Updated July 25, 2025
Written by Dr. Cassandra Monroe, DNP, RN, CNE
Studying for the NCLEX-RN® is a marathon, not a sprint. While mastering content is essential, the real power lies in practice. The more you engage with exam-style questions, the more confident and clinically sharp you'll become. To help you prepare, we’ve compiled 50 high-yield NCLEX-RN practice questions—each designed to reinforce the critical thinking and clinical judgment skills you’ll need to succeed on exam day.
Before you dive in, if you're looking for a full, guided experience, we strongly recommend the NCLEX-RN® Prep Course and Complete Downloadable Study Guide. They're designed to walk you through the exact frameworks used in these questions, especially with the new NGN case-based format.
Safety & Infection Control
Q1: A client with tuberculosis is placed on airborne precautions. Which nursing action is appropriate?
Answer: Place the client in a negative pressure room.
Rationale: Airborne precautions require a negative pressure room to prevent the spread of TB. Nurses should also wear N95 respirators.
Q2: You discover a nurse on your unit is not performing hand hygiene between patient contacts. What is your first action?
Answer: Address the issue directly and privately with the nurse.
Rationale: Patient safety is a priority. Using the chain of command or reporting without first addressing directly may harm collegial trust.
Q3: A toddler admitted with suspected measles needs what type of isolation?
Answer: Airborne precautions.
Rationale: Measles is an airborne disease, requiring a negative pressure room and N95 mask.
Q4: Which of these PPE combinations is appropriate for contact precautions?
Answer: Gloves and gown.
Rationale: Contact precautions require gloves and gown when entering the room. Additional PPE depends on the situation.
Q5: A fall risk patient wants to ambulate alone. What is the best nursing intervention?
Answer: Offer to assist and explain the fall risk.
Rationale: Respect autonomy while prioritizing safety. Explain risks and provide assistance.
Pharmacology & Parenteral Therapy
Q6: A client receiving heparin has an aPTT of 110 seconds. What is your next step?
Answer: Hold the next dose and notify the provider.
Rationale: The therapeutic range is typically 60–80 seconds. 110 seconds indicates a bleeding risk.
Q7: Which statement indicates a need for further teaching in a patient on digoxin?
Answer: "I will take my antacids right after my digoxin."
Rationale: Antacids can interfere with absorption of digoxin.
Q8: The nurse is preparing to administer morphine IV. What is the priority assessment?
Answer: Respiratory rate.
Rationale: Opioids can cause respiratory depression. Monitor RR before and after administration.
Q9: A patient is experiencing nausea after chemotherapy. Which drug is most appropriate?
Answer: Ondansetron.
Rationale: Ondansetron is a serotonin antagonist and gold standard for chemo-induced nausea.
Q10: What is the antidote for a benzodiazepine overdose?
Answer: Flumazenil.
Rationale: Flumazenil reverses benzodiazepine effects but must be used cautiously due to seizure risk.
Physiological Adaptation
Q11: Which ABG result indicates respiratory alkalosis?
Answer: pH 7.48, PaCO2 30 mmHg.
Rationale: Elevated pH and low CO2 indicate respiratory alkalosis, often from hyperventilation.
Q12: A client in shock has cold, clammy skin. What should the nurse anticipate?
Answer: Administer IV fluids and vasopressors.
Rationale: Cold, clammy skin suggests hypoperfusion. Treat the cause to restore circulation.
Q13: A post-op client develops a sudden onset of shortness of breath. What is the priority action?
Answer: Apply oxygen and raise the head of the bed.
Rationale: Suspect pulmonary embolism. Oxygen and positioning come before calling the provider.
Q14: Chest tube output is 250 mL in the past hour. What should the nurse do?
Answer: Notify the provider immediately.
Rationale: Output >200 mL/hour may indicate hemorrhage.
Q15: What is the expected finding in a patient with left-sided heart failure?
Answer: Crackles in lungs.
Rationale: Left-sided HF causes pulmonary congestion, leading to crackles.
Management of Care
Q16: You are delegating to an LPN. Which task is appropriate to assign?
Answer: Administer oral medications.
Rationale: Within LPN scope. Avoid delegating assessments or IV meds unless state law permits.
Q17: Which patient should the nurse assess first?
Answer: A client with new-onset confusion and low oxygen saturation.
Rationale: Use the ABCs. Altered LOC + hypoxia = urgent priority.
Q18: A client refuses a scheduled procedure. What is the nurse’s ethical responsibility?
Answer: Respect the client’s autonomy and document refusal.
Rationale: Autonomy must be honored, even if the nurse disagrees.
Q19: During a mass casualty event, which patient is triaged as highest priority?
Answer: A client with airway obstruction.
Rationale: Triage uses the ABCs. Airway always takes precedence.
Q20: The nurse notices another staff member administering medication without scanning. What action is warranted? Answer: Speak directly to the staff member about the risk. Rationale: Addressing safety breaches promptly protects patients and reinforces protocol.
Health Promotion & Maintenance
Q21: A pregnant woman asks about signs of preeclampsia. What should the nurse include?
Answer: Swelling, headache, visual changes, and high blood pressure.
Rationale: These are classic signs of preeclampsia and require immediate attention.
Q22: A new mother asks how to prevent SIDS. What teaching should the nurse provide?
Answer: Place the baby on their back to sleep.
Rationale: Supine sleep reduces the risk of sudden infant death syndrome.
Q23: What immunization is safe to give during pregnancy?
Answer: Tdap.
Rationale: Tdap is recommended in every pregnancy to protect the newborn from pertussis.
Q24: At what age should a child begin toilet training?
Answer: 18 to 24 months.
Rationale: Most children show readiness between 18 and 24 months, but individual variation is expected.
Q25: What is a key developmental milestone at 9 months?
Answer: Pulling to stand.
Rationale: This gross motor milestone typically occurs around 9 months of age.
Psychosocial Integrity
Q26: Which behavior indicates a positive outcome of crisis intervention?
Answer: The client verbalizes feelings and seeks help.
Rationale: This reflects adaptive coping and engagement, key goals of crisis resolution.
Q27: What is the nurse’s best response to a suicidal client saying, "I don’t want to live anymore"?
Answer: "Tell me more about how you’re feeling right now."
Rationale: Therapeutic communication begins with active listening and empathy. Avoid judgment or dismissal.
Q28: Which finding requires immediate attention in a patient with schizophrenia?
Answer: Command hallucinations to harm others.
Rationale: These present a safety risk and require immediate intervention.
Q29: A client experiencing alcohol withdrawal shows tremors. What is the priority intervention?
Answer: Administer prescribed benzodiazepine.
Rationale: Benzodiazepines prevent seizures and stabilize withdrawal symptoms.
Q30: What therapeutic response best supports a grieving spouse?
Answer: "This must be very difficult for you. I’m here to listen."
Rationale: Offers presence, empathy, and validation of their emotional state.
Reduction of Risk Potential
Q31: A patient receiving IV potassium reports burning at the site. What should the nurse do?
Answer: Stop the infusion and assess the site.
Rationale: Burning may indicate infiltration or phlebitis. IV potassium is irritating and must be administered with caution.
Q32: What lab value indicates potential digoxin toxicity?
Answer: Digoxin level of 2.5 ng/mL.
Rationale: Toxicity occurs at levels >2.0. Monitor for nausea, vision changes, and bradycardia.
Q33: Which test result should be reported immediately: potassium 5.6, sodium 138, calcium 8.9, or BUN 16?
Answer: Potassium 5.6 mEq/L.
Rationale: Hyperkalemia can lead to cardiac dysrhythmias and must be addressed urgently.
Q34: A patient post-colonoscopy reports dizziness. What is your next action? Answer: Check vital signs and assess for bleeding. Rationale: Dizziness may indicate hypotension from bleeding or sedation effects.
Q35: After a biopsy, which finding requires immediate action? Answer: Saturated dressing with bright red blood. Rationale: Active bleeding is a complication. Apply pressure and notify the provider.
Basic Care & Comfort
Q36: What is the best intervention for promoting sleep hygiene?
Answer: Establish a regular bedtime routine.
Rationale: Consistency improves circadian rhythm and rest quality.
Q37: A patient with chronic pain is requesting increased doses. What should the nurse assess first?
Answer: Pain intensity, location, and characteristics.
Rationale: Reassessment ensures appropriate pain management decisions.
Q38: A patient unable to feed himself needs which type of assistive device?
Answer: Adaptive utensils or plate guards.
Rationale: These promote independence and support nutrition.
Q39: How should the nurse position a dying client to ease breathing?
Answer: Elevate the head of the bed.
Rationale: Upright positioning promotes diaphragmatic expansion and reduces dyspnea.
Q40: What nutritional choice best supports wound healing? Answer: High-protein foods like eggs or chicken. Rationale: Protein supports tissue repair and collagen synthesis.
Case-Based Clinical Judgment (NGN Style)
Q41: A patient with pneumonia has new onset confusion and a respiratory rate of 30. Prioritize nursing actions.
Answer: Apply oxygen, assess SpO₂, notify the provider.
Rationale: Confusion + tachypnea signals hypoxia. Follow the ABCs and clinical judgment model.
Q42: Based on the following cues: BP 88/56, HR 122, urine output 10 mL/hr, what is your hypothesis?
Answer: Hypovolemic shock.
Rationale: Low BP, tachycardia, and low urine output indicate decreased perfusion.
Q43: A client with a new tracheostomy is showing signs of distress. What actions should the nurse anticipate?
Answer: Check tube patency, suction, provide oxygen, and notify provider.
Rationale: Airway obstruction is life-threatening. Prompt intervention is key.
Q44: You receive report on four clients. Who do you see first?
Answer: A client post-thyroidectomy with hoarseness and stridor.
Rationale: Stridor indicates airway compromise. Requires immediate assessment.
Q45: Based on the MAR, which medication should be questioned?
Answer: Digoxin 0.25 mg with a potassium level of 3.0 mEq/L.
Rationale: Hypokalemia increases the risk of digoxin toxicity.
Mixed Clinical Reasoning
Q46: What teaching is appropriate for a patient newly diagnosed with type 1 diabetes?
Answer: How to administer insulin and recognize hypoglycemia.
Rationale: Mastery of insulin use and glucose monitoring is foundational.
Q47: A patient is refusing insulin despite a blood glucose of 400 mg/dL. What do you do first?
Answer: Assess the patient’s understanding and concerns.
Rationale: Address barriers to adherence before intervention.
Q48: Which patient is most at risk for pressure injury?
Answer: Bedbound client with poor nutrition and incontinence.
Rationale: Immobility, moisture, and malnutrition are key risk factors.
Q49: What dietary teaching should be provided to a client with renal failure?
Answer: Limit potassium, sodium, and phosphorus.
Rationale: Kidney impairment reduces ability to excrete these electrolytes.
Q50: A family member insists on staying overnight in a semi-private room. What’s the nurse’s response?
Answer: Explain facility policy and offer alternatives to support visitation.
Rationale: Balances patient rights, privacy, and facility regulations.
Ready to Master All of These?
These 50 questions cover just a slice of what you’ll face on the NCLEX-RN®—and understanding how to answer them comes down to more than memorization. It requires practice, reasoning, and structure.
If you're serious about passing on your first attempt, the NCLEX-RN® Prep Course is your complete guide. Pair it with the Complete Downloadable Study Guide for extra practice, organization, and confidence.
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