NGN NCLEX-RN 2026/2027 | Next Generation
NCLEX-RN Study Guide, Clinical Judgment Practice
Questions & Answers, RN Board Exam Prep, Case
Studies, Bow-Tie, Matrix, Trend, Highlighting,
Cloze, Multiple Response, Prioritization, Delegation
& Detailed Rationales
NGN NCLEX-RN 2026/2027 exam-preparation resource focused on the Next Generation NCLEX-RN (NGN) and
its clinical-judgment emphasis. The NGN framework evaluates a candidate's ability to recognize and analyze
cues, prioritize hypotheses, generate solutions, take appropriate action, and evaluate outcomes in realistic
nursing situations. This resource provides original NGN-style practice questions and answers, unfolding case
studies, clinical judgment exercises, prioritization, patient safety, delegation, pharmacology, medical-surgical
nursing, maternal-newborn, pediatrics, mental health, and detailed rationales. It is designed around the
current NCLEX-RN testing approach and common NGN item formats, including extended multiple response,
matrix/grid, bow-tie, trend, cloze and case-study questions, without claiming to reproduce actual NCSBN
examination content.
,Question 1: A nurse is caring for a client with a new prescription for
warfarin. Which laboratory value should the nurse monitor to evaluate
the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
CORRECT ANSWER: B. International normalized ratio (INR)
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent
clotting factors. The INR is the standard laboratory test used to monitor
warfarin therapy, with a typical therapeutic range of 2.0 to 3.0 for most
indications. aPTT is used to monitor heparin therapy, not warfarin.
Question 2: A nurse is assessing a client who is receiving intravenous
heparin. Which finding indicates a potential complication of heparin
therapy?
A. Blood pressure of 118/76 mm Hg
B. Heart rate of 88 beats/min
C. Hematuria
D. Respiratory rate of 18 breaths/min
CORRECT ANSWER: C. Hematuria
Rationale: Hematuria is a sign of bleeding, which is the primary
complication of heparin therapy. Heparin-induced bleeding can manifest
as hematuria, epistaxis, gingival bleeding, or ecchymosis. The other vital
signs listed are within normal limits and do not indicate a complication.
Question 3: A nurse is preparing to administer digoxin to a client with
heart failure. Which assessment finding should the nurse report to the
provider before administering the medication?
A. Heart rate of 58 beats/min
B. Blood pressure of 110/70 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Weight loss of 1 kg since admission
CORRECT ANSWER: A. Heart rate of 58 beats/min
,Rationale: Digoxin slows the heart rate and is withheld if the apical pulse is
below 60 beats/min in adults. A heart rate of 58 beats/min is below the
threshold for safe administration. The other findings are within normal
limits or expected.
Question 4: A nurse is teaching a client about levothyroxine. Which
statement by the client indicates understanding of the teaching?
A. "I should take this medication with breakfast."
B. "I should take this medication at bedtime."
C. "I should take this medication on an empty stomach."
D. "I should take this medication with calcium supplements."
CORRECT ANSWER: C. "I should take this medication on an empty
stomach."
Rationale: Levothyroxine should be taken on an empty stomach, typically
30 to 60 minutes before breakfast, to enhance absorption. Taking it with
food, calcium, or iron can decrease its effectiveness.
Question 5: A nurse is caring for a client with type 1 diabetes who is
experiencing hypoglycemia. Which action should the nurse take first?
A. Administer glucagon intramuscularly
B. Give the client 15 g of a fast-acting carbohydrate
C. Start an intravenous infusion of dextrose 5% in water
D. Obtain a blood glucose reading
CORRECT ANSWER: B. Give the client 15 g of a fast-acting carbohydrate
Rationale: For a conscious client with hypoglycemia, the initial intervention
is to provide 15 g of a fast-acting carbohydrate, such as 4 oz of juice or 3 to
4 glucose tablets. This follows the "rule of 15." Glucagon or IV dextrose is
used if the client is unconscious or unable to swallow.
Question 6: A nurse is assessing a client with diabetic ketoacidosis
(DKA). Which finding should the nurse expect?
A. Blood glucose of 120 mg/dL
B. Respiratory rate of 10 breaths/min
C. Kussmaul respirations
D. Serum pH of 7.45
CORRECT ANSWER: C. Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid breaths that occur as a
compensatory mechanism to blow off carbon dioxide in response to
metabolic acidosis. DKA is characterized by hyperglycemia, metabolic
acidosis, and ketonemia.
Question 7: A nurse is caring for a client with chronic obstructive
pulmonary disease (COPD). Which oxygen delivery method is most
appropriate?
A. Nasal cannula at 6 L/min
B. Simple face mask at 8 L/min
C. Venturi mask at 2 L/min
D. Non-rebreather mask at 10 L/min
CORRECT ANSWER: C. Venturi mask at 2 L/min
Rationale: Clients with COPD should receive low-flow oxygen, typically 1 to
2 L/min via nasal cannula or a Venturi mask, to avoid suppressing the
hypoxic drive. High-flow oxygen can lead to carbon dioxide retention and
respiratory failure.
Question 8: A nurse is assessing a client who has just returned from
surgery. Which finding requires immediate intervention?
A. Blood pressure of 100/60 mm Hg
B. Heart rate of 92 beats/min
C. Oxygen saturation of 88% on room air
D. Temperature of 37.2°C (99°F)
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An oxygen saturation of 88% indicates hypoxemia and requires
immediate intervention, such as administering oxygen and notifying the
provider. The other findings are within acceptable postoperative ranges.
Question 9: A nurse is teaching a client about a low-sodium diet. Which
food should the client avoid?
A. Fresh apples
B. Canned soup
C. Grilled chicken breast
D. Steamed broccoli
CORRECT ANSWER: B. Canned soup
NCLEX-RN Study Guide, Clinical Judgment Practice
Questions & Answers, RN Board Exam Prep, Case
Studies, Bow-Tie, Matrix, Trend, Highlighting,
Cloze, Multiple Response, Prioritization, Delegation
& Detailed Rationales
NGN NCLEX-RN 2026/2027 exam-preparation resource focused on the Next Generation NCLEX-RN (NGN) and
its clinical-judgment emphasis. The NGN framework evaluates a candidate's ability to recognize and analyze
cues, prioritize hypotheses, generate solutions, take appropriate action, and evaluate outcomes in realistic
nursing situations. This resource provides original NGN-style practice questions and answers, unfolding case
studies, clinical judgment exercises, prioritization, patient safety, delegation, pharmacology, medical-surgical
nursing, maternal-newborn, pediatrics, mental health, and detailed rationales. It is designed around the
current NCLEX-RN testing approach and common NGN item formats, including extended multiple response,
matrix/grid, bow-tie, trend, cloze and case-study questions, without claiming to reproduce actual NCSBN
examination content.
,Question 1: A nurse is caring for a client with a new prescription for
warfarin. Which laboratory value should the nurse monitor to evaluate
the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Bleeding time
CORRECT ANSWER: B. International normalized ratio (INR)
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent
clotting factors. The INR is the standard laboratory test used to monitor
warfarin therapy, with a typical therapeutic range of 2.0 to 3.0 for most
indications. aPTT is used to monitor heparin therapy, not warfarin.
Question 2: A nurse is assessing a client who is receiving intravenous
heparin. Which finding indicates a potential complication of heparin
therapy?
A. Blood pressure of 118/76 mm Hg
B. Heart rate of 88 beats/min
C. Hematuria
D. Respiratory rate of 18 breaths/min
CORRECT ANSWER: C. Hematuria
Rationale: Hematuria is a sign of bleeding, which is the primary
complication of heparin therapy. Heparin-induced bleeding can manifest
as hematuria, epistaxis, gingival bleeding, or ecchymosis. The other vital
signs listed are within normal limits and do not indicate a complication.
Question 3: A nurse is preparing to administer digoxin to a client with
heart failure. Which assessment finding should the nurse report to the
provider before administering the medication?
A. Heart rate of 58 beats/min
B. Blood pressure of 110/70 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Weight loss of 1 kg since admission
CORRECT ANSWER: A. Heart rate of 58 beats/min
,Rationale: Digoxin slows the heart rate and is withheld if the apical pulse is
below 60 beats/min in adults. A heart rate of 58 beats/min is below the
threshold for safe administration. The other findings are within normal
limits or expected.
Question 4: A nurse is teaching a client about levothyroxine. Which
statement by the client indicates understanding of the teaching?
A. "I should take this medication with breakfast."
B. "I should take this medication at bedtime."
C. "I should take this medication on an empty stomach."
D. "I should take this medication with calcium supplements."
CORRECT ANSWER: C. "I should take this medication on an empty
stomach."
Rationale: Levothyroxine should be taken on an empty stomach, typically
30 to 60 minutes before breakfast, to enhance absorption. Taking it with
food, calcium, or iron can decrease its effectiveness.
Question 5: A nurse is caring for a client with type 1 diabetes who is
experiencing hypoglycemia. Which action should the nurse take first?
A. Administer glucagon intramuscularly
B. Give the client 15 g of a fast-acting carbohydrate
C. Start an intravenous infusion of dextrose 5% in water
D. Obtain a blood glucose reading
CORRECT ANSWER: B. Give the client 15 g of a fast-acting carbohydrate
Rationale: For a conscious client with hypoglycemia, the initial intervention
is to provide 15 g of a fast-acting carbohydrate, such as 4 oz of juice or 3 to
4 glucose tablets. This follows the "rule of 15." Glucagon or IV dextrose is
used if the client is unconscious or unable to swallow.
Question 6: A nurse is assessing a client with diabetic ketoacidosis
(DKA). Which finding should the nurse expect?
A. Blood glucose of 120 mg/dL
B. Respiratory rate of 10 breaths/min
C. Kussmaul respirations
D. Serum pH of 7.45
CORRECT ANSWER: C. Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid breaths that occur as a
compensatory mechanism to blow off carbon dioxide in response to
metabolic acidosis. DKA is characterized by hyperglycemia, metabolic
acidosis, and ketonemia.
Question 7: A nurse is caring for a client with chronic obstructive
pulmonary disease (COPD). Which oxygen delivery method is most
appropriate?
A. Nasal cannula at 6 L/min
B. Simple face mask at 8 L/min
C. Venturi mask at 2 L/min
D. Non-rebreather mask at 10 L/min
CORRECT ANSWER: C. Venturi mask at 2 L/min
Rationale: Clients with COPD should receive low-flow oxygen, typically 1 to
2 L/min via nasal cannula or a Venturi mask, to avoid suppressing the
hypoxic drive. High-flow oxygen can lead to carbon dioxide retention and
respiratory failure.
Question 8: A nurse is assessing a client who has just returned from
surgery. Which finding requires immediate intervention?
A. Blood pressure of 100/60 mm Hg
B. Heart rate of 92 beats/min
C. Oxygen saturation of 88% on room air
D. Temperature of 37.2°C (99°F)
CORRECT ANSWER: C. Oxygen saturation of 88% on room air
Rationale: An oxygen saturation of 88% indicates hypoxemia and requires
immediate intervention, such as administering oxygen and notifying the
provider. The other findings are within acceptable postoperative ranges.
Question 9: A nurse is teaching a client about a low-sodium diet. Which
food should the client avoid?
A. Fresh apples
B. Canned soup
C. Grilled chicken breast
D. Steamed broccoli
CORRECT ANSWER: B. Canned soup
