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RN Comprehensive Practice Exam Next Generation NCLEX (NGN) Format
Total Questions: 60
Domains: Medical-Surgical, Pharmacology, Maternity,
Pediatrics, Mental Health, Leadership 2025
Case Study 1: Heart Failure (Questions 1–5)
Patient Profile:
Mr. Jones, 76 years old, admitted with shortness of breath, 3+ bilateral leg edema, fatigue. History includes hypertension and chronic heart failure (EF 30%).
Vital Signs:
BP 162/90, HR 104, RR 26, SpO₂ 89% on room air
Labs:
BNP 1400 pg/mL, Na 132 mmol/L, K 4.5 mmol/L, Creatinine 1.6 mg/dL
Orders:
Furosemide 40 mg IV BID 1 / 3
Low-sodium diet Oxygen at 2 L/min via nasal cannula
- Matrix/Grid – Select which findings require immediate follow-up
Finding Requires Follow-Up?BNP 1400 pg/mL Yes / No Sodium 132 mmol/L Yes / No SpO₂ 89% Yes / No Bilateral crackles in lungs Yes / No
: All require follow-up
Rationale: Findings indicate worsening heart failure and hypoxia.
- Multiple Response – Select all appropriate nursing interventions
- Elevate legs above heart
- Administer IV furosemide
- Restrict fluid intake
- Withhold potassium supplements
- Apply anti-embolism stockings
: A, B, C, E
Rationale: Appropriate for fluid overload. No indication to withhold potassium.
- / 3
- Dropdown – Based on the lab values, what is the client at risk for?
Select the best answer:
- Seizure activity
- Digoxin toxicity
- Hypernatremia
- Hyperglycemia
Correct Answer: B) Digoxin toxicity
Rationale: Impaired renal function increases risk of digoxin accumulation.
- Cloze – Which dietary instruction is appropriate?
"Because of your condition, we will provide a ______ diet."
Select one:
- High sodium
- Low potassium
- Low sodium
- / 3
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