NGN/NCLEX Prep Questions and
Rationales 2026 Update | Next
Generation NCLEX RN Practice Exam
Study Guide
The nurse notes the presence of a P wave, QRS complex, flattened T waves, and
occasional U waves on a client's cardiac monitor screen. Fill in the correct missing
information by choosing from the lists of options in the drop-down menus. - Answer- The
nurse should suspect
Your Answer: hypokalemiaCorrect Answer: hypokalemia
because of the
Your Answer: flattened T waves and occasional U wavesCorrect Answer: flattened T waves
and occasional U waves
Rationale:Cardiac changes in hypokalemia include impaired repolarization, resulting in a
flattening of the T wave and eventually the emergence of a U wave. Therefore, the nurse
should suspect hypokalemia. The incidence of potentially lethal ventricular dysrhythmias is
increased in hypokalemia. The nurse should immediately assess the client's vital signs and
cardiac status for signs of hypokalemia. The nurse should also check the client's most recent
serum potassium level and then contact the primary health care provider to report the
findings and obtain prescriptions to treat the hypokalemic state.
The nurse is preparing a client for a chest x-ray and notes that the client is wearing a
religious medal on a chain around the neck. What should the nurse do with regard to this
personal item? Click to highlight the correct answer from the options provided. - Answer- The
nurse should: (Select 1 option)
✓Ask the client if the chain and medal can be removed during the procedure.
Because: (Select 1 option)
✓The chain and medal may have cultural significance.
Rationale:Before certain diagnostic procedures, it is typical to have a client remove personal
objects that are worn on the body because of client safety and the possibility of
compromising test results. Therefore, the nurse should ask the client about the significance
of such an item and its removal because it may have cultural or spiritual significance. If so,
the nurse should ask the client if the item can be either removed temporarily or placed on
another part of the body during the procedure if appropriate.
While preparing a client for surgery scheduled in 1 hour, the client states to the nurse: "I
have changed my mind. I don't want this surgery." Click to highlight the correct answer from
the options provided. - Answer- The nurse should: (Select 1 option)
Cancel the surgery.
Contact the surgeon.
,✓Discuss the client's concerns.
Call the identified support person.
Because: (Select 1 option)
Client consent is required prior to any procedure.
✓Further questions or concerns should be determined and addressed.
Ethical considerations are important for a client undergoing surgery.
The nursing scope of practice places limitations on how the nurse can respond.
Rationale:If the client indicates that he or she does not want a prescribed therapy, treatment,
or procedure such as surgery, the nurse should further investigate the client's request. If the
client indicates that he or she has changed his or her mind about surgery, the nurse should
assess the client and explore with the client his or her concerns about not wanting the
surgery. The nurse would then withhold further surgical preparation and contact the surgeon
to report the client's request so that the surgeon can discuss the consequences of not having
the surgery with the client. Further assessment and follow-up related to the client's request
need to be done. It is the client's right to refuse treatment; however, further investigation is
needed so the interventions can be tailored to specific needs.
The nurse notes that there has been an increase in the number of intravenous (IV) site
infections that developed in the clients being cared for on the nursing unit. How should the
nurse proceed to implement a quality improvement program?For each action, click to specify
whether the action would be:
Indicated: an action that the nurse should take to resolve the problem
Non-essential: an action that the nurse could take without harming the client, but the action
would not be likely to address the problem
Contraindicated: an action that could harm the client and should not be taken - Answer-
Collect identifying patient information
Contraindicated
Note the mental status of the client
Non-essential
Note primary and secondary diagnoses of clients affected
Indicated
Note the type of IV catheter used
Indicated
Note the type of IV site dressings being used
Indicated
Note the medication types being infused
Non-essential
Note frequency of assessments of IV sites
Indicated
Note the expected duration of the IV site
Non-essential
Note care procedures to the IV site
Indicated
Note frequency of changing IV sites
Indicated
, Rationale:Quality improvement, also known as performance improvement, focuses on
processes or systems that significantly contribute to client safety and effective client care
outcomes; criteria are used to monitor outcomes of care and to determine the need for
change to improve the quality of care. If the nurse notes a particular problem, such as an
increase in the number of intravenous (IV) site infections, the nurse should collect data about
the problem. This should include information such as the primary and secondary diagnoses
of the clients developing the infection, the type of IV catheters being used, the site of the
catheter, IV site dressings being used, frequency of assessment and methods of care to the
IV site, and length of time that the IV catheter was inserted. Once these data are collected
and analyzed, the nurse should examine evidence-based practice protocols to identify the
best practices for care to IV sites to prevent infection. These practices can then be
implemented and followed by evaluation of results based on the evidence-based practice
protocols used. Collecting identifying client information is contraindicated because of
confidentiality and is unnecessary in this quality improvement effort. Noting the mental status
of the clients can be done but is not likely to address the
The nurse performs an Allen's test on a client scheduled for an arterial blood gas draw from
the radial artery. On release of pressure from the ulnar artery, color in the hand returns after
20 seconds. How should the nurse interpret the finding? Fill in the correct missing
information by choosing from the lists of options in the drop-down menus. - Answer- The test
result is
Your Answer: Abnormal Correct Answer: Abnormal
because
Your Answer: The time for color to return is prolonge Correct Answer: The time for color to
return is prolonged
Rationale:Failure to determine the presence of adequate collateral circulation before drawing
an arterial blood gas specimen could result in severe ischemic injury to the hand if damage
to the radial artery occurs with arterial puncture. Upon release of pressure on the ulnar
artery, if pinkness fails to return within 6 to 7 seconds, the ulnar artery is insufficient,
indicating that the radial artery should not be used for obtaining a blood specimen. Another
site needs to be selected for the arterial puncture, and the primary health care provider
needs to be notified of the finding.
The nurse has just received a client from the postanesthesia care unit (PACU) and is
monitoring the client's vital signs. Click to highlight the current finding(s) that would be
essential to follow up on. Highlight only finding(s) that require follow-up. To deselect a
finding, click the finding again. - Answer- 30 min ago:
BP= 142/78
HR= 98
RR= 14
Temp= 37.2 C
O2 sat= 95% 3L NC
Current:
BP= 95/54 (F/U correct)
HR= 118 (F/U correct)
RR= 18
Rationales 2026 Update | Next
Generation NCLEX RN Practice Exam
Study Guide
The nurse notes the presence of a P wave, QRS complex, flattened T waves, and
occasional U waves on a client's cardiac monitor screen. Fill in the correct missing
information by choosing from the lists of options in the drop-down menus. - Answer- The
nurse should suspect
Your Answer: hypokalemiaCorrect Answer: hypokalemia
because of the
Your Answer: flattened T waves and occasional U wavesCorrect Answer: flattened T waves
and occasional U waves
Rationale:Cardiac changes in hypokalemia include impaired repolarization, resulting in a
flattening of the T wave and eventually the emergence of a U wave. Therefore, the nurse
should suspect hypokalemia. The incidence of potentially lethal ventricular dysrhythmias is
increased in hypokalemia. The nurse should immediately assess the client's vital signs and
cardiac status for signs of hypokalemia. The nurse should also check the client's most recent
serum potassium level and then contact the primary health care provider to report the
findings and obtain prescriptions to treat the hypokalemic state.
The nurse is preparing a client for a chest x-ray and notes that the client is wearing a
religious medal on a chain around the neck. What should the nurse do with regard to this
personal item? Click to highlight the correct answer from the options provided. - Answer- The
nurse should: (Select 1 option)
✓Ask the client if the chain and medal can be removed during the procedure.
Because: (Select 1 option)
✓The chain and medal may have cultural significance.
Rationale:Before certain diagnostic procedures, it is typical to have a client remove personal
objects that are worn on the body because of client safety and the possibility of
compromising test results. Therefore, the nurse should ask the client about the significance
of such an item and its removal because it may have cultural or spiritual significance. If so,
the nurse should ask the client if the item can be either removed temporarily or placed on
another part of the body during the procedure if appropriate.
While preparing a client for surgery scheduled in 1 hour, the client states to the nurse: "I
have changed my mind. I don't want this surgery." Click to highlight the correct answer from
the options provided. - Answer- The nurse should: (Select 1 option)
Cancel the surgery.
Contact the surgeon.
,✓Discuss the client's concerns.
Call the identified support person.
Because: (Select 1 option)
Client consent is required prior to any procedure.
✓Further questions or concerns should be determined and addressed.
Ethical considerations are important for a client undergoing surgery.
The nursing scope of practice places limitations on how the nurse can respond.
Rationale:If the client indicates that he or she does not want a prescribed therapy, treatment,
or procedure such as surgery, the nurse should further investigate the client's request. If the
client indicates that he or she has changed his or her mind about surgery, the nurse should
assess the client and explore with the client his or her concerns about not wanting the
surgery. The nurse would then withhold further surgical preparation and contact the surgeon
to report the client's request so that the surgeon can discuss the consequences of not having
the surgery with the client. Further assessment and follow-up related to the client's request
need to be done. It is the client's right to refuse treatment; however, further investigation is
needed so the interventions can be tailored to specific needs.
The nurse notes that there has been an increase in the number of intravenous (IV) site
infections that developed in the clients being cared for on the nursing unit. How should the
nurse proceed to implement a quality improvement program?For each action, click to specify
whether the action would be:
Indicated: an action that the nurse should take to resolve the problem
Non-essential: an action that the nurse could take without harming the client, but the action
would not be likely to address the problem
Contraindicated: an action that could harm the client and should not be taken - Answer-
Collect identifying patient information
Contraindicated
Note the mental status of the client
Non-essential
Note primary and secondary diagnoses of clients affected
Indicated
Note the type of IV catheter used
Indicated
Note the type of IV site dressings being used
Indicated
Note the medication types being infused
Non-essential
Note frequency of assessments of IV sites
Indicated
Note the expected duration of the IV site
Non-essential
Note care procedures to the IV site
Indicated
Note frequency of changing IV sites
Indicated
, Rationale:Quality improvement, also known as performance improvement, focuses on
processes or systems that significantly contribute to client safety and effective client care
outcomes; criteria are used to monitor outcomes of care and to determine the need for
change to improve the quality of care. If the nurse notes a particular problem, such as an
increase in the number of intravenous (IV) site infections, the nurse should collect data about
the problem. This should include information such as the primary and secondary diagnoses
of the clients developing the infection, the type of IV catheters being used, the site of the
catheter, IV site dressings being used, frequency of assessment and methods of care to the
IV site, and length of time that the IV catheter was inserted. Once these data are collected
and analyzed, the nurse should examine evidence-based practice protocols to identify the
best practices for care to IV sites to prevent infection. These practices can then be
implemented and followed by evaluation of results based on the evidence-based practice
protocols used. Collecting identifying client information is contraindicated because of
confidentiality and is unnecessary in this quality improvement effort. Noting the mental status
of the clients can be done but is not likely to address the
The nurse performs an Allen's test on a client scheduled for an arterial blood gas draw from
the radial artery. On release of pressure from the ulnar artery, color in the hand returns after
20 seconds. How should the nurse interpret the finding? Fill in the correct missing
information by choosing from the lists of options in the drop-down menus. - Answer- The test
result is
Your Answer: Abnormal Correct Answer: Abnormal
because
Your Answer: The time for color to return is prolonge Correct Answer: The time for color to
return is prolonged
Rationale:Failure to determine the presence of adequate collateral circulation before drawing
an arterial blood gas specimen could result in severe ischemic injury to the hand if damage
to the radial artery occurs with arterial puncture. Upon release of pressure on the ulnar
artery, if pinkness fails to return within 6 to 7 seconds, the ulnar artery is insufficient,
indicating that the radial artery should not be used for obtaining a blood specimen. Another
site needs to be selected for the arterial puncture, and the primary health care provider
needs to be notified of the finding.
The nurse has just received a client from the postanesthesia care unit (PACU) and is
monitoring the client's vital signs. Click to highlight the current finding(s) that would be
essential to follow up on. Highlight only finding(s) that require follow-up. To deselect a
finding, click the finding again. - Answer- 30 min ago:
BP= 142/78
HR= 98
RR= 14
Temp= 37.2 C
O2 sat= 95% 3L NC
Current:
BP= 95/54 (F/U correct)
HR= 118 (F/U correct)
RR= 18
