NCLEX-RN Next Generation (NGN) 2026 Review Pack |
High-Yield Practice Questions & Solutions
Question 1
A nurse assesses a client with heart failure who reports increasing shortness of breath
when lying flat. Which finding requires immediate intervention?
A. Bilateral ankle edema
B. Orthopnea and oxygen saturation of 86%
C. Weight gain of 2 lb in one week
D. Fatigue after walking
Answer: B
Rationale: Orthopnea with hypoxemia indicates worsening pulmonary congestion requiring
prompt intervention.
Question 2
A client receiving IV heparin has an aPTT of 110 seconds. Which action should the nurse
take first?
A. Increase the infusion rate
B. Stop the infusion and notify the provider
C. Administer vitamin K
D. Encourage increased fluid intake
Answer: B
Rationale: An excessively prolonged aPTT increases bleeding risk. The infusion should be
stopped according to protocol and the provider notified.
Question 3
A postoperative client reports calf pain. Which assessment finding is most concerning?
A. Mild bruising at the incision
B. Warm, swollen calf with tenderness
C. Pain rated 4/10 at the incision
,D. Temperature of 99°F (37.2°C)
Answer: B
Rationale: These findings suggest deep vein thrombosis and require immediate evaluation.
Question 4
Which laboratory value should the nurse report immediately?
A. Sodium 138 mEq/L
B. Potassium 6.2 mEq/L
C. Hemoglobin 13 g/dL
D. Calcium 9.2 mg/dL
Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias.
Question 5
A client with diabetes becomes confused and diaphoretic. What is the nurse’s priority
action?
A. Administer insulin
B. Check the blood glucose level
C. Encourage exercise
D. Restrict fluids
Answer: B
Rationale: Symptoms suggest hypoglycemia; blood glucose should be verified
immediately.
Question 6
Which client should the emergency department nurse assess first?
A. Client with a sprained ankle
B. Client with chest pain and diaphoresis
C. Client with a sore throat
D. Client with chronic back pain
,Answer: B
Rationale: Chest pain with diaphoresis may indicate acute myocardial infarction.
Question 7
A client receiving morphine has a respiratory rate of 8/min. Which medication should the
nurse anticipate administering?
A. Protamine sulfate
B. Naloxone
C. Flumazenil
D. Epinephrine
Answer: B
Rationale: Naloxone reverses opioid-induced respiratory depression.
Question 8
Which assessment finding indicates effective treatment of dehydration?
A. Blood pressure 88/54 mm Hg
B. Urine output 35 mL/hr
C. Dry mucous membranes
D. Heart rate 120/min
Answer: B
Rationale: Adequate urine output indicates improved hydration.
Question 9
A nurse prepares to administer packed red blood cells. Which action is appropriate?
A. Use lactated Ringer’s solution
B. Verify blood with another licensed nurse
C. Warm blood in a microwave
D. Add medications to the blood bag
Answer: B
, Rationale: Two licensed personnel should verify the blood product before administration.
Question 10
Which client is at highest risk for developing pressure injuries?
A. Ambulates independently
B. Bedridden with poor nutrition
C. Walks with a cane
D. Exercises daily
Answer: B
Rationale: Immobility and malnutrition significantly increase pressure injury risk.
Question 11
A client with COPD is receiving oxygen therapy. Which finding suggests oxygen is effective?
A. Respiratory rate decreases to 20/min
B. Increased cyanosis
C. Restlessness worsens
D. Oxygen saturation falls to 84%
Answer: A
Rationale: Improved respiratory rate indicates better oxygenation.
Question 12
Which food should a client taking warfarin consume consistently?
A. Spinach in varying amounts
B. Green leafy vegetables in consistent amounts
C. Grapefruit daily
D. Cranberry juice frequently
Answer: B
Rationale: Vitamin K intake should remain consistent to maintain therapeutic
anticoagulation.
High-Yield Practice Questions & Solutions
Question 1
A nurse assesses a client with heart failure who reports increasing shortness of breath
when lying flat. Which finding requires immediate intervention?
A. Bilateral ankle edema
B. Orthopnea and oxygen saturation of 86%
C. Weight gain of 2 lb in one week
D. Fatigue after walking
Answer: B
Rationale: Orthopnea with hypoxemia indicates worsening pulmonary congestion requiring
prompt intervention.
Question 2
A client receiving IV heparin has an aPTT of 110 seconds. Which action should the nurse
take first?
A. Increase the infusion rate
B. Stop the infusion and notify the provider
C. Administer vitamin K
D. Encourage increased fluid intake
Answer: B
Rationale: An excessively prolonged aPTT increases bleeding risk. The infusion should be
stopped according to protocol and the provider notified.
Question 3
A postoperative client reports calf pain. Which assessment finding is most concerning?
A. Mild bruising at the incision
B. Warm, swollen calf with tenderness
C. Pain rated 4/10 at the incision
,D. Temperature of 99°F (37.2°C)
Answer: B
Rationale: These findings suggest deep vein thrombosis and require immediate evaluation.
Question 4
Which laboratory value should the nurse report immediately?
A. Sodium 138 mEq/L
B. Potassium 6.2 mEq/L
C. Hemoglobin 13 g/dL
D. Calcium 9.2 mg/dL
Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias.
Question 5
A client with diabetes becomes confused and diaphoretic. What is the nurse’s priority
action?
A. Administer insulin
B. Check the blood glucose level
C. Encourage exercise
D. Restrict fluids
Answer: B
Rationale: Symptoms suggest hypoglycemia; blood glucose should be verified
immediately.
Question 6
Which client should the emergency department nurse assess first?
A. Client with a sprained ankle
B. Client with chest pain and diaphoresis
C. Client with a sore throat
D. Client with chronic back pain
,Answer: B
Rationale: Chest pain with diaphoresis may indicate acute myocardial infarction.
Question 7
A client receiving morphine has a respiratory rate of 8/min. Which medication should the
nurse anticipate administering?
A. Protamine sulfate
B. Naloxone
C. Flumazenil
D. Epinephrine
Answer: B
Rationale: Naloxone reverses opioid-induced respiratory depression.
Question 8
Which assessment finding indicates effective treatment of dehydration?
A. Blood pressure 88/54 mm Hg
B. Urine output 35 mL/hr
C. Dry mucous membranes
D. Heart rate 120/min
Answer: B
Rationale: Adequate urine output indicates improved hydration.
Question 9
A nurse prepares to administer packed red blood cells. Which action is appropriate?
A. Use lactated Ringer’s solution
B. Verify blood with another licensed nurse
C. Warm blood in a microwave
D. Add medications to the blood bag
Answer: B
, Rationale: Two licensed personnel should verify the blood product before administration.
Question 10
Which client is at highest risk for developing pressure injuries?
A. Ambulates independently
B. Bedridden with poor nutrition
C. Walks with a cane
D. Exercises daily
Answer: B
Rationale: Immobility and malnutrition significantly increase pressure injury risk.
Question 11
A client with COPD is receiving oxygen therapy. Which finding suggests oxygen is effective?
A. Respiratory rate decreases to 20/min
B. Increased cyanosis
C. Restlessness worsens
D. Oxygen saturation falls to 84%
Answer: A
Rationale: Improved respiratory rate indicates better oxygenation.
Question 12
Which food should a client taking warfarin consume consistently?
A. Spinach in varying amounts
B. Green leafy vegetables in consistent amounts
C. Grapefruit daily
D. Cranberry juice frequently
Answer: B
Rationale: Vitamin K intake should remain consistent to maintain therapeutic
anticoagulation.
