NGN NCLEX-PN Exam ACTUAL
EXAM 2025/2026 | Newest Actual
Exam Test Bank | Next Generation
NCLEX | Verified Q&A | Pass
Guaranteed - A+ Graded
TREND: UNFOLDING CASE STUDIES (40
Questions Across 8 Cases)
TREND CASE 1: MEDICAL-SURGICAL — PNEUMONIA &
RESPIRATORY COMPROMISE
Scenario: A 72-year-old female is admitted to the medical-surgical unit with
community-acquired pneumonia. She has a history of hypertension and type 2 diabetes. Vital
signs: BP 142/88, HR 98, RR 24, SpO2 91% on room air, temperature 101.2°F (38.4°C). She is
alert and oriented but reports shortness of breath with minimal activity.
Item 1 (Extended Multiple Response)
Which cues from the scenario are most relevant to the client's immediate clinical
presentation? Select all that apply.
A. Age 72 years
B. Diagnosis of community-acquired pneumonia
C. Respiratory rate 24
D. SpO2 91% on room air
,E. Temperature 101.2°F (38.4°C)
F. History of hypertension
G. Shortness of breath with minimal activity
Correct Answer: C, D, E, G [CORRECT]
Rationale:
● C. Respiratory rate 24: Tachypnea (normal RR 12-20) indicates respiratory distress and
compensatory mechanism for hypoxemia. [CORRECT]
● D. SpO2 91% on room air: Hypoxemia (normal ≥95%) requires immediate intervention; this is
the priority physiological concern. [CORRECT]
● E. Temperature 101.2°F (38.4°C): Fever indicates active infection and increases metabolic
oxygen demands, worsening respiratory compromise. [CORRECT]
● G. Shortness of breath with minimal activity: Subjective indicator of respiratory
decompensation and decreased functional capacity. [CORRECT]
Incorrect options: Age (A), diagnosis (B), and hypertension history (F) are relevant
background data but not immediate clinical cues requiring urgent PN action. The PN must
recognize these immediate cues and report to the RN promptly.
NGN PN Note: CJMM Skill: Recognize Cues. The PN identifies objective and subjective data
indicating respiratory compromise. PN scope: Report SpO2 <92% and tachypnea to RN
immediately; do not independently initiate oxygen without RN direction unless standing orders
exist.
Item 2 (Bow-Tie)
Complete the bow-tie by selecting the most likely condition requiring priority intervention
(center), the most significant risk factor (left), the priority assessment (right top), and the
priority nursing action (right bottom).
Table
Risk Factor Condition Priority Assessment
[Dropdown 1] HYPoxemia [Dropdown 2]
, Priority Nursing Action
[Dropdown 3]
Dropdown Options:
● Dropdown 1 (Risk Factor): A. Age-related changes; B. Pneumonia causing impaired gas
exchange; C. History of diabetes; D. Hypertension
● Dropdown 2 (Priority Assessment): A. Blood glucose level; B. Oxygen saturation and
respiratory effort; C. Blood pressure trends; D. Pain level
● Dropdown 3 (Priority Action): A. Administer rapid-acting insulin; B. Apply supplemental
oxygen as prescribed and report findings to RN; C. Increase IV fluid rate independently; D.
Obtain ECG immediately
Correct Answer:
● Dropdown 1: B. Pneumonia causing impaired gas exchange [CORRECT]
● Dropdown 2: B. Oxygen saturation and respiratory effort [CORRECT]
● Dropdown 3: B. Apply supplemental oxygen as prescribed and report findings to RN
[CORRECT]
Rationale: The client's SpO2 91% and RR 24 indicate hypoxemia secondary to
pneumonia-related impaired gas exchange. The PN must assess oxygenation status
continuously and apply supplemental oxygen per standing orders or RN direction, then report
findings immediately. CJMM Skills: Prioritize Hypotheses (identifying hypoxemia as priority),
Take Action (oxygen application within PN scope).
NGN PN Note: PN scope allows oxygen administration per protocol/RN direction. The PN
cannot independently initiate oxygen without orders but must recognize hypoxemia urgency
and report immediately. This demonstrates clinical judgment in recognizing life-threatening
conditions.
Item 3 (Extended Drag and Drop - Ordered Response)
Place the following nursing actions in the correct order of priority for this client with
respiratory compromise.
Actions to Order:
A. Assess respiratory rate and oxygen saturation
B. Position client in high-Fowler's position
, C. Notify the RN of assessment findings
D. Encourage deep breathing and coughing
E. Document interventions and client response
Correct Order: A → B → C → D → E [CORRECT]
Rationale:
1. A. Assess respiratory rate and oxygen saturation: Assessment is always first to establish
baseline and identify severity. [CORRECT - 1st]
2. B. Position client in high-Fowler's position: Immediate independent nursing intervention to
maximize lung expansion (within PN scope). [CORRECT - 2nd]
3. C. Notify the RN of assessment findings: Report abnormal findings (SpO2 91%, RR 24) to
supervising RN for potential oxygen orders. [CORRECT - 3rd]
4. D. Encourage deep breathing and coughing: After positioning and RN notification, promote
airway clearance (collaborative intervention). [CORRECT - 4th]
5. E. Document interventions and client response: Documentation occurs after all interventions
are implemented. [CORRECT - 5th]
NGN PN Note: CJMM Skills: Recognize Cues → Analyze Cues → Take Action → Evaluate
Outcomes. This prioritization follows the ABCs (Airway, Breathing, Circulation) and PN scope
boundaries. The PN must report abnormal findings before implementing dependent
interventions.
Item 4 (Matrix/Grid)
Select the appropriate nursing action for each potential complication the PN might observe
during the shift.
Table
Appropriate PN
Potential Complication Rationale
Action
Respiratory distress progressing to respiratory [Select
[Select action]
failure rationale]
EXAM 2025/2026 | Newest Actual
Exam Test Bank | Next Generation
NCLEX | Verified Q&A | Pass
Guaranteed - A+ Graded
TREND: UNFOLDING CASE STUDIES (40
Questions Across 8 Cases)
TREND CASE 1: MEDICAL-SURGICAL — PNEUMONIA &
RESPIRATORY COMPROMISE
Scenario: A 72-year-old female is admitted to the medical-surgical unit with
community-acquired pneumonia. She has a history of hypertension and type 2 diabetes. Vital
signs: BP 142/88, HR 98, RR 24, SpO2 91% on room air, temperature 101.2°F (38.4°C). She is
alert and oriented but reports shortness of breath with minimal activity.
Item 1 (Extended Multiple Response)
Which cues from the scenario are most relevant to the client's immediate clinical
presentation? Select all that apply.
A. Age 72 years
B. Diagnosis of community-acquired pneumonia
C. Respiratory rate 24
D. SpO2 91% on room air
,E. Temperature 101.2°F (38.4°C)
F. History of hypertension
G. Shortness of breath with minimal activity
Correct Answer: C, D, E, G [CORRECT]
Rationale:
● C. Respiratory rate 24: Tachypnea (normal RR 12-20) indicates respiratory distress and
compensatory mechanism for hypoxemia. [CORRECT]
● D. SpO2 91% on room air: Hypoxemia (normal ≥95%) requires immediate intervention; this is
the priority physiological concern. [CORRECT]
● E. Temperature 101.2°F (38.4°C): Fever indicates active infection and increases metabolic
oxygen demands, worsening respiratory compromise. [CORRECT]
● G. Shortness of breath with minimal activity: Subjective indicator of respiratory
decompensation and decreased functional capacity. [CORRECT]
Incorrect options: Age (A), diagnosis (B), and hypertension history (F) are relevant
background data but not immediate clinical cues requiring urgent PN action. The PN must
recognize these immediate cues and report to the RN promptly.
NGN PN Note: CJMM Skill: Recognize Cues. The PN identifies objective and subjective data
indicating respiratory compromise. PN scope: Report SpO2 <92% and tachypnea to RN
immediately; do not independently initiate oxygen without RN direction unless standing orders
exist.
Item 2 (Bow-Tie)
Complete the bow-tie by selecting the most likely condition requiring priority intervention
(center), the most significant risk factor (left), the priority assessment (right top), and the
priority nursing action (right bottom).
Table
Risk Factor Condition Priority Assessment
[Dropdown 1] HYPoxemia [Dropdown 2]
, Priority Nursing Action
[Dropdown 3]
Dropdown Options:
● Dropdown 1 (Risk Factor): A. Age-related changes; B. Pneumonia causing impaired gas
exchange; C. History of diabetes; D. Hypertension
● Dropdown 2 (Priority Assessment): A. Blood glucose level; B. Oxygen saturation and
respiratory effort; C. Blood pressure trends; D. Pain level
● Dropdown 3 (Priority Action): A. Administer rapid-acting insulin; B. Apply supplemental
oxygen as prescribed and report findings to RN; C. Increase IV fluid rate independently; D.
Obtain ECG immediately
Correct Answer:
● Dropdown 1: B. Pneumonia causing impaired gas exchange [CORRECT]
● Dropdown 2: B. Oxygen saturation and respiratory effort [CORRECT]
● Dropdown 3: B. Apply supplemental oxygen as prescribed and report findings to RN
[CORRECT]
Rationale: The client's SpO2 91% and RR 24 indicate hypoxemia secondary to
pneumonia-related impaired gas exchange. The PN must assess oxygenation status
continuously and apply supplemental oxygen per standing orders or RN direction, then report
findings immediately. CJMM Skills: Prioritize Hypotheses (identifying hypoxemia as priority),
Take Action (oxygen application within PN scope).
NGN PN Note: PN scope allows oxygen administration per protocol/RN direction. The PN
cannot independently initiate oxygen without orders but must recognize hypoxemia urgency
and report immediately. This demonstrates clinical judgment in recognizing life-threatening
conditions.
Item 3 (Extended Drag and Drop - Ordered Response)
Place the following nursing actions in the correct order of priority for this client with
respiratory compromise.
Actions to Order:
A. Assess respiratory rate and oxygen saturation
B. Position client in high-Fowler's position
, C. Notify the RN of assessment findings
D. Encourage deep breathing and coughing
E. Document interventions and client response
Correct Order: A → B → C → D → E [CORRECT]
Rationale:
1. A. Assess respiratory rate and oxygen saturation: Assessment is always first to establish
baseline and identify severity. [CORRECT - 1st]
2. B. Position client in high-Fowler's position: Immediate independent nursing intervention to
maximize lung expansion (within PN scope). [CORRECT - 2nd]
3. C. Notify the RN of assessment findings: Report abnormal findings (SpO2 91%, RR 24) to
supervising RN for potential oxygen orders. [CORRECT - 3rd]
4. D. Encourage deep breathing and coughing: After positioning and RN notification, promote
airway clearance (collaborative intervention). [CORRECT - 4th]
5. E. Document interventions and client response: Documentation occurs after all interventions
are implemented. [CORRECT - 5th]
NGN PN Note: CJMM Skills: Recognize Cues → Analyze Cues → Take Action → Evaluate
Outcomes. This prioritization follows the ABCs (Airway, Breathing, Circulation) and PN scope
boundaries. The PN must report abnormal findings before implementing dependent
interventions.
Item 4 (Matrix/Grid)
Select the appropriate nursing action for each potential complication the PN might observe
during the shift.
Table
Appropriate PN
Potential Complication Rationale
Action
Respiratory distress progressing to respiratory [Select
[Select action]
failure rationale]
