Actual NCLEX-RN 2026 Exam with NGN
Latest 2026 Version Real Screenshot
Questions and 100% Verified Answers to
Pass NCLEX-RN First Attempt
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EXAM
Question 1
A nurse is caring for a client 2 hours after a total hip arthroplasty. Which finding requires
immediate intervention?
A. Pain level 6 on a 0–10 scale
B. Urinary output of 40 mL in the past hour
C. Oxygen saturation of 89% on room air
D. Heart rate of 92 bpm
Answer: C
Rationale: Oxygen saturation of 89% indicates hypoxemia. After orthopedic surgery,
this could signal fat embolism syndrome, pulmonary embolism, or respiratory
depression from anesthesia. ABCs (Airway, Breathing, Circulation) take priority. Pain (A)
is expected post-op but manageable. Urinary output of 40 mL/hour is adequate (30
mL/hour minimum). HR 92 is within normal range.
Question 2
A nurse receives shift report on 4 clients. Which client should be assessed first?
,A. Client with pneumonia, temperature 38.3°C (101°F), pulse oximetry 92% on 2L oxygen
B. Client with heart failure, 2+ pitting edema, crackles in bilateral lung bases
C. Client post-cholecystectomy 6 hours, reports nausea and abdominal pain 5/10
D. Client with type 1 diabetes, blood glucose 52 mg/dL, awake and alert
Answer: D
Rationale: Blood glucose 52 mg/dL is hypoglycemic. Although the client is awake,
hypoglycemia can rapidly deteriorate to unconsciousness or seizures. This is a safety
priority. The other clients have stable findings: mild hypoxemia in A, expected heart
failure findings in B, and expected post-op symptoms in C.
Question 3
A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Feeding a client with dysphagia
B. Measuring post-void residual via bladder scan
C. Assessing a client's pain level
D. Reinforcing teaching about insulin injection technique
Answer: B
Rationale: Bladder scanning is a technical skill that can be delegated to UAP in many
facilities. A is incorrect—dysphagia requires skilled assessment for aspiration risk. C is
incorrect—assessment is the RN's responsibility. D is incorrect—teaching requires RN
licensure.
,Question 4 (NGN Case Study)
A nurse is assessing a client 30 minutes after a blood transfusion of packed red blood
cells was initiated. The client reports chills and low back pain. Vital signs: BP 98/62, HR
110, RR 24, temp 38.6°C (101.5°F).
Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Stop the transfusion
C. Notify the healthcare provider
D. Obtain a urine sample
Answer: B
Rationale: These findings (chills, back pain, fever, tachycardia) are consistent with an
acute hemolytic transfusion reaction. The immediate priority is to stop the transfusion to
prevent further complications. After stopping, the nurse would maintain IV access with
new tubing, notify the provider, and send the blood bag and tubing to the lab.
Question 5
A client with major depressive disorder is prescribed phenelzine (Nardil). Which food
item on the client's tray should the nurse remove?
A. Broiled chicken
B. Mashed potatoes
C. Aged cheddar cheese
D. Steamed broccoli
Answer: C
, Rationale: Phenelzine is an MAOI. Aged cheese contains tyramine, which can cause
hypertensive crisis. Other foods to avoid: cured meats, fermented foods, red wine, fava
beans. Chicken, potatoes, and broccoli are safe.
Question 6
A nurse is caring for a client with acute pancreatitis. Which laboratory value is most
concerning?
A. Serum calcium 7.2 mg/dL
B. Serum glucose 145 mg/dL
C. Serum amylase 250 units/L
D. White blood cell count 14,000/mm³
Answer: A
Rationale: Hypocalcemia (normal 8.5–10.2 mg/dL) in pancreatitis indicates fat
saponification and is a poor prognostic sign. While elevated amylase (C) and glucose (B)
and leukocytosis (D) are expected in pancreatitis, hypocalcemia suggests severe disease
and risk of complications.
Question 7
A nurse is preparing to administer digoxin to a client with heart failure. The client's
apical pulse is 52 bpm. What is the nurse's priority action?
A. Administer the medication as ordered
B. Hold the medication and reassess in 30 minutes
Latest 2026 Version Real Screenshot
Questions and 100% Verified Answers to
Pass NCLEX-RN First Attempt
Guaranteed
EXAM
Question 1
A nurse is caring for a client 2 hours after a total hip arthroplasty. Which finding requires
immediate intervention?
A. Pain level 6 on a 0–10 scale
B. Urinary output of 40 mL in the past hour
C. Oxygen saturation of 89% on room air
D. Heart rate of 92 bpm
Answer: C
Rationale: Oxygen saturation of 89% indicates hypoxemia. After orthopedic surgery,
this could signal fat embolism syndrome, pulmonary embolism, or respiratory
depression from anesthesia. ABCs (Airway, Breathing, Circulation) take priority. Pain (A)
is expected post-op but manageable. Urinary output of 40 mL/hour is adequate (30
mL/hour minimum). HR 92 is within normal range.
Question 2
A nurse receives shift report on 4 clients. Which client should be assessed first?
,A. Client with pneumonia, temperature 38.3°C (101°F), pulse oximetry 92% on 2L oxygen
B. Client with heart failure, 2+ pitting edema, crackles in bilateral lung bases
C. Client post-cholecystectomy 6 hours, reports nausea and abdominal pain 5/10
D. Client with type 1 diabetes, blood glucose 52 mg/dL, awake and alert
Answer: D
Rationale: Blood glucose 52 mg/dL is hypoglycemic. Although the client is awake,
hypoglycemia can rapidly deteriorate to unconsciousness or seizures. This is a safety
priority. The other clients have stable findings: mild hypoxemia in A, expected heart
failure findings in B, and expected post-op symptoms in C.
Question 3
A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Feeding a client with dysphagia
B. Measuring post-void residual via bladder scan
C. Assessing a client's pain level
D. Reinforcing teaching about insulin injection technique
Answer: B
Rationale: Bladder scanning is a technical skill that can be delegated to UAP in many
facilities. A is incorrect—dysphagia requires skilled assessment for aspiration risk. C is
incorrect—assessment is the RN's responsibility. D is incorrect—teaching requires RN
licensure.
,Question 4 (NGN Case Study)
A nurse is assessing a client 30 minutes after a blood transfusion of packed red blood
cells was initiated. The client reports chills and low back pain. Vital signs: BP 98/62, HR
110, RR 24, temp 38.6°C (101.5°F).
Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Stop the transfusion
C. Notify the healthcare provider
D. Obtain a urine sample
Answer: B
Rationale: These findings (chills, back pain, fever, tachycardia) are consistent with an
acute hemolytic transfusion reaction. The immediate priority is to stop the transfusion to
prevent further complications. After stopping, the nurse would maintain IV access with
new tubing, notify the provider, and send the blood bag and tubing to the lab.
Question 5
A client with major depressive disorder is prescribed phenelzine (Nardil). Which food
item on the client's tray should the nurse remove?
A. Broiled chicken
B. Mashed potatoes
C. Aged cheddar cheese
D. Steamed broccoli
Answer: C
, Rationale: Phenelzine is an MAOI. Aged cheese contains tyramine, which can cause
hypertensive crisis. Other foods to avoid: cured meats, fermented foods, red wine, fava
beans. Chicken, potatoes, and broccoli are safe.
Question 6
A nurse is caring for a client with acute pancreatitis. Which laboratory value is most
concerning?
A. Serum calcium 7.2 mg/dL
B. Serum glucose 145 mg/dL
C. Serum amylase 250 units/L
D. White blood cell count 14,000/mm³
Answer: A
Rationale: Hypocalcemia (normal 8.5–10.2 mg/dL) in pancreatitis indicates fat
saponification and is a poor prognostic sign. While elevated amylase (C) and glucose (B)
and leukocytosis (D) are expected in pancreatitis, hypocalcemia suggests severe disease
and risk of complications.
Question 7
A nurse is preparing to administer digoxin to a client with heart failure. The client's
apical pulse is 52 bpm. What is the nurse's priority action?
A. Administer the medication as ordered
B. Hold the medication and reassess in 30 minutes
