ESTUDYR
NCLEX-RN NGN Standalone Questions | Bowtie,
Matrix, Cloze
Introduction
This question bank is specifically designed to provide targeted practice for Next Generation
NCLEX (NGN) standalone item types, including Bowtie, Matrix/Grid, and Cloze (Drop-down)
questions. These innovative formats assess clinical judgment and critical thinking skills
essential for safe and effective nursing practice. Each question is accompanied by a detailed
rationale and aligned with the Clinical Judgment Measurement Model (NCJMM) steps to
enhance understanding and preparation for the NCLEX-RN 2026.
Question Types Included
This question bank includes three primary NGN standalone item types:
• Bowtie Items require the identification of a central condition, two appropriate
actions a nurse would take, and two critical parameters a nurse would monitor. This
format assesses the ability to connect a client's condition with relevant interventions
and monitoring.
• Matrix/Grid Items present a clinical scenario and require the selection of
appropriate options (e.g., Expected, Concerning, Urgent; Appropriate, Inappropriate,
Contraindicated) across multiple findings or interventions. This format evaluates the
ability to differentiate and prioritize clinical information.
• Cloze (Drop-down) Items involve completing a clinical statement by selecting the
most appropriate option from a drop-down list for each blank. This format assesses
knowledge application and clinical reasoning in specific contexts.
,ESTUDYR
Questions
Bowtie Questions
Question 1: Bowtie Item (Acute Asthma Exacerbation)
A 28-year-old client presents to the emergency department with severe shortness of breath,
wheezing, and chest tightness. They have a history of asthma and report using their
albuterol inhaler every 2 hours without relief. Vital signs: HR 110 bpm, RR 30 breaths/min,
BP 130/85 mmHg, SpO2 89% on room air. Lung sounds reveal diffuse inspiratory and
expiratory wheezing.
Instructions: Drag the most likely condition, two actions the nurse would take, and two
parameters the nurse would monitor to the boxes below.
Condition (1) Actions to Take (2) Parameters to Monitor (2)
Acute Asthma Exacerbation Administer nebulized albuterol SpO2
Elevate head of bed Peak Expiratory Flow (PEF)
Options:
• Conditions: Pneumonia, Acute Asthma Exacerbation, Pulmonary Embolism, Heart
Failure Exacerbation
• Actions to Take: Administer oral corticosteroids, Administer nebulized albuterol,
Administer IV fluids, Elevate head of bed, Prepare for intubation, Obtain sputum
culture
• Parameters to Monitor: Temperature, Blood Glucose, SpO2, Peak Expiratory Flow
(PEF), Urine Output, Pain Level
Correct Answers:
• Condition: Acute Asthma Exacerbation
• Actions to Take: Administer nebulized albuterol, Elevate head of bed
• Parameters to Monitor: SpO2, Peak Expiratory Flow (PEF)
Rationale: The client's history of asthma, severe shortness of breath, wheezing, and low
SpO2 are classic signs of an acute asthma exacerbation. Nebulized albuterol is a first-line
bronchodilator for acute relief, and elevating the head of the bed improves lung expansion.
,ESTUDYR
Monitoring SpO2 assesses oxygenation, and Peak Expiratory Flow (PEF) measures airway
obstruction and response to treatment.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Analysis, Application
• Item Type: Bowtie
• Estimated Difficulty: Moderate
• Source/Reference: Respiratory nursing, emergency care guidelines.
Question 2: Bowtie Item (Diabetic Ketoacidosis)
A 35-year-old client with Type 1 Diabetes Mellitus is admitted to the emergency department
with severe hyperglycemia, Kussmaul respirations, and fruity breath odor. Laboratory
results show blood glucose 580 mg/dL, pH 7.20, HCO3 12 mEq/L. The client is lethargic and
reports abdominal pain.
Instructions: Drag the most likely condition, two actions the nurse would take, and two
parameters the nurse would monitor to the boxes below.
Condition (1) Actions to Take (2) Parameters to Monitor (2)
Diabetic Ketoacidosis Administer IV fluids Blood Glucose
Administer IV insulin Electrolytes (K+)
Options:
• Conditions: Hyperosmolar Hyperglycemic State (HHS), Diabetic Ketoacidosis,
Hypoglycemia, Lactic Acidosis
• Actions to Take: Administer oral glucose, Administer IV fluids, Administer IV insulin,
Administer sodium bicarbonate, Prepare for dialysis, Obtain urine culture
• Parameters to Monitor: Urine Output, Blood Glucose, Blood Pressure, Electrolytes
(K+), Temperature, White Blood Cell Count
Correct Answers:
• Condition: Diabetic Ketoacidosis
• Actions to Take: Administer IV fluids, Administer IV insulin
• Parameters to Monitor: Blood Glucose, Electrolytes (K+)
, ESTUDYR
Rationale: The client's history of Type 1 DM, severe hyperglycemia, Kussmaul respirations,
fruity breath, and acidotic ABG results are classic for Diabetic Ketoacidosis (DKA). Initial
management involves aggressive IV fluid resuscitation to correct dehydration and IV insulin
to lower blood glucose and reverse acidosis. Close monitoring of blood glucose is essential
to guide insulin titration, and electrolytes, particularly potassium, must be monitored due to
shifts caused by insulin and fluid administration.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Analysis, Application
• Item Type: Bowtie
• Estimated Difficulty: Hard
• Source/Reference: Endocrine nursing, emergency care guidelines.
Matrix/Grid Questions
Question 3: Matrix/Grid Item (Post-operative Assessment)
A 68-year-old client is 2 hours post-operative following a total hip arthroplasty. The nurse is
performing the initial post-operative assessment. The client is awake and alert, reports pain
of 5/10, and has an epidural infusion running. Vital signs: HR 88 bpm, RR 16 breaths/min, BP
128/78 mmHg, SpO2 96% on 2L nasal cannula. Surgical dressing is intact with a small
amount of serosanguinous drainage. Pedal pulses are 2+ bilaterally. The client is unable to
move the affected leg.
Instructions: For each finding, click to specify if it is an Expected Finding, a Concerning
Finding, or an Urgent Finding that requires immediate intervention.
Finding Expected Finding Concerning Finding Urgent Finding
Pain of 5/10 X
SpO2 96% on 2L nasal cannula X
Inability to move affected leg X
Small amount of serosanguinous drainage X
Pedal pulses 2+ bilaterally X
NCLEX-RN NGN Standalone Questions | Bowtie,
Matrix, Cloze
Introduction
This question bank is specifically designed to provide targeted practice for Next Generation
NCLEX (NGN) standalone item types, including Bowtie, Matrix/Grid, and Cloze (Drop-down)
questions. These innovative formats assess clinical judgment and critical thinking skills
essential for safe and effective nursing practice. Each question is accompanied by a detailed
rationale and aligned with the Clinical Judgment Measurement Model (NCJMM) steps to
enhance understanding and preparation for the NCLEX-RN 2026.
Question Types Included
This question bank includes three primary NGN standalone item types:
• Bowtie Items require the identification of a central condition, two appropriate
actions a nurse would take, and two critical parameters a nurse would monitor. This
format assesses the ability to connect a client's condition with relevant interventions
and monitoring.
• Matrix/Grid Items present a clinical scenario and require the selection of
appropriate options (e.g., Expected, Concerning, Urgent; Appropriate, Inappropriate,
Contraindicated) across multiple findings or interventions. This format evaluates the
ability to differentiate and prioritize clinical information.
• Cloze (Drop-down) Items involve completing a clinical statement by selecting the
most appropriate option from a drop-down list for each blank. This format assesses
knowledge application and clinical reasoning in specific contexts.
,ESTUDYR
Questions
Bowtie Questions
Question 1: Bowtie Item (Acute Asthma Exacerbation)
A 28-year-old client presents to the emergency department with severe shortness of breath,
wheezing, and chest tightness. They have a history of asthma and report using their
albuterol inhaler every 2 hours without relief. Vital signs: HR 110 bpm, RR 30 breaths/min,
BP 130/85 mmHg, SpO2 89% on room air. Lung sounds reveal diffuse inspiratory and
expiratory wheezing.
Instructions: Drag the most likely condition, two actions the nurse would take, and two
parameters the nurse would monitor to the boxes below.
Condition (1) Actions to Take (2) Parameters to Monitor (2)
Acute Asthma Exacerbation Administer nebulized albuterol SpO2
Elevate head of bed Peak Expiratory Flow (PEF)
Options:
• Conditions: Pneumonia, Acute Asthma Exacerbation, Pulmonary Embolism, Heart
Failure Exacerbation
• Actions to Take: Administer oral corticosteroids, Administer nebulized albuterol,
Administer IV fluids, Elevate head of bed, Prepare for intubation, Obtain sputum
culture
• Parameters to Monitor: Temperature, Blood Glucose, SpO2, Peak Expiratory Flow
(PEF), Urine Output, Pain Level
Correct Answers:
• Condition: Acute Asthma Exacerbation
• Actions to Take: Administer nebulized albuterol, Elevate head of bed
• Parameters to Monitor: SpO2, Peak Expiratory Flow (PEF)
Rationale: The client's history of asthma, severe shortness of breath, wheezing, and low
SpO2 are classic signs of an acute asthma exacerbation. Nebulized albuterol is a first-line
bronchodilator for acute relief, and elevating the head of the bed improves lung expansion.
,ESTUDYR
Monitoring SpO2 assesses oxygenation, and Peak Expiratory Flow (PEF) measures airway
obstruction and response to treatment.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Analysis, Application
• Item Type: Bowtie
• Estimated Difficulty: Moderate
• Source/Reference: Respiratory nursing, emergency care guidelines.
Question 2: Bowtie Item (Diabetic Ketoacidosis)
A 35-year-old client with Type 1 Diabetes Mellitus is admitted to the emergency department
with severe hyperglycemia, Kussmaul respirations, and fruity breath odor. Laboratory
results show blood glucose 580 mg/dL, pH 7.20, HCO3 12 mEq/L. The client is lethargic and
reports abdominal pain.
Instructions: Drag the most likely condition, two actions the nurse would take, and two
parameters the nurse would monitor to the boxes below.
Condition (1) Actions to Take (2) Parameters to Monitor (2)
Diabetic Ketoacidosis Administer IV fluids Blood Glucose
Administer IV insulin Electrolytes (K+)
Options:
• Conditions: Hyperosmolar Hyperglycemic State (HHS), Diabetic Ketoacidosis,
Hypoglycemia, Lactic Acidosis
• Actions to Take: Administer oral glucose, Administer IV fluids, Administer IV insulin,
Administer sodium bicarbonate, Prepare for dialysis, Obtain urine culture
• Parameters to Monitor: Urine Output, Blood Glucose, Blood Pressure, Electrolytes
(K+), Temperature, White Blood Cell Count
Correct Answers:
• Condition: Diabetic Ketoacidosis
• Actions to Take: Administer IV fluids, Administer IV insulin
• Parameters to Monitor: Blood Glucose, Electrolytes (K+)
, ESTUDYR
Rationale: The client's history of Type 1 DM, severe hyperglycemia, Kussmaul respirations,
fruity breath, and acidotic ABG results are classic for Diabetic Ketoacidosis (DKA). Initial
management involves aggressive IV fluid resuscitation to correct dehydration and IV insulin
to lower blood glucose and reverse acidosis. Close monitoring of blood glucose is essential
to guide insulin titration, and electrolytes, particularly potassium, must be monitored due to
shifts caused by insulin and fluid administration.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Analysis, Application
• Item Type: Bowtie
• Estimated Difficulty: Hard
• Source/Reference: Endocrine nursing, emergency care guidelines.
Matrix/Grid Questions
Question 3: Matrix/Grid Item (Post-operative Assessment)
A 68-year-old client is 2 hours post-operative following a total hip arthroplasty. The nurse is
performing the initial post-operative assessment. The client is awake and alert, reports pain
of 5/10, and has an epidural infusion running. Vital signs: HR 88 bpm, RR 16 breaths/min, BP
128/78 mmHg, SpO2 96% on 2L nasal cannula. Surgical dressing is intact with a small
amount of serosanguinous drainage. Pedal pulses are 2+ bilaterally. The client is unable to
move the affected leg.
Instructions: For each finding, click to specify if it is an Expected Finding, a Concerning
Finding, or an Urgent Finding that requires immediate intervention.
Finding Expected Finding Concerning Finding Urgent Finding
Pain of 5/10 X
SpO2 96% on 2L nasal cannula X
Inability to move affected leg X
Small amount of serosanguinous drainage X
Pedal pulses 2+ bilaterally X
