New Generation Nclex Rn Exam 2026/27
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Q1. Bowtie Question
A client with heart failure presents with crackles in lung
bases, SpO2 88%, and 3+ pitting edema.
Intervention Outcome
Problem (1)
(2) (3)
A. Fluid A. Lasix IV A. SpO2
overload push >94%
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Intervention Outcome
Problem (1)
(2) (3)
B. Fluid
B. B. Weight
restriction
Hypovolemia loss 2kg
1L/day
Answer: Problem A, Intervention A, Outcome A
Rationale: Fluid overload causes crackles & edema. IV Lasix
rapidly reduces preload. Target SpO2 >94% indicates
improved oxygenation.
Q2. Matrix Multiple Response (Select all that apply)
A nurse is assessing a client with suspected appendicitis.
Which findings are consistent?
1. Rebound tenderness at RLQ
2. Pain relieved after vomiting
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3. Low-grade fever
4. Sudden relief of pain with rigid abdomen
5. Anorexia
Answer: 1, 3, 5
Rationale: Rebound tenderness (Blumberg sign), low-grade
fever, and anorexia are classic. Sudden pain relief with
rigidity suggests perforation (peritonitis). Vomiting typically
does not relieve pain.
Q3. Drag and Drop (Ordered Response)
Place in correct order the steps for donning PPE for a patient
on airborne precautions:
A. Gloves
B. Gown
C. N95 mask
D. Eye goggles
E. Hand hygiene
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Answer: E → B → C → D → A
Rationale: Hand hygiene first, then gown, then mask (N95),
then eye protection, then gloves.
Q4. Case Study (Partial)
A 72-year-old with COPD is admitted with confusion,
headache, and bounding pulse. ABG: pH 7.28, PaCO2 68,
HCO3 26.
What is the priority nursing action?
A. Apply O2 at 2L nasal cannula
B. Prepare for intubation
C. Encourage deep breathing
D. Administer sodium bicarbonate
Answer: A
Rationale: This is acute hypercapnic respiratory failure.
Low-flow O2 is priority to avoid eliminating hypoxic drive.
Intubation if fails.