NCLEX NGN Pre-Test Questions & Solutions
Comprehensive Study Guide & Clinical Decision-Making Review
Total Questions: 73 Items Format: Multiple Choice & Select All That Apply (SATA) Focus: Clinical Judgment, Safety & Prioritization
STUDY GUIDE OVERVIEW
This study module contains 73 Next Generation NCLEX (NGN) pre-test practice items covering critical nursing areas
including Advanced Med-Surg, Pediatrics, Obstetrics, Mental Health, and Pharmacology. Detailed rationales highlight core
clinical priorities, physiological mechanisms, and safety protocols.
Question 1 SATA
A nurse is assigned to care for a client with chronic renal failure who is undergoing hemodialysis through
an internal AV fistula in the RA. Which intervention should the nurse implement in caring for the client?
Select all that apply.
a. Assessing the radial pulse in the right extremity
b. Using the LA to take BP readings
c. Drawing pre-dialysis blood specimens from the LA
d. Assessing the area over the AV fistula for a bruit and thrill each shift
e. Placing a pressure dressing over the site after each dialysis treatment
f. Administering IV fluids through the venous site of the AV fistula as needed
Correct Answer: A, B, C, D
Rationale: The extremity with an AV fistula must be protected. BP and venipunctures are avoided in the affected extremity
(RA) to prevent thrombosis and damage. The radial pulse distal to the fistula is assessed for circulation. The site is
assessed for a bruit (audible) and thrill (palpable) to confirm patency. The fistula is reserved strictly for hemodialysis—
never for IV infusions. Pressure dressings are not routinely applied post-treatment as tight constriction risks clotting the
graft/fistula.
Question 2
A nurse is evaluating outcomes for a client with Guillain-Barré syndrome. Which outcome does the nurse
recognize as optimal respiratory outcomes for the client? Select all that apply.
a. Normal deep tendon reflexes
b. Improved skeletal muscle tone
c. Absence of paresthesias in the lower extremities
d. Clear sound in the lower lung fields bilaterally
e. pO2 of 85 mmHg and pCO2 of 40 mmHg
Correct Answer: D, E
Rationale: Guillain-Barré syndrome causes ascending muscular weakness that can paralyze respiratory muscles.
Optimal respiratory outcomes are demonstrated by clear bilateral lung sounds and normal arterial blood gas values (pO2
80-100 mmHg, pCO2 35-45 mmHg). Reflexes and muscle tone reflect overall neuromuscular status rather than specific
respiratory outcomes.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 1 of 25
, Question 3
A nurse on the telemetry unit is caring for a client who has had an MI and is now attached to a cardiac
monitor. The nurse is monitoring the client's cardiac rhythm and notes ventricular fibrillation. Which nursing
intervention should the nurse take first?
a. Calling the rapid response team
b. Preparing the client for cardioversion
c. Asking the client to bear down and cough
d. Preparing to administer diltiazem
Correct Answer: A
Rationale: Ventricular fibrillation (VF) is a lethal arrhythmia causing cardiac arrest; the client becomes pulseless and
unconscious. Immediate priority is to activate the emergency response system/rapid response team, initiate CPR, and
defibrillate as soon as possible. Cardioversion is indicated for synchronized rhythms with a pulse, not VF.
Question 4
A nurse developing a plan of care for a client with a spinal cord injury includes measures to prevent
autonomic dysreflexia (hyperreflexia). Which intervention does the nurse incorporate into the plan to prevent
this complication?
a. Keeping the fan running in the client's room
b. Keeping the linens wrinkle free under the client
c. Limiting bladder catheterization to once every 12 hours
d. Avoiding the administration of enemas and rectal suppositories
Correct Answer: B
Rationale: Autonomic dysreflexia is triggered by noxious stimuli below the level of injury (commonly T6 or above). Main
triggers are bladder distension, bowel impaction, and skin irritation (e.g., wrinkled sheets, tight clothing, pressure sores).
Ensuring wrinkle-free linens minimizes skin stimulation. Bladder catheterization should occur every 4-6 hours to prevent
distension.
Question 5
A nurse provides home care instructions to a client who has been fitted with a halo device to treat a cervical
fracture. Which statement by the client indicates the need for further teaching?
a. I need to get more fluids and fiber into my diet
b. I should cut my food into small pieces before I eat
c. I need to put powder under the vest twice a day to prevent sweating
d. I have to check the pin sites everyday and watch for signs of infection
Correct Answer: C
Rationale: Powders and lotions should NOT be used under the halo vest liner because they absorb moisture, cake, and
create a medium for severe skin breakdown and infection. The sheepskin/wool liner should be kept clean and dry.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 2 of 25
, Question 6
A nurse is caring for a client with increased intracranial pressure. In which position should the nurse
maintain the client?
a. Supine with the head extended
b. Side lying with the neck flexed
c. Supine with the head turned to the side
d. Head midline and elevated 30-45 degrees
Correct Answer: D
Rationale: Maintaining the head in a neutral, midline position elevated 30 to 45 degrees promotes venous drainage from
the cranium and reduces intracranial pressure (ICP). Neck flexion or head rotation obstructs jugular venous outflow.
Question 7
A client with a basilar skull fracture has clear fluid leaking from the ears. The nurse should take which action
first?
a. Assess the clear fluid for protein
b. Check the clear fluid for glucose
c. Place cotton balls or dry gauze loosely in the ears
d. Use an otoscope to assess the tympanic membrane for rupture
Correct Answer: B
Rationale: Otorrhea following a basilar skull fracture may indicate cerebrospinal fluid (CSF) leakage. CSF contains
glucose, whereas normal nasal/ear secretions do not. Testing fluid for glucose (or the "halo sign") confirms CSF. Objects
should not be inserted into the ear canal with an active leak.
Question 8
A nurse is caring for a client who has just undergone cardioversion. Which intervention is the nurse's
priority after this procedure?
a. Administer oxygen
b. Monitoring the BP
c. Administering antidysrhythmic medications
d. Monitoring the client's LOC
Correct Answer: A
Rationale: Applying the ABC (Airway, Breathing, Circulation) framework, oxygen administration and airway assessment
take immediate priority post-procedure to ensure adequate tissue oxygenation, especially following sedation and electrical
shock.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 3 of 25
Comprehensive Study Guide & Clinical Decision-Making Review
Total Questions: 73 Items Format: Multiple Choice & Select All That Apply (SATA) Focus: Clinical Judgment, Safety & Prioritization
STUDY GUIDE OVERVIEW
This study module contains 73 Next Generation NCLEX (NGN) pre-test practice items covering critical nursing areas
including Advanced Med-Surg, Pediatrics, Obstetrics, Mental Health, and Pharmacology. Detailed rationales highlight core
clinical priorities, physiological mechanisms, and safety protocols.
Question 1 SATA
A nurse is assigned to care for a client with chronic renal failure who is undergoing hemodialysis through
an internal AV fistula in the RA. Which intervention should the nurse implement in caring for the client?
Select all that apply.
a. Assessing the radial pulse in the right extremity
b. Using the LA to take BP readings
c. Drawing pre-dialysis blood specimens from the LA
d. Assessing the area over the AV fistula for a bruit and thrill each shift
e. Placing a pressure dressing over the site after each dialysis treatment
f. Administering IV fluids through the venous site of the AV fistula as needed
Correct Answer: A, B, C, D
Rationale: The extremity with an AV fistula must be protected. BP and venipunctures are avoided in the affected extremity
(RA) to prevent thrombosis and damage. The radial pulse distal to the fistula is assessed for circulation. The site is
assessed for a bruit (audible) and thrill (palpable) to confirm patency. The fistula is reserved strictly for hemodialysis—
never for IV infusions. Pressure dressings are not routinely applied post-treatment as tight constriction risks clotting the
graft/fistula.
Question 2
A nurse is evaluating outcomes for a client with Guillain-Barré syndrome. Which outcome does the nurse
recognize as optimal respiratory outcomes for the client? Select all that apply.
a. Normal deep tendon reflexes
b. Improved skeletal muscle tone
c. Absence of paresthesias in the lower extremities
d. Clear sound in the lower lung fields bilaterally
e. pO2 of 85 mmHg and pCO2 of 40 mmHg
Correct Answer: D, E
Rationale: Guillain-Barré syndrome causes ascending muscular weakness that can paralyze respiratory muscles.
Optimal respiratory outcomes are demonstrated by clear bilateral lung sounds and normal arterial blood gas values (pO2
80-100 mmHg, pCO2 35-45 mmHg). Reflexes and muscle tone reflect overall neuromuscular status rather than specific
respiratory outcomes.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 1 of 25
, Question 3
A nurse on the telemetry unit is caring for a client who has had an MI and is now attached to a cardiac
monitor. The nurse is monitoring the client's cardiac rhythm and notes ventricular fibrillation. Which nursing
intervention should the nurse take first?
a. Calling the rapid response team
b. Preparing the client for cardioversion
c. Asking the client to bear down and cough
d. Preparing to administer diltiazem
Correct Answer: A
Rationale: Ventricular fibrillation (VF) is a lethal arrhythmia causing cardiac arrest; the client becomes pulseless and
unconscious. Immediate priority is to activate the emergency response system/rapid response team, initiate CPR, and
defibrillate as soon as possible. Cardioversion is indicated for synchronized rhythms with a pulse, not VF.
Question 4
A nurse developing a plan of care for a client with a spinal cord injury includes measures to prevent
autonomic dysreflexia (hyperreflexia). Which intervention does the nurse incorporate into the plan to prevent
this complication?
a. Keeping the fan running in the client's room
b. Keeping the linens wrinkle free under the client
c. Limiting bladder catheterization to once every 12 hours
d. Avoiding the administration of enemas and rectal suppositories
Correct Answer: B
Rationale: Autonomic dysreflexia is triggered by noxious stimuli below the level of injury (commonly T6 or above). Main
triggers are bladder distension, bowel impaction, and skin irritation (e.g., wrinkled sheets, tight clothing, pressure sores).
Ensuring wrinkle-free linens minimizes skin stimulation. Bladder catheterization should occur every 4-6 hours to prevent
distension.
Question 5
A nurse provides home care instructions to a client who has been fitted with a halo device to treat a cervical
fracture. Which statement by the client indicates the need for further teaching?
a. I need to get more fluids and fiber into my diet
b. I should cut my food into small pieces before I eat
c. I need to put powder under the vest twice a day to prevent sweating
d. I have to check the pin sites everyday and watch for signs of infection
Correct Answer: C
Rationale: Powders and lotions should NOT be used under the halo vest liner because they absorb moisture, cake, and
create a medium for severe skin breakdown and infection. The sheepskin/wool liner should be kept clean and dry.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 2 of 25
, Question 6
A nurse is caring for a client with increased intracranial pressure. In which position should the nurse
maintain the client?
a. Supine with the head extended
b. Side lying with the neck flexed
c. Supine with the head turned to the side
d. Head midline and elevated 30-45 degrees
Correct Answer: D
Rationale: Maintaining the head in a neutral, midline position elevated 30 to 45 degrees promotes venous drainage from
the cranium and reduces intracranial pressure (ICP). Neck flexion or head rotation obstructs jugular venous outflow.
Question 7
A client with a basilar skull fracture has clear fluid leaking from the ears. The nurse should take which action
first?
a. Assess the clear fluid for protein
b. Check the clear fluid for glucose
c. Place cotton balls or dry gauze loosely in the ears
d. Use an otoscope to assess the tympanic membrane for rupture
Correct Answer: B
Rationale: Otorrhea following a basilar skull fracture may indicate cerebrospinal fluid (CSF) leakage. CSF contains
glucose, whereas normal nasal/ear secretions do not. Testing fluid for glucose (or the "halo sign") confirms CSF. Objects
should not be inserted into the ear canal with an active leak.
Question 8
A nurse is caring for a client who has just undergone cardioversion. Which intervention is the nurse's
priority after this procedure?
a. Administer oxygen
b. Monitoring the BP
c. Administering antidysrhythmic medications
d. Monitoring the client's LOC
Correct Answer: A
Rationale: Applying the ABC (Airway, Breathing, Circulation) framework, oxygen administration and airway assessment
take immediate priority post-procedure to ensure adequate tissue oxygenation, especially following sedation and electrical
shock.
NCLEX NGN Exam Preparation • Comprehensive Question Bank Page 3 of 25
