NC 268 is a predominantly rural highway that traverse along or near the Yadkin River and its tributaries, between U.S. Route 321 (US 321) and US 601, and through the Sauratown Mountains in its eastern section.

[citation needed] NC 268 overlaps with one state scenic byway: the Upper Yadkin Way, between US 321 and W. Kerr Scott Dam and Reservoir.

[2] NC 268 begins in the west at an intersection with US 321 about five miles (8.0 km) north of downtown Lenoir, Caldwell County.

NC 268 continues independently east roughly paralleling the Yadkin River through the town of Ronda on its way to the Surry County line.

(North Bridge Street) and has an interchange with US 21 Bypass before meeting Interstate 77 (I-77) at its exit 85 in northeast Elkin.

The mainline NC 268 highway then ventures northeast from this point through the community of Little Richmond to meet US 601 at Fairview Crossroads, just south of Dobson.

In 1938, NC 268 was rerouted to run directly between Roaring River and Ronda leaving behind secondary roads that looped further north.

Between 1939-1944, NC 268 was rerouted in Elkin to its current routing, leaving behind Elk Spur Street/West Market Street.

The first is in Wilkes County, where a proposed multi-lane northern bypass would connect the NC 18/NC 268A interchange and go west to US 421.

[11] The second, located in Pilot Mountain, will place NC 268 onto new bypass road (two or multi-lane) south of the downtown area.