NCLEX-RN Next Generation (NGN) 2026
Comprehensive Exam| Questions With
Answers Plus Rationales| Academic Year
2026/27
Instant Pdf Download
SECTION 1: EXTENDED MULTIPLE RESPONSE (Questions 1-15)
QUESTION 1
A nurse is caring for a client with heart failure who reports sudden
shortness of breath, cough with pink frothy sputum, and anxiety. Vital
signs: BP 168/94, HR 118, RR 32, SpO₂ 84% on 2 L/min nasal cannula.
Which actions should the nurse take first? (Select all that apply)
A) Place the client in high-Fowler's position
B) Increase oxygen to 100% via non-rebreather mask
C) Administer IV furosemide as prescribed
D) Prepare for endotracheal intubation
E) Notify the healthcare provider
F) Start a second IV line
Answer: A, B, C
,Rationale: High-Fowler's position improves lung expansion and
reduces venous return, alleviating pulmonary edema. The client is
severely hypoxemic (84%); a non-rebreather mask delivers high FiO₂
to rapidly increase SpO₂. Furosemide, a loop diuretic, reduces
preload and pulmonary congestion. Intubation is not a first action
unless the client fails non-invasive measures. Notifying the provider
is important but should occur after initiating immediate life-saving
interventions. A second IV is not a priority.
QUESTION 2
A nurse is assessing a client who is 24 hours post-operative following
abdominal surgery. The client reports severe pain (8/10), nausea, and has
not voided in 8 hours. Vital signs: BP 140/88, HR 92, RR 20, Temp 37.6°C.
Which findings require immediate intervention? (Select all that apply)
A) Pain level of 8/10
B) Nausea
C) Urinary retention (no voiding in 8 hours)
D) Blood pressure 140/88
E) Heart rate 92
F) Temperature 37.6°C
Answer: A, B, C
Rationale: Pain 8/10 requires intervention for comfort and to
prevent complications (e.g., decreased mobility, respiratory issues).
Nausea increases aspiration risk and impedes oral
intake/medication absorption. No voiding in 8 hours (urinary
retention) can lead to bladder distention, infection, and autonomic
dysreflexia. BP 140/88, HR 92, and temp 37.6 are elevated but
expected post-operative findings.
,QUESTION 3
A nurse is providing discharge teaching to a client with a new ileostomy.
Which statements indicate understanding? (Select all that apply)
A) "My stoma will drain liquid fluid continuously."
B) "I will change my pouch system every 2 weeks."
C) "I will ensure that my medications are enteric-coated."
D) "I should watch for signs of dehydration."
E) "I will avoid foods that cause gas or odor."
F) "I will remove the pouch and let the stoma air out daily."
Answer: A, D, E
Rationale: An ileostomy drains liquid stool continuously because the
colon is bypassed. Dehydration is a risk due to fluid and electrolyte
loss and should be monitored. Avoiding gas/odor-producing foods
(beans, onions, broccoli) reduces discomfort. Pouches should be
changed every 3-7 days, not every 2 weeks. Enteric-coated
medications may not be absorbed properly. Stoma air exposure is
not recommended daily as it can irritate the skin.
QUESTION 4
A nurse is preparing to administer medications. Which clients should the
nurse question the provider's prescription? (Select all that apply)
A) Client with renal insufficiency prescribed metformin
B) Client with asthma prescribed metoprolol
C) Client with glaucoma prescribed atropine
D) Client with heart failure prescribed digoxin
E) Client with diabetes prescribed prednisone
Answer: A, B, C
Rationale: Metformin is contraindicated in renal insufficiency due to
lactic acidosis risk. Beta-blockers (metoprolol) are contraindicated
, in asthma due to bronchoconstriction. Atropine is contraindicated in
glaucoma due to increased intraocular pressure. Digoxin is
appropriate for heart failure (though requires monitoring).
Prednisone is appropriate for diabetes (though requires glucose
monitoring).
QUESTION 5
A nurse is assessing a client with suspected stroke. Which findings
support the diagnosis? (Select all that apply)
A) Sudden severe headache
B) Unilateral facial droop
C) Slurred speech
D) Bilateral arm weakness
E) Nausea and vomiting
F) Visual disturbances
Answer: A, B, C, F
Rationale: Sudden severe headache ("thunderclap") may indicate
hemorrhagic stroke. Unilateral facial droop and slurred speech are
classic stroke signs. Visual disturbances indicate neurological
involvement. Bilateral arm weakness is not typical of stroke (which
usually affects one side). Nausea and vomiting may occur but are
not specific to stroke.
QUESTION 6
A nurse is caring for a client receiving IV vancomycin. Which findings
indicate an adverse reaction requiring immediate action? (Select all that
apply)
Comprehensive Exam| Questions With
Answers Plus Rationales| Academic Year
2026/27
Instant Pdf Download
SECTION 1: EXTENDED MULTIPLE RESPONSE (Questions 1-15)
QUESTION 1
A nurse is caring for a client with heart failure who reports sudden
shortness of breath, cough with pink frothy sputum, and anxiety. Vital
signs: BP 168/94, HR 118, RR 32, SpO₂ 84% on 2 L/min nasal cannula.
Which actions should the nurse take first? (Select all that apply)
A) Place the client in high-Fowler's position
B) Increase oxygen to 100% via non-rebreather mask
C) Administer IV furosemide as prescribed
D) Prepare for endotracheal intubation
E) Notify the healthcare provider
F) Start a second IV line
Answer: A, B, C
,Rationale: High-Fowler's position improves lung expansion and
reduces venous return, alleviating pulmonary edema. The client is
severely hypoxemic (84%); a non-rebreather mask delivers high FiO₂
to rapidly increase SpO₂. Furosemide, a loop diuretic, reduces
preload and pulmonary congestion. Intubation is not a first action
unless the client fails non-invasive measures. Notifying the provider
is important but should occur after initiating immediate life-saving
interventions. A second IV is not a priority.
QUESTION 2
A nurse is assessing a client who is 24 hours post-operative following
abdominal surgery. The client reports severe pain (8/10), nausea, and has
not voided in 8 hours. Vital signs: BP 140/88, HR 92, RR 20, Temp 37.6°C.
Which findings require immediate intervention? (Select all that apply)
A) Pain level of 8/10
B) Nausea
C) Urinary retention (no voiding in 8 hours)
D) Blood pressure 140/88
E) Heart rate 92
F) Temperature 37.6°C
Answer: A, B, C
Rationale: Pain 8/10 requires intervention for comfort and to
prevent complications (e.g., decreased mobility, respiratory issues).
Nausea increases aspiration risk and impedes oral
intake/medication absorption. No voiding in 8 hours (urinary
retention) can lead to bladder distention, infection, and autonomic
dysreflexia. BP 140/88, HR 92, and temp 37.6 are elevated but
expected post-operative findings.
,QUESTION 3
A nurse is providing discharge teaching to a client with a new ileostomy.
Which statements indicate understanding? (Select all that apply)
A) "My stoma will drain liquid fluid continuously."
B) "I will change my pouch system every 2 weeks."
C) "I will ensure that my medications are enteric-coated."
D) "I should watch for signs of dehydration."
E) "I will avoid foods that cause gas or odor."
F) "I will remove the pouch and let the stoma air out daily."
Answer: A, D, E
Rationale: An ileostomy drains liquid stool continuously because the
colon is bypassed. Dehydration is a risk due to fluid and electrolyte
loss and should be monitored. Avoiding gas/odor-producing foods
(beans, onions, broccoli) reduces discomfort. Pouches should be
changed every 3-7 days, not every 2 weeks. Enteric-coated
medications may not be absorbed properly. Stoma air exposure is
not recommended daily as it can irritate the skin.
QUESTION 4
A nurse is preparing to administer medications. Which clients should the
nurse question the provider's prescription? (Select all that apply)
A) Client with renal insufficiency prescribed metformin
B) Client with asthma prescribed metoprolol
C) Client with glaucoma prescribed atropine
D) Client with heart failure prescribed digoxin
E) Client with diabetes prescribed prednisone
Answer: A, B, C
Rationale: Metformin is contraindicated in renal insufficiency due to
lactic acidosis risk. Beta-blockers (metoprolol) are contraindicated
, in asthma due to bronchoconstriction. Atropine is contraindicated in
glaucoma due to increased intraocular pressure. Digoxin is
appropriate for heart failure (though requires monitoring).
Prednisone is appropriate for diabetes (though requires glucose
monitoring).
QUESTION 5
A nurse is assessing a client with suspected stroke. Which findings
support the diagnosis? (Select all that apply)
A) Sudden severe headache
B) Unilateral facial droop
C) Slurred speech
D) Bilateral arm weakness
E) Nausea and vomiting
F) Visual disturbances
Answer: A, B, C, F
Rationale: Sudden severe headache ("thunderclap") may indicate
hemorrhagic stroke. Unilateral facial droop and slurred speech are
classic stroke signs. Visual disturbances indicate neurological
involvement. Bilateral arm weakness is not typical of stroke (which
usually affects one side). Nausea and vomiting may occur but are
not specific to stroke.
QUESTION 6
A nurse is caring for a client receiving IV vancomycin. Which findings
indicate an adverse reaction requiring immediate action? (Select all that
apply)
