NCLEX NGN Newest Next Generation NCLEX
Comprehensive Study Guide, Practice Questions, Case
Studies, and Detailed Rationales | Latest NCLEX-RN NGN
Exam Prep Bundle for Nursing Students with Clinical
Judgment and Test-Taking Strategies
Question 1: A nurse is caring for a client who has just undergone a total hip arthroplasty. Which
of the following actions should the nurse implement to prevent hip dislocation?
A. Allow the client to cross their legs while sitting
B. Instruct the client to flex the hip beyond 90 degrees when sitting
C. Place a pillow between the client’s legs when lying on their side
D. Encourage internal rotation of the affected leg during ambulation
CORRECT ANSWER: C. Place a pillow between the client’s legs when lying on their side
Rationale: Placing a pillow between the legs maintains hip abduction and prevents adduction
past the midline, which is a key precaution to avoid hip dislocation after total hip arthroplasty.
Crossing legs, excessive hip flexion (>90°), and internal rotation are contraindicated as they
increase dislocation risk.
Question 2: A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which
laboratory value should the nurse monitor most closely?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
CORRECT ANSWER: C. Potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium excretion in the urine,
leading to hypokalemia. Monitoring serum potassium levels is essential to prevent
complications such as cardiac arrhythmias, muscle weakness, and fatigue.
Question 3: During a home visit, a nurse observes that an older adult client with type 2 diabetes
mellitus has warm, swollen, and red feet with a foul-smelling ulcer on the right heel. What is
the nurse’s priority action?
A. Apply a topical antibiotic ointment to the ulcer
B. Elevate both feet above heart level
C. Notify the healthcare provider immediately
,D. Encourage increased fluid intake
CORRECT ANSWER: C. Notify the healthcare provider immediately
Rationale: The signs described—warmth, swelling, redness, and foul odor—are indicative of a
serious foot infection, possibly osteomyelitis or cellulitis, which can progress rapidly in diabetic
clients due to impaired circulation and neuropathy. Immediate medical evaluation is critical to
prevent limb loss or systemic infection.
Question 4: A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding would require the nurse to withhold the dose and notify the provider?
A. Apical pulse of 78 beats per minute
B. Serum potassium level of 4.2 mEq/L
C. Apical pulse of 54 beats per minute
D. Blood pressure of 120/80 mm Hg
CORRECT ANSWER: C. Apical pulse of 54 beats per minute
Rationale: Digoxin can cause bradycardia and other arrhythmias. The standard guideline is to
withhold digoxin if the apical pulse is less than 60 beats per minute (or per facility protocol) and
notify the provider, as this may indicate digoxin toxicity.
Question 5: A client is admitted with suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. D-dimer assay
B. Chest x-ray
C. Ventilation-perfusion (V/Q) scan
D. Pulmonary angiography
CORRECT ANSWER: D. Pulmonary angiography
Rationale: Pulmonary angiography is the gold standard for diagnosing pulmonary embolism, as
it directly visualizes clots in the pulmonary arteries. While CT pulmonary angiography (CTPA) is
now more commonly used due to its non-invasive nature, traditional pulmonary angiography
remains definitive. D-dimer is sensitive but not specific; chest x-ray and V/Q scan are supportive
but not conclusive.
Question 6: A nurse is teaching a client about self-administration of enoxaparin (Lovenox) after
discharge. Which statement by the client indicates understanding of the teaching?
A. “I will inject the medication into my arm muscle.”
, B. “I should stop taking the medication if I notice bruising.”
C. “I will pinch a fold of skin and inject at a 90-degree angle.”
D. “I can take aspirin for headaches while on this medication.”
CORRECT ANSWER: C. “I will pinch a fold of skin and inject at a 90-degree angle.”
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously. The
correct technique involves pinching a skin fold and injecting at a 90-degree angle (or 45 degrees
if the client is thin) to ensure subcutaneous delivery and minimize intramuscular injection,
which could cause hematoma. Bruising is common and not a reason to stop therapy without
consulting a provider. Aspirin increases bleeding risk and should be avoided unless approved.
Question 7: A postpartum client reports sudden onset of shortness of breath, chest pain, and
anxiety two days after a cesarean birth. What is the nurse’s priority action?
A. Administer oxygen via nasal cannula
B. Assess for calf tenderness and swelling
C. Place the client in high Fowler’s position and notify the provider
D. Obtain a 12-lead electrocardiogram
CORRECT ANSWER: C. Place the client in high Fowler’s position and notify the provider
Rationale: These symptoms strongly suggest pulmonary embolism, a life-threatening
complication more common postpartum, especially after cesarean delivery. High Fowler’s
position improves ventilation and reduces dyspnea. Immediate notification of the provider is
essential for rapid intervention, including possible anticoagulation or imaging.
Question 8: A client with chronic kidney disease (CKD) is scheduled for hemodialysis. Which
finding should the nurse report to the provider before initiating the procedure?
A. Weight gain of 1.5 kg since last dialysis
B. Presence of a palpable thrill over the arteriovenous fistula
C. Serum potassium level of 6.2 mEq/L
D. Blood pressure of 148/92 mm Hg
CORRECT ANSWER: C. Serum potassium level of 6.2 mEq/L
Rationale: A potassium level of 6.2 mEq/L indicates severe hyperkalemia, which can cause life-
threatening cardiac arrhythmias. While hemodialysis will correct this, the provider must be
notified immediately to prioritize treatment and possibly adjust the dialysis prescription.
Comprehensive Study Guide, Practice Questions, Case
Studies, and Detailed Rationales | Latest NCLEX-RN NGN
Exam Prep Bundle for Nursing Students with Clinical
Judgment and Test-Taking Strategies
Question 1: A nurse is caring for a client who has just undergone a total hip arthroplasty. Which
of the following actions should the nurse implement to prevent hip dislocation?
A. Allow the client to cross their legs while sitting
B. Instruct the client to flex the hip beyond 90 degrees when sitting
C. Place a pillow between the client’s legs when lying on their side
D. Encourage internal rotation of the affected leg during ambulation
CORRECT ANSWER: C. Place a pillow between the client’s legs when lying on their side
Rationale: Placing a pillow between the legs maintains hip abduction and prevents adduction
past the midline, which is a key precaution to avoid hip dislocation after total hip arthroplasty.
Crossing legs, excessive hip flexion (>90°), and internal rotation are contraindicated as they
increase dislocation risk.
Question 2: A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which
laboratory value should the nurse monitor most closely?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
CORRECT ANSWER: C. Potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium excretion in the urine,
leading to hypokalemia. Monitoring serum potassium levels is essential to prevent
complications such as cardiac arrhythmias, muscle weakness, and fatigue.
Question 3: During a home visit, a nurse observes that an older adult client with type 2 diabetes
mellitus has warm, swollen, and red feet with a foul-smelling ulcer on the right heel. What is
the nurse’s priority action?
A. Apply a topical antibiotic ointment to the ulcer
B. Elevate both feet above heart level
C. Notify the healthcare provider immediately
,D. Encourage increased fluid intake
CORRECT ANSWER: C. Notify the healthcare provider immediately
Rationale: The signs described—warmth, swelling, redness, and foul odor—are indicative of a
serious foot infection, possibly osteomyelitis or cellulitis, which can progress rapidly in diabetic
clients due to impaired circulation and neuropathy. Immediate medical evaluation is critical to
prevent limb loss or systemic infection.
Question 4: A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding would require the nurse to withhold the dose and notify the provider?
A. Apical pulse of 78 beats per minute
B. Serum potassium level of 4.2 mEq/L
C. Apical pulse of 54 beats per minute
D. Blood pressure of 120/80 mm Hg
CORRECT ANSWER: C. Apical pulse of 54 beats per minute
Rationale: Digoxin can cause bradycardia and other arrhythmias. The standard guideline is to
withhold digoxin if the apical pulse is less than 60 beats per minute (or per facility protocol) and
notify the provider, as this may indicate digoxin toxicity.
Question 5: A client is admitted with suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. D-dimer assay
B. Chest x-ray
C. Ventilation-perfusion (V/Q) scan
D. Pulmonary angiography
CORRECT ANSWER: D. Pulmonary angiography
Rationale: Pulmonary angiography is the gold standard for diagnosing pulmonary embolism, as
it directly visualizes clots in the pulmonary arteries. While CT pulmonary angiography (CTPA) is
now more commonly used due to its non-invasive nature, traditional pulmonary angiography
remains definitive. D-dimer is sensitive but not specific; chest x-ray and V/Q scan are supportive
but not conclusive.
Question 6: A nurse is teaching a client about self-administration of enoxaparin (Lovenox) after
discharge. Which statement by the client indicates understanding of the teaching?
A. “I will inject the medication into my arm muscle.”
, B. “I should stop taking the medication if I notice bruising.”
C. “I will pinch a fold of skin and inject at a 90-degree angle.”
D. “I can take aspirin for headaches while on this medication.”
CORRECT ANSWER: C. “I will pinch a fold of skin and inject at a 90-degree angle.”
Rationale: Enoxaparin is a low-molecular-weight heparin administered subcutaneously. The
correct technique involves pinching a skin fold and injecting at a 90-degree angle (or 45 degrees
if the client is thin) to ensure subcutaneous delivery and minimize intramuscular injection,
which could cause hematoma. Bruising is common and not a reason to stop therapy without
consulting a provider. Aspirin increases bleeding risk and should be avoided unless approved.
Question 7: A postpartum client reports sudden onset of shortness of breath, chest pain, and
anxiety two days after a cesarean birth. What is the nurse’s priority action?
A. Administer oxygen via nasal cannula
B. Assess for calf tenderness and swelling
C. Place the client in high Fowler’s position and notify the provider
D. Obtain a 12-lead electrocardiogram
CORRECT ANSWER: C. Place the client in high Fowler’s position and notify the provider
Rationale: These symptoms strongly suggest pulmonary embolism, a life-threatening
complication more common postpartum, especially after cesarean delivery. High Fowler’s
position improves ventilation and reduces dyspnea. Immediate notification of the provider is
essential for rapid intervention, including possible anticoagulation or imaging.
Question 8: A client with chronic kidney disease (CKD) is scheduled for hemodialysis. Which
finding should the nurse report to the provider before initiating the procedure?
A. Weight gain of 1.5 kg since last dialysis
B. Presence of a palpable thrill over the arteriovenous fistula
C. Serum potassium level of 6.2 mEq/L
D. Blood pressure of 148/92 mm Hg
CORRECT ANSWER: C. Serum potassium level of 6.2 mEq/L
Rationale: A potassium level of 6.2 mEq/L indicates severe hyperkalemia, which can cause life-
threatening cardiac arrhythmias. While hemodialysis will correct this, the provider must be
notified immediately to prioritize treatment and possibly adjust the dialysis prescription.
