NCLEX-PN Exam Prep Document | 2026/2027 Edition | 250
Verified Questions
NCLEX-PN QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest NGN Guidelines | Graded A+
This comprehensive NCLEX-PN exam preparation document features 250 verified questions and
answers, all graded A+ and aligned with the latest Next Generation NCLEX (NGN) guidelines.
Designed for practical nursing students, it covers essential content areas including pharmacology,
maternal-child health, and medical-surgical nursing. Each question includes detailed rationales to
reinforce learning and critical thinking. Updated for the 2026/2027 academic year, this resource
ensures readiness for the NCLEX-PN licensure exam.
Key Features:
Pharmacology and medication administration
Maternal-child health and obstetrics
Medical-surgical nursing across body systems
Psychiatric and mental health nursing
Pediatric nursing and growth/development
Professional standards and legal/ethical issues
Updates for 2026:
- Integrated NGN-style case studies and unfolding scenarios
- Revised rationales to reflect current evidence-based practice
- Added prioritization and delegation questions per NGN
- Updated pharmacology content with new drug classifications
- Enhanced coverage of infection control and safety protocols
Abstract:
This NCLEX-PN exam preparation document provides 250 verified questions and answers, meticulously graded
A+ and updated to align with the 2026/2027 Next Generation NCLEX (NGN) guidelines. The content spans critical
domains of practical nursing, including pharmacology, maternal-child health, medical-surgical nursing,
psychiatric nursing, and pediatric care. Each question is accompanied by comprehensive rationales that explain
correct and incorrect options, fostering deep understanding and clinical reasoning. The document incorporates
NGN innovations such as case studies, unfolding scenarios, and prioritization exercises to mirror the actual exam
format. Designed for self-assessment and mastery, this resource equips candidates with the knowledge and
confidence to achieve licensure. The questions are organized by content area with weight distributions reflecting
the NCLEX-PN test plan, ensuring targeted study. With a focus on high-yield topics and evidence-based practice,
this compilation serves as an essential tool for nursing students and graduates preparing for the NCLEX-PN.
Keywords:
NCLEX-PN, NGN guidelines, practical nursing, pharmacology, maternal-child health, medical-surgical nursing,
psychiatric nursing, pediatric nursing
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why the answer is correct and
why the other options are incorrect. Rationales include key nursing concepts, clinical reasoning, and references to
current guidelines. Distractors are analyzed to highlight common misconceptions and test-taking strategies.
Compliance Checklist:
All questions updated per 2026/2027 NGN guidelines
Page 1
, Answers verified and graded A+ by subject matter experts
Rationales align with current evidence-based practice
Content distribution matches NCLEX-PN test plan
Includes NGN-style case studies and prioritization items
Suitable for self-study and exam review
Content Area Overview:
Content Area Questions Key Topics Weight
Pharmacology 1-50 Medication administration, drug 20%
classifications, adverse effects, dosage
calculations
Maternal-Child Health 51-90 Antepartum, intrapartum, postpartum care, 16%
newborn assessment, family planning
Medical-Surgical Nursing 91-160 Cardiovascular, respiratory, gastrointestinal, 28%
endocrine, musculoskeletal systems
Psychiatric Nursing 161-200 Mental health disorders, therapeutic 16%
communication, crisis intervention,
psychopharmacology
Pediatric Nursing 201-230 Growth and development, common 12%
childhood illnesses, immunizations,
family-centered care
Professional Standards 231-250 Legal/ethical issues, delegation, 8%
prioritization, infection control, safety
Page 2
,Q1. A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 2 L/min via nasal cannula. The client's arterial blood gas (ABG) results show: pH 7.31,
PaCO2 58 mm Hg, HCO3- 26 mEq/L, PaO2 70 mm Hg. Which intervention should the nurse anticipate first?
A. Increase oxygen flow rate to 4 L/min.
B. Prepare for intubation and mechanical ventilation.
C. Administer a bronchodilator as prescribed.
D. Notify the provider of the ABG results and obtain a repeat sample.
Correct Answer: C. Administer a bronchodilator as prescribed.
Rationale: The ABG indicates uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-). In
COPD, the primary intervention is to improve ventilation. A bronchodilator helps open airways, reduce work of
breathing, and lower PaCO2. Increasing oxygen could blunt hypoxic drive. Intubation is not first line. Notification
is appropriate but not the first action; bronchodilator administration is a priority.
Why Wrong:
A - Increasing oxygen may worsen hypercapnia by decreasing hypoxic drive in a COPD client with chronic
CO2 retention.
B - Mechanical ventilation is reserved for severe respiratory failure; the client is not in acute distress and
PaO2 is adequate.
D - While notifying the provider is important, the nurse should first implement a prescribed intervention to
improve ventilation.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 29.
Q2. A nurse is preparing to administer a continuous IV infusion of heparin at 1200 units/hour. The pharmacy
supplies a bag of 25,000 units in 500 mL of D5W. At how many mL/hour should the nurse set the infusion
pump?
A. 12 mL/hr
B. 24 mL/hr
C. 30 mL/hr
D. 48 mL/hr
Correct Answer: B. 24 mL/hr
Rationale: First, calculate the concentration: 25,000 units / 500 mL = 50 units/mL. To deliver 1200 units/hour,
divide 1200 units/hour by 50 units/mL = 24 mL/hour. This requires dimensional analysis and understanding of
heparin infusion protocols.
Why Wrong:
A - 12 mL/hr would deliver only 600 units/hour, half the prescribed dose.
C - 30 mL/hr would deliver 1500 units/hour, an overdose.
D - 48 mL/hr would deliver 2400 units/hour, double the prescribed dose.
Reference: Lilley, L. L., Collins, S. R., & Snyder, J. S. (2020). Pharmacology and the Nursing Process, 9th Ed., Ch.
34.
Q3. A nurse is assessing a client who is 2 hours post-insertion of a chest tube for a pneumothorax. The
drainage system is connected to suction at -20 cm H2O. Which finding indicates that the chest tube is
functioning correctly?
A. Continuous bubbling in the water seal chamber.
B. Intermittent bubbling in the suction control chamber.
C. Fluctuation (tidaling) in the water seal chamber with inspiration.
D. Absence of drainage in the collection chamber.
Correct Answer: C. Fluctuation (tidaling) in the water seal chamber with inspiration.
Rationale: Fluctuation (tidaling) in the water seal chamber indicates that the chest tube is patent and the lung is
expanding. Continuous bubbling in the water seal suggests an air leak. Intermittent bubbling in the suction control
Page 3
, chamber is normal when suction is applied. Absence of drainage may be normal if minimal fluid is present, but
tidaling is the key sign of patency.
Why Wrong:
A - Continuous bubbling in the water seal indicates an air leak in the system or at the insertion site.
B - Bubbling in the suction control chamber is normal, but it does not confirm chest tube patency.
D - Absence of drainage does not confirm patency; the tube could be occluded.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 27.
Q4. A nurse is reinforcing teaching with a client who has a new prescription for lithium carbonate. The nurse
should instruct the client to report which early sign of lithium toxicity?
A. Fine hand tremor
B. Polydipsia
C. Nausea and vomiting
D. Slurred speech
Correct Answer: C. Nausea and vomiting
Rationale: Early signs of lithium toxicity include gastrointestinal symptoms such as nausea, vomiting, diarrhea,
and drowsiness. Fine hand tremor is a common side effect but not necessarily toxicity. Polydipsia is a side effect.
Slurred speech indicates moderate to severe toxicity. Nausea and vomiting are early and should prompt immediate
serum lithium level check.
Why Wrong:
A - Fine hand tremor is a common side effect of lithium, not an early sign of toxicity.
B - Polydipsia is a side effect of lithium, often occurring at therapeutic levels.
D - Slurred speech is a sign of moderate to severe lithium toxicity, not early.
Reference: Varcarolis, E. M., & Fosbre, C. D. (2021). Essentials of Psychiatric Mental Health Nursing, 4th Ed.,
Ch. 18.
Q5. A nurse is assessing a client with a suspected urinary tract infection (UTI). The client reports urgency,
frequency, and dysuria. The nurse reviews the urinalysis results: specific gravity 1.025, pH 7.5, positive
nitrite, positive leukocyte esterase, and 10-15 WBCs/hpf. Which additional finding would most support a
diagnosis of pyelonephritis?
A. Temperature 37.2°C (99°F)
B. Flank pain
C. Urine output 30 mL/hour
D. Serum creatinine 1.0 mg/dL
Correct Answer: B. Flank pain
Rationale: Flank pain (costovertebral angle tenderness) is a classic sign of pyelonephritis (upper UTI), indicating
kidney inflammation. The other findings are not specific: low-grade fever can occur with cystitis, urine output 30
mL/hr is lower limit of normal, and creatinine 1.0 mg/dL is normal. Pyelonephritis often presents with fever, chills,
and flank pain.
Why Wrong:
A - Low-grade fever can occur with cystitis; high fever (>38.3°C) is more suggestive of pyelonephritis.
C - Urine output 30 mL/hr is within normal range; decreased output is not typical for pyelonephritis.
D - Serum creatinine 1.0 mg/dL is normal; elevated creatinine suggests renal impairment, which may occur in
severe pyelonephritis but is not the most supportive finding.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 62.
Q6. A nurse is reviewing the laboratory results of a client with acute pancreatitis. Which finding is most
indicative of a poor prognosis?
A. Serum amylase 450 units/L
Page 4
Verified Questions
NCLEX-PN QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions
| Updated Per Latest NGN Guidelines | Graded A+
This comprehensive NCLEX-PN exam preparation document features 250 verified questions and
answers, all graded A+ and aligned with the latest Next Generation NCLEX (NGN) guidelines.
Designed for practical nursing students, it covers essential content areas including pharmacology,
maternal-child health, and medical-surgical nursing. Each question includes detailed rationales to
reinforce learning and critical thinking. Updated for the 2026/2027 academic year, this resource
ensures readiness for the NCLEX-PN licensure exam.
Key Features:
Pharmacology and medication administration
Maternal-child health and obstetrics
Medical-surgical nursing across body systems
Psychiatric and mental health nursing
Pediatric nursing and growth/development
Professional standards and legal/ethical issues
Updates for 2026:
- Integrated NGN-style case studies and unfolding scenarios
- Revised rationales to reflect current evidence-based practice
- Added prioritization and delegation questions per NGN
- Updated pharmacology content with new drug classifications
- Enhanced coverage of infection control and safety protocols
Abstract:
This NCLEX-PN exam preparation document provides 250 verified questions and answers, meticulously graded
A+ and updated to align with the 2026/2027 Next Generation NCLEX (NGN) guidelines. The content spans critical
domains of practical nursing, including pharmacology, maternal-child health, medical-surgical nursing,
psychiatric nursing, and pediatric care. Each question is accompanied by comprehensive rationales that explain
correct and incorrect options, fostering deep understanding and clinical reasoning. The document incorporates
NGN innovations such as case studies, unfolding scenarios, and prioritization exercises to mirror the actual exam
format. Designed for self-assessment and mastery, this resource equips candidates with the knowledge and
confidence to achieve licensure. The questions are organized by content area with weight distributions reflecting
the NCLEX-PN test plan, ensuring targeted study. With a focus on high-yield topics and evidence-based practice,
this compilation serves as an essential tool for nursing students and graduates preparing for the NCLEX-PN.
Keywords:
NCLEX-PN, NGN guidelines, practical nursing, pharmacology, maternal-child health, medical-surgical nursing,
psychiatric nursing, pediatric nursing
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why the answer is correct and
why the other options are incorrect. Rationales include key nursing concepts, clinical reasoning, and references to
current guidelines. Distractors are analyzed to highlight common misconceptions and test-taking strategies.
Compliance Checklist:
All questions updated per 2026/2027 NGN guidelines
Page 1
, Answers verified and graded A+ by subject matter experts
Rationales align with current evidence-based practice
Content distribution matches NCLEX-PN test plan
Includes NGN-style case studies and prioritization items
Suitable for self-study and exam review
Content Area Overview:
Content Area Questions Key Topics Weight
Pharmacology 1-50 Medication administration, drug 20%
classifications, adverse effects, dosage
calculations
Maternal-Child Health 51-90 Antepartum, intrapartum, postpartum care, 16%
newborn assessment, family planning
Medical-Surgical Nursing 91-160 Cardiovascular, respiratory, gastrointestinal, 28%
endocrine, musculoskeletal systems
Psychiatric Nursing 161-200 Mental health disorders, therapeutic 16%
communication, crisis intervention,
psychopharmacology
Pediatric Nursing 201-230 Growth and development, common 12%
childhood illnesses, immunizations,
family-centered care
Professional Standards 231-250 Legal/ethical issues, delegation, 8%
prioritization, infection control, safety
Page 2
,Q1. A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 2 L/min via nasal cannula. The client's arterial blood gas (ABG) results show: pH 7.31,
PaCO2 58 mm Hg, HCO3- 26 mEq/L, PaO2 70 mm Hg. Which intervention should the nurse anticipate first?
A. Increase oxygen flow rate to 4 L/min.
B. Prepare for intubation and mechanical ventilation.
C. Administer a bronchodilator as prescribed.
D. Notify the provider of the ABG results and obtain a repeat sample.
Correct Answer: C. Administer a bronchodilator as prescribed.
Rationale: The ABG indicates uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-). In
COPD, the primary intervention is to improve ventilation. A bronchodilator helps open airways, reduce work of
breathing, and lower PaCO2. Increasing oxygen could blunt hypoxic drive. Intubation is not first line. Notification
is appropriate but not the first action; bronchodilator administration is a priority.
Why Wrong:
A - Increasing oxygen may worsen hypercapnia by decreasing hypoxic drive in a COPD client with chronic
CO2 retention.
B - Mechanical ventilation is reserved for severe respiratory failure; the client is not in acute distress and
PaO2 is adequate.
D - While notifying the provider is important, the nurse should first implement a prescribed intervention to
improve ventilation.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 29.
Q2. A nurse is preparing to administer a continuous IV infusion of heparin at 1200 units/hour. The pharmacy
supplies a bag of 25,000 units in 500 mL of D5W. At how many mL/hour should the nurse set the infusion
pump?
A. 12 mL/hr
B. 24 mL/hr
C. 30 mL/hr
D. 48 mL/hr
Correct Answer: B. 24 mL/hr
Rationale: First, calculate the concentration: 25,000 units / 500 mL = 50 units/mL. To deliver 1200 units/hour,
divide 1200 units/hour by 50 units/mL = 24 mL/hour. This requires dimensional analysis and understanding of
heparin infusion protocols.
Why Wrong:
A - 12 mL/hr would deliver only 600 units/hour, half the prescribed dose.
C - 30 mL/hr would deliver 1500 units/hour, an overdose.
D - 48 mL/hr would deliver 2400 units/hour, double the prescribed dose.
Reference: Lilley, L. L., Collins, S. R., & Snyder, J. S. (2020). Pharmacology and the Nursing Process, 9th Ed., Ch.
34.
Q3. A nurse is assessing a client who is 2 hours post-insertion of a chest tube for a pneumothorax. The
drainage system is connected to suction at -20 cm H2O. Which finding indicates that the chest tube is
functioning correctly?
A. Continuous bubbling in the water seal chamber.
B. Intermittent bubbling in the suction control chamber.
C. Fluctuation (tidaling) in the water seal chamber with inspiration.
D. Absence of drainage in the collection chamber.
Correct Answer: C. Fluctuation (tidaling) in the water seal chamber with inspiration.
Rationale: Fluctuation (tidaling) in the water seal chamber indicates that the chest tube is patent and the lung is
expanding. Continuous bubbling in the water seal suggests an air leak. Intermittent bubbling in the suction control
Page 3
, chamber is normal when suction is applied. Absence of drainage may be normal if minimal fluid is present, but
tidaling is the key sign of patency.
Why Wrong:
A - Continuous bubbling in the water seal indicates an air leak in the system or at the insertion site.
B - Bubbling in the suction control chamber is normal, but it does not confirm chest tube patency.
D - Absence of drainage does not confirm patency; the tube could be occluded.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 27.
Q4. A nurse is reinforcing teaching with a client who has a new prescription for lithium carbonate. The nurse
should instruct the client to report which early sign of lithium toxicity?
A. Fine hand tremor
B. Polydipsia
C. Nausea and vomiting
D. Slurred speech
Correct Answer: C. Nausea and vomiting
Rationale: Early signs of lithium toxicity include gastrointestinal symptoms such as nausea, vomiting, diarrhea,
and drowsiness. Fine hand tremor is a common side effect but not necessarily toxicity. Polydipsia is a side effect.
Slurred speech indicates moderate to severe toxicity. Nausea and vomiting are early and should prompt immediate
serum lithium level check.
Why Wrong:
A - Fine hand tremor is a common side effect of lithium, not an early sign of toxicity.
B - Polydipsia is a side effect of lithium, often occurring at therapeutic levels.
D - Slurred speech is a sign of moderate to severe lithium toxicity, not early.
Reference: Varcarolis, E. M., & Fosbre, C. D. (2021). Essentials of Psychiatric Mental Health Nursing, 4th Ed.,
Ch. 18.
Q5. A nurse is assessing a client with a suspected urinary tract infection (UTI). The client reports urgency,
frequency, and dysuria. The nurse reviews the urinalysis results: specific gravity 1.025, pH 7.5, positive
nitrite, positive leukocyte esterase, and 10-15 WBCs/hpf. Which additional finding would most support a
diagnosis of pyelonephritis?
A. Temperature 37.2°C (99°F)
B. Flank pain
C. Urine output 30 mL/hour
D. Serum creatinine 1.0 mg/dL
Correct Answer: B. Flank pain
Rationale: Flank pain (costovertebral angle tenderness) is a classic sign of pyelonephritis (upper UTI), indicating
kidney inflammation. The other findings are not specific: low-grade fever can occur with cystitis, urine output 30
mL/hr is lower limit of normal, and creatinine 1.0 mg/dL is normal. Pyelonephritis often presents with fever, chills,
and flank pain.
Why Wrong:
A - Low-grade fever can occur with cystitis; high fever (>38.3°C) is more suggestive of pyelonephritis.
C - Urine output 30 mL/hr is within normal range; decreased output is not typical for pyelonephritis.
D - Serum creatinine 1.0 mg/dL is normal; elevated creatinine suggests renal impairment, which may occur in
severe pyelonephritis but is not the most supportive finding.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-Surgical Nursing, 10th Ed., Ch. 62.
Q6. A nurse is reviewing the laboratory results of a client with acute pancreatitis. Which finding is most
indicative of a poor prognosis?
A. Serum amylase 450 units/L
Page 4
