NCLEX-RN 2026 Actual Exam
Test Bank
Section 1: Safe and Effective Care Environment (Management of Care, 20 questions)
1. A charge nurse is assigning tasks to an LPN/LVN and a UAP. Which task should the charge nurse
assign to the LPN/LVN?
A. Insert an indwelling urinary catheter for a patient with urinary retention.
B. Feed a patient with dysphagia who requires a thickened liquid diet.
C. Assess a postoperative patient’s surgical incision for signs of infection.
D. Empty a patient’s Jackson-Pratt drain and record output.
Correct Answer: A
• Rationale A: LPN/LVNs can perform sterile procedures (e.g., catheter insertion) under RN
supervision in most states.
• Rationale B: Feeding a stable patient with dysphagia is appropriate for UAP after proper
training.
• Rationale C: Initial assessment of incision is an RN responsibility.
• Rationale D: Emptying a drain is a standard task for UAP, but documenting output may require
LPN if facility policy allows. However, A is more clearly within LPN scope.
2. A nurse receives a handoff report on 4 patients. Which patient should the nurse see first?
A. Patient with COPD, O2 saturation 90% on 2L nasal cannula, respirations 22/min.
B. Patient post-hip replacement, reports pain 4/10, last pain med 3 hours ago.
C. Patient with chest tube, continuous bubbling in water seal chamber.
D. Patient with new type 2 diabetes, blood glucose 180 mg/dL, no symptoms.
Correct Answer: C
• Rationale C: Continuous bubbling in water seal chamber indicates an air leak, which can lead to
pneumothorax – immediate intervention required.
, • Rationale A: O2 sat 90% is acceptable for COPD patient (goal often 88-92%), respirations 22/min
stable.
• Rationale B: Pain 4/10 is moderate, can be addressed after urgent issues.
• Rationale D: Glucose 180 mg/dL is elevated but not critical.
3. A nurse is preparing to delegate vital signs measurement to a UAP. Which patient would be
inappropriate for the UAP to measure?
A. Patient admitted with pneumonia, stable, afebrile.
B. Patient 2 hours post-cardiac catheterization via femoral artery.
C. Patient with wrist fracture, scheduled for OR in 2 hours.
D. Patient with UTI, receiving oral antibiotics.
Correct Answer: B
• Rationale B: Post-cardiac cath patient requires assessment of distal pulses, hematoma, bleeding
– RN should assess, not delegate vital signs alone.
• Rationale A: Stable pneumonia patient – UAP can measure VS.
• Rationale C: Pre-op stable fracture – UAP can measure VS.
• Rationale D: UTI stable – UAP can measure VS.
4. A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs (Jehovah’s
Witness). The provider orders transfusion. What should the nurse do?
A. Administer the transfusion as ordered.
B. Notify the provider and document the patient’s refusal.
C. Ask family to convince the patient.
D. Give the transfusion under implied consent.
Correct Answer: B
• Rationale B: Respect patient autonomy; provider must be informed to find alternatives.
• Rationale A: Violates patient’s right to refuse treatment.
• Rationale C: Unethical to pressure patient.
• Rationale D: Implied consent does not apply when patient explicitly refuses.
5. A nurse manager is implementing a new electronic health record (EHR) system. Which action best
promotes user adoption?
A. Mandate use immediately without training.
B. Provide hands-on training sessions and super-users on each shift.
C. Allow staff to opt out and continue paper charting.
D. Only train night shift staff.
Correct Answer: B
• Rationale B: Hands-on training and support improve confidence and competence.
Test Bank
Section 1: Safe and Effective Care Environment (Management of Care, 20 questions)
1. A charge nurse is assigning tasks to an LPN/LVN and a UAP. Which task should the charge nurse
assign to the LPN/LVN?
A. Insert an indwelling urinary catheter for a patient with urinary retention.
B. Feed a patient with dysphagia who requires a thickened liquid diet.
C. Assess a postoperative patient’s surgical incision for signs of infection.
D. Empty a patient’s Jackson-Pratt drain and record output.
Correct Answer: A
• Rationale A: LPN/LVNs can perform sterile procedures (e.g., catheter insertion) under RN
supervision in most states.
• Rationale B: Feeding a stable patient with dysphagia is appropriate for UAP after proper
training.
• Rationale C: Initial assessment of incision is an RN responsibility.
• Rationale D: Emptying a drain is a standard task for UAP, but documenting output may require
LPN if facility policy allows. However, A is more clearly within LPN scope.
2. A nurse receives a handoff report on 4 patients. Which patient should the nurse see first?
A. Patient with COPD, O2 saturation 90% on 2L nasal cannula, respirations 22/min.
B. Patient post-hip replacement, reports pain 4/10, last pain med 3 hours ago.
C. Patient with chest tube, continuous bubbling in water seal chamber.
D. Patient with new type 2 diabetes, blood glucose 180 mg/dL, no symptoms.
Correct Answer: C
• Rationale C: Continuous bubbling in water seal chamber indicates an air leak, which can lead to
pneumothorax – immediate intervention required.
, • Rationale A: O2 sat 90% is acceptable for COPD patient (goal often 88-92%), respirations 22/min
stable.
• Rationale B: Pain 4/10 is moderate, can be addressed after urgent issues.
• Rationale D: Glucose 180 mg/dL is elevated but not critical.
3. A nurse is preparing to delegate vital signs measurement to a UAP. Which patient would be
inappropriate for the UAP to measure?
A. Patient admitted with pneumonia, stable, afebrile.
B. Patient 2 hours post-cardiac catheterization via femoral artery.
C. Patient with wrist fracture, scheduled for OR in 2 hours.
D. Patient with UTI, receiving oral antibiotics.
Correct Answer: B
• Rationale B: Post-cardiac cath patient requires assessment of distal pulses, hematoma, bleeding
– RN should assess, not delegate vital signs alone.
• Rationale A: Stable pneumonia patient – UAP can measure VS.
• Rationale C: Pre-op stable fracture – UAP can measure VS.
• Rationale D: UTI stable – UAP can measure VS.
4. A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs (Jehovah’s
Witness). The provider orders transfusion. What should the nurse do?
A. Administer the transfusion as ordered.
B. Notify the provider and document the patient’s refusal.
C. Ask family to convince the patient.
D. Give the transfusion under implied consent.
Correct Answer: B
• Rationale B: Respect patient autonomy; provider must be informed to find alternatives.
• Rationale A: Violates patient’s right to refuse treatment.
• Rationale C: Unethical to pressure patient.
• Rationale D: Implied consent does not apply when patient explicitly refuses.
5. A nurse manager is implementing a new electronic health record (EHR) system. Which action best
promotes user adoption?
A. Mandate use immediately without training.
B. Provide hands-on training sessions and super-users on each shift.
C. Allow staff to opt out and continue paper charting.
D. Only train night shift staff.
Correct Answer: B
• Rationale B: Hands-on training and support improve confidence and competence.
