1
NGN NCLEX-PN ACTUAL EXAM 2026/2027 | Next
Generation | Complete 200 Questions with Detailed
Rationales | Verified | Pass Guaranteed - A+ Graded
SECTION 1: CLINICAL JUDGMENT & NGN UNFOLDING CASE
STUDIES (Questions 1–50)
CASE STUDY 1: Postoperative Complications (Q1–Q10)
Client Profile: Mrs. Elena Varga, 68-year-old female, POD #2 after open
cholecystectomy. History of Type 2 diabetes, hypertension, and obesity (BMI 34).
Currently on PCA morphine, IV fluids, and sliding-scale insulin. UAP reports client
"seems more tired today."
Vital Signs (0600): T 37.2°C, P 88, R 18, BP 142/88, SpO2 94% on 2L NC, Pain 4/10
Vital Signs (1200): T 38.4°C, P 102, R 24, BP 128/76, SpO2 91% on 2L NC, Pain 6/10
Laboratory Results:
• WBC 14,200/mm³ (Ref: 4,500–11,000)
• Hgb 10.8 g/dL (Ref: 12–16)
• Glucose 248 mg/dL (Ref: 70–110)
• Potassium 3.2 mEq/L (Ref: 3.5–5.0)
• BUN 28 mg/dL (Ref: 7–20)
Q1. (Recognize Cues) The PN is reviewing the 1200 assessment data. Which three
findings require immediate follow-up? Select all that apply.
A. Temperature 38.4°C B. Pain 6/10 C. SpO2 91% on 2L nasal cannula D. Potassium
3.2 mEq/L E. BP 128/76 F. Glucose 248 mg/dL
Correct Answer: A, C, D
,2
Rationale: A temperature of 38.4°C on POD #2 signals potential infection (surgical
site, respiratory, or urinary) and requires investigation. SpO2 91% on supplemental
oxygen indicates hypoxemia and possible respiratory compromise (atelectasis,
pneumonia, or pulmonary embolism). Potassium 3.2 mEq/L is below normal and
places the client at risk for cardiac dysrhythmias, especially postoperatively. Pain
6/10, while uncomfortable, is not immediately life-threatening. BP 128/76 is within
acceptable postoperative range. Glucose 248 mg/dL is elevated but expected in a
diabetic postoperative client on sliding-scale insulin; it requires monitoring but is not
the highest priority compared to hypoxemia, hypokalemia, and fever.
Q2. (Analyze Cues) The PN recognizes that the client's deteriorating respiratory
status may be related to which complication?
A. Wound dehiscence B. Atelectasis or pneumonia C. Diabetic ketoacidosis D.
Pulmonary embolism from immobility
Correct Answer: B. Atelectasis or pneumonia [CORRECT]
Rationale: Postoperative clients, especially obese and diabetic patients, are at high
risk for atelectasis and pneumonia due to shallow breathing, pain limiting deep
breathing, and immobility. The increasing temperature, tachypnea, and declining
SpO2 support this hypothesis. Wound dehiscence would present with wound
changes, not primarily respiratory symptoms. DKA would show metabolic acidosis,
Kussmaul respirations, and significantly elevated glucose with ketones. While PE is
possible, the gradual onset with fever makes atelectasis/pneumonia more likely on
POD #2.
Q3. (Prioritize Hypotheses) Using the NGN CJMM framework, which hypothesis
should the PN prioritize first?
A. Uncontrolled postoperative pain B. Risk for impaired wound healing C. Ineffective
breathing pattern related to hypoventilation D. Imbalanced nutrition: less than body
requirements
,3
Correct Answer: C. Ineffective breathing pattern related to hypoventilation
[CORRECT]
Rationale: The ABCs (Airway, Breathing, Circulation) take priority in all clinical
situations. The client's declining oxygen saturation (94% → 91%) and increasing
respiratory rate indicate respiratory compromise that could rapidly progress to
respiratory failure. Pain, wound healing, and nutrition are important but secondary to
maintaining adequate oxygenation. The PN must address breathing before other
issues.
Q4. (Generate Solutions) Which two nursing interventions should the PN implement
immediately? Select all that apply.
A. Increase oxygen to 4L NC and reassess SpO2 in 15 minutes B. Encourage use of
incentive spirometer every hour while awake C. Administer a PRN dose of morphine
via PCA D. Notify the RN or provider of SpO2 91% and fever E. Discontinue the
client's IV fluids F. Apply a cooling blanket for temperature 38.4°C
Correct Answer: A, D
Rationale: The PN should increase oxygen to address hypoxemia (SpO2 91%) and
notify the RN or provider because this represents a significant change from baseline
requiring medical evaluation and possible chest X-ray or antibiotics. While incentive
spirometer use is appropriate for prevention, it is not the immediate priority when
the client is already hypoxemic. Additional morphine could further depress
respirations. Discontinuing IV fluids is inappropriate without orders. A cooling
blanket is unnecessary for a moderate fever and may cause shivering, increasing
oxygen demand.
Q5. (Take Actions) The PN delegates ambulation to the UAP. Which instruction is
most appropriate?
, 4
A. "Walk the client to the end of the hall and back twice." B. "Assist the client to walk
for 5 minutes, then have her sit and rest." C. "Have the client dangle her legs at the
bedside for 10 minutes." D. "Ambulate the client only if her SpO2 stays above 95%."
Correct Answer: B. "Assist the client to walk for 5 minutes, then have her sit and
rest." [CORRECT]
Rationale: Early ambulation postoperatively prevents complications, but the client
has declining respiratory status and is on POD #2. A 5-minute walk with rest is
appropriate for a client who is hypoxemic but stable enough to ambulate. Walking to
the end of the hall twice may be too strenuous given current SpO2 91%. Dangling for
10 minutes does not provide adequate mobilization. The PN should not delegate
ambulation contingent on SpO2 monitoring, as the UAP cannot interpret or act on
SpO2 readings independently; this falls outside UAP scope.
Q6. (Evaluate Outcomes) Two hours after interventions, the client's SpO2 is 96% on
3L NC, R 20, T 37.8°C. Which conclusion by the PN is most accurate?
A. The client is fully recovered and oxygen can be discontinued B. Interventions are
effective; continue current plan and monitor C. The client needs immediate transfer
to ICU D. Antibiotics are no longer necessary
Correct Answer: B. Interventions are effective; continue current plan and monitor
[CORRECT]
Rationale: The client's oxygenation has improved (91% → 96%), respiratory rate has
decreased (24 → 20), and temperature is trending down (38.4°C → 37.8°C). These
indicate positive response to interventions, but the client is not fully recovered—
oxygen should not be discontinued abruptly, and continued monitoring is essential.
There is no indication for ICU transfer. The need for antibiotics would be determined
by the provider based on diagnostic findings, not by the PN.
Q7. (Bow-Tie: Actions to Take) The PN is caring for Mrs. Varga. Which three actions
should the PN take? Select the 3 correct actions.
NGN NCLEX-PN ACTUAL EXAM 2026/2027 | Next
Generation | Complete 200 Questions with Detailed
Rationales | Verified | Pass Guaranteed - A+ Graded
SECTION 1: CLINICAL JUDGMENT & NGN UNFOLDING CASE
STUDIES (Questions 1–50)
CASE STUDY 1: Postoperative Complications (Q1–Q10)
Client Profile: Mrs. Elena Varga, 68-year-old female, POD #2 after open
cholecystectomy. History of Type 2 diabetes, hypertension, and obesity (BMI 34).
Currently on PCA morphine, IV fluids, and sliding-scale insulin. UAP reports client
"seems more tired today."
Vital Signs (0600): T 37.2°C, P 88, R 18, BP 142/88, SpO2 94% on 2L NC, Pain 4/10
Vital Signs (1200): T 38.4°C, P 102, R 24, BP 128/76, SpO2 91% on 2L NC, Pain 6/10
Laboratory Results:
• WBC 14,200/mm³ (Ref: 4,500–11,000)
• Hgb 10.8 g/dL (Ref: 12–16)
• Glucose 248 mg/dL (Ref: 70–110)
• Potassium 3.2 mEq/L (Ref: 3.5–5.0)
• BUN 28 mg/dL (Ref: 7–20)
Q1. (Recognize Cues) The PN is reviewing the 1200 assessment data. Which three
findings require immediate follow-up? Select all that apply.
A. Temperature 38.4°C B. Pain 6/10 C. SpO2 91% on 2L nasal cannula D. Potassium
3.2 mEq/L E. BP 128/76 F. Glucose 248 mg/dL
Correct Answer: A, C, D
,2
Rationale: A temperature of 38.4°C on POD #2 signals potential infection (surgical
site, respiratory, or urinary) and requires investigation. SpO2 91% on supplemental
oxygen indicates hypoxemia and possible respiratory compromise (atelectasis,
pneumonia, or pulmonary embolism). Potassium 3.2 mEq/L is below normal and
places the client at risk for cardiac dysrhythmias, especially postoperatively. Pain
6/10, while uncomfortable, is not immediately life-threatening. BP 128/76 is within
acceptable postoperative range. Glucose 248 mg/dL is elevated but expected in a
diabetic postoperative client on sliding-scale insulin; it requires monitoring but is not
the highest priority compared to hypoxemia, hypokalemia, and fever.
Q2. (Analyze Cues) The PN recognizes that the client's deteriorating respiratory
status may be related to which complication?
A. Wound dehiscence B. Atelectasis or pneumonia C. Diabetic ketoacidosis D.
Pulmonary embolism from immobility
Correct Answer: B. Atelectasis or pneumonia [CORRECT]
Rationale: Postoperative clients, especially obese and diabetic patients, are at high
risk for atelectasis and pneumonia due to shallow breathing, pain limiting deep
breathing, and immobility. The increasing temperature, tachypnea, and declining
SpO2 support this hypothesis. Wound dehiscence would present with wound
changes, not primarily respiratory symptoms. DKA would show metabolic acidosis,
Kussmaul respirations, and significantly elevated glucose with ketones. While PE is
possible, the gradual onset with fever makes atelectasis/pneumonia more likely on
POD #2.
Q3. (Prioritize Hypotheses) Using the NGN CJMM framework, which hypothesis
should the PN prioritize first?
A. Uncontrolled postoperative pain B. Risk for impaired wound healing C. Ineffective
breathing pattern related to hypoventilation D. Imbalanced nutrition: less than body
requirements
,3
Correct Answer: C. Ineffective breathing pattern related to hypoventilation
[CORRECT]
Rationale: The ABCs (Airway, Breathing, Circulation) take priority in all clinical
situations. The client's declining oxygen saturation (94% → 91%) and increasing
respiratory rate indicate respiratory compromise that could rapidly progress to
respiratory failure. Pain, wound healing, and nutrition are important but secondary to
maintaining adequate oxygenation. The PN must address breathing before other
issues.
Q4. (Generate Solutions) Which two nursing interventions should the PN implement
immediately? Select all that apply.
A. Increase oxygen to 4L NC and reassess SpO2 in 15 minutes B. Encourage use of
incentive spirometer every hour while awake C. Administer a PRN dose of morphine
via PCA D. Notify the RN or provider of SpO2 91% and fever E. Discontinue the
client's IV fluids F. Apply a cooling blanket for temperature 38.4°C
Correct Answer: A, D
Rationale: The PN should increase oxygen to address hypoxemia (SpO2 91%) and
notify the RN or provider because this represents a significant change from baseline
requiring medical evaluation and possible chest X-ray or antibiotics. While incentive
spirometer use is appropriate for prevention, it is not the immediate priority when
the client is already hypoxemic. Additional morphine could further depress
respirations. Discontinuing IV fluids is inappropriate without orders. A cooling
blanket is unnecessary for a moderate fever and may cause shivering, increasing
oxygen demand.
Q5. (Take Actions) The PN delegates ambulation to the UAP. Which instruction is
most appropriate?
, 4
A. "Walk the client to the end of the hall and back twice." B. "Assist the client to walk
for 5 minutes, then have her sit and rest." C. "Have the client dangle her legs at the
bedside for 10 minutes." D. "Ambulate the client only if her SpO2 stays above 95%."
Correct Answer: B. "Assist the client to walk for 5 minutes, then have her sit and
rest." [CORRECT]
Rationale: Early ambulation postoperatively prevents complications, but the client
has declining respiratory status and is on POD #2. A 5-minute walk with rest is
appropriate for a client who is hypoxemic but stable enough to ambulate. Walking to
the end of the hall twice may be too strenuous given current SpO2 91%. Dangling for
10 minutes does not provide adequate mobilization. The PN should not delegate
ambulation contingent on SpO2 monitoring, as the UAP cannot interpret or act on
SpO2 readings independently; this falls outside UAP scope.
Q6. (Evaluate Outcomes) Two hours after interventions, the client's SpO2 is 96% on
3L NC, R 20, T 37.8°C. Which conclusion by the PN is most accurate?
A. The client is fully recovered and oxygen can be discontinued B. Interventions are
effective; continue current plan and monitor C. The client needs immediate transfer
to ICU D. Antibiotics are no longer necessary
Correct Answer: B. Interventions are effective; continue current plan and monitor
[CORRECT]
Rationale: The client's oxygenation has improved (91% → 96%), respiratory rate has
decreased (24 → 20), and temperature is trending down (38.4°C → 37.8°C). These
indicate positive response to interventions, but the client is not fully recovered—
oxygen should not be discontinued abruptly, and continued monitoring is essential.
There is no indication for ICU transfer. The need for antibiotics would be determined
by the provider based on diagnostic findings, not by the PN.
Q7. (Bow-Tie: Actions to Take) The PN is caring for Mrs. Varga. Which three actions
should the PN take? Select the 3 correct actions.
