NCLEX-RN TEST BANK WITH NGN QUESTIONS
2026 (UPDATED APRIL 2026) | ACTUAL EXAM
PREPARATION WITH DETAILED RATIONALES |
NEXT GENERATION NCLEX PRACTICE GUIDE
NCLEX-RN TEST BANK WITH NGN QUESTIONS 2026
Updated April 2026 | Actual Exam Preparation with Detailed EXPERT
RATIONALE | Next Generation NCLEX Practice Guide
• This 200-question test bank mirrors the actual NCLEX-RN and NGN exam format,
covering all client needs categories — cardiovascular, respiratory, neurological,
endocrine, renal, GI, OB, pediatrics, psychiatric, pharmacology, and management —
complete with detailed EXPERT RATIONALE designed to sharpen your clinical
reasoning and decision-making skills.
• Study Tip: Answer each question independently before checking the correct
answer and EXPERT RATIONALE — resist the urge to peek, use the EXPERT
RATIONALE to understand the "why" behind each answer, and flag questions you
got wrong for a second-pass review to maximize retention and exam readiness.
Q1. A nurse is caring for a client with heart failure who is receiving IV
furosemide (Lasix). Which of the following findings requires the MOST
immediate intervention?
A. Urine output of 200 mL/hour
B. Serum potassium level of 3.1 mEq/L
C. Weight loss of 1 kg since yesterday
D. Blood pressure reading of 110/70 mmHg
E. Respiratory rate of 18 breaths per minute
✓ Correct Answer: B. Serum potassium level of 3.1 mEq/L
EXPERT RATIONALE: Furosemide is a loop diuretic that causes significant
potassium wasting. A serum potassium of 3.1 mEq/L indicates hypokalemia
,(normal: 3.5–5.0 mEq/L), which can precipitate life-threatening cardiac
dysrhythmias, including ventricular fibrillation. This requires immediate
intervention such as potassium replacement and provider notification. The other
findings are expected or acceptable in the context of diuretic therapy for heart
failure.
Q2. A nurse is monitoring a client who had a myocardial infarction (MI) 2
hours ago. Which ECG finding should the nurse report to the provider
IMMEDIATELY?
A. Sinus bradycardia with a rate of 58 beats per minute
B. PR interval of 0.18 seconds
C. New ST-segment elevation in leads II, III, and aVF
D. T-wave inversion in lead V1
E. U waves visible in leads V2 through V4
✓ Correct Answer: C. New ST-segment elevation in leads II, III, and aVF
EXPERT RATIONALE: New ST-segment elevation in leads II, III, and aVF indicates
an acute inferior STEMI (ST-Elevation Myocardial Infarction), requiring immediate
intervention such as emergent PCI or thrombolytic therapy. This pattern reflects
ongoing myocardial injury to the inferior wall supplied by the right coronary artery.
All other findings may warrant monitoring but are not immediately life-threatening
in this context.
Q3. A client is admitted with a blood pressure of 210/130 mmHg, severe
headache, visual disturbances, and confusion. The nurse recognizes this as a
hypertensive emergency. Which intervention should the nurse anticipate
FIRST?
A. Administer oral antihypertensive medication as ordered
B. Place the client in Trendelenburg position
,C. Initiate IV access and prepare IV antihypertensive medications
D. Obtain a 12-lead ECG and chest X-ray
E. Encourage the client to rest quietly and reassess in 30 minutes
✓ Correct Answer: C. Initiate IV access and prepare IV antihypertensive
medications
EXPERT RATIONALE: A hypertensive emergency requires rapid but controlled
blood pressure reduction using IV antihypertensive agents such as nicardipine or
labetalol to prevent end-organ damage (brain, heart, kidneys). Oral medications act
too slowly and are inappropriate for emergencies. Trendelenburg would worsen
cerebral pressure. An ECG is important but is not the first priority — establishing IV
access and medication administration takes precedence.
Q4. A nurse is caring for a client with a permanent pacemaker. The nurse
notes the client's heart rate is 42 bpm on the monitor and the pacemaker is
set to a rate of 70 bpm. Which action should the nurse take FIRST?
A. Document the finding and continue monitoring
B. Reposition the client to the left lateral position
C. Assess the client for signs and symptoms of decreased cardiac output
D. Increase the pacemaker rate on the external controller
E. Administer atropine 0.5 mg IV as per standing orders
✓ Correct Answer: C. Assess the client for signs and symptoms of decreased
cardiac output
EXPERT RATIONALE: A pacemaker firing below its set rate suggests pacemaker
failure to capture or sense. The nurse's first action is to assess the client — checking
for dizziness, hypotension, altered LOC, and chest pain — before taking any action.
Assessment always precedes intervention. Independently adjusting the pacemaker
or administering atropine without physician orders is outside nursing scope, and
documentation alone is insufficient given the clinical concern.
, Q5. A nurse is caring for a client with suspected deep vein thrombosis (DVT) in
the left leg. Which assessment finding BEST supports this diagnosis?
A. Bilateral 2+ pitting edema of both lower extremities
B. Homans' sign negative in both legs
C. Warmth, redness, and unilateral calf swelling with tenderness
D. Pallor and absent pedal pulses in the affected leg
E. Bilateral leg cramps worsening at night
✓ Correct Answer: C. Warmth, redness, and unilateral calf swelling with
tenderness
EXPERT RATIONALE: Classic DVT findings include unilateral calf pain, swelling,
warmth, and redness due to venous inflammation and obstruction. Pallor and
absent pulses suggest arterial occlusion, not venous thrombosis. Bilateral edema is
less specific and may reflect heart failure or venous insufficiency. Homans' sign
(pain on dorsiflexion) is neither sensitive nor specific and is no longer considered a
reliable DVT indicator but the classic presentation described in option C is the
hallmark of DVT.
Q6. A client with atrial fibrillation is started on warfarin therapy. Which
statement by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables."
B. "I will report any unusual bruising or bleeding to my doctor."
C. "I will stop taking my warfarin whenever I feel fine."
D. "I need to have my INR checked regularly."
E. "I should avoid aspirin and NSAIDs unless my doctor says otherwise."
✓ Correct Answer: C. "I will stop taking my warfarin whenever I feel fine."
2026 (UPDATED APRIL 2026) | ACTUAL EXAM
PREPARATION WITH DETAILED RATIONALES |
NEXT GENERATION NCLEX PRACTICE GUIDE
NCLEX-RN TEST BANK WITH NGN QUESTIONS 2026
Updated April 2026 | Actual Exam Preparation with Detailed EXPERT
RATIONALE | Next Generation NCLEX Practice Guide
• This 200-question test bank mirrors the actual NCLEX-RN and NGN exam format,
covering all client needs categories — cardiovascular, respiratory, neurological,
endocrine, renal, GI, OB, pediatrics, psychiatric, pharmacology, and management —
complete with detailed EXPERT RATIONALE designed to sharpen your clinical
reasoning and decision-making skills.
• Study Tip: Answer each question independently before checking the correct
answer and EXPERT RATIONALE — resist the urge to peek, use the EXPERT
RATIONALE to understand the "why" behind each answer, and flag questions you
got wrong for a second-pass review to maximize retention and exam readiness.
Q1. A nurse is caring for a client with heart failure who is receiving IV
furosemide (Lasix). Which of the following findings requires the MOST
immediate intervention?
A. Urine output of 200 mL/hour
B. Serum potassium level of 3.1 mEq/L
C. Weight loss of 1 kg since yesterday
D. Blood pressure reading of 110/70 mmHg
E. Respiratory rate of 18 breaths per minute
✓ Correct Answer: B. Serum potassium level of 3.1 mEq/L
EXPERT RATIONALE: Furosemide is a loop diuretic that causes significant
potassium wasting. A serum potassium of 3.1 mEq/L indicates hypokalemia
,(normal: 3.5–5.0 mEq/L), which can precipitate life-threatening cardiac
dysrhythmias, including ventricular fibrillation. This requires immediate
intervention such as potassium replacement and provider notification. The other
findings are expected or acceptable in the context of diuretic therapy for heart
failure.
Q2. A nurse is monitoring a client who had a myocardial infarction (MI) 2
hours ago. Which ECG finding should the nurse report to the provider
IMMEDIATELY?
A. Sinus bradycardia with a rate of 58 beats per minute
B. PR interval of 0.18 seconds
C. New ST-segment elevation in leads II, III, and aVF
D. T-wave inversion in lead V1
E. U waves visible in leads V2 through V4
✓ Correct Answer: C. New ST-segment elevation in leads II, III, and aVF
EXPERT RATIONALE: New ST-segment elevation in leads II, III, and aVF indicates
an acute inferior STEMI (ST-Elevation Myocardial Infarction), requiring immediate
intervention such as emergent PCI or thrombolytic therapy. This pattern reflects
ongoing myocardial injury to the inferior wall supplied by the right coronary artery.
All other findings may warrant monitoring but are not immediately life-threatening
in this context.
Q3. A client is admitted with a blood pressure of 210/130 mmHg, severe
headache, visual disturbances, and confusion. The nurse recognizes this as a
hypertensive emergency. Which intervention should the nurse anticipate
FIRST?
A. Administer oral antihypertensive medication as ordered
B. Place the client in Trendelenburg position
,C. Initiate IV access and prepare IV antihypertensive medications
D. Obtain a 12-lead ECG and chest X-ray
E. Encourage the client to rest quietly and reassess in 30 minutes
✓ Correct Answer: C. Initiate IV access and prepare IV antihypertensive
medications
EXPERT RATIONALE: A hypertensive emergency requires rapid but controlled
blood pressure reduction using IV antihypertensive agents such as nicardipine or
labetalol to prevent end-organ damage (brain, heart, kidneys). Oral medications act
too slowly and are inappropriate for emergencies. Trendelenburg would worsen
cerebral pressure. An ECG is important but is not the first priority — establishing IV
access and medication administration takes precedence.
Q4. A nurse is caring for a client with a permanent pacemaker. The nurse
notes the client's heart rate is 42 bpm on the monitor and the pacemaker is
set to a rate of 70 bpm. Which action should the nurse take FIRST?
A. Document the finding and continue monitoring
B. Reposition the client to the left lateral position
C. Assess the client for signs and symptoms of decreased cardiac output
D. Increase the pacemaker rate on the external controller
E. Administer atropine 0.5 mg IV as per standing orders
✓ Correct Answer: C. Assess the client for signs and symptoms of decreased
cardiac output
EXPERT RATIONALE: A pacemaker firing below its set rate suggests pacemaker
failure to capture or sense. The nurse's first action is to assess the client — checking
for dizziness, hypotension, altered LOC, and chest pain — before taking any action.
Assessment always precedes intervention. Independently adjusting the pacemaker
or administering atropine without physician orders is outside nursing scope, and
documentation alone is insufficient given the clinical concern.
, Q5. A nurse is caring for a client with suspected deep vein thrombosis (DVT) in
the left leg. Which assessment finding BEST supports this diagnosis?
A. Bilateral 2+ pitting edema of both lower extremities
B. Homans' sign negative in both legs
C. Warmth, redness, and unilateral calf swelling with tenderness
D. Pallor and absent pedal pulses in the affected leg
E. Bilateral leg cramps worsening at night
✓ Correct Answer: C. Warmth, redness, and unilateral calf swelling with
tenderness
EXPERT RATIONALE: Classic DVT findings include unilateral calf pain, swelling,
warmth, and redness due to venous inflammation and obstruction. Pallor and
absent pulses suggest arterial occlusion, not venous thrombosis. Bilateral edema is
less specific and may reflect heart failure or venous insufficiency. Homans' sign
(pain on dorsiflexion) is neither sensitive nor specific and is no longer considered a
reliable DVT indicator but the classic presentation described in option C is the
hallmark of DVT.
Q6. A client with atrial fibrillation is started on warfarin therapy. Which
statement by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables."
B. "I will report any unusual bruising or bleeding to my doctor."
C. "I will stop taking my warfarin whenever I feel fine."
D. "I need to have my INR checked regularly."
E. "I should avoid aspirin and NSAIDs unless my doctor says otherwise."
✓ Correct Answer: C. "I will stop taking my warfarin whenever I feel fine."
