New Generation NCLEX-PN Study Topics –
2025–2026 Review Guide Focus: Clinical
judgment, prioritization, NGN case studies,
unfolding scenarios, and safe nursing practice.
Section 1: Clinical Judgment & Prioritization (Fundamentals)
1. The nurse is caring for a client who is 24 hours post-op from an abdominal surgery. The
client's blood pressure is 90/50 mm Hg, heart rate is 130 bpm, and respiratory rate is 24/min.
The skin is cool and clammy. What is the nurse's priority action?
A. Administer prescribed pain medication.
B. Elevate the head of the bed.
C. Increase the IV fluid rate as prescribed. ✓
D. Notify the surgeon of the vital signs.
2. A client with heart failure reports shortness of breath and waking up breathless at night.
Which finding requires the most immediate intervention?
A. 2+ pitting edema in the ankles.
B. Weight gain of 1 kg (2.2 lbs) in one day.
C. Oxygen saturation of 88% on room air. ✓
D. Crackles heard in the lung bases.
3. The nurse is preparing to administer medications. Which client should the nurse assess
first?
A. A client with diabetes who has a blood glucose of 180 mg/dL.
B. A client on a diuretic who has a potassium level of 3.2 mEq/L. ✓
C. A client with hypertension whose BP is 150/88 mm Hg.
D. A client with pain who rates it as 7/10.
4. Which action by a new graduate LPN/LVN requires the supervising RN to intervene
immediately?
A. Administering insulin 30 minutes before a meal.
B. Auscultating lung sounds before administering a bronchodilator.
C. Crushing extended-release nifedipine to administer via a feeding tube. ✓
D. Checking a client's allergy status before giving a new antibiotic.
,5. A client with a closed head injury has a Glasgow Coma Scale score that has decreased from
15 to 10 over the last hour. What is the nurse's most appropriate first action?
A. Suction the client's airway.
B. Stimulate the client to stay awake.
C. Notify the primary care provider immediately. ✓
D. Administer prescribed morphine for headache.
6. The nurse is caring for a client with a nasogastric tube set to low intermittent suction. The
client complains of nausea and the nurse notes 500 mL of green fluid in the suction canister
from the last 2 hours. What is the priority nursing action?
A. Administer an antiemetic as prescribed.
B. Check the tube for patency and placement. ✓
C. Irrigate the tube with normal saline.
D. Turn off the suction and notify the provider.
7. An elderly client is admitted for dehydration. Which assessment finding is
the most sensitive indicator of fluid status?
A. Skin turgor.
B. Daily weight. ✓
C. Blood pressure.
D. Moisture of mucous membranes.
8. When delegating tasks to a UAP, which client is most appropriate for the UAP to care for?
A. A client who is 1-day post-op and requires ambulation assistance.
B. A client with a new tracheostomy requiring suctioning.
C. A stable client with diabetes requiring a blood glucose check. ✓
D. A client receiving a blood transfusion for the first time.
9. A client with a history of COPD is receiving oxygen at 4 L/min via nasal cannula. The client
becomes lethargic and difficult to arouse. What is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min.
B. Obtain an arterial blood gas (ABG) stat.
C. Stimulate the client and encourage deep breathing.
D. Lower the oxygen flow rate and notify the provider. ✓
10. The nurse discovers a fire in a client's room. What is the correct sequence of actions?
A. Activate alarm, contain fire, evacuate clients.
B. Evacuate clients, contain fire, activate alarm.
C. Rescue clients, activate alarm, contain fire. ✓
D. Contain fire, rescue clients, activate alarm.
,Section 2: Pharmacology
11. A client is prescribed furosemide 40 mg PO daily. Which finding should the nurse report
immediately?
A. A potassium level of 5.8 mEq/L.
B. A potassium level of 3.0 mEq/L. ✓
C. A weight loss of 1 kg after 2 days.
D. Reports of dizziness upon standing.
12. The nurse is administering digoxin to a client with heart failure. Before administration, the
nurse assesses the apical pulse and finds it to be 52 beats/min. What is the nurse's best
action?
A. Administer the digoxin as it is scheduled.
B. Withhold the digoxin and notify the provider. ✓
C. Recheck the pulse in 30 minutes.
D. Administer the dose with food.
13. A client taking warfarin reports increased bruising. Which laboratory result is
the priority for the nurse to review?
A. Hemoglobin and Hematocrit.
B. Platelet count.
C. International Normalized Ratio (INR). ✓
D. Prothrombin Time (PT).
14. A client is prescribed prednisone for a chronic inflammatory condition. The nurse should
teach the client to:
A. Take the medication on an empty stomach.
B. Avoid crowds and people who are sick. ✓
C. Stop the medication abruptly if side effects occur.
D. Limit fluid intake to prevent edema.
15. The nurse is preparing to administer insulin. The order reads "Humulin R 5 units and
Humulin N 10 units subcut every morning." What is the correct sequence?
A. Draw up the Humulin R first, then the Humulin N into the same syringe.
B. Draw up the Humulin N first, then the Humulin R into the same syringe.
C. Draw up the Humulin R and Humulin N in separate syringes.
D. Draw up the Humulin N first, then the Humulin R into the same syringe. ✓ (Clear before
Cloudy)
, 16. A client receiving a vancomycin IV infusion develops flushing and redness of the neck and
chest. The nurse's priority action is to:
A. Slow the infusion rate and monitor the client.
B. Stop the infusion immediately and notify the provider. ✓
C. Administer diphenhydramine as prescribed.
D. This is a normal reaction, so continue the infusion.
17. A client with type 2 diabetes is started on metformin. The nurse should include which
instruction in the teaching plan?
A. "Take this medication with your evening meal."
B. "Report any unusual muscle pain or dark urine immediately."
C. "Avoid drinking alcohol while taking this medication." ✓
D. "This medication can cause weight gain."
18. Before administering the first dose of penicillin, the nurse's most important action is to:
A. Check for a history of allergies. ✓
B. Assess the client's vital signs.
C. Obtain a peak and trough level.
D. Ensure the medication is given with food.
19. A client taking an ACE inhibitor (e.g., lisinopril) calls the clinic to report a persistent, dry
cough. The nurse's best response is:
A. "Take an over-the-counter cough suppressant."
B. "This is a common side effect of your medication." ✓
C. "Stop taking the medication immediately."
D. "Increase your fluid intake to soothe your throat."
20. The nurse is teaching a client about taking levothyroxine. Which statement by the client
indicates understanding?
A. "I will take this medication at bedtime."
B. "I can take this with my calcium supplement."
C. "I will take this on an empty stomach in the morning." ✓
D. "If I miss a dose, I can double up the next day."
Section 3: Medical-Surgical Nursing
21. A client with a below-the-knee amputation complains of pain in the missing foot. What is
the nurse's best response?
A. "That is not possible because your foot is gone."
2025–2026 Review Guide Focus: Clinical
judgment, prioritization, NGN case studies,
unfolding scenarios, and safe nursing practice.
Section 1: Clinical Judgment & Prioritization (Fundamentals)
1. The nurse is caring for a client who is 24 hours post-op from an abdominal surgery. The
client's blood pressure is 90/50 mm Hg, heart rate is 130 bpm, and respiratory rate is 24/min.
The skin is cool and clammy. What is the nurse's priority action?
A. Administer prescribed pain medication.
B. Elevate the head of the bed.
C. Increase the IV fluid rate as prescribed. ✓
D. Notify the surgeon of the vital signs.
2. A client with heart failure reports shortness of breath and waking up breathless at night.
Which finding requires the most immediate intervention?
A. 2+ pitting edema in the ankles.
B. Weight gain of 1 kg (2.2 lbs) in one day.
C. Oxygen saturation of 88% on room air. ✓
D. Crackles heard in the lung bases.
3. The nurse is preparing to administer medications. Which client should the nurse assess
first?
A. A client with diabetes who has a blood glucose of 180 mg/dL.
B. A client on a diuretic who has a potassium level of 3.2 mEq/L. ✓
C. A client with hypertension whose BP is 150/88 mm Hg.
D. A client with pain who rates it as 7/10.
4. Which action by a new graduate LPN/LVN requires the supervising RN to intervene
immediately?
A. Administering insulin 30 minutes before a meal.
B. Auscultating lung sounds before administering a bronchodilator.
C. Crushing extended-release nifedipine to administer via a feeding tube. ✓
D. Checking a client's allergy status before giving a new antibiotic.
,5. A client with a closed head injury has a Glasgow Coma Scale score that has decreased from
15 to 10 over the last hour. What is the nurse's most appropriate first action?
A. Suction the client's airway.
B. Stimulate the client to stay awake.
C. Notify the primary care provider immediately. ✓
D. Administer prescribed morphine for headache.
6. The nurse is caring for a client with a nasogastric tube set to low intermittent suction. The
client complains of nausea and the nurse notes 500 mL of green fluid in the suction canister
from the last 2 hours. What is the priority nursing action?
A. Administer an antiemetic as prescribed.
B. Check the tube for patency and placement. ✓
C. Irrigate the tube with normal saline.
D. Turn off the suction and notify the provider.
7. An elderly client is admitted for dehydration. Which assessment finding is
the most sensitive indicator of fluid status?
A. Skin turgor.
B. Daily weight. ✓
C. Blood pressure.
D. Moisture of mucous membranes.
8. When delegating tasks to a UAP, which client is most appropriate for the UAP to care for?
A. A client who is 1-day post-op and requires ambulation assistance.
B. A client with a new tracheostomy requiring suctioning.
C. A stable client with diabetes requiring a blood glucose check. ✓
D. A client receiving a blood transfusion for the first time.
9. A client with a history of COPD is receiving oxygen at 4 L/min via nasal cannula. The client
becomes lethargic and difficult to arouse. What is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min.
B. Obtain an arterial blood gas (ABG) stat.
C. Stimulate the client and encourage deep breathing.
D. Lower the oxygen flow rate and notify the provider. ✓
10. The nurse discovers a fire in a client's room. What is the correct sequence of actions?
A. Activate alarm, contain fire, evacuate clients.
B. Evacuate clients, contain fire, activate alarm.
C. Rescue clients, activate alarm, contain fire. ✓
D. Contain fire, rescue clients, activate alarm.
,Section 2: Pharmacology
11. A client is prescribed furosemide 40 mg PO daily. Which finding should the nurse report
immediately?
A. A potassium level of 5.8 mEq/L.
B. A potassium level of 3.0 mEq/L. ✓
C. A weight loss of 1 kg after 2 days.
D. Reports of dizziness upon standing.
12. The nurse is administering digoxin to a client with heart failure. Before administration, the
nurse assesses the apical pulse and finds it to be 52 beats/min. What is the nurse's best
action?
A. Administer the digoxin as it is scheduled.
B. Withhold the digoxin and notify the provider. ✓
C. Recheck the pulse in 30 minutes.
D. Administer the dose with food.
13. A client taking warfarin reports increased bruising. Which laboratory result is
the priority for the nurse to review?
A. Hemoglobin and Hematocrit.
B. Platelet count.
C. International Normalized Ratio (INR). ✓
D. Prothrombin Time (PT).
14. A client is prescribed prednisone for a chronic inflammatory condition. The nurse should
teach the client to:
A. Take the medication on an empty stomach.
B. Avoid crowds and people who are sick. ✓
C. Stop the medication abruptly if side effects occur.
D. Limit fluid intake to prevent edema.
15. The nurse is preparing to administer insulin. The order reads "Humulin R 5 units and
Humulin N 10 units subcut every morning." What is the correct sequence?
A. Draw up the Humulin R first, then the Humulin N into the same syringe.
B. Draw up the Humulin N first, then the Humulin R into the same syringe.
C. Draw up the Humulin R and Humulin N in separate syringes.
D. Draw up the Humulin N first, then the Humulin R into the same syringe. ✓ (Clear before
Cloudy)
, 16. A client receiving a vancomycin IV infusion develops flushing and redness of the neck and
chest. The nurse's priority action is to:
A. Slow the infusion rate and monitor the client.
B. Stop the infusion immediately and notify the provider. ✓
C. Administer diphenhydramine as prescribed.
D. This is a normal reaction, so continue the infusion.
17. A client with type 2 diabetes is started on metformin. The nurse should include which
instruction in the teaching plan?
A. "Take this medication with your evening meal."
B. "Report any unusual muscle pain or dark urine immediately."
C. "Avoid drinking alcohol while taking this medication." ✓
D. "This medication can cause weight gain."
18. Before administering the first dose of penicillin, the nurse's most important action is to:
A. Check for a history of allergies. ✓
B. Assess the client's vital signs.
C. Obtain a peak and trough level.
D. Ensure the medication is given with food.
19. A client taking an ACE inhibitor (e.g., lisinopril) calls the clinic to report a persistent, dry
cough. The nurse's best response is:
A. "Take an over-the-counter cough suppressant."
B. "This is a common side effect of your medication." ✓
C. "Stop taking the medication immediately."
D. "Increase your fluid intake to soothe your throat."
20. The nurse is teaching a client about taking levothyroxine. Which statement by the client
indicates understanding?
A. "I will take this medication at bedtime."
B. "I can take this with my calcium supplement."
C. "I will take this on an empty stomach in the morning." ✓
D. "If I miss a dose, I can double up the next day."
Section 3: Medical-Surgical Nursing
21. A client with a below-the-knee amputation complains of pain in the missing foot. What is
the nurse's best response?
A. "That is not possible because your foot is gone."
