NGN NCLEX-RN ACTUAL EXAM 2026/2027 | Next Generation
Latest Test Bank | Complete 180 Questions with Detailed
Rationales | A Grade Verified | Pass Guaranteed
SECTION 1: NGN UNFOLDING CASE STUDIES (Q1-60)
Case Study 1: Medical-Surgical (Q1-10)
Client Scenario: Mrs. Elena Rodriguez, 68 years old, is post-operative day 2 after an open
abdominal hysterectomy for endometrial cancer. She has a history of type 2 diabetes
mellitus, hypertension, and obesity (BMI 34). She is receiving patient-controlled
analgesia (PCA) with morphine, has a Foley catheter, and is on clear liquids. Her incision
is clean, dry, and intact with a Jackson-Pratt drain. Vital signs on admission to the
surgical unit: BP 142/88, HR 88, RR 16, Temp 37.0°C (98.6°F), SpO2 95% on 2L NC.
Q1. The nurse performs the initial post-operative assessment. Which assessment
finding requires immediate follow-up using the NGN Clinical Judgment Measurement
Model?
A. Pain rated 3/10 at the incision site.
B. Urine output of 250 mL over the past 4 hours via Foley catheter.
C. The client asking for ice chips.
D. Capillary blood glucose of 148 mg/dL.
B. Urine output of 250 mL over the past 4 hours via Foley catheter. [CORRECT]
Rationale: Using the CJMM "Recognize Cues" layer, urine output of 250 mL/4 hours
(62.5 mL/hr) falls below the expected minimum of 30 mL/hour for a post-op patient and
may indicate hypovolemia, obstructed JP drain, or early renal compromise; pain 3/10,
ice chip requests, and glucose 148 are expected or manageable findings that do not
require immediate intervention.
Correct Answer: B
,Q2. On post-op day 2 at 0600, the nurse notes the following vital signs: BP 128/76, HR
96, RR 18, Temp 37.2°C, SpO2 94% on 2L NC. The client states she feels "a little short of
breath." Which action should the nurse take first according to the NGN prioritization
framework?
A. Administer the scheduled dose of metformin.
B. Encourage the client to use the incentive spirometer.
C. Increase the oxygen flow rate to 4L per nasal cannula and reassess.
D. Document the finding and continue routine monitoring.
C. Increase the oxygen flow rate to 4L per nasal cannula and reassess. [CORRECT]
Rationale: Applying the ABCs prioritization framework, decreased SpO2 (94%) with
subjective dyspnea indicates potential respiratory compromise; the nurse must first
take action to improve oxygenation before encouraging spirometry (which may be
ineffective if hypoxemic) or administering non-urgent medications.
Correct Answer: C
Q3. The nurse reviews the client's laboratory results from the morning draw. Which value
is most concerning and requires immediate provider notification?
A. Hemoglobin 10.2 g/dL.
B. Potassium 3.2 mEq/L.
C. Sodium 138 mEq/L.
D. White blood cell count 11,500/mm³.
B. Potassium 3.2 mEq/L. [CORRECT]
Rationale: Potassium 3.2 mEq/L represents moderate hypokalemia, which can cause
cardiac dysrhythmias, especially in a post-op patient receiving morphine and with
limited oral intake; while Hgb 10.2 and WBC 11,500 are expected post-operatively, and
sodium 138 is normal, hypokalemia requires immediate repletion and monitoring.
Correct Answer: B
Q4. The client reports her pain is 6/10 and she has not had a bowel movement since
surgery. Her abdomen is distended with hypoactive bowel sounds in all four quadrants.
Based on the CJMM "Analyze Cues" layer, the nurse identifies that these findings most
likely indicate:
A. Paralytic ileus secondary to anesthesia and opioid use.
B. Wound dehiscence.
C. Internal hemorrhage.
D. Diabetic ketoacidosis.
,A. Paralytic ileus secondary to anesthesia and opioid use. [CORRECT]
Rationale: Post-operative opioid use, anesthesia, and limited mobility commonly cause
paralytic ileus, manifesting as abdominal distension, absent/hypoactive bowel sounds,
and constipation; wound dehiscence would present with wound separation, hemorrhage
with hypotension and tachycardia, and DKA with hyperglycemia and ketosis.
Correct Answer: A
Q5. The nurse is preparing to ambulate the client for the first time post-operatively.
Which intervention is most appropriate to ensure client safety?
A. Remove the Foley catheter before ambulation to prevent tripping.
B. Have the client sit on the edge of the bed for 2-3 minutes before standing to assess
for orthostatic hypotension.
C. Administer a PRN dose of morphine immediately before ambulation to prevent pain.
D. Ask the UAP to ambulate the client independently while the nurse administers
medications.
B. Have the client sit on the edge of the bed for 2-3 minutes before standing to assess
for orthostatic hypotension. [CORRECT]
Rationale: Post-operative patients are at risk for orthostatic hypotension due to blood
loss, dehydration, and anesthesia; sitting at the edge of the bed allows assessment for
dizziness or vital sign changes before standing. The Foley should not be removed
without an order, morphine before ambulation increases fall risk, and UAPs cannot
ambulate post-op patients independently.
Correct Answer: B
Q6. The client's Jackson-Pratt drain is collecting serosanguineous fluid. Over the past 8
hours, the output has decreased from 80 mL to 10 mL. The nurse notes the tubing
appears kinked beneath the dressing. Which action should the nurse take?
A. Document the decreased output as an expected improvement.
B. Straighten the tubing, ensure patency, and reassess output in 1 hour.
C. Remove the drain and notify the surgeon.
D. Flush the drain with 10 mL of sterile saline.
B. Straighten the tubing, ensure patency, and reassess output in 1 hour. [CORRECT]
Rationale: A sudden decrease in JP output with visible tubing kinking suggests
mechanical obstruction rather than true resolution; the nurse should first ensure
patency by unkinking the tubing. Removing the drain requires a provider order, flushing
, is contraindicated without an order, and documenting without intervention misses the
cue of potential obstruction.
Correct Answer: B
Q7. At 1400, the client develops shaking chills and her temperature rises to 38.8°C
(101.8°F). Her heart rate is 112 bpm and respiratory rate is 22. Which set of actions
should the nurse take? (Select all that apply.)
A. Obtain blood cultures from two separate sites before administering antibiotics.
B. Administer acetaminophen 650 mg PO as ordered for temperature >38.3°C.
C. Increase the IV fluid rate to 200 mL/hr without an order.
D. Notify the surgeon of the fever and vital sign changes.
E. Apply a cooling blanket and ice packs to reduce temperature rapidly.
A. Obtain blood cultures from two separate sites before administering antibiotics.
[CORRECT]
B. Administer acetaminophen 650 mg PO as ordered for temperature >38.3°C.
[CORRECT]
D. Notify the surgeon of the fever and vital sign changes. [CORRECT]
Rationale: Post-operative fever with tachycardia and chills suggests surgical site
infection or sepsis; blood cultures must be obtained before antibiotics to identify the
organism, antipyretics treat discomfort, and the surgeon must be notified. Increasing IV
fluids without an order is outside RN scope and risks fluid overload; rapid cooling
causes shivering and metabolic acidosis.
Correct Answer: A, B, D
Q8. The surgeon orders IV cefazolin for suspected surgical site infection. The nurse
reviews the client's allergy history, which includes a rash after taking amoxicillin 10
years ago. Which action by the nurse demonstrates appropriate clinical judgment?
A. Withhold the cefazolin and request vancomycin instead.
B. Administer the cefazolin with diphenhydramine premedication.
C. Clarify the allergy history with the client and notify the provider of the penicillin allergy
before administration.
D. Administer the cefazolin because cephalosporins and penicillins do not cross-react.
C. Clarify the allergy history with the client and notify the provider of the penicillin allergy
before administration. [CORRECT]
Rationale: While first-generation cephalosporins (cefazolin) have a low cross-reactivity
with penicillin (approximately 1%), a documented penicillin allergy requires provider
Latest Test Bank | Complete 180 Questions with Detailed
Rationales | A Grade Verified | Pass Guaranteed
SECTION 1: NGN UNFOLDING CASE STUDIES (Q1-60)
Case Study 1: Medical-Surgical (Q1-10)
Client Scenario: Mrs. Elena Rodriguez, 68 years old, is post-operative day 2 after an open
abdominal hysterectomy for endometrial cancer. She has a history of type 2 diabetes
mellitus, hypertension, and obesity (BMI 34). She is receiving patient-controlled
analgesia (PCA) with morphine, has a Foley catheter, and is on clear liquids. Her incision
is clean, dry, and intact with a Jackson-Pratt drain. Vital signs on admission to the
surgical unit: BP 142/88, HR 88, RR 16, Temp 37.0°C (98.6°F), SpO2 95% on 2L NC.
Q1. The nurse performs the initial post-operative assessment. Which assessment
finding requires immediate follow-up using the NGN Clinical Judgment Measurement
Model?
A. Pain rated 3/10 at the incision site.
B. Urine output of 250 mL over the past 4 hours via Foley catheter.
C. The client asking for ice chips.
D. Capillary blood glucose of 148 mg/dL.
B. Urine output of 250 mL over the past 4 hours via Foley catheter. [CORRECT]
Rationale: Using the CJMM "Recognize Cues" layer, urine output of 250 mL/4 hours
(62.5 mL/hr) falls below the expected minimum of 30 mL/hour for a post-op patient and
may indicate hypovolemia, obstructed JP drain, or early renal compromise; pain 3/10,
ice chip requests, and glucose 148 are expected or manageable findings that do not
require immediate intervention.
Correct Answer: B
,Q2. On post-op day 2 at 0600, the nurse notes the following vital signs: BP 128/76, HR
96, RR 18, Temp 37.2°C, SpO2 94% on 2L NC. The client states she feels "a little short of
breath." Which action should the nurse take first according to the NGN prioritization
framework?
A. Administer the scheduled dose of metformin.
B. Encourage the client to use the incentive spirometer.
C. Increase the oxygen flow rate to 4L per nasal cannula and reassess.
D. Document the finding and continue routine monitoring.
C. Increase the oxygen flow rate to 4L per nasal cannula and reassess. [CORRECT]
Rationale: Applying the ABCs prioritization framework, decreased SpO2 (94%) with
subjective dyspnea indicates potential respiratory compromise; the nurse must first
take action to improve oxygenation before encouraging spirometry (which may be
ineffective if hypoxemic) or administering non-urgent medications.
Correct Answer: C
Q3. The nurse reviews the client's laboratory results from the morning draw. Which value
is most concerning and requires immediate provider notification?
A. Hemoglobin 10.2 g/dL.
B. Potassium 3.2 mEq/L.
C. Sodium 138 mEq/L.
D. White blood cell count 11,500/mm³.
B. Potassium 3.2 mEq/L. [CORRECT]
Rationale: Potassium 3.2 mEq/L represents moderate hypokalemia, which can cause
cardiac dysrhythmias, especially in a post-op patient receiving morphine and with
limited oral intake; while Hgb 10.2 and WBC 11,500 are expected post-operatively, and
sodium 138 is normal, hypokalemia requires immediate repletion and monitoring.
Correct Answer: B
Q4. The client reports her pain is 6/10 and she has not had a bowel movement since
surgery. Her abdomen is distended with hypoactive bowel sounds in all four quadrants.
Based on the CJMM "Analyze Cues" layer, the nurse identifies that these findings most
likely indicate:
A. Paralytic ileus secondary to anesthesia and opioid use.
B. Wound dehiscence.
C. Internal hemorrhage.
D. Diabetic ketoacidosis.
,A. Paralytic ileus secondary to anesthesia and opioid use. [CORRECT]
Rationale: Post-operative opioid use, anesthesia, and limited mobility commonly cause
paralytic ileus, manifesting as abdominal distension, absent/hypoactive bowel sounds,
and constipation; wound dehiscence would present with wound separation, hemorrhage
with hypotension and tachycardia, and DKA with hyperglycemia and ketosis.
Correct Answer: A
Q5. The nurse is preparing to ambulate the client for the first time post-operatively.
Which intervention is most appropriate to ensure client safety?
A. Remove the Foley catheter before ambulation to prevent tripping.
B. Have the client sit on the edge of the bed for 2-3 minutes before standing to assess
for orthostatic hypotension.
C. Administer a PRN dose of morphine immediately before ambulation to prevent pain.
D. Ask the UAP to ambulate the client independently while the nurse administers
medications.
B. Have the client sit on the edge of the bed for 2-3 minutes before standing to assess
for orthostatic hypotension. [CORRECT]
Rationale: Post-operative patients are at risk for orthostatic hypotension due to blood
loss, dehydration, and anesthesia; sitting at the edge of the bed allows assessment for
dizziness or vital sign changes before standing. The Foley should not be removed
without an order, morphine before ambulation increases fall risk, and UAPs cannot
ambulate post-op patients independently.
Correct Answer: B
Q6. The client's Jackson-Pratt drain is collecting serosanguineous fluid. Over the past 8
hours, the output has decreased from 80 mL to 10 mL. The nurse notes the tubing
appears kinked beneath the dressing. Which action should the nurse take?
A. Document the decreased output as an expected improvement.
B. Straighten the tubing, ensure patency, and reassess output in 1 hour.
C. Remove the drain and notify the surgeon.
D. Flush the drain with 10 mL of sterile saline.
B. Straighten the tubing, ensure patency, and reassess output in 1 hour. [CORRECT]
Rationale: A sudden decrease in JP output with visible tubing kinking suggests
mechanical obstruction rather than true resolution; the nurse should first ensure
patency by unkinking the tubing. Removing the drain requires a provider order, flushing
, is contraindicated without an order, and documenting without intervention misses the
cue of potential obstruction.
Correct Answer: B
Q7. At 1400, the client develops shaking chills and her temperature rises to 38.8°C
(101.8°F). Her heart rate is 112 bpm and respiratory rate is 22. Which set of actions
should the nurse take? (Select all that apply.)
A. Obtain blood cultures from two separate sites before administering antibiotics.
B. Administer acetaminophen 650 mg PO as ordered for temperature >38.3°C.
C. Increase the IV fluid rate to 200 mL/hr without an order.
D. Notify the surgeon of the fever and vital sign changes.
E. Apply a cooling blanket and ice packs to reduce temperature rapidly.
A. Obtain blood cultures from two separate sites before administering antibiotics.
[CORRECT]
B. Administer acetaminophen 650 mg PO as ordered for temperature >38.3°C.
[CORRECT]
D. Notify the surgeon of the fever and vital sign changes. [CORRECT]
Rationale: Post-operative fever with tachycardia and chills suggests surgical site
infection or sepsis; blood cultures must be obtained before antibiotics to identify the
organism, antipyretics treat discomfort, and the surgeon must be notified. Increasing IV
fluids without an order is outside RN scope and risks fluid overload; rapid cooling
causes shivering and metabolic acidosis.
Correct Answer: A, B, D
Q8. The surgeon orders IV cefazolin for suspected surgical site infection. The nurse
reviews the client's allergy history, which includes a rash after taking amoxicillin 10
years ago. Which action by the nurse demonstrates appropriate clinical judgment?
A. Withhold the cefazolin and request vancomycin instead.
B. Administer the cefazolin with diphenhydramine premedication.
C. Clarify the allergy history with the client and notify the provider of the penicillin allergy
before administration.
D. Administer the cefazolin because cephalosporins and penicillins do not cross-react.
C. Clarify the allergy history with the client and notify the provider of the penicillin allergy
before administration. [CORRECT]
Rationale: While first-generation cephalosporins (cefazolin) have a low cross-reactivity
with penicillin (approximately 1%), a documented penicillin allergy requires provider
