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Free NCLEX-RN Practice Test — 85 Questions with Answers [2026]

Think you’re ready for the NCLEX-RN? Test your knowledge with 75 realistic Next Generation NCLEX (NGN) style questions. Instant scoring, detailed rationales, and a full topic breakdown.

75 questions ~45 minutes Instant scoring No signup needed

Complete NCLEX-RN Quiz Bank

Prepare for the NCLEX-RN exam with a complete set of topic-wise practice quizzes covering all major nursing categories. From Safe & Effective Care to Pharmacology, Pediatrics, Mental Health, and more — each quiz is designed to match the latest exam blueprint with 25 high-quality questions

85 questions | 90 minutes | 70% to pass

Question 1: A nurse is caring for four patients. Which patient should the nurse assess FIRST?

  1. A patient requesting pain medication rated 5 out of 10
  2. A patient with a blood pressure of 142/88 mmHg
  3. A patient with a blood glucose of 180 mg/dL before lunch
  4. A patient with a respiratory rate of 10 and oxygen saturation of 85 percent

Answer: D — Airway and breathing always come first (ABCs). A respiratory rate of 10 with SpO2 of 85 percent indicates respiratory compromise requiring immediate intervention. The other findings are important but not immediately life-threatening.

Question 2: A patient is being discharged on warfarin therapy. Which statement indicates the patient needs FURTHER teaching?

  1. I can take ibuprofen whenever I get a headache since it is over the counter.
  2. I should use an electric razor instead of a straight blade.
  3. I will wear a medical alert bracelet.
  4. I will have regular blood tests to check my INR levels.

Answer: A — Ibuprofen and all NSAIDs increase bleeding risk when combined with warfarin. Patients must avoid NSAIDs and use acetaminophen instead. The other statements reflect correct understanding of warfarin safety precautions.

Question 3: Which action by a newly licensed nurse requires the charge nurse to intervene?

  1. Applying a gait belt before ambulating a post-surgical patient
  2. Documenting vital signs immediately after obtaining them
  3. Checking two patient identifiers before medication administration
  4. Raising all four side rails on a confused, restless patient

Answer: D — Raising all four side rails is considered a restraint and requires a physician order. This is a patient safety and legal violation. The charge nurse must intervene immediately. The other actions reflect appropriate nursing practice.

Question 4: A nurse suspects a colleague is diverting controlled substances. The MOST appropriate action is to:

  1. Confront the colleague directly and demand an explanation
  2. Ignore it because there is no definitive proof
  3. Report the suspicion to the nurse manager or supervisor through proper channels
  4. Discuss the concern with other coworkers to gather their opinions

Answer: C — Suspected drug diversion must be reported through proper channels (nurse manager, supervisor, or compliance hotline) to protect patients. Ignoring it endangers patients. Confronting or gossiping is inappropriate and may compromise the investigation.

Question 5: A patient with a latex allergy is scheduled for surgery. Which action is MOST important for the nurse to take?

  1. Ask the patient to bring their own non-latex gloves
  2. Administer diphenhydramine 30 minutes before surgery
  3. Ensure the operating room is set up as a latex-free environment
  4. Document the allergy and take no further action

Answer: C — Ensuring a latex-free environment is the priority to prevent a potentially fatal anaphylactic reaction. All latex-containing products must be removed and replaced with non-latex alternatives before the patient enters the OR.

Question 6: A nurse receives a telephone order from a physician. The CORRECT action is to:

  1. Refuse all telephone orders as they are not permitted
  2. Write the order and wait for the physician to sign it on the next visit
  3. Have the unit secretary take all telephone orders
  4. Read the order back to the physician to confirm accuracy, then document it with the time and physician name

Answer: D — Read-back verification is a required patient safety practice for telephone and verbal orders. The nurse reads the complete order back to the physician to confirm accuracy, then documents it with date, time, and the prescriber name.

Question 7: A patient signs an informed consent form for surgery. Which situation would make this consent INVALID?

  1. The patient asked questions about the procedure before signing
  2. The surgeon explained risks, benefits, and alternatives
  3. The patient received IV sedation 20 minutes before signing
  4. The patient is 45 years old and alert

Answer: C — Informed consent requires the patient to be competent and free from mind-altering substances. Signing after receiving IV sedation invalidates the consent because the patient cannot make a fully informed, rational decision.

Question 8: A home health nurse visits an elderly patient who reports using herbal supplements. Which response is MOST appropriate?

  1. Ignore the supplements since they are not prescription medications
  2. Tell the patient herbal supplements are always safe and natural
  3. Ask the patient to list all supplements and notify the provider to check for drug interactions
  4. Instruct the patient to stop all supplements immediately

Answer: C — Herbal supplements can interact dangerously with prescribed medications. The nurse should document all supplements and alert the provider. Many herbs affect bleeding, blood pressure, blood sugar, and drug metabolism.

Question 9: A nurse is teaching a 55-year-old patient about recommended health screenings. Which screening should the nurse recommend?

  1. Mammogram every 5 years after age 50
  2. Colonoscopy beginning at age 45 for average-risk individuals
  3. Bone density scan at age 40
  4. Colonoscopy beginning at age 65

Answer: B — Current guidelines recommend colorectal cancer screening beginning at age 45 for average-risk individuals. Options include colonoscopy every 10 years or annual stool-based tests. Earlier screening is indicated for those with risk factors.

Question 10: A patient newly diagnosed with type 2 diabetes asks the nurse about lifestyle modifications. The BEST initial response is:

  1. You should eliminate all carbohydrates from your diet.
  2. Diabetes cannot be managed without medication.
  3. Regular physical activity and a balanced diet are the foundation of managing your diabetes.
  4. You will need insulin injections right away.

Answer: C — Lifestyle modifications (exercise, balanced diet, weight management) are the cornerstone of type 2 diabetes management. Carbohydrates are managed, not eliminated. Medication may be added later but lifestyle changes are always the first intervention.

Question 11: A 50-year-old male patient has no significant medical history. The nurse should recommend which immunization?

  1. Annual influenza vaccine and assessment for other recommended vaccines based on risk factors
  2. Only tetanus boosters are needed for adults
  3. Childhood vaccines should be repeated every 10 years
  4. No immunizations are needed until age 65

Answer: A — Adults need annual influenza vaccines, Td/Tdap boosters every 10 years, and additional vaccines based on age, health conditions, and risk factors. The nurse should assess immunization history and recommend accordingly.

Question 12: A nurse is teaching a patient about preventing osteoporosis. Which statement by the patient indicates understanding?

  1. I will include calcium-rich foods and weight-bearing exercise in my routine.
  2. I should avoid all physical activity to prevent fractures.
  3. I will start taking calcium supplements without talking to my doctor.
  4. Only women need to worry about osteoporosis.

Answer: A — Weight-bearing exercise and adequate calcium and vitamin D intake are key prevention strategies for osteoporosis. Both men and women are at risk. Supplements should be discussed with the provider to determine appropriate dosing.

Question 13: A nurse is performing a community health screening. Which finding requires IMMEDIATE referral?

  1. Blood pressure of 118/76 mmHg
  2. A breast lump discovered during self-examination
  3. Body mass index of 27
  4. A fasting blood glucose of 95 mg/dL

Answer: B — A new breast lump requires immediate referral for diagnostic evaluation (mammogram, ultrasound, possible biopsy) to rule out malignancy. The other findings are either slightly elevated or within normal limits and do not require urgent referral.

Question 14: A patient tells the nurse that they have been feeling hopeless and have thought about ending their life. The PRIORITY nursing action is:

  1. Change the subject to avoid making the patient uncomfortable
  2. Leave the patient alone to process their feelings
  3. Ask the patient directly if they have a plan to harm themselves
  4. Document the statement and address it at the next care conference

Answer: C — When a patient expresses suicidal ideation, the nurse must immediately perform a direct safety assessment by asking about a specific plan, means, and intent. This does not increase suicide risk - it opens critical dialogue and allows for immediate safety interventions.

Question 15: A patient with schizophrenia tells the nurse that the CIA is monitoring them through the television. The BEST therapeutic response is:

  1. I understand the TV is not monitoring you - that is not real.
  2. That must be very frightening for you. You are safe here.
  3. You should ignore those thoughts because they are just your illness.
  4. Let me change the channel so they cannot watch you.

Answer: B — Acknowledge the patient feelings without reinforcing or arguing with the delusion. Saying it must be frightening validates the emotional experience while providing reassurance of safety. Arguing or agreeing with delusions is not therapeutic.

Question 16: A nurse is assessing a patient for signs of alcohol withdrawal. Which finding is MOST concerning?

  1. Anxiety and increased heart rate
  2. Mild hand tremors 12 hours after the last drink
  3. Mild nausea and insomnia
  4. Grand mal seizure with confusion and visual hallucinations

Answer: D — Seizures with hallucinations and confusion indicate severe alcohol withdrawal (delirium tremens), which is a medical emergency with significant mortality risk. This requires immediate intervention including IV benzodiazepines, seizure precautions, and close monitoring.

Question 17: A patient with major depressive disorder is suddenly cheerful and gives away personal belongings. The nurse should:

  1. Document the improvement and take no further action
  2. Recognize this as a potential warning sign for suicide and increase observation immediately
  3. Encourage the patient to continue socializing
  4. Be pleased the patient mood has improved

Answer: B — A sudden mood improvement with giving away possessions is a classic warning sign that a patient has decided to act on a suicide plan and feels relieved. The nurse must immediately increase the level of observation and notify the provider.

Question 18: A patient in sickle cell crisis reports severe pain rated 10 out of 10. The nurse should FIRST:

  1. Tell the patient to try relaxation techniques before giving medication
  2. Administer prescribed opioid analgesics promptly as ordered
  3. Suggest the patient is exaggerating and offer acetaminophen
  4. Apply ice packs to the painful areas

Answer: B — Sickle cell pain crisis causes severe vaso-occlusive pain requiring prompt opioid administration. Pain is what the patient says it is. Delaying treatment or questioning the patient report is inappropriate. Cold application worsens sickling and is contraindicated.

Question 19: A patient with heart failure is being discharged on furosemide. Which instruction is MOST important?

  1. Skip the medication if you do not feel swollen
  2. Weigh yourself daily at the same time and report a gain of 2 or more pounds in one day
  3. Take the medication at bedtime for better absorption
  4. You do not need to monitor your diet while on this medication

Answer: C — Daily weights are the most sensitive indicator of fluid retention in heart failure. A weight gain of 2 pounds in one day (or 5 pounds in one week) suggests fluid overload requiring provider notification. Take diuretics in the morning, not bedtime, to avoid nocturia.

Question 20: A nurse is caring for a patient in diabetic ketoacidosis (DKA). Which findings does the nurse expect?

  1. Hypothermia and hypertension
  2. Slow, shallow respirations and bradycardia
  3. Weight gain and peripheral edema
  4. Kussmaul respirations, fruity breath odor, and blood glucose above 300 mg/dL

Answer: D — DKA presents with Kussmaul respirations (deep, rapid breathing to blow off CO2), fruity acetone breath (from ketone production), hyperglycemia above 300 mg/dL, dehydration, and metabolic acidosis. Treatment includes IV insulin, fluids, and electrolyte replacement.

Question 21: A patient develops sudden onset of chest pain, dyspnea, and a unilateral swollen calf. The nurse should suspect:

  1. Pneumonia
  2. Musculoskeletal chest wall pain
  3. Congestive heart failure exacerbation
  4. Pulmonary embolism originating from a deep vein thrombosis

Answer: D — The triad of sudden chest pain, dyspnea, and unilateral calf swelling strongly suggests a pulmonary embolism from a DVT. This is a life-threatening emergency. Notify the provider immediately and prepare for anticoagulation therapy and diagnostic imaging.

Question 22: A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. The nurse should:

  1. Encourage the patient to eat a banana for energy
  2. Administer a potassium supplement as ordered
  3. Recheck the level in 4 hours before taking action
  4. Recognize this as a life-threatening hyperkalemia and notify the provider immediately

Answer: D — Normal potassium is 3.5 to 5.0 mEq/L. A level of 6.8 is critically elevated and can cause fatal cardiac arrhythmias (peaked T waves, widened QRS, ventricular fibrillation). Expect orders for IV calcium gluconate, insulin with glucose, and possible dialysis.

Question 23: A patient is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse expects to find:

  1. Severe dehydration with high serum sodium
  2. Hyperkalemia and metabolic acidosis
  3. Excessive urination and extreme thirst
  4. Fluid retention, decreased urine output, and dangerously low serum sodium (hyponatremia)

Answer: D — SIADH causes excessive ADH secretion leading to water retention, dilutional hyponatremia, and concentrated urine despite low serum osmolality. Treatment includes fluid restriction, hypertonic saline for severe cases, and addressing the underlying cause.

Question 24: A patient with cirrhosis develops confusion and asterixis (liver flap). The nurse suspects:

  1. Hypoglycemia requiring glucose administration
  2. A transient ischemic attack
  3. Hepatic encephalopathy from elevated ammonia levels
  4. Alcohol intoxication

Answer: C — Confusion and asterixis (flapping hand tremor) in a cirrhosis patient are hallmark signs of hepatic encephalopathy caused by the liver inability to clear ammonia. Expect orders for lactulose (to excrete ammonia via stool) and rifaximin.

Question 25: A patient is receiving a blood transfusion and develops fever, chills, back pain, and dark urine 15 minutes after initiation. The nurse should FIRST:

  1. Slow the transfusion rate and continue monitoring
  2. Stop the transfusion immediately and keep the IV line open with normal saline
  3. Document the reaction and notify the provider at the end of the transfusion
  4. Administer acetaminophen and continue the transfusion

Answer: B — These are signs of a hemolytic transfusion reaction - a life-threatening emergency. Stop the transfusion immediately, maintain IV access with NS, notify the provider and blood bank, send the blood bag and blood samples for analysis, and monitor for shock and renal failure.

Question 26: A nurse is administering metoprolol (a beta-blocker). Before giving the medication, the nurse should:

  1. Check the apical heart rate and blood pressure; hold if HR is below 60 or BP is below 90/60
  2. Check the blood glucose level
  3. Verify the patient has eaten a full meal
  4. Check the serum potassium level

Answer: A — Beta-blockers decrease heart rate and blood pressure. Always check apical pulse for 60 seconds and BP before administration. Hold the dose and notify the provider if HR is below 60 bpm or systolic BP is below 90 mmHg.

Question 27: A patient is prescribed enoxaparin (Lovenox) subcutaneously. The nurse should administer the injection:

  1. Intravenously for faster onset of action
  2. Into the abdominal subcutaneous tissue without aspirating or rubbing the site afterward
  3. Into the vastus lateralis muscle with vigorous massage afterward
  4. Into the deltoid muscle using a 22-gauge needle

Answer: B — Enoxaparin is given subcutaneously in the abdomen (at least 2 inches from the umbilicus). Do NOT aspirate before injection or massage afterward, as this causes bruising and hematoma formation at the injection site. Rotate injection sites.

Question 28: A patient on phenytoin (Dilantin) reports gum overgrowth and has difficulty maintaining balance. The nurse should:

  1. Tell the patient to brush harder to reduce the gum swelling
  2. Discontinue the medication immediately without consulting the provider
  3. Increase the dose to better control seizures
  4. Recognize these as expected side effects, assess the serum phenytoin level, and notify the provider

Answer: D — Gingival hyperplasia and ataxia (balance difficulty) are known phenytoin side effects. Ataxia may indicate toxicity (therapeutic level 10-20 mcg/mL). Check the serum level. Teach meticulous oral hygiene for gum overgrowth. Notify the provider for dose evaluation.

Question 29: A nurse is preparing to administer IV potassium chloride. Which action is ESSENTIAL?

  1. Administer it intramuscularly if IV access is unavailable
  2. Give it undiluted through a peripheral IV for maximum effect
  3. Verify the infusion is diluted, on an infusion pump, and does not exceed 10 mEq per hour peripherally
  4. Administer as a rapid IV push to correct the deficiency quickly

Answer: C — IV potassium must NEVER be given by IV push - it causes fatal cardiac arrest. Always dilute, use an infusion pump, and limit the rate to 10 mEq/hour peripherally. Monitor the IV site, cardiac rhythm, and serum potassium levels.

Question 30: A patient receiving morphine has a respiratory rate of 8 and is difficult to arouse. After stopping the morphine, the nurse should prepare to administer:

  1. Flumazenil (Romazicon)
  2. Protamine sulfate
  3. Vitamin K
  4. Naloxone (Narcan)

Answer: D — Naloxone (Narcan) is the opioid antagonist that reverses morphine-induced respiratory depression. Flumazenil reverses benzodiazepines, protamine reverses heparin, and vitamin K reverses warfarin. Knowing each antidote is critical for NCLEX.

Question 31: A nurse is teaching a patient about reducing the risk of deep vein thrombosis (DVT) after surgery. Which instruction is MOST important?

  1. Cross your legs when sitting to improve circulation
  2. Stay in bed for at least one week after surgery to rest
  3. Perform ankle pumps and early ambulation as directed by the provider
  4. Drink less fluid to reduce swelling in the legs

Answer: C — Early ambulation, ankle pumps, and calf exercises promote venous return and prevent blood stasis that leads to DVT formation. Compression stockings and anticoagulant prophylaxis may also be ordered. Bed rest and leg crossing increase DVT risk.

Question 32: A patient is scheduled for a cardiac catheterization. Which assessment is MOST important before the procedure?

  1. Verifying the patient insurance coverage
  2. Assessing for allergies to iodine, contrast dye, and shellfish
  3. Asking the patient about their favorite foods
  4. Checking the patient last dental exam date

Answer: B — Cardiac catheterization uses iodine-based contrast dye. Allergy to iodine, contrast, or shellfish increases the risk of an anaphylactic reaction. The provider must be notified so premedication with steroids and antihistamines can be ordered.

Question 33: A patient has a chest tube connected to a water-seal drainage system. The nurse observes continuous bubbling in the water-seal chamber. This indicates:

  1. An air leak in the system that must be assessed and reported
  2. Normal functioning of the drainage system
  3. The suction is set at the correct level
  4. The patient lung has fully re-expanded

Answer: A — Continuous bubbling in the water-seal chamber indicates an air leak - either from the patient lung (persistent pneumothorax) or from a connection leak in the tubing system. The nurse should check all connections, assess the patient respiratory status, and notify the provider.

Question 34: A nurse is performing a neurological assessment and notes that the patient pupils are fixed and dilated bilaterally. This finding suggests:

  1. Increased intracranial pressure or brainstem herniation requiring emergency intervention
  2. The patient has recently received atropine eye drops
  3. Normal pupillary response
  4. Mild dehydration affecting eye moisture

Answer: A — Fixed, dilated pupils bilaterally indicate a neurological emergency - most likely severely elevated intracranial pressure with brainstem compression. This is a life-threatening finding. Notify the provider immediately and prepare for emergency interventions.

Question 35: A nurse suspects a patient is developing sepsis. Which assessment findings support this suspicion?

  1. Weight gain of 2 pounds and ankle swelling
  2. Temperature 98.6 F, heart rate 72, blood pressure 120/80
  3. Bradycardia with hypertension and irregular respirations
  4. Temperature 102.4 F, heart rate 118, blood pressure 86/52, and altered mental status

Answer: D — Sepsis presents with fever (or hypothermia), tachycardia, hypotension, and altered mental status. The SIRS criteria include temperature above 100.4 or below 96.8, heart rate above 90, respiratory rate above 20, and WBC abnormalities. Early recognition saves lives.

Question 36: A nurse is caring for a patient with a new tracheostomy. Which item should ALWAYS be kept at the bedside?

  1. A urinary catheter insertion kit
  2. A blood pressure cuff
  3. An extra pillow for positioning
  4. A spare tracheostomy set (one size smaller) and obturator

Answer: D — A spare tracheostomy tube (one size smaller for easier insertion) and the obturator must always be at the bedside in case of accidental decannulation. This is a life-threatening airway emergency that requires immediate tube replacement.

Question 37: A nurse is caring for four patients with potential infectious conditions. Which patient requires AIRBORNE precautions?

  1. A patient with MRSA wound infection
  2. A patient with active pulmonary tuberculosis
  3. A patient with Clostridium difficile diarrhea
  4. A patient with influenza

Answer: B — Active pulmonary TB requires airborne precautions: negative-pressure isolation room and N95 respirator. MRSA requires contact precautions. C. difficile requires contact precautions with soap-and-water handwashing. Influenza requires droplet precautions.

Question 38: A nurse is caring for a patient with a central venous catheter. Which finding indicates a possible catheter-related bloodstream infection?

  1. The patient develops fever, chills, and redness at the insertion site
  2. The IV fluid is infusing at the prescribed rate
  3. The patient reports no discomfort at the site
  4. The dressing is clean, dry, and intact

Answer: A — Fever, chills, and insertion site redness are classic signs of a central line-associated bloodstream infection (CLABSI). The nurse should obtain blood cultures (from the line and peripherally), notify the provider, and anticipate catheter removal and antibiotic therapy.

Question 39: A nurse accidentally sustains a needlestick from a needle used on an HIV-positive patient. The FIRST action is to:

  1. Ignore it since the risk of transmission is very low
  2. Report it at the end of the shift to avoid disrupting patient care
  3. Immediately report to the emergency department for post-exposure prophylaxis evaluation
  4. Apply a bandage and continue working

Answer: C — Needlestick from an HIV-positive source requires immediate action: wash the site, report to the supervisor, and go to the ED for post-exposure prophylaxis (PEP) evaluation. PEP must be started within 2 hours (ideally within 72 hours) for maximum effectiveness.

Question 40: A patient has been on contact precautions for C. difficile. The nurse should perform hand hygiene using:

  1. No special hand hygiene is required for C. difficile
  2. Either method is equally effective for C. difficile
  3. Soap and water because alcohol does not kill C. difficile spores
  4. Alcohol-based hand sanitizer since it is faster

Answer: C — C. difficile produces spores that are resistant to alcohol-based sanitizers. Only thorough handwashing with soap and water physically removes the spores. This is a critical exception to the general preference for alcohol-based hand hygiene in healthcare.

Question 41: A patient develops hives, wheezing, and hypotension during an IV antibiotic infusion. The nurse should FIRST:

  1. Slow the infusion rate and continue monitoring
  2. Administer the next scheduled dose of antibiotic
  3. Stop the infusion immediately, maintain IV access, and call for emergency assistance
  4. Document the reaction and notify the provider at shift change

Answer: C — These are signs of anaphylaxis - a life-threatening allergic reaction. Stop the causative agent immediately, maintain IV access, call for help, prepare epinephrine, and monitor airway, breathing, and circulation. Every second of delay increases mortality risk.

Question 42: A charge nurse must assign four patients. Which patient is MOST appropriate to assign to an experienced LPN/LVN?

  1. A patient with a stable tracheostomy requiring routine suctioning
  2. A newly admitted patient requiring a comprehensive admission assessment
  3. A patient who is 2 hours post-cardiac catheterization requiring frequent neurovascular checks
  4. A patient requiring discharge teaching on a new heart failure medication regimen

Answer: A — LPNs can perform routine care on stable patients including tracheostomy suctioning. Discharge teaching on new complex medications, initial comprehensive assessments, and post-procedure assessments with unstable potential require RN-level judgment and scope of practice.

Question 43: A charge nurse receives report on four patients. Which patient should be assessed FIRST?

  1. A patient 1 day post-appendectomy reporting pain of 4 out of 10
  2. A patient with asthma reporting increased dyspnea and audible wheezing
  3. A patient requesting their scheduled stool softener
  4. A patient with type 2 diabetes with a blood glucose of 200 mg/dL before lunch

Answer: B — Increasing dyspnea and audible wheezing in an asthma patient indicates worsening airway obstruction that can progress to respiratory failure. ABCs (airway, breathing, circulation) always take priority. The other patients have expected or non-urgent findings.

Question 44: A nurse delegates the task of obtaining vital signs on a stable patient to a UAP (unlicensed assistive personnel). Which instruction is MOST appropriate?

  1. You do not need to report the results since the patient is stable
  2. Take the vital signs and document them in the chart yourself
  3. Obtain the vital signs and report all results back to me before I document them
  4. Take the vital signs and only tell me if something seems wrong

Answer: C — When delegating, the RN must provide clear instructions and require the UAP to report ALL results back. The RN retains accountability for assessment and documentation. Telling the UAP to report only abnormal findings is unsafe because they may not recognize abnormalities.

Question 45: An RN is supervising a new graduate nurse. The new nurse prepares to administer insulin without having another nurse verify the dose. The RN should:

  1. Intervene and require a second nurse to verify the insulin dose before administration
  2. Allow it since independent practice builds confidence
  3. Report the new nurse to the board of nursing immediately
  4. Verify the dose after the new nurse has already administered it

Answer: A — Insulin is a high-alert medication requiring independent double verification before administration per most facility policies. The RN must intervene before the medication is given to prevent a potentially dangerous dosing error.

Question 46: A charge nurse must decide which task can be delegated to a UAP. Which task is appropriate?

  1. Developing the nursing care plan for a newly admitted patient
  2. Obtaining a fingerstick blood glucose on a stable diabetic patient
  3. Assessing a patient wound for signs of infection
  4. Educating a patient about a new medication

Answer: B — Obtaining fingerstick blood glucose is a routine, standardized task within UAP scope after proper training. Assessment, education, and care planning require RN clinical judgment and cannot be delegated to unlicensed personnel.

Question 47: A nurse must prioritize care for four patients. Which situation can the nurse address LAST?

  1. A post-operative patient with bright red blood soaking through the abdominal dressing
  2. A patient reporting new onset of crushing chest pain
  3. A patient requesting a warm blanket
  4. A patient who is choking on food in the dining room

Answer: C — Requesting a warm blanket is a comfort measure that can wait. Choking (airway obstruction), hemorrhage (circulation), and chest pain (possible MI) are all emergencies that must be addressed before comfort needs.

Question 48: A post-operative patient has not voided 8 hours after surgery. The nurse should FIRST:

  1. Assess for bladder distention, encourage ambulation if permitted, and try non-invasive measures before catheterization
  2. Document the finding and recheck in 8 more hours
  3. Insert an indwelling catheter immediately
  4. Restrict fluids to reduce urine production

Answer: A — Eight hours without voiding post-operatively requires assessment for urinary retention. Try non-invasive measures first: palpate for bladder distention, assist to bathroom, run warm water, pour warm water over the perineum. Catheterize only if these fail.

Question 49: A nurse is caring for a patient with a new colostomy. During the first assessment, the nurse notes the stoma is dark red and moist. This finding indicates:

  1. Normal, healthy stoma tissue with adequate blood supply
  2. An infection developing at the surgical site
  3. The colostomy bag needs to be changed immediately
  4. Stoma necrosis requiring emergency surgical intervention

Answer: A — A healthy stoma should be beefy red, moist, and slightly raised. Dark red and moist is normal. A pale, dusky, blue, or black stoma indicates impaired blood supply (ischemia/necrosis) and requires immediate provider notification.

Question 50: A patient is 12 hours post-thyroidectomy. Which assessment finding requires IMMEDIATE action?

  1. Tingling and numbness around the mouth and fingertips with a positive Chvostek sign
  2. Temperature of 99.2 degrees Fahrenheit
  3. Incisional pain rated 4 out of 10
  4. Mild sore throat and hoarseness

Answer: A — Perioral tingling, fingertip numbness, and positive Chvostek sign (facial twitching when tapping the facial nerve) indicate hypocalcemia from accidental parathyroid removal or damage during thyroidectomy. This can progress to laryngospasm and seizures. IV calcium gluconate must be available.

Question 51: A nurse is assessing a patient with suspected appendicitis. Which finding is MOST consistent with this diagnosis?

  1. Pain in the left upper quadrant that radiates to the shoulder
  2. Right lower quadrant pain at McBurney point with rebound tenderness
  3. Epigastric pain that worsens when lying flat
  4. Diffuse abdominal pain that improves after eating

Answer: B — McBurney point tenderness (right lower quadrant, one-third of the distance from the right anterior superior iliac spine to the umbilicus) with rebound tenderness is the classic presentation of appendicitis. Do not apply heat - this can cause rupture.

Question 52: A nurse is caring for a patient with a hip fracture who is in Buck traction. Which finding requires IMMEDIATE intervention?

  1. The leg is in proper anatomical alignment
  2. The traction rope is caught between the pulley and the frame
  3. The patient reports mild discomfort in the affected leg
  4. The weights are hanging freely off the end of the bed

Answer: B — A rope caught in the pulley disrupts the traction mechanism and can cause improper alignment, pressure injury, or loss of fracture reduction. Weights should hang freely, ropes should move smoothly through pulleys, and the patient should maintain proper alignment at all times.

Question 53: A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. The patient SpO2 is 91 percent. A new nurse plans to increase the oxygen to 6 L/min. The experienced nurse should:

  1. Discontinue the oxygen entirely since 91 percent is acceptable for COPD
  2. Allow the change and monitor for improvement
  3. Support the decision since higher oxygen improves outcomes
  4. Intervene because high-flow oxygen in COPD patients can suppress the hypoxic drive and cause respiratory failure

Answer: D — COPD patients may rely on hypoxic drive for breathing stimulus. High-flow oxygen can suppress this drive, leading to CO2 retention and respiratory failure. Low-flow oxygen (1-2 L/min) targeting SpO2 of 88-92 percent is appropriate for most COPD patients.

Question 54: A nurse is caring for a patient receiving total parenteral nutrition (TPN). The current bag is empty and the next bag is not available from pharmacy. The nurse should:

  1. Discontinue the infusion and wait for the new bag
  2. Increase the rate of the current empty bag to get the last drops out
  3. Infuse normal saline at the same rate as the TPN
  4. Hang a bag of D10W (10 percent dextrose) to prevent rebound hypoglycemia until the new TPN arrives

Answer: D — Abruptly stopping TPN causes rebound hypoglycemia because the pancreas is producing high insulin levels in response to the concentrated dextrose in TPN. Hanging D10W provides glucose to prevent a dangerous blood sugar crash until the new TPN bag arrives.

Question 55: A patient in labor is having contractions every 2 minutes lasting 90 seconds. The fetal heart rate tracing shows late decelerations. The nurse should FIRST:

  1. Encourage the patient to push with the next contraction
  2. Continue monitoring since this is a normal labor pattern
  3. Prepare the patient for immediate breastfeeding
  4. Reposition the patient to the left lateral side, administer oxygen, increase IV fluids, and notify the provider

Answer: D — Late decelerations indicate uteroplacental insufficiency - the fetus is not receiving adequate oxygen. Immediate interventions include left lateral positioning (improves placental blood flow), oxygen administration, IV fluid bolus, stopping oxytocin if running, and notifying the provider urgently.

Question 56: A nurse is assessing a newborn at 1 minute after birth. The baby has a heart rate of 110, slow irregular respirations, some flexion, grimaces when stimulated, and the body is pink with blue extremities. The APGAR score is:

  1. 5
  2. 8
  3. 6
  4. 7

Answer: D — APGAR scoring: Heart rate above 100 = 2, Slow respirations = 1, Some flexion = 1, Grimace = 1, Pink body with blue extremities (acrocyanosis) = 1. Total = 7. A score of 7 to 10 is considered normal. Below 7 requires intervention.

Question 57: A nurse is teaching a postpartum patient about warning signs to report. Which symptom requires IMMEDIATE medical attention?

  1. Heavy bleeding that soaks more than one pad per hour or passing large clots
  2. Mild mood swings during the first two weeks
  3. Mild uterine cramping while breastfeeding
  4. Slight breast tenderness when the milk comes in

Answer: A — Soaking more than one pad per hour or passing large clots indicates postpartum hemorrhage - the leading cause of maternal death worldwide. The patient should seek emergency care immediately. Causes include uterine atony, retained placenta, and lacerations.

Question 58: A nurse assesses a pregnant patient at 36 weeks gestation who reports a sudden gush of painless bright red vaginal bleeding. The nurse should suspect:

  1. Abruptio placentae requiring immediate delivery
  2. A urinary tract infection causing hematuria
  3. Normal bloody show indicating labor is beginning
  4. Placenta previa and should NOT perform a vaginal examination

Answer: D — Painless, bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa (placenta covering the cervical os). NEVER perform a vaginal exam - this can trigger life-threatening hemorrhage. Notify the provider and prepare for ultrasound.

Question 59: A postpartum nurse notes that a patient uterus is boggy and displaced to the right. The FIRST action is to:

  1. Apply ice packs to the abdomen
  2. Have the patient empty their bladder, then massage the fundus
  3. Notify the provider and prepare for surgery
  4. Administer oxytocin (Pitocin) immediately

Answer: B — A boggy uterus displaced to the right is most commonly caused by a full bladder preventing the uterus from contracting properly. Have the patient void first, then assess the fundus. If it remains boggy after bladder emptying, massage the fundus and notify the provider.

Question 60: A 3-year-old child is admitted with suspected epiglottitis. The nurse should:

  1. Discharge the child home with antibiotic prescription
  2. Keep the child calm and upright, have emergency intubation equipment at the bedside, and avoid throat examination
  3. Immediately inspect the throat using a tongue depressor
  4. Position the child supine and administer oral fluids

Answer: B — Epiglottitis is a life-threatening airway emergency. NEVER examine the throat with a tongue depressor - this can trigger complete airway obstruction. Keep the child calm and in an upright position, maintain a quiet environment, and have emergency airway equipment immediately available.

Question 61: A nurse is assessing a 6-month-old infant. Which finding requires IMMEDIATE intervention?

  1. The infant has a bulging anterior fontanelle and high-pitched cry
  2. The infant babbles and makes cooing sounds
  3. The infant reaches for toys with both hands
  4. The infant cannot roll from back to front yet

Answer: A — A bulging fontanelle with a high-pitched cry in an infant indicates increased intracranial pressure, possibly from meningitis or hydrocephalus. This is a medical emergency. Normal fontanelle should be flat and soft when the infant is calm and upright.

Question 62: A 5-year-old is prescribed amoxicillin for otitis media. The parent asks why the child should finish all the medication even if they feel better. The BEST response is:

  1. Completing the full course prevents antibiotic resistance and ensures the infection is fully eliminated.
  2. You can stop the medication once symptoms improve to save the remaining doses.
  3. The extra doses will boost the immune system.
  4. It does not matter if a few doses are missed at the end.

Answer: A — Incomplete antibiotic courses allow surviving bacteria (the most resistant ones) to multiply, increasing the risk of antibiotic-resistant infections and recurrence. The full prescribed course must be completed even after symptoms resolve.

Question 63: A nurse is assessing an 8-year-old with a new diagnosis of type 1 diabetes. The child is confused, pale, diaphoretic, and trembling. The blood glucose is 52 mg/dL. The nurse should FIRST:

  1. Give 15 grams of a fast-acting carbohydrate such as 4 ounces of juice immediately
  2. Administer insulin to correct the metabolic imbalance
  3. Restrict all food and fluids until the provider arrives
  4. Obtain a hemoglobin A1C level

Answer: A — Blood glucose of 52 with confusion, pallor, and diaphoresis indicates hypoglycemia requiring immediate treatment. Give 15 grams of fast-acting carbohydrate (juice, glucose tablets), wait 15 minutes, and recheck. Insulin would worsen hypoglycemia and is contraindicated.

Question 64: A child is brought to the emergency department with a suspected ingestion of a household chemical. The parent asks if they should induce vomiting. The nurse should advise:

  1. Give the child milk to neutralize the poison
  2. Do NOT induce vomiting - contact Poison Control immediately at 1-800-222-1222 for specific guidance
  3. Yes, always induce vomiting after any poisoning
  4. Wait to see if symptoms develop before taking action

Answer: B — Inducing vomiting is contraindicated for many ingestions (caustic substances, hydrocarbons, sharp objects) as it causes additional esophageal and airway damage. Contact Poison Control for specific guidance based on the substance ingested. Syrup of ipecac is no longer recommended.

Question 65: A patient with bipolar disorder in the manic phase has not slept in 3 days and is pacing the hallway making grandiose statements. The PRIORITY nursing intervention is:

  1. Provide a calm, low-stimulation environment with high-calorie finger foods and ensure safety
  2. Encourage the patient to exercise vigorously to burn off energy
  3. Engage the patient in a long group therapy discussion
  4. Confront the patient about their unrealistic beliefs

Answer: A — During mania, priorities are safety, nutrition, and rest. Provide a calm, low-stimulation environment to reduce agitation. Offer high-calorie finger foods (the patient will not sit for meals). Set firm, consistent limits. Avoid arguing with grandiose beliefs.

Question 66: A nurse is caring for a patient experiencing a panic attack. Which intervention is MOST therapeutic?

  1. Leave the patient alone in a quiet room until the attack passes
  2. Administer oxygen at 10 L/min via non-rebreather mask
  3. Stay with the patient, speak in a calm and reassuring voice, and guide them through slow breathing
  4. Tell the patient there is nothing to be afraid of and they need to calm down

Answer: C — During a panic attack, the nurse should stay with the patient (never leave them alone), maintain a calm demeanor, speak slowly and simply, and guide controlled breathing to reduce hyperventilation. Telling someone to calm down is dismissive and ineffective.

Question 67: A patient on a psychiatric unit refuses to take their prescribed antipsychotic medication. The nurse should:

  1. Respect the patient right to refuse, document the refusal, and notify the provider
  2. Tell the patient they will not be allowed to leave the hospital until they take the medication
  3. Crush the medication and hide it in the patient food
  4. Restrain the patient and administer the medication by injection

Answer: A — Competent patients have the legal right to refuse medication. The nurse must respect this right, document the refusal, educate the patient about consequences of non-adherence, and notify the provider. Forcing or hiding medication is assault and a violation of patient rights.

Question 68: A nurse receives the following lab results for a patient on heparin therapy. Which value should be reported to the provider IMMEDIATELY?

  1. Serum sodium of 140 mEq/L
  2. Hemoglobin 14 g/dL
  3. Platelet count of 42,000/mcL
  4. White blood cell count of 7,500/mcL

Answer: C — A platelet count of 42,000 (normal 150,000-400,000) in a patient on heparin indicates possible heparin-induced thrombocytopenia (HIT) - a serious, potentially fatal complication. The nurse must stop heparin immediately, notify the provider, and anticipate switching to an alternative anticoagulant.

Question 69: A patient has the following arterial blood gas results: pH 7.30, PaCO2 50 mmHg, HCO3 24 mEq/L. This indicates:

  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Respiratory alkalosis
  4. Respiratory acidosis

Answer: D — pH 7.30 is acidotic (below 7.35). PaCO2 of 50 is elevated (above 45), which causes acidosis. HCO3 of 24 is normal (22-26), meaning the kidneys have not yet compensated. This is uncompensated respiratory acidosis, commonly caused by COPD, respiratory depression, or airway obstruction.

Question 70: A patient with heart failure has the following lab result: BNP (B-type natriuretic peptide) of 850 pg/mL. This indicates:

  1. Hepatic failure and portal hypertension
  2. Heart failure with significant ventricular volume overload and wall stress
  3. Normal cardiac function
  4. Acute kidney injury unrelated to cardiac function

Answer: B — BNP above 100 pg/mL suggests heart failure; above 400 strongly indicates it. A BNP of 850 indicates significant ventricular volume overload and stretching. BNP is used to diagnose heart failure, evaluate severity, and monitor treatment response.

Question 71: A patient on digoxin has the following lab values: digoxin level 2.4 ng/mL, potassium 3.2 mEq/L. The nurse should:

  1. Administer the digoxin with extra potassium-rich juice
  2. Administer the next digoxin dose since the level is only slightly above therapeutic range
  3. Increase the digoxin dose to compensate for the low potassium
  4. Hold the digoxin and notify the provider because the supratherapeutic digoxin level combined with hypokalemia creates high toxicity risk

Answer: D — Therapeutic digoxin level is 0.5-2.0 ng/mL; this patient is at 2.4 (toxic). Low potassium (3.2, normal 3.5-5.0) significantly increases digoxin toxicity risk because potassium and digoxin compete for the same cardiac binding sites. Hold digoxin, notify provider, and replace potassium.

Question 72: A patient has the following ABG results: pH 7.48, PaCO2 38 mmHg, HCO3 32 mEq/L. This indicates:

  1. Respiratory alkalosis
  2. Metabolic alkalosis
  3. Respiratory acidosis
  4. Metabolic acidosis

Answer: B — pH 7.48 is alkalotic (above 7.45). PaCO2 of 38 is normal (35-45), so the respiratory system is not the primary cause. HCO3 of 32 is elevated (above 26), which causes alkalosis. This is metabolic alkalosis, commonly caused by vomiting, NG suction, or excessive antacid use.

Question 73: A patient has a serum sodium level of 118 mEq/L. The nurse should FIRST:

  1. Administer a normal saline bolus at a rapid rate
  2. Restrict dietary sodium intake
  3. Implement seizure precautions and notify the provider immediately
  4. Encourage the patient to drink more water

Answer: C — Sodium of 118 is critically low (severe hyponatremia; normal 135-145). Severe hyponatremia causes cerebral edema and can trigger seizures, coma, and death. Implement seizure precautions, perform a neurological assessment, notify the provider, and anticipate fluid restriction or cautious hypertonic saline administration.

Question 74: A patient with a history of peptic ulcer disease reports sudden severe abdominal pain that is rigid and board-like on palpation. The nurse should suspect:

  1. Perforated ulcer requiring emergency surgical intervention
  2. A normal flare-up that will resolve with antacids
  3. Constipation from opioid pain medications
  4. Gastroesophageal reflux exacerbation

Answer: A — A rigid, board-like abdomen with sudden severe pain indicates peritonitis from a perforated ulcer. This is a surgical emergency. Position the patient upright, start IV access, keep NPO, and notify the surgeon immediately.

Question 75: A patient is admitted with acute pancreatitis. Which nursing intervention is the PRIORITY?

  1. Administering pancreatic enzyme supplements with meals
  2. Maintaining NPO status, providing IV fluids, and managing pain
  3. Encouraging the patient to eat small frequent meals to maintain nutrition
  4. Positioning the patient flat on their back to reduce abdominal pressure

Answer: B — Acute pancreatitis requires pancreatic rest (NPO), aggressive IV hydration, and effective pain management. Position the patient in a side-lying or fetal position for comfort. Oral feeding worsens inflammation by stimulating pancreatic enzyme secretion.

Question 76: A patient with Addison disease is admitted with a blood pressure of 76/50 and serum sodium of 126 mEq/L. The nurse recognizes this as:

  1. Cushing syndrome with fluid retention
  2. A normal finding for patients with Addison disease
  3. Addisonian crisis requiring emergency IV corticosteroids and fluid resuscitation
  4. Diabetes insipidus with excessive fluid loss

Answer: C — Addisonian crisis (acute adrenal insufficiency) presents with severe hypotension, hyponatremia, hyperkalemia, and hypoglycemia. It is life-threatening and requires immediate IV hydrocortisone, normal saline fluid resuscitation, and vasopressors if needed.

Question 77: A nurse is caring for a patient who had a stroke 2 hours ago. The provider orders alteplase (tPA). The nurse knows this medication must be administered within:

  1. 12 hours of symptom onset
  2. 24 hours of symptom onset
  3. 4.5 hours of symptom onset for eligible ischemic stroke patients
  4. No time limit exists for tPA administration

Answer: C — Alteplase (tPA) is a thrombolytic that dissolves the clot causing ischemic stroke. It must be given within 4.5 hours of symptom onset to be effective. Beyond this window, the risk of hemorrhagic transformation outweighs the benefit.

Question 78: A nurse discovers that a medication error has occurred but no harm came to the patient. The nurse should:

  1. Complete an incident report and notify the provider and charge nurse
  2. Not report it since no harm occurred
  3. Wait to see if the patient develops symptoms before reporting
  4. Only tell the charge nurse verbally without written documentation

Answer: A — All medication errors must be reported regardless of whether harm occurred. Incident reports help identify system failures and prevent future errors. Near-miss reporting is essential for patient safety improvement and is not used for punitive action.

Question 79: A patient with limited English proficiency needs informed consent for a procedure. The nurse should:

  1. Have a bilingual family member translate the consent discussion
  2. Use a certified medical interpreter to ensure accurate communication
  3. Proceed with a signed consent form in English since the form is standard
  4. Use hand gestures and simple English to explain the procedure

Answer: B — Certified medical interpreters must be used for informed consent to ensure accurate and complete communication. Family members may omit information, lack medical vocabulary, or have conflicts of interest that compromise the consent process.

Question 80: A patient is scheduled for a lumbar puncture. Which position should the nurse assist the patient into?

  1. Prone with arms at the sides
  2. High Fowler sitting position with legs extended
  3. Supine with a pillow under the knees
  4. Lateral recumbent (side-lying) with knees drawn up to the chest and chin tucked

Answer: D — The lateral recumbent (fetal) position with knees drawn up and chin tucked maximally opens the intervertebral spaces for needle insertion during lumbar puncture. An alternative is sitting upright leaning over a bedside table. Post-procedure: keep flat to prevent spinal headache.

Question 81: A nurse is donning PPE to enter the room of a patient on airborne precautions for tuberculosis. Which type of respiratory protection is required?

  1. Standard surgical mask
  2. No respiratory protection is needed if the visit is brief
  3. Simple cloth face covering
  4. N95 respirator that has been fit-tested for the individual nurse

Answer: D — Airborne precautions for TB require an N95 respirator individually fit-tested to ensure a proper seal. Standard surgical masks do not filter the tiny airborne droplet nuclei that carry TB bacteria. The patient must be in a negative-pressure isolation room.

Question 82: Four patients ring their call lights simultaneously. Which patient should the nurse see FIRST?

  1. A patient reporting they feel like something is sitting on their chest and they cannot breathe
  2. A patient asking for assistance to the bathroom
  3. A patient wanting to know when their physician will visit
  4. A patient requesting pain medication for chronic back pain rated 6 out of 10

Answer: A — Feeling of chest pressure with dyspnea suggests a possible myocardial infarction or pulmonary embolism - both are life-threatening emergencies. ABCs (airway, breathing, circulation) always take priority over comfort and informational requests.

Question 83: A patient is started on an SSRI antidepressant. The nurse should teach the patient that:

  1. It typically takes 2 to 4 weeks to feel the full therapeutic effect, and they should not stop it abruptly
  2. The medication can be safely stopped at any time without side effects
  3. This medication is only for short-term use of 2 weeks maximum
  4. The medication works immediately and mood will improve today

Answer: A — SSRIs require 2 to 4 weeks to reach full therapeutic effect. Patients must not stop abruptly as this causes discontinuation syndrome (dizziness, nausea, anxiety, flu-like symptoms). Monitor closely for increased suicidal ideation in the first weeks, especially in young adults.

Question 84: A patient has the following lab result: troponin I level of 2.5 ng/mL (normal less than 0.04 ng/mL). Combined with chest pain and ST elevation on ECG, this indicates:

  1. Pulmonary embolism without cardiac involvement
  2. Acute myocardial infarction with cardiac muscle damage
  3. Gastroesophageal reflux mimicking cardiac symptoms
  4. Normal cardiac enzyme levels with atypical chest pain

Answer: B — Elevated troponin is the most specific biomarker for cardiac muscle damage. A troponin of 2.5 with chest pain and ST elevation confirms acute MI (STEMI). The patient needs emergent cardiac catheterization and reperfusion therapy.

Question 85: A nurse is assessing a newborn and notes yellow discoloration of the skin and sclera at 18 hours of life. This finding suggests:

  1. Dehydration from inadequate feeding
  2. Normal physiological jaundice that requires no intervention
  3. Pathological jaundice requiring immediate investigation and possible phototherapy
  4. A normal variation in skin pigmentation

Answer: C — Jaundice appearing within the first 24 hours of life is always considered pathological (not physiological, which appears after 24 hours). Causes include Rh or ABO blood type incompatibility and require immediate bilirubin level assessment, investigation, and likely phototherapy.

What your score means

85% or above — You’re exam ready!

You have a strong grasp of the NCLEX-RN content. Do one more full practice run the day before your exam to stay sharp. Review any client needs areas where you missed questions for final reinforcement.

70–84% — Almost there. Focus on your weak topics.

You’re close but not quite consistent enough. Use the topic-specific quizzes below to drill down on the areas where you lost points. Aim to score 85%+ before booking your real exam.

Below 70% — More study needed.

Don’t worry — that’s exactly why practice tests exist. Review our NCLEX-RN Study Guide for a complete topic breakdown, then work through each topic quiz individually before retaking this full test.

Premium prep
NCLEX-RN Ultimate Pack — 3500+ questions with answers and Explanations
NGN-style questions, flashcards, study guide, rationales, and full-length mock exams. Only $39.

Practice by topic

Scored low on a specific area? These focused quizzes let you drill down on each NCLEX-RN Client Needs category. Each has 25 questions with full rationales.

Safe & Effective Care
25 questions — 21–33% of exam
Health Promotion & Maintenance
25 questions — 6–12% of exam
Psychosocial Integrity
25 questions — 6–12% of exam
Physiological Adaptation
25 questions — 11–17% of exam
Pharmacology & Parenteral
25 questions — 12–18% of exam
Reduction of Risk Potential
25 questions — 9–15% of exam
Infection Control
25 questions
Prioritization & Delegation
25 questions
Medical-Surgical Nursing
25 questions
Maternal & Newborn
25 questions
Pediatric Nursing
25 questions
Mental Health Nursing
25 questions
Lab Values & Diagnostics
25 questions

How to get the most out of this test

Take it cold first

Don’t study beforehand. Your first score is your honest baseline — it shows you exactly where you stand right now. That information is more valuable than a boosted score.

Read every rationale

Even for questions you got right. NCLEX-RN uses clinical reasoning, not memorization. The rationale teaches you the nursing process and priority-setting logic behind each answer — exactly what the real CAT tests.

Write down every wrong answer

Keep a simple list: the client needs category, the question, and what you got wrong. This becomes your personal study checklist for targeted review.

Drill your weak topics

Use the topic-specific quizzes above to hammer the client needs categories where you lost the most points. Don’t waste time re-studying areas you already know well.

Retake after 3–5 days

Wait a few days, study your weak areas using the cheat sheets and topic quizzes, then take this full test again. When you consistently score 85% or higher, you’re ready for the real NCLEX-RN.

Quick Reference Cheat Sheets

High-yield facts you must know cold for the NCLEX-RN. Bookmark this section and review before your exam day.

Critical Lab Values
Must Memorize
Lab TestNormal RangeCritical Flag
Sodium (Na⁺)136–145 mEq/L<120 or >160
Potassium (K⁺)3.5–5.0 mEq/L<2.5 or >6.5
Glucose (fasting)70–100 mg/dL<40 or >500
Hemoglobin (adult ♀)12–16 g/dL<7 g/dL
Hemoglobin (adult ♂)14–18 g/dL<7 g/dL
Hematocrit37–52%<21% or >65%
Platelets150,000–400,000<50,000
INR (therapeutic)2.0–3.0>4.0
pH (arterial)7.35–7.45<7.20 or >7.60
pO₂80–100 mmHg<60 mmHg
pCO₂35–45 mmHg<20 or >70
Creatinine0.6–1.2 mg/dL>10 mg/dL
ABG Interpretation (ROME)
Step-by-Step
ConditionpHpCO₂HCO₃
Resp. Acidosis↓ <7.35↑ >45Normal
Resp. Alkalosis↑ >7.45↓ <35Normal
Metab. Acidosis↓ <7.35Normal↓ <22
Metab. Alkalosis↑ >7.45Normal↑ >26
ROME Mnemonic
Respiratory Opposite — pH & pCO₂ move in opposite directions
Metabolic Equal — pH & HCO₃ move in the same direction
Prioritization Framework
High Yield
Maslow’s Hierarchy (lowest # = highest priority)
  • 1. Physiological — airway, breathing, circulation, pain, nutrition
  • 2. Safety & Security — fall prevention, infection control, abuse
  • 3. Love & Belonging — family, social support
  • 4. Esteem — dignity, body image, independence
  • 5. Self-Actualization — growth, spirituality
ABC Rule for Airway Priority
Airway → Breathing → Circulation. Always address the airway first unless circulation is the only issue (e.g., cardiac arrest → CAB).
Five Rights of Delegation
Delegation
  • Right Task — Within the delegate’s scope of practice
  • Right Circumstance — Appropriate setting & resources available
  • Right Person — Correct licensure & competency for the task
  • Right Direction — Clear, concise instructions given
  • Right Supervision — RN monitors & evaluates outcomes
RN Cannot Delegate:
Assessment, nursing diagnosis, care planning, evaluation, patient teaching, initial IV push meds, unstable patients.
Isolation Precautions
Infection Control
TypePPE RequiredKey Diseases
ContactGloves + GownC. diff, MRSA, VRE, wounds
DropletSurgical maskInfluenza, pertussis, mumps, meningitis
AirborneN95 + neg. pressure roomTB, measles, varicella, COVID-19
ProtectiveGown + gloves + maskNeutropenia, immunocompromised
Mnemonic: My Chicken Has TB
Measles · Chickenpox (varicella) · Herpes zoster (disseminated) · TB → Airborne precautions
NGN Question Strategy
Test Strategy
  • SATA: Treat each option as True/False independently — don’t look for patterns
  • Priority questions: Use ABC then Maslow. Acute > Chronic. Unstable > Stable.
  • Delegation: RNs handle assessments & unstable patients. UAP handles routine tasks on stable patients.
  • “First action” Qs: Always assess before intervening — unless immediate life threat exists
  • NGN bowtie/matrix: Read all findings first, identify the most urgent concern, then select conditions & actions
  • Eliminate clearly wrong answers first, then choose most therapeutic / least restrictive option
Study guide
NCLEX-RN Study Guide — Master Every Client Needs Category
Category-by-category breakdown with key concepts, NGN strategies, and exam tips.

Frequently asked questions

Is this NCLEX-RN practice test really free?
Yes, completely free. All 75 questions with detailed answer rationales are available with no signup, no email, and no payment required. You can retake it as many times as you want.
How similar are these questions to the real NCLEX-RN?
Our questions are written to reflect the Next Generation NCLEX (NGN) format and cover the same client needs categories with the same approximate weightings as the actual exam. The clinical reasoning style, difficulty level, and question formats (including SATA and scenario-based items) are designed to closely match what you’ll see on test day.
How many questions are on the real NCLEX-RN?
With the Next Generation NCLEX (NGN) format, the exam delivers a minimum of 75 and a maximum of 145 questions using Computerized Adaptive Testing (CAT). The exam stops when the computer determines with 95% confidence whether you are above or below passing competency. The number of questions you receive does not indicate a pass or fail outcome.
What score should I aim for before taking the real exam?
We recommend scoring 85% or higher consistently across multiple practice sessions. The actual NCLEX-RN uses adaptive pass/fail logic rather than a percentage cutoff, but consistently scoring 85%+ on practice tests is a reliable signal that your clinical reasoning is at or above the required competency level.
What’s the difference between the free quiz and the Ultimate NCLEX-RN Pack?
The free quiz gives you 75 questions covering all NCLEX-RN client needs categories. The Ultimate NCLEX-RN Pack ($39) includes 1,000+ NGN-style questions organized by topic, printable flashcards, a 6-week study schedule, a night-before-exam cheat sheet, and a pass guarantee.
Do I need to create an account to take this test?
No. Click start and begin immediately. No account, no email, no signup required. We believe practice should be accessible to everyone preparing for licensure.
I failed the NCLEX-RN. Can this help me pass on my retake?
Absolutely. Start by taking this full practice test to identify your current weak client needs areas. Then use our topic-specific quizzes to focus your study time where it matters most. Many repeat test-takers used ExamKrush to pinpoint exactly which areas cost them points — and passed on their retake.

NCLEX-RN exam resources

Complete guide
NCLEX-RN Exam: Everything You Need to Know [2026]
NGN format, registration, costs, eligibility, and what to expect on test day.
6-week plan
NCLEX-RN Study Schedule — Week-by-Week Plan
A structured 6-week plan covering every client needs category. Also available as a free printable PDF.
Cost breakdown
NCLEX-RN Exam Cost by State [2026]
Registration fees, Pearson VUE costs, ATT timing, and total investment broken down by state.

Get your free NCLEX-RN study schedule

A day-by-day 6-week plan that tells you exactly what to study and when. Built around the NGN client needs categories. Used by 8,000+ ExamKrush students.

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