NCLEX-RN Next Generation (NGN) Master Review:
200 High-Yield Questions with Answers & Rationales
Comprehensive Exam Preparation for Nursing
Licensure Success (2026-2027)
Introduction
Passing the NCLEX-RN is the final and most critical step in your journey from nursing student to licensed
registered nurse. With the introduction of the Next Generation NCLEX (NGN) , the exam has evolved to better
assess clinical judgment—the ability to make sound decisions in complex, real-world patient care scenarios.
The NGN features unfolding case studies, bowtie questions, multiple-response (select all that apply) ,
and stand-alone items that test not just what you know, but how you think.
Section 1: NGN Case Studies (6 cases, 5 questions each)
Case 1: Postoperative Complications
Scenario: A 68-year-old male, day 2 post right total knee replacement. Sudden shortness of breath, HR 118, BP
100/70, RR 28, O2 sat 88% on room air. Reports chest pain and anxiety.
1. What is the priority action?
A. Apply oxygen 4L nasal cannula
Correct. Hypoxia is the priority; oxygen improves saturation while further assessment occurs.
2. Which diagnostic test is most important now?
B. CT pulmonary angiography
Suspected pulmonary embolism; CT angiography is gold standard.
,3. The patient becomes hypotensive (80/50). Which medication is indicated?
C. Heparin IV bolus
Anticoagulation prevents thrombus extension; thrombolytics may be considered if massive PE with
hemodynamic instability.
4. Which finding is most concerning 1 hour later?
D. Sudden jugular vein distension
Indicates increased right heart pressure from massive PE or cardiac tamponade.
5. The nurse prepares for which procedure if patient deteriorates?
E. Embolectomy
Surgical or catheter embolectomy for massive PE unresponsive to thrombolytics.
Case 2: Acute Kidney Injury
Scenario: 55-year-old female, diabetes, admitted with oliguria, BUN 48, Cr 3.2, K+ 6.1, lethargic.
6. What is the priority intervention?
A. IV calcium gluconate
Stabilizes cardiac membranes in hyperkalemia; ECG changes expected.
7. Which medication should be held?
B. Lisinopril
ACE inhibitors worsen hyperkalemia and reduce GFR in AKI.
8. The patient’s ECG shows peaked T waves. Next best action?
C. Regular insulin IV with dextrose
Drives potassium into cells rapidly.
9. Which dietary modification is most important?
D. Low potassium, low phosphate
AKI causes retention of both; high potassium risks arrhythmias.
10. After treatment, urine output increases to 50 mL/hr. What phase is this?
, E. Diuretic phase
Follows oliguric phase; still risk of hypovolemia and electrolyte loss.
Case 3: Mental Health – Bipolar Disorder
Scenario: 32-year-old male, manic episode, talking rapidly, aggressive, not sleeping, weight loss.
11. Which intervention is most therapeutic initially?
A. Provide a quiet, low-stimulation environment
Reduces sensory overload and agitation.
12. The patient refuses oral meds. What should the nurse do?
B. Offer liquid antipsychotic or IM if aggressive
Maintain safety; IM haloperidol or olanzapine may be needed.
13. Which lab is most important to monitor for lithium therapy?
C. Serum creatinine and BUN
*Lithium is nephrotoxic; monitor renal function and levels (0.6-1.2 mEq/L).*
14. The patient says, “I’m the CEO of the universe.” This is an example of?
D. Grandiose delusion
Exaggerated self-importance common in mania.
15. What is the priority expected outcome by day 3?
E. No physical harm to self or others
Safety always first in acute mania.
Case 4: Maternity – Preeclampsia
Scenario: 30-year-old G1P0 at 36 weeks, BP 160/100, proteinuria 3+, headache, epigastric pain.
16. Which medication is indicated for seizure prophylaxis?
A. Magnesium sulfate IV
Prevents eclampsia; monitor DTRs, respiratory rate, urine output.
, 17. The patient reports shortness of breath and crackles. What complication?
B. Pulmonary edema
Magnesium toxicity and fluid overload risk; give furosemide if ordered.
18. Which reflex finding indicates magnesium toxicity?
C. Hyporeflexia or areflexia
Deep tendon reflexes diminish first; then respiratory depression.
19. What is the antidote for magnesium toxicity?
D. Calcium gluconate
*Administer IV push over 3-5 minutes.*
20. The nurse prepares for immediate delivery. Which BP med is safe?
E. Labetalol
IV labetalol or hydralazine preferred for acute severe hypertension in pregnancy.
Case 5: Pediatrics – Asthma Exacerbation
Scenario: 8-year-old child, respiratory distress, wheezing, accessory muscle use, SpO2 89%.
21. First action?
A. Start albuterol nebulizer
Bronchodilation is priority; oxygen if SpO2 <90% after or during neb.
22. After albuterol, wheezing worsens. What does this indicate?
B. Severe obstruction with poor air movement
Silent chest is ominous; need IV corticosteroids and possibly mag sulfate.
23. Which medication is most important for long-term control?
C. Inhaled fluticasone
Corticosteroids reduce airway inflammation; not for acute rescue.
24. The nurse hears decreased breath sounds unilaterally. What is suspected?
200 High-Yield Questions with Answers & Rationales
Comprehensive Exam Preparation for Nursing
Licensure Success (2026-2027)
Introduction
Passing the NCLEX-RN is the final and most critical step in your journey from nursing student to licensed
registered nurse. With the introduction of the Next Generation NCLEX (NGN) , the exam has evolved to better
assess clinical judgment—the ability to make sound decisions in complex, real-world patient care scenarios.
The NGN features unfolding case studies, bowtie questions, multiple-response (select all that apply) ,
and stand-alone items that test not just what you know, but how you think.
Section 1: NGN Case Studies (6 cases, 5 questions each)
Case 1: Postoperative Complications
Scenario: A 68-year-old male, day 2 post right total knee replacement. Sudden shortness of breath, HR 118, BP
100/70, RR 28, O2 sat 88% on room air. Reports chest pain and anxiety.
1. What is the priority action?
A. Apply oxygen 4L nasal cannula
Correct. Hypoxia is the priority; oxygen improves saturation while further assessment occurs.
2. Which diagnostic test is most important now?
B. CT pulmonary angiography
Suspected pulmonary embolism; CT angiography is gold standard.
,3. The patient becomes hypotensive (80/50). Which medication is indicated?
C. Heparin IV bolus
Anticoagulation prevents thrombus extension; thrombolytics may be considered if massive PE with
hemodynamic instability.
4. Which finding is most concerning 1 hour later?
D. Sudden jugular vein distension
Indicates increased right heart pressure from massive PE or cardiac tamponade.
5. The nurse prepares for which procedure if patient deteriorates?
E. Embolectomy
Surgical or catheter embolectomy for massive PE unresponsive to thrombolytics.
Case 2: Acute Kidney Injury
Scenario: 55-year-old female, diabetes, admitted with oliguria, BUN 48, Cr 3.2, K+ 6.1, lethargic.
6. What is the priority intervention?
A. IV calcium gluconate
Stabilizes cardiac membranes in hyperkalemia; ECG changes expected.
7. Which medication should be held?
B. Lisinopril
ACE inhibitors worsen hyperkalemia and reduce GFR in AKI.
8. The patient’s ECG shows peaked T waves. Next best action?
C. Regular insulin IV with dextrose
Drives potassium into cells rapidly.
9. Which dietary modification is most important?
D. Low potassium, low phosphate
AKI causes retention of both; high potassium risks arrhythmias.
10. After treatment, urine output increases to 50 mL/hr. What phase is this?
, E. Diuretic phase
Follows oliguric phase; still risk of hypovolemia and electrolyte loss.
Case 3: Mental Health – Bipolar Disorder
Scenario: 32-year-old male, manic episode, talking rapidly, aggressive, not sleeping, weight loss.
11. Which intervention is most therapeutic initially?
A. Provide a quiet, low-stimulation environment
Reduces sensory overload and agitation.
12. The patient refuses oral meds. What should the nurse do?
B. Offer liquid antipsychotic or IM if aggressive
Maintain safety; IM haloperidol or olanzapine may be needed.
13. Which lab is most important to monitor for lithium therapy?
C. Serum creatinine and BUN
*Lithium is nephrotoxic; monitor renal function and levels (0.6-1.2 mEq/L).*
14. The patient says, “I’m the CEO of the universe.” This is an example of?
D. Grandiose delusion
Exaggerated self-importance common in mania.
15. What is the priority expected outcome by day 3?
E. No physical harm to self or others
Safety always first in acute mania.
Case 4: Maternity – Preeclampsia
Scenario: 30-year-old G1P0 at 36 weeks, BP 160/100, proteinuria 3+, headache, epigastric pain.
16. Which medication is indicated for seizure prophylaxis?
A. Magnesium sulfate IV
Prevents eclampsia; monitor DTRs, respiratory rate, urine output.
, 17. The patient reports shortness of breath and crackles. What complication?
B. Pulmonary edema
Magnesium toxicity and fluid overload risk; give furosemide if ordered.
18. Which reflex finding indicates magnesium toxicity?
C. Hyporeflexia or areflexia
Deep tendon reflexes diminish first; then respiratory depression.
19. What is the antidote for magnesium toxicity?
D. Calcium gluconate
*Administer IV push over 3-5 minutes.*
20. The nurse prepares for immediate delivery. Which BP med is safe?
E. Labetalol
IV labetalol or hydralazine preferred for acute severe hypertension in pregnancy.
Case 5: Pediatrics – Asthma Exacerbation
Scenario: 8-year-old child, respiratory distress, wheezing, accessory muscle use, SpO2 89%.
21. First action?
A. Start albuterol nebulizer
Bronchodilation is priority; oxygen if SpO2 <90% after or during neb.
22. After albuterol, wheezing worsens. What does this indicate?
B. Severe obstruction with poor air movement
Silent chest is ominous; need IV corticosteroids and possibly mag sulfate.
23. Which medication is most important for long-term control?
C. Inhaled fluticasone
Corticosteroids reduce airway inflammation; not for acute rescue.
24. The nurse hears decreased breath sounds unilaterally. What is suspected?
