NGN NCLEX-RN® Full-Length Practice Examination
2026 Test Plan | Clinical Judgment Measurement
Model (CJMM) Focus
Test Engine Status: Linear Adaptive Mode Activated
Total Questions: 50 | Time Allowed: 2 Hours
Question Types: SATA, Matrix/Grid, Drop-down (Cloze), Extended Drag-and-Drop, Multiple
Choice, Enhanced Hot Spot
CASE STUDY 1: Acute Decompensated Heart Failure (Questions 1–
7)
Client Case Record:
Name: M.S., 62-year-old Male
Admitting Diagnosis: Acute Decompensated Heart Failure
Vital Signs (08:00): BP 162/94 mmHg, HR 104 bpm (sinus tachycardia), RR 28 breaths/min,
SpO2 87% on room air, Temp 36.8°C (98.2°F).
Nurses' Notes (08:15): Client is sitting upright in bed, gasping for air, highly anxious.
Productive cough with frothy, pink-tinged sputum. Auscultation reveals diffuse, wet crackles
throughout both lung fields. Pitting edema (3+) in bilateral lower extremities.
Question 1 (SATA)
The nurse reviews the client’s initial assessment data. Which clinical findings
require immediate intervention? Select all that apply.
A. Heart rate of 104 beats per minute
B. Oxygen saturation of 87% on room air
C. 3+ pitting edema in lower extremities
D. Productive cough with pink, frothy sputum
E. Respiratory rate of 28 breaths per minute
F. Body temperature of 36.8°C (98.2°F)
, Question 2 (Matrix/Grid Choice)
The healthcare provider issues emergency orders. For each action, indicate whether it
is Indicated, Contraindicated, or Non-Essential for this client's current status.
Non-
Intervention Indicated Contraindicated
Essential
Administer Furosemide 80 mg IV push ☐ ☐ ☐
Apply Oxygen via Non-Rebreather Mask at
☐ ☐ ☐
15 L/min
Infuse 0.9% Normal Saline bolus at 150
☐ ☐ ☐
mL/hr
Place client in flat, supine position ☐ ☐ ☐
Administer Morphine Sulfate 2 mg IV push ☐ ☐ ☐
Prepare for emergent endotracheal
☐ ☐ ☐
intubation
Question 3 (Drop-down / Cloze)
Complete the sentence by selecting the correct option from each drop-down menu.
The nurse recognizes that the client's pink, frothy sputum is most consistent with [Drop-
down 1: Select] , and the priority intervention to reduce preload is [Drop-down 2: Select] .
Drop-down 1 Options:
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumonia
D. Tuberculosis
Drop-down 2 Options:
, A. Administering IV fluids
B. Placing the client in Trendelenburg position
C. Administering loop diuretics as prescribed
D. Encouraging deep breathing exercises
Question 4 (Extended Drag-and-Drop)
The nurse prepares to administer furosemide. Drag the 3 correct actions from the list below
into the "Correct Administration Steps" column in the proper chronological order.
Available Actions:
1. Assess baseline blood pressure and heart rate
2. Administer the medication via IV push over 1-2 minutes
3. Dilute the medication in 100 mL of D5W
4. Monitor urine output for the next hour
5. Assess for tinnitus or hearing loss
6. Administer the medication intramuscularly
Correct Administration Steps (Chronological)
[Drag Drop Zone 1]
[Drag Drop Zone 2]
[Drag Drop Zone 3]
Question 5 (Multiple Choice)
The client's condition improves after initial treatment. The nurse is preparing discharge
teaching. Which statement by the client indicates a correct understanding of daily weight
monitoring?
A) "I should weigh myself every morning after breakfast."
B) "I will call my provider if I gain more than 2 pounds in 24 hours."
C) "I only need to weigh myself once a week."
D) "It is normal to gain 5 pounds between visits."
, Question 6 (SATA)
The nurse evaluates the client's response to furosemide. Which findings indicate a
therapeutic response? Select all that apply.
A. Urine output increased to 180 mL over 2 hours
B. Respiratory rate decreased from 28 to 18 breaths/min
C. SpO2 improved from 87% to 94% on 2 L/min nasal cannula
D. Crackles are now audible only in the lung bases
E. Serum potassium decreased to 3.2 mEq/L
F. Client reports feeling less anxious and able to lie flat
Question 7 (Hot Spot - Enhanced)
Review the medication administration record (MAR) below. Click on the one medication
that the nurse should question for this client with acute heart failure.
Medication Dose Route Frequency Last Given
Furosemide 80 mg IV push Daily 08:30 today
Metformin 500 mg PO BID 08:00 today
Lisinopril 10 mg PO Daily 08:00 today
Ibuprofen 600 mg PO Q6H PRN pain 06:00 today
Spironolactone 25 mg PO Daily 08:00 today
Click the medication to question:
Furosemide
Metformin
Lisinopril
Ibuprofen
Spironolactone
2026 Test Plan | Clinical Judgment Measurement
Model (CJMM) Focus
Test Engine Status: Linear Adaptive Mode Activated
Total Questions: 50 | Time Allowed: 2 Hours
Question Types: SATA, Matrix/Grid, Drop-down (Cloze), Extended Drag-and-Drop, Multiple
Choice, Enhanced Hot Spot
CASE STUDY 1: Acute Decompensated Heart Failure (Questions 1–
7)
Client Case Record:
Name: M.S., 62-year-old Male
Admitting Diagnosis: Acute Decompensated Heart Failure
Vital Signs (08:00): BP 162/94 mmHg, HR 104 bpm (sinus tachycardia), RR 28 breaths/min,
SpO2 87% on room air, Temp 36.8°C (98.2°F).
Nurses' Notes (08:15): Client is sitting upright in bed, gasping for air, highly anxious.
Productive cough with frothy, pink-tinged sputum. Auscultation reveals diffuse, wet crackles
throughout both lung fields. Pitting edema (3+) in bilateral lower extremities.
Question 1 (SATA)
The nurse reviews the client’s initial assessment data. Which clinical findings
require immediate intervention? Select all that apply.
A. Heart rate of 104 beats per minute
B. Oxygen saturation of 87% on room air
C. 3+ pitting edema in lower extremities
D. Productive cough with pink, frothy sputum
E. Respiratory rate of 28 breaths per minute
F. Body temperature of 36.8°C (98.2°F)
, Question 2 (Matrix/Grid Choice)
The healthcare provider issues emergency orders. For each action, indicate whether it
is Indicated, Contraindicated, or Non-Essential for this client's current status.
Non-
Intervention Indicated Contraindicated
Essential
Administer Furosemide 80 mg IV push ☐ ☐ ☐
Apply Oxygen via Non-Rebreather Mask at
☐ ☐ ☐
15 L/min
Infuse 0.9% Normal Saline bolus at 150
☐ ☐ ☐
mL/hr
Place client in flat, supine position ☐ ☐ ☐
Administer Morphine Sulfate 2 mg IV push ☐ ☐ ☐
Prepare for emergent endotracheal
☐ ☐ ☐
intubation
Question 3 (Drop-down / Cloze)
Complete the sentence by selecting the correct option from each drop-down menu.
The nurse recognizes that the client's pink, frothy sputum is most consistent with [Drop-
down 1: Select] , and the priority intervention to reduce preload is [Drop-down 2: Select] .
Drop-down 1 Options:
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumonia
D. Tuberculosis
Drop-down 2 Options:
, A. Administering IV fluids
B. Placing the client in Trendelenburg position
C. Administering loop diuretics as prescribed
D. Encouraging deep breathing exercises
Question 4 (Extended Drag-and-Drop)
The nurse prepares to administer furosemide. Drag the 3 correct actions from the list below
into the "Correct Administration Steps" column in the proper chronological order.
Available Actions:
1. Assess baseline blood pressure and heart rate
2. Administer the medication via IV push over 1-2 minutes
3. Dilute the medication in 100 mL of D5W
4. Monitor urine output for the next hour
5. Assess for tinnitus or hearing loss
6. Administer the medication intramuscularly
Correct Administration Steps (Chronological)
[Drag Drop Zone 1]
[Drag Drop Zone 2]
[Drag Drop Zone 3]
Question 5 (Multiple Choice)
The client's condition improves after initial treatment. The nurse is preparing discharge
teaching. Which statement by the client indicates a correct understanding of daily weight
monitoring?
A) "I should weigh myself every morning after breakfast."
B) "I will call my provider if I gain more than 2 pounds in 24 hours."
C) "I only need to weigh myself once a week."
D) "It is normal to gain 5 pounds between visits."
, Question 6 (SATA)
The nurse evaluates the client's response to furosemide. Which findings indicate a
therapeutic response? Select all that apply.
A. Urine output increased to 180 mL over 2 hours
B. Respiratory rate decreased from 28 to 18 breaths/min
C. SpO2 improved from 87% to 94% on 2 L/min nasal cannula
D. Crackles are now audible only in the lung bases
E. Serum potassium decreased to 3.2 mEq/L
F. Client reports feeling less anxious and able to lie flat
Question 7 (Hot Spot - Enhanced)
Review the medication administration record (MAR) below. Click on the one medication
that the nurse should question for this client with acute heart failure.
Medication Dose Route Frequency Last Given
Furosemide 80 mg IV push Daily 08:30 today
Metformin 500 mg PO BID 08:00 today
Lisinopril 10 mg PO Daily 08:00 today
Ibuprofen 600 mg PO Q6H PRN pain 06:00 today
Spironolactone 25 mg PO Daily 08:00 today
Click the medication to question:
Furosemide
Metformin
Lisinopril
Ibuprofen
Spironolactone
