WALDEN UNIVERSITY
NCLEX-PN® NEXT
GENERATION (NGN)
ADVANCED EXAM –
VERSION 3
[Clinical Judgment–Focused Assessment (2026)]
NEXT GENERATION NCLEX (NGN) FORMAT
Advanced Level | Case-
Based | Standalone &
Scenario Questions
1
,CASE STUDY 1: ACUTE RESPIRATORY DISTRESS (QUESTIONS 1–6)
Client Profile:
A 68-year-old client with a history of COPD presents with increased
shortness of breath, productive cough, and oxygen saturation of
88% on room air.
1. Which finding requires immediate nursing action?
A. Chronic cough
B. Barrel-shaped chest
C. Oxygen saturation of 88%
D. History of smoking
Rationale: An SpO₂ below 90% indicates hypoxemia requiring
prompt intervention.
2. What is the nurse’s priority action?
A. Encourage fluids
B. Obtain sputum sample
C. Apply supplemental oxygen as prescribed
D. Provide chest physiotherapy
Rationale: Improving oxygenation is the priority.
3. Which assessment best evaluates response to intervention?
A. Lung sounds
B. Respiratory rate
C. Oxygen saturation level
D. Skin color
Rationale: SpO₂ directly reflects oxygenation status.
4. Which breathing technique should be taught?
A. Rapid breathing
B. Breath holding
2
,C. Pursed-lip breathing
D. Supine positioning
Rationale: Pursed-lip breathing improves ventilation in COPD.
5. Which finding indicates improvement?
A. Increased cough
B. SpO₂ increased to 94%
C. Drowsiness
D. Cyanosis
Rationale: Improved oxygen saturation reflects effective care.
6. Which outcome best demonstrates clinical judgment?
A. Client states diagnosis
B. Client maintains adequate oxygenation
C. Client recalls medications
D. Client eats full meal
Rationale: NGN focuses on outcomes tied to physiologic stability.
CASE STUDY 2: ACUTE CHEST PAIN (QUESTIONS 7–12)
Client Profile:
A 55-year-old client reports sudden chest pressure radiating to the
left arm, nausea, and diaphoresis.
7. Which finding is most concerning?
A. Nausea
B. Anxiety
C. Chest pain radiating to the arm
D. Mild headache
Rationale: Radiating chest pain suggests myocardial ischemia.
8. What is the nurse’s priority action?
3
, A. Provide food
B. Obtain history
C. Administer oxygen and notify RN/MD
D. Reassure client
Rationale: Immediate intervention reduces myocardial damage.
9. Which medication is commonly anticipated first?
A. Antibiotic
B. Nitroglycerin
C. Insulin
D. Antacid
Rationale: Nitroglycerin reduces cardiac workload.
10. Which finding indicates worsening condition?
A. Pain relief
B. Drop in blood pressure
C. Calm behavior
D. Improved color
Rationale: Hypotension may indicate cardiogenic shock.
11. Which lab value is most relevant?
A. Sodium
B. Potassium
C. Troponin
D. Calcium
Rationale: Troponin elevation confirms myocardial injury.
12. Appropriate outcome statement:
A. Client verbalizes diet
B. Chest pain resolved and vitals stable
C. Client rests quietly
D. Family informed
4
NCLEX-PN® NEXT
GENERATION (NGN)
ADVANCED EXAM –
VERSION 3
[Clinical Judgment–Focused Assessment (2026)]
NEXT GENERATION NCLEX (NGN) FORMAT
Advanced Level | Case-
Based | Standalone &
Scenario Questions
1
,CASE STUDY 1: ACUTE RESPIRATORY DISTRESS (QUESTIONS 1–6)
Client Profile:
A 68-year-old client with a history of COPD presents with increased
shortness of breath, productive cough, and oxygen saturation of
88% on room air.
1. Which finding requires immediate nursing action?
A. Chronic cough
B. Barrel-shaped chest
C. Oxygen saturation of 88%
D. History of smoking
Rationale: An SpO₂ below 90% indicates hypoxemia requiring
prompt intervention.
2. What is the nurse’s priority action?
A. Encourage fluids
B. Obtain sputum sample
C. Apply supplemental oxygen as prescribed
D. Provide chest physiotherapy
Rationale: Improving oxygenation is the priority.
3. Which assessment best evaluates response to intervention?
A. Lung sounds
B. Respiratory rate
C. Oxygen saturation level
D. Skin color
Rationale: SpO₂ directly reflects oxygenation status.
4. Which breathing technique should be taught?
A. Rapid breathing
B. Breath holding
2
,C. Pursed-lip breathing
D. Supine positioning
Rationale: Pursed-lip breathing improves ventilation in COPD.
5. Which finding indicates improvement?
A. Increased cough
B. SpO₂ increased to 94%
C. Drowsiness
D. Cyanosis
Rationale: Improved oxygen saturation reflects effective care.
6. Which outcome best demonstrates clinical judgment?
A. Client states diagnosis
B. Client maintains adequate oxygenation
C. Client recalls medications
D. Client eats full meal
Rationale: NGN focuses on outcomes tied to physiologic stability.
CASE STUDY 2: ACUTE CHEST PAIN (QUESTIONS 7–12)
Client Profile:
A 55-year-old client reports sudden chest pressure radiating to the
left arm, nausea, and diaphoresis.
7. Which finding is most concerning?
A. Nausea
B. Anxiety
C. Chest pain radiating to the arm
D. Mild headache
Rationale: Radiating chest pain suggests myocardial ischemia.
8. What is the nurse’s priority action?
3
, A. Provide food
B. Obtain history
C. Administer oxygen and notify RN/MD
D. Reassure client
Rationale: Immediate intervention reduces myocardial damage.
9. Which medication is commonly anticipated first?
A. Antibiotic
B. Nitroglycerin
C. Insulin
D. Antacid
Rationale: Nitroglycerin reduces cardiac workload.
10. Which finding indicates worsening condition?
A. Pain relief
B. Drop in blood pressure
C. Calm behavior
D. Improved color
Rationale: Hypotension may indicate cardiogenic shock.
11. Which lab value is most relevant?
A. Sodium
B. Potassium
C. Troponin
D. Calcium
Rationale: Troponin elevation confirms myocardial injury.
12. Appropriate outcome statement:
A. Client verbalizes diet
B. Chest pain resolved and vitals stable
C. Client rests quietly
D. Family informed
4
