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Free NCLEX practice questions with answers and rationales
Ten free NCLEX-style questions, one from each client-needs area of the official test plan. Pick your answer, check it, and read the rationale. Then choose a topic below for a focused set.
Practice by topic
Mixed practice set
Question 1 · Physiological Adaptation
The nurse reviews laboratory results for a client with severe preeclampsia and notes hemolysis, elevated liver enzymes, and a low platelet count. The nurse recognizes this as which condition?
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Answer: A. HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, and it is a severe variant of preeclampsia; delivery is the definitive treatment. Disseminated intravascular coagulation can occur as a complication in severe obstetric emergencies but is a different diagnostic picture involving widespread clotting and bleeding, not specifically defined by this lab triad. Gestational diabetes involves abnormal glucose metabolism and is unrelated to these liver and hematologic findings. Placenta previa is a placental location abnormality causing painless bleeding, not a hepatic/hematologic syndrome.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2
Question 2 · Health Promotion and Maintenance
A pregnant client asks the nurse whether it is safe for her to receive the varicella vaccine during this pregnancy. What is the nurse's best response?
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Answer: B. Varicella vaccine is a live attenuated vaccine, and live vaccines such as MMR and varicella are contraindicated during pregnancy due to theoretical risk to the fetus. There is no trimester during pregnancy in which this live vaccine becomes safe to administer. Co-administering an antiviral medication does not change the contraindication status of a live vaccine in pregnancy; the vaccine should be deferred until after delivery.
Checked against: OpenStax Maternal-Newborn Nursing, 20.3
Question 3 · Safety and Infection Control
The nurse is preparing to administer a chemotherapy agent. Which action is most appropriate to ensure safe administration?
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Answer: B. Chemotherapy agents are high-alert, cytotoxic medications that require verification by two nurses and the use of personal protective equipment (PPE) to protect both the client and the nurse from harmful exposure. Pharmacy verification does not replace the required nursing double-check at the bedside. Clients are not qualified to independently verify chemotherapy doses. The double-check must occur before administration, not documented afterward, to prevent an error from reaching the client.
Checked against: OpenStax Pharmacology for Nurses, 2.1; OpenStax Pharmacology for Nurses, 2.3
Question 4 · Pharmacological and Parenteral Therapies
Before administering the next scheduled dose of magnesium sulfate to a client with preeclampsia, which assessment should the nurse perform first?
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Answer: A. Deep tendon reflexes are the earliest indicator of magnesium toxicity and should be checked before every reassessment or dose, since reflexes disappear before respiratory depression or decreased urine output occur. Blood pressure and fetal heart rate are important ongoing assessments in preeclampsia but are not the specific early warning sign for magnesium toxicity. Urine specific gravity is not the parameter used to monitor magnesium toxicity; urine output volume (less than 30 mL/hr) is the relevant late sign, not specific gravity.
Checked against: OpenStax Maternal-Newborn Nursing, 12.2
Question 5 · Management of Care
Recognize cues: The nurse is assessing four clients at the start of the shift. Which client requires the MOST immediate follow-up?
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Answer: C. Potassium abnormalities jump the queue over other lab findings because both high and low potassium can stop the heart; a level of 5.8 mEq/L with peaked T waves indicates cardiac risk requiring immediate intervention. The client with an elevated BUN and normal creatinine likely has dehydration, not a kidney emergency, and can be addressed after the cardiac priority. A platelet count of 140,000/mm3 is only mildly low and the client has no bleeding, making this lower priority. An INR of 2.8 is within the therapeutic goal range of 2-3 for warfarin and requires no urgent action.
Checked against: OpenStax Pharmacology for Nurses, 40.4
Question 6 · Reduction of Risk Potential
A client with a history of coronary artery disease requests sumatriptan for a migraine. What is the nurse's priority action?
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Answer: D. Triptans such as sumatriptan (-triptan) cause vasoconstriction and are contraindicated in clients with coronary artery disease due to the risk of coronary vasospasm and myocardial ischemia, so the nurse should notify the provider before administering. Simply administering the drug as ordered would be unsafe given this contraindication. Giving water and encouraging rest do not address the underlying safety concern. The priority is to recognize the contraindication and communicate with the provider.
Checked against: OpenStax Pharmacology for Nurses, 12.2
Question 7 · Basic Care and Comfort
A patient reports difficulty breathing and asks to sit up. The nurse plans to place the patient in high Fowler's position. This means the head of the bed should be elevated to what degree range?
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Answer: A. High Fowler's position elevates the head of the bed 60-90 degrees and is used for dyspnea, eating, and reducing intracranial pressure. Semi-Fowler's is 30-45 degrees, which reduces aspiration risk but is lower than high Fowler's. Neither 15-30 degrees nor 90-120 degrees is a standard classification used in practice.
Checked against: OpenStax Clinical Nursing Skills, 14.4; OpenStax Fundamentals of Nursing, 13.3
Question 8 · Psychosocial Integrity
A patient in the psychiatric unit repeatedly asks the nurse open-ended questions to avoid discussing their own feelings and instead redirects conversation to unrelated topics. Which nursing response demonstrates the best therapeutic communication technique?
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Answer: B. The best therapeutic response uses an open-ended, reflective statement that gently points out the pattern and invites the patient back to exploring their feelings, which is consistent with therapeutic communication principles. Asking 'why' is an automatic wrong answer because it can make the patient feel defensive rather than supported. Offering false reassurance that the patient will feel better is not genuine and blocks honest expression of emotion. Actively changing the subject to discharge planning reinforces avoidance rather than helping the patient explore and process their feelings.
Checked against: OpenStax Clinical Nursing Skills, 3.1; OpenStax Psychiatric-Mental Health Nursing, 3.1
Question 9 · Health Promotion and Maintenance
Which nursing action is most effective in preventing hypoglycemia in a newborn at risk, such as an infant of a diabetic mother?
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Answer: C. Early and frequent feeding is the most effective way to prevent and manage neonatal hypoglycemia in at-risk infants such as those born to diabetic mothers or who are large for gestational age. Delaying the first feeding for 12 hours or withholding feeding until glucose results return would allow blood glucose to drop further and increase the risk of complications. Feeding only every 6 hours does not provide adequate frequency to maintain stable glucose levels in a newborn at risk for hypoglycemia.
Checked against: OpenStax Maternal-Newborn Nursing, 24.2
Question 10 · Reduction of Risk Potential
A client receiving heparin therapy has a platelet count that dropped from 250,000/mm3 to 90,000/mm3 over 3 days. Which action should the nurse take first?
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Answer: A. A significant drop in platelet count suggests heparin-induced thrombocytopenia (HIT), a serious complication that requires notifying the provider and discontinuing heparin, often with a switch to an alternative anticoagulant. Increasing the heparin infusion would be dangerous and worsen the condition. Protamine sulfate is used to reverse heparin-related bleeding, not first-line for HIT. Documenting this as an expected finding is unsafe because HIT requires prompt intervention to prevent thrombosis.
Checked against: OpenStax Pharmacology for Nurses, 20.2
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Frequently asked questions
Are these real NCLEX questions?
No. They are NCLEX-style practice questions written for NurseLingo and approved by a licensed RN. NCSBN does not release live exam items; its free official practice materials are linked from our NCLEX guide.
How many practice questions should I do?
There is no official number. What helps most is doing questions regularly and reading the rationale for every option, including the ones you got right, then revisiting the topics you miss.
About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.