NCLEX-RN NEXT GENERATION (NGN) COMPREHENSIVE PRACTICE EXAM
, TABLE OF CONTENTS
NCLEX-RN Next Generation (NGN) Comprehensive Practice Exam
Original Board-Style Questions with Rationales
Chapter Topic Question Numbers
Chapter 1 Management of Care 1–20
Chapter 2 Safety & Infection Prevention and Control 21–40
Chapter 3 Health Promotion & Maintenance 41–60
Chapter 4 Psychosocial Integrity 61–80
Chapter 5 Basic Care & Comfort 81–100
Chapter 6 Pharmacological & Parenteral Therapies 101–135
Chapter 7 Reduction of Risk Potential 136–160
Chapter 8 Physiological Adaptation 161–180
Section II Next Generation (NGN) Clinical Judgment Case Studies 181–240
Next Generation (NGN) Clinical Judgment Case Studies
Case Study Topic Questions
Case Study 1 Adult Medical-Surgical Nursing – Sepsis 181–186
Case Study 2 Cardiovascular Nursing – Acute Myocardial Infarction (STEMI) 187–192
Case Study 3 Respiratory Nursing – COPD Exacerbation 193–198
Case Study 4 Neurological Nursing – Acute Ischemic Stroke 199–204
Case Study 5 Endocrine Nursing – Diabetic Ketoacidosis (DKA) 205–210
Case Study 6 Maternal–Newborn Nursing – Postpartum Hemorrhage 211–216
Case Study 7 Pediatric Nursing – Acute Respiratory Distress 217–222
,Case Study Topic Questions
Case Study 8 Mental Health Nursing – Crisis Intervention 223–228
Case Study 9 Pharmacology – High-Alert Medications 229–234
Case Study 10 Multi-System Prioritization & Delegation 235–240
Exam Features
• Next Generation (NGN) Clinical Judgment Items
• Matrix/Grid Questions
• Bow-Tie Questions
• Highlight the Findings
• Extended Multiple Response (SATA)
• Ordered Response Items
• Drop-Down/Cloze Questions
• Prioritization & Delegation
• Detailed Rationales
• Clinical Judgment Pearls
• NCLEX High-Yield Tips
• Fully Updated for Current NCLEX-RN Test Plan
Chapter 1: Management of Care
Question 1 – Client Prioritization
Clinical Scenario
At 0700, the nurse receives report on four clients admitted to a medical-surgical unit. Which client should the
nurse assess first?
A. A 69-year-old admitted with heart failure whose oxygen saturation has fallen from 95% to 89% over the past
20 minutes despite receiving oxygen at 2 L/min via nasal cannula.
B. A 51-year-old with newly diagnosed type 2 diabetes who is anxious about learning how to self-administer
insulin before discharge later today.
,C. A 63-year-old recovering from laparoscopic colectomy who reports abdominal pain rated 6/10 after walking
in the hallway.
D. A 76-year-old with chronic kidney disease requesting clarification regarding dietary potassium restrictions.
Correct Answer
A
Clinical Rationale
A declining oxygen saturation despite supplemental oxygen indicates worsening respiratory compromise.
Impaired oxygenation threatens tissue perfusion and requires immediate nursing assessment using the ABC
(Airway, Breathing, Circulation) priority framework.
Why the Other Options Are Less Appropriate
B. Education is important but may safely be delayed until unstable clients are evaluated.
C. Postoperative pain requires intervention but does not take precedence over respiratory deterioration.
D. Dietary teaching can occur after urgent physiologic needs have been addressed.
NCLEX High-Yield Tip
When several clients require attention simultaneously, prioritize actual physiologic deterioration over
anticipated or routine care needs.
Clinical Judgment Pearl
Trend changes are often more clinically significant than a single abnormal assessment finding.
Question 2 – Delegation
Clinical Scenario
An RN is supervising an experienced licensed practical nurse (LPN/LVN) and an experienced unlicensed
assistive personnel (UAP). Which task should the RN delegate to the UAP?
A. Assist a stable client recovering from total knee replacement with bathing and ambulation using a gait belt.
B. Reinforce discharge teaching for a client beginning anticoagulant therapy.
C. Assess a client who reports sudden shortness of breath while walking.
D. Evaluate whether intravenous furosemide relieved pulmonary congestion.
Correct Answer
A
Clinical Rationale
,Bathing and ambulation of a stable client are routine nursing activities that do not require clinical judgment
and are appropriate for delegation to trained UAPs.
Why the Other Options Are Less Appropriate
B. Teaching requires nursing knowledge and assessment of understanding.
C. New respiratory symptoms require immediate RN assessment.
D. Evaluating treatment effectiveness is an RN responsibility.
NCLEX High-Yield Tip
Remember the RN retains responsibility for Assessment, Teaching, Evaluation, and Nursing Judgment (ATEN).
Clinical Judgment Pearl
Delegate the task—not the responsibility for the client's overall outcome.
Question 3 – Client Assignment
Clinical Scenario
The charge nurse is assigning clients at the beginning of the shift. Which client is most appropriate for an
experienced LPN/LVN?
A. A client admitted 30 minutes ago with suspected pulmonary embolism who requires a comprehensive
admission assessment.
B. A client receiving the first unit of packed red blood cells for symptomatic anemia.
C. A client on postoperative day two following colon resection who requires a scheduled dressing change,
routine oral medications, and ongoing monitoring of expected recovery.
D. A client who suddenly becomes confused after receiving intravenous opioid medication.
Correct Answer
C
Clinical Rationale
The client has a predictable condition with expected outcomes and requires routine nursing care that falls
within the scope of practice for an experienced LPN/LVN.
Why the Other Options Are Less Appropriate
A. Initial assessments require RN-level clinical judgment.
B. Blood transfusions require RN monitoring for potential transfusion reactions.
D. Acute neurologic changes demand immediate RN assessment.
, NCLEX High-Yield Tip
Stable clients with predictable outcomes are appropriate assignments for LPN/LVNs.
Clinical Judgment Pearl
Whenever a client's condition is changing rapidly, assign that client to the RN.
Question 4 – Ethical Decision-Making
Clinical Scenario
A competent 60-year-old client with end-stage renal disease tells the nurse, "I've decided to stop dialysis
because I understand what that means for my future." The client's adult children insist the treatment continue.
Which nursing action best demonstrates client advocacy?
A. Encourage the family to discuss the benefits of continuing dialysis with the client.
B. Ask the healthcare provider to convince the client to continue treatment.
C. Confirm the client understands the consequences of the decision and communicate the client's wishes to
the healthcare team.
D. Delay further discussion until all family members agree with the client's decision.
Correct Answer
C
Clinical Rationale
A competent adult has the legal and ethical right to refuse treatment. The nurse's responsibility is to ensure
informed decision-making and advocate for the client's expressed wishes.
Why the Other Options Are Less Appropriate
A. Family opinions should not override the client's autonomous decision.
B. The provider may clarify information but cannot compel treatment.
D. Family agreement is not required when a competent client refuses care.
NCLEX High-Yield Tip
Autonomy means competent clients have the right to make informed healthcare decisions—even if others
disagree.
Clinical Judgment Pearl
Advocacy means supporting the client's choices, not the preferences of others.
, Question 5 – Safe Medication Administration
Clinical Scenario
While preparing morning medications, the nurse notices that the prescribed dose of digoxin is significantly
higher than the recommended therapeutic dosage. The client is alert, stable, and waiting to receive
medications.
What should the nurse do first?
A. Administer the medication because it appears on the medication administration record.
B. Hold the medication and contact the prescribing provider to clarify the order before administration.
C. Request another nurse to verify the medication and administer it if both nurses agree.
D. Ask the pharmacist to reduce the dose without contacting the provider.
Correct Answer
B
Clinical Rationale
The nurse has a professional responsibility to question prescriptions that appear unsafe. Administering a
questionable medication without clarification may place the client at significant risk for harm.
Why the Other Options Are Less Appropriate
A. Nurses are accountable for safe medication administration, regardless of who prescribed the medication.
C. A second opinion does not eliminate the need for provider clarification.
D. Pharmacists collaborate in medication safety, but medication orders may only be changed by an authorized
prescriber.
NCLEX High-Yield Tip
When a medication order appears unsafe, remember: Pause → Assess → Clarify → Verify → Administer.
Clinical Judgment Pearl
Safe nursing practice requires independent clinical judgment rather than unquestioningly following written
orders.
Question 6 – Client Safety & Prioritization
Clinical Scenario
The nurse is caring for four clients during a busy morning shift. Which client should the nurse evaluate
immediately?
,A. A 66-year-old admitted with unstable angina who reports persistent substernal chest pain rated 8/10 five
minutes after receiving the first dose of sublingual nitroglycerin.
B. A 73-year-old with atrial fibrillation whose heart rate is 104 beats/min before the scheduled dose of
metoprolol.
C. A 49-year-old recovering from pneumonia who requests assistance walking before lunch.
D. A 62-year-old with heart failure asking when the dietitian will discuss a low-sodium meal plan.
Correct Answer
A
Clinical Rationale
Persistent chest pain that does not improve after nitroglycerin may indicate ongoing myocardial ischemia or an
evolving myocardial infarction. Immediate assessment and intervention are essential to prevent further cardiac
damage.
Why the Other Options Are Less Appropriate
B. Mild tachycardia should be assessed but is less urgent than unresolved chest pain.
C. Ambulation can safely be delayed.
D. Dietary education is important but not an immediate priority.
NCLEX High-Yield Tip
When prioritizing care, remember that ongoing or worsening symptoms despite treatment often indicate the
highest priority.
Clinical Judgment Pearl
The client's response to therapy frequently provides more information than the initial diagnosis.
Question 7 – Delegation
Clinical Scenario
An RN is caring for six clients with the assistance of an experienced UAP. Which task is most appropriate to
delegate?
A. Measure and document intake and output for a stable client receiving oral diuretics for hypertension.
B. Assess a postoperative client who reports numbness and tingling below the surgical incision.
C. Teach a client newly diagnosed with asthma how to use a metered-dose inhaler.
D. Evaluate whether a client's pain has improved after receiving intravenous morphine.
Correct Answer
, A
Clinical Rationale
Monitoring intake and output for a stable client is a routine task appropriate for delegation to trained UAPs.
The RN remains responsible for interpreting the findings.
Why the Other Options Are Less Appropriate
B. New neurologic findings require RN assessment.
C. Client education cannot be delegated.
D. Evaluation of treatment effectiveness requires nursing judgment.
NCLEX High-Yield Tip
Delegate predictable tasks—never nursing judgment.
Clinical Judgment Pearl
A helpful question is, "Can this task be completed safely without making a clinical decision?" If yes, it may be
appropriate for delegation.
Question 8 – Client Assignment
Clinical Scenario
The charge nurse is assigning clients to two RNs and one LPN/LVN. Which client should be assigned to the
experienced RN?
A. A client awaiting discharge after cataract surgery.
B. A client who returned from abdominal aortic aneurysm repair 45 minutes ago.
C. A client receiving routine oral antibiotics for cellulitis.
D. A client scheduled for a routine dressing change following hernia repair.
Correct Answer
B
Clinical Rationale
Clients in the immediate postoperative period after major vascular surgery require frequent assessments for
hemorrhage, shock, and impaired tissue perfusion. Continuous clinical judgment is necessary.
Why the Other Options Are Less Appropriate
A. Stable discharge clients require minimal assessment.
C. Routine medication administration is predictable.
, TABLE OF CONTENTS
NCLEX-RN Next Generation (NGN) Comprehensive Practice Exam
Original Board-Style Questions with Rationales
Chapter Topic Question Numbers
Chapter 1 Management of Care 1–20
Chapter 2 Safety & Infection Prevention and Control 21–40
Chapter 3 Health Promotion & Maintenance 41–60
Chapter 4 Psychosocial Integrity 61–80
Chapter 5 Basic Care & Comfort 81–100
Chapter 6 Pharmacological & Parenteral Therapies 101–135
Chapter 7 Reduction of Risk Potential 136–160
Chapter 8 Physiological Adaptation 161–180
Section II Next Generation (NGN) Clinical Judgment Case Studies 181–240
Next Generation (NGN) Clinical Judgment Case Studies
Case Study Topic Questions
Case Study 1 Adult Medical-Surgical Nursing – Sepsis 181–186
Case Study 2 Cardiovascular Nursing – Acute Myocardial Infarction (STEMI) 187–192
Case Study 3 Respiratory Nursing – COPD Exacerbation 193–198
Case Study 4 Neurological Nursing – Acute Ischemic Stroke 199–204
Case Study 5 Endocrine Nursing – Diabetic Ketoacidosis (DKA) 205–210
Case Study 6 Maternal–Newborn Nursing – Postpartum Hemorrhage 211–216
Case Study 7 Pediatric Nursing – Acute Respiratory Distress 217–222
,Case Study Topic Questions
Case Study 8 Mental Health Nursing – Crisis Intervention 223–228
Case Study 9 Pharmacology – High-Alert Medications 229–234
Case Study 10 Multi-System Prioritization & Delegation 235–240
Exam Features
• Next Generation (NGN) Clinical Judgment Items
• Matrix/Grid Questions
• Bow-Tie Questions
• Highlight the Findings
• Extended Multiple Response (SATA)
• Ordered Response Items
• Drop-Down/Cloze Questions
• Prioritization & Delegation
• Detailed Rationales
• Clinical Judgment Pearls
• NCLEX High-Yield Tips
• Fully Updated for Current NCLEX-RN Test Plan
Chapter 1: Management of Care
Question 1 – Client Prioritization
Clinical Scenario
At 0700, the nurse receives report on four clients admitted to a medical-surgical unit. Which client should the
nurse assess first?
A. A 69-year-old admitted with heart failure whose oxygen saturation has fallen from 95% to 89% over the past
20 minutes despite receiving oxygen at 2 L/min via nasal cannula.
B. A 51-year-old with newly diagnosed type 2 diabetes who is anxious about learning how to self-administer
insulin before discharge later today.
,C. A 63-year-old recovering from laparoscopic colectomy who reports abdominal pain rated 6/10 after walking
in the hallway.
D. A 76-year-old with chronic kidney disease requesting clarification regarding dietary potassium restrictions.
Correct Answer
A
Clinical Rationale
A declining oxygen saturation despite supplemental oxygen indicates worsening respiratory compromise.
Impaired oxygenation threatens tissue perfusion and requires immediate nursing assessment using the ABC
(Airway, Breathing, Circulation) priority framework.
Why the Other Options Are Less Appropriate
B. Education is important but may safely be delayed until unstable clients are evaluated.
C. Postoperative pain requires intervention but does not take precedence over respiratory deterioration.
D. Dietary teaching can occur after urgent physiologic needs have been addressed.
NCLEX High-Yield Tip
When several clients require attention simultaneously, prioritize actual physiologic deterioration over
anticipated or routine care needs.
Clinical Judgment Pearl
Trend changes are often more clinically significant than a single abnormal assessment finding.
Question 2 – Delegation
Clinical Scenario
An RN is supervising an experienced licensed practical nurse (LPN/LVN) and an experienced unlicensed
assistive personnel (UAP). Which task should the RN delegate to the UAP?
A. Assist a stable client recovering from total knee replacement with bathing and ambulation using a gait belt.
B. Reinforce discharge teaching for a client beginning anticoagulant therapy.
C. Assess a client who reports sudden shortness of breath while walking.
D. Evaluate whether intravenous furosemide relieved pulmonary congestion.
Correct Answer
A
Clinical Rationale
,Bathing and ambulation of a stable client are routine nursing activities that do not require clinical judgment
and are appropriate for delegation to trained UAPs.
Why the Other Options Are Less Appropriate
B. Teaching requires nursing knowledge and assessment of understanding.
C. New respiratory symptoms require immediate RN assessment.
D. Evaluating treatment effectiveness is an RN responsibility.
NCLEX High-Yield Tip
Remember the RN retains responsibility for Assessment, Teaching, Evaluation, and Nursing Judgment (ATEN).
Clinical Judgment Pearl
Delegate the task—not the responsibility for the client's overall outcome.
Question 3 – Client Assignment
Clinical Scenario
The charge nurse is assigning clients at the beginning of the shift. Which client is most appropriate for an
experienced LPN/LVN?
A. A client admitted 30 minutes ago with suspected pulmonary embolism who requires a comprehensive
admission assessment.
B. A client receiving the first unit of packed red blood cells for symptomatic anemia.
C. A client on postoperative day two following colon resection who requires a scheduled dressing change,
routine oral medications, and ongoing monitoring of expected recovery.
D. A client who suddenly becomes confused after receiving intravenous opioid medication.
Correct Answer
C
Clinical Rationale
The client has a predictable condition with expected outcomes and requires routine nursing care that falls
within the scope of practice for an experienced LPN/LVN.
Why the Other Options Are Less Appropriate
A. Initial assessments require RN-level clinical judgment.
B. Blood transfusions require RN monitoring for potential transfusion reactions.
D. Acute neurologic changes demand immediate RN assessment.
, NCLEX High-Yield Tip
Stable clients with predictable outcomes are appropriate assignments for LPN/LVNs.
Clinical Judgment Pearl
Whenever a client's condition is changing rapidly, assign that client to the RN.
Question 4 – Ethical Decision-Making
Clinical Scenario
A competent 60-year-old client with end-stage renal disease tells the nurse, "I've decided to stop dialysis
because I understand what that means for my future." The client's adult children insist the treatment continue.
Which nursing action best demonstrates client advocacy?
A. Encourage the family to discuss the benefits of continuing dialysis with the client.
B. Ask the healthcare provider to convince the client to continue treatment.
C. Confirm the client understands the consequences of the decision and communicate the client's wishes to
the healthcare team.
D. Delay further discussion until all family members agree with the client's decision.
Correct Answer
C
Clinical Rationale
A competent adult has the legal and ethical right to refuse treatment. The nurse's responsibility is to ensure
informed decision-making and advocate for the client's expressed wishes.
Why the Other Options Are Less Appropriate
A. Family opinions should not override the client's autonomous decision.
B. The provider may clarify information but cannot compel treatment.
D. Family agreement is not required when a competent client refuses care.
NCLEX High-Yield Tip
Autonomy means competent clients have the right to make informed healthcare decisions—even if others
disagree.
Clinical Judgment Pearl
Advocacy means supporting the client's choices, not the preferences of others.
, Question 5 – Safe Medication Administration
Clinical Scenario
While preparing morning medications, the nurse notices that the prescribed dose of digoxin is significantly
higher than the recommended therapeutic dosage. The client is alert, stable, and waiting to receive
medications.
What should the nurse do first?
A. Administer the medication because it appears on the medication administration record.
B. Hold the medication and contact the prescribing provider to clarify the order before administration.
C. Request another nurse to verify the medication and administer it if both nurses agree.
D. Ask the pharmacist to reduce the dose without contacting the provider.
Correct Answer
B
Clinical Rationale
The nurse has a professional responsibility to question prescriptions that appear unsafe. Administering a
questionable medication without clarification may place the client at significant risk for harm.
Why the Other Options Are Less Appropriate
A. Nurses are accountable for safe medication administration, regardless of who prescribed the medication.
C. A second opinion does not eliminate the need for provider clarification.
D. Pharmacists collaborate in medication safety, but medication orders may only be changed by an authorized
prescriber.
NCLEX High-Yield Tip
When a medication order appears unsafe, remember: Pause → Assess → Clarify → Verify → Administer.
Clinical Judgment Pearl
Safe nursing practice requires independent clinical judgment rather than unquestioningly following written
orders.
Question 6 – Client Safety & Prioritization
Clinical Scenario
The nurse is caring for four clients during a busy morning shift. Which client should the nurse evaluate
immediately?
,A. A 66-year-old admitted with unstable angina who reports persistent substernal chest pain rated 8/10 five
minutes after receiving the first dose of sublingual nitroglycerin.
B. A 73-year-old with atrial fibrillation whose heart rate is 104 beats/min before the scheduled dose of
metoprolol.
C. A 49-year-old recovering from pneumonia who requests assistance walking before lunch.
D. A 62-year-old with heart failure asking when the dietitian will discuss a low-sodium meal plan.
Correct Answer
A
Clinical Rationale
Persistent chest pain that does not improve after nitroglycerin may indicate ongoing myocardial ischemia or an
evolving myocardial infarction. Immediate assessment and intervention are essential to prevent further cardiac
damage.
Why the Other Options Are Less Appropriate
B. Mild tachycardia should be assessed but is less urgent than unresolved chest pain.
C. Ambulation can safely be delayed.
D. Dietary education is important but not an immediate priority.
NCLEX High-Yield Tip
When prioritizing care, remember that ongoing or worsening symptoms despite treatment often indicate the
highest priority.
Clinical Judgment Pearl
The client's response to therapy frequently provides more information than the initial diagnosis.
Question 7 – Delegation
Clinical Scenario
An RN is caring for six clients with the assistance of an experienced UAP. Which task is most appropriate to
delegate?
A. Measure and document intake and output for a stable client receiving oral diuretics for hypertension.
B. Assess a postoperative client who reports numbness and tingling below the surgical incision.
C. Teach a client newly diagnosed with asthma how to use a metered-dose inhaler.
D. Evaluate whether a client's pain has improved after receiving intravenous morphine.
Correct Answer
, A
Clinical Rationale
Monitoring intake and output for a stable client is a routine task appropriate for delegation to trained UAPs.
The RN remains responsible for interpreting the findings.
Why the Other Options Are Less Appropriate
B. New neurologic findings require RN assessment.
C. Client education cannot be delegated.
D. Evaluation of treatment effectiveness requires nursing judgment.
NCLEX High-Yield Tip
Delegate predictable tasks—never nursing judgment.
Clinical Judgment Pearl
A helpful question is, "Can this task be completed safely without making a clinical decision?" If yes, it may be
appropriate for delegation.
Question 8 – Client Assignment
Clinical Scenario
The charge nurse is assigning clients to two RNs and one LPN/LVN. Which client should be assigned to the
experienced RN?
A. A client awaiting discharge after cataract surgery.
B. A client who returned from abdominal aortic aneurysm repair 45 minutes ago.
C. A client receiving routine oral antibiotics for cellulitis.
D. A client scheduled for a routine dressing change following hernia repair.
Correct Answer
B
Clinical Rationale
Clients in the immediate postoperative period after major vascular surgery require frequent assessments for
hemorrhage, shock, and impaired tissue perfusion. Continuous clinical judgment is necessary.
Why the Other Options Are Less Appropriate
A. Stable discharge clients require minimal assessment.
C. Routine medication administration is predictable.
