NCLEX Priority Questions: Free Practice Questions With Rationales (2026)

Priority questions are where most students lose points, and it is almost never because they did not know the content. It is because they picked a correct action that was not the first action. Here are two free practice questions in the NGN style, with the full reasoning worked out. No sign-up needed to read them.

Question 1

Two days after a total hip arthroplasty, your patient suddenly becomes restless and short of breath. Oxygen saturation drops from 96% to 88% on room air, heart rate is 118, and respiratory rate is 28. Which action does the nurse take first?

A. Obtain a 12-lead ECG

B. Raise the head of the bed and apply oxygen

C. Notify the provider

D. Assess the surgical incision

Answer: B. This is a classic presentation of pulmonary embolism after orthopedic surgery. Sudden dyspnea, restlessness, tachycardia, and a falling oxygen saturation in a post-operative orthopedic patient should move pulmonary embolism to the top of your list. The rule that gets you through these questions: when your patient is hypoxemic, you intervene before you investigate or delegate. Raising the head of the bed and applying oxygen are independent nursing actions that address oxygenation immediately, and you do not need an order to do either one. The ECG and the provider call both matter and both come next, but neither puts oxygen into your patient. Assessing the incision does not address the emergency at all.

Question 2

The nurse receives report on four patients at the start of the shift. Which patient does the nurse assess first?

A. A patient with chronic obstructive pulmonary disease whose oxygen saturation is 89% on 2 liters, which is their baseline

B. A post-operative patient reporting incisional pain rated 7 out of 10

C. A patient admitted with pneumonia who has become confused since the previous shift

D. A patient scheduled for discharge who has questions about their medications

Answer: C. A new change in level of consciousness is never a normal finding, and in a patient with pneumonia it may be the earliest sign of hypoxemia or developing sepsis. That is an unexpected change, which always outranks an expected one. Option A looks alarming until you read the last three words: that saturation is this patient's baseline, and chronic carbon dioxide retainers live in the high 80s. Option B is real pain and it needs treatment, but pain is expected after surgery and it is not immediately life-threatening. Option D is important teaching that can wait an hour. The exam is testing whether you can separate unexpected from merely uncomfortable.

The rule to carry into the exam

Run every priority question through three filters, in this order. First, airway, breathing, circulation. Second, unexpected beats expected. Third, an independent action you can take right now beats a dependent action that requires an order. When two answers both look correct, one of them is almost always further down that list than the other, and that is your tie-breaker.

Want more practice like this? The free NCLEX 2026 Starter Kit has a full set of NGN-style questions with rationales, lab values, and a study plan. You can get it at nursepassmastery.com.