NGN practice questions

Practice 3 free Next Generation NCLEX questions. Answer here and read option-by-option rationales.

Practice resource · 2026 · Updated 27 October 2026

Independent practice material; not official exam items.

About the author

Jo-Fan Pan, RN, PhD, medical school professor

Price and free access

Free: 3 questions and every option rationale on this page, with no account or payment required. The separate free check contains 30 questions. Listed full-bank plan: USD 49 / 90 days.

Practice features

Answer in place · Option-by-option rationales · Topic index · Keyboard controls

1 · Reduction of Risk Potential

[Case Study 1, Screen 1: 0800 nurses' notes, vital signs, and 0815 laboratory results.] The nurse reviews the client's information. Select the findings that require follow-up. Select all that apply.

Client chart

CLIENT
63-year-old woman. Weight 70 kg.
History: type 2 diabetes (takes metformin), hypertension (takes lisinopril).
Lives with spouse; independent in all activities; baseline fully oriented.
Home blood pressure readings usually about 132/78 mm Hg.

NURSES' NOTES - 0800
Spouse reports the client has been "sleepy and confused" since last night.
Client reports burning on urination for 3 days and has been eating and
drinking very little for 2 days. Oriented to person only. Skin warm and
flushed; mucous membranes dry. Reports right flank pain, 5/10. Lungs clear
bilaterally. Capillary refill 3 seconds. Last voided a small amount of dark
urine early this morning.

VITAL SIGNS - 0800
Temperature      39.0°C (102.2°F)
Heart rate       116/min
Respiratory rate 24/min
Blood pressure   88/50 mm Hg (MAP 63 mm Hg)
SpO2             95% on room air

LABORATORY RESULTS - 0815            Result            Reference range
WBC                                  18,600/mm³        5,000-10,000/mm³
  Bands                              14%               0-5%
Lactate                              4.1 mmol/L        0.5-2.0 mmol/L
Creatinine                           1.9 mg/dL         0.5-1.1 mg/dL
  (baseline 1 month ago: 0.9 mg/dL)
BUN                                  40 mg/dL          7-20 mg/dL
Glucose (random)                     238 mg/dL         70-140 mg/dL
Sodium                               137 mEq/L         135-145 mEq/L
Potassium                            4.6 mEq/L         3.5-5.0 mEq/L
Platelets                            172,000/mm³       150,000-400,000/mm³
Urinalysis: cloudy; nitrite positive; leukocyte esterase positive;
            WBC more than 50/hpf

Answer and option-by-option rationales

A, C, D, F

A. Oriented to person only
New disorientation can indicate acute organ dysfunction.
B. Lungs clear bilaterally
Clear lungs do not establish sepsis-related organ dysfunction.
C. Respiratory rate 24/min
Tachypnea is a concerning systemic response in this case.
D. Blood pressure 88/50 mm Hg
Hypotension indicates impaired perfusion.
E. Potassium 4.6 mEq/L
The potassium is within the supplied interval.
F. Lactate 4.1 mmol/L
Elevated lactate supports impaired perfusion or severe illness.

Question permalink · Q49

2 · Physiological Adaptation

[Case Study 1, Screen 1.] For each finding, indicate whether it localizes the source of infection or indicates sepsis-related organ dysfunction or hypoperfusion. Each row has one answer. Grid columns: Localizes the source of infection | Indicates organ dysfunction or hypoperfusion.

Client chart

CLIENT
63-year-old woman. Weight 70 kg.
History: type 2 diabetes (takes metformin), hypertension (takes lisinopril).
Lives with spouse; independent in all activities; baseline fully oriented.
Home blood pressure readings usually about 132/78 mm Hg.

NURSES' NOTES - 0800
Spouse reports the client has been "sleepy and confused" since last night.
Client reports burning on urination for 3 days and has been eating and
drinking very little for 2 days. Oriented to person only. Skin warm and
flushed; mucous membranes dry. Reports right flank pain, 5/10. Lungs clear
bilaterally. Capillary refill 3 seconds. Last voided a small amount of dark
urine early this morning.

VITAL SIGNS - 0800
Temperature      39.0°C (102.2°F)
Heart rate       116/min
Respiratory rate 24/min
Blood pressure   88/50 mm Hg (MAP 63 mm Hg)
SpO2             95% on room air

LABORATORY RESULTS - 0815            Result            Reference range
WBC                                  18,600/mm³        5,000-10,000/mm³
  Bands                              14%               0-5%
Lactate                              4.1 mmol/L        0.5-2.0 mmol/L
Creatinine                           1.9 mg/dL         0.5-1.1 mg/dL
  (baseline 1 month ago: 0.9 mg/dL)
BUN                                  40 mg/dL          7-20 mg/dL
Glucose (random)                     238 mg/dL         70-140 mg/dL
Sodium                               137 mEq/L         135-145 mEq/L
Potassium                            4.6 mEq/L         3.5-5.0 mEq/L
Platelets                            172,000/mm³       150,000-400,000/mm³
Urinalysis: cloudy; nitrite positive; leukocyte esterase positive;
            WBC more than 50/hpf

Answer and option-by-option rationales

A: Indicates organ dysfunction or hypoperfusion; B: Localizes the source of infection; C: Indicates organ dysfunction or hypoperfusion; D: Indicates organ dysfunction or hypoperfusion; E: Localizes the source of infection; F: Localizes the source of infection

A. New confusion (oriented to person only)
Acute confusion represents neurologic dysfunction.
B. Burning on urination for 3 days
Dysuria helps localize a urinary source.
C. Creatinine 1.9 mg/dL (baseline 0.9 mg/dL)
The acute creatinine rise indicates renal dysfunction.
D. Lactate 4.1 mmol/L
Elevated lactate indicates systemic illness or hypoperfusion.
E. Cloudy, nitrite-positive urine with more than 50 WBC/hpf
Nitrite-positive pyuria helps identify the urinary source.
F. Right flank pain
Flank pain supports an upper urinary source.

Question permalink · Q50

3 · Reduction of Risk Potential

[Case Study 1, Screen 3: 1300 nurses' notes, vital signs, and 1230 laboratory results.] For each finding, indicate whether it shows improvement or requires follow-up. Each row has one answer. Grid columns: Indicates improvement | Requires follow-up.

Client chart

CLIENT
63-year-old woman. Weight 70 kg.
History: type 2 diabetes (takes metformin), hypertension (takes lisinopril).
Lives with spouse; independent in all activities; baseline fully oriented.
Home blood pressure readings usually about 132/78 mm Hg.

NURSES' NOTES - 0800
Spouse reports the client has been "sleepy and confused" since last night.
Client reports burning on urination for 3 days and has been eating and
drinking very little for 2 days. Oriented to person only. Skin warm and
flushed; mucous membranes dry. Reports right flank pain, 5/10. Lungs clear
bilaterally. Capillary refill 3 seconds. Last voided a small amount of dark
urine early this morning.

VITAL SIGNS - 0800
Temperature      39.0°C (102.2°F)
Heart rate       116/min
Respiratory rate 24/min
Blood pressure   88/50 mm Hg (MAP 63 mm Hg)
SpO2             95% on room air

LABORATORY RESULTS - 0815            Result            Reference range
WBC                                  18,600/mm³        5,000-10,000/mm³
  Bands                              14%               0-5%
Lactate                              4.1 mmol/L        0.5-2.0 mmol/L
Creatinine                           1.9 mg/dL         0.5-1.1 mg/dL
  (baseline 1 month ago: 0.9 mg/dL)
BUN                                  40 mg/dL          7-20 mg/dL
Glucose (random)                     238 mg/dL         70-140 mg/dL
Sodium                               137 mEq/L         135-145 mEq/L
Potassium                            4.6 mEq/L         3.5-5.0 mEq/L
Platelets                            172,000/mm³       150,000-400,000/mm³
Urinalysis: cloudy; nitrite positive; leukocyte esterase positive;
            WBC more than 50/hpf


NURSES' NOTES - 1000
Blood cultures x2 drawn at 0820. Piperacillin-tazobactam IV started at 0835.
Lactated Ringer's solution 2,100 mL IV completed at 0955. Client is lethargic
but arousable. Extremities cool. Indwelling urinary catheter inserted at 0830;
25 mL of urine since insertion.

VITAL SIGNS - 1000
Temperature      38.6°C (101.5°F)
Heart rate       124/min
Respiratory rate 26/min
Blood pressure   80/44 mm Hg (MAP 56 mm Hg)
SpO2             94% on room air

PROVIDER PRESCRIPTIONS - 1000
- Norepinephrine continuous IV infusion; titrate to maintain MAP at or
  above 65 mm Hg.
- Central venous catheter insertion when the provider is available
  (estimated 1 to 2 hours).

IV ACCESS
- 18-gauge peripheral IV, right upper forearm (proximal, below the elbow
  crease): patent, no redness or swelling.
- 20-gauge peripheral IV, dorsum of left hand: patent.


NURSES' NOTES - 1300
Norepinephrine infusing through the right forearm peripheral IV; central
venous catheter insertion delayed because the provider is attending an
emergency. Client is awake and oriented to person, place, and time.
Right forearm IV site: skin around the site is pale, cool, and swollen.
Urine output 45 mL/h for each of the past 2 hours.

VITAL SIGNS - 1300
Temperature      37.9°C (100.2°F)
Heart rate       102/min
Respiratory rate 20/min
Blood pressure   102/56 mm Hg (MAP 71 mm Hg)
SpO2             96% on room air

LABORATORY RESULTS - 1230            Result            Reference range
Lactate                              1.6 mmol/L        0.5-2.0 mmol/L
Platelets                            96,000/mm³        150,000-400,000/mm³

Answer and option-by-option rationales

A: Indicates improvement; B: Indicates improvement; C: Requires follow-up; D: Indicates improvement; E: Requires follow-up; F: Indicates improvement

A. Oriented to person, place, and time
Return of orientation indicates improved neurologic function.
B. Mean arterial pressure 71 mm Hg
The MAP has improved above the stated treatment target.
C. Skin around the right forearm IV site is pale, cool, and swollen
Pale cool swelling suggests extravasation; stop that site and maintain prescribed support via suitable alternate access while activating treatment.
D. Lactate 1.6 mmol/L
Lactate has decreased toward the supplied normal range.
E. Platelet count 96,000/mm³
The platelet decline indicates new coagulation dysfunction requiring follow-up.
F. Urine output 45 mL/h for each of the past 2 hours
Urine output has improved from the earlier low-output state.

Question permalink · Q54

Continue your practice

Try the free 30 questions View paid plan and availability

NCLEX practice questions with rationales

FAQ

How many questions are free?

3 questions and their option-by-option rationales are free on this page. The separate free check has 30 questions.

How do I view the rationales?

Select an answer and choose Check answer & show rationales. You can also open the answer section directly.

Are these official exam questions?

Independent practice material; not official exam items.

What does paid access cost?

USD 49 / 90 days. See the plan page for availability and terms.