NURS_102: NCLEX-PN NGN Practice Exam 2026/2027 Next-
Generation Edition Detailed Rationales and Verified Answers
Course Code: NURS_102
Course Name: NCLEX-PN Next-Generation Nursing
Topic: Practical Nursing Clinical Judgment, High-Probability Core
Concepts, and Detailed Rationales
Academic Year: 2026/2027
1. A licensed practical nurse (LPN) is monitoring a client who is post-op day 1
following a total thyroidectomy. The client reports a "tingling" sensation
around their mouth and fingers. Which of the following is the correct
answer or most critical physiological assessment the nurse should perform
immediately?
A. Assess the surgical dressing for active hemorrhage.
B. Check the client’s peripheral capillary refill time.
C. Tap the facial nerve just below the temple to check for Chvostek's
sign.
D. Auscultate the bilateral lung fields for adventitious sounds.
CORRECT ANSWER: C. Tap the facial nerve just below the temple to
check for Chvostek's sign.
RATIONALE: Numbness and a tingling sensation around the mouth
(circumoral paresthesia) and fingers are classic early signs of acute
hypocalcemia. Hypocalcemia is a high-probability complication post-
thyroidectomy resulting from accidental trauma or removal of the
parathyroid glands. Tapping the facial nerve checks for Chvostek's sign
(facial muscle twitching), which confirms neuromuscular irritability.
Hemorrhage is also a post-op risk, but dressing checks do not address the
neuro-chemical deficit causing paresthesia. Capillary refill and lung sounds
are not specific to hypocalcemia evaluation.
2. A nurse is reinforcing teaching with a client who has been diagnosed with
chronic open-angle glaucoma and has a new prescription for timolol
ophthalmic drops. Which administrative technique represents the correct
answer to prevent systemic absorption of this beta-blocker?
A. Blink rapidly for 30 seconds immediately after drop instillation.
, B. Apply gentle pressure to the inner canthus for 1 to 2 minutes after
administering the drops.
C. Rub the eyelids firmly with a clean tissue to spread the fluid.
D. Keep the eyes tightly closed for a minimum of 10 minutes.
CORRECT ANSWER: B. Apply gentle pressure to the inner canthus for
1 to 2 minutes after administering the drops.
RATIONALE: Timolol is a non-selective beta-adrenergic blocker
applied topically to lower intraocular pressure. Systemic absorption via the
nasolacrimal duct and nasal mucosa can lead to adverse cardiovascular or
respiratory systemic reactions (e.g., bradycardia, bronchospasm). Applying
pressure to the inner canthus (nasolacrimal occlusion) minimizes this risk.
Blinking rapidly, rubbing the eyes, or closing them too tightly can push the
medication out or accelerate unintended structural absorption pathways.
3. An LPN is caring for an older adult client who has been admitted with a
diagnosis of a urinary tract infection (UTI). Which presentation represents
the correct answer as a highly common, atypical manifestation of infection
in a geriatric patient?
A. Acute confusion, altered mental status, and a sudden history of falls.
B. High-grade fever, severe dysuria, and intense flank pain.
C. Massive generalized pitting edema and bounding pulses.
D. Severe projectile vomiting and a rigid, board-like abdomen.
CORRECT ANSWER: A. Acute confusion, altered mental status, and a
sudden history of falls.
RATIONALE: Older adults frequently lack the classic signs of an
infection, such as fever or localized pain. In a geriatric client, a urinary
tract infection (UTI) often manifests atypically as acute confusion
(delirium), lethargy, anorexia, new-onset urinary incontinence, or a
sudden history of falls due to central nervous system sensitivity to systemic
inflammation. Edema points to heart or renal failure. Projectile vomiting
indicates intracranial pressure shifts or severe GI obstruction.
4. A nurse is monitoring a client with severe preeclampsia who is receiving a
continuous intravenous infusion of magnesium sulfate. The nurse notes a
respiratory rate of 10 breaths/min, absent deep tendon reflexes, and a total
urine output of 15 mL over the past hour. Which action represents the
, correct answer or immediate nursing intervention?
A. Place the client in a high-Fowler's position.
B. Increase the infusion rate of the primary maintenance IV fluids.
C. Stop the magnesium sulfate infusion immediately and prepare to
administer calcium gluconate.
D. Administer a prescribed subcutaneous dose of terbutaline.
CORRECT ANSWER: C. Stop the magnesium sulfate infusion
immediately and prepare to administer calcium gluconate.
RATIONALE: A respiratory rate under 12 breaths/min, loss of deep
tendon reflexes, and severe oliguria (urine output <30 mL/hr) are standard
markers of magnesium sulfate toxicity. The immediate clinical safety
action is to turn off the magnesium infusion to prevent respiratory arrest
and prepare to administer the specific antidote, calcium gluconate. High-
Fowler's position does not reverse toxicity. Terbutaline is a tocolytic used to
delay labor, not an antidote for magnesium.
5. A nurse is reviewing lab results for a client with chronic kidney disease.
The client’s serum potassium level is 6.5 mEq/L and the ECG displays
peaked T waves. Which medication should the nurse anticipate
administering first to protect the myocardium?
A. Intravenous calcium gluconate
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide injection
D. Subcutaneous insulin detemir
CORRECT ANSWER: A. Intravenous calcium gluconate
RATIONALE: Severe hyperkalemia with corresponding ECG
alterations (peaked T waves) requires immediate intervention to avert fatal
ventricular fibrillation. Intravenous calcium gluconate serves as a
myocardial membrane stabilizer; it rapidly raises the cardiac threshold
potential, protecting the heart from conduction blocks without lowering the
potassium level itself. Sodium polystyrene sulfonate, furosemide, and
regular insulin (with dextrose) lower potassium, but they take longer to act.
Detemir is a long-acting insulin and is completely ineffective for acute
hyperkalemic shifts
, 6. A nurse is assigned to care for a client who is 2 hours post-op following a
cardiac catheterization via the right femoral artery. Which assessment
finding is the correct answer or requires immediate notification to the
charge nurse?
A. The client reports mild discomfort at the insertion site.
B. A palpable, expanding mass is noted at the right groin, and the right
dorsalis pedis pulse is diminished.
C. The client's capillary refill time on the left great toe is 2 seconds.
D. The client's systemic blood pressure is 118/76 mm Hg.
CORRECT ANSWER: B. A palpable, expanding mass is noted at the right
groin, and the right dorsalis pedis pulse is diminished.
RATIONALE: An expanding mass at the arterial access site indicates a
hematoma or pseudoaneurysm, signaling active bleeding from the femoral
puncture. The compression of the surrounding tissues or loss of blood flow
explains the diminished distal pedal pulse. This is a life-threatening perfusion
crisis. Mild localized discomfort is expected, and a normal blood pressure or
capillary refill on the opposite foot does not clear the emergency.
7. A nurse is caring for a client diagnosed with heart failure who is prescribed
daily furosemide. Which laboratory parameter represents the correct
answer as a critical adverse finding that must be monitored to prevent
digitalis toxicity?
A. Serum sodium level of 138 mEq/L
B. Serum calcium level of 9.2 mg/dL
C. Serum potassium level of 3.1 mEq/L
D. Fasting blood glucose level of 110 mg/dL
CORRECT ANSWER: C. Serum potassium level of 3.1 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes the renal excretion
of potassium, placing the client at high risk for hypokalemia (potassium <3.5
mEq/L). Hypokalemia significantly increases the risk of myocardial sensitivity and
subsequent digitalis toxicity if the client is also receiving digoxin. The sodium,
calcium, and glucose levels listed are within normal or stable limits.
8. A nurse is collecting data from a client at 36 weeks of gestation during a
routine prenatal visit. The client’s blood pressure is 154/98 mm Hg and a
dipstick urinalysis reveals 2+ proteinuria. The client denies any visual
Generation Edition Detailed Rationales and Verified Answers
Course Code: NURS_102
Course Name: NCLEX-PN Next-Generation Nursing
Topic: Practical Nursing Clinical Judgment, High-Probability Core
Concepts, and Detailed Rationales
Academic Year: 2026/2027
1. A licensed practical nurse (LPN) is monitoring a client who is post-op day 1
following a total thyroidectomy. The client reports a "tingling" sensation
around their mouth and fingers. Which of the following is the correct
answer or most critical physiological assessment the nurse should perform
immediately?
A. Assess the surgical dressing for active hemorrhage.
B. Check the client’s peripheral capillary refill time.
C. Tap the facial nerve just below the temple to check for Chvostek's
sign.
D. Auscultate the bilateral lung fields for adventitious sounds.
CORRECT ANSWER: C. Tap the facial nerve just below the temple to
check for Chvostek's sign.
RATIONALE: Numbness and a tingling sensation around the mouth
(circumoral paresthesia) and fingers are classic early signs of acute
hypocalcemia. Hypocalcemia is a high-probability complication post-
thyroidectomy resulting from accidental trauma or removal of the
parathyroid glands. Tapping the facial nerve checks for Chvostek's sign
(facial muscle twitching), which confirms neuromuscular irritability.
Hemorrhage is also a post-op risk, but dressing checks do not address the
neuro-chemical deficit causing paresthesia. Capillary refill and lung sounds
are not specific to hypocalcemia evaluation.
2. A nurse is reinforcing teaching with a client who has been diagnosed with
chronic open-angle glaucoma and has a new prescription for timolol
ophthalmic drops. Which administrative technique represents the correct
answer to prevent systemic absorption of this beta-blocker?
A. Blink rapidly for 30 seconds immediately after drop instillation.
, B. Apply gentle pressure to the inner canthus for 1 to 2 minutes after
administering the drops.
C. Rub the eyelids firmly with a clean tissue to spread the fluid.
D. Keep the eyes tightly closed for a minimum of 10 minutes.
CORRECT ANSWER: B. Apply gentle pressure to the inner canthus for
1 to 2 minutes after administering the drops.
RATIONALE: Timolol is a non-selective beta-adrenergic blocker
applied topically to lower intraocular pressure. Systemic absorption via the
nasolacrimal duct and nasal mucosa can lead to adverse cardiovascular or
respiratory systemic reactions (e.g., bradycardia, bronchospasm). Applying
pressure to the inner canthus (nasolacrimal occlusion) minimizes this risk.
Blinking rapidly, rubbing the eyes, or closing them too tightly can push the
medication out or accelerate unintended structural absorption pathways.
3. An LPN is caring for an older adult client who has been admitted with a
diagnosis of a urinary tract infection (UTI). Which presentation represents
the correct answer as a highly common, atypical manifestation of infection
in a geriatric patient?
A. Acute confusion, altered mental status, and a sudden history of falls.
B. High-grade fever, severe dysuria, and intense flank pain.
C. Massive generalized pitting edema and bounding pulses.
D. Severe projectile vomiting and a rigid, board-like abdomen.
CORRECT ANSWER: A. Acute confusion, altered mental status, and a
sudden history of falls.
RATIONALE: Older adults frequently lack the classic signs of an
infection, such as fever or localized pain. In a geriatric client, a urinary
tract infection (UTI) often manifests atypically as acute confusion
(delirium), lethargy, anorexia, new-onset urinary incontinence, or a
sudden history of falls due to central nervous system sensitivity to systemic
inflammation. Edema points to heart or renal failure. Projectile vomiting
indicates intracranial pressure shifts or severe GI obstruction.
4. A nurse is monitoring a client with severe preeclampsia who is receiving a
continuous intravenous infusion of magnesium sulfate. The nurse notes a
respiratory rate of 10 breaths/min, absent deep tendon reflexes, and a total
urine output of 15 mL over the past hour. Which action represents the
, correct answer or immediate nursing intervention?
A. Place the client in a high-Fowler's position.
B. Increase the infusion rate of the primary maintenance IV fluids.
C. Stop the magnesium sulfate infusion immediately and prepare to
administer calcium gluconate.
D. Administer a prescribed subcutaneous dose of terbutaline.
CORRECT ANSWER: C. Stop the magnesium sulfate infusion
immediately and prepare to administer calcium gluconate.
RATIONALE: A respiratory rate under 12 breaths/min, loss of deep
tendon reflexes, and severe oliguria (urine output <30 mL/hr) are standard
markers of magnesium sulfate toxicity. The immediate clinical safety
action is to turn off the magnesium infusion to prevent respiratory arrest
and prepare to administer the specific antidote, calcium gluconate. High-
Fowler's position does not reverse toxicity. Terbutaline is a tocolytic used to
delay labor, not an antidote for magnesium.
5. A nurse is reviewing lab results for a client with chronic kidney disease.
The client’s serum potassium level is 6.5 mEq/L and the ECG displays
peaked T waves. Which medication should the nurse anticipate
administering first to protect the myocardium?
A. Intravenous calcium gluconate
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide injection
D. Subcutaneous insulin detemir
CORRECT ANSWER: A. Intravenous calcium gluconate
RATIONALE: Severe hyperkalemia with corresponding ECG
alterations (peaked T waves) requires immediate intervention to avert fatal
ventricular fibrillation. Intravenous calcium gluconate serves as a
myocardial membrane stabilizer; it rapidly raises the cardiac threshold
potential, protecting the heart from conduction blocks without lowering the
potassium level itself. Sodium polystyrene sulfonate, furosemide, and
regular insulin (with dextrose) lower potassium, but they take longer to act.
Detemir is a long-acting insulin and is completely ineffective for acute
hyperkalemic shifts
, 6. A nurse is assigned to care for a client who is 2 hours post-op following a
cardiac catheterization via the right femoral artery. Which assessment
finding is the correct answer or requires immediate notification to the
charge nurse?
A. The client reports mild discomfort at the insertion site.
B. A palpable, expanding mass is noted at the right groin, and the right
dorsalis pedis pulse is diminished.
C. The client's capillary refill time on the left great toe is 2 seconds.
D. The client's systemic blood pressure is 118/76 mm Hg.
CORRECT ANSWER: B. A palpable, expanding mass is noted at the right
groin, and the right dorsalis pedis pulse is diminished.
RATIONALE: An expanding mass at the arterial access site indicates a
hematoma or pseudoaneurysm, signaling active bleeding from the femoral
puncture. The compression of the surrounding tissues or loss of blood flow
explains the diminished distal pedal pulse. This is a life-threatening perfusion
crisis. Mild localized discomfort is expected, and a normal blood pressure or
capillary refill on the opposite foot does not clear the emergency.
7. A nurse is caring for a client diagnosed with heart failure who is prescribed
daily furosemide. Which laboratory parameter represents the correct
answer as a critical adverse finding that must be monitored to prevent
digitalis toxicity?
A. Serum sodium level of 138 mEq/L
B. Serum calcium level of 9.2 mg/dL
C. Serum potassium level of 3.1 mEq/L
D. Fasting blood glucose level of 110 mg/dL
CORRECT ANSWER: C. Serum potassium level of 3.1 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes the renal excretion
of potassium, placing the client at high risk for hypokalemia (potassium <3.5
mEq/L). Hypokalemia significantly increases the risk of myocardial sensitivity and
subsequent digitalis toxicity if the client is also receiving digoxin. The sodium,
calcium, and glucose levels listed are within normal or stable limits.
8. A nurse is collecting data from a client at 36 weeks of gestation during a
routine prenatal visit. The client’s blood pressure is 154/98 mm Hg and a
dipstick urinalysis reveals 2+ proteinuria. The client denies any visual
