NCLEX-RN NGN CASE STUDY PRACTICE
EXAMINATION 2026–2027 — COMPREHENSIVE
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
Case Study 1: Heart Failure Exacerbation
A 72-year-old client with heart failure presents with dyspnea, orthopnea, and
weight gain of 3 kg in 2 days. Vital signs: BP 150/90, HR 110, RR 28, SpO₂ 88% on
room air. Lung sounds reveal bilateral crackles. The client has 3+ pitting edema in
the lower extremities.
1. Which finding requires the most immediate intervention?
A) Blood pressure 150/90
B) SpO₂ 88% on room air
C) Heart rate 110
D) Weight gain of 3 kg
Correct Answer: B
SpO₂ 88% indicates significant hypoxemia requiring immediate oxygen therapy.
The other findings are concerning but not as immediately life-threatening as
hypoxemia.
2. The provider orders furosemide 40 mg IV push. Which laboratory value
should the nurse check before administration?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Furosemide causes potassium loss; checking potassium before administration is
,essential to prevent hypokalemia-related dysrhythmias. Sodium, calcium, and
magnesium are less critical in this acute setting.
3. After furosemide administration, which finding indicates a therapeutic
response?
A) Heart rate increases to 120
B) Urine output of 20 mL/hr
C) Lung sounds clear and SpO₂ 94%
D) Weight gain of 1 kg in 2 hours
Correct Answer: C
Clearing of crackles and improved oxygenation indicate reduced pulmonary
congestion. Increased heart rate (A), low urine output (B), and further weight gain
(D) are not therapeutic.
4. The client is placed on a 2-g sodium diet. Which food choice indicates the
client needs further teaching?
A) Fresh fruit salad
B) Baked chicken with herbs
C) Canned vegetable soup
D) Steamed brown rice
Correct Answer: C
Canned soups are high in sodium. The other choices are low-sodium options
appropriate for a 2-g sodium diet.
5. The nurse is preparing discharge teaching. Which client statement indicates
understanding?
A) “I will weigh myself weekly.”
B) “I will take furosemide at bedtime to help me sleep.”
C) “I will call my provider if I gain 2 to 3 pounds in a day.”
D) “I will limit fluid intake only when I feel short of breath.”
Correct Answer: C
A weight gain of 2–3 pounds in a day indicates worsening fluid retention and
requires provider notification. Daily weights, not weekly (A), are needed.
,Furosemide should be taken in the morning (B). Fluid restriction should be
consistent (D).
Case Study 2: Postoperative Hip Arthroplasty
A 75-year-old client is 12 hours postoperative after a right total hip arthroplasty.
Vital signs are stable. The client reports pain 4/10 and is drowsy. The nurse notes
the surgical dressing is dry and intact.
6. Which nursing action is most important to prevent dislocation of the hip
prosthesis?
A) Keep the client in a high Fowler’s position
B) Use an abduction pillow between the legs
C) Encourage the client to cross the legs at the ankles
D) Position the operative leg in external rotation
Correct Answer: B
An abduction pillow prevents adduction and internal rotation, reducing the risk of
posterior dislocation. High Fowler’s (A) can flex the hip beyond 90 degrees.
Crossing legs (C) and external rotation (D) are contraindicated.
7. The client is prescribed enoxaparin subcutaneously. Which injection
technique is correct?
A) Aspirate before injecting
B) Massage the site after injecting
C) Pinch a skin fold on the abdomen and inject at a 90-degree angle
D) Use a 1.5-inch needle in the deltoid
Correct Answer: C
Enoxaparin is given subcutaneously in the abdomen at 90 degrees. Aspiration and
massage are not recommended. A 1.5-inch needle is for intramuscular use.
8. The nurse notes the client’s calf is swollen, warm, and tender on the left leg.
What is the priority action?
A) Massage the calf to improve circulation
B) Measure the calf circumference and notify the provider
, C) Ambulate the client immediately
D) Apply a heating pad to the calf
Correct Answer: B
Swelling, warmth, and tenderness suggest deep vein thrombosis. The nurse should
measure and notify the provider. Massage and ambulation can dislodge the clot.
Heating pad is not first.
9. The client is being transferred from bed to chair. Which device should the
nurse use?
A) Gait belt
B) Hoyer lift
C) Transfer board only
D) No device, hold the client’s arm
Correct Answer: A
A gait belt provides safe support during transfer. A Hoyer lift is for non-weight-
bearing clients. Holding the arm can cause injury. Transfer board alone may not be
sufficient.
10.The client develops sudden dyspnea and pleuritic chest pain. The nurse
suspects pulmonary embolism. What is the immediate action?
A) Administer prescribed pain medication
B) Notify the rapid response team and apply oxygen
C) Encourage the client to cough
D) Ambulate the client
Correct Answer: B
Sudden dyspnea and pleuritic chest pain after hip surgery suggest pulmonary
embolism, a life-threatening emergency. The nurse should call the rapid response
team and apply oxygen. Pain medication, coughing, and ambulation do not
address the emergency.
Case Study 3: Pediatric Asthma Exacerbation
EXAMINATION 2026–2027 — COMPREHENSIVE
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
Case Study 1: Heart Failure Exacerbation
A 72-year-old client with heart failure presents with dyspnea, orthopnea, and
weight gain of 3 kg in 2 days. Vital signs: BP 150/90, HR 110, RR 28, SpO₂ 88% on
room air. Lung sounds reveal bilateral crackles. The client has 3+ pitting edema in
the lower extremities.
1. Which finding requires the most immediate intervention?
A) Blood pressure 150/90
B) SpO₂ 88% on room air
C) Heart rate 110
D) Weight gain of 3 kg
Correct Answer: B
SpO₂ 88% indicates significant hypoxemia requiring immediate oxygen therapy.
The other findings are concerning but not as immediately life-threatening as
hypoxemia.
2. The provider orders furosemide 40 mg IV push. Which laboratory value
should the nurse check before administration?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Furosemide causes potassium loss; checking potassium before administration is
,essential to prevent hypokalemia-related dysrhythmias. Sodium, calcium, and
magnesium are less critical in this acute setting.
3. After furosemide administration, which finding indicates a therapeutic
response?
A) Heart rate increases to 120
B) Urine output of 20 mL/hr
C) Lung sounds clear and SpO₂ 94%
D) Weight gain of 1 kg in 2 hours
Correct Answer: C
Clearing of crackles and improved oxygenation indicate reduced pulmonary
congestion. Increased heart rate (A), low urine output (B), and further weight gain
(D) are not therapeutic.
4. The client is placed on a 2-g sodium diet. Which food choice indicates the
client needs further teaching?
A) Fresh fruit salad
B) Baked chicken with herbs
C) Canned vegetable soup
D) Steamed brown rice
Correct Answer: C
Canned soups are high in sodium. The other choices are low-sodium options
appropriate for a 2-g sodium diet.
5. The nurse is preparing discharge teaching. Which client statement indicates
understanding?
A) “I will weigh myself weekly.”
B) “I will take furosemide at bedtime to help me sleep.”
C) “I will call my provider if I gain 2 to 3 pounds in a day.”
D) “I will limit fluid intake only when I feel short of breath.”
Correct Answer: C
A weight gain of 2–3 pounds in a day indicates worsening fluid retention and
requires provider notification. Daily weights, not weekly (A), are needed.
,Furosemide should be taken in the morning (B). Fluid restriction should be
consistent (D).
Case Study 2: Postoperative Hip Arthroplasty
A 75-year-old client is 12 hours postoperative after a right total hip arthroplasty.
Vital signs are stable. The client reports pain 4/10 and is drowsy. The nurse notes
the surgical dressing is dry and intact.
6. Which nursing action is most important to prevent dislocation of the hip
prosthesis?
A) Keep the client in a high Fowler’s position
B) Use an abduction pillow between the legs
C) Encourage the client to cross the legs at the ankles
D) Position the operative leg in external rotation
Correct Answer: B
An abduction pillow prevents adduction and internal rotation, reducing the risk of
posterior dislocation. High Fowler’s (A) can flex the hip beyond 90 degrees.
Crossing legs (C) and external rotation (D) are contraindicated.
7. The client is prescribed enoxaparin subcutaneously. Which injection
technique is correct?
A) Aspirate before injecting
B) Massage the site after injecting
C) Pinch a skin fold on the abdomen and inject at a 90-degree angle
D) Use a 1.5-inch needle in the deltoid
Correct Answer: C
Enoxaparin is given subcutaneously in the abdomen at 90 degrees. Aspiration and
massage are not recommended. A 1.5-inch needle is for intramuscular use.
8. The nurse notes the client’s calf is swollen, warm, and tender on the left leg.
What is the priority action?
A) Massage the calf to improve circulation
B) Measure the calf circumference and notify the provider
, C) Ambulate the client immediately
D) Apply a heating pad to the calf
Correct Answer: B
Swelling, warmth, and tenderness suggest deep vein thrombosis. The nurse should
measure and notify the provider. Massage and ambulation can dislodge the clot.
Heating pad is not first.
9. The client is being transferred from bed to chair. Which device should the
nurse use?
A) Gait belt
B) Hoyer lift
C) Transfer board only
D) No device, hold the client’s arm
Correct Answer: A
A gait belt provides safe support during transfer. A Hoyer lift is for non-weight-
bearing clients. Holding the arm can cause injury. Transfer board alone may not be
sufficient.
10.The client develops sudden dyspnea and pleuritic chest pain. The nurse
suspects pulmonary embolism. What is the immediate action?
A) Administer prescribed pain medication
B) Notify the rapid response team and apply oxygen
C) Encourage the client to cough
D) Ambulate the client
Correct Answer: B
Sudden dyspnea and pleuritic chest pain after hip surgery suggest pulmonary
embolism, a life-threatening emergency. The nurse should call the rapid response
team and apply oxygen. Pain medication, coughing, and ambulation do not
address the emergency.
Case Study 3: Pediatric Asthma Exacerbation
