Free NCLEX-RN Practice Questions (with Rationales)
These 18 free NCLEX-RN practice questions cover the areas the exam leans on most: pharmacology, prioritization, safety, lab values and infection control. Answer each one, then read the rationale; the reasoning is what transfers to new questions on test day. When you finish, you can keep going with 10 more questions in the free practice bank, no account needed.
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Progress Note Editorial
Evidence-based · For exam prep, not medical advice
update Updated October 2026
Date of last content change
Built by surgery and anesthesiology residents·Written for the NCLEX-RN
High-Yield Topics Covered
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Medication toxicity and antidotes
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Electrolytes and lab values
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Prioritization (ABCs) and delegation
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Infection control and isolation
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Safety and therapeutic communication
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Maternity and insulin safety
Question 1 of 18Score: 0 / 0
Q1Pharmacology
A client takes digoxin. Which finding suggests digoxin toxicity?
Explanation: Digoxin toxicity classically causes visual changes (yellow-green halos), bradycardia, nausea and confusion. Hold the dose and report; check the digoxin level and potassium, because hypokalemia increases the risk of toxicity.
Q2Pharmacology
Which medication reverses the effect of warfarin?
Explanation: Warfarin blocks the vitamin K–dependent clotting factors (II, VII, IX, X), so vitamin K reverses it. Protamine sulfate reverses heparin; naloxone reverses opioids; flumazenil reverses benzodiazepines.
Q3Pharmacology
Which medication reverses unfractionated heparin?
Explanation: Protamine sulfate binds and neutralizes heparin. Monitor the aPTT for heparin therapy; vitamin K is the reversal agent for warfarin.
Q4Lab values
What is the normal adult serum potassium range?
Explanation: Normal serum potassium is about 3.5–5.0 mEq/L. Both low and high potassium can cause dangerous dysrhythmias, which is why potassium is a priority lab.
Q5Lab values
A client’s potassium is 6.4 mEq/L. Which ECG change does the nurse expect?
Explanation: Hyperkalemia typically produces tall, peaked T waves and can progress to widened QRS and life-threatening rhythms. U waves are associated with hypokalemia.
Q6Physiological adaptation
Which position best eases breathing for a client with dyspnea?
Explanation: High Fowler’s lets the diaphragm move down and the lungs expand, making breathing easier. Supine and Trendelenburg push abdominal contents against the diaphragm.
Q7Pharmacology
Which lab values does the nurse monitor for a client taking lithium?
Explanation: Lithium has a narrow therapeutic range, so serum levels are monitored. Low sodium or dehydration raises lithium levels and the risk of toxicity, so sodium and fluid intake matter too.
Q8Prioritization
A client reports crushing chest pain. Which action should the nurse take first?
Explanation: Suspected acute coronary syndrome needs a 12-lead ECG right away to look for a heart attack. Current guidelines give oxygen only if the oxygen saturation is low (below 90%), not routinely.
Q9Prioritization
Which client should the nurse assess first?
Explanation: Stridor signals upper-airway narrowing, an airway problem that can become life-threatening quickly. Using the ABCs (airway, breathing, circulation), the airway problem comes first.
Q10Delegation
Which task can the RN delegate to unlicensed assistive personnel (UAP)?
Explanation: Routine tasks on stable clients, such as vital signs, can be delegated. Assessment, teaching and evaluation require nursing judgment and stay with the RN.
Q11Infection control
A client has Clostridioides difficile infection. Which precautions are required?
Explanation: C. difficile spreads by contact and forms spores that alcohol hand rub does not reliably kill, so use contact precautions and wash hands with soap and water.
Q12Infection control
A client has suspected pulmonary tuberculosis. What does the nurse implement?
Explanation: TB spreads through airborne particles. The client goes in an airborne-infection isolation (negative-pressure) room, and staff wear a fit-tested N95 respirator.
Q13Pharmacology
A client taking an MAOI should avoid which food?
Explanation: MAOIs plus tyramine-rich foods (aged cheese, cured meats, tap beer, fermented products) can cause a hypertensive crisis. Fresh foods are low in tyramine.
Q14Pharmacology
When should the nurse give rapid-acting insulin lispro?
Explanation: Insulin lispro starts working in about 15 minutes, so it is given with or just before a meal. Giving it without food risks hypoglycemia.
Q15Maternity
A client has a boggy uterus and heavy bleeding after birth. What is the nurse’s first action?
Explanation: A boggy uterus suggests uterine atony, the most common cause of postpartum hemorrhage. Fundal massage helps the uterus contract and is the first action; then notify the provider and continue monitoring.
Q16Safety
Which action best reduces fall risk for an older adult at night?
Explanation: A low bed, a call light within reach and a night light reduce falls. Four raised side rails and restraints can increase injury risk and are not first-line fall prevention.
Q17Psychosocial
Which response is an example of therapeutic communication?
Explanation: Open-ended prompts invite the client to share. “Why” questions can sound judgmental, false reassurance shuts the conversation down, and “I know how you feel” shifts the focus to the nurse.
Q18Lab values
Which hemoglobin A1C value reflects good long-term glucose control for most adults with diabetes?
Explanation: For most adults with diabetes, an A1C below 7% is a common target (individual goals vary). A1C reflects average glucose over about 3 months.
Yes. All 18 questions and rationales on this page are free with no sign-up. You can also answer 10 more NCLEX-RN questions in the free practice bank without an account.
Are these questions like the real NCLEX?
They follow the content the NCLEX tests most, but the real exam is computerized adaptive (85–150 items, up to 5 hours) and includes Next Generation case studies. Practice case studies too; see our Next Generation NCLEX guide.
How many questions should I practice before the NCLEX?
There is no magic number. Steady daily practice with careful review of every rationale matters more than volume, and many students complete one or more full question banks before test day.
What topics should I study most for the NCLEX?
The 2026 NCLEX-RN test plan gives the most weight to Management of Care and Pharmacological and Parenteral Therapies, alongside safety, prioritization and physiological adaptation. Use your practice results to find your own weak areas.
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