Free NCLEX-RN Practice Test (2026) — NGN Clinical Judgment Questions

What the Current NCLEX-RN Looks Like

The NCLEX-RN uses computerized adaptive testing (CAT) and the Next Generation NCLEX (NGN) format introduced in 2023. Understanding the structure before you sit down is not optional — it directly affects how you pace yourself and how you approach each question.

• Question count: 85–150 items (CAT adjusts based on your performance)
• Time limit: 5 hours
• NGN case studies: 3 unfolding case studies, each with 6 questions (18 scored NGN items total)
• Standalone clinical judgment items: Approximately 10% of remaining questions
• Unscored pretest items: 15 items distributed throughout — you won't know which ones
• Passing standard: Based on demonstrated ability to practice nursing safely and effectively, not a fixed percentage score

The NGN format tests clinical judgment — your ability to recognize cues, analyze information, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Multiple-choice recall questions still exist but account for a smaller proportion of your score than they did before 2023.

Free NCLEX-RN Practice Questions

The questions below include traditional multiple-choice items and NGN-style clinical judgment questions. Work through them, then check your answers and explanations at the bottom.

Traditional Multiple Choice (10 Questions)

1. A nurse is caring for a client who has just returned from surgery and is receiving IV morphine via PCA. Which finding requires the nurse's immediate action?

   • A) Pain rating of 4/10 reported by the client
   • B) Respiratory rate of 8 breaths per minute
   • C) Blood pressure of 118/76 mmHg
   • D) Oxygen saturation of 95% on room air

2. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment finding should prompt the nurse to withhold the medication and notify the provider?

   • A) Apical pulse of 58 beats per minute
   • B) Blood pressure of 130/82 mmHg
   • C) Serum potassium of 3.2 mEq/L
   • D) Blood glucose of 104 mg/dL

3. A client with chronic kidney disease asks why they need to limit potassium in their diet. The nurse's best response is:

   • A) "Your kidneys can no longer filter potassium efficiently, which can cause dangerous heart rhythms."
   • B) "Potassium makes your kidneys work harder and accelerates the disease."
   • C) "High potassium levels cause fluid retention and worsen swelling."
   • D) "Your medication interacts with potassium and reduces its effectiveness."

4. Which of the following clients should the nurse prioritize first using the ABC framework?

   • A) A client with a blood glucose of 52 mg/dL who is alert and oriented
   • B) A client with a heart rate of 108 bpm and mild diaphoresis
   • C) A client with oxygen saturation of 88% on room air and use of accessory muscles
   • D) A client reporting severe abdominal pain rated 9/10

5. A nurse is teaching a client newly diagnosed with type 2 diabetes about foot care. Which statement by the client indicates a need for further teaching?

   • A) "I will inspect my feet daily for cuts or sores."
   • B) "I should soak my feet in hot water to improve circulation."
   • C) "I will wear shoes even when indoors."
   • D) "I should trim my toenails straight across."

6. A nurse is caring for a client in alcohol withdrawal. Which medication should the nurse anticipate administering?

   • A) Haloperidol
   • B) Naloxone
   • C) Lorazepam
   • D) Methadone

7. A client is in skeletal traction for a femur fracture. Which nursing action is the priority?

   • A) Ensure weights hang freely and off the floor
   • B) Reposition the client every 4 hours
   • C) Assess pin sites for signs of infection daily
   • D) Administer PRN analgesics before physical therapy

8. A nurse is preparing to perform a blood transfusion. Before hanging the blood, the nurse should:

   • A) Obtain vital signs, then begin the transfusion without delay
   • B) Verify the blood type and client identification with a second licensed nurse
   • C) Prime the IV tubing with normal saline, then switch to dextrose once blood begins
   • D) Pre-medicate the client with acetaminophen and diphenhydramine per standing orders

9. A client with a nasogastric tube in place reports nausea and the nurse observes abdominal distension. Which action should the nurse take first?

   • A) Administer an antiemetic as ordered
   • B) Check the NG tube placement and patency
   • C) Advance the tube 2–3 cm and reassess
   • D) Notify the physician immediately

10. Which of the following lab values is most consistent with early sepsis?

    • A) WBC 5,000/mm³, temperature 37.2°C, HR 68 bpm
    • B) WBC 18,000/mm³, temperature 38.9°C, HR 112 bpm
    • C) WBC 3,800/mm³, temperature 36.8°C, HR 78 bpm
    • D) WBC 8,500/mm³, temperature 37.5°C, HR 85 bpm

NGN Clinical Judgment — Unfolding Case Study

Read the scenario, then answer each question. Each question builds on the previous one.

Scenario: A 68-year-old client is admitted to the medical unit with a 3-day history of productive cough, fever, and progressive shortness of breath. Vital signs on admission: temperature 38.8°C (101.8°F), HR 102 bpm, RR 24 breaths/min, BP 106/68 mmHg, SpO₂ 89% on room air. The client appears fatigued and uses accessory muscles to breathe. Lung sounds reveal crackles in the right lower lobe.

11. Recognize Cues: Which findings from the admission assessment are most concerning and require immediate action? Select all that apply.

    • A) SpO₂ of 89% on room air
    • B) Temperature of 38.8°C
    • C) Respiratory rate of 24 breaths/min
    • D) Blood pressure of 106/68 mmHg
    • E) Heart rate of 102 bpm
    • F) Crackles in the right lower lobe

12. Analyze Cues: Based on the assessment findings, which condition is the priority hypothesis?

    • A) Pulmonary embolism
    • B) Community-acquired pneumonia with early sepsis
    • C) Congestive heart failure exacerbation
    • D) Chronic obstructive pulmonary disease exacerbation

13. Prioritize Hypotheses: The client's blood pressure drops to 92/58 mmHg 30 minutes after admission. Which condition should now be the nurse's primary concern?

    • A) Aspiration pneumonia
    • B) Septic shock
    • C) Anaphylaxis
    • D) Hypovolemic shock from dehydration only

14. Generate Solutions: Which of the following interventions should the nurse initiate first?

    • A) Apply supplemental oxygen and notify the provider immediately
    • B) Obtain a sputum culture, then wait for physician orders
    • C) Administer oral fluids and reassess in 30 minutes
    • D) Place the client in Trendelenburg position and call a rapid response

15. Take Action: The provider orders blood cultures × 2, IV piperacillin-tazobactam, IV fluid bolus 500 mL NS, and supplemental oxygen to maintain SpO₂ ≥ 94%. What is the correct sequence for the nurse to follow?

    • A) Start oxygen → Give antibiotics → Draw blood cultures → Begin IV fluids
    • B) Draw blood cultures → Start oxygen → Begin IV fluids → Give antibiotics
    • C) Start oxygen → Draw blood cultures → Begin IV fluids → Give antibiotics
    • D) Give antibiotics → Draw blood cultures → Start oxygen → Begin IV fluids

Answer Key & Explanations

Traditional Multiple Choice:

• 1 — B: Respiratory rate of 8 is opioid-induced respiratory depression — an airway/breathing emergency. Act immediately.
• 2 — C: Hypokalemia (K+ < 3.5) potentiates digoxin toxicity and fatal arrhythmias. Withhold and notify.
• 3 — A: Correct patient-centered explanation — impaired filtration leads to hyperkalemia and cardiac arrhythmia risk.
• 4 — C: SpO₂ 88% with accessory muscle use = respiratory failure. Airway/breathing always first.
• 5 — B: Hot water soaking risks burns due to diabetic neuropathy (impaired sensation). This is dangerous and incorrect.
• 6 — C: Benzodiazepines (lorazepam) are first-line for alcohol withdrawal to prevent seizures.
• 7 — A: Weights that rest on the floor eliminate traction — restoring traction is always the first priority.
• 8 — B: Two-nurse verification of blood product and patient identity is mandatory before transfusion begins.
• 9 — B: NG tube obstruction or displacement is the most likely cause — check patency before any other intervention.
• 10 — B: Elevated WBC, fever, and tachycardia meet SIRS criteria — consistent with early sepsis.

NGN Case Study:

• 11 — A, C, D: SpO₂ 89%, RR 24, and BP 106/68 are immediately actionable. Fever and tachycardia are concerning but secondary.
• 12 — B: Productive cough + fever + crackles + hypoxia + tachycardia = community-acquired pneumonia. Low BP suggests early sepsis.
• 13 — B: BP dropping to 92/58 with known infection = septic shock. This changes the clinical priority significantly.
• 14 — A: Oxygen is the most immediately life-saving intervention. Notify the provider simultaneously — don't wait.
• 15 — C: Oxygen first (immediate safety), then blood cultures (before antibiotics — cultures after antibiotics are unreliable), then IV fluids, then antibiotics.

What the Full NCLEX Tests Beyond This Sample

This 15-question set introduces the two main question formats. The real NCLEX includes:

• Three complete unfolding case studies (6 questions each) requiring sustained clinical reasoning across a patient's deteriorating condition
• Multiple select all that apply (SATA), drop-down rationale, extended multiple response, and matrix grid question formats
• 85–150 adaptive questions that increase in difficulty as you demonstrate competency
• Questions spanning all four client-needs categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity

A full NCLEX diagnostic — available free with a StudyBuddy account — identifies your weakest client-needs category, shows your clinical judgment score by NGN cognitive skill, and builds a personalized study schedule based on your target test date.

How to Prepare for the NGN Format Specifically

Most NCLEX failures in 2025–2026 are not content failures — they are clinical judgment failures. Students know the facts but struggle to apply them under time pressure in a deteriorating patient scenario.

• Practice the six cognitive skills explicitly. The NGN framework tests: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Practice identifying which skill each question is testing — this reframes how you approach case studies.
• Never answer NCLEX questions based on what you would do in a real clinical setting. Answer based on what a newly licensed RN with no experienced backup would do following the nursing process. Clinical shortcuts don't apply.
• Use the ABC + Maslow framework for prioritization questions. Airway, Breathing, Circulation take precedence. Physiological needs come before psychosocial needs. When in doubt, ask: what will kill this patient first?
• Build stamina, not just knowledge. Five hours of sustained clinical decision-making is physically and mentally demanding. Practice with full-length timed exams at least twice before your test date.