Preparing for the NCLEX-RN in 2026? This free practice test includes 60 original NCLEX-style questions with detailed rationales, organized around the major Client Needs categories used in the official exam blueprint: Management of Care, Safety and Infection Control, Health Promotion, Psychosocial Integrity, Basic Care and Pharmacology, and Physiological Adaptation. Every question is written in the scenario-based, clinical-judgment style used on the real exam — not simple recall.
The NCLEX-RN, administered by the National Council of State Boards of Nursing (NCSBN), is required for licensure as a Registered Nurse in the United States and is also recognized in parts of Canada. Since the rollout of the Next Generation NCLEX (NGN), the exam places heavy emphasis on clinical judgment — your ability to recognize cues, prioritize actions, and make sound nursing decisions, not just recall facts. This practice test reflects that approach.
- ✔ Delegation & care coordination
- ✔ Infection control & PPE protocols
- ✔ Health promotion across the lifespan
- ✔ Psychosocial integrity & grief support
- ✔ Pharmacology & medication safety
- ✔ Physiological adaptation & emergencies
- ✔ Clinical judgment & prioritization
- ✔ NGN-style scenario reasoning
NCLEX-RN Exam Format Overview (2026)
Here's a quick refresher before you start. Always confirm current details on NCSBN's official website, as testing specifications are reviewed periodically.
| Exam Detail | Overview |
|---|---|
| Question Count | Variable — computerized adaptive testing (CAT), typically 70–145 items |
| Time Limit | Up to 5 hours including breaks |
| Question Types | Multiple choice, multiple response, case studies, bowtie and trend items (NGN format) |
| Scoring Model | Pass/fail, based on the 95% confidence interval against the passing standard |
| Core Focus | Clinical judgment across the Clinical Judgment Measurement Model (CJMM) |
| Client Needs Categories | Safe & Effective Care Environment, Health Promotion, Psychosocial Integrity, Physiological Integrity |
Management of Care (Q1–10)
SAFE & EFFECTIVE CARE ENVIRONMENTThis category tests delegation, prioritization, supervision, and care coordination — core responsibilities of an RN managing a patient assignment.
1. The RN is making patient assignments for the shift. Which patient should be assigned to the Licensed Practical Nurse (LPN)?
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Correct Answer: B — LPN scope of practice typically includes routine, stable care tasks like dressing changes. Initial patient teaching, unstable post-op patients, and acute emergencies require RN-level assessment and judgment.
2. A nursing assistant reports that a patient refuses to get out of bed for ambulation as scheduled. What should the RN do first?
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Correct Answer: B — The RN must assess the underlying reason (pain, dizziness, fear) before deciding next steps; delegation does not remove RN accountability for assessment.
3. Which task is appropriate to delegate to an unlicensed assistive personnel (UAP)?
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Correct Answer: B — Routine vital signs on stable patients fall within UAP scope. Medication administration, care planning, and patient education require licensed nursing judgment.
4. Using the SBAR framework to hand off a patient, what does the "B" represent?
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Correct Answer: B — SBAR stands for Situation, Background, Assessment, Recommendation — a standardized communication tool for safe handoffs.
5. The RN has four patients. Which patient should be assessed first?
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Correct Answer: B — New-onset respiratory distress is a potential airway/breathing emergency and takes priority under the ABC (Airway, Breathing, Circulation) framework.
6. A physician's order is unclear regarding medication dosage. What should the RN do?
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Correct Answer: B — Unclear orders must always be clarified directly with the prescriber to ensure patient safety; nurses should never guess on medication orders.
7. Which situation requires the RN to file an incident report?
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Correct Answer: B — Falls are reportable safety events requiring documentation and an incident report, regardless of injury severity.
8. A patient requests to see their medical record. What is the RN's best response?
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Correct Answer: B — Patients have a legal right to access their health records; the RN should guide them through the facility's proper request process.
9. Which action best reflects the ethical principle of patient autonomy?
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Correct Answer: B — Autonomy means respecting a competent, informed patient's right to make their own healthcare decisions, including refusal of treatment.
10. The RN is supervising a nursing student performing a sterile dressing change. What is the RN's primary responsibility?
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Correct Answer: B — RNs retain accountability when supervising students and must directly verify safe, correct technique during procedures they have not yet been independently validated on.
Safety and Infection Control (Q11–20)
SAFE & EFFECTIVE CARE ENVIRONMENTThis category covers infection prevention, standard and transmission-based precautions, and safe handling practices.
11. Which personal protective equipment (PPE) sequence is correct when donning for contact precautions?
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Correct Answer: B — Standard PPE donning sequence is gown first, then gloves, ensuring the gloves cover the gown cuffs for a secure barrier.
12. A patient is diagnosed with active tuberculosis. What type of precautions should be implemented?
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Correct Answer: C — Tuberculosis is spread via airborne droplet nuclei and requires airborne precautions, including an N95 respirator and a negative-pressure isolation room.
13. Which of the following is the single most effective method to prevent the spread of healthcare-associated infections?
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Correct Answer: B — Hand hygiene remains the single most effective infection control measure in healthcare settings, even when gloves are worn.
14. A patient on a fall-risk protocol attempts to get out of bed alone. What is the priority nursing action?
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Correct Answer: B — Restraints are a last resort. Reinforcing call light use, bed alarms, and safety teaching are the least restrictive, appropriate first interventions.
15. Which of the following is a correct practice for safe medication administration?
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Correct Answer: B — Using two patient identifiers (e.g., name and date of birth) before administering any medication is a core safety standard to prevent medication errors.
16. A sharps container is observed to be three-quarters full. What should the RN do?
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Correct Answer: B — Sharps containers should be replaced at the manufacturer's fill line (commonly around three-quarters full) to prevent injury; contents should never be compressed or manually handled.
17. Which finding in a postoperative patient is most concerning for a wound infection?
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Correct Answer: B — Increasing redness, warmth, and purulent (pus-like) drainage are classic signs of surgical site infection requiring prompt evaluation.
18. A patient with neutropenia is at greatest risk for which complication?
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Correct Answer: B — Neutropenia means a low neutrophil count, severely reducing the body's ability to fight infection, making infection prevention precautions critical.
19. Which action is appropriate when transporting a patient on droplet precautions through hallways?
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Correct Answer: B — Having the patient wear a mask during transport helps contain droplet spread and protects others in shared spaces.
20. A nurse discovers a medication error after administering the wrong dose. What is the priority action?
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Correct Answer: B — Patient safety comes first: assess immediately for adverse effects, then notify the provider and follow facility protocol for incident reporting.
Health Promotion and Maintenance (Q21–30)
HEALTH PROMOTIONThis category covers growth and development, health screening, disease prevention, and patient education across the lifespan.
21. At what age would a nurse expect a child to typically begin walking independently?
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Correct Answer: C — Most toddlers begin walking independently between 12–15 months, though a range is considered normal developmentally.
22. Which immunization schedule guidance should the nurse provide to a parent of a healthy newborn?
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Correct Answer: B — Nurses should educate caregivers to follow the recommended immunization schedule, which begins shortly after birth to protect against preventable diseases.
23. A pregnant patient asks about safe weight gain during pregnancy. What is the most appropriate nursing response?
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Correct Answer: B — Recommended weight gain in pregnancy varies based on pre-pregnancy BMI, and patients should be guided individually by their healthcare provider.
24. Which teaching point is most important for a patient newly diagnosed with hypertension?
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Correct Answer: B — Hypertension management requires ongoing lifestyle changes (diet, exercise, sodium reduction) combined with consistent medication adherence, even when asymptomatic.
25. A nurse is teaching breast self-examination. When should this typically be performed for accurate results?
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Correct Answer: B — Performing self-exams a few days after menstruation, when hormonal swelling and tenderness are reduced, gives the most reliable results.
26. Which finding would be expected as a normal age-related change in an older adult?
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Correct Answer: B — Mild short-term memory changes and slower processing are normal aging changes; sudden disorientation or significant functional loss suggests an acute issue requiring evaluation.
27. A nurse is counseling a patient about smoking cessation. Which statement reflects a patient-centered approach?
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Correct Answer: B — Open-ended, non-judgmental questions that explore the patient's barriers support a patient-centered, motivational approach to behavior change.
28. Which screening is recommended for early detection of colorectal cancer in average-risk adults starting around age 45?
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Correct Answer: B — Colorectal cancer screening (colonoscopy or alternative approved methods) is recommended starting around age 45 for average-risk adults per current guidelines.
29. A new parent asks about safe sleep practices to reduce SIDS risk. What is the correct guidance?
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Correct Answer: B — Back-sleeping on a firm surface without loose bedding is the evidence-based recommendation to reduce SIDS risk.
30. Which lifestyle factor has the strongest evidence for reducing cardiovascular disease risk?
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Correct Answer: B — A combination of regular activity, not smoking, and balanced nutrition has the strongest evidence base for reducing cardiovascular risk, rather than any single isolated change.
Psychosocial Integrity (Q31–40)
PSYCHOSOCIAL INTEGRITYThis category covers therapeutic communication, mental health, coping, grief, and crisis intervention.
31. A patient recently diagnosed with a terminal illness states, "This can't be happening to me." Which stage of grief does this reflect?
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Correct Answer: B — Statements rejecting the reality of a diagnosis reflect denial, an early stage in Kübler-Ross's grief model, used as a temporary protective coping mechanism.
32. Which therapeutic communication technique is being used when the nurse says, "It sounds like you're feeling overwhelmed"?
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Correct Answer: B — Reflecting restates the patient's expressed feelings back to them, validating their emotional experience and encouraging further sharing.
33. A patient expresses a specific plan and means to end their life. What is the nurse's priority action?
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Correct Answer: B — Active suicidal ideation with a specific plan is a safety emergency requiring immediate intervention, continuous observation, and urgent notification of the care team — this overrides confidentiality concerns.
34. A patient with generalized anxiety disorder is hyperventilating before a procedure. What is the most appropriate nursing intervention?
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Correct Answer: B — Staying present and coaching slow, controlled breathing is a non-pharmacological first-line intervention that helps reduce acute anxiety symptoms.
35. Which behavior in a patient with major depressive disorder suggests improving mood and requires increased safety monitoring?
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Correct Answer: B — A sudden lift in mood/energy after a period of hopelessness can indicate the patient has made a decision about suicide and now has the energy to act — this requires increased monitoring, not relief.
36. A patient diagnosed with alcohol use disorder is admitted and begins to show tremors and anxiety 12 hours after their last drink. What should the nurse anticipate?
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Correct Answer: B — Tremors and anxiety within hours of the last drink are classic early alcohol withdrawal signs, which can progress and require close monitoring and prompt management.
37. Which nursing approach best supports a patient experiencing acute grief after a sudden loss?
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Correct Answer: B — Supportive presence and active listening validate the grieving process; suppressing emotional expression is not therapeutic.
38. A patient with schizophrenia states they hear voices telling them to leave the hospital. What is the best initial nursing response?
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Correct Answer: B — This response acknowledges the patient's experience without reinforcing the hallucination as real, while maintaining a therapeutic, non-confrontational connection.
39. According to Maslow's hierarchy of needs, which patient need should the nurse address first?
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Correct Answer: B — Physiological needs, including airway, sit at the base of Maslow's hierarchy and take priority over psychosocial or higher-level needs.
40. A patient becomes verbally aggressive toward staff. What is the nurse's best initial approach?
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Correct Answer: B — Calm, non-threatening de-escalation techniques are the first-line approach to aggressive behavior, reserving security involvement for situations where safety is directly at risk.
Basic Care and Pharmacological Therapies (Q41–50)
PHYSIOLOGICAL INTEGRITYThis category covers comfort measures, mobility, nutrition, and safe medication administration principles.
41. A patient on bed rest is at risk for pressure injury. Which intervention is most effective for prevention?
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Correct Answer: B — Repositioning at least every 2 hours combined with regular skin assessment is the standard evidence-based approach to pressure injury prevention.
42. Before administering a medication via nasogastric tube, what is the priority nursing action?
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Correct Answer: B — Verifying tube placement before each use is essential to prevent aspiration from inadvertent administration into the lungs.
43. A patient is prescribed a medication with a narrow therapeutic index. What does this require from the nursing perspective?
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Correct Answer: B — Narrow therapeutic index medications have a small margin between effective and toxic doses, requiring close monitoring of levels and toxicity signs.
44. Which finding would the nurse expect in a patient with adequate hydration status?
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Correct Answer: B — Moist mucous membranes and adequate urine output are signs of normal hydration status; the other findings suggest dehydration.
45. A patient with dysphagia is at greatest risk for which complication during meals?
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Correct Answer: B — Dysphagia (difficulty swallowing) significantly increases aspiration risk, requiring careful diet texture modification and positioning during meals.
46. Which nursing action best supports safe early ambulation after surgery?
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Correct Answer: B — Gradual, assisted ambulation with assessment for orthostatic symptoms supports safety while promoting the well-documented benefits of early postoperative mobility.
47. A patient receiving opioid pain medication should be monitored most closely for which adverse effect?
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Correct Answer: B — Respiratory depression is the most serious and life-threatening adverse effect of opioid medications, requiring close respiratory rate and sedation level monitoring.
48. Before administering an as-needed pain medication, what should the nurse assess first?
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Correct Answer: B — Pain assessment, including severity and response to prior doses, guides safe and appropriate administration of as-needed pain medication.
49. Which non-pharmacological intervention is appropriate for promoting comfort in a postoperative patient?
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Correct Answer: B — Comfort positioning, a calm environment, and relaxation techniques are effective non-pharmacological comfort measures that complement medication.
50. A patient on long-term corticosteroid therapy should be monitored for which complication?
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Correct Answer: B — Long-term corticosteroid use can elevate blood glucose, suppress the immune response increasing infection risk, and weaken bone density over time.
Physiological Adaptation (Q51–60)
PHYSIOLOGICAL INTEGRITYThis category covers managing acute, chronic, and life-threatening physiological conditions and complications.
51. A patient with a history of heart failure presents with sudden weight gain and increased shortness of breath. What does the nurse suspect?
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Correct Answer: B — Rapid weight gain with worsening dyspnea in a heart failure patient strongly suggests fluid retention and decompensation, requiring prompt evaluation.
52. A patient with type 1 diabetes presents with confusion, rapid breathing, and a fruity breath odor. What does the nurse suspect?
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Correct Answer: B — Confusion, rapid breathing (Kussmaul respirations), and fruity breath odor are classic signs of diabetic ketoacidosis, a medical emergency requiring immediate intervention.
53. A patient receiving a blood transfusion develops chills, fever, and back pain shortly after the transfusion starts. What is the nurse's priority action?
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Correct Answer: B — These symptoms suggest a possible transfusion reaction. The transfusion must be stopped immediately, the line kept open with saline, and the provider notified without delay.
54. Which early sign would the nurse expect in a patient developing compartment syndrome after a fracture?
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Correct Answer: B — Pain that is severe and disproportionate to the injury, especially with passive stretching, is an early hallmark sign of compartment syndrome and requires urgent evaluation.
55. A patient with chronic kidney disease has an elevated potassium level. Which finding should the nurse monitor most closely?
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Correct Answer: B — Hyperkalemia can cause dangerous cardiac arrhythmias, making cardiac monitoring the priority concern in patients with elevated potassium levels.
56. A patient with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen. What is an important nursing consideration?
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Correct Answer: B — In some COPD patients who rely on a hypoxic drive to breathe, excessive oxygen can suppress respiration, so the lowest effective flow rate to meet target saturation is used.
57. A patient post-myocardial infarction reports new, sudden chest pain unrelieved by prescribed nitroglycerin. What is the priority action?
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Correct Answer: B — Unrelieved chest pain after appropriate intervention requires immediate provider notification and ECG evaluation to rule out an evolving cardiac event.
58. A patient with cirrhosis develops confusion and asterixis (flapping tremor). What complication does the nurse suspect?
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Correct Answer: B — Confusion combined with asterixis in a patient with liver disease is characteristic of hepatic encephalopathy, caused by elevated ammonia levels affecting brain function.
59. A patient with a new tracheostomy develops sudden difficulty breathing and the inner cannula appears obstructed. What is the priority action?
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Correct Answer: B — An obstructed tracheostomy is an airway emergency; the nurse must act immediately to clear or replace the inner cannula rather than waiting for another provider.
60. A patient in septic shock has a sudden drop in blood pressure and increased heart rate. What is the priority nursing intervention?
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Correct Answer: B — Aggressive IV fluid resuscitation is a cornerstone of early septic shock management to restore perfusion, alongside prompt provider notification.
🩺 How did you score? Let us know in the comments which Client Needs category you'd like a deeper practice set on next.
Frequently Asked Questions About the NCLEX-RN Exam
How many questions are on the NCLEX-RN exam?▾
The NCLEX-RN uses computerized adaptive testing (CAT), so the number of questions varies by candidate, typically ranging between 70 and 145 items depending on performance. Always check NCSBN's official site for the current format.
What is a good score on this practice test?▾
The NCLEX-RN is pass/fail and does not use a percentage score, so treat this practice test as a learning tool rather than a predictor. Scoring 80% or higher while understanding the rationale behind each answer is a strong sign of readiness.
What is clinical judgment and why does it matter for NCLEX?▾
Clinical judgment is the ability to recognize cues, analyze patient data, prioritize actions, and evaluate outcomes. The Next Generation NCLEX places heavy emphasis on this skill, which is why this practice test uses scenario-based questions rather than simple recall.
Is this practice test affiliated with NCSBN?▾
No. This is an independently created study resource and is not officially affiliated with, endorsed by, or sponsored by the National Council of State Boards of Nursing (NCSBN).