NCLEX-RN NEXT GENERATION (NGN) QUESTIONS AND ANSWERS WITH
RATIONALES 2026 New Version
1. EXTENDED DRAG-AND-DROP-PRIORITY
A nurse receives report on five clients. Arrange the clients in the order the nurse should assess
them, from highest to lowest priority.
Options:
A. Client with pneumonia, SpO2 88% on 4 L/min nasal cannula
B. Client with diabetes, blood glucose 210 mg/dL before lunch
C. Postoperative client reporting incisional pain 7/10
D.Client after thyroidectomy with new inspiratory stridor
E. Client with heart failure who has new pink, frothy sputum and severe dyspnea
Answer spaces:
Priority Client
1st D
2nd E
3rd A
4th C
5th B
Rationale: New stridor indicates possible upper-airway obstruction and is the immediate priority
under ABCs. Pink frothy sputum with severe dyspnea suggests acute pulmonary edema, another
immediate respiratory emergency. An SpO2 of 88% despite supplemental oxygen indicates
significant hypoxemia and requires prompt intervention. Severe postoperative pain requires
management but is lower priority than airway and breathing compromise. A glucose of 210 mg/dL
requires treatment as prescribed but is generally not immediately life-threatening.
2. EXTENDED DRAG-AND-DROP-INSULIN
A client with type 1 diabetes is prescribed regular insulin and NPH insulin in the same syringe.
Place the actions in the correct order.
Options:
A. Withdraw the prescribed dose of NPH insulin
B. Inject air into the NPH insulin vial
C. Withdraw the prescribed dose of regular insulin
D.Inject air into the regular insulin vial
Correct order:
B→D→C→A
Rationale:When mixing regular and NPH insulin, air is introduced into the cloudy NPH first,followed
by air into the clear regular insulin. The nurse then withdraws regular insulin first,followed by NPH.
NCLEX Memory Tip:Clear before cloudy when withdrawing insulin.
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, 6.CLOZE-STROKE
A client suddenly develops facial drooping, right-sided weakness, and slurred speech.Complete
the sentence:
The nurse should suspect [acute stroke / hypovolemic shock / pulmonary embolism],immediately
[activate the stroke response / give oral fluids / encourage ambulation],and determine the client's
[last known well time / last bowel movement / usual bedtime].
Answer:
The nurse should suspect acute stroke, immediately activate the stroke response, and determine
the client's last known well time.
Rationale: Sudden focal neurologic deficits suggest acute stroke. Rapid activation of the stroke
pathway and determination of last known well are essential because eligibility for certain
interventions depends heavily on timing.
7.CLOZE-TRANSFUSION REACTION
Fifteen minutes after packed red blood cells are started, a client develops fever, chills,and lower back
pain.
Complete the sentence:
The nurse should first [stop the transfusion / slow the transfusion/ administer acetaminophen],
maintain IV access using [normal saline / dextrose 5% / lactated Ringer's through the blood tubing]
according to protocol, and [notify the provider and blood bank /restart the blood immediately / discard
all materials without investigation].
Answer:
The nurse should first stop the transfusion, maintain IV access with normal saline according to protocol,
and notify the provider and blood bank.
Rationale: These findings suggest an acute transfusion reaction. The priority is to stop exposure to
the blood product immediately. The client is then assessed, IV access maintained appropriately,and
the required provider/blood-bank notification and reaction protocol initiated.
HIGHLIGHT/MATRIX
8. HIGHLIGHT -IDENTIFY THE PRIORITY FINDINGS
A 68-year-old client with heart failure is admitted with increasing shortness of breath.Nursing
Notes:
Client awake and oriented.
Temperature 37.1℃.
Heart rate 112/min.
Respiratory rate 32/min.
SpO2 84% on room air.
Bilateral crackles are present.
Client reports difficulty breathing while lying flat.
Pink,frothy sputum is noted.
Mild bilateral ankle edema is present.
Highlight the findings requiring immediate follow-up.
Correct highlights:
Respiratory rate 32/min
SpO2 84% on room air
RATIONALES 2026 New Version
1. EXTENDED DRAG-AND-DROP-PRIORITY
A nurse receives report on five clients. Arrange the clients in the order the nurse should assess
them, from highest to lowest priority.
Options:
A. Client with pneumonia, SpO2 88% on 4 L/min nasal cannula
B. Client with diabetes, blood glucose 210 mg/dL before lunch
C. Postoperative client reporting incisional pain 7/10
D.Client after thyroidectomy with new inspiratory stridor
E. Client with heart failure who has new pink, frothy sputum and severe dyspnea
Answer spaces:
Priority Client
1st D
2nd E
3rd A
4th C
5th B
Rationale: New stridor indicates possible upper-airway obstruction and is the immediate priority
under ABCs. Pink frothy sputum with severe dyspnea suggests acute pulmonary edema, another
immediate respiratory emergency. An SpO2 of 88% despite supplemental oxygen indicates
significant hypoxemia and requires prompt intervention. Severe postoperative pain requires
management but is lower priority than airway and breathing compromise. A glucose of 210 mg/dL
requires treatment as prescribed but is generally not immediately life-threatening.
2. EXTENDED DRAG-AND-DROP-INSULIN
A client with type 1 diabetes is prescribed regular insulin and NPH insulin in the same syringe.
Place the actions in the correct order.
Options:
A. Withdraw the prescribed dose of NPH insulin
B. Inject air into the NPH insulin vial
C. Withdraw the prescribed dose of regular insulin
D.Inject air into the regular insulin vial
Correct order:
B→D→C→A
Rationale:When mixing regular and NPH insulin, air is introduced into the cloudy NPH first,followed
by air into the clear regular insulin. The nurse then withdraws regular insulin first,followed by NPH.
NCLEX Memory Tip:Clear before cloudy when withdrawing insulin.
1|Page
, 6.CLOZE-STROKE
A client suddenly develops facial drooping, right-sided weakness, and slurred speech.Complete
the sentence:
The nurse should suspect [acute stroke / hypovolemic shock / pulmonary embolism],immediately
[activate the stroke response / give oral fluids / encourage ambulation],and determine the client's
[last known well time / last bowel movement / usual bedtime].
Answer:
The nurse should suspect acute stroke, immediately activate the stroke response, and determine
the client's last known well time.
Rationale: Sudden focal neurologic deficits suggest acute stroke. Rapid activation of the stroke
pathway and determination of last known well are essential because eligibility for certain
interventions depends heavily on timing.
7.CLOZE-TRANSFUSION REACTION
Fifteen minutes after packed red blood cells are started, a client develops fever, chills,and lower back
pain.
Complete the sentence:
The nurse should first [stop the transfusion / slow the transfusion/ administer acetaminophen],
maintain IV access using [normal saline / dextrose 5% / lactated Ringer's through the blood tubing]
according to protocol, and [notify the provider and blood bank /restart the blood immediately / discard
all materials without investigation].
Answer:
The nurse should first stop the transfusion, maintain IV access with normal saline according to protocol,
and notify the provider and blood bank.
Rationale: These findings suggest an acute transfusion reaction. The priority is to stop exposure to
the blood product immediately. The client is then assessed, IV access maintained appropriately,and
the required provider/blood-bank notification and reaction protocol initiated.
HIGHLIGHT/MATRIX
8. HIGHLIGHT -IDENTIFY THE PRIORITY FINDINGS
A 68-year-old client with heart failure is admitted with increasing shortness of breath.Nursing
Notes:
Client awake and oriented.
Temperature 37.1℃.
Heart rate 112/min.
Respiratory rate 32/min.
SpO2 84% on room air.
Bilateral crackles are present.
Client reports difficulty breathing while lying flat.
Pink,frothy sputum is noted.
Mild bilateral ankle edema is present.
Highlight the findings requiring immediate follow-up.
Correct highlights:
Respiratory rate 32/min
SpO2 84% on room air
