NCLEX-RN 2026 TEST PLAN – NEXT
GENERATION NCLEX (NGN) HIGH-YIELD
PRACTICE EXAM 260 Questions – NGN Case
Studies, Bow-Tie Items, Matrix, & Traditional
MCQs Detailed Rationales
TABLE OF CONTENTS
1. Management of Care – NGN Case Studies (Questions 1–30)
2. Safety & Infection Control – NGN Bow-Tie Items (Questions 31–
50)
3. Health Promotion & Maintenance – NGN Matrix (Questions 51–
70)
4. Psychosocial Integrity – NGN Drag & Drop (Questions 71–85)
5. Basic Care & Comfort – NGN Multiple Response (Questions 86–
100)
6. Pharmacological & Parenteral Therapies – Traditional
(Questions 101–140)
7. Reduction of Risk Potential – Traditional (Questions 141–180)
8. Physiological Adaptation – Traditional (Questions 181–220)
9. NGN Comprehensive Case Studies (Questions 221–260)
MANAGEMENT OF CARE – NGN CASE STUDIES (Questions 1–
30)
,Case Study 1: Post-Operative Care
A 72-year-old male is postoperative day 1 after a right total hip
arthroplasty. He has a history of hypertension and type 2 diabetes.
Current vital signs: BP 110/70, HR 88, RR 18, O2 saturation 94% on
room air, temperature 99.2°F (37.3°C). He reports pain rated 6/10. He has
an indwelling urinary catheter and an IV infusing normal saline at 50
mL/hr.
Question 1 (NGN Bow-Tie Item) Place the following nursing actions in
order of priority:
A. Administer prescribed pain medication B. Assess respiratory status and
lung sounds C. Turn the patient to the left side D. Check the surgical
dressing for bleeding
Correct Order: B, A, D, C Rationale: Airway/breathing is always first.
After confirming respiratory status, address pain (A), then assess dressing
(D), then turn (C).
Question 2 (Select all that apply) Which of the following findings would
indicate a potential complication requiring immediate notification of the
provider? (Select all that apply)
A. Oxygen saturation 89% on room air B. Pain rated 4/10 after
medication C. Sudden shortness of breath D. Urine output 30 mL in the
last hour E. Warmth and redness in the left calf
Correct Answers: A, C, E Rationale: O2 sat 89% (A) and sudden SOB
(C) suggest pulmonary embolism. Calf warmth/redness (E) suggests
DVT. Pain 4/10 (B) is acceptable. Urine output 30 mL/hr (D) is adequate.
Question 3 (Matrix: For each finding, click if "Critical" or "Non-
critical")
,Finding Critical Non-critical
Temperature 99.2°F ☐ ☑
Pain 6/10 ☐ ☑
O2 saturation 89% ☑ ☐
Blood glucose 180 ☐ ☑
mg/dL
Rationale: O2 saturation 89% is critical (hypoxia). Low-grade fever (A)
is expected post-op. Pain 6/10 requires treatment but not critical. Glucose
180 (D) is elevated but not emergent in this stable patient.
Case Study 2: Emergency Department Triage
A 45-year-old female presents to the ED with sudden onset of severe
headache described as "the worst headache of my life." She has no
history of migraines. Vital signs: BP 180/110, HR 102, RR 20, O2
saturation 99%, temperature 98.8°F (37.1°C). She is awake, alert, and
oriented.
Question 4 (NGN Bow-Tie Item) What is the priority nursing action?
A. Administer acetaminophen for headache B. Prepare for non-contrast
CT head stat C. Start IV fluids D. Obtain a thorough headache history
Correct Answer: B Rationale: Thunderclap headache suggests
subarachnoid hemorrhage until proven otherwise. Non-contrast CT head
is the priority. Pain medication (A) may be given but not before CT.
Question 5 (Select all that apply) Which of the following are risk factors
for subarachnoid hemorrhage? (Select all that apply)
A. Hypertension B. Smoking C. Female gender D. Family history of
cerebral aneurysm E. Age >40
, Correct Answers: A, B, D Rationale: Hypertension (A), smoking (B),
and family history of aneurysm (D) are risk factors. Female gender (C) is
not a significant risk factor.
Question 6 (Matrix: For each symptom, indicate if it is "Expected" or
"Unexpected" for subarachnoid hemorrhage)
Symptom Expected Unexpected
Photophobia ☑ ☐
Nuchal rigidity (neck ☑ ☐
stiffness)
Unilateral arm ☐ ☑
weakness
Nausea and vomiting ☑ ☐
Rationale: Photophobia, nuchal rigidity, and nausea/vomiting are
expected. Focal neurologic deficits (unilateral weakness) suggest other
pathology.
Case Study 3: Pediatric Respiratory Distress
A 4-year-old male is brought to the pediatric clinic with barking cough,
stridor, and respiratory distress. He has no fever. Symptoms worsened
overnight. He is sitting upright, drooling, and appears anxious.
Question 7 (NGN Bow-Tie Item) What is the most likely diagnosis?
A. Bacterial tracheitis B. Croup (laryngotracheobronchitis) C.
Epiglottitis D. Foreign body aspiration
Correct Answer: B Rationale: Barking cough + stridor + no fever +
worse at night = croup (viral). Epiglottitis (C) presents with fever,
drooling, and toxic appearance.
GENERATION NCLEX (NGN) HIGH-YIELD
PRACTICE EXAM 260 Questions – NGN Case
Studies, Bow-Tie Items, Matrix, & Traditional
MCQs Detailed Rationales
TABLE OF CONTENTS
1. Management of Care – NGN Case Studies (Questions 1–30)
2. Safety & Infection Control – NGN Bow-Tie Items (Questions 31–
50)
3. Health Promotion & Maintenance – NGN Matrix (Questions 51–
70)
4. Psychosocial Integrity – NGN Drag & Drop (Questions 71–85)
5. Basic Care & Comfort – NGN Multiple Response (Questions 86–
100)
6. Pharmacological & Parenteral Therapies – Traditional
(Questions 101–140)
7. Reduction of Risk Potential – Traditional (Questions 141–180)
8. Physiological Adaptation – Traditional (Questions 181–220)
9. NGN Comprehensive Case Studies (Questions 221–260)
MANAGEMENT OF CARE – NGN CASE STUDIES (Questions 1–
30)
,Case Study 1: Post-Operative Care
A 72-year-old male is postoperative day 1 after a right total hip
arthroplasty. He has a history of hypertension and type 2 diabetes.
Current vital signs: BP 110/70, HR 88, RR 18, O2 saturation 94% on
room air, temperature 99.2°F (37.3°C). He reports pain rated 6/10. He has
an indwelling urinary catheter and an IV infusing normal saline at 50
mL/hr.
Question 1 (NGN Bow-Tie Item) Place the following nursing actions in
order of priority:
A. Administer prescribed pain medication B. Assess respiratory status and
lung sounds C. Turn the patient to the left side D. Check the surgical
dressing for bleeding
Correct Order: B, A, D, C Rationale: Airway/breathing is always first.
After confirming respiratory status, address pain (A), then assess dressing
(D), then turn (C).
Question 2 (Select all that apply) Which of the following findings would
indicate a potential complication requiring immediate notification of the
provider? (Select all that apply)
A. Oxygen saturation 89% on room air B. Pain rated 4/10 after
medication C. Sudden shortness of breath D. Urine output 30 mL in the
last hour E. Warmth and redness in the left calf
Correct Answers: A, C, E Rationale: O2 sat 89% (A) and sudden SOB
(C) suggest pulmonary embolism. Calf warmth/redness (E) suggests
DVT. Pain 4/10 (B) is acceptable. Urine output 30 mL/hr (D) is adequate.
Question 3 (Matrix: For each finding, click if "Critical" or "Non-
critical")
,Finding Critical Non-critical
Temperature 99.2°F ☐ ☑
Pain 6/10 ☐ ☑
O2 saturation 89% ☑ ☐
Blood glucose 180 ☐ ☑
mg/dL
Rationale: O2 saturation 89% is critical (hypoxia). Low-grade fever (A)
is expected post-op. Pain 6/10 requires treatment but not critical. Glucose
180 (D) is elevated but not emergent in this stable patient.
Case Study 2: Emergency Department Triage
A 45-year-old female presents to the ED with sudden onset of severe
headache described as "the worst headache of my life." She has no
history of migraines. Vital signs: BP 180/110, HR 102, RR 20, O2
saturation 99%, temperature 98.8°F (37.1°C). She is awake, alert, and
oriented.
Question 4 (NGN Bow-Tie Item) What is the priority nursing action?
A. Administer acetaminophen for headache B. Prepare for non-contrast
CT head stat C. Start IV fluids D. Obtain a thorough headache history
Correct Answer: B Rationale: Thunderclap headache suggests
subarachnoid hemorrhage until proven otherwise. Non-contrast CT head
is the priority. Pain medication (A) may be given but not before CT.
Question 5 (Select all that apply) Which of the following are risk factors
for subarachnoid hemorrhage? (Select all that apply)
A. Hypertension B. Smoking C. Female gender D. Family history of
cerebral aneurysm E. Age >40
, Correct Answers: A, B, D Rationale: Hypertension (A), smoking (B),
and family history of aneurysm (D) are risk factors. Female gender (C) is
not a significant risk factor.
Question 6 (Matrix: For each symptom, indicate if it is "Expected" or
"Unexpected" for subarachnoid hemorrhage)
Symptom Expected Unexpected
Photophobia ☑ ☐
Nuchal rigidity (neck ☑ ☐
stiffness)
Unilateral arm ☐ ☑
weakness
Nausea and vomiting ☑ ☐
Rationale: Photophobia, nuchal rigidity, and nausea/vomiting are
expected. Focal neurologic deficits (unilateral weakness) suggest other
pathology.
Case Study 3: Pediatric Respiratory Distress
A 4-year-old male is brought to the pediatric clinic with barking cough,
stridor, and respiratory distress. He has no fever. Symptoms worsened
overnight. He is sitting upright, drooling, and appears anxious.
Question 7 (NGN Bow-Tie Item) What is the most likely diagnosis?
A. Bacterial tracheitis B. Croup (laryngotracheobronchitis) C.
Epiglottitis D. Foreign body aspiration
Correct Answer: B Rationale: Barking cough + stridor + no fever +
worse at night = croup (viral). Epiglottitis (C) presents with fever,
drooling, and toxic appearance.
