NCLEX-RN 2026 PRACTICE QUESTIONS
(NGN-Aligned) ) Exam with questions and
well verified answers actual!!!!!
NCLEX-RN 2026 PRACTICE QUESTIONS (BATCH 1: Q1–Q20)
1. Prioritization / ABCs
A nurse is caring for four clients. Which client requires immediate assessment?
• A. Client with asthma reporting increased use of albuterol inhaler
• B. Client post-op day 1 with clear lung sounds and oxygen saturation 96%
• C. Client with heart failure reporting sudden weight gain of 3 lbs overnight
• D. Client with pneumonia experiencing mild fatigue and productive cough
✅ Correct Answer: A
Rationales:
• A: Increased rescue inhaler use indicates worsening bronchospasm and potential respiratory
failure. This requires immediate airway/breathing assessment.
• B: Clear lung sounds and normal SpO₂ reflect stable post-operative status. No urgent
intervention needed.
• C: A 3 lb weight gain overnight suggests fluid retention, common in heart failure. Requires
monitoring but is not an immediate life threat.
• D: Fatigue and productive cough are expected in pneumonia. Stable unless accompanied by
hypoxia, tachypnea, or altered mentation.
2. Pharmacology / Anticoagulants
A client on warfarin therapy has an INR of 4.2. The nurse should anticipate which prescription?
• A. Administer vitamin K IV
, • B. Hold warfarin and monitor INR
• C. Increase warfarin dose by 10%
• D. Give fresh frozen plasma immediately
✅ Correct Answer: B
Rationales:
• A: IV vitamin K is reserved for INR >10 or active bleeding. Oral vitamin K or holding the dose is
preferred for INR 4–5 without bleeding.
• B: INR 4.2 is above therapeutic range (2.0–3.0) but not critically high. Holding warfarin and
rechecking is standard per clinical guidelines.
• C: Increasing the dose would further elevate INR and increase bleeding risk. Contraindicated.
• D: FFP is used for life-threatening bleeding or INR >10 with hemorrhage. Not indicated for
asymptomatic supratherapeutic INR.
3. NGN Cue Recognition / Case Excerpt
A client with type 2 diabetes reports blurred vision, polyuria, and nausea. Blood glucose is 420 mg/dL.
Which finding should the nurse prioritize for further assessment?
• A. Serum potassium 4.8 mEq/L
• B. Urine ketones negative
• C. Respirations 24/min and deep
• D. Blood pressure 138/82 mmHg
✅ Correct Answer: C
Rationales:
• A: K⁺ 4.8 is within normal limits. Insulin therapy will be needed, but potassium is currently
stable.
• B: Negative urine ketones suggest hyperosmolar hyperglycemic state (HHS), not DKA. Important,
but not immediately life-threatening.
• C: Deep, rapid respirations (Kussmaul) indicate metabolic acidosis, likely DKA. Requires
immediate ABG, electrolyte, and fluid assessment.
• D: BP 138/82 is mildly elevated but stable. Not a priority cue in acute hyperglycemia.
4. Delegation / Scope of Practice
Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)?
, • A. Perform initial admission assessment for a new stroke client
• B. Administer IV push furosemide to a client with pulmonary edema
• C. Reinforce teaching for a client newly diagnosed with hypertension
• D. Evaluate response to PRN antiemetic in a post-op client
✅ Correct Answer: C
Rationales:
• A: Initial comprehensive assessments require RN-level clinical judgment and are outside LPN
scope.
• B: IV push medications, especially high-risk diuretics, require RN assessment and licensure. LPNs
may administer IV meds in some states but not IV push without specific certification.
• C: LPNs can reinforce education already initiated by the RN, as it involves reviewing established
teaching points within their scope.
• D: Evaluation of medication response requires clinical judgment and falls under RN
responsibilities.
5. Maternal / Preeclampsia
A client at 36 weeks gestation has severe preeclampsia. Which finding indicates magnesium sulfate
toxicity?
• A. Deep tendon reflexes 2+
• B. Urine output 30 mL/hr
• C. Respiratory rate 10/min
• D. Blood pressure 140/90 mmHg
✅ Correct Answer: C
Rationales:
• A: 2+ reflexes are normal. Diminished or absent reflexes indicate early Mg toxicity.
• B: 30 mL/hr is the minimum acceptable output. Mg toxicity is suspected if output drops below
25–30 mL/hr over 4 hours.
• C: RR <12/min indicates CNS depression from magnesium toxicity. Requires immediate calcium
gluconate administration.
• D: BP 140/90 reflects controlled hypertension. Not indicative of Mg toxicity.
6. Pediatric / Respiratory
, A 6-month-old with bronchiolitis is breathing 60/min with nasal flaring and subcostal retractions. Which
intervention is priority?
• A. Administer albuterol via nebulizer
• B. Apply supplemental oxygen to maintain SpO₂ ≥90%
• C. Suction the nasopharynx before feeding
• D. Place in prone position to improve ventilation
✅ Correct Answer: B
Rationales:
• A: Bronchiolitis is viral; bronchodilators are generally ineffective and not first-line per current
guidelines.
• B: Tachypnea with retractions indicates respiratory distress. Maintaining oxygenation is the
priority to prevent hypoxia and fatigue.
• C: Suctioning may be helpful but is secondary to securing adequate oxygenation in acute
distress.
• D: Prone positioning is contraindicated in infants <1 year due to SIDS risk and airway
compromise.
7. Psychiatric / Therapeutic Communication
A client with major depression states, “I’m a burden to everyone. They’d be better off without me.”
Which nurse response is most appropriate?
• A. “You have so much to live for. Let’s list your accomplishments.”
• B. “I understand you feel hopeless. Are you having thoughts of harming yourself?”
• C. “That’s not true. Your family loves you very much.”
• D. “Let’s focus on your medication schedule instead of negative thoughts.”
✅ Correct Answer: B
Rationales:
• A: Positive reframing minimizes the client’s pain and does not assess suicide risk.
• B: Validates emotion, uses therapeutic silence, and directly assesses for suicidal ideation, which
is essential for safety planning.
• C: False reassurance dismisses the client’s feelings and blocks therapeutic communication.
• D: Redirecting avoids addressing the critical safety concern and invalidates the emotional
distress.
(NGN-Aligned) ) Exam with questions and
well verified answers actual!!!!!
NCLEX-RN 2026 PRACTICE QUESTIONS (BATCH 1: Q1–Q20)
1. Prioritization / ABCs
A nurse is caring for four clients. Which client requires immediate assessment?
• A. Client with asthma reporting increased use of albuterol inhaler
• B. Client post-op day 1 with clear lung sounds and oxygen saturation 96%
• C. Client with heart failure reporting sudden weight gain of 3 lbs overnight
• D. Client with pneumonia experiencing mild fatigue and productive cough
✅ Correct Answer: A
Rationales:
• A: Increased rescue inhaler use indicates worsening bronchospasm and potential respiratory
failure. This requires immediate airway/breathing assessment.
• B: Clear lung sounds and normal SpO₂ reflect stable post-operative status. No urgent
intervention needed.
• C: A 3 lb weight gain overnight suggests fluid retention, common in heart failure. Requires
monitoring but is not an immediate life threat.
• D: Fatigue and productive cough are expected in pneumonia. Stable unless accompanied by
hypoxia, tachypnea, or altered mentation.
2. Pharmacology / Anticoagulants
A client on warfarin therapy has an INR of 4.2. The nurse should anticipate which prescription?
• A. Administer vitamin K IV
, • B. Hold warfarin and monitor INR
• C. Increase warfarin dose by 10%
• D. Give fresh frozen plasma immediately
✅ Correct Answer: B
Rationales:
• A: IV vitamin K is reserved for INR >10 or active bleeding. Oral vitamin K or holding the dose is
preferred for INR 4–5 without bleeding.
• B: INR 4.2 is above therapeutic range (2.0–3.0) but not critically high. Holding warfarin and
rechecking is standard per clinical guidelines.
• C: Increasing the dose would further elevate INR and increase bleeding risk. Contraindicated.
• D: FFP is used for life-threatening bleeding or INR >10 with hemorrhage. Not indicated for
asymptomatic supratherapeutic INR.
3. NGN Cue Recognition / Case Excerpt
A client with type 2 diabetes reports blurred vision, polyuria, and nausea. Blood glucose is 420 mg/dL.
Which finding should the nurse prioritize for further assessment?
• A. Serum potassium 4.8 mEq/L
• B. Urine ketones negative
• C. Respirations 24/min and deep
• D. Blood pressure 138/82 mmHg
✅ Correct Answer: C
Rationales:
• A: K⁺ 4.8 is within normal limits. Insulin therapy will be needed, but potassium is currently
stable.
• B: Negative urine ketones suggest hyperosmolar hyperglycemic state (HHS), not DKA. Important,
but not immediately life-threatening.
• C: Deep, rapid respirations (Kussmaul) indicate metabolic acidosis, likely DKA. Requires
immediate ABG, electrolyte, and fluid assessment.
• D: BP 138/82 is mildly elevated but stable. Not a priority cue in acute hyperglycemia.
4. Delegation / Scope of Practice
Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)?
, • A. Perform initial admission assessment for a new stroke client
• B. Administer IV push furosemide to a client with pulmonary edema
• C. Reinforce teaching for a client newly diagnosed with hypertension
• D. Evaluate response to PRN antiemetic in a post-op client
✅ Correct Answer: C
Rationales:
• A: Initial comprehensive assessments require RN-level clinical judgment and are outside LPN
scope.
• B: IV push medications, especially high-risk diuretics, require RN assessment and licensure. LPNs
may administer IV meds in some states but not IV push without specific certification.
• C: LPNs can reinforce education already initiated by the RN, as it involves reviewing established
teaching points within their scope.
• D: Evaluation of medication response requires clinical judgment and falls under RN
responsibilities.
5. Maternal / Preeclampsia
A client at 36 weeks gestation has severe preeclampsia. Which finding indicates magnesium sulfate
toxicity?
• A. Deep tendon reflexes 2+
• B. Urine output 30 mL/hr
• C. Respiratory rate 10/min
• D. Blood pressure 140/90 mmHg
✅ Correct Answer: C
Rationales:
• A: 2+ reflexes are normal. Diminished or absent reflexes indicate early Mg toxicity.
• B: 30 mL/hr is the minimum acceptable output. Mg toxicity is suspected if output drops below
25–30 mL/hr over 4 hours.
• C: RR <12/min indicates CNS depression from magnesium toxicity. Requires immediate calcium
gluconate administration.
• D: BP 140/90 reflects controlled hypertension. Not indicative of Mg toxicity.
6. Pediatric / Respiratory
, A 6-month-old with bronchiolitis is breathing 60/min with nasal flaring and subcostal retractions. Which
intervention is priority?
• A. Administer albuterol via nebulizer
• B. Apply supplemental oxygen to maintain SpO₂ ≥90%
• C. Suction the nasopharynx before feeding
• D. Place in prone position to improve ventilation
✅ Correct Answer: B
Rationales:
• A: Bronchiolitis is viral; bronchodilators are generally ineffective and not first-line per current
guidelines.
• B: Tachypnea with retractions indicates respiratory distress. Maintaining oxygenation is the
priority to prevent hypoxia and fatigue.
• C: Suctioning may be helpful but is secondary to securing adequate oxygenation in acute
distress.
• D: Prone positioning is contraindicated in infants <1 year due to SIDS risk and airway
compromise.
7. Psychiatric / Therapeutic Communication
A client with major depression states, “I’m a burden to everyone. They’d be better off without me.”
Which nurse response is most appropriate?
• A. “You have so much to live for. Let’s list your accomplishments.”
• B. “I understand you feel hopeless. Are you having thoughts of harming yourself?”
• C. “That’s not true. Your family loves you very much.”
• D. “Let’s focus on your medication schedule instead of negative thoughts.”
✅ Correct Answer: B
Rationales:
• A: Positive reframing minimizes the client’s pain and does not assess suicide risk.
• B: Validates emotion, uses therapeutic silence, and directly assesses for suicidal ideation, which
is essential for safety planning.
• C: False reassurance dismisses the client’s feelings and blocks therapeutic communication.
• D: Redirecting avoids addressing the critical safety concern and invalidates the emotional
distress.
