NCLEX-RN Next Generation (NGN) 2026 | Comprehensive
Practice Exam & Detailed Rationales
1. A nurse is caring for a client with heart failure. Which assessment finding requires
immediate intervention?
A. Weight gain of 1 lb (0.45 kg) in 24 hours
B. Crackles in both lung bases and oxygen saturation of 88%
C. Heart rate of 88/min
D. Blood pressure of 128/78 mm Hg
Answer: B
Rationale: Crackles with an oxygen saturation of 88% indicate pulmonary edema and
impaired oxygenation, requiring immediate intervention.
2. Which laboratory value should the nurse report immediately for a client receiving
warfarin?
A. INR 1.2
B. INR 2.5
C. INR 4.8
,D. Hemoglobin 13 g/dL
Answer: C
Rationale: An INR of 4.8 significantly increases the risk of bleeding and requires prompt
provider notification.
3. A client receiving insulin becomes confused and diaphoretic. What is the nurse’s
priority action?
A. Administer glucagon immediately.
B. Check the client’s blood glucose.
C. Give long-acting insulin.
D. Encourage exercise.
Answer: B
Rationale: The nurse should first verify hypoglycemia by checking the blood glucose unless
the client is unconscious.
4. Which client should the emergency department nurse assess first?
A. Client with a sprained ankle
,B. Client with chest pain and diaphoresis
C. Client with a sore throat
D. Client requesting a medication refill
Answer: B
Rationale: Chest pain accompanied by diaphoresis may indicate an acute myocardial
infarction and requires immediate assessment.
5. Which electrolyte imbalance is most commonly associated with muscle weakness
and cardiac dysrhythmias?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Low potassium levels impair muscle contraction and cardiac electrical
conduction.
, 6. A nurse is teaching a client taking digoxin. Which finding should the client report
immediately?
A. Mild headache
B. Yellow or blurred vision
C. Increased appetite
D. Dry skin
Answer: B
Rationale: Visual disturbances are classic signs of digoxin toxicity.
7. Which intervention best prevents ventilator-associated pneumonia (VAP)?
A. Supine positioning
B. Elevating the head of the bed 30–45 degrees
C. Restricting fluids
D. Limiting oral care
Answer: B
Rationale: Elevating the head of the bed reduces aspiration risk and is a key evidence-
based VAP prevention strategy.
Practice Exam & Detailed Rationales
1. A nurse is caring for a client with heart failure. Which assessment finding requires
immediate intervention?
A. Weight gain of 1 lb (0.45 kg) in 24 hours
B. Crackles in both lung bases and oxygen saturation of 88%
C. Heart rate of 88/min
D. Blood pressure of 128/78 mm Hg
Answer: B
Rationale: Crackles with an oxygen saturation of 88% indicate pulmonary edema and
impaired oxygenation, requiring immediate intervention.
2. Which laboratory value should the nurse report immediately for a client receiving
warfarin?
A. INR 1.2
B. INR 2.5
C. INR 4.8
,D. Hemoglobin 13 g/dL
Answer: C
Rationale: An INR of 4.8 significantly increases the risk of bleeding and requires prompt
provider notification.
3. A client receiving insulin becomes confused and diaphoretic. What is the nurse’s
priority action?
A. Administer glucagon immediately.
B. Check the client’s blood glucose.
C. Give long-acting insulin.
D. Encourage exercise.
Answer: B
Rationale: The nurse should first verify hypoglycemia by checking the blood glucose unless
the client is unconscious.
4. Which client should the emergency department nurse assess first?
A. Client with a sprained ankle
,B. Client with chest pain and diaphoresis
C. Client with a sore throat
D. Client requesting a medication refill
Answer: B
Rationale: Chest pain accompanied by diaphoresis may indicate an acute myocardial
infarction and requires immediate assessment.
5. Which electrolyte imbalance is most commonly associated with muscle weakness
and cardiac dysrhythmias?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Low potassium levels impair muscle contraction and cardiac electrical
conduction.
, 6. A nurse is teaching a client taking digoxin. Which finding should the client report
immediately?
A. Mild headache
B. Yellow or blurred vision
C. Increased appetite
D. Dry skin
Answer: B
Rationale: Visual disturbances are classic signs of digoxin toxicity.
7. Which intervention best prevents ventilator-associated pneumonia (VAP)?
A. Supine positioning
B. Elevating the head of the bed 30–45 degrees
C. Restricting fluids
D. Limiting oral care
Answer: B
Rationale: Elevating the head of the bed reduces aspiration risk and is a key evidence-
based VAP prevention strategy.
