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

Answer: A, B, C

Help a client walk in the hall on day 3 after knee replacement who has already walked with physical therapy: Correct. The client is stable and has already been evaluated walking with therapy, so routine ambulation is delegable.

Measure and record intake and output: Correct. Measuring and recording I&O is a standardized task. The RN interprets the totals.

Reposition an immobile, stable client every 2 hours: Correct. Turning and positioning a stable client is basic care within UAP training.

Assess a client's surgical incision for signs of infection: Incorrect. Assessment requires clinical judgment and cannot be delegated to a UAP.

Teach a client how to use crutches on the stairs: Incorrect. Teaching and checking that the client can safely perform a new skill is an RN (or physical therapy) responsibility.

Check whether a client's pain is relieved after an oral opioid: Incorrect. Evaluating a client's response to medication requires judgment and stays with the licensed nurse.

Delegate routine care of stable clients (ambulation, I&O, repositioning); keep assessment, teaching and evaluation with the RN. Scoring: +1 for each correct choice, −1 for each incorrect choice.

Answer: C

"Please come now; may I give acetaminophen and increase the IV to 100 mL/h?": Asking for a bedside evaluation is right, but the orders requested do not match the assessment. Acetaminophen treats only the fever, and a 25 mL/h rate increase is not fluid resuscitation for a BP of 90/56 mm Hg. Cultures and lactate are not requested.

"May I draw blood cultures and a lactate now and call you with the results?": Cultures and lactate are appropriate, but this delays treatment of the hypotension and oliguria until results return and does not ask the provider to evaluate a deteriorating client at the bedside.

"Please come now; may I draw cultures and lactate and give a fluid bolus?": Correct. The cues (fever, HR 118, BP 90/56, RR 24, new confusion, oliguria) fit possible sepsis. An effective recommendation asks for prompt bedside evaluation and for orders matching early sepsis care: blood cultures and lactate first, then IV fluid resuscitation for the hypotension, with antibiotics to follow once cultures are drawn.

"Please come now; may I start an IV antibiotic and draw cultures after it?": Antibiotics are part of early sepsis care, but blood cultures should be drawn before the first dose because antibiotics can sterilize the cultures. This request also does nothing for the hypotension and low urine output.

In SBAR the recommendation states clearly what the nurse needs (bedside evaluation, specific orders) and how urgently, matched to the assessment the nurse reported. For suspected sepsis with hypotension: cultures and lactate before antibiotics, plus a fluid bolus.

Answer: A

Center of the drape on the tabletop: Correct. Only the part of the field that is at or above table (waist) level and inside the outer 1-inch border is considered sterile, so sterile items are placed in the center.

Outer 1-inch border of the drape on the tabletop: The outer 1-inch (2.5 cm) border is considered contaminated because it touches or lies close to the nonsterile surface and is handled when the drape is opened.

Drape hanging below the edge of the table: Anything below the level of the tabletop (waist level) is out of the nurse's direct view and is considered nonsterile, even though the drape itself was sterile.

On a sterile field, only the surface at table level inside the 1-inch border is sterile; the edges and anything below the tabletop are not.

Answer: C

A victim who is walking around the scene holding a deformed forearm: In START, any victim who can walk is tagged minor (green) at the first step, however painful the injury looks. An isolated forearm fracture can wait.

A victim who does not breathe even after the airway is repositioned: A victim who stays apneic after the airway is repositioned is tagged expectant or deceased (black). In a mass-casualty event, resources go to victims who can be saved.

A victim who cannot walk, breathes 18/min and has a capillary refill of 4 seconds: Correct. The respirations are under 30/min, but a capillary refill longer than 2 seconds (or no radial pulse) signals poor perfusion and possible shock. That meets START criteria for immediate (red) care, such as hemorrhage control.

A victim who cannot walk, breathes 24/min, has a radial pulse and follows commands: This victim cannot walk, but breathing is under 30/min, perfusion is adequate and mental status is intact. That makes the victim delayed (yellow): serious but able to wait briefly.

START sorts by walking, then respirations (absent or over 30/min), perfusion (capillary refill over 2 seconds or no radial pulse) and mental status. Any failed check in a breathing victim means an immediate (red) tag.

Answer: C

Just below the xiphoid process: The fundus reaches its highest point near the xiphoid at about 36 weeks; at 16 weeks this would mean a uterus much larger than dates (e.g. multiple gestation, polyhydramnios or wrong dates).

At the level of the umbilicus: The fundus reaches the umbilicus at about 20 weeks. Finding it there at 16 weeks would be larger than expected for dates.

Midway between the symphysis pubis and the umbilicus: Correct. The fundus rises out of the pelvis at about 12 weeks, is about midway between the symphysis pubis and the umbilicus at 16 weeks, and reaches the umbilicus at 20 weeks.

Just above the symphysis pubis: The fundus first becomes palpable just above the symphysis at about 12 weeks; at 16 weeks this would be smaller than expected and would need follow-up.

Fundal landmarks: just above the symphysis at about 12 weeks, midway to the umbilicus at about 16 weeks, at the umbilicus at about 20 weeks, then roughly 1 cm per week to the xiphoid at about 36 weeks.

Answer: C

Tell the client it is good to see the medication working.: This assumes the change is improvement. A sudden lift in mood together with giving away valued possessions can mean the client has made a decision to die. Praising it closes off the conversation the nurse needs to have.

Notify the provider that the sertraline dose may need adjusting.: The concern is immediate safety, not the dose. The nurse must first assess suicide risk; the provider is then notified with the assessment findings.

Ask the client directly whether they are thinking of suicide.: Correct. Antidepressants can restore energy before mood fully improves, and a sudden calm with giving away possessions are warning signs. Asking directly about suicidal thoughts, plan, means and timing does not increase risk and decides what level of precautions is needed.

Move the client to a room closer to the nurses' station.: Room location alone does not address the risk, and changing it before assessing skips the step that sets the right precautions (for example one-to-one observation if a plan is present).

A sudden calm, giving away possessions and the early weeks of antidepressant therapy are suicide red flags; the first step is to ask directly about suicidal thoughts and a plan.

Answer: C

Check the gastric residual volume: Residual volume may help explain the event later, but checking it while formula is still running delays protecting the airway.

Auscultate the lungs for crackles: Lung assessment is needed, but in a likely aspiration the first step is to stop any more formula from entering the airway.

Stop the tube feeding infusion: Correct. Sudden coughing and falling SpO2 during a feeding suggest aspiration or a displaced tube. Stopping the infusion right away keeps more formula out of the airway. Then the nurse raises the head of the bed, suctions as needed, assesses and notifies the provider.

Request a prescription for a chest x-ray: An x-ray may be needed to check tube position or aspiration, but it does not stop the ongoing harm. Airway protection comes first.

When signs of aspiration appear during an enteral feeding, stop the feeding first, then protect the airway and assess.

Answer: 9.8 mL

1. Convert weight to kilograms: 46 lb ÷ 2.2 lb/kg = 20.909… kg (do not round yet).
2. Find the dose in mg: 20.909… kg × 15 mg/kg = 313.636… mg.
3. Convert mg to mL: 313.636… mg × (5 mL / 160 mg) = 9.801… mL.
4. Round at the end to one decimal place: 9.8 mL.
5. Check by dimensional analysis in one line: 46 lb × (1 kg/2.2 lb) × (15 mg/kg) × (5 mL/160 mg) = 9.80 mL. Common errors: using 46 as kilograms (21.6 mL) or forgetting the 5 mL volume (2.0 mL).

For weight-based doses, convert lb to kg (÷ 2.2), multiply by the mg/kg order, then convert mg to mL with the concentration. Round only once, at the end.

Answer: D

Prepare to administer protamine sulfate as an antidote.: Protamine reverses heparin's anticoagulant effect when the problem is bleeding. This client has a clotting problem. Reversing anticoagulation would not treat the immune reaction and could make thrombosis worse.

Request a prescription to change to subcutaneous enoxaparin.: Low-molecular-weight heparin cross-reacts with the heparin antibodies that cause HIT, so it is contraindicated. A non-heparin anticoagulant such as argatroban is used instead.

Anticipate a platelet transfusion to correct the low count.: In HIT the low count comes from platelet activation and clot formation, not from bleeding. Transfused platelets can feed more thrombosis, so platelets are generally avoided unless the client is actively bleeding.

Stop the heparin infusion and notify the health care provider.: Correct. A platelet drop of more than 50% after 5–10 days of heparin, plus a new arterial clot in the left foot, points to heparin-induced thrombocytopenia (HIT). All heparin must stop, including flushes, and the provider must be notified to start a non-heparin anticoagulant.

HIT is an immune reaction that causes clotting, not bleeding. Stop all heparin, avoid low-molecular-weight heparin and platelet transfusion, and expect a direct thrombin inhibitor.

Answer: "Client is restless and oriented to person only; spouse states the client was fully oriented at 2200.", "Respirations 26/min and shallow; SpO2 90% on 2 L/min nasal cannula.", "BP 88/50 mm Hg, HR 118/min.", "Voided 80 mL of dark amber urine, the only void since 2130."

1. Keyed — new restlessness and disorientation: an acute change from full orientation at 2200. In an older adult with infection, acute confusion signals cerebral hypoperfusion or hypoxemia and is one of the qSOFA criteria for sepsis.
2. Keyed — RR 26/min, shallow, with SpO2 90% on 2 L/min: tachypnea (22/min or more is a qSOFA criterion) plus falling oxygenation despite oxygen means gas exchange is worsening. Airway and breathing come first.
3. Keyed — BP 88/50 mm Hg (MAP about 63 mm Hg) with HR 118/min: BP has fallen from 132/78 on admission. Hypotension with tachycardia points to sepsis-induced hypoperfusion, and SBP below 90 mm Hg meets the notify-provider order.
4. Keyed — 80 mL of dark urine in about 6.5 hours (about 12 mL/h): far below 0.5 mL/kg/h (36 mL/h for 72 kg). Oliguria is a sign of poor kidney perfusion, an organ-dysfunction cue.
5. Not keyed — chills, rust-colored sputum and unchanged right lower lobe crackles are expected findings of the pneumonia already being treated. Active bowel sounds, a clean IV site and a safe bed position are normal or expected.

Acute changes from baseline (new confusion, tachypnea with falling SpO2, hypotension and oliguria) need immediate follow-up. Findings that are expected and unchanged for the known diagnosis do not.

Answer: B

Give the prescribed PRN oral analgesic: The headache comes from a dangerous rise in blood pressure. An analgesic does not lower it and delays the action that does.

Sit the client upright in bed: Correct. These findings show autonomic dysreflexia, which can cause stroke or seizures. Sitting the client upright (with the legs lowered if possible) pools blood in the lower body and lowers blood pressure quickly. Next, the nurse loosens tight clothing and looks for the trigger.

Check the bladder for distention: A full bladder is the most common trigger, and it is checked right after the client is sat up. Positioning lowers the pressure first, in seconds.

Call the provider to report the findings: The provider must be told, but the nurse can act right away to lower blood pressure. Calling first delays treatment of an emergency.

Autonomic dysreflexia (injury at T6 or above): sit the client up first, then find and remove the trigger (bladder, bowel, skin), and give antihypertensives if the pressure stays high.

Answer: Heart rate: Worsening; Blood pressure: Worsening; Urine output: Worsening; Capillary refill: Worsening; Mental status: Worsening; Temperature: Unchanged; Pain score: Improving

Rising heart rate, narrowing pulse pressure, falling urine output, slower capillary refill and new restlessness together trace progression from compensated to progressive hypovolemic shock; the 4-g/dL hemoglobin drop suggests surgical bleeding that needs immediate escalation.

Answer: Condition: Pulmonary embolism · Actions: Raise the head of the bed to 45 degrees, keeping hip flexion under 90 degrees + Apply oxygen and titrate to keep SpO2 at or above 92% · Monitor: Oxygen saturation + Respiratory rate and work of breathing

Sudden dyspnea, pleuritic pain, tachycardia and hypoxemia after orthopedic surgery with calf signs of DVT indicate pulmonary embolism. Support oxygenation first (head of bed raised within hip precautions, oxygen) and track SpO2 and respiratory effort.

Answer: (1) hypovolemic shock, (2) heart rate 124/min, BP 96/58 mm Hg and capillary refill 4 seconds, (3) hypokalemia, (4) moves potassium from the blood into the cells

In DKA, restore circulating volume first. Then expect potassium to fall once insulin starts, because the normal or high initial potassium hides a total body deficit. Scoring: 1 point for each correct drop-down.

Answer: "only 1 wet diaper since 2200 last night", "difficult to keep awake", "Capillary refill 4 seconds", "hands and feet cool and mottled", "Weight 11.0 kg; weight was 12.0 kg at a clinic visit 10 days ago"

1. 'Only 1 wet diaper since 2200 last night' — about 12 hours with a single void is oliguria. A toddler normally wets a diaper every 3–4 hours; the kidneys are conserving water because circulating volume is low. Requires follow-up.
2. 'Difficult to keep awake' — lethargy means the brain is not being perfused well. It is a sign of severe dehydration and early shock in a child. Requires immediate follow-up.
3. 'Capillary refill 4 seconds' — normal is 2 seconds or less. A delay longer than 3 seconds shows peripheral vasoconstriction from low circulating volume. Requires immediate follow-up.
4. 'Hands and feet cool and mottled' — the body is shunting blood away from the skin to protect the heart and brain. Together with the delayed capillary refill, this points to compensated hypovolemic shock.
5. 'Weight 11.0 kg; was 12.0 kg 10 days ago' — a 1 kg loss is about 8% of body weight in a few days. Acute weight loss is the most reliable estimate of fluid loss, and more than 6–9% means moderate to severe dehydration.
6. Not keyed: 'offering apple juice and a sports drink' needs caregiver teaching later (these drinks are high in sugar and low in sodium), but it is not a physiological finding that needs immediate follow-up. Clear lungs and a soft abdomen with hyperactive bowel sounds are expected with gastroenteritis. Mild diaper erythema needs routine skin care only. The ill sibling helps explain the source and guides isolation, but it is not a sign of the child's instability.

In a child, lethargy, capillary refill longer than 3 seconds, cool mottled extremities, oliguria and acute weight loss of more than 6% signal severe dehydration with compensated shock. Blood pressure stays normal until late, so these perfusion cues need immediate action.