Free NCLEX-PN Comprehensive Mixed Review Practice Test (Updated 2026)

1. A nurse is preparing to administer insulin to a client with diabetes. Which action by the nurse demonstrates adherence to the “Five Rights” of medication administration?

2. Which type of isolation precaution is required for a client diagnosed with Clostridioides difficile (C. diff) infection?

3. A nurse is caring for a client receiving a blood transfusion. Fifteen minutes after the transfusion begins, the client reports chills and lower back pain. What is the nurse’s priority action?

4. A nurse is preparing to insert a peripheral IV catheter. Which action best demonstrates aseptic technique during the procedure?

5. A nurse is preparing medications for two clients: one with a sulfa allergy and one without known allergies. The nurse notices that sulfamethoxazole-trimethoprim (Bactrim) and metformin vials are stored next to each other and look similar. What is the best action to prevent a medication error?

6. A nurse is caring for a client on contact precautions for MRSA. The nurse needs to take the client’s blood pressure and then assist with a wound dressing change. What is the correct sequence for personal protective equipment (PPE) use?

7. A nurse is preparing to administer high-alert medication (insulin) to a client. The medication order reads: “Insulin glargine 10 units SQ nightly.” The available insulin concentration is 100 units/mL. Which action ensures safe administration?

8. A nurse is caring for a client with a central venous catheter (CVC) used for antibiotic administration. The dressing over the insertion site is transparent, dry, and intact, and was changed 5 days ago. The client’s IV antibiotic is due. What is the appropriate nursing action?

9. A nurse is reviewing medication orders for a client admitted with sepsis. The client is currently receiving vancomycin IV every 12 hours. The provider orders gentamicin 80 mg IV every 8 hours. The nurse should recognize that this combination requires:

10. A nurse discovers that a controlled substance (oxycodone) was wasted during medication administration, but the waste was not witnessed by another nurse as required by facility policy. The medication was already administered to the client. What is the most appropriate action?

11. A patient with schizophrenia is being discharged home. The LPN is reviewing the medication schedule with the patient and family. Which statement by the family member indicates understanding of the antipsychotic medication regimen?

12. The LPN is caring for a patient who has been diagnosed with major depressive disorder. The patient states, “I don’t see the point in continuing treatment. Nothing will ever get better.” What is the priority nursing action?

13. An LPN is working with a psychiatric nursing assistant (PNA) on an inpatient mental health unit. Which task is most appropriate for the LPN to delegate to the PNA?

14. A patient with bipolar disorder is admitted during a manic episode. The patient has been talking rapidly, pacing the hallway, and has not slept for 48 hours. The patient refuses to eat, stating, “

15. When communicating with a patient who has hearing impairment and is experiencing acute anxiety, which action by the LPN demonstrates appropriate therapeutic communication?

16. The LPN is reviewing the medical record of a patient admitted with dementia. The family asks, “Why can’t we just restrain him when he gets agitated and tries to wander?” What is the best response by the LPN?

17. An LPN is caring for a patient from a different cultural background who has been diagnosed with post-traumatic stress disorder (PTSD). The patient’s family wants to perform a traditional healing ceremony in the hospital room. What is the most appropriate action by the LPN?

18. The LPN is documenting care for a patient with borderline personality disorder who exhibited self-harming behavior earlier in the shift. Which documentation entry is most appropriate?

19. A patient with obsessive-compulsive disorder (OCD) spends 45 minutes washing hands before meals. The LPN is planning care with the RN. Which intervention should be included in the care plan?

20. The LPN is participating in shift change report for a patient who was admitted voluntarily for depression but is now requesting discharge against medical advice (AMA). The patient states, “I’m not getting better, and I need to go home to my family.” Which action should the LPN take?

21. A nurse is teaching a client about dietary sources of protein for wound healing. Which food should the nurse recommend as the BEST source of complete protein?

22. A client with chronic obstructive pulmonary disease (COPD) reports difficulty sleeping due to shortness of breath when lying flat. Which position should the nurse recommend to promote better sleep?

23. A nurse is caring for a client who is 1 day postoperative following total hip replacement. Which intervention is MOST important for preventing complications during mobility?

24. A client with chronic lower back pain asks the nurse about non-pharmacological pain management techniques. The client states, “I don’t want to take more pills.” Which intervention should the nurse suggest FIRST?

25. A nurse is assessing a client who reports persistent fatigue despite sleeping 8-9 hours nightly. The client states, “I wake up feeling exhausted, and my spouse says I snore loudly.” Which condition should the nurse suspect and report to the RN?

26. Which statement by a client indicates understanding of stress management techniques taught by the nurse?

27. A nurse is providing wellness teaching to a group of older adults about preventing dehydration. Which statement by a participant indicates a need for further teaching?

28. A client with type 2 diabetes is being discharged. The client asks about exercise recommendations. Which instruction should the nurse include in the teaching plan?

29. A nurse is caring for a client who is 2 days postoperative and has not had a bowel movement. The client reports abdominal discomfort and bloating. Which intervention should the nurse implement FIRST?

30. A nurse is teaching a client about proper body mechanics to prevent injury during lifting. Which action by the client demonstrates correct understanding?

31. A nurse is monitoring a client who is 6 hours postoperative following an abdominal hysterectomy. Which assessment finding requires immediate notification of the healthcare provider?

32. Which intervention is most effective for preventing catheter-associated urinary tract infection (CAUTI) in a client with an indwelling urinary catheter?

33. A nurse is caring for a client with heart failure who has been receiving furosemide (Lasix) 40 mg IV twice daily. The nurse monitors for which electrolyte imbalance as the highest risk?

34. A nurse is documenting a client’s response to pain medication. Which documentation entry demonstrates the most complete and legally defensible nursing note?

35. A nurse is providing discharge teaching to a client newly diagnosed with type 2 diabetes. Which statement by the client indicates a need for further teaching about hypoglycemia prevention?

36. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. The client’s family member increases the oxygen to 6 L/min because the client “looks like they’re struggling to breathe.” What is the nurse’s priority action?

37. A nurse is monitoring a client receiving a continuous heparin infusion for deep vein thrombosis (DVT). The morning aPTT result is 98 seconds (normal: 25-35 seconds; therapeutic range: 46-70 seconds). The nurse should take which priority action?

38. A nurse receives a verbal order from a healthcare provider during an emergency: “Give epinephrine 1 mg IV push for asystole.” The nurse should take which action regarding this order?

39. A nurse is caring for a client who is 24 hours postoperative following a total hip arthroplasty. The client reports sudden onset of sharp chest pain and difficulty breathing. The nurse notes the client appears anxious and diaphoretic. Vital signs reveal heart rate 112 bpm, blood pressure 128/78 mmHg, respiratory rate 28 breaths/min, and oxygen saturation 91% on room air. Which condition should the nurse suspect as the priority concern?

40. A nurse is caring for four clients. Which client should the nurse assess first based on risk reduction principles?