Next Generation NCLEX NGN Exam

Next Generation NCLEX (NGN) Exam 2025/2026 Edition Clinical Judgment Questions & Answers

Section 1: Introduction

This document features a cu and set of Next Generation NCLEX (NGN) exam questions, reflecting the 2025/2026 NCSBN blueprint. It includes advanced clinical judgment scenarios using NGN item types such as case studies, bowtie questions, matrix/grid, cloze (drop-down), and multiple-response formats. Content areas span across the nursing process, prioritization, delegation, safety, pharmacology, patient education, and evidence-based interventions, designed to evaluate decision-making skills under realistic clinical conditions. Each response is and , making this resource essential for NCLEX-RN and NCLEX-PN candidates preparing under the NGN framework.

Section 2: Exam Questions and Answers

Format: NGN-style case scenarios and performance-based items

Correct answer highlighted Rationales provided to reinforce NCSBN’s Clinical Judgment Measurement Model

(CJMM)

• A patient presents with sudden chest pain, diaphoresis, and shortness of breath. Vital

signs: BP 160/90 mmHg, HR 110 bpm, RR 24/min, SpO2 92%. Which action should

the nurse take first?(a) Administer oxygen via nasal cannula (b) Obtain an electrocardiogram (ECG) (c) Provide a nitroglycerin tablet (d) Assess pain level using a scale Rationale: Per CJMM, recognizing cues (chest pain, vital signs) prioritizes ECG to identify potential myocardial infarction.

• A patient is 2 hours post-appendectomy. Condition: Pain 7/10, temp 38.2°C, incision

site red. What is the priority nursing action (left side) and potential complication to monitor (right side)?(a) Administer analgesics Infection (b) Assess incision site Wound infection (c) Increase IV fluids Hypothermia (d) Encourage ambulation Bleeding Rationale: CJMM emphasizes assessing cues (redness, fever) to prioritize incision evaluation.

3. Match the medication to its primary use:

(a) Furosemide Diuretic (b) Morphine Pain management (c) Warfarin Anticoagulant (d) Insulin Blood glucose control Rationale: CJMM supports analyzing medication purpose for safe administration. 1 / 3

• A 3-year-old with vomiting has dry mucous membranes and no tears. The nurse

should initiate ____ (a) IV fluids, (b) oral rehydration, (c) oxygen therapy, (d) IV fluids.

Rationale: CJMM guides prioritizing IV fluids for severe dehydration.

5. Select all actions to prevent falls in an elderly patient with dementia:

(a) Keep bed in low position (b) Ensure call bell within reach (c) Use non-slip footwear (d) Leave room lights off

Rationale: CJMM supports multiple fall prevention strategies.

• A patient with DKA has blood glucose 450 mg/dL, pH 7.1, and Kussmaul

respirations. What is the nurse’s next action?(a) Administer oral glucose (b) Start IV insulin drip (c) Encourage deep breathing (d) Discontinue IV fluids

Rationale: CJMM prioritizes insulin for acidosis correction.

• A patient 1 hour postpartum has soaked 2 pads and BP 90/60 mmHg. Priority action

(left side) and complication (right side)?(a) Monitor vital signs Infection (b) Notify physician Hemorrhagic shock (c) Encourage ambulation Clot formation (d) Administer oxytocin Uterine atony

Rationale: CJMM recognizes severe bleeding as urgent.

8. Match the task to the healthcare team member:

(a) Insert Foley catheter Registered Nurse (b) Take vital signs Licensed Practical Nurse (c) Administer IV medication Registered Nurse (d) Assist with bathing Nursing Assistant

Rationale: CJMM aligns delegation with scope.

• A patient with wheezing has SpO2 88%. The nurse should administer ____ (a)

nebulized albuterol, (b) IV antibiotics, (c) oral corticosteroids, (d) nebulized albuterol.

Rationale: CJMM prioritizes bronchodilation for airway relief.

10. Select all measures to prevent hospital-acquired infections:

(a) Hand hygiene (b) Use of personal protective equipment (c) Sharing needles (d) Sterile technique

Rationale: CJMM emphasizes infection control measures.

• A patient exhibits facial droop and slurred speech. Time since onset is 1 hour. What is

the nurse’s priority?(a) Perform a full physical exam (b) Activate stroke protocol (c) Administer antipyretics (d) Encourage oral fluids

Rationale: CJMM prioritizes rapid stroke response.

• A patient is diaphoretic with a blood glucose of 50 mg/dL. Priority action (left side)

and complication (right side)?(a) Administer IV fluids Hyperglycemia (b) Provide oral glucose Seizure 2 / 3

(c) Monitor vital signs Dehydration (d) Encourage ambulation Coma

Rationale: CJMM corrects hypoglycemia to prevent seizures.

13. Match the topic to the patient condition:

(a) Diabetes management Insulin administration (b) Hypertension Low-sodium diet (c) Asthma Peak flow monitoring (d) Heart failure Fluid restriction

Rationale: CJMM tailors education to needs.

• A patient with a 20% TBSA burn has a heart rate of 120 bpm. The nurse should

prioritize ____ (a) wound dressing, (b) pain management, (c) fluid resuscitation, (d) antibiotic therapy.

Rationale: CJMM prioritizes fluid for burn shock.

15. Select all actions to ensure medication safety:

(a) Verify patient identity (b) Check for allergies (c) Administer expired medication (d) Document administration

Rationale: CJMM ensures multiple safety checks.

• A patient with a fever of 39°C and WBC 18,000/mm³ requires intervention. What is

the nurse’s first action?(a) Administer antipyretics (b) Obtain blood cultures (c) Increase oxygen flow (d) Encourage fluids

Rationale: CJMM prioritizes infection identification.

• A patient with cough and crackles has SpO2 90%. Priority action (left side) and

complication (right side)?(a) Administer antibiotics Respiratory failure (b) Administer oxygen Hypoxemia (c) Encourage ambulation Dehydration (d) Monitor temperature Sepsis

Rationale: CJMM addresses hypoxemia with oxygen.

18. Match the patient need to the priority level:

(a) Chest pain High (b) Fever Low (c) Difficulty breathing High (d) Routine dressing change Low

Rationale: CJMM prioritizes life-threatening cues.

• A patient with ST-elevation on ECG needs ____ (a) beta-blockers, (b) aspirin, (c)

diuretics, (d) anticoagulants.

Rationale: CJMM supports aspirin for MI.

20. Select all tasks a nurse can delegate to a nursing assistant:

(a) Assist with ambulation (b) Measure vital signs (c) Administer IV medications (d) Provide hygiene care

Rationale: CJMM aligns with scope of practice.

• A patient with hives and wheezing after penicillin reports difficulty breathing. What is

the nurse’s priority?

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