Quick answer: Every question here is free. This page has six NCLEX-RN sample questions with full rationales (Management of Care, trauma diagnostics, a heparin drip calculation, two select-all-that-apply items, and a Next Generation NCLEX drag-and-drop), plus a free library of 49 practice sets with 480 more questions across the 2026 NCLEX-RN test plan. No account is needed to read them.
Practice questions are one of the most effective ways to prepare for the NCLEX-RN. Not passive reading. Not flashcards. Active recall under exam-like conditions, followed by studying the rationale for every answer — right and wrong. Below is a set of sample questions spanning multiple NCLEX test plan categories, including a Next Generation NCLEX (NGN) item type. Each comes with a full rationale.
Management of Care
Management of Care is the largest category on the NCLEX-RN, accounting for roughly 15-21% of your exam under the 2026 test plan. It covers delegation, prioritization, ethical practice, legal responsibilities, informed consent, advance directives, and quality improvement. The question below tests your understanding of evidence-based quality monitoring — a topic the NCSBN has increasingly emphasized.
Show answer & rationale
Why the other answers are wrong:
A — Reviewing product usage tells you how much soap or sanitizer was dispensed, but not whether it was used at the right times, by the right people, or with proper technique. A unit could have high product consumption and still have poor compliance if staff are washing at non-critical moments and skipping critical ones.
B — Self-reporting is consistently unreliable. Studies show healthcare workers overestimate their own hand hygiene compliance by a significant margin — often reporting 80-90% compliance when observed rates are closer to 40-50%. Social desirability bias makes self-report the least accurate method.
D — Infection rate analysis is an outcome measure, not a process measure. Infection rates are influenced by dozens of variables beyond hand hygiene (patient acuity, antibiotic stewardship, environmental cleaning, device utilization). By the time you see a spike in infection rates, the compliance problem has been ongoing. Direct observation catches the problem in real time.
Clinical pearl: On the NCLEX, when a question asks about the “most effective” method for monitoring a behavior, look for the option that provides the most direct, real-time data. Proxy measures and self-reports are always weaker than direct observation.
Physiological Adaptation
Physiological Adaptation questions test your ability to manage clients with acute, chronic, and life-threatening conditions. Expect scenarios involving shock, trauma, organ failure, and emergency interventions. You need to know not just what to do, but which intervention gives you the most information or the best outcome in a specific clinical context.
Show answer & rationale
The key phrase in this question is hemodynamically stable. This is what makes CT the right answer. A CT scan takes time — the patient must be transported to the scanner and remain still. You can only justify that time if the patient’s vital signs are stable.
Why the other answers are wrong:
A — FAST exam is a rapid bedside ultrasound that detects free fluid (blood) in the abdomen. It is fast, portable, and useful in unstable patients who need an immediate answer: is there blood in the belly, yes or no? But FAST cannot identify which organ is injured, cannot grade injury severity, and misses retroperitoneal injuries entirely. It is a screening tool, not a comprehensive one.
C — Diagnostic peritoneal lavage (DPL) is an invasive procedure that was largely replaced by FAST and CT. It involves inserting a catheter into the peritoneal cavity and instilling saline to check for blood. While sensitive for intraperitoneal hemorrhage, it is invasive, cannot identify the specific injury source, and does not evaluate retroperitoneal structures. It is rarely performed in modern trauma centers.
D — Serial abdominal examinations have a role in clinical monitoring but are subjective, examiner-dependent, and cannot detect injuries before they become clinically apparent. Relying solely on serial exams risks delayed diagnosis of significant injuries.
Clinical pearl: On the NCLEX, hemodynamic status often determines the correct diagnostic or intervention choice. Stable patient = you have time for comprehensive workup (CT). Unstable patient = you need rapid answers and immediate intervention (FAST, then OR).
Pharmacological Therapies
Pharmacology is consistently one of the highest-yield categories on the NCLEX. You will see dosage calculations, medication administration safety, adverse effects, drug interactions, and client education. Dosage calculation questions require you to show your work mentally — set up the problem, convert units, and solve. No shortcuts.
Show answer & rationale
Step 1 — Convert pounds to kilograms:
176 lbs ÷ 2.2 = 80 kg
Step 2 — Calculate the dose in units per hour:
80 kg × 18 units/kg/hour = 1,440 units/hour
Step 3 — Determine the concentration of the heparin drip:
25,000 units ÷ 250 mL = 100 units/mL
Step 4 — Calculate the infusion rate:
1,440 units/hour ÷ 100 units/mL = 14.4 mL/hour
The infusion pump should be set to 14.4 mL/hour.
Why the other answers are wrong:
A — 5.8 mL/hour results from dividing the hourly dose by the bag volume instead of the concentration (1,440 units ÷ 250 mL = 5.76, rounded to 5.8), a common setup error.
B — 6.3 mL/hour could result from using an incorrect concentration (e.g., forgetting to simplify 25,000/250) or a multiplication error in the dose calculation.
D — 15.8 mL/hour results from rounding the weight up to 88 kg instead of correctly converting 176 lbs to 80 kg — a common error when students confuse the conversion factor or skip the conversion entirely.
Clinical pearl: For weight-based heparin calculations on the NCLEX, always follow the same sequence: convert weight, calculate dose, determine concentration, solve for rate. Write out each step. The most common errors are (1) forgetting to convert pounds to kilograms and (2) using the wrong concentration. If your answer does not match any option, recheck your weight conversion first.
Want to practice in the app? Your free account includes 25 NCLEX-style questions with full rationales and progress tracking. No credit card.
Psychosocial Integrity
Psychosocial Integrity questions address mental health, coping, grief, therapeutic communication, and cultural considerations. Select All That Apply (SATA) questions in this category require you to evaluate each option independently — there is no set number of correct answers. Under the NGN scoring model, SATA items use +/- scoring: you earn a point for each correct option you select and lose a point for each incorrect one (the item score can’t drop below zero), so guessing extra options can cost you points.
Show answer & rationale
Therapeutic nursing care for a grieving client is grounded in presence, validation, and support — not redirection, avoidance, or minimization.
A — Encourage expression of feelings: Correct. Verbalizing feelings is a core therapeutic intervention in grief. Suppressing emotions delays the grieving process and can lead to complicated grief. Asking open-ended questions like “Can you tell me about your spouse?” or “What are you feeling right now?” creates space for processing.
C — Provide grief support group information: Correct. Connecting clients with community resources is a fundamental nursing role. Grief support groups provide peer support, normalize the experience, and reduce isolation. The nurse should provide this information and let the client decide when they are ready.
E — Listen actively and without judgment: Correct. Active listening — maintaining eye contact, using silence therapeutically, reflecting, and not interrupting — is the foundation of therapeutic communication. Grieving clients need to feel heard. The nurse does not need to “fix” anything. Being present is the intervention.
F — Acknowledge grief is individual: Correct. There is no universal timeline for grief. Kubler-Ross’s stages (denial, anger, bargaining, depression, acceptance) are not linear and not experienced by everyone. Telling a client that their grief process is valid and that there is no “right way” to grieve reduces guilt and self-judgment.
Why the other answers are wrong:
B — Avoiding discussion of the deceased is non-therapeutic. It communicates that the client’s grief is uncomfortable or unwelcome, which leads to emotional suppression. Many grieving clients want to talk about their loved one — it is part of how they process the loss and preserve the bond.
D — Telling the client to move on is dismissive, invalidating, and non-therapeutic. Phrases like “you need to move on,” “they’re in a better place,” or “at least they’re not suffering” minimize the client’s pain. These are social platitudes, not therapeutic interventions.
Clinical pearl: On SATA questions about therapeutic communication and grief, eliminate any option that involves avoiding, redirecting, minimizing, or giving advice. The correct answers almost always involve listening, validating, being present, and connecting to resources.
Health Promotion and Maintenance
Health Promotion and Maintenance covers disease prevention, screening guidelines, developmental milestones, prenatal and postpartum care, and health teaching. Screening recommendation questions require you to know current guidelines from the USPSTF, ACS, and ACOG — including age-specific intervals. These are high-yield because the guidelines are concrete and testable.
Show answer & rationale
A — Screening mammogram every 1-2 years: Correct. The USPSTF (2024) recommends mammography every 2 years for women 40-74. The American Cancer Society recommends yearly screening from 45 to 54, then every 2 years from 55, with the option to continue yearly. At 56, screening every 1-2 years fits both guidelines.
B — Colonoscopy every 10 years: Correct. The USPSTF and ACS recommend colorectal cancer screening beginning at age 45 for average-risk individuals. Colonoscopy every 10 years is one of several accepted modalities (alternatives include annual FIT, FIT-DNA every 3 years, or CT colonography every 5 years). At age 56 with no significant history, a colonoscopy every 10 years is standard.
C — Pap smear every 3-5 years: Correct. For women aged 30-65, the USPSTF recommends cervical cancer screening by Pap smear every 3 years, HPV testing every 5 years, or co-testing (Pap + HPV) every 5 years. At age 56, this client is within the screening window.
F — Blood pressure screening: Correct. The USPSTF (Grade A, 2021) recommends hypertension screening for adults 18 and older and suggests annual screening from age 40. At 56, this client should have her blood pressure checked every year, and elevated office readings should be confirmed with measurements outside the clinical setting before a diagnosis is made.
Why the other answers are wrong:
D — DEXA scan: The USPSTF recommends bone density screening with DEXA for women aged 65 and older, or for younger postmenopausal women with risk factors (low body weight, family history of fracture, glucocorticoid use, smoking, excessive alcohol). A 56-year-old with no significant history does not meet the criteria for routine DEXA screening.
E — Annual chest X-ray: Routine chest X-rays are not recommended for asymptomatic individuals. Low-dose CT (not chest X-ray) is recommended for lung cancer screening, but only for adults aged 50-80 with a 20-pack-year smoking history who currently smoke or quit within the past 15 years. This client has no indicated risk factors.
Clinical pearl: For screening questions, always consider three variables: the client’s age, sex, and risk factors. The NCLEX tests whether you can match the right screening to the right population. Memorize the age cutoffs for mammography (40-45 to start, depending on guideline), colonoscopy (45), cervical cancer (21-65), and DEXA (65 for women, or earlier with risk factors).
Next Generation NCLEX: Drag-and-Drop (Cloze)
The Next Generation NCLEX introduced six new item types designed to test clinical judgment more rigorously. Drag-and-drop classification questions ask you to sort interventions, findings, or actions into categories — typically “Indicated vs. Contraindicated,” “Expected vs. Unexpected,” or “Effective vs. Ineffective.” You must evaluate each item individually against the clinical scenario. Here is an example.
Classify each intervention as INDICATED or CONTRAINDICATED for this client.
Show answer & rationale
| Intervention | Classification |
|---|---|
| Establish two large-bore IV access sites | INDICATED |
| Obtain type and crossmatch | INDICATED |
| Administer IV proton pump inhibitor | INDICATED |
| Maintain NPO status | INDICATED |
| Administer aspirin or NSAIDs | CONTRAINDICATED |
| Administer warfarin | CONTRAINDICATED |
| Apply heat to the abdomen | CONTRAINDICATED |
| Encourage oral fluid intake | CONTRAINDICATED |
INDICATED interventions explained:
Two large-bore IVs: This client is hemodynamically unstable. Two large-bore peripheral IVs (16-gauge or 18-gauge) are essential for rapid volume resuscitation with crystalloid or blood products. A single IV is insufficient for the volume of fluid this client may need.
Type and crossmatch: With active GI hemorrhage and signs of shock, this client will likely need packed red blood cells. Type and crossmatch must be sent immediately so blood is available when needed. Do not wait for the hemoglobin result — clinical signs of hemorrhagic shock are indication enough.
IV proton pump inhibitor: IV PPI (e.g., pantoprazole 80 mg bolus followed by 8 mg/hour infusion) reduces gastric acid secretion, promotes clot stability over a bleeding vessel, and reduces the risk of rebleeding. It is commonly started while awaiting endoscopy, and ACG guidelines recommend high-dose PPI therapy after endoscopic hemostasis.
NPO status: The client should remain NPO for two reasons: (1) they may need emergent endoscopy, which requires an empty stomach to reduce aspiration risk, and (2) oral intake could provoke further vomiting, which increases pressure on a bleeding vessel.
CONTRAINDICATED interventions explained:
Aspirin/NSAIDs: These inhibit platelet aggregation and are directly toxic to gastric mucosa. Aspirin irreversibly inhibits COX-1, impairing the platelet plug that may be the only thing slowing the hemorrhage. NSAIDs are one of the most common causes of GI bleeds. Administering either would worsen bleeding.
Warfarin: Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors (II, VII, IX, X). In an actively bleeding patient, adding anticoagulation is dangerous. If this client were already on warfarin, the priority would be to reverse it (vitamin K, PCC, or FFP).
Heat to abdomen: Heat causes vasodilation, which increases blood flow to the area and can worsen hemorrhage. In any active bleeding situation, heat application is contraindicated. Cold application may be considered in some contexts, but the immediate priority here is IV resuscitation, not topical measures.
Oral fluids: The client needs IV volume resuscitation, not oral fluids. Oral intake is contraindicated because (1) the client is vomiting blood — oral fluids will likely be vomited, (2) the client needs to be NPO for potential endoscopy, and (3) oral fluids cannot provide the volume or speed of resuscitation this patient requires.
Clinical pearl: For NGN drag-and-drop questions, evaluate each item in isolation against the clinical picture. Ask yourself: “Does this intervention help stabilize this patient, or does it risk making things worse?” In any acute hemorrhage scenario, the contraindicated items will always include anticoagulants, antiplatelet agents, vasodilators, heat, and anything that delays definitive treatment.
You just worked through sample questions across every major NCLEX category. Keep the momentum — create a free NCLEX Key account and practice more, with a full rationale on every answer. No credit card.
How to Get the Most Out of Practice Questions
Doing practice questions without a strategy is like running on a treadmill — effort without progress. Here is how to make every question count.
Read every rationale, even on questions you get right. The rationale is where the learning happens. If you got a question correct but for the wrong reason, you have a knowledge gap that will surface on harder questions. Read why each incorrect option is wrong. That is where the NCLEX pulls its distractors from.
Track your weak areas by category. After every practice session, look at which NCLEX categories you are scoring lowest in. If you are consistently missing Pharmacology and Management of Care questions, those become your study priorities. Do not keep practicing what you already know well — it feels productive but it is not.
Simulate real test conditions. At least once a week, do a timed practice session with no notes, no phone, and no pausing. The NCLEX is a timed exam with a maximum of 5 hours. Building stamina and managing test anxiety are skills that only develop under realistic conditions.
Review wrong answers the same day. Studying the rationale for each miss is what corrects the error, and spaced repetition research shows that revisiting the same material again a few days later produces stronger long-term retention than a single review. When you finish a practice quiz, go back through every wrong answer before you close your laptop.
Do not memorize questions — learn the principle. The NCLEX will never give you the exact same question you practiced. But it will test the same underlying principles in different clinical contexts. When you study a rationale, ask yourself: “What is the general rule here that applies to other situations?”
Looking for more free practice? See the best free NCLEX practice questions in 2026, including official NCLEX.com resources.
Frequently Asked Questions
Are the NCLEX practice questions on this page free?
Yes. Every sample question here and all 49 practice sets in this page’s free library are completely free, and each question includes a full rationale that explains why the correct answer is right and why every other option is wrong. Creating a free NCLEX Key account (no credit card required) gives you more questions to practice with.
How many free NCLEX practice questions are there?
The free library on this page links to 49 practice sets — 480 NCLEX-style practice questions in total — spanning the full NCLEX-RN test plan, from pharmacology and med-surg to OB, pediatrics, mental health, and leadership. Each set focuses on one high-yield topic so you can target your weak areas.
Do these questions include Next Generation NCLEX (NGN) items?
Yes. This page includes a Next Gen NCLEX drag-and-drop (cloze) example, and our question bank includes NGN-style item types so you can practice the clinical-judgment format the current NCLEX uses.
Is a rationale included for every question?
Yes. Every question comes with a complete rationale — not just the correct answer, but an explanation of why each distractor is wrong, plus clinical pearls. Reading the rationale for every question, even the ones you get right, is the fastest way to close knowledge gaps.
How should I use practice questions to prepare for the NCLEX?
Do questions actively under exam-like conditions, then read the rationale for every answer. Track which NCLEX categories you score lowest in and prioritize those, review your wrong answers the same day, and focus on learning the underlying principle rather than memorizing individual questions.
Continue Studying
- The Complete NCLEX-RN Study Guide — A structured prep plan from your first day of studying through exam day.
- Next Generation NCLEX (NGN) Question Types Explained — Breakdowns and strategies for all 6 NGN item types.
- NCLEX Pharmacology Review — Drug classes, mechanisms, side effects, and nursing considerations for the highest-yield medications.
- How the NCLEX CAT Algorithm Works — Understanding the computerized adaptive testing engine and what it means when your exam shuts off.
New — practice the 6 Next Gen NCLEX formats: our Next Generation NCLEX practice questions walk through a bow-tie, matrix, cloze, highlight, extended-response, and trend-style data item, each with a full rationale.
NCLEX Practice Questions by Topic
Browse the full free library — 49 practice sets, 480 NCLEX-style questions, every answer with a complete rationale. Pick a topic and start practicing.
Fundamentals, Safety & Leadership
- Fundamentals & Safety — Falls, restraints, fire safety (RACE/PASS), seizure care
- Delegation & Assignment — RN/LPN/UAP scope, five rights of delegation, safe assignment
- Prioritization & Triage — Which client first — ABCs, Maslow, START triage
- Nursing Ethics & Legal — Autonomy, advance directives, HIPAA, mandatory reporting
- Therapeutic Communication — Best responses, blocks to avoid, empathy vs sympathy
- Infection Control & Precautions — Standard, contact, droplet & airborne precautions, PPE
Pharmacology, Dosage & Pain
- Pharmacology — Insulin, heparin, digoxin, opioids, ACE inhibitors, lithium
- Dosage Calculation — Oral doses, IV drip rates, weight-based & safe-dose math
- Pain Management — Self-report, pain scales, WHO ladder, opioid safety, PCA
- Psychiatric Medications — Antipsychotic EPS, clozapine, SSRIs, MAOIs, lithium
Cardiac, Circulatory & Blood
- Cardiac — ACS/MI, heart failure, A-fib, nitroglycerin, beta-blockers
- Cardiac Dysrhythmias & ECG — Sinus, a-fib, SVT, VT/VF — shockable vs non-shockable
- Shock — The 4 categories, sepsis bundle, anaphylaxis, neurogenic
- Hematology & Transfusion — Transfusion reactions, anemias, sickle cell, HIT, DIC
Respiratory & Acid-Base
- Respiratory — Asthma, COPD, chest tubes, PE, TB, oxygen devices
- Respiratory Procedures & Airway — Suctioning, tracheostomy, ventilator alarms, VAP
- Acid-Base & ABG — ABG interpretation with ROME, compensation, 4 disorders
Fluids, Electrolytes, Labs & Diagnostics
- Fluids & Electrolytes — IV fluid tonicity, fluid volume deficit vs excess, electrolytes
- IV Therapy & Central Lines — Infiltration, air embolism, PICC/port care, CLABSI, TPN
- Lab Values — Potassium, digoxin, INR, ABGs — when to act vs hold
- Diagnostic Tests & Procedures — LP, paracentesis, thoracentesis, cardiac cath, contrast
Endocrine, GI & Genitourinary
- Endocrine — Diabetes, DKA/HHS, thyroid, adrenal, SIADH & DI
- Thyroid, Adrenal & Pituitary — Hypo/hyperthyroid, thyroid storm, Addison vs Cushing
- Diabetes Management — DKA vs HHS, rule of 15, insulin, sick-day rules, foot care
- Gastrointestinal (GI) — GI bleed, cirrhosis, pancreatitis, IBD, ostomy care
- Renal & Genitourinary — AKI vs CKD, TURP/CBI, nephrotic syndrome, dialysis
Neuro, Musculoskeletal, Skin & Immune
- Neuro — Stroke/tPA, increased ICP, seizures, autonomic dysreflexia
- Musculoskeletal (MSK) — Compartment syndrome, fat embolism, hip precautions, traction
- MSK Devices & Mobility — Crutch gaits, cane & walker use, traction, cast care
- Integumentary & Burns — Parkland formula, burn depth, pressure-injury staging
- Wound Care & Ostomy — Healing phases, dressings, drains, stoma assessment
- Oncology & Cancer Care — Neutropenic precautions, radiation safety, emergencies
- Immune & Immunology — HIV/AIDS, autoimmune, anaphylaxis, transplant, vaccines
Maternal, Newborn & Child
- Antepartum & High-Risk Pregnancy — Naegele's, GTPAL, preeclampsia, previa vs abruptio
- Maternity (OB) — FHR decelerations, labor stages, prolapsed cord, L&D
- Newborn & Postpartum — Apgar, reflexes, jaundice, BUBBLE-HE, hemorrhage
- Pediatric (Peds) — Epiglottitis vs croup, RSV, tet spells, poison safety
- Growth & Development — Erikson, Piaget, play by age, immunizations, prevention
Mental Health, Older Adult & Whole-Person Care
- Mental Health (Psych) — Suicide risk, therapeutic response, NMS, withdrawal
- Gerontology & Older Adult — Delirium vs dementia, Beers criteria, falls, elder abuse
- Community & Public Health — Incidence vs prevalence, immunity, prevention levels
- End-of-Life & Palliative Care — Palliative vs hospice, signs of dying, double effect
- Emergency & Trauma — ABCDE primary survey, ESI triage, antidotes, heat stroke
- Perioperative Nursing — Consent, malignant hyperthermia, PACU, evisceration
- Bow-Tie (NGN) — Central condition, actions to take, parameters to monitor
- Matrix / Grid (NGN) — Multiple-response grids scored per row
- Cloze / Drop-Down (NGN) — Fill-in-the-blank clinical sentences
- Highlight (NGN) — Select the relevant findings in a chart or passage
- Trend (NGN) — Interpret changing data across timepoints
Practice questions like these
Put it to the test with NCLEX-style practice questions — free, full rationale on every answer. No credit card.
Start Practicing FreeSources
- NCSBN 2026 NCLEX-RN Test Plan — Management of Care is 15-21% of the RN exam, the largest category
- NCSBN Help Center: What are the current scoring models? — SATA items use +/- scoring: points subtracted for incorrect selections, floored at 0
- American Cancer Society: Recommendations for the Early Detection of Breast Cancer — Annual mammograms at 45-54; at 55+ switch to every 2 years or continue yearly
- USPSTF: Cervical Cancer Screening — Ages 30-65: cytology every 3 years, hrHPV every 5 years, or cotesting every 5 years
- USPSTF: Hypertension in Adults Screening — Grade A BP screening for adults 18+, annually from age 40
- USPSTF: Lung Cancer Screening — LDCT for ages 50-80, 20 pack-years, current smokers or quit within 15 years
Sources checked September 2026.