NCLEX-RN Comprehensive Practice Exam 2026: 100
Questions & Answers with Rationales
1. The nurse receives report on four clients. Which client should the nurse assess first?
A. A client with pneumonia who has a temperature of 38.1°C (100.6°F)
B. A client with heart failure who has new-onset confusion and an oxygen saturation of
86%
C. A client with diabetes who has a blood glucose level of 72 mg/dL
D. A client with a fractured wrist reporting pain of 7/10
2. A nurse is assessing a client with suspected hypovolemic shock. Which finding is
most concerning?
A. Heart rate of 108/min
B. Blood pressure of 86/54 mmHg
C. Respiratory rate of 22/min
D. Cool extremities
3. A client with asthma suddenly develops severe shortness of breath and difficulty
speaking. Which action should the nurse take first?
A. Obtain a peak expiratory flow rate
B. Place the client in a supine position
C. Assess airway and breathing
D. Encourage oral fluids
4. A postoperative client reports sudden shortness of breath and sharp chest pain. The
nurse notes tachycardia and decreased oxygen saturation. Which complication should
the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
5. Which assessment finding requires the nurse to intervene immediately in a client with
increased intracranial pressure?
,A. Headache
B. Restlessness
C. Unequal pupils
D. Mild nausea
6. A nurse is caring for a client who has dysphagia following a stroke. Which intervention
is most appropriate?
A. Offer thin liquids with meals
B. Place food on the unaffected side of the mouth
C. Encourage the client to drink through a straw
D. Position the client flat after eating
7. Select all that apply. Which findings are commonly associated with hypoglycemia?
A. Tremors
B. Diaphoresis
C. Confusion
D. Bradycardia
E. Hunger
F. Warm, dry skin
8. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which finding requires immediate follow-up?
A. Oxygen saturation of 90%
B. Respiratory rate of 20/min
C. Increasing drowsiness and difficulty staying awake
D. Productive cough with clear sputum
9. A nurse is caring for a client with heart failure. Which finding indicates worsening fluid
retention?
A. Weight loss of 1 kg
B. Decreased ankle edema
C. New bilateral crackles
,D. Increased urine output
10. Which client should the nurse assign to an experienced RN rather than an assistive
personnel (AP)?
A. A stable client who needs assistance with bathing
B. A client who requires routine vital signs
C. A client who needs assessment after receiving a blood transfusion
D. A stable client who needs assistance eating
11. A nurse is preparing to administer medication to a client. The client states, “This pill
looks different from what I usually take.” What should the nurse do?
A. Administer the medication because it is listed on the MAR
B. Ask another nurse to give the medication
C. Hold the medication and verify the order and medication
D. Tell the client that medications may look different between manufacturers
12. A client with diabetes is awake, alert, and experiencing symptoms of hypoglycemia.
What is the nurse’s priority action?
A. Administer a rapid source of glucose
B. Administer long-acting insulin
C. Encourage the client to exercise
D. Restrict oral intake
13. A nurse is caring for a client who has a central venous catheter. Which finding
should be reported immediately?
A. Dressing is clean and dry
B. Catheter is secured
C. Sudden shortness of breath after catheter manipulation
D. Mild tenderness at the insertion site
14. A client receiving a blood transfusion develops chills, fever, and back discomfort.
What is the nurse’s first action?
A. Slow the transfusion
B. Stop the transfusion
, C. Administer prescribed medication
D. Reassess the client in 15 minutes
15. Select all that apply. Which interventions help reduce the risk of pressure injuries?
A. Reposition immobile clients regularly
B. Keep skin clean and dry
C. Massage reddened bony prominences
D. Provide adequate nutrition and hydration
E. Use pressure-redistributing surfaces
F. Keep the head of the bed elevated as high as possible continuously
16. A client with suspected meningitis is admitted to the unit. Which precaution is
appropriate initially?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Protective isolation
17. A nurse is assessing a client after a thyroidectomy. Which finding requires
immediate intervention?
A. Mild sore throat
B. Hoarse voice
C. Stridor
D. Incisional discomfort
18. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which
finding is the greatest concern?
A. Muscle weakness
B. Fatigue
C. Cardiac dysrhythmia
D. Mild nausea
Questions & Answers with Rationales
1. The nurse receives report on four clients. Which client should the nurse assess first?
A. A client with pneumonia who has a temperature of 38.1°C (100.6°F)
B. A client with heart failure who has new-onset confusion and an oxygen saturation of
86%
C. A client with diabetes who has a blood glucose level of 72 mg/dL
D. A client with a fractured wrist reporting pain of 7/10
2. A nurse is assessing a client with suspected hypovolemic shock. Which finding is
most concerning?
A. Heart rate of 108/min
B. Blood pressure of 86/54 mmHg
C. Respiratory rate of 22/min
D. Cool extremities
3. A client with asthma suddenly develops severe shortness of breath and difficulty
speaking. Which action should the nurse take first?
A. Obtain a peak expiratory flow rate
B. Place the client in a supine position
C. Assess airway and breathing
D. Encourage oral fluids
4. A postoperative client reports sudden shortness of breath and sharp chest pain. The
nurse notes tachycardia and decreased oxygen saturation. Which complication should
the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
5. Which assessment finding requires the nurse to intervene immediately in a client with
increased intracranial pressure?
,A. Headache
B. Restlessness
C. Unequal pupils
D. Mild nausea
6. A nurse is caring for a client who has dysphagia following a stroke. Which intervention
is most appropriate?
A. Offer thin liquids with meals
B. Place food on the unaffected side of the mouth
C. Encourage the client to drink through a straw
D. Position the client flat after eating
7. Select all that apply. Which findings are commonly associated with hypoglycemia?
A. Tremors
B. Diaphoresis
C. Confusion
D. Bradycardia
E. Hunger
F. Warm, dry skin
8. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which finding requires immediate follow-up?
A. Oxygen saturation of 90%
B. Respiratory rate of 20/min
C. Increasing drowsiness and difficulty staying awake
D. Productive cough with clear sputum
9. A nurse is caring for a client with heart failure. Which finding indicates worsening fluid
retention?
A. Weight loss of 1 kg
B. Decreased ankle edema
C. New bilateral crackles
,D. Increased urine output
10. Which client should the nurse assign to an experienced RN rather than an assistive
personnel (AP)?
A. A stable client who needs assistance with bathing
B. A client who requires routine vital signs
C. A client who needs assessment after receiving a blood transfusion
D. A stable client who needs assistance eating
11. A nurse is preparing to administer medication to a client. The client states, “This pill
looks different from what I usually take.” What should the nurse do?
A. Administer the medication because it is listed on the MAR
B. Ask another nurse to give the medication
C. Hold the medication and verify the order and medication
D. Tell the client that medications may look different between manufacturers
12. A client with diabetes is awake, alert, and experiencing symptoms of hypoglycemia.
What is the nurse’s priority action?
A. Administer a rapid source of glucose
B. Administer long-acting insulin
C. Encourage the client to exercise
D. Restrict oral intake
13. A nurse is caring for a client who has a central venous catheter. Which finding
should be reported immediately?
A. Dressing is clean and dry
B. Catheter is secured
C. Sudden shortness of breath after catheter manipulation
D. Mild tenderness at the insertion site
14. A client receiving a blood transfusion develops chills, fever, and back discomfort.
What is the nurse’s first action?
A. Slow the transfusion
B. Stop the transfusion
, C. Administer prescribed medication
D. Reassess the client in 15 minutes
15. Select all that apply. Which interventions help reduce the risk of pressure injuries?
A. Reposition immobile clients regularly
B. Keep skin clean and dry
C. Massage reddened bony prominences
D. Provide adequate nutrition and hydration
E. Use pressure-redistributing surfaces
F. Keep the head of the bed elevated as high as possible continuously
16. A client with suspected meningitis is admitted to the unit. Which precaution is
appropriate initially?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Protective isolation
17. A nurse is assessing a client after a thyroidectomy. Which finding requires
immediate intervention?
A. Mild sore throat
B. Hoarse voice
C. Stridor
D. Incisional discomfort
18. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which
finding is the greatest concern?
A. Muscle weakness
B. Fatigue
C. Cardiac dysrhythmia
D. Mild nausea
