KAPLAN NGN CASE STUDY PRACTICE EXAM Complete
Practice Examination with Correct Answers & Detailed
Rationales | 2026/2027 Edition
1. A nurse is caring for a client who reports sudden, sharp chest pain that increases
with inspiration. The client is restless and has an SpO₂ of 89% on room air. Which
action should the nurse take FIRST?
A) Administer oxygen at 2 L/min via nasal cannula
B) Position the client in high-Fowler's position
C) Assess lung sounds
D) Notify the provider immediately
Answer: B
Rationale: High-Fowler's position maximizes lung expansion and oxygenation. While
oxygen administration is important, positioning is a non-invasive, immediate action that
can improve breathing. Airway and breathing are the priority .
2. What is the correct order of the clinical judgment steps according to the NCSBN
Clinical Judgment Measurement Model?
A) Analyze cues → Recognize cues → Prioritize hypotheses → Generate solutions → Take
action → Evaluate outcomes
B) Recognize cues → Analyze cues → Prioritize hypotheses → Generate solutions → Take
action → Evaluate outcomes
C) Generate solutions → Recognize cues → Analyze cues → Prioritize hypotheses → Take
action → Evaluate outcomes
D) Prioritize hypotheses → Recognize cues → Analyze cues → Generate solutions → Take
action → Evaluate outcomes
Answer: B
Rationale: The correct order of clinical judgment steps is: Recognize cues, Analyze cues,
Prioritize hypotheses, Generate solutions, Take action, Evaluate outcomes .
,3. A client with a history of seizures begins to have a generalized tonic-clonic
seizure. What is the nurse's PRIORITY action?
A) Restrain the client's limbs to prevent injury
B) Insert a padded tongue blade
C) Lower the client to the floor and protect the head
D) Administer IV lorazepam immediately
Answer: C
Rationale: The priority during a seizure is to prevent injury. The nurse should ease the
client to the floor, clear the area, and protect the head. Never restrain or insert anything
into the mouth during a seizure .
4. A nurse is assessing a client 2 days post-operative following a total hip
arthroplasty. Which finding requires IMMEDIATE intervention?
A) Pain score 4/10 with movement
B) Mild swelling of the operative leg
C) Shortness of breath and chest pain
D) Temperature 99.2°F (37.3°C)
Answer: C
Rationale: Shortness of breath and chest pain suggest pulmonary embolism, a major risk
after hip surgery. The other findings are expected post-operative findings .
5. A nurse is caring for four clients. Which client should be assessed FIRST?
A) Client with chronic back pain requesting medication
B) Client with new-onset chest pain radiating to the jaw
C) Client requesting discharge teaching
D) Client with a scheduled wound dressing change
Answer: B
Rationale: Chest pain radiating to the jaw is a classic sign of acute coronary syndrome
(MI). This is life-threatening and takes priority over stable, chronic issues .
,6. Which patient should the nurse assess FIRST?
A) A patient with diabetes who needs insulin
B) A patient 2 hours post-total hip replacement reporting sudden shortness of breath
C) A patient requesting pain medication before physical therapy
D) A patient scheduled for discharge with new wound care instructions
Answer: B
Rationale: Sudden shortness of breath post-hip surgery suggests pulmonary embolism, a
life-threatening emergency requiring immediate assessment. The other patients have
stable, non-urgent needs .
7. A nurse is assessing a client with acute pancreatitis. Which laboratory finding is
MOST specific to this diagnosis?
A) Elevated amylase
B) Elevated lipase
C) Hypocalcemia
D) Elevated liver function tests
Answer: B
Rationale: Lipase is more specific for pancreatitis than amylase. Amylase rises within 24
hours but can be elevated in other conditions. Hypocalcemia may occur but is not
diagnostic .
8. A nurse is caring for a client in heart failure. Which assessment finding indicates
worsening of the condition?
A) Weight loss of 2 pounds in 24 hours
B) Peripheral edema
C) Jugular venous distention
D) Shortness of breath with exertion
Answer: C
Rationale: Jugular venous distention indicates increased central venous pressure and
, worsening heart failure. Peripheral edema and dyspnea with exertion are also signs but
JVD is a more specific indicator of fluid overload .
9. What is the nurse's priority action when a client with chest pain has an SpO₂ of
89%?
A) Administer oxygen at 2 L/min
B) Position the client in high-Fowler's position
C) Notify the provider
D) Obtain a 12-lead ECG
Answer: B
Rationale: High-Fowler's position maximizes lung expansion and oxygenation. While
oxygen is important, positioning is a non-invasive, immediate action .
10. A nurse is using the "just culture" approach after a medication error. Which
statement reflects this approach?
A) "The nurse should be fired for this error."
B) "The error should not be reported to protect the nurse."
C) "The focus should be on system-level factors that contributed to the error."
D) "The nurse should be suspended without pay."
Answer: C
Rationale: Just culture focuses on system-level factors rather than blaming individuals.
This promotes learning and sustainable safety improvements .
11. A nurse is assessing a client in diabetic ketoacidosis (DKA). Which finding is
MOST concerning?
A) Blood glucose 520 mg/dL
B) Serum bicarbonate 12 mEq/L
C) Blood pH 7.20
D) Urine ketones 4+
Practice Examination with Correct Answers & Detailed
Rationales | 2026/2027 Edition
1. A nurse is caring for a client who reports sudden, sharp chest pain that increases
with inspiration. The client is restless and has an SpO₂ of 89% on room air. Which
action should the nurse take FIRST?
A) Administer oxygen at 2 L/min via nasal cannula
B) Position the client in high-Fowler's position
C) Assess lung sounds
D) Notify the provider immediately
Answer: B
Rationale: High-Fowler's position maximizes lung expansion and oxygenation. While
oxygen administration is important, positioning is a non-invasive, immediate action that
can improve breathing. Airway and breathing are the priority .
2. What is the correct order of the clinical judgment steps according to the NCSBN
Clinical Judgment Measurement Model?
A) Analyze cues → Recognize cues → Prioritize hypotheses → Generate solutions → Take
action → Evaluate outcomes
B) Recognize cues → Analyze cues → Prioritize hypotheses → Generate solutions → Take
action → Evaluate outcomes
C) Generate solutions → Recognize cues → Analyze cues → Prioritize hypotheses → Take
action → Evaluate outcomes
D) Prioritize hypotheses → Recognize cues → Analyze cues → Generate solutions → Take
action → Evaluate outcomes
Answer: B
Rationale: The correct order of clinical judgment steps is: Recognize cues, Analyze cues,
Prioritize hypotheses, Generate solutions, Take action, Evaluate outcomes .
,3. A client with a history of seizures begins to have a generalized tonic-clonic
seizure. What is the nurse's PRIORITY action?
A) Restrain the client's limbs to prevent injury
B) Insert a padded tongue blade
C) Lower the client to the floor and protect the head
D) Administer IV lorazepam immediately
Answer: C
Rationale: The priority during a seizure is to prevent injury. The nurse should ease the
client to the floor, clear the area, and protect the head. Never restrain or insert anything
into the mouth during a seizure .
4. A nurse is assessing a client 2 days post-operative following a total hip
arthroplasty. Which finding requires IMMEDIATE intervention?
A) Pain score 4/10 with movement
B) Mild swelling of the operative leg
C) Shortness of breath and chest pain
D) Temperature 99.2°F (37.3°C)
Answer: C
Rationale: Shortness of breath and chest pain suggest pulmonary embolism, a major risk
after hip surgery. The other findings are expected post-operative findings .
5. A nurse is caring for four clients. Which client should be assessed FIRST?
A) Client with chronic back pain requesting medication
B) Client with new-onset chest pain radiating to the jaw
C) Client requesting discharge teaching
D) Client with a scheduled wound dressing change
Answer: B
Rationale: Chest pain radiating to the jaw is a classic sign of acute coronary syndrome
(MI). This is life-threatening and takes priority over stable, chronic issues .
,6. Which patient should the nurse assess FIRST?
A) A patient with diabetes who needs insulin
B) A patient 2 hours post-total hip replacement reporting sudden shortness of breath
C) A patient requesting pain medication before physical therapy
D) A patient scheduled for discharge with new wound care instructions
Answer: B
Rationale: Sudden shortness of breath post-hip surgery suggests pulmonary embolism, a
life-threatening emergency requiring immediate assessment. The other patients have
stable, non-urgent needs .
7. A nurse is assessing a client with acute pancreatitis. Which laboratory finding is
MOST specific to this diagnosis?
A) Elevated amylase
B) Elevated lipase
C) Hypocalcemia
D) Elevated liver function tests
Answer: B
Rationale: Lipase is more specific for pancreatitis than amylase. Amylase rises within 24
hours but can be elevated in other conditions. Hypocalcemia may occur but is not
diagnostic .
8. A nurse is caring for a client in heart failure. Which assessment finding indicates
worsening of the condition?
A) Weight loss of 2 pounds in 24 hours
B) Peripheral edema
C) Jugular venous distention
D) Shortness of breath with exertion
Answer: C
Rationale: Jugular venous distention indicates increased central venous pressure and
, worsening heart failure. Peripheral edema and dyspnea with exertion are also signs but
JVD is a more specific indicator of fluid overload .
9. What is the nurse's priority action when a client with chest pain has an SpO₂ of
89%?
A) Administer oxygen at 2 L/min
B) Position the client in high-Fowler's position
C) Notify the provider
D) Obtain a 12-lead ECG
Answer: B
Rationale: High-Fowler's position maximizes lung expansion and oxygenation. While
oxygen is important, positioning is a non-invasive, immediate action .
10. A nurse is using the "just culture" approach after a medication error. Which
statement reflects this approach?
A) "The nurse should be fired for this error."
B) "The error should not be reported to protect the nurse."
C) "The focus should be on system-level factors that contributed to the error."
D) "The nurse should be suspended without pay."
Answer: C
Rationale: Just culture focuses on system-level factors rather than blaming individuals.
This promotes learning and sustainable safety improvements .
11. A nurse is assessing a client in diabetic ketoacidosis (DKA). Which finding is
MOST concerning?
A) Blood glucose 520 mg/dL
B) Serum bicarbonate 12 mEq/L
C) Blood pH 7.20
D) Urine ketones 4+
