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NCLEX-RN Practice Questions: 2,640 Questions with Full Rationales

Preparing for the NCLEX-RN? certcrack.com gives you 2,640 original practice questions built on the official 2026–2029 NCLEX-RN Test Plan, organized into 20 timed practice sets of 100 questions at the real exam's pace — plus 12 interactive Next Gen NCLEX case studies. Every question carries a full rationale: why the correct answer is right, and why each wrong answer is wrong. The language is plain and direct, for US graduates and internationally educated nurses alike.

Start free Practice Set 1 — 100 questions Try the free NGN case study

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Try sample questions from free Practice Set 1

These are real questions from the free set — all 20 sets are written to this standard.

1. A patient on a cardiac monitor suddenly shows a rapid, wide-complex rhythm at 180 beats per minute. He is awake but pale and sweaty, reports chest discomfort, and has a blood pressure of 92/60 mmHg. The nurse should:

  1. Begin chest compressions (CPR) immediately, because any wide-complex rhythm is treated as a cardiac arrest
  2. Give the patient's routine morning medications, chart the rhythm change, and recheck in 15 minutes
  3. Obtain a complete 12-lead electrocardiogram (ECG) and wait for review before taking any action
  4. Prepare for synchronized cardioversion for unstable ventricular tachycardia
Correct answer: D. A rapid wide-complex rhythm in a patient who has a pulse but is pale, sweaty, and hypotensive with chest discomfort is unstable ventricular tachycardia; synchronized cardioversion is the treatment. CPR (A) is for a patient with no pulse — this patient has one. Routine medications and a 15-minute delay (B) let an unstable rhythm deteriorate into arrest, and pausing for a full 12-lead ECG before acting (C) delays the definitive treatment.

2. A child weighs 22 kg. Order: amoxicillin 40 mg/kg/day divided every 8 hours (3 doses). Available: 250 mg per 5 mL. Volume per dose:

  1. 5.0 mL
  2. 8.8 mL
  3. 5.9 mL
  4. 17.6 mL
Correct answer: C. Daily dose = 22 × 40 = 880 mg/day. Per dose = 880 ÷ 3 = 293.3 mg. Concentration = 250 ÷ 5 = 50 mg/mL. Volume = 293.3 ÷ 50 = 5.87 → 5.9 mL. A uses 250 mg as the dose (the "one strength = one dose" trap). B divides by 2 doses instead of 3. D gives the whole day's dose at once.

3. Which delegation decision shows the RN checking the "right circumstance" before assigning a task?

  1. The RN delegates the task because the same task was delegated safely yesterday
  2. The RN assigns the task to the first unlicensed assistive personnel (UAP) she sees in the hallway, provided the UAP has worked on the unit for several years and is familiar with the patient population and the routine equipment used there
  3. The RN assigns routine vital signs for a stable patient whose condition has been predictable all shift, and keeps the newly admitted chest-pain patient's checks for herself
  4. The RN writes the task on the assignment sheet without speaking to the person who will do it
Correct answer: C. Right circumstance means this patient, in this situation, now: stability and predictability make routine vital signs delegable for the stable patient, while a new chest-pain presentation turns vital signs into assessment, which the RN keeps. A: yesterday's safe delegation does not settle today's circumstance — patients change. B: availability is not circumstance; the patient's condition was never considered. D: writing a task down without communication skips direction, and never checks the patient's suitability.

4. A client's indwelling catheter drainage tubing becomes disconnected from the bag. The nurse should:

  1. Reconnect the ends quickly after wiping them, and continue using the same bag
  2. Tape the connection back together securely
  3. Leave the system open until the next routine bag change
  4. Replace the catheter and drainage system using sterile technique, per policy
Correct answer: D. Once the closed system is opened, the inner surfaces are contaminated; practice per policy is to replace the catheter and drainage system with sterile technique rather than reconnecting contaminated ends. Wiping and reconnecting (A) pushes surface bacteria into a system that drains directly to the bladder. Tape (B) seals a contaminated connection without removing the contamination. Leaving the system open (C) guarantees ongoing contamination and infection risk.

5. An older client is prescribed amitriptyline for nerve pain and reports dry mouth, constipation, urinary hesitancy, and morning grogginess. The nurse recognizes these as:

  1. Anticholinergic effects of a tricyclic antidepressant; report them for regimen review
  2. Signs the drug is working perfectly, requiring no report
  3. Effects of too little drug in the system
  4. A reason to add an over-the-counter antihistamine at bedtime to dry up the mouth secretions and help him sleep through the night
Correct answer: A. Tricyclics block muscarinic receptors along with their therapeutic targets; in older adults this anticholinergic burden is a well-known prescribing caution, and tricyclic overdose is additionally cardiotoxic — another reason the regimen gets reviewed, not shrugged at. B grades a side-effect cluster as success. C inverts the dose direction. D stacks a second anticholinergic onto the first.

6. A client with anxiety says rapidly, "I cannot sleep, my heart pounds, I keep thinking something terrible will happen, and I cannot sit still." Which response best uses clarification and focusing?

  1. "You need to calm down and stop thinking that way right now, please."
  2. "I will ask the provider for a stronger sleeping medication for tonight."
  3. "Everyone on this unit has trouble sleeping at first, so you are not alone in that."
  4. "You mentioned several things. Which one troubles you the most right now?"
Correct answer: D. D focuses a scattered, anxious account on one priority concern, which helps the client organize thoughts and lets the nurse assess what to address first. A gives a directive the anxious client cannot simply obey and dismisses the experience. B jumps to a medication fix without exploring what the client is experiencing. C generalizes in a way that minimizes this client's distress by making it routine.

Get the complete book on Amazon

NCLEX-RN Complete Study Guide & Practice Questions by H.A.Addis — the 35-chapter study guide plus all 2,640 questions with full rationales and the 12 NGN case studies.

$12.99 · Kindle edition

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The code printed inside the book unlocks Practice Sets 2–20 and NGN Cases 2–12 on certcrack.com — free, and it never expires. The sets are not sold on this site; they come with the book.

Built on the official NCLEX-RN Test Plan

Every set mixes questions across the eight Client Needs categories of the 2026–2029 NCLEX-RN Test Plan, at the official weights:

Exam facts: NCLEX-RN

Frequently asked questions

How many questions are on the NCLEX-RN exam?

The NCLEX-RN is a computerized adaptive test of 85 to 150 questions. The exam ends once the computer is 95% confident your ability is clearly above or below the passing standard, so strong candidates often finish near 85 questions. You have up to 5 hours, including breaks.

Where can I practice NCLEX-RN questions for free?

Right here on certcrack.com. Practice Set 1 — a full 100-question timed set — and the first interactive NGN case study are completely free, with no account needed. Every question includes a full rationale explaining why the correct answer is right and why each wrong answer is wrong.

How do I unlock Practice Sets 2–20 and the other NGN cases?

Sets 2–20 and NGN Cases 2–12 come with the book, NCLEX-RN Complete Study Guide & Practice Questions by H.A.Addis, available on Amazon. The code printed inside the book unlocks all of them on certcrack.com — free, and the access never expires. They are not sold separately on this site.

Are these real NCLEX questions?

No — and that is deliberate. Every one of the 2,640 questions is 100% original, written from the official NCLEX-RN Test Plan in the same style and difficulty as the real exam. Real exam questions are confidential; original questions built on the same blueprint prepare you for the exam without crossing that line.

What are Next Gen NCLEX (NGN) questions?

Since April 2023 the NCLEX includes case-study item types that measure clinical judgment: highlighting findings in a chart, drop-down (cloze) completions, bow-tie diagrams, select-all-that-apply, and trend questions. They are scored with partial credit — for example, select-all items give +1 for each correct choice and −1 for each incorrect one, down to a floor of zero. certcrack.com's 12 interactive cases are scored with those same rules.

Is this book suitable for internationally educated nurses?

Yes. The study guide is written in plain English and speaks to internationally educated nurses throughout — including how US practice, delegation, and scope rules may differ from what you trained with — while covering the same test plan US graduates study.

What score do I need to pass the NCLEX-RN?

There is no percentage to aim at. The adaptive test compares your ability estimate against the passing standard (0.00 logits) and passes you when it is 95% confident you are above it. The practical goal is consistent accuracy on test-plan questions at and above that standard — which is exactly what timed sets at real-exam pace train.

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