NCLEX-RN NGN Actual Exam Mastery: 250-Question Comprehensive Guide (Latest
2025/2026)
Master the Next Generation NCLEX with this 250-question ultimate practice bank. This set is
specifically designed to simulate the NGN clinical judgment model, focusing on the high-
yield topics that actually appear on the exam: Prioritization (Who do you see first?),
Pharmacology safety/antidotes, EKG/Lab values, and Maternity/Pediatric milestones.
Every question includes a bolded answer and a detailed rationale in italics to help
you understand the nursing logic required to pass. Perfect for final review and boosting
your confidence before test day!
The nurse has received shift report on four patients. Which patient should the nurse
assess first?
A. A patient with a chest tube whose water seal chamber has intermittent
bubbling.
B. A patient with a femoral artery sheath following a cardiac cath who reports
"warmth" under their buttocks.
C. A patient with COPD who is using pursed-lip breathing and has an SpO2 of
90%.
D. A patient who is 8 hours post-op from a thyroidectomy reporting a headache.
Answer: B. BROADWAY
Rationale: Reporting "warmth" under the buttocks in a patient with a femoral
sheath is a classic sign of retroperitoneal or posterior bleeding. The other options
describe expected findings for their conditions.
Which task is most appropriate for the RN to delegate to an Unlicensed Assistive
Personnel (UAP)?
A. Feeding a patient with a fresh stroke who was just cleared by speech therapy.
B. Performing a sterile dressing change on a central line.
C. Collecting a clean-catch urine specimen from a stable patient.
D. Showing a patient how to use an incentive spirometer.
Answer: C. BROADWAY
Rationale: UAPs can perform routine, non-invasive tasks. The first feeding after a
stroke is an assessment (RN), sterile dressings are for licensed staff, and
teaching is the sole responsibility of the RN.
, The nurse is caring for a patient with a GCS of 7. What is the priority nursing action?
A. Assess the patient’s pupil response.
B. Prepare for endotracheal intubation.
C. Perform a sternal rub.
D. Check the patient's blood glucose level.
Answer: B. BROADWAY
Rationale: The rule of thumb is "GCS of 8, we intubate." A score of 7 indicates
the patient cannot protect their own airway.
A patient with Type 1 Diabetes is found sweaty, shaky, and confused. What is the
nurse's first action?
A. Administer 10 units of Regular Insulin.
B. Call the Rapid Response Team.
C. Check the patient’s capillary blood glucose.
D. Give the patient 4 ounces of orange juice.
Answer: C. BROADWAY
Rationale: Assessment is the first step. While the patient shows signs of
hypoglycemia, the nurse must verify the blood sugar level before implementing
the "Rule of 15" or calling for help.
Which patient should the nurse transition to a "private room" first to ensure safety?
A. A patient with a WBC count of 18,000/mm³.
B. A patient with persistent cough and night sweats.
C. A patient with a Stage 3 pressure ulcer on the coccyx.
D. A patient with a hemoglobin of 7.2 g/dL.
Answer: B. BROADWAY
Rationale: Cough and night sweats are hallmark signs of Tuberculosis (Airborne
precautions), requiring an immediate private, negative-pressure room.
Pharmacology & Parenteral Therapies
A patient is receiving an IV Heparin infusion for a DVT. The nurse notes the patient’s
aPTT is 110 seconds (Control is 30). What is the priority action?
A. Increase the infusion rate.
B. Document the finding as therapeutic.
C. Stop the infusion and prepare Protamine Sulfate.
D. Switch the infusion to Warfarin.
Answer: C. BROADWAY
,Rationale: The therapeutic range for aPTT is 1.5 to 2.5 times the control (approx. 45–75
seconds). 110 seconds is dangerously high, putting the patient at risk for hemorrhage.
A patient is taking Digoxin for heart failure. Which electrolyte imbalance most
significantly increases the risk of Digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B. BROADWAY
Rationale: Low potassium allows Digoxin to bind more easily to its receptors, leading to
toxic levels even with standard doses.
The nurse is preparing to administer Spironolactone. Which food choice should the
patient be taught to avoid?
A. White bread
B. Apples
C. Bananas
D. Chicken breast
Answer: C. BROADWAY
Rationale: Spironolactone is a potassium-sparing diuretic. Consuming high-potassium
foods like bananas increases the risk of Hyperkalemia.
A patient is prescribed Lisinopril. The nurse should instruct the patient to report which
"life-threatening" side effect immediately?
A. A dry, hacking cough.
B. Swelling of the tongue and lips.
C. Dizziness when standing up.
D. Increased frequency of urination.
Answer: B. BROADWAY
Rationale: Swelling of the face/tongue (Angioedema) is a medical emergency
associated with ACE inhibitors that can lead to airway obstruction.
A patient is in Ventricular Tachycardia but has a pulse. Which medication is the drug
of choice?
A. Epinephrine
B. Adenosine
C. Amiodarone
D. Atropine
Answer: C. BROADWAY
, Rationale: Amiodarone is the primary anti-arrhythmic for ventricular rhythms. Adenosine
is for SVT, and Atropine is for Bradycardia.
Fluid, Electrolytes & Acid-Base
A patient's ABG results are: pH 7.28, PaCO2 55, HCO3 24. How should the nurse
interpret this?
A. Metabolic Acidosis, uncompensated.
B. Respiratory Acidosis, uncompensated.
C. Respiratory Alkalosis, fully compensated.
D. Metabolic Alkalosis, partially compensated.
Answer: B. BROADWAY
Rationale: Low pH (<7.35) = Acidosis. High CO2 (>45) = Respiratory cause. Normal
Bicarb = No compensation.
A patient with a small bowel obstruction has had a nasogastric tube (NGT) to low
suction for 48 hours. Which imbalance is the patient at risk for?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: C. BROADWAY
Rationale: Gastric contents are highly acidic. Suctioning out the acid results in a "loss of
acid," causing the body to become more alkaline (Metabolic Alkalosis).
Which finding is a classic sign of Hypercalcemia?
A. Positive Chvostek’s sign.
B. Muscle weakness and constipation.
C. Tingling around the mouth.
D. Prolonged QT interval on EKG.
Answer: B. BROADWAY
Rationale: High calcium acts as a sedative, slowing down muscle movement and GI
motility. Chvostek's and tingling are signs of LOW calcium.
A patient is admitted with a serum sodium level of 115 mEq/L. What is the priority
nursing intervention?
A. Encourage oral fluid intake.
B. Administer a 0.45% Sodium Chloride bolus.
C. Initiate seizure precautions.
D. Monitor for signs of peripheral edema.
2025/2026)
Master the Next Generation NCLEX with this 250-question ultimate practice bank. This set is
specifically designed to simulate the NGN clinical judgment model, focusing on the high-
yield topics that actually appear on the exam: Prioritization (Who do you see first?),
Pharmacology safety/antidotes, EKG/Lab values, and Maternity/Pediatric milestones.
Every question includes a bolded answer and a detailed rationale in italics to help
you understand the nursing logic required to pass. Perfect for final review and boosting
your confidence before test day!
The nurse has received shift report on four patients. Which patient should the nurse
assess first?
A. A patient with a chest tube whose water seal chamber has intermittent
bubbling.
B. A patient with a femoral artery sheath following a cardiac cath who reports
"warmth" under their buttocks.
C. A patient with COPD who is using pursed-lip breathing and has an SpO2 of
90%.
D. A patient who is 8 hours post-op from a thyroidectomy reporting a headache.
Answer: B. BROADWAY
Rationale: Reporting "warmth" under the buttocks in a patient with a femoral
sheath is a classic sign of retroperitoneal or posterior bleeding. The other options
describe expected findings for their conditions.
Which task is most appropriate for the RN to delegate to an Unlicensed Assistive
Personnel (UAP)?
A. Feeding a patient with a fresh stroke who was just cleared by speech therapy.
B. Performing a sterile dressing change on a central line.
C. Collecting a clean-catch urine specimen from a stable patient.
D. Showing a patient how to use an incentive spirometer.
Answer: C. BROADWAY
Rationale: UAPs can perform routine, non-invasive tasks. The first feeding after a
stroke is an assessment (RN), sterile dressings are for licensed staff, and
teaching is the sole responsibility of the RN.
, The nurse is caring for a patient with a GCS of 7. What is the priority nursing action?
A. Assess the patient’s pupil response.
B. Prepare for endotracheal intubation.
C. Perform a sternal rub.
D. Check the patient's blood glucose level.
Answer: B. BROADWAY
Rationale: The rule of thumb is "GCS of 8, we intubate." A score of 7 indicates
the patient cannot protect their own airway.
A patient with Type 1 Diabetes is found sweaty, shaky, and confused. What is the
nurse's first action?
A. Administer 10 units of Regular Insulin.
B. Call the Rapid Response Team.
C. Check the patient’s capillary blood glucose.
D. Give the patient 4 ounces of orange juice.
Answer: C. BROADWAY
Rationale: Assessment is the first step. While the patient shows signs of
hypoglycemia, the nurse must verify the blood sugar level before implementing
the "Rule of 15" or calling for help.
Which patient should the nurse transition to a "private room" first to ensure safety?
A. A patient with a WBC count of 18,000/mm³.
B. A patient with persistent cough and night sweats.
C. A patient with a Stage 3 pressure ulcer on the coccyx.
D. A patient with a hemoglobin of 7.2 g/dL.
Answer: B. BROADWAY
Rationale: Cough and night sweats are hallmark signs of Tuberculosis (Airborne
precautions), requiring an immediate private, negative-pressure room.
Pharmacology & Parenteral Therapies
A patient is receiving an IV Heparin infusion for a DVT. The nurse notes the patient’s
aPTT is 110 seconds (Control is 30). What is the priority action?
A. Increase the infusion rate.
B. Document the finding as therapeutic.
C. Stop the infusion and prepare Protamine Sulfate.
D. Switch the infusion to Warfarin.
Answer: C. BROADWAY
,Rationale: The therapeutic range for aPTT is 1.5 to 2.5 times the control (approx. 45–75
seconds). 110 seconds is dangerously high, putting the patient at risk for hemorrhage.
A patient is taking Digoxin for heart failure. Which electrolyte imbalance most
significantly increases the risk of Digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B. BROADWAY
Rationale: Low potassium allows Digoxin to bind more easily to its receptors, leading to
toxic levels even with standard doses.
The nurse is preparing to administer Spironolactone. Which food choice should the
patient be taught to avoid?
A. White bread
B. Apples
C. Bananas
D. Chicken breast
Answer: C. BROADWAY
Rationale: Spironolactone is a potassium-sparing diuretic. Consuming high-potassium
foods like bananas increases the risk of Hyperkalemia.
A patient is prescribed Lisinopril. The nurse should instruct the patient to report which
"life-threatening" side effect immediately?
A. A dry, hacking cough.
B. Swelling of the tongue and lips.
C. Dizziness when standing up.
D. Increased frequency of urination.
Answer: B. BROADWAY
Rationale: Swelling of the face/tongue (Angioedema) is a medical emergency
associated with ACE inhibitors that can lead to airway obstruction.
A patient is in Ventricular Tachycardia but has a pulse. Which medication is the drug
of choice?
A. Epinephrine
B. Adenosine
C. Amiodarone
D. Atropine
Answer: C. BROADWAY
, Rationale: Amiodarone is the primary anti-arrhythmic for ventricular rhythms. Adenosine
is for SVT, and Atropine is for Bradycardia.
Fluid, Electrolytes & Acid-Base
A patient's ABG results are: pH 7.28, PaCO2 55, HCO3 24. How should the nurse
interpret this?
A. Metabolic Acidosis, uncompensated.
B. Respiratory Acidosis, uncompensated.
C. Respiratory Alkalosis, fully compensated.
D. Metabolic Alkalosis, partially compensated.
Answer: B. BROADWAY
Rationale: Low pH (<7.35) = Acidosis. High CO2 (>45) = Respiratory cause. Normal
Bicarb = No compensation.
A patient with a small bowel obstruction has had a nasogastric tube (NGT) to low
suction for 48 hours. Which imbalance is the patient at risk for?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: C. BROADWAY
Rationale: Gastric contents are highly acidic. Suctioning out the acid results in a "loss of
acid," causing the body to become more alkaline (Metabolic Alkalosis).
Which finding is a classic sign of Hypercalcemia?
A. Positive Chvostek’s sign.
B. Muscle weakness and constipation.
C. Tingling around the mouth.
D. Prolonged QT interval on EKG.
Answer: B. BROADWAY
Rationale: High calcium acts as a sedative, slowing down muscle movement and GI
motility. Chvostek's and tingling are signs of LOW calcium.
A patient is admitted with a serum sodium level of 115 mEq/L. What is the priority
nursing intervention?
A. Encourage oral fluid intake.
B. Administer a 0.45% Sodium Chloride bolus.
C. Initiate seizure precautions.
D. Monitor for signs of peripheral edema.
