Free practice

Free NCLEX practice questions (with rationales)

7 sample questions · answers & rationales included

Below are seven free, NCLEX-RN-style practice questions written to mirror how the real licensure exam tests clinical judgment. They are spread across the NCLEX Client Needs categories — management of care, safety and infection control, pharmacological therapies, reduction of risk potential, physiological adaptation, health promotion, and psychosocial integrity — and include one Select-All-That-Apply (SATA) item. Each question has the full stem, four answer options, the correct answer, a rationale for every option (so you learn why the distractors are wrong, not just which choice is right), an overall rationale, and a quick test-taking tip. Read the stem, commit to an answer, and only then open the rationale.

These seven are a sample. The full Lumen question bank covers every Next Gen NCLEX (NGN) item type — matrix, drop-down, bow-tie, trend, and more — with partial-credit scoring that mirrors the real exam, plus a spaced-repetition review queue that brings back the items you miss until they stick. Open it free at app.lumennursing.com.

Question 1 · Management of Care (delegation)

A charge nurse on a busy medical-surgical unit must assign tasks during a short-staffed shift. Which task is most appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

  1. Obtaining routine vital signs on a stable client who is two days post-op.
  2. Reinforcing discharge teaching about a new prescription for a client going home today.
  3. Performing the admission assessment on a newly arrived client.
  4. Evaluating whether a client's pain has improved after receiving an analgesic.
Show the answer & rationale

Correct answer: A.

  • A — Correct. Routine vital signs on a stable client involve a predictable, standardized skill with a foreseeable outcome, which falls within a UAP's scope.
  • B — Incorrect. Teaching requires nursing knowledge and judgment and cannot be delegated to a UAP.
  • C — Incorrect. Assessment is a core nursing responsibility; it requires clinical judgment and cannot be delegated.
  • D — Incorrect. Evaluating a client's response to an intervention is part of the nursing process and stays with the RN.

Overall rationale: Under the five rights of delegation, the RN may delegate routine, stable, low-judgment tasks. Assessment, teaching, and evaluation each require nursing judgment and remain the nurse's responsibility.

Tip: If an option contains the word assess, teach, evaluate, or plan, it is almost never delegable to a UAP.

Question 2 · Safety & Infection Control (isolation precautions)

A client is admitted with suspected pulmonary tuberculosis and a productive cough. Which action by the nurse is most important when entering the client's room?

  1. Apply a fit-tested N95 respirator before entering the negative-pressure room.
  2. Apply a standard surgical mask before entering the room.
  3. Place the client in a private room with the door open for ventilation.
  4. Wear a gown and gloves but no respiratory protection for routine care.
Show the answer & rationale

Correct answer: A.

  • A — Correct. Tuberculosis spreads by airborne droplet nuclei, so airborne precautions require a fit-tested N95 (or higher) respirator and a negative-pressure airborne infection isolation room.
  • B — Incorrect. A surgical mask does not filter the small airborne particles that transmit TB; it is appropriate for droplet, not airborne, precautions.
  • C — Incorrect. The door to a negative-pressure room must stay closed to maintain the pressure gradient that contains airborne particles.
  • D — Incorrect. Gown and gloves address contact precautions; TB requires respiratory protection above all.

Overall rationale: Matching the precaution to the route of transmission is the safety priority. Airborne organisms (TB, measles, varicella) require an N95 and a negative-pressure room with the door closed.

Tip: Memorize the airborne group with the mnemonic My Chicken Hez TB — Measles, Chickenpox (varicella), Herpes zoster (disseminated), and TB.

Question 3 · Pharmacological & Parenteral Therapies (adverse effect)

A client receiving intravenous vancomycin develops flushing and an erythematous rash over the face, neck, and upper torso about 10 minutes into the infusion. What is the nurse's priority action?

  1. Stop or slow the infusion, as these findings are consistent with an infusion-rate reaction.
  2. Continue the infusion at the current rate and document the finding.
  3. Administer the next scheduled dose early to maintain therapeutic levels.
  4. Increase the infusion rate to finish the dose before the reaction worsens.
Show the answer & rationale

Correct answer: A.

  • A — Correct. Flushing and upper-body erythema during a vancomycin infusion describe an infusion-reaction (formerly called red man syndrome) caused by infusing too rapidly. Stopping or slowing the infusion is the immediate, appropriate response.
  • B — Incorrect. Continuing at the same rate lets the reaction progress and risks hypotension; documentation alone does not protect the client.
  • C — Incorrect. Giving more drug compounds the problem and is not indicated.
  • D — Incorrect. A faster rate is the direct cause of the reaction and would worsen it.

Overall rationale: This reaction is rate-dependent rather than a true allergy. The first action is to stop or slow the infusion; the provider may then order a slower re-infusion and an antihistamine.

Tip: When a problem appears during an infusion, controlling the infusion itself is usually the first nursing action — you can act on the IV faster than you can reach the provider.

Question 4 · Reduction of Risk Potential (lab interpretation)

A nurse reviews morning labs for a client with chronic kidney disease and notes a serum potassium of 6.8 mEq/L. Which action should the nurse take first?

  1. Obtain a 12-lead ECG to assess for life-threatening cardiac changes.
  2. Encourage the client to eat a banana to confirm dietary intake.
  3. Document the value and recheck the potassium in the morning.
  4. Administer the client's scheduled oral potassium supplement.
Show the answer & rationale

Correct answer: A.

  • A — Correct. A potassium of 6.8 mEq/L is severe hyperkalemia (normal 3.5–5.0). The most dangerous effect is on the heart, so the nurse first assesses for peaked T waves, a widening QRS, and dysrhythmias with a 12-lead ECG.
  • B — Incorrect. A banana adds potassium and would worsen an already dangerous level.
  • C — Incorrect. A critical value this high requires action now, not a delayed recheck.
  • D — Incorrect. Giving more potassium to a hyperkalemic client is unsafe and should be held.

Overall rationale: Severe hyperkalemia is a cardiac emergency. Assessment of the highest-risk system comes first, after which the provider may order calcium gluconate, insulin with dextrose, and other measures to shift and remove potassium.

Tip: When a lab is critically abnormal, ask which body system it can kill the client through — potassium and magnesium point you straight to the heart.

Question 5 · Physiological Adaptation (acute complication, Select All That Apply)

A client who is one day post-op from a total hip arthroplasty suddenly becomes dyspneic, anxious, and tachycardic, with an oxygen saturation of 86% on room air. The nurse suspects a pulmonary embolism. Which interventions should the nurse implement? Select all that apply.

  1. Apply supplemental oxygen and titrate to maintain an adequate oxygen saturation.
  2. Raise the head of the bed to a high-Fowler position to ease the work of breathing.
  3. Stay with the client and notify the provider or rapid response team immediately.
  4. Have the client get up and ambulate the hallway to clear the lungs.
  5. Anticipate orders for anticoagulation and diagnostic testing such as a CT angiogram.
Show the answer & rationale

Correct answers: A, B, C, and E.

  • A — Correct. Hypoxemia is the immediate threat; supplemental oxygen is a first-line action for a suspected PE.
  • B — Correct. A high-Fowler position improves lung expansion and reduces the work of breathing.
  • C — Correct. The nurse stays with the unstable client and escalates immediately, because a PE can deteriorate rapidly.
  • D — Incorrect. Ambulating an acutely hypoxic, unstable client is unsafe and can dislodge additional clot; the client needs rest and monitoring.
  • E — Correct. Anticoagulation and confirmatory imaging (CT pulmonary angiography) are expected next steps, so the nurse prepares for them.

Overall rationale: Immobility and orthopedic surgery are major risk factors for venous thromboembolism. The nurse oxygenates, positions for ventilation, stays with the client, escalates, and prepares for anticoagulation — while avoiding any action (like ambulation) that increases risk.

Tip: On SATA items, evaluate each option as its own true-or-false question; one wrong inclusion is the most common way points are lost.

Question 6 · Health Promotion & Maintenance (recognizing risk)

During a routine prenatal visit, a client at 30 weeks' gestation reports a headache, blurred vision, and swelling of the hands and face. Her blood pressure is 158/104 mmHg. Which finding most warrants further evaluation for preeclampsia?

  1. The combination of new-onset hypertension with headache, visual changes, and edema.
  2. Mild ankle swelling at the end of the day that resolves with rest.
  3. Increased frequency of urination during the third trimester.
  4. Occasional lower-back discomfort relieved by position changes.
Show the answer & rationale

Correct answer: A.

  • A — Correct. New-onset hypertension after 20 weeks together with a headache, visual disturbance, and facial/hand edema is the classic picture of preeclampsia and demands prompt evaluation.
  • B — Incorrect. Mild, dependent ankle edema that resolves with rest is a common, expected change in pregnancy.
  • C — Incorrect. Urinary frequency is a normal third-trimester finding from the enlarged uterus pressing on the bladder.
  • D — Incorrect. Positional lower-back discomfort is an expected musculoskeletal change of pregnancy.

Overall rationale: Distinguishing expected physiologic changes from danger signs is central to health promotion. The clustering of hypertension, neurologic symptoms, and facial edema separates preeclampsia from normal pregnancy discomforts.

Tip: When findings cluster into a recognizable danger pattern, weigh the pattern as a whole rather than judging each symptom in isolation.

Question 7 · Psychosocial Integrity (therapeutic communication)

A client newly diagnosed with breast cancer tells the nurse, "I just don't see how I can get through all of this treatment." Which response by the nurse is most therapeutic?

  1. "This feels overwhelming right now. Can you tell me more about what worries you most?"
  2. "Don't worry — treatments today are very advanced and most people do fine."
  3. "You should focus on staying positive; a good attitude really helps recovery."
  4. "Why do you feel that way when your prognosis is actually quite good?"
Show the answer & rationale

Correct answer: A.

  • A — Correct. Reflecting the client's feeling and inviting her to say more uses empathy and an open-ended question, which keeps the focus on the client and encourages her to express her concerns.
  • B — Incorrect. False reassurance dismisses the client's feelings and closes the conversation.
  • C — Incorrect. Offering advice and minimizing the emotion shifts the burden onto the client and blocks communication.
  • D — Incorrect. "Why" questions sound challenging and can make a client feel defensive rather than heard.

Overall rationale: Therapeutic communication centers the client's emotions, uses open-ended exploration, and avoids false reassurance, advice-giving, and probing "why" questions that shut a client down.

Tip: The best therapeutic-communication answer almost always acknowledges the feeling and opens the door for the client to keep talking.

Want to understand the formats and the reasoning these questions are built on? Read our guide to the Next Gen NCLEX question types to see how matrix, bow-tie, drop-down, and the rest are scored, and our guide to the Clinical Judgment Measurement Model to learn the six-step reasoning process the exam rewards. When you are ready for hundreds more items with partial-credit scoring and a review queue, open the app at app.lumennursing.com.

Lumen is a study tool for educational use and is not medical advice; see our Terms for details. Always defer to your instructors, your institution's policies, and current clinical guidelines for real patient care.

← All study guides

Want more than seven?

Practice hundreds of NCLEX-style questions free — every Next Gen item type, partial-credit scoring that mirrors the real exam, a rationale on every option, and a review queue that brings back what you miss until it sticks.

Practice more free