NCSBN
NEXT-GENERATION NCLEX Exam Questions And Correct Answers New Version 2026
NCLEX QUESTIONS AND ANSWERS
,[CASE STUDY BLOCK 1: NEXT-GENERATION NCLEX MINI-CASE]
Client Context: A 62-year-old male with a history of severe liver cirrhosis is admitted to the medical unit.
· Initial Assessment (08:00): Alert and oriented x 3, abdomen distended and taut with shifting dullness, 2+
pitting bilateral pedal edema. Vital Signs: BP 118/72, HR 86, RR 16, Temp 37.1℃C,SpO2 96% on room air.
Follow-up Assessment (14:00): Lethargic, oriented to person only, exhibits a flapping tremor of the hands when
wrists are extended (asterixis).
· Recent Laboratory Results: Hemoglobin: 11.2 g/dL, Platelets: 88,000/mm3, Serum Sodium: 132mEq/L, Serum
Potassium: 3.6 mEq/L, Blood Urea Nitrogen (BUN): 28 mg/dL, Serum Ammonia:118 μmol/L (Normal: 15-45 μ
mol/L).
1. Based on the client context and assessment tracking, which prescription should the nurse anticipate
administering first to address the underlying cause of the client's mental status change?
A) IV Furosemide 40 mg push
B) Oral Lactulose 30 mL
C) IV Sodium Polystyrene Sulfonate
D) Oral Rifaximin 550 mg
Answer: B
· Rationale: The client is exhibiting signs of worsening hepatic encephalopathy, secondary to high serum
ammonia levels. Lactulose is an osmotic laxative that converts ammonia (\(NH {3}\)) into ammonium (\(NH
{4}^{+}\))in the gut, which is unabsorbable and excreted in the stool, reducing neurotoxicity. Rifaximin is an
antibiotic used adjunctively, but lactulose is the primary first-line treatment for acute reduction of
encephalopathy. Furosemide could worsen dehydration and hypokalemic alkalosis, worsening encephalopathy.
2. The nurse is preparing to administer the prescribed lactulose to the client. Which therapeutic
response indicates the medication has achieved its clinical objective?
A) The client's abdominal girth decreases by 3 cm within 24 hours.
B) The client produces 2 to 3 soft, loose stools per day and experiences improved orientation.
C) The serum sodium level normalizes to 140 mEq/L.
D) The client's bilateral pitting pedal edema resolves to 0.
Answer: B
· Rationale: The explicit therapeutic goal of lactulose titration in hepatic encephalopathy is to induce 2 to 3
soft, loose stools per day while decreasing neurocognitive symptoms (resolving asterixis and lethargy). It is
not titrated to cause heavy watery diarrhea (which induces hypovolemia and electrolyte imbalances) or to
treat ascites/pedal edema (which are managed via diuretics and paracentesis).
[SELECT ALL THAT APPLY (SATA) BLOCK]
, 3. A nurse is planning care for a client who underwent an open cholecystectomy 12 hours ago. Which
interventions should the nurse include in the plan of care to minimize postoperative respiratory
complications? (Select all that apply.)
· A) Assist the client to ambulate as early as tolerated.
· B) Teach the client to perform incentive spirometry 10 times every hour while awake.
· C) Administer scheduled opioid analgesics continuously regardless of pain level to suppress coughing.
D) Instruct the client to splint the abdominal incision with a pillow when deep breathing and coughing.
E) Maintain the client in a strict flat supine position for the first 24 hours.
· Answers: A, B, D
· Rationale: Early ambulation (A), incentive spirometry (B), and incision splinting (D) all promote lung expansion,
maximize alveolar recruitment, and mobilize secretions to prevent atelectasis and pneumonia. Over-sedating
with opioids (C) suppresses the respiratory drive and the cough reflex, increasing the risk of respiratory failure.
A strict supine position (E) restricts diaphragmatic excursion; the head of the bed should be elevated to Semi-
Fowler's or Fowler's.
4. A nurse is conducting discharge teaching for a client newly diagnosed with type 1diabetes mellitus. Which
signs and symptoms of severe hypoglycemia should the nurse instruct the client and family to monitor for?
(Select all that apply.)
A) Diaphoresis and cool, clammy skin
B) Increased thirst and polyuria
C) Palpitations and tremors
D) Deep, rapid Kussmaul respirations
E) Acute confusion, slurred speech, or irritability
Answers: A, C, E
Rationale: Hypoglycemia triggers an autonomous sympathetic nervous system surge,presenting as sweating,
cold skin ((A), tachycardia/palpitations, and tremors (C). Central nervous system glucose deprivation causes
neuroglycopenic symptoms like confusion and slurred speech (E). Thirst, polyuria (B), and Kussmaul respirations
(D) are classic markers of profound hyperglycemia and diabetic ketoacidosis (DKA).
5. A nurse is reviewing infection control practices on an inpatient unit. Which clinical scenarios require
the implementation of contact precautions? (Select all that apply.)
· A) A client with a draining abdominal abscess testing positive for Methicillin-Resistant
Staphylococcus aureus (MRSA).
· B) A child admitted with a high fever and a maculopapular rash suspected to be rubeola (measles).
· C) An adult client with an active, foul-smelling liquid stool infection testing positive for Clostridium difficile.
· D) A pregnant client presenting with a disseminated vesicular rash from Varicella-Zoster.
· E) An elderly client with an unhealed pressure injury colonized with Vancomycin-Resistant Enterococcus
(VRE).
Answers: A, C, E
· Rationale: MRSA in a draining wound (A), C. difficile (C), and VRE (E) are highly transmissible via direct or
indirect surface contact, mandating contact precautions. Measles (B) requires
, airborne precautions. Varicella (D) requires a combination of both airborne and contact precautions;
selecting it purely under contact without recognizing its primary airborne status ignores the room negative-
pressure requirement.
6. A nurse is caring for an infant with a suspected diagnosis of congenital heart disease causing a right-to-
left shunt. Which clinical manifestations should the nurse expect to assess? (Select all that apply.)
A) Persistent cyanosis that does not improve significantly with oxygen therapy.
B) Clubbing of the fingers and toes over time.
C) High-pitched, bounding peripheral pulses in all limbs.
D) Polycythemia noted on a complete blood count.
E) Overt circumoral cyanosis during feedings or crying.
Answers: A, B, D, E
Rationale: Right-to-left cardiac shunts allow deoxygenated systemic venous blood to bypass the lungs and enter
systemic circulation directly, causing profound hypoxemia that shows up as cyanosis (A, E). Over time, chronic
tissue hypoxia leads to digital clubbing (B) and stimulates erythropoietin production, resulting in compensatory
polycythemia (D). Bounding pulses (C) are associated with a patent ductus arteriosus (left-to-right shunt), not
standard cyanotic shunting anomalies.
7. A client with severe preeclampsia is receiving an intravenous magnesium sulfate infusion for seizure
prophylaxis. Which assessment findings should alert the nurse to immediate magnesium toxicity? (Select
all that apply.)
A) Deep tendon reflexes scored at 0 or 1+
B) Respiratory rate of 9 breaths/min
C) Urinary output of 50 mL/hour
D) Sudden onset of clonus and hyperreflexia
E) Altered mental status or extreme lethargy
Answers: A, B, E
Rationale: Magnesium sulfate is a central nervous system depressant. Toxicity impairs neuromuscular
transmission, resulting in diminished or absent deep tendon reflexes (A),respiratory depression (B), and
somnolence/lethargy (E). A urinary output of 50 mL/hr (C) is safe (>30 mL/hr), though low output can lead to
toxicity. Clonus and hyperreflexia (D) signify an undertreated preeclamptic state, not magnesium toxicity.
[PRIORITIZATION & MANAGEMENT OF CARE BLOCK]
8. After receiving the morning handoff report, which client should the nurse assess first?
· A) A client with a deep vein thrombosis who is receiving a continuous heparin infusion and has an aPTT of 75
seconds.
·B) A client with pneumonia who has an oxygen saturation of 89% while using a 2 L/min nasal cannula.
NEXT-GENERATION NCLEX Exam Questions And Correct Answers New Version 2026
NCLEX QUESTIONS AND ANSWERS
,[CASE STUDY BLOCK 1: NEXT-GENERATION NCLEX MINI-CASE]
Client Context: A 62-year-old male with a history of severe liver cirrhosis is admitted to the medical unit.
· Initial Assessment (08:00): Alert and oriented x 3, abdomen distended and taut with shifting dullness, 2+
pitting bilateral pedal edema. Vital Signs: BP 118/72, HR 86, RR 16, Temp 37.1℃C,SpO2 96% on room air.
Follow-up Assessment (14:00): Lethargic, oriented to person only, exhibits a flapping tremor of the hands when
wrists are extended (asterixis).
· Recent Laboratory Results: Hemoglobin: 11.2 g/dL, Platelets: 88,000/mm3, Serum Sodium: 132mEq/L, Serum
Potassium: 3.6 mEq/L, Blood Urea Nitrogen (BUN): 28 mg/dL, Serum Ammonia:118 μmol/L (Normal: 15-45 μ
mol/L).
1. Based on the client context and assessment tracking, which prescription should the nurse anticipate
administering first to address the underlying cause of the client's mental status change?
A) IV Furosemide 40 mg push
B) Oral Lactulose 30 mL
C) IV Sodium Polystyrene Sulfonate
D) Oral Rifaximin 550 mg
Answer: B
· Rationale: The client is exhibiting signs of worsening hepatic encephalopathy, secondary to high serum
ammonia levels. Lactulose is an osmotic laxative that converts ammonia (\(NH {3}\)) into ammonium (\(NH
{4}^{+}\))in the gut, which is unabsorbable and excreted in the stool, reducing neurotoxicity. Rifaximin is an
antibiotic used adjunctively, but lactulose is the primary first-line treatment for acute reduction of
encephalopathy. Furosemide could worsen dehydration and hypokalemic alkalosis, worsening encephalopathy.
2. The nurse is preparing to administer the prescribed lactulose to the client. Which therapeutic
response indicates the medication has achieved its clinical objective?
A) The client's abdominal girth decreases by 3 cm within 24 hours.
B) The client produces 2 to 3 soft, loose stools per day and experiences improved orientation.
C) The serum sodium level normalizes to 140 mEq/L.
D) The client's bilateral pitting pedal edema resolves to 0.
Answer: B
· Rationale: The explicit therapeutic goal of lactulose titration in hepatic encephalopathy is to induce 2 to 3
soft, loose stools per day while decreasing neurocognitive symptoms (resolving asterixis and lethargy). It is
not titrated to cause heavy watery diarrhea (which induces hypovolemia and electrolyte imbalances) or to
treat ascites/pedal edema (which are managed via diuretics and paracentesis).
[SELECT ALL THAT APPLY (SATA) BLOCK]
, 3. A nurse is planning care for a client who underwent an open cholecystectomy 12 hours ago. Which
interventions should the nurse include in the plan of care to minimize postoperative respiratory
complications? (Select all that apply.)
· A) Assist the client to ambulate as early as tolerated.
· B) Teach the client to perform incentive spirometry 10 times every hour while awake.
· C) Administer scheduled opioid analgesics continuously regardless of pain level to suppress coughing.
D) Instruct the client to splint the abdominal incision with a pillow when deep breathing and coughing.
E) Maintain the client in a strict flat supine position for the first 24 hours.
· Answers: A, B, D
· Rationale: Early ambulation (A), incentive spirometry (B), and incision splinting (D) all promote lung expansion,
maximize alveolar recruitment, and mobilize secretions to prevent atelectasis and pneumonia. Over-sedating
with opioids (C) suppresses the respiratory drive and the cough reflex, increasing the risk of respiratory failure.
A strict supine position (E) restricts diaphragmatic excursion; the head of the bed should be elevated to Semi-
Fowler's or Fowler's.
4. A nurse is conducting discharge teaching for a client newly diagnosed with type 1diabetes mellitus. Which
signs and symptoms of severe hypoglycemia should the nurse instruct the client and family to monitor for?
(Select all that apply.)
A) Diaphoresis and cool, clammy skin
B) Increased thirst and polyuria
C) Palpitations and tremors
D) Deep, rapid Kussmaul respirations
E) Acute confusion, slurred speech, or irritability
Answers: A, C, E
Rationale: Hypoglycemia triggers an autonomous sympathetic nervous system surge,presenting as sweating,
cold skin ((A), tachycardia/palpitations, and tremors (C). Central nervous system glucose deprivation causes
neuroglycopenic symptoms like confusion and slurred speech (E). Thirst, polyuria (B), and Kussmaul respirations
(D) are classic markers of profound hyperglycemia and diabetic ketoacidosis (DKA).
5. A nurse is reviewing infection control practices on an inpatient unit. Which clinical scenarios require
the implementation of contact precautions? (Select all that apply.)
· A) A client with a draining abdominal abscess testing positive for Methicillin-Resistant
Staphylococcus aureus (MRSA).
· B) A child admitted with a high fever and a maculopapular rash suspected to be rubeola (measles).
· C) An adult client with an active, foul-smelling liquid stool infection testing positive for Clostridium difficile.
· D) A pregnant client presenting with a disseminated vesicular rash from Varicella-Zoster.
· E) An elderly client with an unhealed pressure injury colonized with Vancomycin-Resistant Enterococcus
(VRE).
Answers: A, C, E
· Rationale: MRSA in a draining wound (A), C. difficile (C), and VRE (E) are highly transmissible via direct or
indirect surface contact, mandating contact precautions. Measles (B) requires
, airborne precautions. Varicella (D) requires a combination of both airborne and contact precautions;
selecting it purely under contact without recognizing its primary airborne status ignores the room negative-
pressure requirement.
6. A nurse is caring for an infant with a suspected diagnosis of congenital heart disease causing a right-to-
left shunt. Which clinical manifestations should the nurse expect to assess? (Select all that apply.)
A) Persistent cyanosis that does not improve significantly with oxygen therapy.
B) Clubbing of the fingers and toes over time.
C) High-pitched, bounding peripheral pulses in all limbs.
D) Polycythemia noted on a complete blood count.
E) Overt circumoral cyanosis during feedings or crying.
Answers: A, B, D, E
Rationale: Right-to-left cardiac shunts allow deoxygenated systemic venous blood to bypass the lungs and enter
systemic circulation directly, causing profound hypoxemia that shows up as cyanosis (A, E). Over time, chronic
tissue hypoxia leads to digital clubbing (B) and stimulates erythropoietin production, resulting in compensatory
polycythemia (D). Bounding pulses (C) are associated with a patent ductus arteriosus (left-to-right shunt), not
standard cyanotic shunting anomalies.
7. A client with severe preeclampsia is receiving an intravenous magnesium sulfate infusion for seizure
prophylaxis. Which assessment findings should alert the nurse to immediate magnesium toxicity? (Select
all that apply.)
A) Deep tendon reflexes scored at 0 or 1+
B) Respiratory rate of 9 breaths/min
C) Urinary output of 50 mL/hour
D) Sudden onset of clonus and hyperreflexia
E) Altered mental status or extreme lethargy
Answers: A, B, E
Rationale: Magnesium sulfate is a central nervous system depressant. Toxicity impairs neuromuscular
transmission, resulting in diminished or absent deep tendon reflexes (A),respiratory depression (B), and
somnolence/lethargy (E). A urinary output of 50 mL/hr (C) is safe (>30 mL/hr), though low output can lead to
toxicity. Clonus and hyperreflexia (D) signify an undertreated preeclamptic state, not magnesium toxicity.
[PRIORITIZATION & MANAGEMENT OF CARE BLOCK]
8. After receiving the morning handoff report, which client should the nurse assess first?
· A) A client with a deep vein thrombosis who is receiving a continuous heparin infusion and has an aPTT of 75
seconds.
·B) A client with pneumonia who has an oxygen saturation of 89% while using a 2 L/min nasal cannula.
