NCLEX NGN Clinical Judgment Study Guide | 10 Original Case
Studies & 100 Questions | Prioritization, Delegation & Detailed
Answer Rationales 2026/2027
Case 1 Fluid loss and falling perfusion
A 76-year-old adult has had vomiting and poor intake for two days. Previously
alert, the patient is now confused and dizzy. BP is 86/50 mm Hg, pulse
122/minute, and urine output has fallen. Mucous membranes are dry. The RN is at
the bedside; an emergency response team is available.
Use the facts provided. Unless stated otherwise, treat each question as referring to
the original case, not to hypothetical changes introduced in other questions. The
final item introduces its own new deterioration.
1. Recognise cues. Which finding most directly requires attention in this case?
A. New confusion with BP 86/50 and falling urine output
B. An unchanged preference for the room lighting
C. The usual breakfast choice from yesterday
D. An old administrative appointment entry
2. Analyse cues. Which interpretation best links the case findings?
A. Fluid overload is the leading explanation
B. The change is merely the patient’s usual cognitive baseline
C. Orthostatic symptoms can be managed by walking practice alone
D. Possible impaired perfusion associated with fluid-volume loss
3. Prioritise. Which need should guide the RN’s attention before routine nonurgent
tasks?
A. Finish routine filing before responding
B. Complete optional teaching for a different stable patient first
C. Address the case’s current physiologic or transmission-safety threat
D. Stable patient requesting replacement bed linen
4. Generate solutions. Which outcome is most relevant for the plan?
A. Obtain a complete routine history before any safety measures are started
B. Improving mental status and perfusion without new respiratory compromise
C. Complete the full discharge-teaching checklist before the current concern is
controlled
D. Restore the usual activity schedule regardless of the new findings
,5. Take action. Which response best addresses the current case?
A. Assess airway breathing and circulation and activate urgent clinical help while
staying with the patient
B. Wait until the next shift without reassessment
C. Ask an unlicensed assistant to make the initial clinical assessment and treatment
decision
D. Send the dizzy patient to walk unassisted to obtain a standing weight
,Case 1 questions continued
6. Evaluate outcomes. Which result best supports progress toward the goal?
A. BP falls further and the patient becomes less responsive
B. A routine unrelated request is completed
C. A form is signed but the patient or safety status is not reassessed
D. Mental status improves and BP rises toward baseline with appropriate
treatment
7. Delegation. Which task is suitable for trained support personnel when permitted
by policy?
A. Decide which emergency treatment to prescribe
B. Perform the RN’s initial clinical evaluation and decide whether escalation is
necessary
C. Ask trained support staff to bring the emergency equipment while the RN
assesses
D. Independently diagnose the current problem
8. Communication. Which handoff best conveys the relevant concern?
A. Report an assumed diagnosis without the supporting findings
B. Report Vomiting, BP 86/50, pulse 122, new confusion and reduced output and
state the current response and request
C. Say only that the patient is probably fine
D. Report only the patient’s room number
9. Safety check. Which proposed action should the RN stop or correct?
A. Send the dizzy patient to walk unassisted to obtain a standing weight
B. Reassess the relevant patient findings
C. Communicate objective findings to the appropriate clinician
D. Use the facility’s applicable emergency or safety protocol
10. Reassess and revise. The patient now shows this change: BP falls further and
the patient becomes less responsive. What should the RN do?
A. Continue the original plan without informing anyone
B. Document the change only after the next routine round
C. Ask support staff to decide whether deterioration matters
D. Immediately reassess, escalate the new deterioration and update care through
the authorised pathway
, Case 2 New breathlessness during fluid therapy
A 70-year-old adult with a history of heart failure is receiving a prescribed IV fluid
infusion. The patient develops new breathlessness, bilateral crackles and oxygen
saturation of 88%, down from 96%. The patient is awake and distressed. A nursing
assistant is nearby. The unit has a rapid escalation pathway.
Use the facts provided. Unless stated otherwise, treat each question as referring to
the original case, not to hypothetical changes introduced in other questions. The
final item introduces its own new deterioration.
11. Recognise cues. Which finding most directly requires attention in this case?
A. An unchanged preference for the room lighting
B. The usual breakfast choice from yesterday
C. An old administrative appointment entry
D. New breathlessness with crackles and falling oxygen saturation
12. Analyse cues. Which interpretation best links the case findings?
A. Anxiety alone explains the entire pattern
B. The heart-failure history means the findings need no new review
C. Possible fluid-related pulmonary congestion with impaired oxygenation
D. The infusion proves fluid deficit is still the only problem
13. Prioritise. Which need should guide the RN’s attention before routine
nonurgent tasks?
A. Complete optional teaching for a different stable patient first
B. Address the case’s current physiologic or transmission-safety threat
C. Stable patient requesting the television remote
D. Finish routine filing before responding
14. Generate solutions. Which outcome is most relevant for the plan?
A. Breathing and oxygenation improve without worsening fluid-related signs
B. Complete the full discharge-teaching checklist before the current concern is
controlled
C. Restore the usual activity schedule regardless of the new findings
D. Obtain a complete routine history before any safety measures are started
15. Take action. Which response best addresses the current case?
A. Wait until the next shift without reassessment
B. Ask an unlicensed assistant to make the initial clinical assessment and treatment
decision
C. Increase the infusion rate because breathlessness must mean dehydration
Studies & 100 Questions | Prioritization, Delegation & Detailed
Answer Rationales 2026/2027
Case 1 Fluid loss and falling perfusion
A 76-year-old adult has had vomiting and poor intake for two days. Previously
alert, the patient is now confused and dizzy. BP is 86/50 mm Hg, pulse
122/minute, and urine output has fallen. Mucous membranes are dry. The RN is at
the bedside; an emergency response team is available.
Use the facts provided. Unless stated otherwise, treat each question as referring to
the original case, not to hypothetical changes introduced in other questions. The
final item introduces its own new deterioration.
1. Recognise cues. Which finding most directly requires attention in this case?
A. New confusion with BP 86/50 and falling urine output
B. An unchanged preference for the room lighting
C. The usual breakfast choice from yesterday
D. An old administrative appointment entry
2. Analyse cues. Which interpretation best links the case findings?
A. Fluid overload is the leading explanation
B. The change is merely the patient’s usual cognitive baseline
C. Orthostatic symptoms can be managed by walking practice alone
D. Possible impaired perfusion associated with fluid-volume loss
3. Prioritise. Which need should guide the RN’s attention before routine nonurgent
tasks?
A. Finish routine filing before responding
B. Complete optional teaching for a different stable patient first
C. Address the case’s current physiologic or transmission-safety threat
D. Stable patient requesting replacement bed linen
4. Generate solutions. Which outcome is most relevant for the plan?
A. Obtain a complete routine history before any safety measures are started
B. Improving mental status and perfusion without new respiratory compromise
C. Complete the full discharge-teaching checklist before the current concern is
controlled
D. Restore the usual activity schedule regardless of the new findings
,5. Take action. Which response best addresses the current case?
A. Assess airway breathing and circulation and activate urgent clinical help while
staying with the patient
B. Wait until the next shift without reassessment
C. Ask an unlicensed assistant to make the initial clinical assessment and treatment
decision
D. Send the dizzy patient to walk unassisted to obtain a standing weight
,Case 1 questions continued
6. Evaluate outcomes. Which result best supports progress toward the goal?
A. BP falls further and the patient becomes less responsive
B. A routine unrelated request is completed
C. A form is signed but the patient or safety status is not reassessed
D. Mental status improves and BP rises toward baseline with appropriate
treatment
7. Delegation. Which task is suitable for trained support personnel when permitted
by policy?
A. Decide which emergency treatment to prescribe
B. Perform the RN’s initial clinical evaluation and decide whether escalation is
necessary
C. Ask trained support staff to bring the emergency equipment while the RN
assesses
D. Independently diagnose the current problem
8. Communication. Which handoff best conveys the relevant concern?
A. Report an assumed diagnosis without the supporting findings
B. Report Vomiting, BP 86/50, pulse 122, new confusion and reduced output and
state the current response and request
C. Say only that the patient is probably fine
D. Report only the patient’s room number
9. Safety check. Which proposed action should the RN stop or correct?
A. Send the dizzy patient to walk unassisted to obtain a standing weight
B. Reassess the relevant patient findings
C. Communicate objective findings to the appropriate clinician
D. Use the facility’s applicable emergency or safety protocol
10. Reassess and revise. The patient now shows this change: BP falls further and
the patient becomes less responsive. What should the RN do?
A. Continue the original plan without informing anyone
B. Document the change only after the next routine round
C. Ask support staff to decide whether deterioration matters
D. Immediately reassess, escalate the new deterioration and update care through
the authorised pathway
, Case 2 New breathlessness during fluid therapy
A 70-year-old adult with a history of heart failure is receiving a prescribed IV fluid
infusion. The patient develops new breathlessness, bilateral crackles and oxygen
saturation of 88%, down from 96%. The patient is awake and distressed. A nursing
assistant is nearby. The unit has a rapid escalation pathway.
Use the facts provided. Unless stated otherwise, treat each question as referring to
the original case, not to hypothetical changes introduced in other questions. The
final item introduces its own new deterioration.
11. Recognise cues. Which finding most directly requires attention in this case?
A. An unchanged preference for the room lighting
B. The usual breakfast choice from yesterday
C. An old administrative appointment entry
D. New breathlessness with crackles and falling oxygen saturation
12. Analyse cues. Which interpretation best links the case findings?
A. Anxiety alone explains the entire pattern
B. The heart-failure history means the findings need no new review
C. Possible fluid-related pulmonary congestion with impaired oxygenation
D. The infusion proves fluid deficit is still the only problem
13. Prioritise. Which need should guide the RN’s attention before routine
nonurgent tasks?
A. Complete optional teaching for a different stable patient first
B. Address the case’s current physiologic or transmission-safety threat
C. Stable patient requesting the television remote
D. Finish routine filing before responding
14. Generate solutions. Which outcome is most relevant for the plan?
A. Breathing and oxygenation improve without worsening fluid-related signs
B. Complete the full discharge-teaching checklist before the current concern is
controlled
C. Restore the usual activity schedule regardless of the new findings
D. Obtain a complete routine history before any safety measures are started
15. Take action. Which response best addresses the current case?
A. Wait until the next shift without reassessment
B. Ask an unlicensed assistant to make the initial clinical assessment and treatment
decision
C. Increase the infusion rate because breathlessness must mean dehydration
