There are no NCLEX-RN past papers. The exam is computerised adaptive testing, every candidate's item set is assembled as they answer, and disclosure of examination items is prohibited — so "previous year questions" for this exam do not and cannot exist. What exists is the test plan, which fixes the content distribution, and item formats that NCSBN describes in its tutorial. The questions below are drawn from the Myndaq practice bank, written to those formats and distributed across the eight Client Needs areas roughly in the plan's proportions. They are not reproductions of any official item. They sit alongside the Myndaq NCLEX-RN course.
The pattern you are practising for
- 85 to 150 items, decided adaptively, within five hours including all breaks. Fifteen items on every exam are unscored pretest items you cannot identify.
- Eight content areas with published ranges: Management of Care 15–21%, Safety and Infection Prevention and Control 10–16%, Health Promotion and Maintenance 6–12%, Psychosocial Integrity 6–12%, Basic Care and Comfort 6–12%, Pharmacological and Parenteral Therapies 13–19%, Reduction of Risk Potential 9–15%, Physiological Adaptation 11–17%.
- Clinical judgment is measured by 18 case-study items in three sets of six, plus approximately 10% stand-alone items.
- Partial credit exists for items with more than one key, scored by plus/minus, zero/one or rationale scoring.
- The exam's length tells you nothing about the result — a candidate can pass or fail at 85 items or at 150.
Every item below has a single best answer. The rationales explain the wrong options too, because on an adaptive exam the wrong options you are drawn to are the data that tells you what to study.
Management of Care
Question 1 — prioritisation. The nurse begins the shift with four clients. Which client should the nurse plan to assess first?
- A. A client being discharged this afternoon who needs prescription teaching
- B. A client with pneumonia whose oxygen saturation was 91% on 2 L nasal cannula at report and now reports increasing shortness of breath
- C. A client with stable heart failure due for morning weight and daily furosemide
- D. A client 1 day postoperative from a knee replacement requesting scheduled pain medication
Answer: B. Airway and breathing take priority, and this client is both borderline and worsening — an unstable, potentially deteriorating picture. The other three are important but stable, scheduled tasks. Prioritisation items reward the word that signals change: "now reports increasing".
Question 2 — escalation. The nurse is assessing a client after a diagnostic procedure and identifies findings that indicate the client is deteriorating. Which finding warrants the most immediate escalation to the provider?
- A. Oral temperature of 37.1 °C (98.8 °F)
- B. Reports of mild thirst after the procedure
- C. New confusion with a heart rate of 124 beats/min and blood pressure 86/50 mmHg
- D. Blood pressure of 128/78 mmHg and heart rate of 76 beats/min
Answer: C. New confusion with tachycardia and hypotension is haemodynamic instability and possible shock. A and D are normal values and B is an expected minor complaint. The item is testing whether you can find the one abnormal cluster among normal findings dressed up with numbers.
Question 3 — delegation. The nurse is delegating a complete bed bath for a stable dependent client to assistive personnel (AP). Which instruction is most important for the nurse to provide?
- A. "Use hot water so the client stays warm throughout the bath."
- B. "Leave the room while the client rests between washing each area."
- C. "Massage any reddened bony prominences to improve circulation."
- D. "Report any reddened or broken skin areas you observe during the bath."
Answer: D. Assessment of skin integrity stays with the nurse; the AP's job is to observe and report so the nurse can assess for pressure injury. A risks burns and dry skin, B leaves a dependent client unattended, and C can worsen tissue damage. Delegation items turn on what cannot be delegated — assessment, teaching, evaluation.
Safety and Infection Prevention and Control
Question 4 — chain of infection. The nurse is precepting a new graduate and reviews the chain of infection. When a nurse ensures a client's productive cough is contained with tissues and a mask, which link in the chain is being interrupted?
- A. Portal of exit
- B. Portal of entry
- C. Reservoir
- D. Susceptible host
Answer: A. Respiratory secretions leaving the body through the mouth and nose are the portal of exit. Portal of entry is how organisms enter a new host; the reservoir is where the organism lives; the susceptible host is the person at risk. Containing secretions acts at their point of exit.
Health Promotion and Maintenance
Question 5 — newborn thermoregulation. The nurse places a newborn under a radiant warmer immediately after birth, dries the infant, removes wet linens, and applies a cap. Which additional action BEST reduces heat loss by convection?
- A. Move the warmer away from the exterior window
- B. Place a plastic wrap over the infant to reduce evaporation
- C. Close doors and reduce air drafts in the delivery room
- D. Warm the mattress and blankets before placing the infant on them
Answer: C. Convection is heat loss to moving air, so reducing drafts is the matching intervention. Pre-warming surfaces addresses conduction, distance from a cold window addresses radiation, and wrap addresses evaporation. Each wrong option is a correct intervention for a different mechanism — the item tests whether you match mechanism to action.
Question 6 — antepartum laboratory values. The nurse is reviewing routine antepartum laboratory results for a client at 28 weeks' gestation. The results show hemoglobin 10.4 g/dL, hematocrit 32%, and normal red cell indices (normal MCV, normal MCHC). Which interpretation should guide the nurse's next action?
- A. These values are abnormally low and require an urgent transfusion referral
- B. These values indicate folate deficiency and require increased dietary folate only
- C. These values reflect expected hemodilution of pregnancy and warrant continued routine monitoring
- D. These values indicate iron-deficiency anemia requiring immediate ferrous sulfate therapy
Answer: C. Plasma volume expands more than red cell mass in the second and third trimesters, producing a physiologic dilutional anaemia; a haemoglobin of 10.4 g/dL with normal indices is within acceptable pregnancy limits. Iron and folate deficiency would typically show abnormal indices — microcytic or macrocytic — which are absent, and 10.4 g/dL does not meet transfusion criteria.
Psychosocial Integrity
Question 7 — acute anxiety. The nurse is developing a plan of care for a client newly diagnosed with panic disorder who is experiencing an acute panic attack in the clinic. Which nursing action should the nurse take first?
- A. Explore possible triggers that precipitated the current episode
- B. Encourage the client to describe the physical sensations in detail
- C. Stay with the client and provide a calm, low-stimulation environment
- D. Teach the client cognitive restructuring techniques for future attacks
Answer: C. During an acute panic attack the client cannot process complex information; presence and reduced stimulation promote safety and a sense of control. Teaching and trigger exploration belong after the acute phase, and focusing on physical sensations can heighten the panic. "First" items in psychosocial content almost always resolve to safety and presence before insight.
Basic Care and Comfort
Question 8 — enteral feeding. The nurse is preparing to administer an intermittent bolus enteral feeding through a nasogastric tube. Which action should the nurse take FIRST before instilling the formula?
- A. Elevate the head of the bed to at least 30 degrees
- B. Flush the tube with 30 mL of sterile water
- C. Auscultate over the stomach while injecting air
- D. Warm the formula to body temperature in a microwave
Answer: A. Positioning to reduce aspiration risk is the priority first step. Auscultating injected air is an unreliable, outdated placement check; microwaving formula heats unevenly and is unsafe; flushing follows placement verification and positioning rather than preceding them.
Pharmacological and Parenteral Therapies
Three of the four items in this area are fill-in-the-blank calculations, because that format appears on the exam and is where a candidate with sound clinical knowledge can still lose an item to arithmetic.
Question 9 — oral dose. The nurse has an order to administer 500 mg of an oral medication. The medication is supplied as an oral suspension labeled 125 mg/5 mL. How many milliliters should the nurse administer? Record your answer as a whole number.
Answer: 20. Dose = (Desired ÷ Have) × Quantity = (500 ÷ 125) × 5 mL = 4 × 5 = 20 mL. The two classic errors: treating the concentration as 125 mg per 1 mL gives 4 mL; inverting the ratio gives 2.5 mL. Write the units through the calculation and the errors show themselves.
Question 10 — weight-based paediatric dose. The nurse is caring for a child who weighs 30.8 lb with an order for a medication dosed at 5 mg/kg/dose. The drug is supplied as 20 mg/mL. How many milliliters should the nurse administer per dose? Record your answer rounded to the nearest tenth.
Answer: 3.5. Convert first: 30.8 lb ÷ 2.2 = 14 kg. Dose = 5 mg/kg × 14 kg = 70 mg. Volume = 70 mg ÷ 20 mg/mL = 3.5 mL. Skipping the pound-to-kilogram conversion is the error this item is written to catch, and it produces a volume more than twice the safe dose.
Question 11 — drip rate. The nurse is preparing to infuse 400 mL of an antibiotic solution over 120 minutes using tubing with a drop factor of 15 gtt/mL. At what rate in drops per minute (gtt/min) should the nurse set the manual infusion? Record your answer as a whole number.
Answer: 50. gtt/min = (Volume × Drop factor) ÷ Time in minutes = (400 × 15) ÷ 120 = 6000 ÷ 120 = 50. Converting the time to hours, or using the wrong drop factor, yields 25 or 100; the formula only works with minutes in the denominator.
Question 12 — total parenteral nutrition. The nurse is caring for a client receiving total parenteral nutrition when the next bag has not arrived from the pharmacy and the current bag is nearly empty. Which solution should the nurse hang to prevent rebound hypoglycemia while awaiting the TPN?
- A. Sterile water
- B. 10% dextrose in water
- C. 0.9% normal saline
- D. Lactated Ringer's solution
Answer: B. Ten percent dextrose maintains glucose delivery when TPN is interrupted. Saline and lactated Ringer's contain no dextrose, and sterile water is never infused alone because it is hypotonic and causes haemolysis.
Reduction of Risk Potential
Question 13 — IV complication. The nurse is caring for a client with a peripheral IV who reports pain at the site, and the nurse observes redness and warmth along the path of the vein with a palpable cord, while the isotonic fluid continues to infuse and there is no swelling. Which is the nurse's priority action?
- A. Elevate the extremity and continue the infusion
- B. Slow the infusion rate and apply a cold compress
- C. Discontinue the IV and restart it in a different vein
- D. Flush the catheter with heparin to clear the vein
Answer: C. Redness, warmth, tenderness and a palpable cord along the vein are phlebitis; the priority is to remove the irritant and restart elsewhere. Slowing or elevating leaves the catheter in the inflamed vein, and heparin addresses occlusion, not inflammation. The absence of swelling is the detail that separates this from infiltration.
Physiological Adaptation
Question 14 — heart failure. The nurse is caring for a client with left-sided heart failure. Which assessment finding does the nurse most expect based on the pathophysiology of this condition?
- A. Dependent sacral edema and weight loss
- B. Crackles in the lungs and dyspnea
- C. Peripheral edema and jugular venous distention
- D. Hepatomegaly and ascites
Answer: B. Left-sided failure backs blood into the pulmonary circulation, producing crackles and dyspnoea. Peripheral oedema, jugular venous distention, hepatomegaly and ascites are systemic congestion — right-sided failure. Items that pair left and right findings are testing whether you have the mechanism, not the list.
How to use practice like this
Do not score yourself as a percentage. The exam has no percentage pass mark — it estimates ability item by item and stops when it is 95% certain either way — so what a practice set tells you is which areas and which reasoning patterns fail you. Sort every miss into one of three: did not know the content, knew it but misread the question's priority word ("first", "most immediate", "best"), or knew it but fell for a true statement attached to the wrong option. Then weight your study by the plan: Management of Care and Pharmacological and Parenteral Therapies together are about a third of the exam, and calculation items are lost to units, not to pharmacology. Set the calculations up with units written through, every time, until the habit holds under a clock. For the full distribution and the case-study format, see the test plan explained.
Quick answers
Are there NCLEX-RN past papers?
No. The exam is adaptive and item disclosure is prohibited, so there is no archive. The questions here are Myndaq practice items written to the exam's formats.
How many questions will I get?
Between 85 and 150, including 15 unscored pretest items, within five hours including breaks.
Is there a percentage pass mark?
No. The computer compares an ability estimate with the passing standard and stops when it is 95% certain either way, at maximum length, or when time runs out.
Are calculation questions on the exam?
Yes — fill-in-the-blank items exist among the exam's multiple formats, and the test plan describes several formats with partial-credit scoring.
Which areas should I practise most?
Management of Care (15–21%) and Pharmacological and Parenteral Therapies (13–19%), then Physiological Adaptation (11–17%), per the current test plan.
