NC 42 is a winding country state highway that bypasses many of the larger cities in the eastern/central part of North Carolina. Despite its long length (223.3 miles), it is not noted for being convenient for long-distance travel; US 64 often provides a shorter, faster alternative routing for a large part of NC 42's length. Because it is well connected to many other major Interstate and US routes, NC 42 is a local connector for smaller communities along its route.

NC 42 was first dedicated in 1922 as a modest 19-mile (31 km) connector from Wilson to Pinetops. In the 1930s & 40s it was extended west to Clayton, and by 1950 it reached Fuquay-Varina. In the late 50s, early 60s it was extended in both directions to Conetoe in the east and Asheboro to the west. The last extension came in 1990 to meet with the I 73/74/US 220 freeway in Asheboro.