NCLEX-RN NGN Actual Exam Mastery 250+-Question Comprehensive Guide (Latest
2025/2026)
Master the Next Generation NCLEX with this 250-question ultimate practice bank. This set is
specifically designed to simulate the NGN clinical judgment model, focusing on the high-
yield topics that actually appear on the exam: Prioritization (Who do you see first?),
Pharmacology safety/antidotes, EKG/Lab values, and Maternity/Pediatric milestones.
Every question includes a bolded answer and a detailed rationale in italics to help
you understand the nursing logic required to pass. Perfect for final review and boosting
your confidence before test day!
1. A nurse is caring for a client with heart failure. Which assessment finding
requires immediate intervention?
A. 2+ pitting edema in the lower extremities
B. Pink, frothy sputum and restlessness
C. Crackles limited to the lung bases
D. Weight gain of 1 lb in 24 hours
Answer: B. PINK, FROTHY SPUTUM AND RESTLESSNESS
Rationale: These are classic signs of acute pulmonary edema, a life-threatening
complication of heart failure that requires immediate oxygen and diuretics.
2. A client is prescribed Spironolactone. Which laboratory result should the nurse
report to the provider?
A. Sodium 138 mEq/L
B. Potassium 5.6 mEq/L
C. Chloride 100 mEq/L
D. Magnesium 2.1 mEq/L
Answer: B. POTASSIUM 5.6 MEQ/L
Rationale: Spironolactone is a potassium-sparing diuretic; a level above 5.0 indicates
hyperkalemia, which risks cardiac arrest.
3. Which client should the nurse assess first after receiving the change-of-shift
report?
A. A client with a GCS of 15 awaiting discharge
B. A client with a casted leg reporting "pins and needles"
C. A client 2 days post-op reporting pain of 6/10
,D. A client with pneumonia and an SpO2 of 94% on 2L
Answer: B. A CLIENT WITH A CASTED LEG REPORTING "PINS AND NEEDLES"
Rationale: Paresthesia is an early sign of Compartment Syndrome, a neurovascular
emergency.
4. A nurse is preparing to administer Regular insulin at 0800. At what time is the
client at the highest risk for hypoglycemia?
A. 0830
B. 1000
C. 1400
D. 2000
Answer: B. 1000
Rationale: Regular insulin is short-acting and peaks in 2–4 hours (between 1000 and
1200).
5. A client has a chest tube for a pneumothorax. The nurse notes continuous
bubbling in the water-seal chamber. What is the priority action?
A. Document it as a normal finding
B. Check the system for an air leak
C. Increase the suction wall pressure
D. Clamp the tube for 15 minutes
Answer: B. CHECK THE SYSTEM FOR AN AIR LEAK
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Bubbling should only be intermittent during expiration.
6. Which immunization is contraindicated for a pregnant client?
A. Inactivated Influenza
B. Tdap
C. MMR (Measles, Mumps, Rubella)
D. Hepatitis B
Answer: C. MMR (MEASLES, MUMPS, RUBELLA)
Rationale: MMR is a live-virus vaccine; live vaccines are contraindicated during
pregnancy due to the risk to the fetus.
7. A client presents with a tracheal deviation to the right and absent breath
sounds on the left. What is the priority intervention?
A. Obtain a STAT Chest X-ray
B. Prepare for needle decompression
,C. Administer Albuterol via nebulizer
D. Position the client in prone
Answer: B. PREPARE FOR NEEDLE DECOMPRESSION
Rationale: These are signs of a tension pneumothorax, which causes cardiovascular
collapse if not relieved immediately.
8. An infant is admitted with suspected Epiglottitis. Which action should the
nurse avoid?
A. Administering humidified oxygen
B. Monitoring pulse oximetry
C. Inspecting the throat with a tongue blade
D. Keeping the infant in a parent's lap
Answer: C. INSPECTING THE THROAT WITH A TONGUE BLADE
Rationale: Using a tongue blade can cause a laryngospasm that completely occludes
the airway.
9. A client is receiving a blood transfusion and reports lower back pain and chills.
What is the nurse's first action?
A. Slow the infusion rate
B. Administer Diphenhydramine
C. Stop the transfusion
D. Check the client's temperature
Answer: C. STOP THE TRANSFUSION
Rationale: Flank pain and chills indicate a hemolytic reaction. The nurse must stop the
infusion immediately to prevent further damage.
10. What is the priority nursing intervention for a client during an active tonic-
clonic seizure?
A. Insert a padded tongue blade
B. Restrain the client's arms
C. Turn the client to a side-lying position
D. Administer oral suctioning
Answer: C. TURN THE CLIENT TO A SIDE-LYING POSITION
Rationale: Side-lying positioning protects the airway and prevents aspiration.
11. A client with a GCS of 7 requires what priority intervention?
A. Monitoring of pupillary response
B. Preparation for endotracheal intubation
, C. Range of motion exercises
D. Administration of IV fluids
Answer: B. PREPARATION FOR ENDOTRACHEAL INTUBATION
Rationale: "GCS of 8, we intubate." A score of 7 means the client cannot protect their
own airway.
12. A nurse is caring for a client with a DVT. The client suddenly reports chest
pain and shortness of breath. What should the nurse suspect?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Pneumothorax
D. Anxiety Attack
Answer: B. PULMONARY EMBOLISM
Rationale: A dislodged DVT that travels to the lungs is a Pulmonary Embolism (PE).
13. A client is prescribed Lisinopril. Which side effect should the nurse instruct
the client to report?
A. Yellowing of the skin
B. Dry, persistent cough
C. Increased appetite
D. Blurred vision
Answer: B. DRY, PERSISTENT COUGH
Rationale: A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation.
14. What is the "Gold Standard" lab test for diagnosing a Myocardial Infarction?
A. CK-MB
B. Myoglobin
C. Troponin I
D. BNP
Answer: C. TROPONIN I
Rationale: Troponin is highly specific to cardiac muscle damage.
15. A client with Cirrhosis has a high ammonia level and is confused. What
medication does the nurse anticipate?
A. Spironolactone
B. Lactulose
C. Propranolol
2025/2026)
Master the Next Generation NCLEX with this 250-question ultimate practice bank. This set is
specifically designed to simulate the NGN clinical judgment model, focusing on the high-
yield topics that actually appear on the exam: Prioritization (Who do you see first?),
Pharmacology safety/antidotes, EKG/Lab values, and Maternity/Pediatric milestones.
Every question includes a bolded answer and a detailed rationale in italics to help
you understand the nursing logic required to pass. Perfect for final review and boosting
your confidence before test day!
1. A nurse is caring for a client with heart failure. Which assessment finding
requires immediate intervention?
A. 2+ pitting edema in the lower extremities
B. Pink, frothy sputum and restlessness
C. Crackles limited to the lung bases
D. Weight gain of 1 lb in 24 hours
Answer: B. PINK, FROTHY SPUTUM AND RESTLESSNESS
Rationale: These are classic signs of acute pulmonary edema, a life-threatening
complication of heart failure that requires immediate oxygen and diuretics.
2. A client is prescribed Spironolactone. Which laboratory result should the nurse
report to the provider?
A. Sodium 138 mEq/L
B. Potassium 5.6 mEq/L
C. Chloride 100 mEq/L
D. Magnesium 2.1 mEq/L
Answer: B. POTASSIUM 5.6 MEQ/L
Rationale: Spironolactone is a potassium-sparing diuretic; a level above 5.0 indicates
hyperkalemia, which risks cardiac arrest.
3. Which client should the nurse assess first after receiving the change-of-shift
report?
A. A client with a GCS of 15 awaiting discharge
B. A client with a casted leg reporting "pins and needles"
C. A client 2 days post-op reporting pain of 6/10
,D. A client with pneumonia and an SpO2 of 94% on 2L
Answer: B. A CLIENT WITH A CASTED LEG REPORTING "PINS AND NEEDLES"
Rationale: Paresthesia is an early sign of Compartment Syndrome, a neurovascular
emergency.
4. A nurse is preparing to administer Regular insulin at 0800. At what time is the
client at the highest risk for hypoglycemia?
A. 0830
B. 1000
C. 1400
D. 2000
Answer: B. 1000
Rationale: Regular insulin is short-acting and peaks in 2–4 hours (between 1000 and
1200).
5. A client has a chest tube for a pneumothorax. The nurse notes continuous
bubbling in the water-seal chamber. What is the priority action?
A. Document it as a normal finding
B. Check the system for an air leak
C. Increase the suction wall pressure
D. Clamp the tube for 15 minutes
Answer: B. CHECK THE SYSTEM FOR AN AIR LEAK
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Bubbling should only be intermittent during expiration.
6. Which immunization is contraindicated for a pregnant client?
A. Inactivated Influenza
B. Tdap
C. MMR (Measles, Mumps, Rubella)
D. Hepatitis B
Answer: C. MMR (MEASLES, MUMPS, RUBELLA)
Rationale: MMR is a live-virus vaccine; live vaccines are contraindicated during
pregnancy due to the risk to the fetus.
7. A client presents with a tracheal deviation to the right and absent breath
sounds on the left. What is the priority intervention?
A. Obtain a STAT Chest X-ray
B. Prepare for needle decompression
,C. Administer Albuterol via nebulizer
D. Position the client in prone
Answer: B. PREPARE FOR NEEDLE DECOMPRESSION
Rationale: These are signs of a tension pneumothorax, which causes cardiovascular
collapse if not relieved immediately.
8. An infant is admitted with suspected Epiglottitis. Which action should the
nurse avoid?
A. Administering humidified oxygen
B. Monitoring pulse oximetry
C. Inspecting the throat with a tongue blade
D. Keeping the infant in a parent's lap
Answer: C. INSPECTING THE THROAT WITH A TONGUE BLADE
Rationale: Using a tongue blade can cause a laryngospasm that completely occludes
the airway.
9. A client is receiving a blood transfusion and reports lower back pain and chills.
What is the nurse's first action?
A. Slow the infusion rate
B. Administer Diphenhydramine
C. Stop the transfusion
D. Check the client's temperature
Answer: C. STOP THE TRANSFUSION
Rationale: Flank pain and chills indicate a hemolytic reaction. The nurse must stop the
infusion immediately to prevent further damage.
10. What is the priority nursing intervention for a client during an active tonic-
clonic seizure?
A. Insert a padded tongue blade
B. Restrain the client's arms
C. Turn the client to a side-lying position
D. Administer oral suctioning
Answer: C. TURN THE CLIENT TO A SIDE-LYING POSITION
Rationale: Side-lying positioning protects the airway and prevents aspiration.
11. A client with a GCS of 7 requires what priority intervention?
A. Monitoring of pupillary response
B. Preparation for endotracheal intubation
, C. Range of motion exercises
D. Administration of IV fluids
Answer: B. PREPARATION FOR ENDOTRACHEAL INTUBATION
Rationale: "GCS of 8, we intubate." A score of 7 means the client cannot protect their
own airway.
12. A nurse is caring for a client with a DVT. The client suddenly reports chest
pain and shortness of breath. What should the nurse suspect?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Pneumothorax
D. Anxiety Attack
Answer: B. PULMONARY EMBOLISM
Rationale: A dislodged DVT that travels to the lungs is a Pulmonary Embolism (PE).
13. A client is prescribed Lisinopril. Which side effect should the nurse instruct
the client to report?
A. Yellowing of the skin
B. Dry, persistent cough
C. Increased appetite
D. Blurred vision
Answer: B. DRY, PERSISTENT COUGH
Rationale: A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation.
14. What is the "Gold Standard" lab test for diagnosing a Myocardial Infarction?
A. CK-MB
B. Myoglobin
C. Troponin I
D. BNP
Answer: C. TROPONIN I
Rationale: Troponin is highly specific to cardiac muscle damage.
15. A client with Cirrhosis has a high ammonia level and is confused. What
medication does the nurse anticipate?
A. Spironolactone
B. Lactulose
C. Propranolol
