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2026 NCLEX RN TEST REAL EXAM
ENHANCED CLINICAL JUDGMENT
SCENARIO BASED QUESTIONS TESTING
DEEPER REASONING
REAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
NEWEST 2026 2027 EDITION
SECTION 1 CLINICAL JUDGMENT IN MEDICAL
SURGICAL NURSING
QUESTIONS 1 TO 25
1 A nurse is caring for a patient who is 2 hours
post‑operative following a total knee replacement. The
patient reports pain rated 8 out of 10. The nurse
administers morphine 4 mg intravenously as prescribed.
Thirty minutes later, the patient reports the pain is now 6
out of 10 and states I still have a lot of pain. The
respiratory rate is 12 breaths per minute. What should the
nurse do next and why?
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A Administer another dose of morphine because the pain
is still high
B Wait the full prescribed interval before giving more
opioid because respiratory rate is borderline
C Notify the provider because the patient is not
responding adequately to the current dose
D Reposition the patient and apply ice before considering
additional medication
ANSWER B
Rationale A respiratory rate of 12 is borderline. The nurse
must prioritize respiratory safety over pain control.
Waiting the full interval allows time to reassess
respiratory status and prevents cumulative respiratory
depression.
2 A nurse is caring for a patient with heart failure who has
crackles in both lung bases, 2+ pitting edema in the lower
extremities, and a weight gain of 2 kg in 24 hours. The
provider orders furosemide 40 mg intravenous. One hour
after administration, the patient has a urine output of 800
mL. The nurse notes that the patient now reports dizziness
when sitting up. Why is the patient dizzy?
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A The furosemide caused ototoxicity
B The rapid diuresis led to hypovolemia and orthostatic
hypotension
C The patient is having an allergic reaction to furosemide
D The patient's blood pressure increased due to fluid
shifts
ANSWER B
Rationale Furosemide causes diuresis. A large urine
output in one hour can reduce intravascular volume,
leading to orthostatic hypotension. The nurse should
assess blood pressure and assist the patient with position
changes.
3 A nurse is assessing a patient with chronic obstructive
pulmonary disease who has a oxygen saturation of 88
percent on room air. The patient is alert and oriented but
reports feeling short of breath. The nurse applies a nasal
cannula at 2 liters per minute. Why is 2 liters per minute
an appropriate starting flow rate for this patient?
A Higher flow rates may suppress the patient's hypoxic
drive
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B The patient needs the lowest oxygen possible to avoid
carbon dioxide retention
C The patient's oxygen saturation goal is only 88 to 90
percent
D The patient is not in respiratory distress
ANSWER A
Rationale Some patients with COPD rely on hypoxic
drive to breathe. High oxygen flow rates can decrease
respiratory drive and cause carbon dioxide retention.
Starting at 2 liters per minute allows assessment of
response without suppressing ventilation.
4 A nurse is caring for a patient with diabetes mellitus
who has a blood glucose of 45 mg per dL and is
unconscious. The nurse administers glucagon 1 mg
intramuscularly. Why does the nurse choose the
intramuscular route instead of oral glucose?
A Intramuscular injection provides faster absorption than
oral
B The patient is unconscious and cannot protect the
airway for oral intake
2026 NCLEX RN TEST REAL EXAM
ENHANCED CLINICAL JUDGMENT
SCENARIO BASED QUESTIONS TESTING
DEEPER REASONING
REAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
NEWEST 2026 2027 EDITION
SECTION 1 CLINICAL JUDGMENT IN MEDICAL
SURGICAL NURSING
QUESTIONS 1 TO 25
1 A nurse is caring for a patient who is 2 hours
post‑operative following a total knee replacement. The
patient reports pain rated 8 out of 10. The nurse
administers morphine 4 mg intravenously as prescribed.
Thirty minutes later, the patient reports the pain is now 6
out of 10 and states I still have a lot of pain. The
respiratory rate is 12 breaths per minute. What should the
nurse do next and why?
, Page 2 of 79
A Administer another dose of morphine because the pain
is still high
B Wait the full prescribed interval before giving more
opioid because respiratory rate is borderline
C Notify the provider because the patient is not
responding adequately to the current dose
D Reposition the patient and apply ice before considering
additional medication
ANSWER B
Rationale A respiratory rate of 12 is borderline. The nurse
must prioritize respiratory safety over pain control.
Waiting the full interval allows time to reassess
respiratory status and prevents cumulative respiratory
depression.
2 A nurse is caring for a patient with heart failure who has
crackles in both lung bases, 2+ pitting edema in the lower
extremities, and a weight gain of 2 kg in 24 hours. The
provider orders furosemide 40 mg intravenous. One hour
after administration, the patient has a urine output of 800
mL. The nurse notes that the patient now reports dizziness
when sitting up. Why is the patient dizzy?
, Page 3 of 79
A The furosemide caused ototoxicity
B The rapid diuresis led to hypovolemia and orthostatic
hypotension
C The patient is having an allergic reaction to furosemide
D The patient's blood pressure increased due to fluid
shifts
ANSWER B
Rationale Furosemide causes diuresis. A large urine
output in one hour can reduce intravascular volume,
leading to orthostatic hypotension. The nurse should
assess blood pressure and assist the patient with position
changes.
3 A nurse is assessing a patient with chronic obstructive
pulmonary disease who has a oxygen saturation of 88
percent on room air. The patient is alert and oriented but
reports feeling short of breath. The nurse applies a nasal
cannula at 2 liters per minute. Why is 2 liters per minute
an appropriate starting flow rate for this patient?
A Higher flow rates may suppress the patient's hypoxic
drive
, Page 4 of 79
B The patient needs the lowest oxygen possible to avoid
carbon dioxide retention
C The patient's oxygen saturation goal is only 88 to 90
percent
D The patient is not in respiratory distress
ANSWER A
Rationale Some patients with COPD rely on hypoxic
drive to breathe. High oxygen flow rates can decrease
respiratory drive and cause carbon dioxide retention.
Starting at 2 liters per minute allows assessment of
response without suppressing ventilation.
4 A nurse is caring for a patient with diabetes mellitus
who has a blood glucose of 45 mg per dL and is
unconscious. The nurse administers glucagon 1 mg
intramuscularly. Why does the nurse choose the
intramuscular route instead of oral glucose?
A Intramuscular injection provides faster absorption than
oral
B The patient is unconscious and cannot protect the
airway for oral intake
