·15 min read

Free NCLEX Practice Questions (With Rationales)

Preparing for the NCLEX can feel overwhelming.

There is always another chapter to review, another set of notes to organize, another video lecture to watch. Many nursing students spend hours rereading material, highlighting pages, and making flashcards — only to sit down for practice questions and realize very little is actually sticking.

That's because passing the NCLEX is not about how much content you look at. It's about how well you can think like a nurse under pressure.

That means practicing questions that feel real. Clinical scenarios. Patient priorities. Medications that look familiar but have one dangerous detail hidden in the stem. The kind of questions that force you to slow down, assess, and choose the safest answer.

That's what this page is for.

Below are 25 free NCLEX-style practice questions with full clinical rationales, covering pharmacology, medical-surgical nursing, maternal-newborn, pediatrics, psychiatric nursing, fundamentals, and fluid & electrolytes.

Take your time. Answer honestly. Read every rationale — especially when you get a question right.

Sometimes the biggest lesson is hidden in why the other answers were wrong.

If you want practice built around your own ATI chapters, lecture slides, or notes, Mila Learning lets you upload your materials and turns them into personalized NCLEX exams in seconds.

Let's begin.

How to get the most from these questions

A quick tip before you start.

Don't treat practice questions like a scorecard. Treat them like feedback.

Every missed question is valuable because it points directly at a weak spot. Maybe pharmacology is shaky. Maybe prioritization questions trip you up. Maybe you know the content, but rush the stem and miss one important clue.

That's where growth happens.

A simple way to practice:

  • Time yourself. About one minute per question — that's the pacing of the real NCLEX.
  • Answer honestly. No guessing-and-checking. Commit to your answer first.
  • Read every rationale. Even when you got it right. The “why each distractor is wrong” is where the real learning is.
  • Notice patterns. Track which categories you missed most.
  • Drill your weak areas. That's how confidence is built.

Now, the questions.

Pharmacology (5 questions)

Question 1

A nurse on a medical-surgical unit is preparing to administer the 0900 dose of digoxin 0.25 mg PO to a 72-year-old male admitted with heart failure. Which assessment finding should cause the nurse to withhold the medication and notify the provider?

  • A)Blood pressure 130/80 mmHg
  • B)Apical pulse 56 beats/min
  • C)Respiratory rate 18 breaths/min
  • D)Temperature 99.2°F (37.3°C)
Correct answer: B
Rationale: Digoxin slows heart rate. In adults, it should be held when the apical pulse is below 60 beats/min, because giving it could worsen bradycardia or signal toxicity. The other findings are within expected limits and would not require holding the medication.

Question 2

A 65-year-old patient with heart failure has been prescribed furosemide (Lasix) 40 mg IV daily. Which lab value should the nurse monitor most closely to prevent a serious adverse effect?

  • A)Sodium
  • B)Potassium
  • C)Calcium
  • D)Magnesium
Correct answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia can trigger life-threatening cardiac arrhythmias, especially in patients also taking digoxin. While furosemide can affect sodium, calcium, and magnesium, potassium depletion carries the most immediate cardiac risk.

Question 3

A 58-year-old patient is receiving a continuous IV heparin infusion for a deep vein thrombosis. Which lab test should the nurse monitor to evaluate the therapeutic response?

  • A)Prothrombin time (PT)
  • B)International normalized ratio (INR)
  • C)Activated partial thromboplastin time (aPTT)
  • D)Complete blood count (CBC)
Correct answer: C
Rationale: aPTT monitors unfractionated heparin therapy, with a therapeutic range of 1.5 to 2.5 times the control value. PT and INR are used for warfarin. CBC and platelet counts are monitored for heparin-induced thrombocytopenia (HIT) but don't measure therapeutic effect.

Question 4

A 68-year-old patient with type 2 diabetes is receiving regular insulin per sliding scale before meals. At 0730, the nurse checks the patient's blood glucose, which is 312 mg/dL, and administers 8 units of regular insulin subcutaneously per the prescribed sliding scale. Which assessment is the nurse's priority during the next 2-4 hours?

  • A)Auscultate bowel sounds every hour
  • B)Monitor for signs of hypoglycemia
  • C)Check capillary refill bilaterally
  • D)Assess deep tendon reflexes
Correct answer: B
Rationale: Regular insulin has an onset of about 30 minutes and peaks at 2-4 hours. During that peak, hypoglycemia is the priority concern — watch for diaphoresis, tremors, confusion, hunger, irritability, and tachycardia. Bowel sounds, capillary refill, and DTRs are not the priority during the active phase of insulin.

Question 5

A nurse is providing discharge teaching to a 65-year-old patient newly prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further teaching?

  • A)"I'll need regular blood tests to check my INR."
  • B)"I should keep my intake of leafy greens consistent rather than vary it."
  • C)"I'll start taking ibuprofen for my arthritis pain."
  • D)"I'll use a soft toothbrush to prevent gum bleeding."
Correct answer: C
Rationale: NSAIDs like ibuprofen significantly increase bleeding risk when combined with warfarin. The patient should use acetaminophen instead and check with the provider before starting any new medication. INR monitoring (A), consistent vitamin K intake (B), and bleeding precautions (D) all reflect correct understanding.

Medical-Surgical Nursing (5 questions)

Question 6

A 72-year-old patient on post-operative day 3 after a total hip replacement suddenly reports shortness of breath and sharp chest pain that worsens with deep breathing. Vital signs: HR 118, RR 28, SpO₂ 88% on room air. Which action should the nurse take FIRST?

  • A)Elevate the head of the bed and apply supplemental oxygen
  • B)Notify the primary care provider
  • C)Obtain a STAT 12-lead ECG
  • D)Prepare the patient for a CT pulmonary angiogram
Correct answer: A
Rationale: This presentation strongly suggests a pulmonary embolism — a known post-op complication after hip surgery. Following the ABCs, breathing comes first. Elevating the head of bed improves respiratory mechanics, and supplemental oxygen immediately addresses hypoxia (SpO₂ 88%). Notification, ECG, and diagnostic workup come after stabilizing oxygenation.

Question 7

A 62-year-old post-operative patient has a chest tube connected to a water-seal drainage system following a right upper lobectomy. Which observation by the nurse indicates the system is functioning properly?

  • A)Continuous bubbling in the water-seal chamber
  • B)Tidaling (gentle fluctuation) in the water-seal chamber during respiration
  • C)No drainage in the collection chamber after 8 hours
  • D)The chest tube is clamped at the insertion site
Correct answer: B
Rationale: Tidaling — gentle fluctuation that rises with inspiration and falls with expiration — means the system is patent and responding normally to pressure changes. Continuous bubbling suggests an air leak. Absence of drainage may indicate a clot or kinked tubing. Chest tubes should not be clamped, as this can cause tension pneumothorax.

Question 8

A nurse is caring for a 55-year-old patient on post-operative day 2 following open abdominal surgery. Which assessment finding would cause the nurse to notify the provider immediately?

  • A)Hypoactive bowel sounds in all four quadrants
  • B)Reported pain of 4/10 with ambulation
  • C)Absence of flatus or bowel movement since surgery
  • D)Rigid, distended abdomen with bilious vomiting
Correct answer: D
Rationale: A rigid, distended abdomen with bilious vomiting is a red flag for paralytic ileus or mechanical bowel obstruction — a potentially life-threatening complication that requires immediate provider notification. Hypoactive bowel sounds are expected post-op. Pain of 4/10 with ambulation is manageable. No flatus or BM for 2 days is common after abdominal surgery.

Question 9

A 72-year-old patient is brought to the emergency department by family who report sudden onset of slurred speech and right-sided weakness 45 minutes ago. Vital signs: BP 178/96, HR 88, RR 18, SpO₂ 96%. Which action should the nurse anticipate FIRST?

  • A)Administer aspirin 325 mg PO
  • B)Obtain a non-contrast CT scan of the head
  • C)Initiate IV thrombolytic therapy
  • D)Place the patient in Trendelenburg position
Correct answer: B
Rationale: Before any treatment, the team must determine whether this is an ischemic or hemorrhagic stroke. A non-contrast CT scan is the first critical step. Aspirin (A) and thrombolytics (C) are contraindicated in hemorrhagic stroke and cannot be given without imaging. Trendelenburg (D) increases intracranial pressure and is contraindicated in suspected stroke.

Question 10

A nurse is caring for a 24-year-old patient with type 1 diabetes admitted with 48 hours of nausea and vomiting. Vital signs: BP 96/58, HR 124, RR 32 (deep and rapid), T 99.1°F. Labs: glucose 432 mg/dL, pH 7.21, bicarbonate 14 mEq/L. Which intervention should the nurse anticipate FIRST?

  • A)Administer subcutaneous regular insulin
  • B)Initiate IV normal saline at 1 L/hour
  • C)Administer sodium bicarbonate IV push
  • D)Begin dextrose 5% in water IV
Correct answer: B
Rationale: This patient is in DKA. The priority is fluid resuscitation with isotonic IV fluids (0.9% normal saline) to restore intravascular volume and improve perfusion before insulin therapy. Insulin in DKA is given IV, not subcutaneously, and only after fluids are initiated. Sodium bicarbonate is reserved for severe acidosis (pH < 6.9). Dextrose is added later when glucose drops to 200-250 mg/dL.

Maternal-Newborn (3 questions)

Question 11

A nurse is assessing a newborn 12 hours after birth. Which finding would require immediate intervention?

  • A)Respiratory rate of 42 breaths/min
  • B)Bluish discoloration of the hands and feet
  • C)Heart rate of 178 beats/min while crying
  • D)Yellow-tinged skin and sclera
Correct answer: D
Rationale: Jaundice within the first 24 hours of life is pathological and may signal hemolytic disease (such as ABO or Rh incompatibility) or another serious condition. Acrocyanosis (blue hands/feet) is normal in newborns due to immature peripheral circulation. RR 42 and HR 178 while crying are within normal newborn ranges.

Question 12

A nurse is caring for a 28-year-old woman 2 hours after a vaginal delivery. The nurse notes a saturated peripad in the past 15 minutes, a boggy fundus that is displaced to the right, and a BP of 102/64 (down from 124/78 at delivery). Which action should the nurse take FIRST?

  • A)Notify the healthcare provider
  • B)Administer oxytocin 10 units IM
  • C)Massage the fundus and assist the patient to void
  • D)Increase the IV fluid rate
Correct answer: C
Rationale: A boggy, right-displaced fundus typically means a full bladder is preventing the uterus from contracting. The first action is to massage the fundus and help the patient void — this often resolves the atony and the bleeding. If the fundus remains boggy after voiding, oxytocin and provider notification follow. Increasing fluids treats hypovolemia but doesn't address the cause.

Question 13

A 32-year-old patient at 36 weeks gestation is receiving magnesium sulfate IV for severe preeclampsia. The nurse assesses the patient and finds deep tendon reflexes 1+, respirations 10 breaths/min, and urine output 18 mL/hour over the past hour. Which action should the nurse take FIRST?

  • A)Stop the magnesium sulfate infusion
  • B)Administer calcium gluconate 1 g IV
  • C)Increase the patient's IV fluid rate
  • D)Notify the healthcare provider
Correct answer: A
Rationale: Diminished DTRs, respiratory depression below 12, and oliguria below 30 mL/hr are classic signs of magnesium toxicity. The first action is to stop the infusion to halt further toxicity. Calcium gluconate is the antidote and is given after stopping the drug. Provider notification and fluid adjustment come after the immediate intervention.

Pediatrics (3 questions)

Question 14

A 4-year-old is admitted to the emergency department with suspected epiglottitis. The child is drooling, sitting upright in a tripod position, and has audible stridor. Which action should the nurse avoid?

  • A)Allowing the child to remain in a position of comfort on the parent's lap
  • B)Inspecting the throat with a tongue depressor
  • C)Keeping emergency intubation equipment nearby
  • D)Monitoring oxygen saturation continuously
Correct answer: B
Rationale: Never place a tongue depressor in the throat of a child with suspected epiglottitis — it can cause laryngospasm and complete airway obstruction. The child should be kept calm, allowed to assume a comfortable position (often tripod on a caregiver's lap), have emergency airway equipment at the bedside, and have continuous pulse oximetry.

Question 15

A nurse is assessing a 9-month-old infant admitted with gastroenteritis and suspected dehydration. Which finding indicates moderate-to-severe dehydration?

  • A)Slightly dry mucous membranes
  • B)Capillary refill of 2 seconds
  • C)Sunken anterior fontanel and poor skin turgor
  • D)Heart rate of 130 beats/min while awake
Correct answer: C
Rationale: A sunken anterior fontanel and poor skin turgor (“tenting”) are classic signs of moderate-to-severe dehydration in infants. Slightly dry mucous membranes suggest only mild dehydration. Capillary refill of 2 seconds is normal (< 3 seconds). HR 130 is within the normal range for a 9-month-old while awake.

Question 16

A nurse in a pediatric clinic is reviewing immunization records for a healthy 6-month-old infant who is up to date on all vaccines. Which combination of vaccines should the nurse anticipate administering at this visit?

  • A)MMR and varicella
  • B)DTaP, Hib, IPV, PCV13, and rotavirus
  • C)HPV and meningococcal
  • D)Tdap and influenza only
Correct answer: B
Rationale: At the 6-month well-child visit, healthy infants receive DTaP, Hib, IPV, PCV13, and rotavirus per the CDC immunization schedule. MMR and varicella are first given at 12-15 months. HPV and meningococcal are adolescent vaccines. Tdap is for adolescents and adults.

Psychiatric Nursing (3 questions)

Question 17

A 34-year-old patient admitted for major depressive disorder tells the nurse, "I just don't see the point in living anymore." What is the priority nursing action?

  • A)Document the statement in the medical record
  • B)Ask the patient directly if they are thinking about suicide
  • C)Notify the family members immediately
  • D)Administer the prescribed antidepressant medication
Correct answer: B
Rationale: When a patient makes a statement suggesting suicidal ideation, the nurse should ask directly: “Are you thinking about hurting yourself?” Asking does not increase suicide risk — it opens therapeutic dialogue and allows for safety planning. Documentation, family notification, and medication are important but come after direct risk assessment.

Question 18

A nurse is reassessing a 45-year-old patient with bipolar disorder who has been taking lithium 600 mg twice daily for 6 weeks. The patient reports new-onset coarse hand tremor, diarrhea, and confusion. The most recent lithium level is 1.8 mEq/L. Which action should the nurse take FIRST?

  • A)Encourage the patient to drink extra fluids
  • B)Hold the next dose of lithium and notify the provider
  • C)Administer the next scheduled dose with food
  • D)Reassure the patient that these are common side effects
Correct answer: B
Rationale: A lithium level above 1.5 mEq/L is in the toxic range, and the patient's symptoms (coarse tremor, diarrhea, confusion) confirm clinical toxicity. Hold the dose immediately and notify the provider. Encouraging fluids is appropriate later but isn't the priority. The next dose should NOT be given. These symptoms aren't common side effects — untreated, they can progress to seizures and coma.

Question 19

A nurse is talking with a 22-year-old patient newly diagnosed with generalized anxiety disorder. The patient says, "I feel like I'm going crazy. Nothing helps." Which response by the nurse demonstrates therapeutic communication?

  • A)"Don't worry — anxiety is very treatable. You'll feel better soon."
  • B)"Tell me more about what you mean when you say nothing helps."
  • C)"Have you tried meditation? Many of my patients find it useful."
  • D)"Anxiety is just your body's response to stress. It's not real danger."
Correct answer: B
Rationale: Open-ended exploration (“tell me more”) invites the patient to express feelings and clarify their experience — the foundation of therapeutic communication. False reassurance (A) dismisses concerns. Giving advice (C) shifts focus to the nurse's perspective. Minimizing the experience (D) invalidates the patient.

Fundamentals & Safety (4 questions)

Question 20

A 45-year-old patient is strictly NPO in preparation for surgery in 3 hours. The patient tells the nurse, "My mouth is so dry — can I please have something to drink?" What is the best nursing response?

  • A)"I'm sorry, I know it's uncomfortable. Let me provide oral care with a moistened sponge."
  • B)"Just a small sip of water won't affect your surgery."
  • C)"I'll bring you some ice chips to help with the dryness."
  • D)"Try not to think about it — the surgery will be over soon."
Correct answer: A
Rationale: Oral care with a moistened sponge or oral swab safely relieves dryness without breaking NPO status. Ice chips count as oral intake and are not permitted for strict pre-op NPO. A sip of water could cause aspiration during anesthesia. Dismissing the patient's discomfort doesn't provide patient-centered care.

Question 21

A charge nurse on a medical unit is making assignments for the shift. Which task is most appropriate to delegate to unlicensed assistive personnel (UAP)?

  • A)Administering a scheduled oral medication to a stable patient
  • B)Assessing the effectiveness of a newly prescribed pain medication
  • C)Obtaining routine vital signs on a stable post-operative patient
  • D)Teaching a patient about their discharge medications
Correct answer: C
Rationale: Routine vital signs on a stable patient are within the UAP's scope. Medication administration, assessment of effectiveness, and patient teaching all require RN clinical judgment and licensure. The 5 Rights of Delegation (right task, circumstance, person, direction/communication, supervision) guide these decisions.

Question 22

A nurse is assigned to care for a patient newly admitted with active pulmonary tuberculosis. Which combination of personal protective equipment (PPE) and room placement is required?

  • A)Surgical mask in a private room with standard airflow
  • B)N95 respirator in an airborne-infection isolation room with negative pressure
  • C)Surgical mask and gloves in a standard semi-private room
  • D)N95 respirator in a standard private room with positive pressure
Correct answer: B
Rationale: Active pulmonary TB spreads through airborne droplet nuclei that remain suspended in air. Airborne precautions require an N95 respirator and an airborne-infection isolation room (AIIR) with negative pressure. A surgical mask is insufficient — it doesn't filter the small particles. Positive-pressure rooms are used for immunocompromised patients (protective isolation), not for airborne precautions.

Question 23

A nurse is preparing to administer a scheduled intravenous medication on a busy medical unit. What is the most reliable method to correctly identify the patient?

  • A)Ask the patient to state their name and date of birth
  • B)Check the patient's room number against the medication administration record (MAR)
  • C)Verify two identifiers on the patient's wristband against the MAR
  • D)Use the full name written on the door or whiteboard
Correct answer: C
Rationale: The Joint Commission's National Patient Safety Goals require two patient identifiers (typically name and DOB, or medical record number) verified against the MAR before medication administration. Asking the patient alone is insufficient — confused or sedated patients may answer incorrectly. Room numbers and door labels are unreliable because patients can be moved.

Fluid & Electrolytes (2 questions)

Question 24

A 48-year-old patient who had a recent thyroidectomy reports numbness and tingling around the mouth and in the fingertips. On assessment, the nurse inflates a blood pressure cuff above systolic pressure and observes carpal spasm. Which electrolyte imbalance does this finding most likely indicate?

  • A)Hyperkalemia
  • B)Hypocalcemia
  • C)Hypernatremia
  • D)Hypomagnesemia
Correct answer: B
Rationale: Trousseau's sign (carpal spasm induced by inflating a BP cuff above systolic pressure for ~3 minutes) is a classic indicator of hypocalcemia. Thyroidectomy patients are at elevated risk because the parathyroid glands can be damaged or removed during surgery, leading to decreased PTH and low calcium. Circumoral and fingertip paresthesias are additional hallmarks. Chvostek's sign (facial twitching when the facial nerve is tapped) is another indicator.

Question 25

A nurse is reviewing labs on a 58-year-old patient with chronic kidney disease. The serum potassium level is 6.4 mEq/L, and the ECG shows peaked T waves. Which medication does the nurse anticipate administering FIRST?

  • A)Furosemide 40 mg IV
  • B)Calcium gluconate 1 g IV
  • C)Sodium polystyrene sulfonate (Kayexalate) 30 g PO
  • D)Regular insulin 10 units with dextrose 50% IV
Correct answer: B
Rationale: With ECG changes (peaked T waves), the priority is stabilizing the cardiac membrane. IV calcium gluconate is administered FIRST — it doesn't lower potassium but protects the heart from arrhythmias while other treatments take effect. Insulin/dextrose and Kayexalate lower potassium but act more slowly. Furosemide is more useful with adequate kidney function and is less effective in CKD.

A quick word before you go

If you missed a few questions, that's normal.

If you missed many, that's useful.

Every wrong answer tells you exactly where to focus next.

That's how progress happens. Not by rereading everything. Not by highlighting another chapter. By identifying weak spots and practicing deliberately.

That's why Mila Learning was built.

Upload your ATI chapter. Upload your lecture slides. Upload your notes.

Mila turns them into personalized NCLEX practice in seconds, with questions built around what you are actually studying — not generic question banks.

Study smarter. Feel less overwhelmed. Walk into exam day ready.

Try Mila free →

Frequently asked questions

How many NCLEX practice questions should I do before my exam?

Most NCLEX prep experts recommend completing at least 2,000 to 3,000 practice questions before sitting for the exam. But the raw number isn't what matters — it's how you practice. Take questions under timed conditions, read every rationale, and track your weak areas systematically. Students who pass on their first attempt typically average 50-100 practice questions per day in the final 4-6 weeks before testing. Cramming 500 questions in the last week is far less effective than spreading practice consistently across weeks.

Are these questions accurate to the real NCLEX?

Yes. The 25 questions on this page are written in NCLEX-style format: clinical scenario stems with patient demographics and context, four plausible answer choices, one definitively correct answer, and full clinical rationales. The real NCLEX-RN uses the same structure but also includes alternate formats (select-all-that-apply, ordered response, drag-and-drop, hot-spot, fill-in-the-blank calculations). For full exposure to those alternate formats, supplement with a question bank that includes them. Clinical content here reflects current evidence-based standards (CDC guidelines, Joint Commission patient safety goals, AHA recommendations).

What's the difference between NCLEX practice questions and NCLEX-style questions?

“NCLEX practice questions” can refer to anything marketed for NCLEX prep — quality varies widely. “NCLEX-style questions” specifically follow the format and difficulty of the real exam: they require clinical application rather than recall, include realistic patient scenarios, use plausible distractors that test common misconceptions, and provide rationales explaining the reasoning. A well-written NCLEX-style question forces you to think through what a nurse would actually do at the bedside — not recall a textbook fact. Every question on this page is NCLEX-style.

Do free NCLEX questions work as well as paid question banks like UWorld?

Free NCLEX questions are excellent for breadth, exposure, and practicing the question format. Paid banks like UWorld, Kaplan, and Archer offer significantly more questions (UWorld has over 2,200), adaptive difficulty, detailed analytics, and nurse-educator-written rationales. The most effective strategy combines both: free questions for exposure and weak-area identification, paid banks for high-volume practice in your final weeks. Many students who passed on the first attempt used a paid bank as their primary tool and free resources as supplementary practice.

Can I still pass NCLEX with only free practice questions?

Yes — many students pass using only free or low-cost resources, especially when combined with their nursing program's textbooks, lecture materials, and any included question banks (like ATI). The key isn't the source of the questions — it's how you study them. Students who pass with free resources take questions consistently every day, read every rationale carefully, identify and drill their weakest content areas, and use multiple sources for variety. The students who fail are usually the ones who do questions passively without analyzing the reasoning. Paid or free, that approach doesn't work.

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