Getting ready for the NCLEX-RN? Start here. The free sample questions below are written in the style of the NCSBN NCLEX-RN test plan — a clinical scenario, one best answer, and a rationale that explains the clinical judgment behind it. Work each one before you read the answer.
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Written to the official test plan, each with a full rationale. Pick an answer to test yourself, then reveal the explanation.
5 free sample questions · full bank in the course
A nurse in a semi-private room is providing discharge instructions to a patient newly diagnosed with Hepatitis C. The roommate’s family is present behind the curtain, and the patient expresses concern about others hearing their medical history.
Reveal answer & explanation
✓ Correct: A Escort the patient to a private consultation room for the discharge session.
Why. Option A is the best choice because HIPAA requires nurses to take reasonable safeguards to protect health information, especially when discussing sensitive diagnoses like Hepatitis C in shared spaces. Moving to a private room provides the highest level of confidentiality and addresses the patient’s expressed concern. Option B is insufficient because sound travels easily through curtains in semi-private rooms, making eavesdropping likely. Option C is a common practice but only provides visual privacy, not auditory privacy, which is the primary concern during verbal teaching. Option D is clinically inappropriate as it may delay necessary education and the discharge process, and there is no guarantee the visitors will leave in a timely manner. The presence of the roommate’s family and the patient’s anxiety are the discriminating cues that necessitate a more secure environment for communication.
A patient with a subarachnoid hemorrhage is at risk for cerebral salt wasting syndrome. The nurse monitors the patient’s intake and output, daily weights, and serum sodium levels. Which clinical finding would most clearly indicate that the patient is experiencing an alteration in perfusion related to this syndrome?
Reveal answer & explanation
✓ Correct: B Decreased serum sodium levels accompanied by a significant increase in urine output.
Why. The correct answer is B because cerebral salt wasting (CSW) is a complication of subarachnoid hemorrhage characterized by primary hyponatremia and excessive renal sodium wasting, leading to polyuria and volume depletion. This hypovolemia directly threatens cerebral perfusion. Option A describes a state more consistent with dehydration, but with low output, which is contradictory. Option C describes diabetes insipidus, where high sodium is paired with high output. Option D describes the Syndrome of Inappropriate Antidiuretic Hormone (SIADH), which causes hyponatremia but typically results in low urine output and a euvolemic or hypervolemic state. Distinguishing between SIADH and CSW is critical because CSW requires aggressive fluid and sodium replacement to maintain blood pressure and cerebral blood flow, whereas SIADH typically requires fluid restriction, which could be dangerous for a patient at risk for vasospasm.
A patient who underwent a total thyroidectomy 12 hours ago is being monitored for complications. The nurse observes the respiratory rate has increased from 14 to 22 breaths/minute, and the patient has become increasingly restless. What is the nurse’s most appropriate clinical action?
Reveal answer & explanation
✓ Correct: B Assess the surgical site for a hematoma.
Why. Post-thyroidectomy patients are at high risk for airway obstruction due to hemorrhage or laryngeal edema. Increasing restlessness and tachypnea are early signs of hypoxia and airway compromise. Assessing the surgical site (Option B) is the priority because a neck hematoma can rapidly compress the trachea. Administering a sedative (Option A) is dangerous as it can mask signs of hypoxia and suppress respiratory drive. Checking for a Chvostek sign (Option C) assesses for hypocalcemia, which is a potential complication but usually occurs later and does not explain acute respiratory changes. Placing the patient in high-Fowler position (Option D) may help slightly with breathing but does not identify the life-threatening cause of the trend. The nurse must focus on identifying the source of airway obstruction.
A nurse is monitoring a client receiving an intermittent infusion of Vancomycin. The client reports sudden pain at the site, and the nurse finds the area is erythematous, warm, and tender to touch, but without visible swelling or blanching. Which action is required?
Reveal answer & explanation
✓ Correct: A Stop the infusion and remove the catheter.
Why. The correct answer is A because erythema, warmth, and tenderness without swelling indicate phlebitis or chemical irritation from the medication. Vancomycin is a known irritant, and the nurse must stop the infusion and remove the catheter to prevent further venous wall damage. Option B is incorrect because aspiration is primarily used for extravasation of vesicants, and ice packs are not the standard treatment for general phlebitis. Option C is unsafe because continuing the infusion in an already inflamed vein will exacerbate the injury, regardless of dilution. Option D is incorrect because a pressure dressing is not indicated for phlebitis and could impair circulation to the affected area. By focusing on the cues of warmth and erythema, the nurse identifies phlebitis and prioritizes removing the source of irritation over attempting to salvage the current IV access.
A client with a T6 spinal cord injury is being monitored in the rehabilitation unit. The nurse notes the client has developed nasal congestion, a heart rate of 52 beats/minute, and a blood pressure of 160/90 mmHg. Which intervention is the priority?
Reveal answer & explanation
✓ Correct: A Elevate the client to a sitting position.
Why. This client presents with signs of Autonomic Dysreflexia, evidenced by the T6 injury level, bradycardia, and hypertension. The first action the nurse should take is to elevate the head of the bed to a 90-degree sitting position (Option A). This uses gravity to help lower the blood pressure by promoting venous pooling in the lower extremities. Assessing for deep vein thrombosis (Option B) is important for spinal cord injury clients but does not address this acute hypertensive crisis. Increasing the rate of intravenous fluids (Option C) would dangerously elevate the blood pressure further. Applying a cooling blanket (Option D) is inappropriate because the flushing and sweating associated with this condition are autonomic responses to noxious stimuli, not a primary thermoregulation failure or infection requiring cooling.
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How close are these to the actual NCLEX-RN?
Very close in how they make you think. The NCLEX-RN is a computerized adaptive test (CAT) of 85 to 150 items over a maximum of five hours, and since April 2023 the Next Generation NCLEX adds case studies that score clinical judgment in steps — recognize cues, analyze, prioritize, act, evaluate. Because it adapts, the questions get harder as you answer correctly, so a “hard” exam usually means you are passing. The samples below train the same recognize-and-act reasoning the real test rewards.
How is the NCLEX-RN weighted?
The test plan groups every item under four Client Needs, two of which split into sub-categories. Pharmacological and Parenteral Therapies is the single heaviest sub-area.
| Client Need | Percent of the exam |
|---|---|
| Management of Care | 15–21% |
| Safety and Infection Control | 10–16% |
| Health Promotion and Maintenance | 6–12% |
| Psychosocial Integrity | 6–12% |
| Basic Care and Comfort | 6–12% |
| Pharmacological and Parenteral Therapies | 13–19% |
| Reduction of Risk Potential | 9–15% |
| Physiological Adaptation | 11–17% |
Sample NCLEX-RN questions
- A 22-year-old patient with a moderate intellectual disability is seen for a biopsy of a suspicious skin lesion. The patient lives in a group home, has no legal guardian, and demonstrates the ability to understand the procedure. How should the nurse obtain consent?
- A. Require the group home manager to sign the consent
- B. Obtain the informed consent directly from the patient
- C. Postpone the biopsy until a legal guardian is appointed
- D. Seek consent from the patient’s primary care physician
Answer: B. Adults are legally presumed competent to make their own health decisions unless a court has ruled otherwise. An intellectual disability does not by itself remove that right — if the patient can understand the specific procedure, they give their own consent. This is a Management of Care question, and Management of Care is the largest single category on the exam.
- A patient with chronic peptic ulcer disease and osteoarthritis is admitted with a fractured femur. The provider orders ketorolac 30 mg IV every 6 hours for pain. What is the nurse’s best action?
- A. Administer the ketorolac and provide a concurrent antacid
- B. Withhold the ketorolac and suggest an alternative such as acetaminophen
- C. Administer the ketorolac and monitor for hematemesis
- D. Withhold the ketorolac and assess for a salicylate allergy
Answer: B. Ketorolac is a potent NSAID contraindicated in active or prior peptic ulcer disease because of the high GI-bleeding risk. Adding an antacid (A) or watching for bleeding (C) does not remove the contraindication; the safe action is to hold it and recommend a safer analgesic. That is Pharmacological and Parenteral Therapies — the heaviest sub-category on the test.
Want 2,818 more questions like these?
Our NCLEX-RN prep course contains 19 full-length simulators — 2,818 questions total, spread across the Client Needs above and written in the Next Generation style, each with a full rationale. It is $19.99 once for lifetime access, and the free simulator lets you baseline before paying anything.
Unlock 2,818 NCLEX-RN practice questions across 19 full-length simulators — $19.99 lifetime →
Round out your prep with the NCLEX-RN cheat sheet and the NCLEX-RN study plan.
Frequently asked questions
How many questions is the NCLEX-RN?
It is a variable-length computer adaptive test: a minimum of 85 items and a maximum of 150 items, over a maximum of five hours. The test stops as soon as it is confident of a pass-or-fail decision.
What is the hardest part of the NCLEX-RN?
Pharmacological and Parenteral Therapies is the heaviest single sub-category at 13-19%, and Management of Care leads the Safe and Effective Care Environment area at 15-21%. Together they decide a large share of the exam.
Are these real NCLEX questions?
No. Real NCLEX items are confidential. These are original questions written to the NCSBN test plan and Next Generation style, drawn from our own 2,818-question bank.
What score do I need to pass the NCLEX-RN?
There is no percentage score. The adaptive engine passes you when it is 95% confident your ability is above the passing standard, so the goal is consistent correct reasoning, not a target number.
Sources & references
The exam facts on this page are drawn from official certifying-body materials, reviewed 2026-06-18 by the DrCertifications exam-prep team (10+ years in exam preparation and publishing).