NCLEX-RN Practice Tests 2026

Delegation, consent and priorities — the reasoning layer of the RN exam.

• A competent adult client refuses a prescribed blood transfusion for religious reasons. What should the nurse do first?

  Notify the provider and document the refusalAsk the family to change the client's mindHang the unit because it was already ordered

• Which task is appropriate to assign to a float nurse from another unit?

  A stable post-operative client awaiting dischargeA client on an insulin infusion with hourly glucose checksA client just admitted with unexplained chest pain

• Before a client signs an operative consent form, the nurse's role is to:

  Verify the client understands and witness the signatureExplain the surgical risks to the clientObtain the signature without the provider present

Precautions, PPE and error prevention — high-yield on every form.

• A client has Clostridioides difficile. Which protective equipment and hand hygiene method are correct?

  Gown and gloves, with soap-and-water handwashingN95 respirator with alcohol-based rubSurgical mask and sterile gloves

• Which client requires airborne precautions?

  MeaslesMRSA wound infectionRotavirus diarrhea

• A nurse sustains a needlestick injury. What is the correct first action?

  Wash the site with soap and water, then report per policyCover it with a bandage and finish the shiftSqueeze the site forcefully to express blood

Rapid-fire med safety checks you should answer without hesitating.

• Before giving digoxin, the nurse checks the apical pulse for one full minute. The nurse holds the dose and notifies the provider when the rate is:

  58/min in an adult76/min in an adult98/min in an adult

• Which instruction is priority for a client starting metformin?

  Tell the provider before scans that use contrast dyeTake the dose only at bedtimeStop the drug if the mouth feels dry

• A client taking lisinopril develops lip and tongue swelling. What should the nurse do first?

  Stop the drug and notify the provider immediatelyOffer warm tea and reassess in an hourDocument the finding and continue the medication

Lab values and complications — know which number to report first.

• A client on furosemide has the following morning labs. Which value should the nurse report first?

  Potassium 2.9 mEq/LSodium 137 mEq/LGlucose 110 mg/dL

• Two hours after a thoracentesis, a client has sudden dyspnea and asymmetrical chest movement. The nurse suspects:

  PneumothoraxAnxietyMuscle soreness

• Before a client goes for a bronchoscopy, the nurse verifies:

  NPO status and the signed consentOnly the most recent blood pressureThat breakfast was served early

Emergency positions and first actions — the reflexes NCLEX loves.

• The best position for a client in hypovolemic shock is:

  Supine with legs elevatedHigh Fowler'sProne with head flat

• A client suddenly becomes dyspneic while a central line is infusing. The nurse suspects an air embolism and should:

  Clamp the tubing and place the client on the left side, head downSit the client upright and slow the infusionRemove the line and apply a loose dressing

• Priority teaching for a client learning colostomy care:

  Empty the pouch when it is one-third to one-half fullReplace the whole pouching system every dayLimit fluids to keep output low

Prevention and screening facts every candidate should carry in.

• Which immunizations should the nurse encourage for a healthy 68-year-old?

  Annual influenza and shingles vaccineA yearly MMR boosterThe BCG vaccine annually

• Priority home teaching to prevent falls for an older adult:

  Remove loose rugs and add night lightingWear socks without slippers on tile floorsKeep nightstands far from the bed for exercise

• A teen says exams and sports feel overwhelming. The best first suggestion is:

  Regular activity, sleep and slow breathing exercisesEnergy drinks to stay focusedSkipping meals to save study time

Therapeutic communication in one breath — answer, then explain.

• A client newly diagnosed with cancer says, "I feel fine. The tests must be wrong." The nurse recognizes this as:

  DenialProjectionSublimation

• A client with schizophrenia says, "The voices tell me to hurt myself." The nurse's priority is to:

  Ask directly whether the client plans to self-harmIgnore the statement to avoid reinforcing itRedirect to a card game

• The best response to a frightened preoperative client is:

  "Tell me more about what is worrying you.""Don't worry — everything will be fine.""The surgeon does hundreds of these."

Daily-care essentials — mobility, skin, nutrition, swallowing.

• When repositioning an immobile client every two hours, the nurse should:

  Follow a turn schedule and inspect the skin each timeMassage reddened bony areas to restore circulationApply powder and extra layers under the client

• Which food choice is highest in fiber for a client with constipation?

  An apple with the skin onWhite ricePlain yogurt

• For a client with dysphagia, the priority during meals is:

  Upright positioning and thickened liquids as orderedOffering a straw to speed intakeEncouraging conversation during eating

The PN-specific rule the exam rewards: collect data, escalate, don't exceed scope.

• Which task can the PN delegate to an assistive personnel?

  Vital signs on a stable clientTeaching a client about insulin injectionsAssessing new lung sounds

• A PN is caring for a client on a continuous heparin infusion. Which action is within PN scope?

  Report an aPTT outside the expected range to the RNIncrease the rate when the aPTT comes back lowDiscontinue the infusion independently

• The PN receives an order that appears to exceed their scope. The first action is:

  Notify the supervising RN before proceedingCarry out the order because it is writtenAsk the unlicensed assistant to do it

Who do you see first? Three-second reflexes for exam day.

• Four clients call at once. Who does the RN see first?

  New shortness of breath with an oxygen saturation of 88%A request for pain medication rated 3/10A routine dressing change due now

• Which client should the nurse assess first at shift start?

  Chest pain radiating to the jaw, started 10 minutes agoA scheduled discharge at noonA client waiting for breakfast

• The fire alarm sounds. Following RACE, the nurse's first step is to:

  Rescue any client in immediate dangerActivate the alarm pull stationGrab the nearest fire extinguisher