance directives?
A. "My nurse will make decisions for me."
B. "An advance directive communicates my wishes about future health care."
C. "I can complete one only after becoming seriously ill."
D. "My family must make all decisions."
Answer: B
Rationale: Advance directives allow individuals to communicate preferences regarding future
medical care and decision-making.
9. The nurse discovers a medication error. What is the priority action?
A. Complete an incident report
B. Notify the nurse manager
C. Assess the client
D. Document the incident report in the medical record
Answer: C
Rationale: The client's safety is the immediate priority. The nurse first assesses the client,
provides necessary interventions, and then follows reporting procedures.
, 10. Which client requires airborne precautions?
A. A client with influenza
B. A client with pulmonary tuberculosis
C. A client with MRSA in a wound
D. A client with Clostridioides difficile infection
Answer: B
Rationale: Pulmonary tuberculosis requires airborne precautions, including an appropriate
negative-pressure environment and respiratory protection according to facility policy.
11. Which action is appropriate when caring for a client with C. difficile?
A. Use alcohol-based sanitizer only
B. Perform hand hygiene with soap and water
C. Place the client on airborne precautions
D. Require an N95 respirator for all visitors
Answer: B
Rationale: Soap and water is important when caring for clients with C. difficile because spores
are not reliably removed by alcohol-based sanitizer alone.
12. Which client should receive immediate intervention?
A. Client with a temperature of 38°C (100.4°F)
B. Client reporting nausea
C. Client with oxygen saturation of 84%
D. Client requesting pain medication
Answer: C
Rationale: An oxygen saturation of 84% indicates significant hypoxemia and requires immediate
assessment and intervention.
13. The nurse is preparing to apply restraints. Which principle is correct?
Exam — 300 Original Ques ons with
Detailed Ra onales & NGN Case Studies
1. The nurse receives reports on four clients. Which client should the nurse assess
first?
A. A client with COPD requesting assistance to the bathroom
B. A postoperative client reporting pain of 7/10
C. A client with a potassium level of 6.2 mEq/L
D. A client scheduled for discharge education
Answer: C
Rationale: A potassium level of 6.2 mEq/L indicates significant hyperkalemia and creates a risk
for life-threatening cardiac dysrhythmias. This client requires immediate assessment and
intervention.
2. Which task is appropriate for the RN to delegate to unlicensed assistive
personnel (UAP)?
A. Assess a client's pain after medication administration
B. Teach a client how to use an incentive spirometer
C. Obtain routine vital signs for a stable client
D. Evaluate a client's response to treatment
Answer: C
Rationale: UAP can perform routine, predictable tasks such as obtaining vital signs for stable
clients. Assessment, teaching, and evaluation remain the responsibility of the RN.
3. Which client assignment is most appropriate for a newly licensed RN?
A. A client receiving titrated vasoactive medication
B. A stable client recovering from an uncomplicated appendectomy
,C. A client experiencing an acute gastrointestinal hemorrhage
D. A client requiring complex ventilator management
Answer: B
Rationale: A newly licensed RN should initially care for stable clients with predictable outcomes.
Clients requiring complex or rapidly changing care should be assigned to experienced nurses.
4. A client refuses a prescribed medication. What is the nurse's priority action?
A. Ask the family to convince the client
B. Document the refusal and notify the provider when appropriate
C. Administer the medication without informing the client
D. Tell the client the medication is mandatory
Answer: B
Rationale: Competent clients have the right to refuse treatment. The nurse should assess the
reason for refusal, provide appropriate information, document the refusal, and notify the
provider as indicated.
5. Which action protects client confidentiality?
A. Discussing client information in the elevator
B. Sharing information with a visitor who asks about the client
C. Accessing a medical record only when involved in the client's care
D. Leaving the electronic health record open during a break
Answer: C
Rationale: Health information should be accessed only when necessary for professional
responsibilities. Discussing information publicly or leaving records accessible violates
confidentiality.
6. Which intervention is most appropriate for a client at high risk for falls?
A. Keep all four side rails raised
B. Place frequently used items within reach
C. Encourage the client to walk independently
D. Keep the room completely dark at night
,Answer: B
Rationale: Keeping needed items within reach reduces unnecessary movement and fall risk. Four
raised side rails may constitute a restraint.
7. The nurse suspects elder abuse. Which action is appropriate?
A. Ignore the concern until the client confirms abuse
B. Document objective findings and follow reporting requirements
C. Confront the suspected abuser immediately
D. Ask the family to investigate
Answer: B
Rationale: The nurse should objectively document findings and follow applicable institutional
and legal reporting procedures for suspected abuse.
8. Which client statement demonstrates understanding of advance directives?
A. "My nurse will make decisions for me."
B. "An advance directive communicates my wishes about future health care."
C. "I can complete one only after becoming seriously ill."
D. "My family must make all decisions."
Answer: B
Rationale: Advance directives allow individuals to communicate preferences regarding future
medical care and decision-making.
9. The nurse discovers a medication error. What is the priority action?
A. Complete an incident report
B. Notify the nurse manager
C. Assess the client
D. Document the incident report in the medical record
Answer: C
Rationale: The client's safety is the immediate priority. The nurse first assesses the client,
provides necessary interventions, and then follows reporting procedures.
, 10. Which client requires airborne precautions?
A. A client with influenza
B. A client with pulmonary tuberculosis
C. A client with MRSA in a wound
D. A client with Clostridioides difficile infection
Answer: B
Rationale: Pulmonary tuberculosis requires airborne precautions, including an appropriate
negative-pressure environment and respiratory protection according to facility policy.
11. Which action is appropriate when caring for a client with C. difficile?
A. Use alcohol-based sanitizer only
B. Perform hand hygiene with soap and water
C. Place the client on airborne precautions
D. Require an N95 respirator for all visitors
Answer: B
Rationale: Soap and water is important when caring for clients with C. difficile because spores
are not reliably removed by alcohol-based sanitizer alone.
12. Which client should receive immediate intervention?
A. Client with a temperature of 38°C (100.4°F)
B. Client reporting nausea
C. Client with oxygen saturation of 84%
D. Client requesting pain medication
Answer: C
Rationale: An oxygen saturation of 84% indicates significant hypoxemia and requires immediate
assessment and intervention.
13. The nurse is preparing to apply restraints. Which principle is correct?
