NCLEX-RN NGN Clinical Judgment 2026 — Case
Studies, Bow-Tie & SATA Prac ce Ques ons
1. A client with pneumonia has a respiratory rate of 32/min, oxygen saturation of 86% on
room air, and increasing confusion. Which action should the nurse take first?
A. Obtain a sputum specimen
B. Apply supplemental oxygen
C. Encourage oral fluids
D. Administer the prescribed antibiotic
Answer: B. Apply supplemental oxygen
Rationale: Severe hypoxemia is the immediate priority. Oxygen should be initiated while
additional assessment and treatment occur.
2. A postoperative client suddenly reports shortness of breath and sharp chest pain. The
heart rate is 124/min and oxygen saturation is 88%. Which complication should the nurse
suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Pneumonia
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are classic
findings of pulmonary embolism.
3. A client receiving IV potassium chloride reports burning at the IV site. What should the
nurse do first?
A. Slow the infusion
B. Stop the infusion
C. Apply a warm compress
D. Document the finding
Answer: B. Stop the infusion
Rationale: Burning may indicate IV infiltration or irritation. The infusion should be stopped
immediately and the IV site assessed.
4. A client with heart failure has crackles, dyspnea, and pink frothy sputum. Which action is
priority?
A. Place the client supine
B. Administer oxygen and position upright
, C. Encourage increased oral fluids
D. Obtain a daily weight
Answer: B. Administer oxygen and position upright
Rationale: The findings indicate acute pulmonary edema. Upright positioning and oxygen
support ventilation and oxygenation.
5. A client taking warfarin has an INR of 5.8 and bleeding gums. Which prescription should
the nurse anticipate?
A. Additional warfarin
B. Vitamin K
C. Aspirin
D. Heparin
Answer: B. Vitamin K
Rationale: Excessive anticoagulation with bleeding may require reversal with vitamin K.
6. Which finding in a client receiving morphine requires immediate intervention?
A. Constipation
B. Nausea
C. Respiratory rate of 8/min
D. Mild drowsiness
Answer: C. Respiratory rate of 8/min
Rationale: Opioids can cause life-threatening respiratory depression. A markedly decreased
respiratory rate requires immediate intervention.
7. A client with diabetes is awake, diaphoretic, shaky, and has a blood glucose of 52 mg/dL.
What should the nurse do first?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Encourage exercise
D. Recheck the glucose in 1 hour
Answer: B. Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia should receive approximately 15 g
of rapid-acting carbohydrate.
8. Which client should the nurse assess first?
A. Client with chronic arthritis reporting pain
B. Client with COPD whose oxygen saturation is 90% and unchanged
C. Client 8 hours after craniotomy who is newly agitated
D. Client awaiting discharge instructions
,Answer: C. Client 8 hours after craniotomy who is newly agitated
Rationale: New agitation after neurosurgery may indicate increased intracranial pressure or
neurologic deterioration and requires immediate assessment.
9. A client with suspected stroke develops facial drooping and difficulty speaking. What is
the nurse's priority?
A. Give oral fluids
B. Determine the time symptoms began
C. Place the client in Trendelenburg position
D. Encourage ambulation
Answer: B. Determine the time symptoms began
Rationale: The time of symptom onset is critical for determining eligibility for time-sensitive
stroke therapies.
10. A client with hyperkalemia has peaked T waves on the ECG. Which medication should
the nurse anticipate administering first to stabilize the myocardium?
A. Calcium gluconate
B. Furosemide
C. Sodium polystyrene sulfonate
D. Regular insulin only
Answer: A. Calcium gluconate
Rationale: IV calcium stabilizes the cardiac membrane during significant hyperkalemia and
ECG changes.
11. A client with sepsis has BP 82/48 mm Hg, HR 126/min, temperature 39.2°C, and altered
mental status. Which finding is most concerning?
A. Temperature of 39.2°C
B. Heart rate of 126/min
C. Blood pressure of 82/48 mm Hg
D. Respiratory rate of 24/min
Answer: C. Blood pressure of 82/48 mm Hg
Rationale: Severe hypotension indicates inadequate tissue perfusion and possible septic shock.
12. Which assessment finding suggests worsening respiratory failure?
A. Respiratory rate of 18/min
B. Oxygen saturation of 97%
C. Increasing somnolence and decreasing respiratory effort
D. Clear bilateral breath sounds
Answer: C. Increasing somnolence and decreasing respiratory effort
Rationale: Declining consciousness and respiratory effort may indicate severe hypoxemia or
hypercapnia and impending respiratory arrest.
, 13. A client taking lisinopril develops swelling of the lips and tongue. Which action is
priority?
A. Give the next dose with food
B. Assess the airway immediately
C. Encourage oral fluids
D. Place the client flat
Answer: B. Assess the airway immediately
Rationale: Angioedema can rapidly obstruct the airway and is a medical emergency.
14. A client with DKA has glucose 520 mg/dL and dehydration. Which intervention is
generally initiated first?
A. IV isotonic fluids
B. Oral glucose
C. Long-acting insulin
D. Potassium restriction
Answer: A. IV isotonic fluids
Rationale: Initial treatment of DKA includes restoration of circulating volume with IV isotonic
fluid while subsequent insulin and electrolyte management occur.
15. A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this most likely indicate?
A. Normal drainage
B. An air leak
C. Tube obstruction
D. Lung re-expansion
Answer: B. An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates an air leak in the
system.
16. A client with a new tracheostomy becomes restless and has an oxygen saturation of 82%.
What should the nurse do first?
A. Remove the tracheostomy
B. Assess airway patency and oxygenation
C. Offer oral fluids
D. Place the client supine
Answer: B. Assess airway patency and oxygenation
Rationale: Restlessness and severe hypoxemia indicate possible airway obstruction. Airway and
oxygenation take priority.
17. A client receiving chemotherapy has a neutrophil count of 400/mm³. Which intervention
is appropriate?
A. Place fresh flowers in the room
Studies, Bow-Tie & SATA Prac ce Ques ons
1. A client with pneumonia has a respiratory rate of 32/min, oxygen saturation of 86% on
room air, and increasing confusion. Which action should the nurse take first?
A. Obtain a sputum specimen
B. Apply supplemental oxygen
C. Encourage oral fluids
D. Administer the prescribed antibiotic
Answer: B. Apply supplemental oxygen
Rationale: Severe hypoxemia is the immediate priority. Oxygen should be initiated while
additional assessment and treatment occur.
2. A postoperative client suddenly reports shortness of breath and sharp chest pain. The
heart rate is 124/min and oxygen saturation is 88%. Which complication should the nurse
suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Pneumonia
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are classic
findings of pulmonary embolism.
3. A client receiving IV potassium chloride reports burning at the IV site. What should the
nurse do first?
A. Slow the infusion
B. Stop the infusion
C. Apply a warm compress
D. Document the finding
Answer: B. Stop the infusion
Rationale: Burning may indicate IV infiltration or irritation. The infusion should be stopped
immediately and the IV site assessed.
4. A client with heart failure has crackles, dyspnea, and pink frothy sputum. Which action is
priority?
A. Place the client supine
B. Administer oxygen and position upright
, C. Encourage increased oral fluids
D. Obtain a daily weight
Answer: B. Administer oxygen and position upright
Rationale: The findings indicate acute pulmonary edema. Upright positioning and oxygen
support ventilation and oxygenation.
5. A client taking warfarin has an INR of 5.8 and bleeding gums. Which prescription should
the nurse anticipate?
A. Additional warfarin
B. Vitamin K
C. Aspirin
D. Heparin
Answer: B. Vitamin K
Rationale: Excessive anticoagulation with bleeding may require reversal with vitamin K.
6. Which finding in a client receiving morphine requires immediate intervention?
A. Constipation
B. Nausea
C. Respiratory rate of 8/min
D. Mild drowsiness
Answer: C. Respiratory rate of 8/min
Rationale: Opioids can cause life-threatening respiratory depression. A markedly decreased
respiratory rate requires immediate intervention.
7. A client with diabetes is awake, diaphoretic, shaky, and has a blood glucose of 52 mg/dL.
What should the nurse do first?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Encourage exercise
D. Recheck the glucose in 1 hour
Answer: B. Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia should receive approximately 15 g
of rapid-acting carbohydrate.
8. Which client should the nurse assess first?
A. Client with chronic arthritis reporting pain
B. Client with COPD whose oxygen saturation is 90% and unchanged
C. Client 8 hours after craniotomy who is newly agitated
D. Client awaiting discharge instructions
,Answer: C. Client 8 hours after craniotomy who is newly agitated
Rationale: New agitation after neurosurgery may indicate increased intracranial pressure or
neurologic deterioration and requires immediate assessment.
9. A client with suspected stroke develops facial drooping and difficulty speaking. What is
the nurse's priority?
A. Give oral fluids
B. Determine the time symptoms began
C. Place the client in Trendelenburg position
D. Encourage ambulation
Answer: B. Determine the time symptoms began
Rationale: The time of symptom onset is critical for determining eligibility for time-sensitive
stroke therapies.
10. A client with hyperkalemia has peaked T waves on the ECG. Which medication should
the nurse anticipate administering first to stabilize the myocardium?
A. Calcium gluconate
B. Furosemide
C. Sodium polystyrene sulfonate
D. Regular insulin only
Answer: A. Calcium gluconate
Rationale: IV calcium stabilizes the cardiac membrane during significant hyperkalemia and
ECG changes.
11. A client with sepsis has BP 82/48 mm Hg, HR 126/min, temperature 39.2°C, and altered
mental status. Which finding is most concerning?
A. Temperature of 39.2°C
B. Heart rate of 126/min
C. Blood pressure of 82/48 mm Hg
D. Respiratory rate of 24/min
Answer: C. Blood pressure of 82/48 mm Hg
Rationale: Severe hypotension indicates inadequate tissue perfusion and possible septic shock.
12. Which assessment finding suggests worsening respiratory failure?
A. Respiratory rate of 18/min
B. Oxygen saturation of 97%
C. Increasing somnolence and decreasing respiratory effort
D. Clear bilateral breath sounds
Answer: C. Increasing somnolence and decreasing respiratory effort
Rationale: Declining consciousness and respiratory effort may indicate severe hypoxemia or
hypercapnia and impending respiratory arrest.
, 13. A client taking lisinopril develops swelling of the lips and tongue. Which action is
priority?
A. Give the next dose with food
B. Assess the airway immediately
C. Encourage oral fluids
D. Place the client flat
Answer: B. Assess the airway immediately
Rationale: Angioedema can rapidly obstruct the airway and is a medical emergency.
14. A client with DKA has glucose 520 mg/dL and dehydration. Which intervention is
generally initiated first?
A. IV isotonic fluids
B. Oral glucose
C. Long-acting insulin
D. Potassium restriction
Answer: A. IV isotonic fluids
Rationale: Initial treatment of DKA includes restoration of circulating volume with IV isotonic
fluid while subsequent insulin and electrolyte management occur.
15. A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this most likely indicate?
A. Normal drainage
B. An air leak
C. Tube obstruction
D. Lung re-expansion
Answer: B. An air leak
Rationale: Continuous bubbling in the water-seal chamber usually indicates an air leak in the
system.
16. A client with a new tracheostomy becomes restless and has an oxygen saturation of 82%.
What should the nurse do first?
A. Remove the tracheostomy
B. Assess airway patency and oxygenation
C. Offer oral fluids
D. Place the client supine
Answer: B. Assess airway patency and oxygenation
Rationale: Restlessness and severe hypoxemia indicate possible airway obstruction. Airway and
oxygenation take priority.
17. A client receiving chemotherapy has a neutrophil count of 400/mm³. Which intervention
is appropriate?
A. Place fresh flowers in the room
