NCLEX-RN ACTUAL EXAM TEST BANK 2026/2027 | Real &
Exact Questions & Answers | Next Generation NCLEX (NGN) |
Verified Questions with Rationales | Pass Guaranteed - A+
Graded
CATEGORY 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (15-20%)
SUBCATEGORY: Management of Care (10-15%)
Q1: A nurse on a medical-surgical unit receives report on four clients. Which client
should the nurse assess FIRST?
A. A 72-year-old with heart failure who reports increased shortness of breath when
walking to the bathroom
B. A 58-year-old post-operative day 2 after abdominal surgery with a temperature of
100.2°F (37.9°C)
C. A 45-year-old with diabetes whose blood glucose is 248 mg/dL before lunch
D. A 34-year-old admitted for observation after a syncopal episode, currently alert and
oriented
Correct Answer: A
Rationale:
Correct: The client with heart failure reporting increased shortness of breath (dyspnea)
with minimal exertion represents potential acute decompensated heart failure or
pulmonary edema, which is a life-threatening condition requiring immediate
assessment. Using the ABCs (Airway, Breathing, Circulation) prioritization framework,
breathing issues take precedence. This client may need immediate interventions such
,as oxygen therapy, positioning (high Fowler's), diuretics, or even emergency respiratory
support. The nurse must assess for signs of respiratory distress, oxygen saturation,
lung sounds, and cardiovascular stability.
Incorrect Options:
● Option B: While a low-grade fever post-operatively warrants monitoring, it does
not represent an immediate life threat. Fever on post-op day 2 is common and
often resolves with ambulation and hydration. This can be addressed after the
more acute situation.
● Option C: A blood glucose of 248 mg/dL is elevated but not immediately
dangerous in a diabetic client before a meal. While hyperglycemia requires
management, it does not pose the same immediate threat to life as respiratory
compromise.
● Option D: This client is stable, alert, and oriented. The syncopal episode has
resolved, and observation status indicates no active emergency. This is the
lowest priority of the four clients.
Nursing Pearl: Always prioritize using the ABCs (Airway, Breathing, Circulation)
framework. Any indication of respiratory compromise, cardiovascular instability, or
neurological deterioration takes precedence over stable or less acute findings.
NCLEX Tip: When prioritizing which client to see first, look for keywords indicating acute
changes in respiratory status, chest pain, neurological changes, or hemodynamic
instability. Stable vital signs and chronic conditions are lower priority.
Q2: A registered nurse (RN) is delegating tasks to unlicensed assistive personnel (UAP)
on a busy medical-surgical unit. Which task is MOST APPROPRIATE to delegate to the
UAP?
A. Assessing a client's pain level after receiving oral analgesics
B. Measuring and recording intake and output for a client with heart failure
C. Teaching a newly diagnosed diabetic client about insulin administration
D. Evaluating the effectiveness of a client's breathing treatments
,Correct Answer: B
Rationale:
Correct: Measuring and recording intake and output is a task that falls within the scope
of practice for unlicensed assistive personnel. This is a routine, standardized procedure
that does not require nursing judgment, assessment, or teaching. The RN remains
responsible for interpreting the data and making clinical decisions based on the
findings, but the data collection itself can be safely delegated following the five rights of
delegation (right task, right circumstance, right person, right direction/communication,
right supervision).
Incorrect Options:
● Option A: Pain assessment requires nursing judgment and clinical reasoning.
Pain is the fifth vital sign and involves subjective data collection, interpretation,
and evaluation of interventions—tasks that cannot be delegated to UAP.
● Option C: Client education, especially regarding complex medication
administration like insulin, requires professional nursing knowledge, teaching
skills, and evaluation of learning. This is an RN responsibility that cannot be
delegated.
● Option D: Evaluating effectiveness of treatments requires assessment skills,
clinical judgment, and the ability to analyze patient responses to interventions.
This is a nursing function that cannot be delegated.
Nursing Pearl: Remember the "Five Rights of Delegation": Right Task (appropriate to
delegate), Right Circumstances (appropriate setting/client condition), Right Person
(competent UAP), Right Direction/Communication (clear instructions), and Right
Supervision (appropriate monitoring). Tasks involving assessment, planning, evaluation,
and teaching cannot be delegated to UAP.
NCLEX Tip: On delegation questions, eliminate options that involve assessment,
evaluation, teaching, or clinical judgment. Safe delegation tasks include: vital signs on
, stable clients, hygiene care, feeding, ambulation assistance, specimen collection, and
data collection (I&O, weights).
Q3: A nurse is caring for a client who was just informed by the physician that she has
terminal cancer with a prognosis of 2-3 months. The client states, "I don't believe this is
happening. The test results must be wrong." Which response by the nurse demonstrates
therapeutic communication?
A. "I understand this is difficult, but the doctor wouldn't tell you this if it weren't true."
B. "You seem to be in shock. Would you like me to call your family?"
C. "This must be very hard to accept. Would you like to talk about how you're feeling?"
D. "Many people feel this way at first, but eventually you'll come to accept your
diagnosis."
Correct Answer: C
Rationale:
Correct: This response demonstrates therapeutic communication by acknowledging the
client's feelings (validation), offering presence and support, and using an open-ended
question to encourage the client to express emotions. The client is exhibiting denial,
which is a normal first stage of grief (Kübler-Ross). The nurse's role is not to force
acceptance but to provide a safe space for the client to process the information at their
own pace. This response maintains the therapeutic relationship and respects the
client's emotional state.
Incorrect Options:
● Option A: This response is non-therapeutic as it minimizes the client's feelings
and essentially tells them their reaction is wrong. It also creates a power dynamic
that may damage trust.
● Option B: While identifying the emotional state is appropriate, immediately
offering to call family may be premature and could be interpreted as the nurse
Exact Questions & Answers | Next Generation NCLEX (NGN) |
Verified Questions with Rationales | Pass Guaranteed - A+
Graded
CATEGORY 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (15-20%)
SUBCATEGORY: Management of Care (10-15%)
Q1: A nurse on a medical-surgical unit receives report on four clients. Which client
should the nurse assess FIRST?
A. A 72-year-old with heart failure who reports increased shortness of breath when
walking to the bathroom
B. A 58-year-old post-operative day 2 after abdominal surgery with a temperature of
100.2°F (37.9°C)
C. A 45-year-old with diabetes whose blood glucose is 248 mg/dL before lunch
D. A 34-year-old admitted for observation after a syncopal episode, currently alert and
oriented
Correct Answer: A
Rationale:
Correct: The client with heart failure reporting increased shortness of breath (dyspnea)
with minimal exertion represents potential acute decompensated heart failure or
pulmonary edema, which is a life-threatening condition requiring immediate
assessment. Using the ABCs (Airway, Breathing, Circulation) prioritization framework,
breathing issues take precedence. This client may need immediate interventions such
,as oxygen therapy, positioning (high Fowler's), diuretics, or even emergency respiratory
support. The nurse must assess for signs of respiratory distress, oxygen saturation,
lung sounds, and cardiovascular stability.
Incorrect Options:
● Option B: While a low-grade fever post-operatively warrants monitoring, it does
not represent an immediate life threat. Fever on post-op day 2 is common and
often resolves with ambulation and hydration. This can be addressed after the
more acute situation.
● Option C: A blood glucose of 248 mg/dL is elevated but not immediately
dangerous in a diabetic client before a meal. While hyperglycemia requires
management, it does not pose the same immediate threat to life as respiratory
compromise.
● Option D: This client is stable, alert, and oriented. The syncopal episode has
resolved, and observation status indicates no active emergency. This is the
lowest priority of the four clients.
Nursing Pearl: Always prioritize using the ABCs (Airway, Breathing, Circulation)
framework. Any indication of respiratory compromise, cardiovascular instability, or
neurological deterioration takes precedence over stable or less acute findings.
NCLEX Tip: When prioritizing which client to see first, look for keywords indicating acute
changes in respiratory status, chest pain, neurological changes, or hemodynamic
instability. Stable vital signs and chronic conditions are lower priority.
Q2: A registered nurse (RN) is delegating tasks to unlicensed assistive personnel (UAP)
on a busy medical-surgical unit. Which task is MOST APPROPRIATE to delegate to the
UAP?
A. Assessing a client's pain level after receiving oral analgesics
B. Measuring and recording intake and output for a client with heart failure
C. Teaching a newly diagnosed diabetic client about insulin administration
D. Evaluating the effectiveness of a client's breathing treatments
,Correct Answer: B
Rationale:
Correct: Measuring and recording intake and output is a task that falls within the scope
of practice for unlicensed assistive personnel. This is a routine, standardized procedure
that does not require nursing judgment, assessment, or teaching. The RN remains
responsible for interpreting the data and making clinical decisions based on the
findings, but the data collection itself can be safely delegated following the five rights of
delegation (right task, right circumstance, right person, right direction/communication,
right supervision).
Incorrect Options:
● Option A: Pain assessment requires nursing judgment and clinical reasoning.
Pain is the fifth vital sign and involves subjective data collection, interpretation,
and evaluation of interventions—tasks that cannot be delegated to UAP.
● Option C: Client education, especially regarding complex medication
administration like insulin, requires professional nursing knowledge, teaching
skills, and evaluation of learning. This is an RN responsibility that cannot be
delegated.
● Option D: Evaluating effectiveness of treatments requires assessment skills,
clinical judgment, and the ability to analyze patient responses to interventions.
This is a nursing function that cannot be delegated.
Nursing Pearl: Remember the "Five Rights of Delegation": Right Task (appropriate to
delegate), Right Circumstances (appropriate setting/client condition), Right Person
(competent UAP), Right Direction/Communication (clear instructions), and Right
Supervision (appropriate monitoring). Tasks involving assessment, planning, evaluation,
and teaching cannot be delegated to UAP.
NCLEX Tip: On delegation questions, eliminate options that involve assessment,
evaluation, teaching, or clinical judgment. Safe delegation tasks include: vital signs on
, stable clients, hygiene care, feeding, ambulation assistance, specimen collection, and
data collection (I&O, weights).
Q3: A nurse is caring for a client who was just informed by the physician that she has
terminal cancer with a prognosis of 2-3 months. The client states, "I don't believe this is
happening. The test results must be wrong." Which response by the nurse demonstrates
therapeutic communication?
A. "I understand this is difficult, but the doctor wouldn't tell you this if it weren't true."
B. "You seem to be in shock. Would you like me to call your family?"
C. "This must be very hard to accept. Would you like to talk about how you're feeling?"
D. "Many people feel this way at first, but eventually you'll come to accept your
diagnosis."
Correct Answer: C
Rationale:
Correct: This response demonstrates therapeutic communication by acknowledging the
client's feelings (validation), offering presence and support, and using an open-ended
question to encourage the client to express emotions. The client is exhibiting denial,
which is a normal first stage of grief (Kübler-Ross). The nurse's role is not to force
acceptance but to provide a safe space for the client to process the information at their
own pace. This response maintains the therapeutic relationship and respects the
client's emotional state.
Incorrect Options:
● Option A: This response is non-therapeutic as it minimizes the client's feelings
and essentially tells them their reaction is wrong. It also creates a power dynamic
that may damage trust.
● Option B: While identifying the emotional state is appropriate, immediately
offering to call family may be premature and could be interpreted as the nurse
