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Next Generation NCLEX-RN (NGN) Comprehensive
Examination: -Question Multiple-Choice Review with
Clinical Judgment and Evidence-Based Rationales
EXAM TITLE
Next Generation NCLEX-RN (NGN) Comprehensive Review: Advanced Clinical Judgment,
Prioritization, Delegation, and Client Care Scenarios for Registered Nurse Licensure
Examination Preparation
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1-25)
1. A charge nurse is assigning client care for the day shift. Which client should be assigned to
the most experienced registered nurse?
A) A 45-year-old client with diabetes mellitus requiring insulin administration
B) A 68-year-old client 2 days post-operative from a total hip replacement
C) A 32-year-old client with pneumonia receiving IV antibiotics
D) A 55-year-old client with acute respiratory distress syndrome requiring mechanical
ventilation
CorreCt Answer: D) A 55-year-old client with acute respiratory distress syndrome
requiring mechanical ventilation
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Rationale: The most experienced RN should care for the most unstable client. ARDS with
mechanical ventilation requires advanced assessment skills, ventilator management knowledge,
and rapid clinical decision-making. The other clients are stable and can be assigned to less
experienced staff.
2. A nurse manager is planning staff assignments on a medical-surgical unit. Which task can be
delegated to a licensed practical/vocational nurse (LPN/LVN)?
A) Performing the initial admission assessment on a new client
B) Administering IV push medications to a client with cardiac arrhythmia
C) Administering an oral antihypertensive medication to a stable client
D) Developing the nursing care plan for a client with diabetes
CorreCt Answer: C) Administering an oral antihypertensive medication to a stable client
Rationale: LPN/LVNs can administer oral medications to stable clients. Initial assessments, IV
push medications, and care plan development are within the RN scope of practice. The RN is
responsible for delegating tasks appropriately and supervising LPN/LVN practice.
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3. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by
the client indicates a need for further teaching?
A) "I will take my medication at the same time every day."
B) "I should report any unusual bleeding or bruising to my healthcare provider."
C) "I can take ibuprofen for headaches since it is over-the-counter."
D) "I need to have my blood levels checked regularly."
CorreCt Answer: C) "I can take ibuprofen for headaches since it is over-the-counter."
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken with warfarin.
Clients should avoid NSAIDs and use acetaminophen for pain. The other statements
demonstrate correct understanding of warfarin therapy.
4. A nurse enters a client's room and finds the client on the floor between the bed and the
bathroom. Which action should the nurse take first?
A) Assess the client for injuries
B) Call for assistance
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C) Document the incident
D) Help the client back to bed
CorreCt Answer: A) Assess the client for injuries
Rationale: The nurse should first assess the client for injuries before moving them. Moving a
client without assessing for spinal or other injuries can cause further harm. After assessment,
the nurse should call for assistance and then document the incident.
5. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A) Verify the client's identity using two identifiers
B) Check the client's vital signs before the transfusion
C) Administer the blood within 4 hours of obtaining from the blood bank
D) Obtain informed consent for the transfusion
CorreCt Answer: A) Verify the client's identity using two identifiers
Rationale: Verifying the client's identity using two identifiers (name, date of birth, medical
record number) is the most critical action to prevent transfusion reactions caused by ABO
Next Generation NCLEX-RN (NGN) Comprehensive
Examination: -Question Multiple-Choice Review with
Clinical Judgment and Evidence-Based Rationales
EXAM TITLE
Next Generation NCLEX-RN (NGN) Comprehensive Review: Advanced Clinical Judgment,
Prioritization, Delegation, and Client Care Scenarios for Registered Nurse Licensure
Examination Preparation
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1-25)
1. A charge nurse is assigning client care for the day shift. Which client should be assigned to
the most experienced registered nurse?
A) A 45-year-old client with diabetes mellitus requiring insulin administration
B) A 68-year-old client 2 days post-operative from a total hip replacement
C) A 32-year-old client with pneumonia receiving IV antibiotics
D) A 55-year-old client with acute respiratory distress syndrome requiring mechanical
ventilation
CorreCt Answer: D) A 55-year-old client with acute respiratory distress syndrome
requiring mechanical ventilation
,2
Rationale: The most experienced RN should care for the most unstable client. ARDS with
mechanical ventilation requires advanced assessment skills, ventilator management knowledge,
and rapid clinical decision-making. The other clients are stable and can be assigned to less
experienced staff.
2. A nurse manager is planning staff assignments on a medical-surgical unit. Which task can be
delegated to a licensed practical/vocational nurse (LPN/LVN)?
A) Performing the initial admission assessment on a new client
B) Administering IV push medications to a client with cardiac arrhythmia
C) Administering an oral antihypertensive medication to a stable client
D) Developing the nursing care plan for a client with diabetes
CorreCt Answer: C) Administering an oral antihypertensive medication to a stable client
Rationale: LPN/LVNs can administer oral medications to stable clients. Initial assessments, IV
push medications, and care plan development are within the RN scope of practice. The RN is
responsible for delegating tasks appropriately and supervising LPN/LVN practice.
,3
3. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by
the client indicates a need for further teaching?
A) "I will take my medication at the same time every day."
B) "I should report any unusual bleeding or bruising to my healthcare provider."
C) "I can take ibuprofen for headaches since it is over-the-counter."
D) "I need to have my blood levels checked regularly."
CorreCt Answer: C) "I can take ibuprofen for headaches since it is over-the-counter."
Rationale: Ibuprofen and other NSAIDs increase the risk of bleeding when taken with warfarin.
Clients should avoid NSAIDs and use acetaminophen for pain. The other statements
demonstrate correct understanding of warfarin therapy.
4. A nurse enters a client's room and finds the client on the floor between the bed and the
bathroom. Which action should the nurse take first?
A) Assess the client for injuries
B) Call for assistance
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C) Document the incident
D) Help the client back to bed
CorreCt Answer: A) Assess the client for injuries
Rationale: The nurse should first assess the client for injuries before moving them. Moving a
client without assessing for spinal or other injuries can cause further harm. After assessment,
the nurse should call for assistance and then document the incident.
5. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A) Verify the client's identity using two identifiers
B) Check the client's vital signs before the transfusion
C) Administer the blood within 4 hours of obtaining from the blood bank
D) Obtain informed consent for the transfusion
CorreCt Answer: A) Verify the client's identity using two identifiers
Rationale: Verifying the client's identity using two identifiers (name, date of birth, medical
record number) is the most critical action to prevent transfusion reactions caused by ABO
