NEXTGEN NCLEX EXam
(245+ Case-based, SATA, MCQs)
CASE STUDY 1: ACUTE MYOCARDIAL INFARCTION
A 58-year-old client presents with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST elevation.
1. What is the nurse’s priority action?
A. Administer morphine
B. Obtain ECG
C. Give oxygen
D. Start IV fluids
Answer: B
Rationale: ECG confirms MI and guides treatment.
2. Which medications should the nurse anticipate? (Select all that apply)
A. Aspirin
B. Nitroglycerin
C. Morphine
D. Metformin
E. Heparin
Answer: A, B, C, E
Rationale: Standard MI management.
3. Which finding requires immediate intervention?
A. HR 90
B. BP 130/80
C. SpO₂ 85%
D. Temp 37°C
Answer: C
Rationale: Hypoxia is priority.
,4. Which complication is most likely in first 24 hrs?
A. Infection
B. Arrhythmia
C. Renal failure
D. Stroke
Answer: B
Rationale: Most common early complication.
CASE STUDY 2: COPD EXACERBATION
A 65-year-old client with COPD presents with dyspnea, RR 32, SpO₂ 84%, and
confusion.
5. What is the priority intervention?
A. High-flow oxygen
B. No oxygen
C. Low-flow oxygen
D. Encourage walking
Answer: C
Rationale: Prevent CO₂ retention.
6. Which findings indicate worsening condition? (Select all that apply)
A. Confusion
B. Use of accessory muscles
C. SpO₂ 92%
D. Tachypnea
E. Cyanosis
Answer: A, B, D, E
Rationale: Respiratory distress.
7. Which medication is priority?
A. Albuterol
B. Insulin
C. Furosemide
D. Warfarin
,Answer: A
Rationale: Bronchodilation.
8. ABG shows high CO₂. What does this indicate?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Normal
Answer: B
Rationale: CO₂ retention.
CASE STUDY 3: HYPOGLYCEMIA
A diabetic client is found unconscious. Blood glucose is 38 mg/dL.
9. What is the nurse’s first action?
A. Give insulin
B. Provide oral glucose
C. Administer IV dextrose
D. Wait and monitor
Answer: C
Rationale: Unconscious → IV treatment.
10. Which symptoms are expected? (Select all that apply)
A. Sweating
B. Tremors
C. Confusion
D. Polyuria
E. Tachycardia
Answer: A, B, C, E
Rationale: Hypoglycemia signs.
11. After treatment, what is priority?
A. Give high-fat meal
B. Monitor glucose
C. Discharge
, D. Exercise
Answer: B
Rationale: Prevent recurrence.
CASE STUDY 4: SEPSIS
A client presents with fever, HR 120, BP 85/50, lactate elevated.
12. What is the priority action?
A. Antibiotics after 24 hrs
B. IV fluids
C. Sleep
D. Diet
Answer: B
Rationale: Shock management.
13. Which findings indicate septic shock? (Select all that apply)
A. Hypotension
B. Tachycardia
C. Confusion
D. Warm skin early
E. Bradycardia
Answer: A, B, C, D
Rationale: Classic signs.
14. Which medication is expected?
A. Vasopressors
B. Insulin
C. Antacids
D. Laxatives
Answer: A
Rationale: Maintain BP.
CASE STUDY 5: STROKE
A client presents with slurred speech and right-sided weakness.
(245+ Case-based, SATA, MCQs)
CASE STUDY 1: ACUTE MYOCARDIAL INFARCTION
A 58-year-old client presents with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST elevation.
1. What is the nurse’s priority action?
A. Administer morphine
B. Obtain ECG
C. Give oxygen
D. Start IV fluids
Answer: B
Rationale: ECG confirms MI and guides treatment.
2. Which medications should the nurse anticipate? (Select all that apply)
A. Aspirin
B. Nitroglycerin
C. Morphine
D. Metformin
E. Heparin
Answer: A, B, C, E
Rationale: Standard MI management.
3. Which finding requires immediate intervention?
A. HR 90
B. BP 130/80
C. SpO₂ 85%
D. Temp 37°C
Answer: C
Rationale: Hypoxia is priority.
,4. Which complication is most likely in first 24 hrs?
A. Infection
B. Arrhythmia
C. Renal failure
D. Stroke
Answer: B
Rationale: Most common early complication.
CASE STUDY 2: COPD EXACERBATION
A 65-year-old client with COPD presents with dyspnea, RR 32, SpO₂ 84%, and
confusion.
5. What is the priority intervention?
A. High-flow oxygen
B. No oxygen
C. Low-flow oxygen
D. Encourage walking
Answer: C
Rationale: Prevent CO₂ retention.
6. Which findings indicate worsening condition? (Select all that apply)
A. Confusion
B. Use of accessory muscles
C. SpO₂ 92%
D. Tachypnea
E. Cyanosis
Answer: A, B, D, E
Rationale: Respiratory distress.
7. Which medication is priority?
A. Albuterol
B. Insulin
C. Furosemide
D. Warfarin
,Answer: A
Rationale: Bronchodilation.
8. ABG shows high CO₂. What does this indicate?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Normal
Answer: B
Rationale: CO₂ retention.
CASE STUDY 3: HYPOGLYCEMIA
A diabetic client is found unconscious. Blood glucose is 38 mg/dL.
9. What is the nurse’s first action?
A. Give insulin
B. Provide oral glucose
C. Administer IV dextrose
D. Wait and monitor
Answer: C
Rationale: Unconscious → IV treatment.
10. Which symptoms are expected? (Select all that apply)
A. Sweating
B. Tremors
C. Confusion
D. Polyuria
E. Tachycardia
Answer: A, B, C, E
Rationale: Hypoglycemia signs.
11. After treatment, what is priority?
A. Give high-fat meal
B. Monitor glucose
C. Discharge
, D. Exercise
Answer: B
Rationale: Prevent recurrence.
CASE STUDY 4: SEPSIS
A client presents with fever, HR 120, BP 85/50, lactate elevated.
12. What is the priority action?
A. Antibiotics after 24 hrs
B. IV fluids
C. Sleep
D. Diet
Answer: B
Rationale: Shock management.
13. Which findings indicate septic shock? (Select all that apply)
A. Hypotension
B. Tachycardia
C. Confusion
D. Warm skin early
E. Bradycardia
Answer: A, B, C, D
Rationale: Classic signs.
14. Which medication is expected?
A. Vasopressors
B. Insulin
C. Antacids
D. Laxatives
Answer: A
Rationale: Maintain BP.
CASE STUDY 5: STROKE
A client presents with slurred speech and right-sided weakness.
