KAPLAN NCLEX-RN NEXT GENERATION NCLEX (NGN) EXAM PRACTICE |
COMPREHENSIVE STUDY GUIDE | ADVANCED TESTBANK WITH PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Safe and Effective Care Environment
ii. Management of Care and Delegation
iii. Safety and Infection Prevention and Control
iv. Health Promotion and Maintenance
v. Psychosocial Integrity
vi. Basic Care and Comfort
vii. Pharmacological and Parenteral Therapies
viii. Reduction of Risk Potential
ix. Physiological Adaptation and Complex Acute Care
x. Clinical Judgment and NGN Decision-Making
INTRODUCTION
This comprehensive Kaplan NCLEX-RN Next Generation NCLEX (NGN) practice set is
designed around the current 2026 NCLEX-RN framework and emphasizes clinical
judgment, prioritization, safety, pharmacology, physiological adaptation,
psychosocial care, and management of care. The questions progress beyond simple
recall by requiring interpretation of clinical findings, recognition of deterioration,
prioritization of interventions, delegation, medication safety, and evidence-based
nursing judgment. Students should expect realistic scenarios involving competing
priorities and subtle clinical cues. The difficulty ranges from advanced to extremely
challenging, making this set useful for graduate-level review and intensive licensure
preparation. The questions are structured as original study exercises rather than
reproductions of secure examination content.
Question 1
A nurse receives handoff for four clients on a medical-surgical unit. Which client
should the nurse assess first?
A. A client with chronic heart failure who gained 1.5 kg over the past 3 days and
reports needing two pillows to sleep
,B. A client with diabetic ketoacidosis whose serum potassium is 4.8 mEq/L after
insulin therapy was initiated
C. A client with pneumonia who is receiving oxygen at 2 L/min and has a respiratory
rate of 22/min
D. A client 12 hours after thyroidectomy who reports tingling around the mouth
and has a positive Chvostek sign
🔴 Correct Answer: D. A client 12 hours after thyroidectomy who reports tingling
around the mouth and has a positive Chvostek sign.
🔵 Explanation: Perioral paresthesia and a positive Chvostek sign after thyroidectomy
suggest acute hypocalcemia, which can progress to laryngospasm and airway
compromise. This is the most immediately life-threatening finding. The other clients
require assessment but do not demonstrate the same immediate risk to airway or
neuromuscular function.
Question 2
A client with septic shock has received 30 mL/kg of crystalloid solution. The blood
pressure remains 82/46 mm Hg, and the serum lactate is 4.6 mmol/L. Which
prescription should the nurse anticipate?
A. Administer an IV loop diuretic
B. Initiate a vasopressor infusion
C. Restrict fluids to prevent pulmonary edema
D. Administer a rapid-acting insulin infusion
🔴 Correct Answer: B. Initiate a vasopressor infusion.
🔵 Explanation: Persistent hypotension despite appropriate initial fluid resuscitation
indicates the need for vasopressor support, commonly norepinephrine, to restore
vascular tone and maintain organ perfusion. Diuresis and fluid restriction would
worsen hypoperfusion, while insulin does not address the immediate hemodynamic
problem.
Question 3
The nurse is caring for a client receiving unfractionated heparin for an acute
pulmonary embolism. Which finding requires the most immediate intervention?
,A. Activated partial thromboplastin time of 68 seconds
B. Platelet count decreasing from 210,000/mm³ to 92,000/mm³
C. Mild ecchymosis at a venipuncture site
D. Hemoglobin decreasing from 13.2 g/dL to 12.8 g/dL
🔴 Correct Answer: B. Platelet count decreasing from 210,000/mm³ to
92,000/mm³.
🔵 Explanation: A substantial platelet decline during heparin therapy raises concern
for heparin-induced thrombocytopenia (HIT), a prothrombotic immune-mediated
complication. The nurse should recognize the potential for catastrophic thrombosis
and promptly notify the provider and anticipate discontinuation of heparin and
alternative anticoagulation.
Question 4
A client with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked
T waves on the ECG. Which prescribed medication should the nurse
administer first?
A. Sodium polystyrene sulfonate
B. Regular insulin with dextrose
C. IV calcium gluconate
D. Oral sodium bicarbonate
🔴 Correct Answer: C. IV calcium gluconate.
🔵 Explanation: IV calcium stabilizes the myocardial membrane and reduces the
immediate risk of lethal dysrhythmias associated with severe hyperkalemia and ECG
changes. Insulin with dextrose shifts potassium intracellularly but does not stabilize
the cardiac membrane. Potassium-removal therapies act more slowly.
Question 5
A postoperative client suddenly becomes restless and confused. The oxygen
saturation falls from 96% to 86%, respiratory rate increases to 30/min, and the client
reports pleuritic chest pain. Which action should the nurse take first?
A. Administer the prescribed opioid analgesic
B. Place the client in Trendelenburg position
, C. Apply supplemental oxygen and rapidly assess respiratory status
D. Encourage the client to ambulate to improve circulation
🔴 Correct Answer: C. Apply supplemental oxygen and rapidly assess respiratory
status.
🔵 Explanation: Acute hypoxemia, tachypnea, pleuritic chest pain, and altered mental
status suggest a potentially life-threatening pulmonary embolism or other acute
respiratory compromise. Immediate oxygenation and focused assessment take priority
while additional emergency interventions are initiated.
Question 6
A nurse is preparing to administer digoxin to an adult client with heart failure. The
client has an apical pulse of 48/min and reports nausea and seeing yellow-green
halos around lights. What should the nurse do?
A. Administer the medication with food
B. Hold the dose and notify the provider
C. Administer half of the prescribed dose
D. Give the medication and reassess the pulse in 1 hour
🔴 Correct Answer: B. Hold the dose and notify the provider.
🔵 Explanation: Bradycardia, nausea, and visual disturbances are concerning for
digoxin toxicity. The nurse should withhold the medication and notify the provider for
further evaluation, including assessment of renal function, electrolyte levels, and
serum digoxin concentration as appropriate.
Question 7
A client receiving a continuous IV insulin infusion for diabetic ketoacidosis has a
glucose level that decreased from 480 mg/dL to 190 mg/dL. The anion gap remains
elevated. Which action is most appropriate?
A. Stop the insulin infusion immediately
B. Continue insulin therapy and add dextrose as prescribed
C. Administer glucagon and discontinue IV fluids
D. Switch immediately to subcutaneous long-acting insulin
COMPREHENSIVE STUDY GUIDE | ADVANCED TESTBANK WITH PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Safe and Effective Care Environment
ii. Management of Care and Delegation
iii. Safety and Infection Prevention and Control
iv. Health Promotion and Maintenance
v. Psychosocial Integrity
vi. Basic Care and Comfort
vii. Pharmacological and Parenteral Therapies
viii. Reduction of Risk Potential
ix. Physiological Adaptation and Complex Acute Care
x. Clinical Judgment and NGN Decision-Making
INTRODUCTION
This comprehensive Kaplan NCLEX-RN Next Generation NCLEX (NGN) practice set is
designed around the current 2026 NCLEX-RN framework and emphasizes clinical
judgment, prioritization, safety, pharmacology, physiological adaptation,
psychosocial care, and management of care. The questions progress beyond simple
recall by requiring interpretation of clinical findings, recognition of deterioration,
prioritization of interventions, delegation, medication safety, and evidence-based
nursing judgment. Students should expect realistic scenarios involving competing
priorities and subtle clinical cues. The difficulty ranges from advanced to extremely
challenging, making this set useful for graduate-level review and intensive licensure
preparation. The questions are structured as original study exercises rather than
reproductions of secure examination content.
Question 1
A nurse receives handoff for four clients on a medical-surgical unit. Which client
should the nurse assess first?
A. A client with chronic heart failure who gained 1.5 kg over the past 3 days and
reports needing two pillows to sleep
,B. A client with diabetic ketoacidosis whose serum potassium is 4.8 mEq/L after
insulin therapy was initiated
C. A client with pneumonia who is receiving oxygen at 2 L/min and has a respiratory
rate of 22/min
D. A client 12 hours after thyroidectomy who reports tingling around the mouth
and has a positive Chvostek sign
🔴 Correct Answer: D. A client 12 hours after thyroidectomy who reports tingling
around the mouth and has a positive Chvostek sign.
🔵 Explanation: Perioral paresthesia and a positive Chvostek sign after thyroidectomy
suggest acute hypocalcemia, which can progress to laryngospasm and airway
compromise. This is the most immediately life-threatening finding. The other clients
require assessment but do not demonstrate the same immediate risk to airway or
neuromuscular function.
Question 2
A client with septic shock has received 30 mL/kg of crystalloid solution. The blood
pressure remains 82/46 mm Hg, and the serum lactate is 4.6 mmol/L. Which
prescription should the nurse anticipate?
A. Administer an IV loop diuretic
B. Initiate a vasopressor infusion
C. Restrict fluids to prevent pulmonary edema
D. Administer a rapid-acting insulin infusion
🔴 Correct Answer: B. Initiate a vasopressor infusion.
🔵 Explanation: Persistent hypotension despite appropriate initial fluid resuscitation
indicates the need for vasopressor support, commonly norepinephrine, to restore
vascular tone and maintain organ perfusion. Diuresis and fluid restriction would
worsen hypoperfusion, while insulin does not address the immediate hemodynamic
problem.
Question 3
The nurse is caring for a client receiving unfractionated heparin for an acute
pulmonary embolism. Which finding requires the most immediate intervention?
,A. Activated partial thromboplastin time of 68 seconds
B. Platelet count decreasing from 210,000/mm³ to 92,000/mm³
C. Mild ecchymosis at a venipuncture site
D. Hemoglobin decreasing from 13.2 g/dL to 12.8 g/dL
🔴 Correct Answer: B. Platelet count decreasing from 210,000/mm³ to
92,000/mm³.
🔵 Explanation: A substantial platelet decline during heparin therapy raises concern
for heparin-induced thrombocytopenia (HIT), a prothrombotic immune-mediated
complication. The nurse should recognize the potential for catastrophic thrombosis
and promptly notify the provider and anticipate discontinuation of heparin and
alternative anticoagulation.
Question 4
A client with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked
T waves on the ECG. Which prescribed medication should the nurse
administer first?
A. Sodium polystyrene sulfonate
B. Regular insulin with dextrose
C. IV calcium gluconate
D. Oral sodium bicarbonate
🔴 Correct Answer: C. IV calcium gluconate.
🔵 Explanation: IV calcium stabilizes the myocardial membrane and reduces the
immediate risk of lethal dysrhythmias associated with severe hyperkalemia and ECG
changes. Insulin with dextrose shifts potassium intracellularly but does not stabilize
the cardiac membrane. Potassium-removal therapies act more slowly.
Question 5
A postoperative client suddenly becomes restless and confused. The oxygen
saturation falls from 96% to 86%, respiratory rate increases to 30/min, and the client
reports pleuritic chest pain. Which action should the nurse take first?
A. Administer the prescribed opioid analgesic
B. Place the client in Trendelenburg position
, C. Apply supplemental oxygen and rapidly assess respiratory status
D. Encourage the client to ambulate to improve circulation
🔴 Correct Answer: C. Apply supplemental oxygen and rapidly assess respiratory
status.
🔵 Explanation: Acute hypoxemia, tachypnea, pleuritic chest pain, and altered mental
status suggest a potentially life-threatening pulmonary embolism or other acute
respiratory compromise. Immediate oxygenation and focused assessment take priority
while additional emergency interventions are initiated.
Question 6
A nurse is preparing to administer digoxin to an adult client with heart failure. The
client has an apical pulse of 48/min and reports nausea and seeing yellow-green
halos around lights. What should the nurse do?
A. Administer the medication with food
B. Hold the dose and notify the provider
C. Administer half of the prescribed dose
D. Give the medication and reassess the pulse in 1 hour
🔴 Correct Answer: B. Hold the dose and notify the provider.
🔵 Explanation: Bradycardia, nausea, and visual disturbances are concerning for
digoxin toxicity. The nurse should withhold the medication and notify the provider for
further evaluation, including assessment of renal function, electrolyte levels, and
serum digoxin concentration as appropriate.
Question 7
A client receiving a continuous IV insulin infusion for diabetic ketoacidosis has a
glucose level that decreased from 480 mg/dL to 190 mg/dL. The anion gap remains
elevated. Which action is most appropriate?
A. Stop the insulin infusion immediately
B. Continue insulin therapy and add dextrose as prescribed
C. Administer glucagon and discontinue IV fluids
D. Switch immediately to subcutaneous long-acting insulin
