[NCLEX NEXT GEN PRACTICE EXAM 2] – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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CORE DOMAINS
• Management of Care• Safety and Infection Control• Health Promotion and Maintenance• Psychosocial Integrity• Basic Care and Comfort• Pharmacological and Parenteral
Therapies• Reduction of Risk Potential• Physiological Adaptation
INTRODUCTION
This comprehensive practice examination is designed to prepare nursing candidates for the rigors of the Next Generation NCLEX. The assessment focuses on the clinical
judgment measurement model, evaluating the candidate's ability to analyze cues, prioritize hypotheses, and take action in complex healthcare scenarios. Through a series of
multiple-choice and scenario-based questions, this exam tests foundational knowledge alongside advanced decision-making skills. The content emphasizes real-world
application, ethical practice, and regulatory compliance within the modern healthcare environment. By simulating the actual exam structure, this resource ensures that learners
are equipped with the critical thinking necessary to provide safe and effective patient-centered care.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client with a suspected pulmonary embolism. Which of the following actions should the nurse take first?
A. Initiate an intravenous line for heparin therapy.
B. Obtain a sample for arterial blood gas analysis.
🟢 C. Elevate the head of the bed to high-Fowler's position.
D. Instruct the client to perform incentive spirometry.
🔴 RATIONALE: Elevating the head of the bed is the priority intervention to promote lung expansion and gas exchange in a client experiencing respiratory distress related to a
pulmonary embolism.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment finding requires the nurse to withhold the medication?
A. Blood pressure 100/60 mmHg.
B. Respiratory rate 22 breaths per minute.
🟢 C. Apical pulse 52 beats per minute.
D. Serum potassium level 4.8 mEq/L.
🔴 RATIONALE: Digoxin is an inotropic agent that slows the heart rate. It should be held if the apical pulse is below 60 beats per minute to prevent further bradycardia.
3. Which of the following tasks should a registered nurse (RN) delegate to a licensed practical nurse (LPN)?
A. Developing the initial plan of care for a new admission.
🟢 B. Administering a scheduled subcutaneous insulin injection.
C. Teaching a client how to manage a new colostomy.
D. Evaluating a client’s response to a PRN pain medication.
🔴 RATIONALE: LPNs can perform routine tasks such as medication administration. Assessment, planning, and teaching are responsibilities of the RN.
, 4. A client in the emergency department reports sudden, severe "tearing" chest pain radiating to the back. What should the nurse suspect?
🟢 A. Aortic dissection.
B. Myocardial infarction.
C. Pneumothorax.
D. Pericarditis.
🔴 RATIONALE: Sudden, tearing or ripping pain that radiates to the back or between the shoulder blades is a classic sign of an aortic dissection, a medical emergency.
5. A nurse is caring for a client with a serum sodium level of 122 mEq/L. Which intervention is the priority?
A. Encourage increased oral fluid intake.
B. Administer a loop diuretic as prescribed.
🟢 C. Implement seizure precautions.
D. Monitor weight every 24 hours.
🔴 RATIONALE: Severe hyponatremia (below 125 mEq/L) places the client at high risk for cerebral edema and seizures; safety precautions are the priority.
6. A client with a chest tube has continuous bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally.
🟢 B. There is an air leak in the system.
C. The suction pressure is too high.
D. The lung has fully re-expanded.
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak between the client and the drainage system. Intermittent bubbling is normal during
expiration.
7. Which of the following medications is used to treat a client experiencing an acute manic episode?
A. Sertraline.
B. Donepezil.
🟢 C. Lithium carbonate.
D. Amitriptyline.
🔴 RATIONALE: Lithium is a mood stabilizer and the gold standard for treating acute mania and preventing future episodes in bipolar disorder.
8. A nurse is assessing a client with Cushing’s syndrome. Which of the following clinical manifestations should the nurse expect?
🟢 A. Truncal obesity and moon face.
B. Weight loss and hypotension.
C. Hyperpigmentation and tachycardia.
D. Polydipsia and polyuria.
🔴 RATIONALE: Cushing’s syndrome is characterized by excessive cortisol, leading to fat redistribution (truncal obesity, moon face, buffalo hump) and skin thinning.
, 9. A nurse is caring for a client post-thyroidectomy. The nurse notes the client has a positive Chvostek's sign. Which medication should be available?
A. Potassium chloride.
🟢 B. Calcium gluconate.
C. Magnesium sulfate.
D. Sodium bicarbonate.
🔴 RATIONALE: A positive Chvostek's sign indicates hypocalcemia, often caused by accidental removal of the parathyroid glands during thyroid surgery. Calcium gluconate is
the treatment.
10. A nurse is evaluating the effectiveness of a client's nitroglycerin therapy for angina. Which statement by the client indicates understanding?
A. "I will swallow the tablet with a full glass of water."
B. "I should take a tablet every 15 minutes until the pain stops."
🟢 C. "I will sit down before taking the medication to avoid dizziness."
D. "The medication should be stored in a clear plastic container."
🔴 RATIONALE: Nitroglycerin is a potent vasodilator that can cause orthostatic hypotension; sitting prevents falls. It is taken sublingually and stored in dark glass.
11. A nurse is providing discharge teaching to a client on warfarin. Which food should the client be instructed to keep consistent in their diet?
A. Bananas.
B. Red meat.
🟢 C. Spinach.
D. Dairy products.
🔴 RATIONALE: Spinach is high in Vitamin K, the antagonist to warfarin. Consistent intake is necessary to maintain stable INR levels.
12. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following laboratory values should the nurse expect?
🟢 A. pH 7.25, HCO3 16 mEq/L.
B. pH 7.50, HCO3 30 mEq/L.
C. pH 7.35, PaCO2 40 mmHg.
D. pH 7.45, HCO3 24 mEq/L.
🔴 RATIONALE: DKA is characterized by metabolic acidosis, shown by a low pH and low bicarbonate levels.
13. A nurse is caring for a client with a deep vein thrombosis (DVT). Which action is contraindicated?
A. Elevating the affected extremity.
B. Administering prescribed anticoagulants.
🟢 C. Massaging the affected leg to relieve pain.
D. Applying warm, moist compresses.
🔴 RATIONALE: Massaging the leg of a client with DVT can dislodge the clot, leading to a pulmonary embolism.
DOWNLOAD PDF.
CORE DOMAINS
• Management of Care• Safety and Infection Control• Health Promotion and Maintenance• Psychosocial Integrity• Basic Care and Comfort• Pharmacological and Parenteral
Therapies• Reduction of Risk Potential• Physiological Adaptation
INTRODUCTION
This comprehensive practice examination is designed to prepare nursing candidates for the rigors of the Next Generation NCLEX. The assessment focuses on the clinical
judgment measurement model, evaluating the candidate's ability to analyze cues, prioritize hypotheses, and take action in complex healthcare scenarios. Through a series of
multiple-choice and scenario-based questions, this exam tests foundational knowledge alongside advanced decision-making skills. The content emphasizes real-world
application, ethical practice, and regulatory compliance within the modern healthcare environment. By simulating the actual exam structure, this resource ensures that learners
are equipped with the critical thinking necessary to provide safe and effective patient-centered care.
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client with a suspected pulmonary embolism. Which of the following actions should the nurse take first?
A. Initiate an intravenous line for heparin therapy.
B. Obtain a sample for arterial blood gas analysis.
🟢 C. Elevate the head of the bed to high-Fowler's position.
D. Instruct the client to perform incentive spirometry.
🔴 RATIONALE: Elevating the head of the bed is the priority intervention to promote lung expansion and gas exchange in a client experiencing respiratory distress related to a
pulmonary embolism.
2. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment finding requires the nurse to withhold the medication?
A. Blood pressure 100/60 mmHg.
B. Respiratory rate 22 breaths per minute.
🟢 C. Apical pulse 52 beats per minute.
D. Serum potassium level 4.8 mEq/L.
🔴 RATIONALE: Digoxin is an inotropic agent that slows the heart rate. It should be held if the apical pulse is below 60 beats per minute to prevent further bradycardia.
3. Which of the following tasks should a registered nurse (RN) delegate to a licensed practical nurse (LPN)?
A. Developing the initial plan of care for a new admission.
🟢 B. Administering a scheduled subcutaneous insulin injection.
C. Teaching a client how to manage a new colostomy.
D. Evaluating a client’s response to a PRN pain medication.
🔴 RATIONALE: LPNs can perform routine tasks such as medication administration. Assessment, planning, and teaching are responsibilities of the RN.
, 4. A client in the emergency department reports sudden, severe "tearing" chest pain radiating to the back. What should the nurse suspect?
🟢 A. Aortic dissection.
B. Myocardial infarction.
C. Pneumothorax.
D. Pericarditis.
🔴 RATIONALE: Sudden, tearing or ripping pain that radiates to the back or between the shoulder blades is a classic sign of an aortic dissection, a medical emergency.
5. A nurse is caring for a client with a serum sodium level of 122 mEq/L. Which intervention is the priority?
A. Encourage increased oral fluid intake.
B. Administer a loop diuretic as prescribed.
🟢 C. Implement seizure precautions.
D. Monitor weight every 24 hours.
🔴 RATIONALE: Severe hyponatremia (below 125 mEq/L) places the client at high risk for cerebral edema and seizures; safety precautions are the priority.
6. A client with a chest tube has continuous bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally.
🟢 B. There is an air leak in the system.
C. The suction pressure is too high.
D. The lung has fully re-expanded.
🔴 RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak between the client and the drainage system. Intermittent bubbling is normal during
expiration.
7. Which of the following medications is used to treat a client experiencing an acute manic episode?
A. Sertraline.
B. Donepezil.
🟢 C. Lithium carbonate.
D. Amitriptyline.
🔴 RATIONALE: Lithium is a mood stabilizer and the gold standard for treating acute mania and preventing future episodes in bipolar disorder.
8. A nurse is assessing a client with Cushing’s syndrome. Which of the following clinical manifestations should the nurse expect?
🟢 A. Truncal obesity and moon face.
B. Weight loss and hypotension.
C. Hyperpigmentation and tachycardia.
D. Polydipsia and polyuria.
🔴 RATIONALE: Cushing’s syndrome is characterized by excessive cortisol, leading to fat redistribution (truncal obesity, moon face, buffalo hump) and skin thinning.
, 9. A nurse is caring for a client post-thyroidectomy. The nurse notes the client has a positive Chvostek's sign. Which medication should be available?
A. Potassium chloride.
🟢 B. Calcium gluconate.
C. Magnesium sulfate.
D. Sodium bicarbonate.
🔴 RATIONALE: A positive Chvostek's sign indicates hypocalcemia, often caused by accidental removal of the parathyroid glands during thyroid surgery. Calcium gluconate is
the treatment.
10. A nurse is evaluating the effectiveness of a client's nitroglycerin therapy for angina. Which statement by the client indicates understanding?
A. "I will swallow the tablet with a full glass of water."
B. "I should take a tablet every 15 minutes until the pain stops."
🟢 C. "I will sit down before taking the medication to avoid dizziness."
D. "The medication should be stored in a clear plastic container."
🔴 RATIONALE: Nitroglycerin is a potent vasodilator that can cause orthostatic hypotension; sitting prevents falls. It is taken sublingually and stored in dark glass.
11. A nurse is providing discharge teaching to a client on warfarin. Which food should the client be instructed to keep consistent in their diet?
A. Bananas.
B. Red meat.
🟢 C. Spinach.
D. Dairy products.
🔴 RATIONALE: Spinach is high in Vitamin K, the antagonist to warfarin. Consistent intake is necessary to maintain stable INR levels.
12. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following laboratory values should the nurse expect?
🟢 A. pH 7.25, HCO3 16 mEq/L.
B. pH 7.50, HCO3 30 mEq/L.
C. pH 7.35, PaCO2 40 mmHg.
D. pH 7.45, HCO3 24 mEq/L.
🔴 RATIONALE: DKA is characterized by metabolic acidosis, shown by a low pH and low bicarbonate levels.
13. A nurse is caring for a client with a deep vein thrombosis (DVT). Which action is contraindicated?
A. Elevating the affected extremity.
B. Administering prescribed anticoagulants.
🟢 C. Massaging the affected leg to relieve pain.
D. Applying warm, moist compresses.
🔴 RATIONALE: Massaging the leg of a client with DVT can dislodge the clot, leading to a pulmonary embolism.
