NEW GENERATION NCLEX QUESTIONS | 2026/2027 EDITION – REAL
EXAM-STYLE QUESTIONS WITH VERIFIED ANSWERS (100%
CORRECT | NGN FORMAT | GRADED A+)
Aligned with the NCSBN NCLEX-RN Test Plan, the Next Generation NCLEX (NGN) Measurement Model, and Clinical
Judgment Competency Standards (2026/2027 Edition)
150 Questions | 9 Content Sections | Item Types: Multiple Choice, Multiple Response (SATA), Fill-in-the-Blank Calculation,
Drag-and-Drop Ordering, Bow-Tie, Hot Spot, Trend, Extended Multiple Response
10 Extended NGN Case Studies (Multi-Item Testlets) | 30 Priority-Setting Questions | 25 Pharmacology Questions | Detailed
Rationales with NCSBN/NGN Methodology
Section 1: Management of Care – NGN Scenarios
Q1: The nurse receives report on four postoperative clients. Which client should the nurse assess first?
A. A client 2 days post-appendectomy who is ambulating in the hallway with the unlicensed assistive personnel
B. A client 4 hours post-thyroidectomy reporting incision pain rated 6/10 thirty minutes after receiving oral
analgesia
C. A client 1 day post-abdominal surgery with sudden shortness of breath, heart rate 122/min, and oxygen
saturation of 88% on room air [CORRECT]
D. A client scheduled for discharge this morning who is requesting assistance completing paperwork
Correct Answer: C
Rationale: Sudden dyspnea, tachycardia, and hypoxia after surgery suggest pulmonary embolism, an immediately
life-threatening condition that requires assessment first. The NCSBN Clinical Judgment Measurement Model begins with
recognizing cues that indicate physiologic deterioration. Pain that has already received analgesia, routine discharge needs,
and a client who is stable enough to ambulate do not take priority over compromised airway, breathing, or circulation.
Q2: After receiving shift report, which client should the nurse see first?
A. A client with chronic atrial fibrillation whose apical pulse is 80/min and who is awaiting a breakfast tray
B. A client 2 hours after transurethral resection of the prostate whose catheter is draining bright red urine with
clots [CORRECT]
C. A client with COPD whose oxygen saturation is 90% on 2 L/min nasal cannula, consistent with baseline, and
who asks for an extra blanket
D. An older adult client who requests assistance getting to the bathroom
Correct Answer: B
Rationale: Bright red urine with clots shortly after TURP indicates active postoperative bleeding, which requires
immediate assessment and intervention. Applying prioritization frameworks, the nurse addresses actual or potential threats
to physiologic stability before stable or self-care requests. The client with atrial fibrillation is stable, the COPD client is at
baseline, and toileting assistance can be delegated or addressed immediately afterward.
NGN-Style Practice Examination with Verified Answers Page 1
,New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q3: A nurse is delegating tasks to an unlicensed assistive personnel (UAP) at the beginning of the shift. Which
task is appropriate to delegate?
A. Assessing neurologic status hourly for a client after a stroke
B. Ambulating a stable postoperative client in the hallway twice today [CORRECT]
C. Teaching a client how to walk with crutches before discharge
D. Administering a PRN oral analgesic to a client reporting pain
Correct Answer: B
Rationale: Ambulating a stable client is within the UAP scope of practice and requires no nursing judgment beyond basic
safety. Under the NCSBN five rights of delegation, assessment, teaching, and medication administration remain with
licensed personnel. The initial assessment, client education, and medication administration must be performed by the RN or
LPN, not the UAP.
Q4: A preoperative client signed the surgical consent form 2 hours ago and now tells the nurse, 'I still do not
understand why the surgeon wants to remove my gallbladder.' Which action should the nurse take first?
A. Explain the risks and benefits of the procedure in simple language
B. Notify the surgeon that the client has questions about the procedure [CORRECT]
C. Document that informed consent was obtained and continue preoperative preparation
D. Ask the client to sign a second consent form confirming understanding
Correct Answer: B
Rationale: The provider performing the surgery is legally responsible for explaining the procedure, risks, benefits, and
alternatives; the nurse must contact the surgeon so clarification occurs before sedation. Informed consent must be voluntary
and informed, and the nurse's role is to witness the signature and verify understanding. The nurse may reinforce but not
replace the provider's explanation, and the client's questions must be resolved before anesthesia is administered.
Q5: The nurse is reviewing advance directives with a newly admitted client. Which statements by the client
reflect an accurate understanding of advance directives? Select all that apply.
A. 'I can name my daughter as my health care proxy in a durable power of attorney.'
B. 'My living will guides my care only when I cannot communicate my own wishes.'
C. 'Once my advance directive is signed, it can never be changed.'
D. 'My health care proxy can make decisions for me only when I am unable to make them myself.'
E. 'The hospital will decide my end-of-life care if I do not complete these documents.'
F. 'I should give copies of my advance directive to my provider and my family.'
Correct Answers: A, B, D, F [CORRECT]
Rationale: A durable power of attorney for health care designates a surrogate decision maker, the living will applies when
the client cannot communicate, the proxy's authority activates only in the event of incapacity, and copies should be
distributed so the documents are available when needed. Client self-determination is protected under the Patient
Self-Determination Act, and hospitals must ask clients about advance directives, not substitute their own decisions. An
advance directive may be revised or revoked at any time, so the statement that it can never be changed is incorrect.
NGN-Style Practice Examination with Verified Answers Page 2
,New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q6: A postpartum client who is a practicing Jehovah's Witness is bleeding heavily and refuses blood transfusion.
The client is alert and has signed a refusal form. Which action should the nurse take?
A. Notify the provider so a court order can be obtained to transfuse the client
B. Ensure the client understands the risks of refusal, document the refusal and notification, and support the
client's decision [CORRECT]
C. Administer the transfusion while the client is sedated for another procedure
D. Ask the client's family to talk her out of refusing treatment
Correct Answer: B
Rationale: A competent adult has the legal and ethical right to refuse treatment based on the principle of autonomy, even
when refusal may result in death. The nurse must verify understanding, document the informed refusal, notify the provider,
and continue supportive care such as fluid resuscitation and close monitoring. Transfusing against expressed wishes,
obtaining a court order for a competent adult, or pressuring the client violates client rights and advocacy standards.
Q7: A hospitalized older adult with acute delirium repeatedly attempts to climb out of bed and pull out the
urinary catheter and peripheral IV. Redirection, reorientation, family presence, and moving the client near the
nurses' station have not worked. The nurse anticipates the need for protective measures. Complete the diagram
by selecting the correct condition, action, and parameter to monitor.
Condition: Client attempting to remove invasive lines after less restrictive measures fail
Action to Take: Obtain a health care provider order for the least restrictive restraint and apply it correctly
Parameter to Monitor: Circulation, skin integrity, and range of motion with release at least every 2 hours
Rationale: Restraints are a last resort used only after alternatives fail and only with a provider order, because they pose
risks of injury, circulatory compromise, and psychological harm. The order must specify the least restrictive device, be
time-limited, and be renewed per facility policy; PRN restraint orders are never acceptable. The nurse must release the
restraint at least every 2 hours for range of motion, assess circulation and skin integrity, and document behavior, alternatives
attempted, and ongoing need. Applying restraints without an order, using PRN orders, or asking family to physically restrict
the client violates regulatory and safety standards.
Q8: A client falls while getting out of bed unassisted. Which documentation by the nurse is correct?
A. Document in the chart that an incident report was filed about the fall
B. Document objective findings, the client's assessment, interventions, and notifications, and complete the
incident report separately [CORRECT]
C. Document that the fall occurred because another unit failed to answer the call light
D. Delay documentation until the end of the shift to allow time to complete the incident report
Correct Answer: B
Rationale: The medical record must contain only objective, factual documentation of the event, assessment findings, care
provided, and notifications; the incident report is a separate risk-management document that is never referenced in the
chart. Referencing the incident report in the chart or assigning blame creates discoverable, nonobjective entries. Timely
charting is a legal duty, and delaying documentation compromises accuracy and continuity of care.
NGN-Style Practice Examination with Verified Answers Page 3
, New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q9: Following a mass-casualty event, the triage nurse using the START system evaluates four victims. Which
victim should be tagged for immediate (red) treatment?
A. A victim walking with superficial lacerations on both forearms
B. A victim with a respiratory rate of 32/min, capillary refill of 3 seconds, and confusion [CORRECT]
C. A victim with a deep laceration, controlled bleeding, respiratory rate of 18/min, and normal mentation
D. A victim who is not breathing after one attempt to reposition the airway
Correct Answer: B
Rationale: Under START triage, a respiratory rate greater than 30/min, delayed capillary refill greater than 2 seconds, or
inability to follow commands places the victim in the immediate (red) category for life-saving intervention first.
Ambulatory victims are tagged green (minor), victims with controlled injuries and stable vital signs are yellow (delayed),
and victims who are apneic after airway repositioning are black (expectant) in a disaster setting, where resources are
directed to those most likely to survive.
Q10: A caller identifying himself as the spouse of an admitted client asks the nurse for the client's diagnosis and
condition. The caller cannot provide the client access code, and the client has not listed this individual as
authorized to receive information. Which action should the nurse take?
A. Provide the client's general condition since the caller claims to be the spouse
B. Do not disclose any information; explain the confidentiality policy, offer to take a message, and ask the client
to authorize disclosure if desired [CORRECT]
C. Transfer the call to the client's room so the caller can speak directly with the client
D. Disclose the diagnosis after verifying the caller's name matches the client's last name
Correct Answer: B
Rationale: HIPAA requires the nurse to verify that a person is authorized before sharing protected health information, and
a shared last name or self-identified relationship is not verification. The nurse may take a message and ask the client
whether disclosure is permitted, protecting both confidentiality and the client's right to control information. Sharing even a
general condition without authorization, transferring the call, or disclosing to any requester violates the minimum necessary
standard.
Q11: A client with terminal ovarian cancer tells the nurse she wants to stop chemotherapy and enter hospice, but
her family insists she continue treatment. Which action by the nurse best demonstrates advocacy?
A. Encourage the family to accept the hospice decision because the prognosis is poor
B. Arrange a family meeting with the health care team to explore the client's goals and ensure her decisions are
informed and honored [CORRECT]
C. Advise the client that continuing chemotherapy offers the best chance of survival
D. Document the client's refusal of chemotherapy and notify the provider without further discussion
Correct Answer: B
Rationale: Advocacy means supporting the client's autonomous, informed decision while facilitating communication
among the client, family, and health care team. A structured family meeting allows the team to clarify prognosis and goals
of care so the client's choice is informed and the family's concerns are addressed. Pressuring the client in either direction,
offering personal opinions about prognosis, or simply documenting refusal without facilitating understanding falls short of
the advocacy role.
NGN-Style Practice Examination with Verified Answers Page 4
EXAM-STYLE QUESTIONS WITH VERIFIED ANSWERS (100%
CORRECT | NGN FORMAT | GRADED A+)
Aligned with the NCSBN NCLEX-RN Test Plan, the Next Generation NCLEX (NGN) Measurement Model, and Clinical
Judgment Competency Standards (2026/2027 Edition)
150 Questions | 9 Content Sections | Item Types: Multiple Choice, Multiple Response (SATA), Fill-in-the-Blank Calculation,
Drag-and-Drop Ordering, Bow-Tie, Hot Spot, Trend, Extended Multiple Response
10 Extended NGN Case Studies (Multi-Item Testlets) | 30 Priority-Setting Questions | 25 Pharmacology Questions | Detailed
Rationales with NCSBN/NGN Methodology
Section 1: Management of Care – NGN Scenarios
Q1: The nurse receives report on four postoperative clients. Which client should the nurse assess first?
A. A client 2 days post-appendectomy who is ambulating in the hallway with the unlicensed assistive personnel
B. A client 4 hours post-thyroidectomy reporting incision pain rated 6/10 thirty minutes after receiving oral
analgesia
C. A client 1 day post-abdominal surgery with sudden shortness of breath, heart rate 122/min, and oxygen
saturation of 88% on room air [CORRECT]
D. A client scheduled for discharge this morning who is requesting assistance completing paperwork
Correct Answer: C
Rationale: Sudden dyspnea, tachycardia, and hypoxia after surgery suggest pulmonary embolism, an immediately
life-threatening condition that requires assessment first. The NCSBN Clinical Judgment Measurement Model begins with
recognizing cues that indicate physiologic deterioration. Pain that has already received analgesia, routine discharge needs,
and a client who is stable enough to ambulate do not take priority over compromised airway, breathing, or circulation.
Q2: After receiving shift report, which client should the nurse see first?
A. A client with chronic atrial fibrillation whose apical pulse is 80/min and who is awaiting a breakfast tray
B. A client 2 hours after transurethral resection of the prostate whose catheter is draining bright red urine with
clots [CORRECT]
C. A client with COPD whose oxygen saturation is 90% on 2 L/min nasal cannula, consistent with baseline, and
who asks for an extra blanket
D. An older adult client who requests assistance getting to the bathroom
Correct Answer: B
Rationale: Bright red urine with clots shortly after TURP indicates active postoperative bleeding, which requires
immediate assessment and intervention. Applying prioritization frameworks, the nurse addresses actual or potential threats
to physiologic stability before stable or self-care requests. The client with atrial fibrillation is stable, the COPD client is at
baseline, and toileting assistance can be delegated or addressed immediately afterward.
NGN-Style Practice Examination with Verified Answers Page 1
,New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q3: A nurse is delegating tasks to an unlicensed assistive personnel (UAP) at the beginning of the shift. Which
task is appropriate to delegate?
A. Assessing neurologic status hourly for a client after a stroke
B. Ambulating a stable postoperative client in the hallway twice today [CORRECT]
C. Teaching a client how to walk with crutches before discharge
D. Administering a PRN oral analgesic to a client reporting pain
Correct Answer: B
Rationale: Ambulating a stable client is within the UAP scope of practice and requires no nursing judgment beyond basic
safety. Under the NCSBN five rights of delegation, assessment, teaching, and medication administration remain with
licensed personnel. The initial assessment, client education, and medication administration must be performed by the RN or
LPN, not the UAP.
Q4: A preoperative client signed the surgical consent form 2 hours ago and now tells the nurse, 'I still do not
understand why the surgeon wants to remove my gallbladder.' Which action should the nurse take first?
A. Explain the risks and benefits of the procedure in simple language
B. Notify the surgeon that the client has questions about the procedure [CORRECT]
C. Document that informed consent was obtained and continue preoperative preparation
D. Ask the client to sign a second consent form confirming understanding
Correct Answer: B
Rationale: The provider performing the surgery is legally responsible for explaining the procedure, risks, benefits, and
alternatives; the nurse must contact the surgeon so clarification occurs before sedation. Informed consent must be voluntary
and informed, and the nurse's role is to witness the signature and verify understanding. The nurse may reinforce but not
replace the provider's explanation, and the client's questions must be resolved before anesthesia is administered.
Q5: The nurse is reviewing advance directives with a newly admitted client. Which statements by the client
reflect an accurate understanding of advance directives? Select all that apply.
A. 'I can name my daughter as my health care proxy in a durable power of attorney.'
B. 'My living will guides my care only when I cannot communicate my own wishes.'
C. 'Once my advance directive is signed, it can never be changed.'
D. 'My health care proxy can make decisions for me only when I am unable to make them myself.'
E. 'The hospital will decide my end-of-life care if I do not complete these documents.'
F. 'I should give copies of my advance directive to my provider and my family.'
Correct Answers: A, B, D, F [CORRECT]
Rationale: A durable power of attorney for health care designates a surrogate decision maker, the living will applies when
the client cannot communicate, the proxy's authority activates only in the event of incapacity, and copies should be
distributed so the documents are available when needed. Client self-determination is protected under the Patient
Self-Determination Act, and hospitals must ask clients about advance directives, not substitute their own decisions. An
advance directive may be revised or revoked at any time, so the statement that it can never be changed is incorrect.
NGN-Style Practice Examination with Verified Answers Page 2
,New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q6: A postpartum client who is a practicing Jehovah's Witness is bleeding heavily and refuses blood transfusion.
The client is alert and has signed a refusal form. Which action should the nurse take?
A. Notify the provider so a court order can be obtained to transfuse the client
B. Ensure the client understands the risks of refusal, document the refusal and notification, and support the
client's decision [CORRECT]
C. Administer the transfusion while the client is sedated for another procedure
D. Ask the client's family to talk her out of refusing treatment
Correct Answer: B
Rationale: A competent adult has the legal and ethical right to refuse treatment based on the principle of autonomy, even
when refusal may result in death. The nurse must verify understanding, document the informed refusal, notify the provider,
and continue supportive care such as fluid resuscitation and close monitoring. Transfusing against expressed wishes,
obtaining a court order for a competent adult, or pressuring the client violates client rights and advocacy standards.
Q7: A hospitalized older adult with acute delirium repeatedly attempts to climb out of bed and pull out the
urinary catheter and peripheral IV. Redirection, reorientation, family presence, and moving the client near the
nurses' station have not worked. The nurse anticipates the need for protective measures. Complete the diagram
by selecting the correct condition, action, and parameter to monitor.
Condition: Client attempting to remove invasive lines after less restrictive measures fail
Action to Take: Obtain a health care provider order for the least restrictive restraint and apply it correctly
Parameter to Monitor: Circulation, skin integrity, and range of motion with release at least every 2 hours
Rationale: Restraints are a last resort used only after alternatives fail and only with a provider order, because they pose
risks of injury, circulatory compromise, and psychological harm. The order must specify the least restrictive device, be
time-limited, and be renewed per facility policy; PRN restraint orders are never acceptable. The nurse must release the
restraint at least every 2 hours for range of motion, assess circulation and skin integrity, and document behavior, alternatives
attempted, and ongoing need. Applying restraints without an order, using PRN orders, or asking family to physically restrict
the client violates regulatory and safety standards.
Q8: A client falls while getting out of bed unassisted. Which documentation by the nurse is correct?
A. Document in the chart that an incident report was filed about the fall
B. Document objective findings, the client's assessment, interventions, and notifications, and complete the
incident report separately [CORRECT]
C. Document that the fall occurred because another unit failed to answer the call light
D. Delay documentation until the end of the shift to allow time to complete the incident report
Correct Answer: B
Rationale: The medical record must contain only objective, factual documentation of the event, assessment findings, care
provided, and notifications; the incident report is a separate risk-management document that is never referenced in the
chart. Referencing the incident report in the chart or assigning blame creates discoverable, nonobjective entries. Timely
charting is a legal duty, and delaying documentation compromises accuracy and continuity of care.
NGN-Style Practice Examination with Verified Answers Page 3
, New Generation NCLEX Questions | 2026/2027 Edition 150 Questions | NGN Format
Q9: Following a mass-casualty event, the triage nurse using the START system evaluates four victims. Which
victim should be tagged for immediate (red) treatment?
A. A victim walking with superficial lacerations on both forearms
B. A victim with a respiratory rate of 32/min, capillary refill of 3 seconds, and confusion [CORRECT]
C. A victim with a deep laceration, controlled bleeding, respiratory rate of 18/min, and normal mentation
D. A victim who is not breathing after one attempt to reposition the airway
Correct Answer: B
Rationale: Under START triage, a respiratory rate greater than 30/min, delayed capillary refill greater than 2 seconds, or
inability to follow commands places the victim in the immediate (red) category for life-saving intervention first.
Ambulatory victims are tagged green (minor), victims with controlled injuries and stable vital signs are yellow (delayed),
and victims who are apneic after airway repositioning are black (expectant) in a disaster setting, where resources are
directed to those most likely to survive.
Q10: A caller identifying himself as the spouse of an admitted client asks the nurse for the client's diagnosis and
condition. The caller cannot provide the client access code, and the client has not listed this individual as
authorized to receive information. Which action should the nurse take?
A. Provide the client's general condition since the caller claims to be the spouse
B. Do not disclose any information; explain the confidentiality policy, offer to take a message, and ask the client
to authorize disclosure if desired [CORRECT]
C. Transfer the call to the client's room so the caller can speak directly with the client
D. Disclose the diagnosis after verifying the caller's name matches the client's last name
Correct Answer: B
Rationale: HIPAA requires the nurse to verify that a person is authorized before sharing protected health information, and
a shared last name or self-identified relationship is not verification. The nurse may take a message and ask the client
whether disclosure is permitted, protecting both confidentiality and the client's right to control information. Sharing even a
general condition without authorization, transferring the call, or disclosing to any requester violates the minimum necessary
standard.
Q11: A client with terminal ovarian cancer tells the nurse she wants to stop chemotherapy and enter hospice, but
her family insists she continue treatment. Which action by the nurse best demonstrates advocacy?
A. Encourage the family to accept the hospice decision because the prognosis is poor
B. Arrange a family meeting with the health care team to explore the client's goals and ensure her decisions are
informed and honored [CORRECT]
C. Advise the client that continuing chemotherapy offers the best chance of survival
D. Document the client's refusal of chemotherapy and notify the provider without further discussion
Correct Answer: B
Rationale: Advocacy means supporting the client's autonomous, informed decision while facilitating communication
among the client, family, and health care team. A structured family meeting allows the team to clarify prognosis and goals
of care so the client's choice is informed and the family's concerns are addressed. Pressuring the client in either direction,
offering personal opinions about prognosis, or simply documenting refusal without facilitating understanding falls short of
the advocacy role.
NGN-Style Practice Examination with Verified Answers Page 4
