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NGN NCLEX RN ACTUAL EXAM
2026/2027 Complete Questions and
Verified Answers with Rationales Graded
A Pass Guaranteed - A+ Graded
SECTION 1: MANAGEMENT OF CARE (Questions 1-20)
Q1: 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. [CORRECT]
D. A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with stable oxygen
saturation
Correct Answer: C 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 (C). The other clients (A, B, D) are stable with
predictable care needs and could be safely assigned to a less experienced RN or LPN under
supervision.
Q2: 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. [CORRECT]
C. Administering oral medications to a client with heart failure
D. Assessing a postoperative client's surgical incision for signs of infection
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Correct Answer: B Rationale: Assisting with ambulation for a stable postoperative client (B) is
within the UAP scope of practice and does not require nursing judgment. Inserting catheters (A),
administering medications (C), and assessing incisions (D) require nursing licensure and clinical
decision-making that cannot be delegated to UAP.
Q3: 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." [CORRECT]
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."
Correct Answer: A Rationale: When brain death has been declared, the ventilator maintains
oxygenation to preserve organ viability for donation (A). This honest, factual explanation
respects the family's need for information while being culturally sensitive. Options B, C, and D
provide false hope or incomplete information that could increase family distress.
Q4: 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. [CORRECT]
Correct Answer: D Rationale: The first step is to address the colleague directly (D) to verify
facts and allow for clarification, following the chain of communication principle. If unresolved,
escalate to the nurse manager (B). Incident reports (A) and client notification (C) occur after
verification and appropriate chain of command follow-through.
Q5: 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
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C. Double-checking a high-alert medication before administration. [CORRECT]
D. Treating all clients equally regardless of their background
Correct Answer: C Rationale: Nonmaleficence means "do no harm." Double-checking high-
alert medications (C) prevents potential harm from medication errors. Option A demonstrates
autonomy, B demonstrates beneficence, and D demonstrates justice.
Q6: 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. Honor the client's current verbal request and notify the physician. [CORRECT]
C. Contact the client's family to make the decision
D. Implement the DNR order as documented
Correct Answer: B Rationale: A competent client's current expressed wishes supersede prior
advance directives (B). The nurse must advocate for client autonomy while facilitating
communication with the physician to review and potentially update the advance directive. Living
wills can be revoked or modified by the client at any time.
Q7: The nurse is supervising an LPN who has been assigned four clients. Which observation
requires immediate intervention by the RN?
A. The LPN is administering oral medications to a client with stable heart failure
B. The LPN is documenting intake and output for a client with renal disease
C. The LPN is planning to initiate a blood transfusion on a client with anemia. [CORRECT]
D. The LPN is providing wound care for a client with a stage 2 pressure injury
Correct Answer: C Rationale: Initiating blood transfusions requires RN assessment and
monitoring due to the risk of transfusion reactions; this task is outside LPN scope of practice in
most jurisdictions (C). Oral medications (A), I&O documentation (B), and wound care (D) are
appropriate LPN tasks within their scope and competence level.
Q8: During a disaster drill, the nurse is assigned to the triage area. Which client should be
assigned the highest priority (red tag/immediate)?
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A. A client with a closed fracture of the femur
B. A client with respiratory distress and absent breath sounds on one side. [CORRECT]
C. A client with a large laceration requiring 50 sutures
D. A client with a suspected spinal cord injury but stable vital signs
Correct Answer: B Rationale: Respiratory distress with absent breath sounds suggests a tension
pneumothorax, a life-threatening condition requiring immediate intervention (B). This follows
the START triage system where respiratory compromise takes highest priority. Fractures (A),
lacerations (C), and stable spinal injuries (D) are lower priorities when resources are limited.
Q9: A nurse is reviewing discharge plans for a client with heart failure. Which intervention best
promotes continuity of care?
A. Providing a copy of the hospital's general brochure on heart disease
B. Scheduling a follow-up appointment with the cardiologist in 6 months
C. Coordinating home health nursing visits and medication reconciliation before discharge.
[CORRECT]
D. Telling the client to call the doctor if symptoms worsen
Correct Answer: C Rationale: Continuity of care requires coordinated transitions between
settings. Arranging home health services and ensuring medication reconciliation (C) prevents
gaps in care and reduces readmission risk. General brochures (A), delayed follow-up (B), and
vague instructions (D) do not ensure seamless care transitions.
Q10: The nurse is caring for a client whose family insists on using herbal remedies that interact
with prescribed cardiac medications. Which action demonstrates client advocacy?
A. Refusing to care for the client until the family stops the herbal remedies
B. Respecting the family's cultural beliefs without discussing potential interactions
C. Providing education about interactions while facilitating a discussion with the healthcare
provider. [CORRECT]
D. Reporting the family to social services for noncompliance
Correct Answer: C Rationale: Advocacy involves supporting client autonomy while ensuring
safety. Educating about interactions and facilitating provider discussion (C) respects cultural
NGN NCLEX RN ACTUAL EXAM
2026/2027 Complete Questions and
Verified Answers with Rationales Graded
A Pass Guaranteed - A+ Graded
SECTION 1: MANAGEMENT OF CARE (Questions 1-20)
Q1: 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. [CORRECT]
D. A 72-year-old with pneumonia receiving IV antibiotics every 12 hours with stable oxygen
saturation
Correct Answer: C 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 (C). The other clients (A, B, D) are stable with
predictable care needs and could be safely assigned to a less experienced RN or LPN under
supervision.
Q2: 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. [CORRECT]
C. Administering oral medications to a client with heart failure
D. Assessing a postoperative client's surgical incision for signs of infection
,2
Correct Answer: B Rationale: Assisting with ambulation for a stable postoperative client (B) is
within the UAP scope of practice and does not require nursing judgment. Inserting catheters (A),
administering medications (C), and assessing incisions (D) require nursing licensure and clinical
decision-making that cannot be delegated to UAP.
Q3: 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." [CORRECT]
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."
Correct Answer: A Rationale: When brain death has been declared, the ventilator maintains
oxygenation to preserve organ viability for donation (A). This honest, factual explanation
respects the family's need for information while being culturally sensitive. Options B, C, and D
provide false hope or incomplete information that could increase family distress.
Q4: 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. [CORRECT]
Correct Answer: D Rationale: The first step is to address the colleague directly (D) to verify
facts and allow for clarification, following the chain of communication principle. If unresolved,
escalate to the nurse manager (B). Incident reports (A) and client notification (C) occur after
verification and appropriate chain of command follow-through.
Q5: 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
,3
C. Double-checking a high-alert medication before administration. [CORRECT]
D. Treating all clients equally regardless of their background
Correct Answer: C Rationale: Nonmaleficence means "do no harm." Double-checking high-
alert medications (C) prevents potential harm from medication errors. Option A demonstrates
autonomy, B demonstrates beneficence, and D demonstrates justice.
Q6: 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. Honor the client's current verbal request and notify the physician. [CORRECT]
C. Contact the client's family to make the decision
D. Implement the DNR order as documented
Correct Answer: B Rationale: A competent client's current expressed wishes supersede prior
advance directives (B). The nurse must advocate for client autonomy while facilitating
communication with the physician to review and potentially update the advance directive. Living
wills can be revoked or modified by the client at any time.
Q7: The nurse is supervising an LPN who has been assigned four clients. Which observation
requires immediate intervention by the RN?
A. The LPN is administering oral medications to a client with stable heart failure
B. The LPN is documenting intake and output for a client with renal disease
C. The LPN is planning to initiate a blood transfusion on a client with anemia. [CORRECT]
D. The LPN is providing wound care for a client with a stage 2 pressure injury
Correct Answer: C Rationale: Initiating blood transfusions requires RN assessment and
monitoring due to the risk of transfusion reactions; this task is outside LPN scope of practice in
most jurisdictions (C). Oral medications (A), I&O documentation (B), and wound care (D) are
appropriate LPN tasks within their scope and competence level.
Q8: During a disaster drill, the nurse is assigned to the triage area. Which client should be
assigned the highest priority (red tag/immediate)?
, 4
A. A client with a closed fracture of the femur
B. A client with respiratory distress and absent breath sounds on one side. [CORRECT]
C. A client with a large laceration requiring 50 sutures
D. A client with a suspected spinal cord injury but stable vital signs
Correct Answer: B Rationale: Respiratory distress with absent breath sounds suggests a tension
pneumothorax, a life-threatening condition requiring immediate intervention (B). This follows
the START triage system where respiratory compromise takes highest priority. Fractures (A),
lacerations (C), and stable spinal injuries (D) are lower priorities when resources are limited.
Q9: A nurse is reviewing discharge plans for a client with heart failure. Which intervention best
promotes continuity of care?
A. Providing a copy of the hospital's general brochure on heart disease
B. Scheduling a follow-up appointment with the cardiologist in 6 months
C. Coordinating home health nursing visits and medication reconciliation before discharge.
[CORRECT]
D. Telling the client to call the doctor if symptoms worsen
Correct Answer: C Rationale: Continuity of care requires coordinated transitions between
settings. Arranging home health services and ensuring medication reconciliation (C) prevents
gaps in care and reduces readmission risk. General brochures (A), delayed follow-up (B), and
vague instructions (D) do not ensure seamless care transitions.
Q10: The nurse is caring for a client whose family insists on using herbal remedies that interact
with prescribed cardiac medications. Which action demonstrates client advocacy?
A. Refusing to care for the client until the family stops the herbal remedies
B. Respecting the family's cultural beliefs without discussing potential interactions
C. Providing education about interactions while facilitating a discussion with the healthcare
provider. [CORRECT]
D. Reporting the family to social services for noncompliance
Correct Answer: C Rationale: Advocacy involves supporting client autonomy while ensuring
safety. Educating about interactions and facilitating provider discussion (C) respects cultural
