NCLEX-RN 2026 Test Plan Practice Questions – NGN
Format | 260 High-Yield Questions with Rationales |
Bow-Tie, Matrix, Drag & Drop Already Graded A+
for Guaranteed Pass
TABLE OF CONTENTS
1. Management of Care – NGN Case Studies (Questions 1–30)
2. Safety & Infection Control – NGN Bow-Tie Items (Questions 31–50)
3. Health Promotion & Maintenance – NGN Matrix (Questions 51–70)
4. Psychosocial Integrity – NGN Drag & Drop (Questions 71–85)
5. Basic Care & Comfort – NGN Multiple Response (Questions 86–100)
6. Pharmacological & Parenteral Therapies – Traditional (Questions 101–140)
7. Reduction of Risk Potential – Traditional (Questions 141–180)
8. Physiological Adaptation – Traditional (Questions 181–220)
9. NGN Comprehensive Case Studies (Questions 221–260)
MANAGEMENT OF CARE – NGN CASE STUDIES (Questions 1–
30)
Case Study 1: Preoperative Care – Health Equity Focus
A 68-year-old male is scheduled for an elective right total knee arthroplasty. He speaks limited
English and his primary language is Spanish. He has a history of hypertension and type 2 diabetes. He
lives alone and has limited health literacy.
Question 1 (NGN Bow-Tie Item) What is the priority nursing action prior to obtaining informed
consent?
,A. Ask the provider to explain the procedure in simple terms B. Obtain a certified medical interpreter
for the consent discussion C. Have the patient's adult daughter translate the consent form D. Provide
the consent form in English and ask the patient to sign
Correct Answer: B Rationale: A certified medical interpreter is required by federal law (Title VI of
the Civil Rights Act) for meaningful communication. Family members (C) may not accurately
translate medical information and cannot be used unless the patient requests them. The provider (A)
must obtain consent, but an interpreter is needed first. Providing English-only forms (D) violates the
patient's right to understand.
Question 2 (Select all that apply) Which of the following actions demonstrate culturally competent
care for this patient? (Select all that apply)
A. Providing written materials in Spanish B. Using a certified interpreter for all teaching sessions C.
Assessing the patient's understanding using teach-back D. Assuming the patient understands based on
nodding E. Incorporating the patient's cultural beliefs into the care plan
Correct Answers: A, B, C, E Rationale: Written materials in Spanish (A), certified interpreters (B),
teach-back (C), and incorporating cultural beliefs (E) are culturally competent. Assuming
understanding based on nodding (D) is a common error (nodding may indicate politeness, not
comprehension).
Question 3 (Matrix: For each intervention, indicate if it is "Appropriate" or "Inappropriate" for this
patient)
Intervention Appropriate Inappropriate
Use the patient's daughter as the ☐ ☑
sole interpreter
Provide a Spanish-language ☑ ☐
consent form
Assess health literacy using a ☑ ☐
validated tool
Speak loudly and slowly in ☐ ☑
English
Rationale: Using family as the sole interpreter (A) is inappropriate (may filter information, violate
confidentiality). Spanish consent forms (B) are appropriate. Health literacy assessment (C) is
appropriate. Speaking loudly in English (D) does not improve understanding and is inappropriate.
,Case Study 2: End-of-Life Care – Dignity Across the Lifespan
A 78-year-old female with end-stage heart failure is admitted to the palliative care unit. She has a
valid advance directive stating "no CPR, no intubation, and no artificial nutrition." Her family is
requesting that "everything be done."
Question 4 (NGN Bow-Tie Item) What is the priority nursing action?
A. Honor the family's request to avoid conflict B. Notify the provider to meet with the family to
review the advance directive C. Tell the family that they have no legal standing D. Call the ethics
committee immediately
Correct Answer: B Rationale: The nurse should first notify the provider to meet with the family to
review the advance directive. The provider can explain the legal and ethical basis for honoring the
patient's wishes. The nurse should not unilaterally override the advance directive (A) or dismiss the
family (C). The ethics committee (D) may be involved if there is conflict, but the provider should
address it first.
Question 5 (Select all that apply) Which of the following actions support a "dignity across the
lifespan" approach for this patient? (Select all that apply)
A. Continue to provide comfort measures (pain management, turning, oral care) B. Honor the
patient's advance directive C. Facilitate a family meeting with the palliative care team D. Initiate CPR
if the patient arrests despite the advance directive E. Offer spiritual support if the patient/family
desires
Correct Answers: A, B, C, E Rationale: Comfort measures (A), honoring the advance directive (B),
family meetings (C), and spiritual support (E) support dignity. Initiating CPR (D) violates the advance
directive and the patient's autonomy.
Question 6 (Matrix: For each intervention, indicate if it is "Consistent" or "Inconsistent" with
palliative care principles)
Intervention Consistent Inconsistent
Continue regular pain ☑ ☐
assessments
Discontinue all medications ☐ ☑
Offer emotional support to the ☑ ☐
family
Withdraw antibiotics for an ☑ ☐
infection
, Rationale: Pain assessments (A) and emotional support (C) are consistent. Discontinuing all
medications (B) is inconsistent (comfort medications should continue). Withdrawing antibiotics (D)
may be appropriate if the goal is comfort (antibiotics may prolong suffering).
Case Study 3: Pediatric Respiratory Distress – Health Equity
A 3-year-old male is brought to the emergency department with barking cough, stridor, and
respiratory distress. He has no fever. His family lives in a rural area and has limited access to
healthcare. He is sitting upright, drooling, and appears anxious.
Question 7 (NGN Bow-Tie Item) What is the most likely diagnosis?
A. Bacterial tracheitis B. Croup (laryngotracheobronchitis) C. Epiglottitis D. Foreign body aspiration
Correct Answer: B Rationale: Barking cough + stridor + no fever + worse at night = croup (viral).
Epiglottitis (C) presents with fever, drooling, and toxic appearance. Foreign body aspiration (D)
typically has a sudden onset of choking.
Question 8 (Select all that apply) Which of the following interventions are appropriate for this child?
(Select all that apply)
A. Administer racemic epinephrine nebulizer B. Administer dexamethasone (oral or IM) C. Place in
supine position D. Provide cool mist humidification E. Prepare for immediate intubation
Correct Answers: A, B, D Rationale: Racemic epinephrine for moderate-severe stridor,
dexamethasone for inflammation, cool mist for comfort. Supine position (C) worsens distress.
Intubation (E) is rare in croup.
Question 9 (Matrix: For each assessment finding, indicate if it is "Mild," "Moderate," or "Severe"
croup)
Finding Mild Moderate Severe
Stridor at rest ☐ ☑ ☑
Barking cough ☑ ☑ ☑
Respiratory rate 24 ☑ ☐ ☐
Cyanosis ☐ ☐ ☑
Rationale: Stridor at rest indicates moderate-severe. Barking cough can occur at any severity. RR 24
is normal (mild). Cyanosis is severe.
Format | 260 High-Yield Questions with Rationales |
Bow-Tie, Matrix, Drag & Drop Already Graded A+
for Guaranteed Pass
TABLE OF CONTENTS
1. Management of Care – NGN Case Studies (Questions 1–30)
2. Safety & Infection Control – NGN Bow-Tie Items (Questions 31–50)
3. Health Promotion & Maintenance – NGN Matrix (Questions 51–70)
4. Psychosocial Integrity – NGN Drag & Drop (Questions 71–85)
5. Basic Care & Comfort – NGN Multiple Response (Questions 86–100)
6. Pharmacological & Parenteral Therapies – Traditional (Questions 101–140)
7. Reduction of Risk Potential – Traditional (Questions 141–180)
8. Physiological Adaptation – Traditional (Questions 181–220)
9. NGN Comprehensive Case Studies (Questions 221–260)
MANAGEMENT OF CARE – NGN CASE STUDIES (Questions 1–
30)
Case Study 1: Preoperative Care – Health Equity Focus
A 68-year-old male is scheduled for an elective right total knee arthroplasty. He speaks limited
English and his primary language is Spanish. He has a history of hypertension and type 2 diabetes. He
lives alone and has limited health literacy.
Question 1 (NGN Bow-Tie Item) What is the priority nursing action prior to obtaining informed
consent?
,A. Ask the provider to explain the procedure in simple terms B. Obtain a certified medical interpreter
for the consent discussion C. Have the patient's adult daughter translate the consent form D. Provide
the consent form in English and ask the patient to sign
Correct Answer: B Rationale: A certified medical interpreter is required by federal law (Title VI of
the Civil Rights Act) for meaningful communication. Family members (C) may not accurately
translate medical information and cannot be used unless the patient requests them. The provider (A)
must obtain consent, but an interpreter is needed first. Providing English-only forms (D) violates the
patient's right to understand.
Question 2 (Select all that apply) Which of the following actions demonstrate culturally competent
care for this patient? (Select all that apply)
A. Providing written materials in Spanish B. Using a certified interpreter for all teaching sessions C.
Assessing the patient's understanding using teach-back D. Assuming the patient understands based on
nodding E. Incorporating the patient's cultural beliefs into the care plan
Correct Answers: A, B, C, E Rationale: Written materials in Spanish (A), certified interpreters (B),
teach-back (C), and incorporating cultural beliefs (E) are culturally competent. Assuming
understanding based on nodding (D) is a common error (nodding may indicate politeness, not
comprehension).
Question 3 (Matrix: For each intervention, indicate if it is "Appropriate" or "Inappropriate" for this
patient)
Intervention Appropriate Inappropriate
Use the patient's daughter as the ☐ ☑
sole interpreter
Provide a Spanish-language ☑ ☐
consent form
Assess health literacy using a ☑ ☐
validated tool
Speak loudly and slowly in ☐ ☑
English
Rationale: Using family as the sole interpreter (A) is inappropriate (may filter information, violate
confidentiality). Spanish consent forms (B) are appropriate. Health literacy assessment (C) is
appropriate. Speaking loudly in English (D) does not improve understanding and is inappropriate.
,Case Study 2: End-of-Life Care – Dignity Across the Lifespan
A 78-year-old female with end-stage heart failure is admitted to the palliative care unit. She has a
valid advance directive stating "no CPR, no intubation, and no artificial nutrition." Her family is
requesting that "everything be done."
Question 4 (NGN Bow-Tie Item) What is the priority nursing action?
A. Honor the family's request to avoid conflict B. Notify the provider to meet with the family to
review the advance directive C. Tell the family that they have no legal standing D. Call the ethics
committee immediately
Correct Answer: B Rationale: The nurse should first notify the provider to meet with the family to
review the advance directive. The provider can explain the legal and ethical basis for honoring the
patient's wishes. The nurse should not unilaterally override the advance directive (A) or dismiss the
family (C). The ethics committee (D) may be involved if there is conflict, but the provider should
address it first.
Question 5 (Select all that apply) Which of the following actions support a "dignity across the
lifespan" approach for this patient? (Select all that apply)
A. Continue to provide comfort measures (pain management, turning, oral care) B. Honor the
patient's advance directive C. Facilitate a family meeting with the palliative care team D. Initiate CPR
if the patient arrests despite the advance directive E. Offer spiritual support if the patient/family
desires
Correct Answers: A, B, C, E Rationale: Comfort measures (A), honoring the advance directive (B),
family meetings (C), and spiritual support (E) support dignity. Initiating CPR (D) violates the advance
directive and the patient's autonomy.
Question 6 (Matrix: For each intervention, indicate if it is "Consistent" or "Inconsistent" with
palliative care principles)
Intervention Consistent Inconsistent
Continue regular pain ☑ ☐
assessments
Discontinue all medications ☐ ☑
Offer emotional support to the ☑ ☐
family
Withdraw antibiotics for an ☑ ☐
infection
, Rationale: Pain assessments (A) and emotional support (C) are consistent. Discontinuing all
medications (B) is inconsistent (comfort medications should continue). Withdrawing antibiotics (D)
may be appropriate if the goal is comfort (antibiotics may prolong suffering).
Case Study 3: Pediatric Respiratory Distress – Health Equity
A 3-year-old male is brought to the emergency department with barking cough, stridor, and
respiratory distress. He has no fever. His family lives in a rural area and has limited access to
healthcare. He is sitting upright, drooling, and appears anxious.
Question 7 (NGN Bow-Tie Item) What is the most likely diagnosis?
A. Bacterial tracheitis B. Croup (laryngotracheobronchitis) C. Epiglottitis D. Foreign body aspiration
Correct Answer: B Rationale: Barking cough + stridor + no fever + worse at night = croup (viral).
Epiglottitis (C) presents with fever, drooling, and toxic appearance. Foreign body aspiration (D)
typically has a sudden onset of choking.
Question 8 (Select all that apply) Which of the following interventions are appropriate for this child?
(Select all that apply)
A. Administer racemic epinephrine nebulizer B. Administer dexamethasone (oral or IM) C. Place in
supine position D. Provide cool mist humidification E. Prepare for immediate intubation
Correct Answers: A, B, D Rationale: Racemic epinephrine for moderate-severe stridor,
dexamethasone for inflammation, cool mist for comfort. Supine position (C) worsens distress.
Intubation (E) is rare in croup.
Question 9 (Matrix: For each assessment finding, indicate if it is "Mild," "Moderate," or "Severe"
croup)
Finding Mild Moderate Severe
Stridor at rest ☐ ☑ ☑
Barking cough ☑ ☑ ☑
Respiratory rate 24 ☑ ☐ ☐
Cyanosis ☐ ☐ ☑
Rationale: Stridor at rest indicates moderate-severe. Barking cough can occur at any severity. RR 24
is normal (mild). Cyanosis is severe.
