New Generation (NGN) NCLEX RN Exam –
2026/2027 Edition – 150-Question Full-Length
Practice Set with Detailed Rationales | with
complete solutions.
SECTION 1: MANAGEMENT OF CARE (Questions 1-
15)
1. The charge nurse is making assignments on a medical-surgical
unit. Which client should be assigned to the most experienced
registered nurse (RN)?
A) A 45-year-old with type 2 diabetes requiring blood glucose monitoring and
insulin administration before meals
B) A 62-year-old 3 days post-cholecystectomy with stable vital signs and a
Jackson-Pratt drain
C) A 58-year-old with new-onset atrial fibrillation, started on amiodarone IV,
with a heart rate of 110-120 bpm
D) A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with
stable oxygen saturation
Answer: C) A 58-year-old with new-onset atrial fibrillation, started on
amiodarone IV, with a heart rate of 110-120 bpm
Rationale: The client with new-onset atrial fibrillation on amiodarone IV
requires close monitoring for dysrhythmias, hypotension, and adverse
effects, necessitating the clinical judgment of the most experienced RN. The
other clients are stable with predictable care needs and could be safely
assigned to a less experienced RN or LPN under supervision.
,Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
2. A nurse is delegating tasks to unlicensed assistive personnel
(UAP) on a busy surgical unit. Which task is appropriate to delegate
to the UAP?
A) Inserting a urinary catheter for a client with urinary retention
B) Assisting a client with ambulation post-laparoscopic cholecystectomy
C) Administering oral medications to a client with heart failure
D) Assessing a postoperative client's surgical incision for signs of infection
Answer: B) Assisting a client with ambulation post-laparoscopic
cholecystectomy
Rationale: Assisting with ambulation for a stable postoperative client is
within the UAP scope of practice and does not require nursing judgment.
Inserting catheters, administering medications, and assessing incisions
require nursing licensure and clinical decision-making that cannot be
delegated to UAP.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
3. The nurse is caring for a client who has been declared brain dead
and is an organ donor. The family expresses confusion about why
the ventilator is still running. What is the nurse's best response?
A) "The ventilator keeps the organs viable until they can be harvested."
B) "There is still a chance your loved one might recover."
C) "The doctor hasn't made the final decision yet."
D) "We need to keep the ventilator on for legal reasons."
,Answer: A) "The ventilator keeps the organs viable until they can be
harvested."
Rationale: When brain death has been declared, the ventilator maintains
oxygenation to preserve organ viability for donation. This honest, factual
explanation respects the family's need for information while being culturally
sensitive. The other options provide false hope or incomplete information
that could increase family distress.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
4. A nurse discovers that a colleague documented administering a
medication that was not actually given. What is the nurse's first
action?
A) Complete an incident report immediately
B) Notify the nurse manager of the error
C) Inform the client about the medication error
D) Discuss the concern directly with the colleague
Answer: D) Discuss the concern directly with the colleague
Rationale: The first step is to address the colleague directly to verify facts
and allow for clarification, following the chain of communication principle. If
unresolved, escalate to the nurse manager. Incident reports and client
notification occur after verification and appropriate chain of command follow-
through.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
5. Which action by the nurse demonstrates the ethical principle of
nonmaleficence?
, A) Providing detailed information about treatment options to a client
B) Ensuring a client receives appropriate pain medication to prevent
suffering
C) Double-checking a high-alert medication before administration
D) Treating all clients equally regardless of their background
Answer: C) Double-checking a high-alert medication before
administration
Rationale: Nonmaleficence means "do no harm." Double-checking high-alert
medications prevents potential harm from medication errors. Option A
demonstrates autonomy, B demonstrates beneficence, and D demonstrates
justice.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
6. A client with a living will is admitted with a myocardial infarction
and requests "everything possible" be done, contradicting the living
will stating DNR status. What is the nurse's priority action?
A) Follow the living will because it is a legal document
B) Notify the provider immediately to clarify the client's current wishes
C) Honor the client's verbal request for full treatment
D) Contact the ethics committee for a decision
Answer: B) Notify the provider immediately to clarify the client's
current wishes
Rationale: When a client's verbal wishes contradict their living will, the nurse
should notify the provider to clarify the client's current wishes and document
the conversation. A living will is a legal document, but the client's current
expressed wishes should be considered, especially if they are alert and
oriented.
2026/2027 Edition – 150-Question Full-Length
Practice Set with Detailed Rationales | with
complete solutions.
SECTION 1: MANAGEMENT OF CARE (Questions 1-
15)
1. The charge nurse is making assignments on a medical-surgical
unit. Which client should be assigned to the most experienced
registered nurse (RN)?
A) A 45-year-old with type 2 diabetes requiring blood glucose monitoring and
insulin administration before meals
B) A 62-year-old 3 days post-cholecystectomy with stable vital signs and a
Jackson-Pratt drain
C) A 58-year-old with new-onset atrial fibrillation, started on amiodarone IV,
with a heart rate of 110-120 bpm
D) A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with
stable oxygen saturation
Answer: C) A 58-year-old with new-onset atrial fibrillation, started on
amiodarone IV, with a heart rate of 110-120 bpm
Rationale: The client with new-onset atrial fibrillation on amiodarone IV
requires close monitoring for dysrhythmias, hypotension, and adverse
effects, necessitating the clinical judgment of the most experienced RN. The
other clients are stable with predictable care needs and could be safely
assigned to a less experienced RN or LPN under supervision.
,Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
2. A nurse is delegating tasks to unlicensed assistive personnel
(UAP) on a busy surgical unit. Which task is appropriate to delegate
to the UAP?
A) Inserting a urinary catheter for a client with urinary retention
B) Assisting a client with ambulation post-laparoscopic cholecystectomy
C) Administering oral medications to a client with heart failure
D) Assessing a postoperative client's surgical incision for signs of infection
Answer: B) Assisting a client with ambulation post-laparoscopic
cholecystectomy
Rationale: Assisting with ambulation for a stable postoperative client is
within the UAP scope of practice and does not require nursing judgment.
Inserting catheters, administering medications, and assessing incisions
require nursing licensure and clinical decision-making that cannot be
delegated to UAP.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
3. The nurse is caring for a client who has been declared brain dead
and is an organ donor. The family expresses confusion about why
the ventilator is still running. What is the nurse's best response?
A) "The ventilator keeps the organs viable until they can be harvested."
B) "There is still a chance your loved one might recover."
C) "The doctor hasn't made the final decision yet."
D) "We need to keep the ventilator on for legal reasons."
,Answer: A) "The ventilator keeps the organs viable until they can be
harvested."
Rationale: When brain death has been declared, the ventilator maintains
oxygenation to preserve organ viability for donation. This honest, factual
explanation respects the family's need for information while being culturally
sensitive. The other options provide false hope or incomplete information
that could increase family distress.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
4. A nurse discovers that a colleague documented administering a
medication that was not actually given. What is the nurse's first
action?
A) Complete an incident report immediately
B) Notify the nurse manager of the error
C) Inform the client about the medication error
D) Discuss the concern directly with the colleague
Answer: D) Discuss the concern directly with the colleague
Rationale: The first step is to address the colleague directly to verify facts
and allow for clarification, following the chain of communication principle. If
unresolved, escalate to the nurse manager. Incident reports and client
notification occur after verification and appropriate chain of command follow-
through.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
5. Which action by the nurse demonstrates the ethical principle of
nonmaleficence?
, A) Providing detailed information about treatment options to a client
B) Ensuring a client receives appropriate pain medication to prevent
suffering
C) Double-checking a high-alert medication before administration
D) Treating all clients equally regardless of their background
Answer: C) Double-checking a high-alert medication before
administration
Rationale: Nonmaleficence means "do no harm." Double-checking high-alert
medications prevents potential harm from medication errors. Option A
demonstrates autonomy, B demonstrates beneficence, and D demonstrates
justice.
Source: NGN NCLEX RN Actual Exam 2026/2027, Stuvia
6. A client with a living will is admitted with a myocardial infarction
and requests "everything possible" be done, contradicting the living
will stating DNR status. What is the nurse's priority action?
A) Follow the living will because it is a legal document
B) Notify the provider immediately to clarify the client's current wishes
C) Honor the client's verbal request for full treatment
D) Contact the ethics committee for a decision
Answer: B) Notify the provider immediately to clarify the client's
current wishes
Rationale: When a client's verbal wishes contradict their living will, the nurse
should notify the provider to clarify the client's current wishes and document
the conversation. A living will is a legal document, but the client's current
expressed wishes should be considered, especially if they are alert and
oriented.
