NCLEX-RN Next Generation (NGN) 2026
Comprehensive Practice Exam & Study
Guide Exam Correct 100 Questions And
Answers Graded A+
1. A nurse is assessing a client with heart failure. Which
finding is an early indicator of decreased cardiac output?
A) Jugular vein distention
B) Pulmonary crackles
C) Decreased urinary output
D) Hepatomegaly
Answer: C – Decreased urinary output
Rationale: As cardiac output falls, renal perfusion decreases,
leading to reduced urine output (often <30 mL/hr). JVD, crackles,
and hepatomegaly are later signs of fluid overload.
2. NGN Case Study – Part 1 (Questions 2-4)
*A 68-year-old male with COPD presents with worsening dyspnea,
productive cough, and confusion. Vital signs: HR 118, RR 32, BP
148/90, SpO2 86% on room air, temperature 38.9°C (102°F).*
Which assessment finding requires immediate intervention?
, A) Respiratory rate of 32
B) Temperature of 38.9°C
C) Confusion
D) Productive cough
Answer: C – Confusion
Rationale: Confusion in a COPD patient indicates hypercapnia or
hypoxia affecting cerebral function—a sign of respiratory failure.
While high RR and fever are concerning, confusion signals
impending decompensation.
3. (Same case) The nurse should prepare for which
intervention first?
A) Chest physiotherapy
B) Sputum culture
C) Non-invasive positive pressure ventilation (NIPPV)
D) Antipyretic administration
Answer: C – NIPPV (BiPAP)
Rationale: Acute hypercapnic respiratory failure in COPD is initially
managed with NIPPV to improve ventilation and reduce work of
breathing. ABGs would guide therapy.
4. (Same case) Which laboratory value is most concerning?
A) PaO2 55 mmHg
, B) PaCO2 68 mmHg
C) pH 7.30
D) HCO3 30 mEq/L
Answer: B – PaCO2 68 mmHg
Rationale: COPD patients normally have elevated PaCO2, but a
sudden rise to 68 with mental status change indicates acute-on-
chronic respiratory failure. pH 7.30 shows acidosis but is expected;
treatment targets lowering PaCO2.
5. NGN Bow-Tie Question
Fill in the blank: A client with major depressive disorder and SSRI
therapy reports headache, confusion, fever, and muscle rigidity. The
nurse suspects ____________ and should prepare to
administer ____________.
Answer: Serotonin syndrome ; Cyproheptadine
Rationale: Serotonin syndrome causes autonomic instability,
hyperthermia, and rigidity. Cyproheptadine (5-HT2 antagonist) is
the antidote. Stop the SSRI.
6. A nurse is delegating tasks to an LPN. Which task is
appropriate?
A) Initial admission assessment of a post-op patient
B) Administer IV push morphine to a patient in pain
, C) Insert a Foley catheter in a stable patient
D) Create the nursing care plan for a diabetic patient
Answer: C – Insert a Foley catheter
Rationale: LPNs can perform sterile procedures like catheter
insertion in stable patients. Initial assessments, IV push meds, and
care plan creation are RN responsibilities.
7. Which lab result most indicates heparin therapy is
therapeutic?
A) INR 2.0–3.0
B) aPTT 60–80 seconds (normal 25–35)
C) Platelets 150,000
D) PT 12–14 seconds
Answer: B – aPTT 60–80 seconds
Rationale: Heparin efficacy is monitored by aPTT; therapeutic
range is 1.5–2.5 times normal. INR monitors warfarin.
8. NGN Matrix: A client has the following ABGs: pH 7.25,
PaCO2 50, HCO3 24. Which row correctly identifies the
condition?
Row pH PaCO2 HCO3 Interpretation
A Low High Normal Respiratory acidosis
Comprehensive Practice Exam & Study
Guide Exam Correct 100 Questions And
Answers Graded A+
1. A nurse is assessing a client with heart failure. Which
finding is an early indicator of decreased cardiac output?
A) Jugular vein distention
B) Pulmonary crackles
C) Decreased urinary output
D) Hepatomegaly
Answer: C – Decreased urinary output
Rationale: As cardiac output falls, renal perfusion decreases,
leading to reduced urine output (often <30 mL/hr). JVD, crackles,
and hepatomegaly are later signs of fluid overload.
2. NGN Case Study – Part 1 (Questions 2-4)
*A 68-year-old male with COPD presents with worsening dyspnea,
productive cough, and confusion. Vital signs: HR 118, RR 32, BP
148/90, SpO2 86% on room air, temperature 38.9°C (102°F).*
Which assessment finding requires immediate intervention?
, A) Respiratory rate of 32
B) Temperature of 38.9°C
C) Confusion
D) Productive cough
Answer: C – Confusion
Rationale: Confusion in a COPD patient indicates hypercapnia or
hypoxia affecting cerebral function—a sign of respiratory failure.
While high RR and fever are concerning, confusion signals
impending decompensation.
3. (Same case) The nurse should prepare for which
intervention first?
A) Chest physiotherapy
B) Sputum culture
C) Non-invasive positive pressure ventilation (NIPPV)
D) Antipyretic administration
Answer: C – NIPPV (BiPAP)
Rationale: Acute hypercapnic respiratory failure in COPD is initially
managed with NIPPV to improve ventilation and reduce work of
breathing. ABGs would guide therapy.
4. (Same case) Which laboratory value is most concerning?
A) PaO2 55 mmHg
, B) PaCO2 68 mmHg
C) pH 7.30
D) HCO3 30 mEq/L
Answer: B – PaCO2 68 mmHg
Rationale: COPD patients normally have elevated PaCO2, but a
sudden rise to 68 with mental status change indicates acute-on-
chronic respiratory failure. pH 7.30 shows acidosis but is expected;
treatment targets lowering PaCO2.
5. NGN Bow-Tie Question
Fill in the blank: A client with major depressive disorder and SSRI
therapy reports headache, confusion, fever, and muscle rigidity. The
nurse suspects ____________ and should prepare to
administer ____________.
Answer: Serotonin syndrome ; Cyproheptadine
Rationale: Serotonin syndrome causes autonomic instability,
hyperthermia, and rigidity. Cyproheptadine (5-HT2 antagonist) is
the antidote. Stop the SSRI.
6. A nurse is delegating tasks to an LPN. Which task is
appropriate?
A) Initial admission assessment of a post-op patient
B) Administer IV push morphine to a patient in pain
, C) Insert a Foley catheter in a stable patient
D) Create the nursing care plan for a diabetic patient
Answer: C – Insert a Foley catheter
Rationale: LPNs can perform sterile procedures like catheter
insertion in stable patients. Initial assessments, IV push meds, and
care plan creation are RN responsibilities.
7. Which lab result most indicates heparin therapy is
therapeutic?
A) INR 2.0–3.0
B) aPTT 60–80 seconds (normal 25–35)
C) Platelets 150,000
D) PT 12–14 seconds
Answer: B – aPTT 60–80 seconds
Rationale: Heparin efficacy is monitored by aPTT; therapeutic
range is 1.5–2.5 times normal. INR monitors warfarin.
8. NGN Matrix: A client has the following ABGs: pH 7.25,
PaCO2 50, HCO3 24. Which row correctly identifies the
condition?
Row pH PaCO2 HCO3 Interpretation
A Low High Normal Respiratory acidosis
