ESTUDYR
NCLEX-RN 2026 Next Generation CAT Simulation
Exam| Complete 85+ | Questions and Answers
With Rationales
This document outlines a sample full-length NCLEX-RN Computerized Adaptive Testing (CAT)
simulation exam, designed to replicate the actual testing environment and adhere to the
NCSBN 2026 Test Plan blueprint. The exam incorporates Next Generation NCLEX (NGN) item
types, including case studies and stand-alone NGN questions, alongside traditional multiple-
choice and select-all-that-apply (SATA) formats. Each question is accompanied by a detailed
rationale and metadata tags, aligning with the Clinical Judgment Measurement Model
(NCJMM) steps where applicable.
Exam Structure Overview (85-item )
Item Type Quantity Percentage (approx.)
NGN Case Study Items 18 (3 cases x 6 questions) 21%
Stand-alone NGN Items 8 9%
Traditional Items 59 70%
Total Scored Items 85 100%
Note: This example focuses on the scored items. Actual exams also include 15 unscored
pretest items.
,ESTUDYR
: A 72-year-old female presents to the emergency department with sudden
onset of severe right-sided abdominal pain, nausea, and vomiting. She reports a history of
gallstones. On examination, she is afebrile, heart rate 98 bpm, blood pressure 130/80
mmHg, respiratory rate 18. Abdominal assessment reveals guarding and rebound
tenderness in the right upper quadrant. Laboratory results show a white blood cell count
(WBC) of 14,000/mm³ (normal 4,500-11,000/mm³), amylase 180 U/L (normal 25-125 U/L),
and lipase 250 U/L (normal 0-160 U/L).
Question 1: Recognize Cues (NCJMM Step 1)
Which of the following findings are significant cues indicating an acute inflammatory
process in this patient? (Select all that apply.)
a) Sudden onset of severe right-sided abdominal pain
b) Nausea and vomiting
c) History of gallstones
d) WBC count of 14,000/mm³
e) Amylase 180 U/L
f) Lipase 250 U/L
Correct Answers: a, b, d, e, f
Rationale: (NCJMM Step 1 – Recognize Cues) The sudden onset of severe pain, nausea, and
vomiting are classic symptoms of an acute abdominal process. An elevated WBC count,
amylase, and lipase levels are all indicative of inflammation, particularly in the pancreas or
gallbladder. A history of gallstones (c) is a risk factor but not a direct cue of the current acute
inflammatory process.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Analysis
• Item Type: Extended Multiple Response (SATA)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, gastroenterology guidelines.
,ESTUDYR
Question 2: Analyze Cues (NCJMM Step 2)
Based on the presented cues, what is the most likely priority interpretation of the patient's
condition?
a) Acute cholecystitis
b) Acute pancreatitis
c) Biliary colic
d) Peritonitis
Correct Answer: b
Rationale: (NCJMM Step 2 – Analyze Cues) While acute cholecystitis (a) is possible given the
gallstone history and RUQ pain, the significantly elevated amylase and lipase levels strongly
point towards acute pancreatitis (b). Biliary colic (c) typically involves intermittent pain
without significant inflammatory markers. Peritonitis (d) is a serious complication that might
develop, but acute pancreatitis is the most direct interpretation of the current lab findings
combined with symptoms.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, gastroenterology guidelines.
Question 3: Prioritize Hypotheses (NCJMM Step 3)
Considering the most likely interpretation, which nursing diagnosis is the highest priority for
this patient?
a) Acute Pain related to pancreatic inflammation
b) Deficient Fluid Volume related to nausea and vomiting
c) Imbalanced Nutrition: Less Than Body Requirements related to inability to ingest food
d) Risk for Infection related to inflammatory process
Correct Answer: a
Rationale: (NCJMM Step 3 – Prioritize Hypotheses) Acute pain (a) is often severe in
pancreatitis and can lead to physiological stress and complications if not managed
effectively. While fluid volume deficit (b), imbalanced nutrition (c), and risk for infection (d)
, ESTUDYR
are all relevant, managing acute pain is typically the immediate priority to ensure patient
comfort and prevent further physiological deterioration.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Prioritization
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, pain management guidelines.
Question 4: Generate Solutions (NCJMM Step 4)
Which of the following interventions would be appropriate to include in the initial plan of
care for this patient? (Select all that apply.)
a) Administer intravenous fluids as prescribed
b) Administer opioid analgesics as prescribed
c) Maintain NPO status
d) Prepare for immediate surgical intervention
e) Encourage a low-fat diet
Correct Answers: a, b, c
Rationale: (NCJMM Step 4 – Generate Solutions) For acute pancreatitis, initial management
includes aggressive intravenous fluid resuscitation (a), pain control with opioid analgesics
(b), and maintaining NPO (nil per os) status (c) to rest the pancreas. Immediate surgical
intervention (d) is typically not indicated unless complications arise. A low-fat diet (e) is for
recovery, not initial acute management.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Application
• Item Type: Extended Multiple Response (SATA)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, pancreatitis management
protocols.
Question 5: Take Action (NCJMM Step 5)
The nurse administers prescribed intravenous fluids and opioid analgesics. Two hours later,
the patient reports pain is 4/10 (down from 8/10), but now complains of increasing
shortness of breath and has crackles in both lung bases. What is the nurse's priority action?
NCLEX-RN 2026 Next Generation CAT Simulation
Exam| Complete 85+ | Questions and Answers
With Rationales
This document outlines a sample full-length NCLEX-RN Computerized Adaptive Testing (CAT)
simulation exam, designed to replicate the actual testing environment and adhere to the
NCSBN 2026 Test Plan blueprint. The exam incorporates Next Generation NCLEX (NGN) item
types, including case studies and stand-alone NGN questions, alongside traditional multiple-
choice and select-all-that-apply (SATA) formats. Each question is accompanied by a detailed
rationale and metadata tags, aligning with the Clinical Judgment Measurement Model
(NCJMM) steps where applicable.
Exam Structure Overview (85-item )
Item Type Quantity Percentage (approx.)
NGN Case Study Items 18 (3 cases x 6 questions) 21%
Stand-alone NGN Items 8 9%
Traditional Items 59 70%
Total Scored Items 85 100%
Note: This example focuses on the scored items. Actual exams also include 15 unscored
pretest items.
,ESTUDYR
: A 72-year-old female presents to the emergency department with sudden
onset of severe right-sided abdominal pain, nausea, and vomiting. She reports a history of
gallstones. On examination, she is afebrile, heart rate 98 bpm, blood pressure 130/80
mmHg, respiratory rate 18. Abdominal assessment reveals guarding and rebound
tenderness in the right upper quadrant. Laboratory results show a white blood cell count
(WBC) of 14,000/mm³ (normal 4,500-11,000/mm³), amylase 180 U/L (normal 25-125 U/L),
and lipase 250 U/L (normal 0-160 U/L).
Question 1: Recognize Cues (NCJMM Step 1)
Which of the following findings are significant cues indicating an acute inflammatory
process in this patient? (Select all that apply.)
a) Sudden onset of severe right-sided abdominal pain
b) Nausea and vomiting
c) History of gallstones
d) WBC count of 14,000/mm³
e) Amylase 180 U/L
f) Lipase 250 U/L
Correct Answers: a, b, d, e, f
Rationale: (NCJMM Step 1 – Recognize Cues) The sudden onset of severe pain, nausea, and
vomiting are classic symptoms of an acute abdominal process. An elevated WBC count,
amylase, and lipase levels are all indicative of inflammation, particularly in the pancreas or
gallbladder. A history of gallstones (c) is a risk factor but not a direct cue of the current acute
inflammatory process.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Analysis
• Item Type: Extended Multiple Response (SATA)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, gastroenterology guidelines.
,ESTUDYR
Question 2: Analyze Cues (NCJMM Step 2)
Based on the presented cues, what is the most likely priority interpretation of the patient's
condition?
a) Acute cholecystitis
b) Acute pancreatitis
c) Biliary colic
d) Peritonitis
Correct Answer: b
Rationale: (NCJMM Step 2 – Analyze Cues) While acute cholecystitis (a) is possible given the
gallstone history and RUQ pain, the significantly elevated amylase and lipase levels strongly
point towards acute pancreatitis (b). Biliary colic (c) typically involves intermittent pain
without significant inflammatory markers. Peritonitis (d) is a serious complication that might
develop, but acute pancreatitis is the most direct interpretation of the current lab findings
combined with symptoms.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, gastroenterology guidelines.
Question 3: Prioritize Hypotheses (NCJMM Step 3)
Considering the most likely interpretation, which nursing diagnosis is the highest priority for
this patient?
a) Acute Pain related to pancreatic inflammation
b) Deficient Fluid Volume related to nausea and vomiting
c) Imbalanced Nutrition: Less Than Body Requirements related to inability to ingest food
d) Risk for Infection related to inflammatory process
Correct Answer: a
Rationale: (NCJMM Step 3 – Prioritize Hypotheses) Acute pain (a) is often severe in
pancreatitis and can lead to physiological stress and complications if not managed
effectively. While fluid volume deficit (b), imbalanced nutrition (c), and risk for infection (d)
, ESTUDYR
are all relevant, managing acute pain is typically the immediate priority to ensure patient
comfort and prevent further physiological deterioration.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Prioritization
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, pain management guidelines.
Question 4: Generate Solutions (NCJMM Step 4)
Which of the following interventions would be appropriate to include in the initial plan of
care for this patient? (Select all that apply.)
a) Administer intravenous fluids as prescribed
b) Administer opioid analgesics as prescribed
c) Maintain NPO status
d) Prepare for immediate surgical intervention
e) Encourage a low-fat diet
Correct Answers: a, b, c
Rationale: (NCJMM Step 4 – Generate Solutions) For acute pancreatitis, initial management
includes aggressive intravenous fluid resuscitation (a), pain control with opioid analgesics
(b), and maintaining NPO (nil per os) status (c) to rest the pancreas. Immediate surgical
intervention (d) is typically not indicated unless complications arise. A low-fat diet (e) is for
recovery, not initial acute management.
Metadata:
• Content Category: Physiological Adaptation
• Cognitive Level: Application
• Item Type: Extended Multiple Response (SATA)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, pancreatitis management
protocols.
Question 5: Take Action (NCJMM Step 5)
The nurse administers prescribed intravenous fluids and opioid analgesics. Two hours later,
the patient reports pain is 4/10 (down from 8/10), but now complains of increasing
shortness of breath and has crackles in both lung bases. What is the nurse's priority action?
