NCLEX-RN Exam 2026/2027 – 300+ Questions, Answers &
Detailed Rationales
ORIGINAL • UNOFFICIAL • INDEPENDENT PRACTICE RESOURCE
Section 1: Brief Introduction
The NCLEX-RN assesses the entry-level knowledge, clinical judgment, and safe-care competencies of
candidates seeking RN licensure. This original, unofficial 300-item practice set covers the major client-
needs areas, including management of care, safety and infection prevention, health promotion,
psychosocial integrity, and physiological integrity. It is not an authenticated NCLEX examination or
affiliated with NCSBN; NGN-inspired item structures are adaptations to a static four-choice A–D format,
not interactive interfaces.
Section 2: The Complete Exam
1. [Case 1 • Prioritize] A client reports crushing chest pressure, diaphoresis, and nausea. The ECG
is being obtained. Which action should the nurse take first?
A. Rapidly assess airway, breathing, circulation, obtain vital signs, and activate the
chest-pain response pathway.
B. Ask the client to walk to reduce anxiety.
C. Delay assessment until the full medical history is completed.
D. Give food to prevent nausea.
Rationale: Possible acute coronary syndrome requires rapid assessment and protocol activation;
walking and oral intake can delay care or worsen risk. The alternative choices either delay
appropriate evaluation, add avoidable risk, or fail to address the key finding. [R1,R5]
2. A client with acute pulmonary edema is sitting upright, severely dyspneic, and has pink frothy
sputum. What is the priority?
A. Encourage oral fluids.
B. Place the client flat and elevate the legs.
C. Wait for the next routine vital-sign round.
D. Support oxygenation and ventilation, activate urgent assistance, and prepare
prescribed therapy.
Rationale: Acute pulmonary edema threatens gas exchange and requires immediate respiratory
support and escalation. Positioning flat or adding fluid can worsen distress. [R5]
1
,3. A client with heart failure gained 2.5 kg (5.5 lb) in four days and reports increasing orthopnea.
What should the nurse do?
A. Recommend doubling the diuretic without an order.
B. Reassure the client that rapid weight gain is expected.
C. Notify the heart-failure team promptly and assess volume status and respiratory
function.
D. Advise increasing sodium intake.
Rationale: Rapid weight gain with orthopnea suggests worsening fluid overload and needs
prompt evaluation. Medication changes require prescriber guidance. [R5]
4. A client taking warfarin has an INR above the prescribed range and new hematuria. What is the
priority action?
A. Encourage aspirin for pain.
B. Administer the next dose early.
C. Tell the client to stop all fluids.
D. Assess for bleeding and notify the prescriber promptly; follow the anticoagulation
protocol.
Rationale: Hematuria with a supratherapeutic INR signals possible bleeding and requires
prompt assessment and clinical direction. Do not add antiplatelet medicines or change therapy
independently. [R7]
5. A client with atrial fibrillation suddenly develops facial droop and difficulty speaking. What
should the nurse do first?
A. Place the client in a walking trial.
B. Activate the stroke response and determine the last-known-well time.
C. Give oral fluids and reassess in an hour.
D. Administer an anticoagulant before imaging.
Rationale: Sudden focal neurologic deficits require immediate stroke activation; last-known-well
time guides time-sensitive evaluation. Oral intake and empiric anticoagulation are unsafe before
assessment. [R6]
6. A client with peripheral arterial disease reports calf pain while walking that resolves with rest.
Which teaching is appropriate?
A. Stop all walking permanently.
B. Apply direct heat to numb feet.
C. Follow a structured walking plan and inspect feet daily while continuing risk-factor
management.
D. Keep legs elevated above the heart all day.
Rationale: Intermittent claudication often benefits from supervised/structured walking and
cardiovascular risk reduction. Foot inspection is important; avoid burns and unnecessary
immobility. [R5]
2
,7. A client with a suspected deep-vein thrombosis has unilateral calf swelling and tenderness.
Which action should the nurse take?
A. Massage the calf firmly.
B. Limit unnecessary manipulation and promptly notify the clinician for diagnostic
evaluation.
C. Encourage vigorous ambulation before assessment.
D. Apply a tourniquet above the knee.
Rationale: A possible DVT needs timely diagnostic assessment; vigorous massage is avoided
because of embolization concern. Follow the clinician’s mobility and anticoagulation plan. [R7]
8. A client taking an ACE inhibitor develops tongue swelling and hoarseness. What is the priority?
A. Treat as a potential airway emergency and activate emergency assistance.
B. Schedule routine follow-up next month.
C. Offer a lozenge and continue the medication.
D. Ask the client to lie flat and sleep.
Rationale: Angioedema can obstruct the airway and requires urgent intervention; further doses
should be withheld pending immediate clinician direction. The alternative choices either delay
appropriate evaluation, add avoidable risk, or fail to address the key finding. [R8]
9. A client with aortic stenosis reports syncope during exertion. Which nursing response is best?
A. Stop exertion, assess stability, and urgently notify the cardiac team.
B. Document the event as an expected effect of aging.
C. Recommend a hot shower to improve circulation.
D. Encourage the client to resume exercise at a faster pace.
Rationale: Exertional syncope with aortic stenosis may indicate impaired cardiac output and
requires urgent assessment. Prevent further exertion while escalating. [R5]
10. A client with a permanent pacemaker reports dizziness and has a pulse markedly below the
programmed lower rate. What should the nurse do?
A. Ask the client to remove the device dressing.
B. Ignore the pulse because pacemakers prevent all dysrhythmias.
C. Tell the client to adjust the pacemaker settings at home.
D. Assess rhythm and perfusion and obtain immediate device/cardiology evaluation.
Rationale: Symptoms with a rate below the expected programmed limit may reflect device or
rhythm problems. Assess and escalate promptly; patients should not alter settings. [R5]
3
, 11. A client receiving hemodialysis develops chest pain and hypotension during treatment. Which
action is the priority?
A. Stop or modify dialysis per protocol, assess ABCs, and alert the dialysis team
immediately.
B. Ask the client to stand and walk.
C. Wait until the session is complete.
D. Increase ultrafiltration to remove fluid faster.
Rationale: Chest pain and hypotension during dialysis may indicate serious hemodynamic or
cardiac compromise. Follow the emergency dialysis protocol and support circulation. [R9]
12. A client with COPD becomes increasingly drowsy and has shallow respirations. What should
the nurse do?
A. Assume drowsiness is normal for COPD.
B. Delay reassessment until after lunch.
C. Give a sedative to reduce work of breathing.
D. Assess ventilation and oxygenation immediately and escalate for possible
respiratory failure.
Rationale: New somnolence with shallow respirations can indicate hypercapnia or respiratory
failure. Immediate assessment and escalation take priority over sedation. [R10]
13. A client with asthma has severe wheezing, accessory-muscle use, and can speak only single
words. Which action is best?
A. Encourage the client to lie flat.
B. Activate emergency support and implement the prescribed acute asthma plan while
monitoring response.
C. Give a sedative to decrease anxiety.
D. Delay reliever therapy until spirometry is completed.
Rationale: Single-word speech and increased work of breathing are danger signs in severe
asthma. Follow the urgent action plan and reassess continuously. [R11]
14. A client with a tracheostomy suddenly has noisy breathing and reduced airflow. What should
the nurse do first?
A. Assess airway patency and oxygenation and follow the emergency tracheostomy
protocol.
B. Give oral fluids.
C. Wait for a routine respiratory treatment.
D. Remove the tube and leave it out.
Rationale: A tracheostomy obstruction or displacement can rapidly compromise ventilation.
Assess immediately and use the patient-specific emergency algorithm. [R1,R12]
4
Detailed Rationales
ORIGINAL • UNOFFICIAL • INDEPENDENT PRACTICE RESOURCE
Section 1: Brief Introduction
The NCLEX-RN assesses the entry-level knowledge, clinical judgment, and safe-care competencies of
candidates seeking RN licensure. This original, unofficial 300-item practice set covers the major client-
needs areas, including management of care, safety and infection prevention, health promotion,
psychosocial integrity, and physiological integrity. It is not an authenticated NCLEX examination or
affiliated with NCSBN; NGN-inspired item structures are adaptations to a static four-choice A–D format,
not interactive interfaces.
Section 2: The Complete Exam
1. [Case 1 • Prioritize] A client reports crushing chest pressure, diaphoresis, and nausea. The ECG
is being obtained. Which action should the nurse take first?
A. Rapidly assess airway, breathing, circulation, obtain vital signs, and activate the
chest-pain response pathway.
B. Ask the client to walk to reduce anxiety.
C. Delay assessment until the full medical history is completed.
D. Give food to prevent nausea.
Rationale: Possible acute coronary syndrome requires rapid assessment and protocol activation;
walking and oral intake can delay care or worsen risk. The alternative choices either delay
appropriate evaluation, add avoidable risk, or fail to address the key finding. [R1,R5]
2. A client with acute pulmonary edema is sitting upright, severely dyspneic, and has pink frothy
sputum. What is the priority?
A. Encourage oral fluids.
B. Place the client flat and elevate the legs.
C. Wait for the next routine vital-sign round.
D. Support oxygenation and ventilation, activate urgent assistance, and prepare
prescribed therapy.
Rationale: Acute pulmonary edema threatens gas exchange and requires immediate respiratory
support and escalation. Positioning flat or adding fluid can worsen distress. [R5]
1
,3. A client with heart failure gained 2.5 kg (5.5 lb) in four days and reports increasing orthopnea.
What should the nurse do?
A. Recommend doubling the diuretic without an order.
B. Reassure the client that rapid weight gain is expected.
C. Notify the heart-failure team promptly and assess volume status and respiratory
function.
D. Advise increasing sodium intake.
Rationale: Rapid weight gain with orthopnea suggests worsening fluid overload and needs
prompt evaluation. Medication changes require prescriber guidance. [R5]
4. A client taking warfarin has an INR above the prescribed range and new hematuria. What is the
priority action?
A. Encourage aspirin for pain.
B. Administer the next dose early.
C. Tell the client to stop all fluids.
D. Assess for bleeding and notify the prescriber promptly; follow the anticoagulation
protocol.
Rationale: Hematuria with a supratherapeutic INR signals possible bleeding and requires
prompt assessment and clinical direction. Do not add antiplatelet medicines or change therapy
independently. [R7]
5. A client with atrial fibrillation suddenly develops facial droop and difficulty speaking. What
should the nurse do first?
A. Place the client in a walking trial.
B. Activate the stroke response and determine the last-known-well time.
C. Give oral fluids and reassess in an hour.
D. Administer an anticoagulant before imaging.
Rationale: Sudden focal neurologic deficits require immediate stroke activation; last-known-well
time guides time-sensitive evaluation. Oral intake and empiric anticoagulation are unsafe before
assessment. [R6]
6. A client with peripheral arterial disease reports calf pain while walking that resolves with rest.
Which teaching is appropriate?
A. Stop all walking permanently.
B. Apply direct heat to numb feet.
C. Follow a structured walking plan and inspect feet daily while continuing risk-factor
management.
D. Keep legs elevated above the heart all day.
Rationale: Intermittent claudication often benefits from supervised/structured walking and
cardiovascular risk reduction. Foot inspection is important; avoid burns and unnecessary
immobility. [R5]
2
,7. A client with a suspected deep-vein thrombosis has unilateral calf swelling and tenderness.
Which action should the nurse take?
A. Massage the calf firmly.
B. Limit unnecessary manipulation and promptly notify the clinician for diagnostic
evaluation.
C. Encourage vigorous ambulation before assessment.
D. Apply a tourniquet above the knee.
Rationale: A possible DVT needs timely diagnostic assessment; vigorous massage is avoided
because of embolization concern. Follow the clinician’s mobility and anticoagulation plan. [R7]
8. A client taking an ACE inhibitor develops tongue swelling and hoarseness. What is the priority?
A. Treat as a potential airway emergency and activate emergency assistance.
B. Schedule routine follow-up next month.
C. Offer a lozenge and continue the medication.
D. Ask the client to lie flat and sleep.
Rationale: Angioedema can obstruct the airway and requires urgent intervention; further doses
should be withheld pending immediate clinician direction. The alternative choices either delay
appropriate evaluation, add avoidable risk, or fail to address the key finding. [R8]
9. A client with aortic stenosis reports syncope during exertion. Which nursing response is best?
A. Stop exertion, assess stability, and urgently notify the cardiac team.
B. Document the event as an expected effect of aging.
C. Recommend a hot shower to improve circulation.
D. Encourage the client to resume exercise at a faster pace.
Rationale: Exertional syncope with aortic stenosis may indicate impaired cardiac output and
requires urgent assessment. Prevent further exertion while escalating. [R5]
10. A client with a permanent pacemaker reports dizziness and has a pulse markedly below the
programmed lower rate. What should the nurse do?
A. Ask the client to remove the device dressing.
B. Ignore the pulse because pacemakers prevent all dysrhythmias.
C. Tell the client to adjust the pacemaker settings at home.
D. Assess rhythm and perfusion and obtain immediate device/cardiology evaluation.
Rationale: Symptoms with a rate below the expected programmed limit may reflect device or
rhythm problems. Assess and escalate promptly; patients should not alter settings. [R5]
3
, 11. A client receiving hemodialysis develops chest pain and hypotension during treatment. Which
action is the priority?
A. Stop or modify dialysis per protocol, assess ABCs, and alert the dialysis team
immediately.
B. Ask the client to stand and walk.
C. Wait until the session is complete.
D. Increase ultrafiltration to remove fluid faster.
Rationale: Chest pain and hypotension during dialysis may indicate serious hemodynamic or
cardiac compromise. Follow the emergency dialysis protocol and support circulation. [R9]
12. A client with COPD becomes increasingly drowsy and has shallow respirations. What should
the nurse do?
A. Assume drowsiness is normal for COPD.
B. Delay reassessment until after lunch.
C. Give a sedative to reduce work of breathing.
D. Assess ventilation and oxygenation immediately and escalate for possible
respiratory failure.
Rationale: New somnolence with shallow respirations can indicate hypercapnia or respiratory
failure. Immediate assessment and escalation take priority over sedation. [R10]
13. A client with asthma has severe wheezing, accessory-muscle use, and can speak only single
words. Which action is best?
A. Encourage the client to lie flat.
B. Activate emergency support and implement the prescribed acute asthma plan while
monitoring response.
C. Give a sedative to decrease anxiety.
D. Delay reliever therapy until spirometry is completed.
Rationale: Single-word speech and increased work of breathing are danger signs in severe
asthma. Follow the urgent action plan and reassess continuously. [R11]
14. A client with a tracheostomy suddenly has noisy breathing and reduced airflow. What should
the nurse do first?
A. Assess airway patency and oxygenation and follow the emergency tracheostomy
protocol.
B. Give oral fluids.
C. Wait for a routine respiratory treatment.
D. Remove the tube and leave it out.
Rationale: A tracheostomy obstruction or displacement can rapidly compromise ventilation.
Assess immediately and use the patient-specific emergency algorithm. [R1,R12]
4
