Next Generation NCLEX-RN (NGN) Comprehensive Practice Examination: 150 High-Yield Questions with Evidence-Based Rationales for Clinical Judgment Mastery

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Next Generation NCLEX-RN (NGN) Comprehensive
Practice Examination: 150 High-Yield Questions
with Evidence-Based Rationales for Clinical
Judgment Mastery


SECTION 1: MANAGEMENT OF CARE (Questions 1-25)


1. A charge nurse is making assignments for a medical-surgical unit. Which client should be


assigned to the most experienced registered nurse?


A. A client with pneumonia requiring IV antibiotics


B. A client with newly diagnosed diabetes requiring education


C. A client with a chest tube who is 2 days post-operative


D. A client with acute respiratory distress requiring continuous BiPAP and frequent ABG


monitoring


CorreCt Answer: D


Rationale: The most experienced RN should be assigned to the client with the most complex


and unstable condition. Continuous BiPAP with frequent ABG monitoring indicates respiratory


instability requiring advanced assessment skills and clinical judgment. Options A, B, and C


represent stable clients who can be appropriately cared for by less experienced staff.

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2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is


appropriate for the nurse to delegate?


A. Administering a tube feeding


B. Performing a sterile dressing change


C. Measuring and recording intake and output


D. Assessing a client's lung sounds


CorreCt Answer: C


Rationale: Measuring and recording intake and output is a non-invasive, routine task within the


UAP's scope of practice. Administration of tube feedings, sterile dressing changes, and


assessments require nursing judgment and are not appropriate for delegation to UAP.




3. A nurse on a busy medical unit receives a report on four clients. Which client should the


nurse assess first?


A. A client with heart failure reporting mild shortness of breath on exertion


B. A client post-cholecystectomy with a temperature of 99.8°F (37.7°C)

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C. A client with COPD who has oxygen saturation of 89% on 2L nasal cannula


D. A client with diabetes who has a blood glucose of 180 mg/dL


CorreCt Answer: C


Rationale: The client with COPD and oxygen saturation of 89% is hypoxemic despite receiving


supplemental oxygen, indicating potential respiratory compromise requiring immediate


assessment. The ABCs (Airway, Breathing, Circulation) framework prioritizes this client first.




4. A nurse is caring for a client who refuses a prescribed blood transfusion due to religious


beliefs. What is the nurse's best action?


A. Administer the transfusion anyway to preserve the client's life


B. Notify the provider and document the client's refusal


C. Ask the client's family to persuade the client to accept the transfusion


D. Delay the transfusion until the client changes their mind


CorreCt Answer: B

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Rationale: Clients have the right to refuse treatment based on religious or personal beliefs. The


nurse should respect the client's autonomy, notify the provider, and document the refusal.


Forcing treatment violates the client's legal and ethical rights.




5. A charge nurse is evaluating a newly licensed nurse's documentation. Which


documentation entry requires correction?


A. "Client ambulated 50 feet with assistance, tolerated well"


B. "Client complained of pain, administered morphine 2mg IV, pain decreased to 3/10"


C. "Client appears tired and depressed"


D. "Client's vital signs: BP 118/72, HR 76, RR 18, Temp 98.6°F"


CorreCt Answer: C


Rationale: Documentation must be objective and factual. "Client appears tired and depressed"


is subjective and based on the nurse's interpretation. The correct documentation should include


specific, observable behaviors.