NCLEX-PN Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

"Your children are grown now. You don't need to pick them up.": Reality orientation in moderate dementia often causes distress and arguments because the resident cannot hold on to the correction.

"You can't leave. The door is locked for your safety.": This is true but blocks her feelings and is likely to increase agitation.

"Tell me about your children. Let's sit and have a snack.": Correct. Validation responds to the feeling behind the words (her need to care for her children). Then redirection to a calm activity eases late-day agitation without argument.

"Wait here while I call the school for you.": This is a deception that feeds the false belief and may lead to more distress when no call comes.

In moderate to late dementia, validate the emotion and redirect rather than correct. Late-afternoon agitation (sundowning) also responds to routine, light and calm activity.

Answer: D

"That is a kind gift. Your roommate will treasure it.": This praises the act and misses the warning sign. Giving away valued items with a statement about not needing them is a classic cue of suicide planning.

"You'll be home soon. Things will look better then.": False reassurance closes the conversation and tells the client the nurse does not want to hear their feelings.

"Why would you give away something so special?": "Why" questions can sound judgmental and make clients defensive. It also avoids asking directly about suicide.

"Are you thinking about killing yourself?": Correct. Asking directly and clearly about suicide does not plant the idea. It shows the nurse takes the client seriously and gathers the data needed. The nurse stays with the client and reports to the RN right away.

Withdrawal plus giving away possessions and hinting at not being around are suicide warning signs. Ask directly, keep the client safe, and report immediately.

Answer: A, C, D, F

Turn and reposition the resident at least every 2 hours: Correct. Regular repositioning shifts pressure off bony areas before tissue damage starts.

Massage reddened areas over bony prominences: Incorrect. Massaging reddened skin over bones can damage fragile tissue and small blood vessels. Red areas are relieved of pressure, not massaged.

Keep the head of the bed at 30 degrees or lower when possible: Correct. A higher head of the bed makes the resident slide down, which causes shear at the sacrum. Keeping it at 30 degrees or less, unless contraindicated, reduces shear.

Use a lift sheet to move the resident up in bed: Correct. Lifting with a sheet instead of dragging prevents friction and shear on the skin.

Seat the resident on a ring-shaped (donut) cushion: Incorrect. Ring cushions press on the tissue around the opening and reduce blood flow to the center. They are not recommended.

Place a pillow between the knees when the resident is side-lying: Correct. A pillow keeps the bony knees and ankles from pressing against each other.

Pressure injury prevention: relieve pressure (turning, padding), reduce shear and friction (low head of bed, lift sheet), and avoid massage and ring cushions.

Answer: 100 mL/hr

1. The pump rate uses volume and time only; the 750 mg dose is not needed.
2. Set up dimensional analysis: (150 mL / 90 min) × (60 min / 1 hr).
3. Cancel minutes: (150 × 60) ÷ 90 = 9,000 ÷ 90 = 100 mL/hr.
4. Check: 90 minutes is 1.5 hours, and 150 mL ÷ 1.5 hr = 100 mL/hr. A common error is dividing 150 by 90 and entering 1.7 mL/hr, which is mL per minute.

Pump rate (mL/hr) = total volume ÷ time in hours; convert minutes to hours by multiplying by 60 min/hr.

Answer: (1) transfusion-associated circulatory overload, (2) stop the transfusion and keep the IV line open with 0.9% sodium chloride, (3) raise the head of the bed and report to the RN and provider

Rising BP, heart rate and breathing rate with crackles and falling SpO2 but a stable temperature during a transfusion point to circulatory overload. Stop the transfusion, keep the line open with saline, sit the client up and report.

Answer: Condition: Digoxin toxicity · Actions: Hold the 0900 digoxin dose + Report the findings and digoxin level to the provider · Monitor: Serum digoxin level + Apical heart rate and rhythm

Gastrointestinal upset, visual changes, confusion and bradycardia in an older adult taking digoxin, especially with declining kidney function, point to toxicity. Hold the dose, report to the provider, and monitor the apical pulse and serum level.

Answer: A, B, C

Give 120 mL (4 oz) of fruit juice now: Correct. The client is awake and swallows without coughing, so the protocol calls for 15 g of fast-acting oral carbohydrate. Four ounces of juice gives about 15 g and is absorbed quickly.

Recheck the point-of-care glucose 15 minutes after the juice: Correct. The "rule of 15" requires a recheck in 15 minutes. If glucose is still below 70 mg/dL, the treatment is repeated. This client's sulfonylurea and kidney disease make a repeat low likely.

Report the glucose results to the RN and provider and ask about the 0730 glipizide dose: Correct. The protocol requires notifying the provider of every glucose below 70 mg/dL. Giving more glipizide could cause another low, so the nurse questions the dose instead of giving it routinely. Changing the order is the provider's decision.

Give glucagon 1 mg IM now: Incorrect. Glucagon is for a client who cannot swallow safely or is unresponsive. This client can swallow, so oral carbohydrate is faster, safer and causes less nausea.

Prepare to give dextrose 50% 25 mL IV push: Incorrect. IV dextrose is for a client who cannot take oral carbohydrate. IV push medication is also outside PN scope; the protocol assigns it to the RN.

Give 8 oz of whole milk with peanut butter crackers as the first treatment: Incorrect. Fat and protein slow how fast sugar is absorbed, so this snack raises glucose too slowly for the first treatment. A carbohydrate-plus-protein snack is used after glucose is back above 70 mg/dL when the next meal is more than 1 hour away.

Keep the client NPO until the 0730 breakfast tray arrives: Incorrect. Withholding food leaves a confused client hypoglycemic for over an hour and risks seizures. Treatment is needed now.

Ask the AP to recheck the client's glucose in 1 hour: Incorrect. One hour is too long to wait; the protocol recheck is at 15 minutes. Deciding whether treatment worked is the nurse's responsibility and should not be left to the AP.

For a conscious client who can swallow: 15 g fast-acting carbohydrate, recheck in 15 minutes, repeat as needed, then report. Glucagon and IV dextrose are for clients who cannot swallow, and IV push is outside PN scope.

Answer: "used his albuterol inhaler about every 2 hours since yesterday", "changed from white to thick yellow-green, and he is coughing up more of it than usual", "speaking in 4- to 5-word phrases", "Using neck and shoulder muscles with each breath", "Expiratory wheezes in all lung fields", "SpO2 87% on oxygen 2 L/min by nasal cannula"

1. 'Used his albuterol inhaler about every 2 hours since yesterday' — requires follow-up. The order allows a dose every 4 hours as needed. Needing the rescue inhaler twice as often as prescribed means the airways are narrowing and the usual treatment is no longer controlling symptoms. Frequent albuterol also adds tachycardia and tremor.
2. 'Changed from white to thick yellow-green, and he is coughing up more of it than usual' — requires follow-up. A change in sputum color and an increase in amount are two of the main signs of a COPD exacerbation, and purulent sputum suggests a bacterial infection. The orders list any change in sputum as a reason to notify.
3. 'Speaking in 4- to 5-word phrases' — requires follow-up. At baseline he speaks in full sentences. Shorter phrases show that he is more breathless at rest.
4. 'Using neck and shoulder muscles with each breath' — requires follow-up. Accessory muscle use is new and shows increased work of breathing. A client who tires from this work can progress to respiratory failure.
5. 'Expiratory wheezes in all lung fields' — requires follow-up. His baseline has no wheezes. New, widespread wheezing means bronchospasm and narrowed airways.
6. 'SpO2 87% on oxygen 2 L/min by nasal cannula' — requires follow-up. This is below his prescribed target of 88–92% and below his baseline of 89–91% on the same flow, so it meets the order's notification criteria.
7. Not keyed: Pursed-lip breathing is a technique he learned in pulmonary rehabilitation and uses at baseline; it helps keep the airways open. A barrel-shaped chest is a long-term change from air trapping in COPD. Being alert and oriented, eating his usual breakfast and a working concentrator with intact tubing are all expected and reassuring. New confusion or drowsiness, by contrast, would suggest carbon dioxide retention.
8. Not selectable: the wife's report of a cold last week is history about another person, not a finding about the client, so it is not something the nurse follows up on in this visit. It becomes a cue when the nurse analyzes possible causes of the exacerbation in the next item.

Compare every finding with the client's own baseline. In COPD, increased dyspnea, more sputum, purulent sputum and more frequent rescue-inhaler use signal an exacerbation. An SpO2 below the client's prescribed target needs follow-up and reporting, while long-term changes such as a barrel chest do not.

Answer: "Resident is pulling at her gown and calling for her late husband; oriented to person only (her baseline is person and place).", "Drifts off mid-sentence and cannot keep her attention on simple questions.", "Temperature 38.3 °C (100.9 °F), heart rate 104/min, respiratory rate 22/min.", "Blood pressure 108/62 mm Hg (usually 130s/70s).", "Voided 120 mL of cloudy, foul-smelling urine since 0600."

1. Keyed — pulling at her gown, calling for her late husband and oriented to person only: an acute drop from her baseline (person and place at 2200 last night). A sudden change in cognition in an older adult is never "just the dementia" and must be reported.
2. Keyed — drifting off mid-sentence and unable to focus: inattention that began within hours is the core feature of delirium. Alzheimer disease alone changes slowly over months and leaves attention fairly intact in the mild-to-moderate stage.
3. Keyed — temperature 38.3 °C (100.9 °F), HR 104/min, RR 22/min: fever with tachycardia and tachypnea is a systemic response to infection. RR 22/min or more plus altered mental status meets 2 quick sepsis screening (qSOFA) criteria. The fever also meets the standing notify-provider order.
4. Keyed — BP 108/62 mm Hg against her usual 130s/70s: a downward trend while the heart rate climbs suggests early loss of circulating volume or vasodilation from sepsis, even though the value is not yet hypotensive.
5. Keyed — 120 mL of cloudy, foul-smelling urine in 4 hours (about 30 mL/h, roughly 0.5 mL/kg/h for 58 kg): signs of a urinary tract infection plus low output that suggests dehydration. Both need to be reported with the positive dipstick.
6. Not keyed — glasses and hearing aids in place, SpO2 95% with clear lungs, intact skin, her usual walking ability and a low bed with the call light in reach are normal findings or safety measures already in place.

An acute change from a resident's own baseline (new confusion with inattention, fever, rising heart and respiratory rates, a falling blood pressure and low, cloudy urine output) needs follow-up and a report. Findings that match her baseline do not.

Answer: A

Hypokalemia: Correct. Furosemide is a loop diuretic that causes potassium loss in the urine. Muscle cramps, weakness, an irregular pulse, flattened T waves and U waves are classic signs of a low potassium level. The nurse reports the findings to the RN or primary health care provider.

Hyperkalemia: High potassium causes tall, peaked T waves, not flat T waves with U waves. A loop diuretic lowers potassium rather than raising it.

Hypocalcemia: Low calcium can cause muscle cramps, but it is linked to tingling, positive Chvostek and Trousseau signs and a long QT interval. U waves point to low potassium.

Hypernatremia: High sodium causes thirst, dry mucous membranes, restlessness and confusion. It does not produce U waves or flat T waves.

Loop diuretic + cramps + weakness + flat T waves and U waves = hypokalemia. Report it promptly because it can cause dangerous dysrhythmias.