Next Generation NCLEX (NGN) Exam |
2025/2026 Edition | Verified Clinical Judgment
Questions & Answers | A+ Graded
Section 1: Introduction
This document features a curated and verified set of Next Generation NCLEX (NGN)
exam questions, reflecting the 2025/2026 NCSBN blueprint. It includes advanced
clinical judgment scenarios using NGN item types such as case studies, bowtie
questions, matrix/grid, cloze (drop-down), and multiple-response formats. Content
areas span across the nursing process, prioritization, delegation, safety,
pharmacology, patient education, and evidence-based interventions, designed to
evaluate decision-making skills under realistic clinical conditions. Each response is
100% correct and A+ graded, making this resource essential for NCLEX-RN and
NCLEX-PN candidates preparing under the NGN framework.
Section 2: Exam Questions and Answers
Format: NGN-style case scenarios and performance-based items
Correct answer highlighted
Rationales provided to reinforce NCSBN’s Clinical Judgment Measurement Model
(CJMM)
1. A patient presents with sudden chest pain, diaphoresis, and shortness of breath. Vital
signs: BP 160/90 mmHg, HR 110 bpm, RR 24/min, SpO2 92%. Which action should
the nurse take first?
(a) Administer oxygen via nasal cannula
(b) Obtain an electrocardiogram (ECG)
(c) Provide a nitroglycerin tablet
(d) Assess pain level using a scale
Rationale: Per CJMM, recognizing cues (chest pain, vital signs) prioritizes ECG to
identify potential myocardial infarction.
2. A patient is 2 hours post-appendectomy. Condition: Pain 7/10, temp 38.2°C, incision
site red. What is the priority nursing action (left side) and potential complication to
monitor (right side)?
(a) Administer analgesics | Infection
(b) Assess incision site | Wound infection
(c) Increase IV fluids | Hypothermia
(d) Encourage ambulation | Bleeding
Rationale: CJMM emphasizes assessing cues (redness, fever) to prioritize incision
evaluation.
3. Match the medication to its primary use:
(a) Furosemide | Diuretic
(b) Morphine | Pain management
(c) Warfarin | Anticoagulant
(d) Insulin | Blood glucose control
Rationale: CJMM supports analyzing medication purpose for safe administration.
,4. A 3-year-old with vomiting has dry mucous membranes and no tears. The nurse
should initiate ____ (a) IV fluids, (b) oral rehydration, (c) oxygen therapy, (d) IV
fluids.
Rationale: CJMM guides prioritizing IV fluids for severe dehydration.
5. Select all actions to prevent falls in an elderly patient with dementia:
(a) Keep bed in low position
(b) Ensure call bell within reach
(c) Use non-slip footwear
(d) Leave room lights off
Rationale: CJMM supports multiple fall prevention strategies.
6. A patient with DKA has blood glucose 450 mg/dL, pH 7.1, and Kussmaul
respirations. What is the nurse’s next action?
(a) Administer oral glucose
(b) Start IV insulin drip
(c) Encourage deep breathing
(d) Discontinue IV fluids
Rationale: CJMM prioritizes insulin for acidosis correction.
7. A patient 1 hour postpartum has soaked 2 pads and BP 90/60 mmHg. Priority action
(left side) and complication (right side)?
(a) Monitor vital signs | Infection
(b) Notify physician | Hemorrhagic shock
(c) Encourage ambulation | Clot formation
(d) Administer oxytocin | Uterine atony
Rationale: CJMM recognizes severe bleeding as urgent.
8. Match the task to the healthcare team member:
(a) Insert Foley catheter | Registered Nurse
(b) Take vital signs | Licensed Practical Nurse
(c) Administer IV medication | Registered Nurse
(d) Assist with bathing | Nursing Assistant
Rationale: CJMM aligns delegation with scope.
9. A patient with wheezing has SpO2 88%. The nurse should administer ____ (a)
nebulized albuterol, (b) IV antibiotics, (c) oral corticosteroids, (d) nebulized albuterol.
Rationale: CJMM prioritizes bronchodilation for airway relief.
10. Select all measures to prevent hospital-acquired infections:
(a) Hand hygiene
(b) Use of personal protective equipment
(c) Sharing needles
(d) Sterile technique
Rationale: CJMM emphasizes infection control measures.
11. A patient exhibits facial droop and slurred speech. Time since onset is 1 hour. What is
the nurse’s priority?
(a) Perform a full physical exam
(b) Activate stroke protocol
(c) Administer antipyretics
(d) Encourage oral fluids
Rationale: CJMM prioritizes rapid stroke response.
12. A patient is diaphoretic with a blood glucose of 50 mg/dL. Priority action (left side)
and complication (right side)?
(a) Administer IV fluids | Hyperglycemia
(b) Provide oral glucose | Seizure
, (c) Monitor vital signs | Dehydration
(d) Encourage ambulation | Coma
Rationale: CJMM corrects hypoglycemia to prevent seizures.
13. Match the topic to the patient condition:
(a) Diabetes management | Insulin administration
(b) Hypertension | Low-sodium diet
(c) Asthma | Peak flow monitoring
(d) Heart failure | Fluid restriction
Rationale: CJMM tailors education to needs.
14. A patient with a 20% TBSA burn has a heart rate of 120 bpm. The nurse should
prioritize ____ (a) wound dressing, (b) pain management, (c) fluid resuscitation, (d)
antibiotic therapy.
Rationale: CJMM prioritizes fluid for burn shock.
15. Select all actions to ensure medication safety:
(a) Verify patient identity
(b) Check for allergies
(c) Administer expired medication
(d) Document administration
Rationale: CJMM ensures multiple safety checks.
16. A patient with a fever of 39°C and WBC 18,000/mm³ requires intervention. What is
the nurse’s first action?
(a) Administer antipyretics
(b) Obtain blood cultures
(c) Increase oxygen flow
(d) Encourage fluids
Rationale: CJMM prioritizes infection identification.
17. A patient with cough and crackles has SpO2 90%. Priority action (left side) and
complication (right side)?
(a) Administer antibiotics | Respiratory failure
(b) Administer oxygen | Hypoxemia
(c) Encourage ambulation | Dehydration
(d) Monitor temperature | Sepsis
Rationale: CJMM addresses hypoxemia with oxygen.
18. Match the patient need to the priority level:
(a) Chest pain | High
(b) Fever | Low
(c) Difficulty breathing | High
(d) Routine dressing change | Low
Rationale: CJMM prioritizes life-threatening cues.
19. A patient with ST-elevation on ECG needs ____ (a) beta-blockers, (b) aspirin, (c)
diuretics, (d) anticoagulants.
Rationale: CJMM supports aspirin for MI.
20. Select all tasks a nurse can delegate to a nursing assistant:
(a) Assist with ambulation
(b) Measure vital signs
(c) Administer IV medications
(d) Provide hygiene care
Rationale: CJMM aligns with scope of practice.
21. A patient with hives and wheezing after penicillin reports difficulty breathing. What is
the nurse’s priority?
2025/2026 Edition | Verified Clinical Judgment
Questions & Answers | A+ Graded
Section 1: Introduction
This document features a curated and verified set of Next Generation NCLEX (NGN)
exam questions, reflecting the 2025/2026 NCSBN blueprint. It includes advanced
clinical judgment scenarios using NGN item types such as case studies, bowtie
questions, matrix/grid, cloze (drop-down), and multiple-response formats. Content
areas span across the nursing process, prioritization, delegation, safety,
pharmacology, patient education, and evidence-based interventions, designed to
evaluate decision-making skills under realistic clinical conditions. Each response is
100% correct and A+ graded, making this resource essential for NCLEX-RN and
NCLEX-PN candidates preparing under the NGN framework.
Section 2: Exam Questions and Answers
Format: NGN-style case scenarios and performance-based items
Correct answer highlighted
Rationales provided to reinforce NCSBN’s Clinical Judgment Measurement Model
(CJMM)
1. A patient presents with sudden chest pain, diaphoresis, and shortness of breath. Vital
signs: BP 160/90 mmHg, HR 110 bpm, RR 24/min, SpO2 92%. Which action should
the nurse take first?
(a) Administer oxygen via nasal cannula
(b) Obtain an electrocardiogram (ECG)
(c) Provide a nitroglycerin tablet
(d) Assess pain level using a scale
Rationale: Per CJMM, recognizing cues (chest pain, vital signs) prioritizes ECG to
identify potential myocardial infarction.
2. A patient is 2 hours post-appendectomy. Condition: Pain 7/10, temp 38.2°C, incision
site red. What is the priority nursing action (left side) and potential complication to
monitor (right side)?
(a) Administer analgesics | Infection
(b) Assess incision site | Wound infection
(c) Increase IV fluids | Hypothermia
(d) Encourage ambulation | Bleeding
Rationale: CJMM emphasizes assessing cues (redness, fever) to prioritize incision
evaluation.
3. Match the medication to its primary use:
(a) Furosemide | Diuretic
(b) Morphine | Pain management
(c) Warfarin | Anticoagulant
(d) Insulin | Blood glucose control
Rationale: CJMM supports analyzing medication purpose for safe administration.
,4. A 3-year-old with vomiting has dry mucous membranes and no tears. The nurse
should initiate ____ (a) IV fluids, (b) oral rehydration, (c) oxygen therapy, (d) IV
fluids.
Rationale: CJMM guides prioritizing IV fluids for severe dehydration.
5. Select all actions to prevent falls in an elderly patient with dementia:
(a) Keep bed in low position
(b) Ensure call bell within reach
(c) Use non-slip footwear
(d) Leave room lights off
Rationale: CJMM supports multiple fall prevention strategies.
6. A patient with DKA has blood glucose 450 mg/dL, pH 7.1, and Kussmaul
respirations. What is the nurse’s next action?
(a) Administer oral glucose
(b) Start IV insulin drip
(c) Encourage deep breathing
(d) Discontinue IV fluids
Rationale: CJMM prioritizes insulin for acidosis correction.
7. A patient 1 hour postpartum has soaked 2 pads and BP 90/60 mmHg. Priority action
(left side) and complication (right side)?
(a) Monitor vital signs | Infection
(b) Notify physician | Hemorrhagic shock
(c) Encourage ambulation | Clot formation
(d) Administer oxytocin | Uterine atony
Rationale: CJMM recognizes severe bleeding as urgent.
8. Match the task to the healthcare team member:
(a) Insert Foley catheter | Registered Nurse
(b) Take vital signs | Licensed Practical Nurse
(c) Administer IV medication | Registered Nurse
(d) Assist with bathing | Nursing Assistant
Rationale: CJMM aligns delegation with scope.
9. A patient with wheezing has SpO2 88%. The nurse should administer ____ (a)
nebulized albuterol, (b) IV antibiotics, (c) oral corticosteroids, (d) nebulized albuterol.
Rationale: CJMM prioritizes bronchodilation for airway relief.
10. Select all measures to prevent hospital-acquired infections:
(a) Hand hygiene
(b) Use of personal protective equipment
(c) Sharing needles
(d) Sterile technique
Rationale: CJMM emphasizes infection control measures.
11. A patient exhibits facial droop and slurred speech. Time since onset is 1 hour. What is
the nurse’s priority?
(a) Perform a full physical exam
(b) Activate stroke protocol
(c) Administer antipyretics
(d) Encourage oral fluids
Rationale: CJMM prioritizes rapid stroke response.
12. A patient is diaphoretic with a blood glucose of 50 mg/dL. Priority action (left side)
and complication (right side)?
(a) Administer IV fluids | Hyperglycemia
(b) Provide oral glucose | Seizure
, (c) Monitor vital signs | Dehydration
(d) Encourage ambulation | Coma
Rationale: CJMM corrects hypoglycemia to prevent seizures.
13. Match the topic to the patient condition:
(a) Diabetes management | Insulin administration
(b) Hypertension | Low-sodium diet
(c) Asthma | Peak flow monitoring
(d) Heart failure | Fluid restriction
Rationale: CJMM tailors education to needs.
14. A patient with a 20% TBSA burn has a heart rate of 120 bpm. The nurse should
prioritize ____ (a) wound dressing, (b) pain management, (c) fluid resuscitation, (d)
antibiotic therapy.
Rationale: CJMM prioritizes fluid for burn shock.
15. Select all actions to ensure medication safety:
(a) Verify patient identity
(b) Check for allergies
(c) Administer expired medication
(d) Document administration
Rationale: CJMM ensures multiple safety checks.
16. A patient with a fever of 39°C and WBC 18,000/mm³ requires intervention. What is
the nurse’s first action?
(a) Administer antipyretics
(b) Obtain blood cultures
(c) Increase oxygen flow
(d) Encourage fluids
Rationale: CJMM prioritizes infection identification.
17. A patient with cough and crackles has SpO2 90%. Priority action (left side) and
complication (right side)?
(a) Administer antibiotics | Respiratory failure
(b) Administer oxygen | Hypoxemia
(c) Encourage ambulation | Dehydration
(d) Monitor temperature | Sepsis
Rationale: CJMM addresses hypoxemia with oxygen.
18. Match the patient need to the priority level:
(a) Chest pain | High
(b) Fever | Low
(c) Difficulty breathing | High
(d) Routine dressing change | Low
Rationale: CJMM prioritizes life-threatening cues.
19. A patient with ST-elevation on ECG needs ____ (a) beta-blockers, (b) aspirin, (c)
diuretics, (d) anticoagulants.
Rationale: CJMM supports aspirin for MI.
20. Select all tasks a nurse can delegate to a nursing assistant:
(a) Assist with ambulation
(b) Measure vital signs
(c) Administer IV medications
(d) Provide hygiene care
Rationale: CJMM aligns with scope of practice.
21. A patient with hives and wheezing after penicillin reports difficulty breathing. What is
the nurse’s priority?
