NCLEX (NGN) Practice Exam: PN Fundamentals New 2026 Proctored Exam Next Generation NCLEX (NGN) Format | Practical Nursing Fundamentals

NCLEX (NGN) Practice Exam: PN Fundamentals New

2026 Proctored Exam

Next Generation NCLEX (NGN) Format | Practical

Nursing Fundamentals




Questions 1-85

Question 1 (Single Answer)

A practical nurse is preparing to administer morning medications to a client with
dysphagia. Which action should the nurse take FIRST?

 A. Crush all medications and mix with applesauce

 B. Assess the client's ability to swallow safely

 C. Offer the client a full glass of water with medications

 D. Administer medications via the intravenous route

✅ Correct Answer: B. Assess the client's ability to swallow safely

Rationale: Safety is the priority. Before administering any oral medication to a client
with dysphagia, the nurse must assess swallowing ability to prevent aspiration.
Crushing medications (A) may be inappropriate for extended-release or enteric-coated
formulations and requires a provider order. Offering water (C) without assessment
increases aspiration risk. IV administration (D) is not indicated unless ordered and does
not address the fundamental assessment need.



Question 2 (Select All That Apply)

,A practical nurse is caring for a client receiving enteral tube feedings. Which
interventions should the nurse include to prevent aspiration? Select all that apply.

 A. Keep the head of the bed elevated at least 30-45 degrees during feeding

 B. Check gastric residual volume every 4-6 hours per protocol

 C. Administer feedings at room temperature

 D. Verify tube placement before initiating feeding

 E. Flush the tube with 30 mL water before and after medication administration

✅ Correct Answers: A, B, D, E

Rationale: Elevating the head of bed (A) uses gravity to reduce reflux and aspiration
risk. Checking gastric residuals (B) helps identify delayed gastric emptying. Verifying
tube placement (D) is critical to ensure feeding enters the GI tract, not the lungs.
Flushing with water (E) maintains tube patency and prevents medication buildup. While
room temperature feedings (C) may improve comfort, this does not directly prevent
aspiration.



Question 3 (Case Study Part 1 of 4)

Scenario: A 78-year-old client is admitted with a stage 3 pressure injury on the sacrum.
The client has limited mobility, urinary incontinence, and a BMI of 17. The provider
orders a wound care consult and nutritional support.

Question 3: Which finding should the practical nurse report IMMEDIATELY to the RN?

 A. The wound bed appears pink with granulation tissue

 B. The client reports pain level of 3/10 at the wound site

 C. The client has a temperature of 38.5°C (101.3°F)

 D. The wound drainage is serosanguinous and moderate in amount

✅ Correct Answer: C. The client has a temperature of 38.5°C (101.3°F)

,Rationale: Fever is a systemic sign of infection, which is a critical complication of
pressure injuries requiring immediate intervention. Pink granulation tissue (A) indicates
healing. Mild pain (B) is expected with stage 3 injuries. Serosanguinous drainage (D) is
typical in the inflammatory/proliferative phases. Infection poses the greatest risk for
sepsis and delayed healing.



Question 4 (Case Study Part 2 of 4)

Continuing Scenario: The RN delegates wound care to the practical nurse.

Question 4: Which action by the practical nurse demonstrates appropriate delegation
acceptance?

 A. Performing the wound assessment and documenting findings independently

 B. Cleaning the wound with normal saline using clean technique

 C. Changing the wound dressing using sterile technique as directed

 D. Selecting a new dressing type based on wound appearance

✅ Correct Answer: C. Changing the wound dressing using sterile technique as
directed

Rationale: Practical nurses can perform sterile dressing changes within their scope
when delegated by an RN. Wound assessment (A) and dressing selection (D) require
RN-level judgment. Clean technique (B) is inappropriate for a stage 3 pressure injury,
which requires sterile technique to prevent infection.



Question 5 (Case Study Part 3 of 4)

Continuing Scenario: The client's family asks about preventing future pressure injuries
after discharge.

Question 5: Which instruction should the practical nurse include in discharge teaching?

 A. "Massage bony prominences daily to improve circulation"

 B. "Reposition the client every 2 hours while in bed"

,  C. "Use a donut-shaped cushion for sitting"

 D. "Limit fluid intake to reduce incontinence episodes"

✅ Correct Answer: B. "Reposition the client every 2 hours while in bed"

Rationale: Regular repositioning relieves pressure and is evidence-based for pressure
injury prevention. Massaging bony prominences (A) can cause tissue damage in at-risk
clients. Donut cushions (C) increase pressure on surrounding tissue and are
contraindicated. Limiting fluids (D) leads to dehydration and skin breakdown; adequate
hydration supports skin integrity.



Question 6 (Case Study Part 4 of 4)

Continuing Scenario: The practical nurse is evaluating the client's nutritional intake.

Question 6: Which finding indicates the nutritional intervention is effective?

 A. Client consumes 50% of meals without assistance

 B. Client's albumin level increases from 2.8 to 3.4 g/dL

 C. Client reports enjoying the provided supplements

 D. Client's weight remains stable for 3 days

✅ Correct Answer: B. Client's albumin level increases from 2.8 to 3.4 g/dL

Rationale: Albumin is a laboratory indicator of nutritional status and protein stores; an
increase suggests improved nutrition. Meal consumption percentage (A) and
supplement preference (C) are subjective and don't confirm physiological improvement.
Weight stability over 3 days (D) is too short a timeframe to evaluate nutritional
intervention effectiveness in a malnourished client.



Question 7 (Bow-Tie Item)

Scenario: A client with diabetes mellitus is scheduled for a fasting blood glucose test at
0700.