NCLEX-PN Exam Comprehensive | NCLEX-PN Comprehensive Exam
Study Guide & Exam Prep 2026–2027 | Next Generation NCLEX-PN
(NGN) Review for LPN/LVN Candidates | Safe & Effective Care
Environment, Health Promotion & Maintenance, Psychosocial
Integrity, Basic Care & Comfort, Pharmacological & Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation,
Clinical Judgment, Prioritization, Delegation, Patient Safety &
Infection Control | Practice Questions, NGN Case Studies & Detailed
Rationales
Question 1: A nurse is assessing a client who has just been admitted with a
diagnosis of major depressive disorder. Which of the following findings should
the nurse expect to observe?
A. Increased energy and psychomotor agitation
B. Anhedonia and psychomotor retardation
C. Grandiose delusions and rapid speech
D. Flight of ideas and decreased need for sleep
CORRECT ANSWER: B. Anhedonia and psychomotor retardation
Rationale: Major depressive disorder is characterized by a persistent low mood
and a loss of interest or pleasure in previously enjoyed activities (anhedonia).
Psychomotor retardation, which includes slowed speech, thinking, and physical
movement, is a common behavioral manifestation. Options A, C, and D are more
characteristic of manic or hypomanic episodes.
Question 2: A nurse is caring for a client who is prescribed lithium carbonate.
Which of the following client statements indicates a need for further teaching?
A. "I should maintain a consistent salt intake in my diet."
B. "I will take this medication with food to avoid stomach upset."
C. "I need to drink at least 2 to 3 liters of fluids each day."
D. "If I miss a dose, I should double the next dose to catch up."
CORRECT ANSWER: D. "If I miss a dose, I should double the next dose to catch
up."
,Rationale: Clients taking lithium should never double a dose if one is missed, as
this can lead to toxicity. They should take the missed dose as soon as
remembered, unless it is close to the time for the next dose, in which case the
missed dose should be skipped. Maintaining consistent sodium and fluid intake is
crucial for lithium therapy.
Question 3: A nurse is performing a focused assessment on a client who has a
history of heart failure. Which of the following findings is the earliest indicator
of fluid volume excess?
A. Pitting edema in the lower extremities
B. A weight gain of 2 pounds in 24 hours
C. Bibasilar crackles upon auscultation
D. Distended neck veins when sitting upright
CORRECT ANSWER: B. A weight gain of 2 pounds in 24 hours
Rationale: A rapid weight gain, such as 2 to 3 pounds in 24 hours or 5 pounds in a
week, is the earliest and most sensitive indicator of fluid retention in a client with
heart failure. Edema, crackles, and distended neck veins are later signs of
significant fluid volume excess.
Question 4: A nurse is teaching a client about the use of a peak flow meter.
Which of the following instructions should the nurse include?
A. "Use the meter immediately after taking your bronchodilator inhaler."
B. "Stand or sit upright and take a deep breath before blowing into the meter."
C. "Blow into the meter as slowly and gently as possible."
D. "You only need to use the meter when you are experiencing asthma
symptoms."
CORRECT ANSWER: B. "Stand or sit upright and take a deep breath before
blowing into the meter."
Rationale: To use a peak flow meter correctly, the client should stand or sit
upright, take as deep a breath as possible, and then blow out as hard and as fast
as they can. It is used to monitor asthma control, not just during symptoms, and is
typically used before taking a bronchodilator to establish a baseline.
,Question 5: A nurse is preparing to administer digoxin to an adult client. Which
of the following findings should the nurse identify as a contraindication to
administering the medication?
A. A heart rate of 58 beats per minute
B. A serum potassium level of 4.0 mEq/L
C. A serum digoxin level of 1.5 ng/mL
D. A blood pressure of 110/70 mm Hg
CORRECT ANSWER: A. A heart rate of 58 beats per minute
Rationale: Digoxin slows the heart rate. The nurse should withhold the medication
and notify the provider if the adult client's apical pulse is less than 60 beats per
minute. A serum digoxin level of 1.5 ng/mL is within the therapeutic range (0.5 to
2.0 ng/mL).
Question 6: A nurse is assessing a client who is at 32 weeks of gestation. The
client reports a sudden gush of fluid from her vagina. Which of the following
actions should the nurse take first?
A. Perform a sterile vaginal examination.
B. Assess the fetal heart rate.
C. Check the client's temperature.
D. Obtain a sample of the fluid for testing.
CORRECT ANSWER: B. Assess the fetal heart rate.
Rationale: When a client reports a gush of fluid, the priority is to assess the fetal
status. Rupture of membranes can lead to cord prolapse, which is an emergency.
Therefore, the nurse's first action should be to assess the fetal heart rate for signs
of distress.
Question 7: A nurse is providing teaching to a client who has a new prescription
for warfarin. Which of the following foods should the nurse instruct the client to
maintain a consistent intake of?
A. Bananas
B. Leafy green vegetables
C. Dairy products
D. Citrus fruits
, CORRECT ANSWER: B. Leafy green vegetables
Rationale: Leafy green vegetables are high in vitamin K, which is the antidote for
warfarin. Clients should maintain a consistent daily intake of vitamin K rather than
eliminating it, as fluctuating intake can alter the medication's effect (INR levels).
Question 8: A nurse is caring for a client who is postoperative following a total
hip arthroplasty. Which of the following actions should the nurse take to
prevent dislocation of the new hip?
A. Place a pillow between the client's legs when turning.
B. Keep the client's hip flexed greater than 90 degrees.
C. Encourage the client to cross their legs when sitting.
D. Position the client on the operative side immediately after surgery.
CORRECT ANSWER: A. Place a pillow between the client's legs when turning.
Rationale: To prevent dislocation of a new hip prosthesis, the nurse should use an
abduction pillow or regular pillow between the legs to keep the hips in abduction
and prevent adduction (crossing the midline). The hip should not be flexed more
than 90 degrees.
Question 9: A nurse is evaluating a client's understanding of a low-sodium diet.
Which of the following food choices by the client indicates a correct
understanding of the teaching?
A. Canned vegetable soup
B. A fresh apple
C. Processed cheese slices
D. A frozen TV dinner
CORRECT ANSWER: B. A fresh apple
Rationale: Fresh fruits, such as an apple, are naturally low in sodium. Canned
soups, processed cheeses, and frozen prepared meals are typically high in sodium
and should be avoided on a low-sodium diet.
Question 10: A nurse is assessing a client who is experiencing acute alcohol
withdrawal. Which of the following findings should the nurse expect?
Study Guide & Exam Prep 2026–2027 | Next Generation NCLEX-PN
(NGN) Review for LPN/LVN Candidates | Safe & Effective Care
Environment, Health Promotion & Maintenance, Psychosocial
Integrity, Basic Care & Comfort, Pharmacological & Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation,
Clinical Judgment, Prioritization, Delegation, Patient Safety &
Infection Control | Practice Questions, NGN Case Studies & Detailed
Rationales
Question 1: A nurse is assessing a client who has just been admitted with a
diagnosis of major depressive disorder. Which of the following findings should
the nurse expect to observe?
A. Increased energy and psychomotor agitation
B. Anhedonia and psychomotor retardation
C. Grandiose delusions and rapid speech
D. Flight of ideas and decreased need for sleep
CORRECT ANSWER: B. Anhedonia and psychomotor retardation
Rationale: Major depressive disorder is characterized by a persistent low mood
and a loss of interest or pleasure in previously enjoyed activities (anhedonia).
Psychomotor retardation, which includes slowed speech, thinking, and physical
movement, is a common behavioral manifestation. Options A, C, and D are more
characteristic of manic or hypomanic episodes.
Question 2: A nurse is caring for a client who is prescribed lithium carbonate.
Which of the following client statements indicates a need for further teaching?
A. "I should maintain a consistent salt intake in my diet."
B. "I will take this medication with food to avoid stomach upset."
C. "I need to drink at least 2 to 3 liters of fluids each day."
D. "If I miss a dose, I should double the next dose to catch up."
CORRECT ANSWER: D. "If I miss a dose, I should double the next dose to catch
up."
,Rationale: Clients taking lithium should never double a dose if one is missed, as
this can lead to toxicity. They should take the missed dose as soon as
remembered, unless it is close to the time for the next dose, in which case the
missed dose should be skipped. Maintaining consistent sodium and fluid intake is
crucial for lithium therapy.
Question 3: A nurse is performing a focused assessment on a client who has a
history of heart failure. Which of the following findings is the earliest indicator
of fluid volume excess?
A. Pitting edema in the lower extremities
B. A weight gain of 2 pounds in 24 hours
C. Bibasilar crackles upon auscultation
D. Distended neck veins when sitting upright
CORRECT ANSWER: B. A weight gain of 2 pounds in 24 hours
Rationale: A rapid weight gain, such as 2 to 3 pounds in 24 hours or 5 pounds in a
week, is the earliest and most sensitive indicator of fluid retention in a client with
heart failure. Edema, crackles, and distended neck veins are later signs of
significant fluid volume excess.
Question 4: A nurse is teaching a client about the use of a peak flow meter.
Which of the following instructions should the nurse include?
A. "Use the meter immediately after taking your bronchodilator inhaler."
B. "Stand or sit upright and take a deep breath before blowing into the meter."
C. "Blow into the meter as slowly and gently as possible."
D. "You only need to use the meter when you are experiencing asthma
symptoms."
CORRECT ANSWER: B. "Stand or sit upright and take a deep breath before
blowing into the meter."
Rationale: To use a peak flow meter correctly, the client should stand or sit
upright, take as deep a breath as possible, and then blow out as hard and as fast
as they can. It is used to monitor asthma control, not just during symptoms, and is
typically used before taking a bronchodilator to establish a baseline.
,Question 5: A nurse is preparing to administer digoxin to an adult client. Which
of the following findings should the nurse identify as a contraindication to
administering the medication?
A. A heart rate of 58 beats per minute
B. A serum potassium level of 4.0 mEq/L
C. A serum digoxin level of 1.5 ng/mL
D. A blood pressure of 110/70 mm Hg
CORRECT ANSWER: A. A heart rate of 58 beats per minute
Rationale: Digoxin slows the heart rate. The nurse should withhold the medication
and notify the provider if the adult client's apical pulse is less than 60 beats per
minute. A serum digoxin level of 1.5 ng/mL is within the therapeutic range (0.5 to
2.0 ng/mL).
Question 6: A nurse is assessing a client who is at 32 weeks of gestation. The
client reports a sudden gush of fluid from her vagina. Which of the following
actions should the nurse take first?
A. Perform a sterile vaginal examination.
B. Assess the fetal heart rate.
C. Check the client's temperature.
D. Obtain a sample of the fluid for testing.
CORRECT ANSWER: B. Assess the fetal heart rate.
Rationale: When a client reports a gush of fluid, the priority is to assess the fetal
status. Rupture of membranes can lead to cord prolapse, which is an emergency.
Therefore, the nurse's first action should be to assess the fetal heart rate for signs
of distress.
Question 7: A nurse is providing teaching to a client who has a new prescription
for warfarin. Which of the following foods should the nurse instruct the client to
maintain a consistent intake of?
A. Bananas
B. Leafy green vegetables
C. Dairy products
D. Citrus fruits
, CORRECT ANSWER: B. Leafy green vegetables
Rationale: Leafy green vegetables are high in vitamin K, which is the antidote for
warfarin. Clients should maintain a consistent daily intake of vitamin K rather than
eliminating it, as fluctuating intake can alter the medication's effect (INR levels).
Question 8: A nurse is caring for a client who is postoperative following a total
hip arthroplasty. Which of the following actions should the nurse take to
prevent dislocation of the new hip?
A. Place a pillow between the client's legs when turning.
B. Keep the client's hip flexed greater than 90 degrees.
C. Encourage the client to cross their legs when sitting.
D. Position the client on the operative side immediately after surgery.
CORRECT ANSWER: A. Place a pillow between the client's legs when turning.
Rationale: To prevent dislocation of a new hip prosthesis, the nurse should use an
abduction pillow or regular pillow between the legs to keep the hips in abduction
and prevent adduction (crossing the midline). The hip should not be flexed more
than 90 degrees.
Question 9: A nurse is evaluating a client's understanding of a low-sodium diet.
Which of the following food choices by the client indicates a correct
understanding of the teaching?
A. Canned vegetable soup
B. A fresh apple
C. Processed cheese slices
D. A frozen TV dinner
CORRECT ANSWER: B. A fresh apple
Rationale: Fresh fruits, such as an apple, are naturally low in sodium. Canned
soups, processed cheeses, and frozen prepared meals are typically high in sodium
and should be avoided on a low-sodium diet.
Question 10: A nurse is assessing a client who is experiencing acute alcohol
withdrawal. Which of the following findings should the nurse expect?
