Next Generation NCLEX NGN Exam

Next Generation NCLEX (NGN) Exam | 2025/2026 Edition | Verified Clinical Judgment Questions & Answers | A+ Graded

Section 1: Introduction

This document features a curated and verified 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 100% correct and A+ graded, 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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