NCLEX-RN NEXT GENERATION (NGN) PRACTICE EXAM - (150
QUESTIONS) UP-TO-DATE ACTUAL EXAM QUESTIONS AND 100%
ACCURATE SOLUTIONS | VERIFIED ANSWERS - INSTANT PDF
DOWNLOAD
Examiner/Administrator: National Council of State Boards of Nursing
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NURSE LICENSURE SIMULATION BOOKLET
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Candidate Name: _______________________________________
Candidate ID Number: ___________________________________
Testing Date: __________________________________________
Testing Centre/Location: _________________________________
Signature: _____________________________________________
Time Allowed: 5 Hours Maximum Testing Time
Approximate Number of Questions: 150
Question Types Included:
• Multiple Choice Questions
• Case Studies
• Matrix/Grid Questions
• Cloze/Drop-Down Items
• Multiple Response Questions
• Prioritization Questions
• Bow-Tie Clinical Judgment Items
Core Clinical Domains Assessed:
• Management of Care
• Safety and Infection Control
• Pharmacological Therapies
• Physiological Adaptation
• Reduction of Risk Potential
,• Psychosocial Integrity
• Health Promotion and Maintenance
• Clinical Judgment and Decision-Making
• Pediatric, Maternal, Mental Health, and Adult Nursing
Candidate Instructions:
Read each question carefully before selecting an answer. This Next
Generation NCLEX-RN simulation is designed to assess advanced clinical
judgment, prioritization, patient safety awareness, and evidence-based
nursing practice. Some items may contain unfolding case scenarios requiring
interpretation of laboratory values, prioritization of nursing interventions,
and evaluation of patient outcomes. Candidates are expected to apply nursing
process principles, delegation skills, and therapeutic communication
strategies throughout the examination. Allocate time appropriately because
the full assessment contains approximately 150 questions modeled after the
current NGN examination structure.
This original simulation examination has been independently developed for
educational and preparation purposes only. It is not affiliated with or
endorsed by the National Council of State Boards of Nursing. All questions
are newly created to reflect the style, rigor, and clinical reasoning emphasis of
the current NGN testing framework.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━
Q1. A nurse in the emergency department is caring for a 72-year-old client
admitted with septic shock secondary to pneumonia. The client’s blood pressure
is 78/42 mm Hg, heart rate is 132/min, temperature is 39.4°C (102.9°F), lactate
level is 5.2 mmol/L, and urine output is 15 mL/hr. Which prescription should
the nurse implement first?
A. Administer broad-spectrum IV antibiotics
B. Insert an indwelling urinary catheter
C. Initiate rapid infusion of isotonic crystalloid fluids
D. Obtain blood cultures
Correct Answer: C. Initiate rapid infusion of isotonic crystalloid fluids
Explanation: Septic shock involves severe vasodilation and tissue
hypoperfusion. Immediate restoration of intravascular volume through rapid
isotonic fluid resuscitation is the priority to improve circulation and organ
perfusion. Although antibiotics are essential, circulation must first be
,stabilized. Blood cultures should ideally be obtained before antibiotics, but
delaying resuscitation increases mortality risk. Inserting a urinary catheter
helps monitor output but does not immediately treat shock.
Q2. A postoperative client suddenly develops shortness of breath, chest pain,
and oxygen saturation of 84% on room air. Which action should the nurse take
first?
A. Place the client in high-Fowler position and administer oxygen
B. Notify the rapid response team
C. Prepare the client for CT angiography
D. Administer prescribed morphine sulfate
Correct Answer: A. Place the client in high-Fowler position and
administer oxygen
Explanation: The client is demonstrating manifestations of a pulmonary
embolism with acute hypoxemia. Airway and oxygenation are the immediate
priorities. Elevating the head of the bed and administering oxygen support gas
exchange while additional interventions are arranged. Calling the rapid
response team is appropriate after immediate stabilization measures begin. CT
angiography confirms diagnosis but is not the first action. Morphine may
reduce anxiety and pain but does not address oxygenation first.
Q3. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
assessment finding indicates that treatment has been effective?
A. Blood glucose level decreases from 580 mg/dL to 300 mg/dL
B. Serum potassium level increases to 5.6 mEq/L
C. Arterial pH increases from 7.12 to 7.36
D. Respiratory rate decreases from 32/min to 26/min
Correct Answer: C. Arterial pH increases from 7.12 to 7.36
Explanation: DKA is characterized by metabolic acidosis caused by ketone
accumulation. Correction of acidosis demonstrated by normalization of
arterial pH is the strongest indicator that treatment is effective. Glucose
reduction alone does not indicate full resolution because ketoacidosis may
persist. Elevated potassium is dangerous and not therapeutic. Respiratory
improvement is encouraging but less definitive than correction of acidosis.
, Q4. A nurse delegates care activities to an experienced unlicensed assistive
personnel (UAP). Which task is appropriate to delegate?
A. Assessing a postoperative incision for signs of infection
B. Teaching a client how to use an incentive spirometer
C. Obtaining routine vital signs for a stable client
D. Evaluating pain medication effectiveness
Correct Answer: C. Obtaining routine vital signs for a stable client
Explanation: UAPs may perform routine, noninvasive, standardized tasks
for stable clients. Vital sign collection falls within this scope. Assessment,
teaching, and evaluation require nursing judgment and must be performed by
the licensed nurse. Monitoring surgical wounds and evaluating medication
response involve clinical interpretation beyond UAP responsibilities.
Q5. A client receiving a blood transfusion develops chills, fever, low back pain,
and anxiety after 15 minutes. Which action should the nurse take first?
A. Slow the infusion rate
B. Administer prescribed diphenhydramine
C. Stop the transfusion immediately
D. Obtain another unit of blood
Correct Answer: C. Stop the transfusion immediately
Explanation: The client is exhibiting signs of an acute hemolytic
transfusion reaction, a potentially fatal emergency. The nurse must stop the
transfusion immediately to prevent further exposure to incompatible blood.
Slowing the infusion is unsafe. Diphenhydramine is used for mild allergic
reactions, not severe hemolytic reactions. Another unit should never be
obtained before investigation of the reaction.
Q6. A nurse is assessing a client with increased intracranial pressure (ICP).
Which finding requires immediate intervention?
A. Glasgow Coma Scale score decreases from 14 to 11
B. Blood pressure 148/88 mm Hg
QUESTIONS) UP-TO-DATE ACTUAL EXAM QUESTIONS AND 100%
ACCURATE SOLUTIONS | VERIFIED ANSWERS - INSTANT PDF
DOWNLOAD
Examiner/Administrator: National Council of State Boards of Nursing
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━
NURSE LICENSURE SIMULATION BOOKLET
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━
Candidate Name: _______________________________________
Candidate ID Number: ___________________________________
Testing Date: __________________________________________
Testing Centre/Location: _________________________________
Signature: _____________________________________________
Time Allowed: 5 Hours Maximum Testing Time
Approximate Number of Questions: 150
Question Types Included:
• Multiple Choice Questions
• Case Studies
• Matrix/Grid Questions
• Cloze/Drop-Down Items
• Multiple Response Questions
• Prioritization Questions
• Bow-Tie Clinical Judgment Items
Core Clinical Domains Assessed:
• Management of Care
• Safety and Infection Control
• Pharmacological Therapies
• Physiological Adaptation
• Reduction of Risk Potential
,• Psychosocial Integrity
• Health Promotion and Maintenance
• Clinical Judgment and Decision-Making
• Pediatric, Maternal, Mental Health, and Adult Nursing
Candidate Instructions:
Read each question carefully before selecting an answer. This Next
Generation NCLEX-RN simulation is designed to assess advanced clinical
judgment, prioritization, patient safety awareness, and evidence-based
nursing practice. Some items may contain unfolding case scenarios requiring
interpretation of laboratory values, prioritization of nursing interventions,
and evaluation of patient outcomes. Candidates are expected to apply nursing
process principles, delegation skills, and therapeutic communication
strategies throughout the examination. Allocate time appropriately because
the full assessment contains approximately 150 questions modeled after the
current NGN examination structure.
This original simulation examination has been independently developed for
educational and preparation purposes only. It is not affiliated with or
endorsed by the National Council of State Boards of Nursing. All questions
are newly created to reflect the style, rigor, and clinical reasoning emphasis of
the current NGN testing framework.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━
Q1. A nurse in the emergency department is caring for a 72-year-old client
admitted with septic shock secondary to pneumonia. The client’s blood pressure
is 78/42 mm Hg, heart rate is 132/min, temperature is 39.4°C (102.9°F), lactate
level is 5.2 mmol/L, and urine output is 15 mL/hr. Which prescription should
the nurse implement first?
A. Administer broad-spectrum IV antibiotics
B. Insert an indwelling urinary catheter
C. Initiate rapid infusion of isotonic crystalloid fluids
D. Obtain blood cultures
Correct Answer: C. Initiate rapid infusion of isotonic crystalloid fluids
Explanation: Septic shock involves severe vasodilation and tissue
hypoperfusion. Immediate restoration of intravascular volume through rapid
isotonic fluid resuscitation is the priority to improve circulation and organ
perfusion. Although antibiotics are essential, circulation must first be
,stabilized. Blood cultures should ideally be obtained before antibiotics, but
delaying resuscitation increases mortality risk. Inserting a urinary catheter
helps monitor output but does not immediately treat shock.
Q2. A postoperative client suddenly develops shortness of breath, chest pain,
and oxygen saturation of 84% on room air. Which action should the nurse take
first?
A. Place the client in high-Fowler position and administer oxygen
B. Notify the rapid response team
C. Prepare the client for CT angiography
D. Administer prescribed morphine sulfate
Correct Answer: A. Place the client in high-Fowler position and
administer oxygen
Explanation: The client is demonstrating manifestations of a pulmonary
embolism with acute hypoxemia. Airway and oxygenation are the immediate
priorities. Elevating the head of the bed and administering oxygen support gas
exchange while additional interventions are arranged. Calling the rapid
response team is appropriate after immediate stabilization measures begin. CT
angiography confirms diagnosis but is not the first action. Morphine may
reduce anxiety and pain but does not address oxygenation first.
Q3. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which
assessment finding indicates that treatment has been effective?
A. Blood glucose level decreases from 580 mg/dL to 300 mg/dL
B. Serum potassium level increases to 5.6 mEq/L
C. Arterial pH increases from 7.12 to 7.36
D. Respiratory rate decreases from 32/min to 26/min
Correct Answer: C. Arterial pH increases from 7.12 to 7.36
Explanation: DKA is characterized by metabolic acidosis caused by ketone
accumulation. Correction of acidosis demonstrated by normalization of
arterial pH is the strongest indicator that treatment is effective. Glucose
reduction alone does not indicate full resolution because ketoacidosis may
persist. Elevated potassium is dangerous and not therapeutic. Respiratory
improvement is encouraging but less definitive than correction of acidosis.
, Q4. A nurse delegates care activities to an experienced unlicensed assistive
personnel (UAP). Which task is appropriate to delegate?
A. Assessing a postoperative incision for signs of infection
B. Teaching a client how to use an incentive spirometer
C. Obtaining routine vital signs for a stable client
D. Evaluating pain medication effectiveness
Correct Answer: C. Obtaining routine vital signs for a stable client
Explanation: UAPs may perform routine, noninvasive, standardized tasks
for stable clients. Vital sign collection falls within this scope. Assessment,
teaching, and evaluation require nursing judgment and must be performed by
the licensed nurse. Monitoring surgical wounds and evaluating medication
response involve clinical interpretation beyond UAP responsibilities.
Q5. A client receiving a blood transfusion develops chills, fever, low back pain,
and anxiety after 15 minutes. Which action should the nurse take first?
A. Slow the infusion rate
B. Administer prescribed diphenhydramine
C. Stop the transfusion immediately
D. Obtain another unit of blood
Correct Answer: C. Stop the transfusion immediately
Explanation: The client is exhibiting signs of an acute hemolytic
transfusion reaction, a potentially fatal emergency. The nurse must stop the
transfusion immediately to prevent further exposure to incompatible blood.
Slowing the infusion is unsafe. Diphenhydramine is used for mild allergic
reactions, not severe hemolytic reactions. Another unit should never be
obtained before investigation of the reaction.
Q6. A nurse is assessing a client with increased intracranial pressure (ICP).
Which finding requires immediate intervention?
A. Glasgow Coma Scale score decreases from 14 to 11
B. Blood pressure 148/88 mm Hg
