NCLEX-RN 2026 Comprehensive Predictor Practice
Exam | Final Review Questions with Verified Answers &
Rationales | INSTANT PDF DOWNLOAD
NCLEX-RN 2026 Predictor practice exam. This resource contains 160 high-yield questions covering all core
content areas: medical-surgical nursing, maternal newborn, pediatrics, mental health, pharmacology,
prioritization, delegation, and safety. Each question includes the correct answer and a rationale. Use this
exam as a final readiness test to identify weak areas and build confidence before the NCLEX.
Key Topics Covered
• Medical-Surgical Nursing – Cardiovascular, respiratory, renal, endocrine, GI, neurology, oncology,
immunology, infectious disease
• Maternal Newborn – Antepartum, intrapartum, postpartum, newborn assessment, complications,
breastfeeding
• Pediatric Nursing – Growth and development, acute/chronic illnesses, immunizations, safety
• Mental Health Nursing – Therapeutic communication, depression, bipolar, schizophrenia, substance
abuse, suicide precautions
• Pharmacology – Mechanism, side effects, interactions, patient teaching
• Prioritization & Delegation – ABCs, Maslow, stable vs unstable, RN/LPN/UAP roles
• Safety & Infection Control – Restraints, fall prevention, transmission-based precautions, emergency
response
Questions 1–160
1. A client with heart failure has crackles in bilateral lung bases, jugular vein distention, and an S3
gallop. Which medication should the nurse prepare to administer first?
A) Metoprolol
B) Furosemide IV
C) Digoxin
D) Spironolactone
Answer B: Furosemide IV
Rationale: IV furosemide rapidly reduces preload and pulmonary congestion. Beta-blockers and digoxin are
not for acute decompensation.
,2. The nurse is caring for a client with a new tracheostomy. Which finding requires immediate
action?
A) Small amount of serous drainage at the stoma site
B) Difficulty passing a suction catheter and decreased breath sounds
C) Temperature 37.8°C (100°F)
D) Oxygen saturation 94% on room air
Answer B: Difficulty passing a suction catheter and decreased breath sounds
Rationale: Inability to pass catheter and diminished breath sounds suggest tube obstruction; suction or
replace tube immediately.
3. A client with bipolar disorder in a manic episode has not slept for 3 days and is pacing rapidly.
Which nursing intervention is most appropriate?
A) Administer a sedative IM
B) Provide a quiet, low-stimulation environment and offer high-calorie finger foods
C) Place the client in seclusion
D) Allow the client to continue pacing without intervention
Answer B: Provide a quiet, low-stimulation environment and offer high-calorie finger foods
Rationale: Reduce stimuli to decrease agitation; offer portable snacks and fluids to maintain nutrition.
4. A child with a history of asthma has a peak flow reading of 50% of personal best. The child is
speaking in short phrases and has retractions. Which action should the nurse take first?
A) Administer an oral corticosteroid
B) Administer a rescue bronchodilator (albuterol) via nebulizer
C) Call 911
D) Apply oxygen at 2 L/min via nasal cannula
Answer B: Administer a rescue bronchodilator (albuterol) via nebulizer
Rationale: Peak flow 50-80% (yellow zone) indicates moderate exacerbation; treat with bronchodilator
first. Red zone (<50%) with severe symptoms may need 911.
5. The charge nurse is making assignments. Which client is most appropriate to assign to an LPN?
A) Client with a new tracheostomy requiring frequent suctioning
B) Client with a urinary tract infection on oral antibiotics
C) Client with a chest tube on water seal
,D) Client receiving IV dopamine for septic shock
Answer B: Client with a urinary tract infection on oral antibiotics
Rationale: Stable client on oral meds is within LPN scope. Tracheostomy, chest tube, and vasopressors
require RN.
6. A client with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L. Which ECG change
does the nurse expect?
A) Prominent U waves
B) Peaked T waves
C) Prolonged PR interval
D) ST depression
Answer B: Peaked T waves
Rationale: Hyperkalemia causes peaked T waves, then wide QRS, and eventually sine wave. Prominent U
waves are hypokalemia.
7. A postpartum client who delivered 2 hours ago has a boggy fundus displaced to the right and heavy
lochia with clots. What is the priority nursing action?
A) Administer methylergonovine IM
B) Assist the client to void
C) Perform fundal massage
D) Increase the oxytocin infusion rate
Answer B: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder; emptying the bladder allows the
uterus to contract.
8. A client with major depressive disorder is started on phenelzine (MAOI). Which food should the
nurse instruct the client to avoid?
A) Broiled chicken
B) Aged cheddar cheese
C) Fresh apples
D) White rice
Answer B: Aged cheddar cheese
, Rationale: MAOIs require a low-tyramine diet; aged cheese, cured meats, and fermented foods cause
hypertensive crisis.
9. A client with a pulmonary embolism is receiving a heparin infusion. The aPTT is 110 seconds
(control 30). Which action should the nurse take?
A) Continue the infusion at the same rate
B) Decrease the infusion rate and notify the provider
C) Increase the infusion rate
D) Stop the heparin and administer protamine
Answer B: Decrease the infusion rate and notify the provider
Rationale: aPTT 110 is supratherapeutic (goal 45-75). Reduce rate and notify provider; protamine for
severe bleeding.
10. A toddler is brought to the emergency department after ingesting a button battery. Which action
should the nurse take first?
A) Induce vomiting
B) Obtain an X-ray to locate the battery
C) Administer activated charcoal
D) Give a laxative
Answer B: Obtain an X-ray to locate the battery
Rationale: Button batteries can cause esophageal burns; immediate X-ray is needed for localization. Do not
induce vomiting.
11. The nurse is assessing a client with a suspected pulmonary embolism. Which finding is most
consistent?
A) Bradycardia and hypotension
B) Sudden dyspnea and pleuritic chest pain
C) Productive cough with green sputum
D) Fever and chills
Answer B: Sudden dyspnea and pleuritic chest pain
Rationale: Classic PE symptoms include sudden dyspnea, pleuritic chest pain, tachycardia, and sometimes
hemoptysis.
Exam | Final Review Questions with Verified Answers &
Rationales | INSTANT PDF DOWNLOAD
NCLEX-RN 2026 Predictor practice exam. This resource contains 160 high-yield questions covering all core
content areas: medical-surgical nursing, maternal newborn, pediatrics, mental health, pharmacology,
prioritization, delegation, and safety. Each question includes the correct answer and a rationale. Use this
exam as a final readiness test to identify weak areas and build confidence before the NCLEX.
Key Topics Covered
• Medical-Surgical Nursing – Cardiovascular, respiratory, renal, endocrine, GI, neurology, oncology,
immunology, infectious disease
• Maternal Newborn – Antepartum, intrapartum, postpartum, newborn assessment, complications,
breastfeeding
• Pediatric Nursing – Growth and development, acute/chronic illnesses, immunizations, safety
• Mental Health Nursing – Therapeutic communication, depression, bipolar, schizophrenia, substance
abuse, suicide precautions
• Pharmacology – Mechanism, side effects, interactions, patient teaching
• Prioritization & Delegation – ABCs, Maslow, stable vs unstable, RN/LPN/UAP roles
• Safety & Infection Control – Restraints, fall prevention, transmission-based precautions, emergency
response
Questions 1–160
1. A client with heart failure has crackles in bilateral lung bases, jugular vein distention, and an S3
gallop. Which medication should the nurse prepare to administer first?
A) Metoprolol
B) Furosemide IV
C) Digoxin
D) Spironolactone
Answer B: Furosemide IV
Rationale: IV furosemide rapidly reduces preload and pulmonary congestion. Beta-blockers and digoxin are
not for acute decompensation.
,2. The nurse is caring for a client with a new tracheostomy. Which finding requires immediate
action?
A) Small amount of serous drainage at the stoma site
B) Difficulty passing a suction catheter and decreased breath sounds
C) Temperature 37.8°C (100°F)
D) Oxygen saturation 94% on room air
Answer B: Difficulty passing a suction catheter and decreased breath sounds
Rationale: Inability to pass catheter and diminished breath sounds suggest tube obstruction; suction or
replace tube immediately.
3. A client with bipolar disorder in a manic episode has not slept for 3 days and is pacing rapidly.
Which nursing intervention is most appropriate?
A) Administer a sedative IM
B) Provide a quiet, low-stimulation environment and offer high-calorie finger foods
C) Place the client in seclusion
D) Allow the client to continue pacing without intervention
Answer B: Provide a quiet, low-stimulation environment and offer high-calorie finger foods
Rationale: Reduce stimuli to decrease agitation; offer portable snacks and fluids to maintain nutrition.
4. A child with a history of asthma has a peak flow reading of 50% of personal best. The child is
speaking in short phrases and has retractions. Which action should the nurse take first?
A) Administer an oral corticosteroid
B) Administer a rescue bronchodilator (albuterol) via nebulizer
C) Call 911
D) Apply oxygen at 2 L/min via nasal cannula
Answer B: Administer a rescue bronchodilator (albuterol) via nebulizer
Rationale: Peak flow 50-80% (yellow zone) indicates moderate exacerbation; treat with bronchodilator
first. Red zone (<50%) with severe symptoms may need 911.
5. The charge nurse is making assignments. Which client is most appropriate to assign to an LPN?
A) Client with a new tracheostomy requiring frequent suctioning
B) Client with a urinary tract infection on oral antibiotics
C) Client with a chest tube on water seal
,D) Client receiving IV dopamine for septic shock
Answer B: Client with a urinary tract infection on oral antibiotics
Rationale: Stable client on oral meds is within LPN scope. Tracheostomy, chest tube, and vasopressors
require RN.
6. A client with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L. Which ECG change
does the nurse expect?
A) Prominent U waves
B) Peaked T waves
C) Prolonged PR interval
D) ST depression
Answer B: Peaked T waves
Rationale: Hyperkalemia causes peaked T waves, then wide QRS, and eventually sine wave. Prominent U
waves are hypokalemia.
7. A postpartum client who delivered 2 hours ago has a boggy fundus displaced to the right and heavy
lochia with clots. What is the priority nursing action?
A) Administer methylergonovine IM
B) Assist the client to void
C) Perform fundal massage
D) Increase the oxytocin infusion rate
Answer B: Assist the client to void
Rationale: A displaced boggy fundus often indicates a distended bladder; emptying the bladder allows the
uterus to contract.
8. A client with major depressive disorder is started on phenelzine (MAOI). Which food should the
nurse instruct the client to avoid?
A) Broiled chicken
B) Aged cheddar cheese
C) Fresh apples
D) White rice
Answer B: Aged cheddar cheese
, Rationale: MAOIs require a low-tyramine diet; aged cheese, cured meats, and fermented foods cause
hypertensive crisis.
9. A client with a pulmonary embolism is receiving a heparin infusion. The aPTT is 110 seconds
(control 30). Which action should the nurse take?
A) Continue the infusion at the same rate
B) Decrease the infusion rate and notify the provider
C) Increase the infusion rate
D) Stop the heparin and administer protamine
Answer B: Decrease the infusion rate and notify the provider
Rationale: aPTT 110 is supratherapeutic (goal 45-75). Reduce rate and notify provider; protamine for
severe bleeding.
10. A toddler is brought to the emergency department after ingesting a button battery. Which action
should the nurse take first?
A) Induce vomiting
B) Obtain an X-ray to locate the battery
C) Administer activated charcoal
D) Give a laxative
Answer B: Obtain an X-ray to locate the battery
Rationale: Button batteries can cause esophageal burns; immediate X-ray is needed for localization. Do not
induce vomiting.
11. The nurse is assessing a client with a suspected pulmonary embolism. Which finding is most
consistent?
A) Bradycardia and hypotension
B) Sudden dyspnea and pleuritic chest pain
C) Productive cough with green sputum
D) Fever and chills
Answer B: Sudden dyspnea and pleuritic chest pain
Rationale: Classic PE symptoms include sudden dyspnea, pleuritic chest pain, tachycardia, and sometimes
hemoptysis.
