NCLEX-RN NGN Actual
Exam Questions 2026 | Pass
First Attempt
1. Recognize Cues — Multiple Response
Which findings require immediate attention? Select all that apply.
A. SpO₂ 86%
B. Respiratory rate 30/min
C. 3+ lower-extremity edema
D. Pink, frothy sputum
E. Weight gain of 3 kg
F. BP 168/94 mmHg
Answer: A, B, D
Rationale: Severe hypoxemia, tachypnea, and pink frothy sputum indicate acute respiratory
compromise and possible pulmonary edema. These findings require immediate intervention. Edema and
recent weight gain support fluid overload but are less immediately life-threatening.
2. Analyze Cues — Single Response
Which condition is most consistent with the client's findings?
A. Pulmonary embolism
B. Acute pulmonary edema associated with heart failure
C. Pneumothorax
D. Stable chronic heart failure
Answer: B
Rationale: Bilateral crackles, hypoxemia, pink frothy sputum, significant edema, hypertension, and
rapid weight gain strongly indicate acute decompensated heart failure with pulmonary edema.
,3. Prioritize Hypotheses
Which problem should the nurse address first?
A. Excess fluid volume
B. Activity intolerance
C. Impaired gas exchange
D. Peripheral edema
Answer: C
Rationale: Airway and breathing take priority. The client's oxygenation is severely impaired,
making impaired gas exchange the immediate priority.
4. Take Action — Multiple Response
Which interventions should the nurse anticipate? Select all that apply.
A. Position the client upright
B. Administer supplemental oxygen as prescribed
C. Administer prescribed IV loop diuretic
D. Encourage increased oral fluid intake
E. Place the client flat in bed
F. Monitor respiratory status and oxygen saturation
Answer: A, B, C, F
Rationale: Upright positioning improves ventilation. Oxygen addresses hypoxemia, while an IV loop
diuretic such as furosemide may reduce pulmonary congestion when prescribed. Close respiratory
monitoring is essential. Increasing fluids and placing the client flat would worsen the situation.
5. Evaluate Outcomes
After treatment, which finding best indicates that the interventions were
effective?
A. SpO₂ increases to 94%
B. Respiratory rate increases to 34/min
C. Crackles become more extensive
D. Client develops increasing anxiety and restlessness
Answer: A
Rationale: Improved oxygen saturation indicates improved gas exchange. Increasing respiratory distress,
crackles, anxiety, or restlessness would suggest worsening hypoxemia or respiratory compromise.
,Case Study 2: Hypoglycemia
A 64-year-old client with type 2 diabetes receives insulin before breakfast. Two hours later, the
client becomes confused, diaphoretic, shaky, and irritable.
Blood glucose: 48 mg/dL
6. Recognize Cues
Which findings are consistent with hypoglycemia? Select all that apply.
A. Diaphoresis
B. Tremors
C. Confusion
D. Irritability
E. Increased thirst
F. Blood glucose 48 mg/dL
Answer: A, B, C, D, F
Rationale: Hypoglycemia can cause adrenergic manifestations such as sweating and tremors
and neuroglycopenic symptoms such as confusion and behavioral changes. A glucose of 48
mg/dL confirms significant hypoglycemia. Increased thirst is more commonly associated with
hyperglycemia.
7. Take Action
The client is awake and able to swallow safely. What should the nurse do first?
A. Administer 15 g of a rapid-acting carbohydrate
B. Administer the client's next insulin dose
C. Give a high-protein meal immediately
D. Encourage the client to ambulate
Answer: A
Rationale: A conscious client who can safely swallow should receive approximately 15 g of rapid-acting
carbohydrate, followed by reassessment of blood glucose according to protocol.
8. Evaluate Outcomes
Fifteen minutes after treatment, the glucose is 52 mg/dL and the client remains
symptomatic. What is the priority action?
A. Repeat the rapid-acting carbohydrate treatment according to protocol
B. Administer long-acting insulin
, C. Encourage exercise
D. Wait one hour before reassessing
Answer: A
Rationale: Persistent hypoglycemia requires another treatment with rapid-acting carbohydrate
according to the facility's hypoglycemia protocol, followed by repeat glucose assessment.
Stand-Alone NGN Questions
9. Prioritization
The nurse receives report on four clients. Which client should be assessed first?
A. Client with COPD whose SpO₂ is 91% on prescribed oxygen
B. Client 1 day after surgery reporting pain of 7/10
C. Client with pneumonia who is newly confused and has a respiratory rate of 32/min
D. Client with diabetes whose premeal glucose is 210 mg/dL
Answer: C
Rationale: New confusion combined with tachypnea in a client with pneumonia suggests
worsening hypoxemia or respiratory deterioration. This client has the greatest immediate threat to life.
10. Medication Safety — Multiple Response
A client is prescribed digoxin. Which findings should cause the nurse to withhold the
medication and notify the provider? Select all that apply.
A. Apical pulse 52/min
B. Nausea and vomiting
C. Yellow/green visual disturbances
D. Potassium 4.2 mEq/L
E. New confusion
F. Blood pressure 128/76 mmHg
Answer: A, B, C, E
Rationale: Bradycardia, gastrointestinal symptoms, visual disturbances, and new neurologic changes can
indicate digoxin toxicity. A potassium of 4.2 mEq/L and BP of 128/76 mmHg are not, by themselves,
reasons to withhold the medication.
11. Recognize Cues — Multiple Response
Which findings are concerning for sepsis with possible shock? Select all
that apply.
Exam Questions 2026 | Pass
First Attempt
1. Recognize Cues — Multiple Response
Which findings require immediate attention? Select all that apply.
A. SpO₂ 86%
B. Respiratory rate 30/min
C. 3+ lower-extremity edema
D. Pink, frothy sputum
E. Weight gain of 3 kg
F. BP 168/94 mmHg
Answer: A, B, D
Rationale: Severe hypoxemia, tachypnea, and pink frothy sputum indicate acute respiratory
compromise and possible pulmonary edema. These findings require immediate intervention. Edema and
recent weight gain support fluid overload but are less immediately life-threatening.
2. Analyze Cues — Single Response
Which condition is most consistent with the client's findings?
A. Pulmonary embolism
B. Acute pulmonary edema associated with heart failure
C. Pneumothorax
D. Stable chronic heart failure
Answer: B
Rationale: Bilateral crackles, hypoxemia, pink frothy sputum, significant edema, hypertension, and
rapid weight gain strongly indicate acute decompensated heart failure with pulmonary edema.
,3. Prioritize Hypotheses
Which problem should the nurse address first?
A. Excess fluid volume
B. Activity intolerance
C. Impaired gas exchange
D. Peripheral edema
Answer: C
Rationale: Airway and breathing take priority. The client's oxygenation is severely impaired,
making impaired gas exchange the immediate priority.
4. Take Action — Multiple Response
Which interventions should the nurse anticipate? Select all that apply.
A. Position the client upright
B. Administer supplemental oxygen as prescribed
C. Administer prescribed IV loop diuretic
D. Encourage increased oral fluid intake
E. Place the client flat in bed
F. Monitor respiratory status and oxygen saturation
Answer: A, B, C, F
Rationale: Upright positioning improves ventilation. Oxygen addresses hypoxemia, while an IV loop
diuretic such as furosemide may reduce pulmonary congestion when prescribed. Close respiratory
monitoring is essential. Increasing fluids and placing the client flat would worsen the situation.
5. Evaluate Outcomes
After treatment, which finding best indicates that the interventions were
effective?
A. SpO₂ increases to 94%
B. Respiratory rate increases to 34/min
C. Crackles become more extensive
D. Client develops increasing anxiety and restlessness
Answer: A
Rationale: Improved oxygen saturation indicates improved gas exchange. Increasing respiratory distress,
crackles, anxiety, or restlessness would suggest worsening hypoxemia or respiratory compromise.
,Case Study 2: Hypoglycemia
A 64-year-old client with type 2 diabetes receives insulin before breakfast. Two hours later, the
client becomes confused, diaphoretic, shaky, and irritable.
Blood glucose: 48 mg/dL
6. Recognize Cues
Which findings are consistent with hypoglycemia? Select all that apply.
A. Diaphoresis
B. Tremors
C. Confusion
D. Irritability
E. Increased thirst
F. Blood glucose 48 mg/dL
Answer: A, B, C, D, F
Rationale: Hypoglycemia can cause adrenergic manifestations such as sweating and tremors
and neuroglycopenic symptoms such as confusion and behavioral changes. A glucose of 48
mg/dL confirms significant hypoglycemia. Increased thirst is more commonly associated with
hyperglycemia.
7. Take Action
The client is awake and able to swallow safely. What should the nurse do first?
A. Administer 15 g of a rapid-acting carbohydrate
B. Administer the client's next insulin dose
C. Give a high-protein meal immediately
D. Encourage the client to ambulate
Answer: A
Rationale: A conscious client who can safely swallow should receive approximately 15 g of rapid-acting
carbohydrate, followed by reassessment of blood glucose according to protocol.
8. Evaluate Outcomes
Fifteen minutes after treatment, the glucose is 52 mg/dL and the client remains
symptomatic. What is the priority action?
A. Repeat the rapid-acting carbohydrate treatment according to protocol
B. Administer long-acting insulin
, C. Encourage exercise
D. Wait one hour before reassessing
Answer: A
Rationale: Persistent hypoglycemia requires another treatment with rapid-acting carbohydrate
according to the facility's hypoglycemia protocol, followed by repeat glucose assessment.
Stand-Alone NGN Questions
9. Prioritization
The nurse receives report on four clients. Which client should be assessed first?
A. Client with COPD whose SpO₂ is 91% on prescribed oxygen
B. Client 1 day after surgery reporting pain of 7/10
C. Client with pneumonia who is newly confused and has a respiratory rate of 32/min
D. Client with diabetes whose premeal glucose is 210 mg/dL
Answer: C
Rationale: New confusion combined with tachypnea in a client with pneumonia suggests
worsening hypoxemia or respiratory deterioration. This client has the greatest immediate threat to life.
10. Medication Safety — Multiple Response
A client is prescribed digoxin. Which findings should cause the nurse to withhold the
medication and notify the provider? Select all that apply.
A. Apical pulse 52/min
B. Nausea and vomiting
C. Yellow/green visual disturbances
D. Potassium 4.2 mEq/L
E. New confusion
F. Blood pressure 128/76 mmHg
Answer: A, B, C, E
Rationale: Bradycardia, gastrointestinal symptoms, visual disturbances, and new neurologic changes can
indicate digoxin toxicity. A potassium of 4.2 mEq/L and BP of 128/76 mmHg are not, by themselves,
reasons to withhold the medication.
11. Recognize Cues — Multiple Response
Which findings are concerning for sepsis with possible shock? Select all
that apply.
