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NCLEX-RN FINAL EXAM 2025-2026, QUESTIONS WITH
DETAILED RATIONALES,100% CORRECT ALREADY GRADED
A+
1) Topic: Management of Care — Prioritization (Delegation)
Question:
A charge nurse on a medical-surgical unit must assign the following four
tasks. Which task should the charge nurse assign to a newly licensed RN
(assuming all other staff are available and licensure allows)?
A. Administer a scheduled IV antibiotic to a client with cellulitis.
B. Perform admission assessment for a client who arrived with chest pain.
C. Delegate wound dressing for a stable, postoperative client to a nursing
assistant.
D. Supervise insertion of a peripheral IV for a dehydrated client.
Correct answer: A
Rationale (detailed):
Assigning tasks requires matching patient acuity with provider competency.
A newly licensed RN is competent to administer IV medications (A)
according to medication administration rights and hospital policies.
Admission assessment for chest pain (B) is higher risk and requires
experienced triage/assessment skills because chest pain may represent an
unstable cardiac issue — better assigned to an experienced RN. Delegating
wound dressing (C) to an unlicensed nursing assistant is inappropriate if the
dressing requires assessment or sterile technique; wound care that requires
clinical judgment should be assigned to an RN. Insertion of a peripheral IV
(D) may require specific technical skill and institutional privileges;
supervision or assignment depends on experience — not the best for a newly
licensed RN as first-choice assignment when a straightforward, routine IV
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antibiotic administration is available. Thus A is the safest match of task to
newly licensed RN. NCSBN+1
Test-taking tip: When choosing delegation/assignment answers, pick the
option that is stable, predictable, and within the licensure scope for the least
experienced RN.
2) Topic: Pharmacological & Parenteral Therapies — Pharmacology
Mechanism
Question:
A client is started on enalapril for hypertension. Which assessment finding is
most important for the nurse to monitor during the first week of therapy?
A. Blood urea nitrogen (BUN) and creatinine
B. Serum potassium
C. Cough severity
D. Orthostatic blood pressures
Correct answer: B (Serum potassium) — most important during first week
Rationale (detailed):
ACE inhibitors (like enalapril) reduce angiotensin II formation, decreasing
aldosterone → decreased potassium excretion, so hyperkalemia risk is
immediate and potentially life-threatening. Monitoring potassium is crucial
especially early in therapy or when combined with potassium-sparing
diuretics or supplements. BUN/creatinine (A) are important because ACE
inhibitors can affect renal function (especially in bilateral renal artery
stenosis), but hyperkalemia has more immediate arrhythmia risk. Cough (C)
is a common adverse effect but not immediately life-threatening; it may
prompt discontinuation but does not require emergent labs. Orthostatic BPs
(D) are relevant for antihypertensives but hyperkalemia risk is prioritized in
the first week. NCSBN+1
Test-taking tip: Pick the option that prevents the most acute harm
(arrhythmia from hyperkalemia).
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3) Topic: Physiological Adaptation — Cardiac Assessment
Question:
A client with left-sided heart failure has dyspnea, crackles bilaterally, and
pink frothy sputum. Which action should the nurse perform first?
A. Administer high-flow oxygen via nonrebreather.
B. Place the client in high-Fowler’s position.
C. Start morphine IV for anxiety and preload reduction.
D. Obtain an arterial blood gas (ABG).
Correct answer: B (Place in high-Fowler’s position)
Rationale (detailed):
In acute pulmonary edema due to left heart failure, prioritization follows
Airway → Breathing → Circulation. Placing the client upright (high-
Fowler’s) immediately improves respiratory mechanics and reduces venous
return (preload). Oxygen and advanced interventions follow. Administering
high-flow oxygen (A) is appropriate but positioning is fastest and
noninvasive — do it first. Morphine (C) reduces preload and alleviates
anxiety, but carries risk; it’s not the first immediate step. ABG (D) can
clarify gas exchange but is diagnostic and secondary to immediate measures
to optimize ventilation. So immediate positioning is correct. Registered
Nursing+1
Test-taking tip: With respiratory distress choose simple, immediate
interventions (positioning, suction, oxygen) before diagnostics.
4) Topic: Safety & Infection Control — Isolation Precautions
Question:
Which precaution is required for a client diagnosed with pulmonary
tuberculosis (active, confirmed)?
A. Contact precautions with gown and gloves only.
B. Droplet precautions with surgical mask for providers.
C. Airborne precautions with N95 respirator for staff.
D. Standard precautions only.
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Correct answer: C
Rationale (detailed):
Mycobacterium tuberculosis is transmitted by airborne droplet nuclei that
remain suspended; the recommended control is airborne precautions with
negative-pressure room and N95 respirators (or equivalent). Droplet
precautions (B) are for larger droplets (e.g., influenza), contact (A) is for
direct contact pathogens, and standard precautions (D) are baseline.
Airborne control prevents inhalation of infectious droplet nuclei. NCSBN+1
Test-taking tip: Remember: TB = airborne (N95 + negative pressure).
5) Topic: Health Promotion & Maintenance — Immunization
Question:
A 68-year-old client asks whether to receive the shingles (herpes zoster)
vaccine. The nurse should advise:
A. No — the vaccine is only for people older than 80.
B. Yes — recommended for adults ≥50 (or ≥60 depending on vaccine
policy) to reduce risk and severity.
C. Only if traveling internationally.
D. Avoid — it’s contraindicated after age 65.
Correct answer: B
Rationale (detailed):
Shingles vaccines (recombinant zoster vaccine — e.g., Shingrix) are
recommended for older adults (commonly ≥50 or ≥60 depending on
country-specific guidance) to prevent herpes zoster and postherpetic
neuralgia; many public health bodies recommend vaccination for older
adults such as age 50+ or 60+. Age 68 falls squarely within the
recommended range. Options A, C, and D are incorrect. Check current
national guidelines for exact age thresholds and contraindications
(immunocompromised status, severe allergy). NCSBN+1
Test-taking tip: When asked about routine vaccines, choose the general
preventive recommendation for the age group.
NCLEX-RN FINAL EXAM 2025-2026, QUESTIONS WITH
DETAILED RATIONALES,100% CORRECT ALREADY GRADED
A+
1) Topic: Management of Care — Prioritization (Delegation)
Question:
A charge nurse on a medical-surgical unit must assign the following four
tasks. Which task should the charge nurse assign to a newly licensed RN
(assuming all other staff are available and licensure allows)?
A. Administer a scheduled IV antibiotic to a client with cellulitis.
B. Perform admission assessment for a client who arrived with chest pain.
C. Delegate wound dressing for a stable, postoperative client to a nursing
assistant.
D. Supervise insertion of a peripheral IV for a dehydrated client.
Correct answer: A
Rationale (detailed):
Assigning tasks requires matching patient acuity with provider competency.
A newly licensed RN is competent to administer IV medications (A)
according to medication administration rights and hospital policies.
Admission assessment for chest pain (B) is higher risk and requires
experienced triage/assessment skills because chest pain may represent an
unstable cardiac issue — better assigned to an experienced RN. Delegating
wound dressing (C) to an unlicensed nursing assistant is inappropriate if the
dressing requires assessment or sterile technique; wound care that requires
clinical judgment should be assigned to an RN. Insertion of a peripheral IV
(D) may require specific technical skill and institutional privileges;
supervision or assignment depends on experience — not the best for a newly
licensed RN as first-choice assignment when a straightforward, routine IV
,2|Page
antibiotic administration is available. Thus A is the safest match of task to
newly licensed RN. NCSBN+1
Test-taking tip: When choosing delegation/assignment answers, pick the
option that is stable, predictable, and within the licensure scope for the least
experienced RN.
2) Topic: Pharmacological & Parenteral Therapies — Pharmacology
Mechanism
Question:
A client is started on enalapril for hypertension. Which assessment finding is
most important for the nurse to monitor during the first week of therapy?
A. Blood urea nitrogen (BUN) and creatinine
B. Serum potassium
C. Cough severity
D. Orthostatic blood pressures
Correct answer: B (Serum potassium) — most important during first week
Rationale (detailed):
ACE inhibitors (like enalapril) reduce angiotensin II formation, decreasing
aldosterone → decreased potassium excretion, so hyperkalemia risk is
immediate and potentially life-threatening. Monitoring potassium is crucial
especially early in therapy or when combined with potassium-sparing
diuretics or supplements. BUN/creatinine (A) are important because ACE
inhibitors can affect renal function (especially in bilateral renal artery
stenosis), but hyperkalemia has more immediate arrhythmia risk. Cough (C)
is a common adverse effect but not immediately life-threatening; it may
prompt discontinuation but does not require emergent labs. Orthostatic BPs
(D) are relevant for antihypertensives but hyperkalemia risk is prioritized in
the first week. NCSBN+1
Test-taking tip: Pick the option that prevents the most acute harm
(arrhythmia from hyperkalemia).
,3|Page
3) Topic: Physiological Adaptation — Cardiac Assessment
Question:
A client with left-sided heart failure has dyspnea, crackles bilaterally, and
pink frothy sputum. Which action should the nurse perform first?
A. Administer high-flow oxygen via nonrebreather.
B. Place the client in high-Fowler’s position.
C. Start morphine IV for anxiety and preload reduction.
D. Obtain an arterial blood gas (ABG).
Correct answer: B (Place in high-Fowler’s position)
Rationale (detailed):
In acute pulmonary edema due to left heart failure, prioritization follows
Airway → Breathing → Circulation. Placing the client upright (high-
Fowler’s) immediately improves respiratory mechanics and reduces venous
return (preload). Oxygen and advanced interventions follow. Administering
high-flow oxygen (A) is appropriate but positioning is fastest and
noninvasive — do it first. Morphine (C) reduces preload and alleviates
anxiety, but carries risk; it’s not the first immediate step. ABG (D) can
clarify gas exchange but is diagnostic and secondary to immediate measures
to optimize ventilation. So immediate positioning is correct. Registered
Nursing+1
Test-taking tip: With respiratory distress choose simple, immediate
interventions (positioning, suction, oxygen) before diagnostics.
4) Topic: Safety & Infection Control — Isolation Precautions
Question:
Which precaution is required for a client diagnosed with pulmonary
tuberculosis (active, confirmed)?
A. Contact precautions with gown and gloves only.
B. Droplet precautions with surgical mask for providers.
C. Airborne precautions with N95 respirator for staff.
D. Standard precautions only.
, 4|Page
Correct answer: C
Rationale (detailed):
Mycobacterium tuberculosis is transmitted by airborne droplet nuclei that
remain suspended; the recommended control is airborne precautions with
negative-pressure room and N95 respirators (or equivalent). Droplet
precautions (B) are for larger droplets (e.g., influenza), contact (A) is for
direct contact pathogens, and standard precautions (D) are baseline.
Airborne control prevents inhalation of infectious droplet nuclei. NCSBN+1
Test-taking tip: Remember: TB = airborne (N95 + negative pressure).
5) Topic: Health Promotion & Maintenance — Immunization
Question:
A 68-year-old client asks whether to receive the shingles (herpes zoster)
vaccine. The nurse should advise:
A. No — the vaccine is only for people older than 80.
B. Yes — recommended for adults ≥50 (or ≥60 depending on vaccine
policy) to reduce risk and severity.
C. Only if traveling internationally.
D. Avoid — it’s contraindicated after age 65.
Correct answer: B
Rationale (detailed):
Shingles vaccines (recombinant zoster vaccine — e.g., Shingrix) are
recommended for older adults (commonly ≥50 or ≥60 depending on
country-specific guidance) to prevent herpes zoster and postherpetic
neuralgia; many public health bodies recommend vaccination for older
adults such as age 50+ or 60+. Age 68 falls squarely within the
recommended range. Options A, C, and D are incorrect. Check current
national guidelines for exact age thresholds and contraindications
(immunocompromised status, severe allergy). NCSBN+1
Test-taking tip: When asked about routine vaccines, choose the general
preventive recommendation for the age group.
