The NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a nursing certification awarded by NCSBN.
NCSBN publishes the official exam outline, eligibility rules and fees — see NCSBN's official page before you book.
Twenty NCLEX-RN (National Council Licensure Examination for Registered Nurses) questions, with the answers hidden until you want them — covering Pathology, Procedures, Pharmacology, Psychology and more. They are real cards from our 1030-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. NCSBN publishes the official exam outline — check it for the real blueprint.
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A post-operative patient is on strict bed rest. Which physiological sequence leads to the development of hypostatic pneumonia?
Show answer →Immobility causes mucus to pool in dependent airways due to gravity and decreased surfactant production. This leads to atelectasis (alveolar collapse), which creates an environment for bacterial growth (hypostatic pneumonia). NCLEX Strategy: The priority intervention is frequent position changes every 2 hours and incentive spirometry to mobilize secretions and expand alveoli. Distractor: Deep vein thrombosis is a vascular, not respiratory, pathology.
Explain the role of Virchow's Triad in an immobile patient's risk for Venous Thromboembolism (VTE).
Show answer →Virchow's Triad includes: 1) Venous Stasis (lack of skeletal muscle pump), 2) Hypercoagulability (increased clotting factors/fibrinogen), and 3) Endothelial Damage (vessel wall pressure). Immobility primarily triggers stasis. NCLEX Pearl: Look for sudden onset dyspnea (PE) or unilateral calf warmth/edema (DVT). Prophylaxis with LMWH or sequential compression devices (SCDs) is a standard of care.
How does prolonged immobility contribute to a negative nitrogen balance and what is the systemic consequence?
Show answer →Immobility triggers muscle catabolism (protein breakdown). When protein breakdown exceeds intake, a negative nitrogen balance occurs. This results in muscle wasting, impaired wound healing, and decreased immune function. NCLEX Tip: Nursing priority is a high-protein, high-calorie diet (unless contraindicated by renal failure) to provide the building blocks for tissue repair.
An immobile patient develops renal calculi. What is the underlying pathological mechanism related to bone metabolism?
Show answer →Lack of weight-bearing triggers osteoclast activity, causing bone resorption (calcium moves from bone to blood), leading to hypercalcemia. In a supine position, the renal pelvis lacks gravity-assisted drainage, causing urinary stasis. Hypercalcemia + Stasis = Renal Calculi. NCLEX Strategy: Encourage 2000-3000 mL of fluid intake daily to dilute urine and prevent stone formation.
When preparing a sterile field using a pre-packaged kit, in which order must the nurse unfold the flaps to maintain surgical asepsis?
Show answer →1. Open the flap furthest away from the body first. 2. Open the side flaps. 3. Open the flap closest to the body last. Rationale: This sequence prevents the nurse's unsterile arm from crossing over the sterile field during setup. Exam Strategy: NCSBN frequently tests the far-side-side-near sequence. Remember: Reaching over a sterile field is an automatic breach.
During a sterile dressing change, the patient suddenly coughs toward the sterile field. The nurse observes no visible moisture on the supplies. What is the priority action?
Show answer →The nurse must discard the entire sterile field and start over with new supplies. Rationale: Moisture from the breath (droplets) can travel and contaminate the field even if not visible to the naked eye. Any suspicion of contamination renders the field unsterile. Exam Strategy: NCLEX prioritizes infection control and patient safety. If there is any doubt about sterility, the correct answer is always to replace the equipment. Do not attempt to save or clean a contaminated field.
A 78-year-old patient with a Creatinine Clearance (CrCl) of 35 mL/min is prescribed Digoxin. Which pharmacokinetic phase is most clinically significant in this scenario, and what is the primary nursing priority?
Show answer →Excretion. Digoxin is primarily excreted unchanged by the kidneys. A decreased CrCl indicates renal impairment, which increases the drug's half-life and the risk for toxicity. Priority: Monitor serum digoxin levels (therapeutic range: 0.5–2 ng/mL) and potassium levels, as hypokalemia potentiates digoxin toxicity. NCLEX Strategy: NCSBN often tests renal function (BUN/Creatinine) in relation to drugs with narrow therapeutic indices. Distractor: Metabolism in the liver is less significant for Digoxin than renal excretion.
The nurse is preparing an IV infusion of Heparin for a patient with a pulmonary embolism. According to ISMP and NCSBN safety standards, which action is mandatory during the administration process to ensure patient safety?
Show answer →Independent Double-Check. Heparin is a high-alert medication. Two RNs must independently verify the vial, concentration, calculation, and pump settings. Independent means the second nurse calculates the dose without seeing the first nurse's work to prevent confirmation bias. NCLEX Strategy: High-alert meds (Insulin, Heparin, Potassium, Opioids) always require enhanced verification. If an option suggests a double-check, ensure it specifies it is independent.
A patient awaiting a mastectomy says, I'm not sure if I can handle looking at myself after this. How should the nurse respond to facilitate therapeutic communication?
Show answer →The best response is a reflection of feelings or an open-ended statement: You're concerned about how you'll feel about your body after the procedure. Rationale: This acknowledges the patient's concern and encourages further expression. NCLEX strategy: Avoid Don't worry (false reassurance) or Why do you feel that way? (defensive). Focus on What or How or reflecting the emotion stated. Key 2026 NCLEX focus: Prioritizing the patient's emotional cues over clinical tasks during the assessment phase.
A patient with schizophrenia says, The voices are telling me the food is poisoned and I shouldn't eat it. Which response by the nurse is most therapeutic?
Show answer →Response: I don't hear any voices, but I can see that you are frightened. I will stay with you while you eat. Rationale: This uses presenting reality and acknowledging feelings without validating the hallucination. NCLEX Tip: Never argue about the hallucination or agree with it. Focus on the emotional impact (fear) and provide safety/presence. In 2026 standards, safety and validation are the dual priorities for patients with active psychosis.
A client with a BMI of 24 is at 10 weeks gestation. History: 1 spontaneous abortion (8 weeks), 1 term birth (39 weeks), 1 preterm birth (34 weeks). Both children are living. Calculate the GTPAL.
Show answer →G4, T1, P1, A1, L2. G (Gravida): 4 pregnancies total including current. T (Term): 1 (birth at 37+ weeks). P (Preterm): 1 (birth 20-36.6 weeks). A (Abortion/Miscarriage): 1 (before 20 weeks). L (Living): 2 children. Strategy: NCLEX tests the distinction between gravidity and parity. Note: Twins count as 1 parity/gravida but 2 living. If the current pregnancy is ongoing, it counts in G but not T/P/A until delivery.
A newborn at 1 minute of life has a HR of 110, slow/irregular respirations, some flexion of extremities, a grimace when suctioned, and a pink body with blue hands/feet. What is the APGAR score?
Show answer →Score: 6 (HR >100 = 2; Resp slow/irreg = 1; Flexion = 1; Grimace = 1; Acrocyanosis = 1). Rationale: APGAR is assessed at 1 and 5 minutes. 0-3 indicates severe distress, 4-6 moderate difficulty, 7-10 stable. NCLEX Tip: Distinguish between grimace (1 pt) and cough/sneeze/cry (2 pts) for Reflex Irritability (Grimace).
Which Right of Delegation is violated if an RN asks a UAP to perform a sterile dressing change on a post-op patient with a dehiscing wound?
Show answer →Right Task. Sterile procedures and assessments of unstable wounds require professional nursing judgment. The 5 Rights are: Task, Circumstance, Person, Direction/Communication, and Supervision/Evaluation. Exam Strategy: UAPs should only perform standard, non-invasive tasks (ADLs, hygiene, stable vitals). If a task requires the nursing process (TAPE: Teaching, Assessment, Planning, Evaluation), it cannot be delegated.
A client is admitted with watery diarrhea and suspected Clostridioides difficile. Which infection control measure is the priority for the nurse to implement?
Show answer →Contact Precautions are mandatory. Priority: Hand hygiene must be performed with soap and water\, not alcohol-based rubs\, as spores are resistant to alcohol. PPE includes gloves and gown. Dedicated equipment (stethoscope\, BP cuff) should stay in the room. Disinfect surfaces with bleach-based solutions. NCLEX Tip: Look for soap and water as the specific differentiator for C. diff and Norovirus. Alcohol-based sanitizers are ineffective against these specific spores.
A patient with COPD presents with: pH 7.31, PaCO2 52 mmHg, HCO3 28 mEq/L. How should the nurse interpret this acid-base imbalance?
Show answer →Respiratory Acidosis, Partially Compensated. Rationale: 1. pH < 7.35 (Acidosis). 2. PaCO2 > 45 (Respiratory cause). 3. HCO3 > 26 (Kidneys are retaining bicarbonate to compensate). NCLEX Tip: COPD is the classic CO2 retainer scenario. Compensation is partial because the pH has not yet returned to the normal range (7.35-7.45). If the pH were 7.36, it would be Fully Compensated.
When lifting a heavy object from the floor, which action by the nurse demonstrates proper body mechanics according to current safety standards?
Show answer →Key principles: 1) Maintain a wide base of support (feet shoulder-width apart). 2) Flex knees and hips (squat) rather than bending at the waist. 3) Keep the object as close to the body/center of gravity as possible. 4) Use the large muscles of the legs (quadriceps/gluteals) instead of back muscles. 5) Tighten abdominal muscles to support the spine. NCLEX Tip: Avoid twisting (pivoting is correct) and bending at the waist (common distractors). Always assess the weight before lifting; if it exceeds the 35 lb NIOSH limit, use assistive equipment.
To successfully prove nursing malpractice, a plaintiff must establish four specific legal elements. Identify these elements and explain which one is most frequently the point of contention in clinical litigation.
Show answer →1. Duty: A nurse-patient relationship existed. 2. Breach of Duty: Failure to meet the standard of care. 3. Causation (Proximate Cause): The breach directly caused the injury. 4. Damages: Physical or financial harm occurred. NCLEX Tip: Breach of Duty is often tested via scenarios where a nurse fails to follow a facility's Policy & Procedure (P&P). The Standard of Care is what a reasonably prudent nurse would do in a similar situation. If you follow P&P, you are generally protected from breach claims.
A nurse reviews a chart for a patient with HF: weight gain 3lbs/24h, BP 150/90, HR 88, crackles in bases, and a history of gout. Which cue is MOST critical to address first for the NGN Recognizing Cues step?
Show answer →The 3lb weight gain and crackles are the most critical cues indicating fluid volume overload. In NGN, Recognizing Cues requires filtering noise (gout) from urgent clinical findings. Weight gain >2lbs/day is a red flag for worsening HF. Strategy: Look for cues that deviate from the patient's baseline and indicate acute physiological instability. Distinguish between chronic conditions and acute exacerbations.
A patient is scheduled for an elective cholecystectomy. While prepping, the patient tells the nurse, "I'm still not sure what they are actually cutting out." What is the nurse's priority action?
Show answer →The nurse must notify the surgeon that the patient requires further explanation before the procedure. While the nurse witnesses the signature, the provider is responsible for explaining risks, benefits, and alternatives. **NCLEX Strategy:** The nurse's role in informed consent is to verify the patient is competent, the signature is authentic, and the patient understands the information. If the patient expresses confusion, the nurse MUST advocate for the patient by pausing the process and calling the provider back to the bedside. Do not explain the procedure yourself.
A 16-year-old is at the clinic for a sports physical. The parent stays in the room and answers all questions. What is the nurse's priority action to ensure a developmentally appropriate assessment?
Show answer →The priority is to interview the adolescent privately. NCLEX-RN emphasizes confidentiality and establishing trust to facilitate the disclosure of high-risk behaviors (sexual health, substance use, safety). The nurse should explain to the parent that private time is standard for this age group. Strategy: Look for the HEADSS assessment (Home, Education, Activities, Drugs, Sexuality, Suicide/Safety) which requires a confidential environment to be effective.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Pathology questions
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Procedures questions
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Pharmacology questions
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Psychology questions
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Obstetrics questions
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Pediatrics questions
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Management questions
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