NCLEX-RN practice questions for the 2026 test-plan period.

Answer: Absent bowel sounds with distention, gastric residual 350 mL, and emesis.

Absent bowel sounds with distention, a high gastric residual, and vomiting indicate intolerance and are indications to hold the feeding. Gastric pH of 4.5 confirms gastric placement. Glucose 165 is treated per correction scale. SpO₂ 96% is normal.

Study tip: Any single sign of GI intolerance = hold and reassess. Aspiration is a top NCLEX-tested harm.

Answer: "I will take ibuprofen if I get a headache."

NSAIDs inhibit platelet aggregation and irritate the gastric mucosa, potentiating bleeding with warfarin. Acetaminophen is preferred. The other statements demonstrate correct bleeding precautions and consistent vitamin K intake.

Study tip: Warfarin + NSAID = bleed. Warfarin + vitamin K = ↓INR. Keep both steady.

Answer: aPTT

aPTT is used to monitor unfractionated heparin (therapeutic 1.5–2.5× control). PT/INR monitor warfarin. Platelets are monitored for HIT but do not measure therapeutic effect.

Study tip: Heparin → aPTT. Warfarin → PT/INR. Memorize the pair.

Answer: A stable client requiring assistance with a bed bath and oral care.

Delegate stable, predictable, uncomplicated tasks (bath, oral care, stable VS) to AP. First ambulation, sterile suctioning, and blood administration require RN assessment.

Study tip: Stable + predictable + non-invasive = delegatable. Anything with judgment stays with the RN.

Answer: Pinpoint pupils, RR 6/min, decreased LOC.

The opioid toxidrome is miosis, respiratory depression, and CNS depression. Other options describe sympathomimetic, serotonergic, or withdrawal syndromes.

Study tip: Opioid triad: pinpoint pupils, ↓RR, ↓LOC. Give naloxone.

Answer: "This is a lot to take in. I'll be nearby if you want to talk."

The nurse acknowledges feelings and offers presence without pressuring interaction. "Why" questions can feel confrontational; false reassurance and dismissive statements block communication.

Study tip: Therapeutic = acknowledge feelings + offer presence. Avoid "why", false reassurance, and advice.

Answer: The client with stable COPD receiving scheduled nebulizer treatments.

The LPN/LVN cares for clients whose condition is stable and whose outcomes are predictable. New-onset chest pain and the immediate post-thyroidectomy client are unstable and need registered-nurse assessment; initial teaching about a new device must be initiated by the RN, although the LPN/LVN may reinforce it afterwards.

Study tip: Stable + predictable = LPN. New, unstable, or first-time teaching = RN.

Answer: Vital signs, assisted ambulation, intake and output, and a bed bath.

Unlicensed assistive personnel may perform standard, unchanging tasks on stable clients. Reinforcing teaching requires a licensed nurse, and evaluating the effect of a medication is nursing judgement that cannot be assigned.

Study tip: If the task needs teaching, judgement, or evaluation, it cannot go to a UAP.

Answer: Apical pulse of 52 beats per minute.

Digoxin slows conduction, and an apical rate below 60 beats per minute in an adult is the standard parameter for holding the dose and reporting. The blood pressure and potassium are within expected limits; a different-looking tablet should be verified but is not the priority hold parameter.

Study tip: Count the apical pulse for a full minute before every digoxin dose.

Answer: Negative-pressure room with an N95 respirator worn on entry.

Tuberculosis requires airborne precautions: an airborne-infection isolation room with negative pressure, the door kept closed, and a fit-tested N95 respirator for every person entering. A surgical mask on the client is used only for transport.

Study tip: Airborne = private negative-pressure room, door closed, N95 on the nurse.