Next Generation NCLEX (NGN) Practice Exam
ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Initial Presentation:
A 72-year-old male with chronic HF (EF 35%) presents to ED with
worsening SOB, orthopnea, and 2+ pitting edema in lower
extremities. VS: BP 160/94, HR 112, RR 28, O2 88% on room air,
temp 98.6°F. Lungs: crackles bilaterally to mid-fields. JVD noted.
Question 1 (Matrix/Multiple Response)
Select all interventions the nurse should implement immediately
(Select 3):
A. Place patient in high-Fowler's position
B. Administer IV furosemide as ordered
C. Restrict oral fluids to 500 mL/day
D. Apply continuous pulse oximetry
E. Encourage coughing and deep breathing
F. Prepare for immediate intubation
Rationale Q1:
, Correct: A, B, D – High-Fowler's reduces preload and
improves breathing (A). IV furosemide rapidly reduces fluid
overload (B). Continuous pulse ox monitors oxygenation
status (D).
Incorrect: C – Fluid restriction is typically 1.5-2L, not 500mL
(too extreme acutely). E – Not priority; patient is tachypneic
and fatigued. F – Not yet indicated (O2 88% can be managed
with supplemental O2 first).
Question 2 (Bowtie)
Complete the bowtie by selecting ONE condition, ONE
intervention, and ONE monitoring parameter for this patient.
Right Side Bottom
Left Side
Center (Priority (Priority (Monitorin
(Potential
Condition) Interventio g
Causes)
n) Parameter)
A. Increase
Acute
beta- A. Daily
A. Pneumonia decompensate
blocker weight
d HF
dose
B. B. Hourly
B. Pulmonary
Administer urine
embolism
O2 via NC output
, Right Side Bottom
Left Side
Center (Priority (Priority (Monitorin
(Potential
Condition) Interventio g
Causes)
n) Parameter)
C. Acute C. Start IV
decompensate nitroglyceri C. BNP level
d HF n
D. Cardiac D. Prepare D. Cardiac
tamponade for dialysis enzymes
Rationale Q2:
Center: Acute decompensated HF – Clinical picture
(crackles, JVD, edema, low EF) confirms HF exacerbation.
Right: Administer O2 via NC – Immediate oxygen to
maintain SpO2 >90% is first-line before diuretics.
Bottom: Hourly urine output – Critical to assess response
to diuretic therapy and prevent AKI.
Question 3 (Drag-and-Drop/Ordered Response)
Place the following actions in priority order (1=first, 5=last):
___ Administer IV furosemide 40 mg
___ Apply non-rebreather mask at 10 L/min
___ Obtain STAT chest X-ray
___ Auscultate lung sounds
___ Insert indwelling urinary catheter
, Rationale Q3:
1. Apply non-rebreather – Address hypoxemia first (SpO2
88%).
2. Auscultate lung sounds – Establish baseline before
interventions.
3. Administer IV furosemide – Reduce fluid overload after O2
started.
4. Insert urinary catheter – Monitor strict I&O after diuretic
given.
5. Obtain STAT CXR – Diagnostic but not emergent.
Question 4 (Multiple Response – Select N)
The nurse reviews morning labs (post-furosemide 12 hours).
Which findings require immediate notification to the provider?
(Select 2)
A. Potassium 3.1 mEq/L
B. BUN 42 mg/dL
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mg/dL
E. Glucose 110 mg/dL
Rationale Q4:
Correct: A and B – K+ 3.1 is severe hypokalemia (loop
diuretic side effect) → risk for dysrhythmias. BUN 42 indicates
prerenal azotemia (dehydration or poor perfusion).
ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Initial Presentation:
A 72-year-old male with chronic HF (EF 35%) presents to ED with
worsening SOB, orthopnea, and 2+ pitting edema in lower
extremities. VS: BP 160/94, HR 112, RR 28, O2 88% on room air,
temp 98.6°F. Lungs: crackles bilaterally to mid-fields. JVD noted.
Question 1 (Matrix/Multiple Response)
Select all interventions the nurse should implement immediately
(Select 3):
A. Place patient in high-Fowler's position
B. Administer IV furosemide as ordered
C. Restrict oral fluids to 500 mL/day
D. Apply continuous pulse oximetry
E. Encourage coughing and deep breathing
F. Prepare for immediate intubation
Rationale Q1:
, Correct: A, B, D – High-Fowler's reduces preload and
improves breathing (A). IV furosemide rapidly reduces fluid
overload (B). Continuous pulse ox monitors oxygenation
status (D).
Incorrect: C – Fluid restriction is typically 1.5-2L, not 500mL
(too extreme acutely). E – Not priority; patient is tachypneic
and fatigued. F – Not yet indicated (O2 88% can be managed
with supplemental O2 first).
Question 2 (Bowtie)
Complete the bowtie by selecting ONE condition, ONE
intervention, and ONE monitoring parameter for this patient.
Right Side Bottom
Left Side
Center (Priority (Priority (Monitorin
(Potential
Condition) Interventio g
Causes)
n) Parameter)
A. Increase
Acute
beta- A. Daily
A. Pneumonia decompensate
blocker weight
d HF
dose
B. B. Hourly
B. Pulmonary
Administer urine
embolism
O2 via NC output
, Right Side Bottom
Left Side
Center (Priority (Priority (Monitorin
(Potential
Condition) Interventio g
Causes)
n) Parameter)
C. Acute C. Start IV
decompensate nitroglyceri C. BNP level
d HF n
D. Cardiac D. Prepare D. Cardiac
tamponade for dialysis enzymes
Rationale Q2:
Center: Acute decompensated HF – Clinical picture
(crackles, JVD, edema, low EF) confirms HF exacerbation.
Right: Administer O2 via NC – Immediate oxygen to
maintain SpO2 >90% is first-line before diuretics.
Bottom: Hourly urine output – Critical to assess response
to diuretic therapy and prevent AKI.
Question 3 (Drag-and-Drop/Ordered Response)
Place the following actions in priority order (1=first, 5=last):
___ Administer IV furosemide 40 mg
___ Apply non-rebreather mask at 10 L/min
___ Obtain STAT chest X-ray
___ Auscultate lung sounds
___ Insert indwelling urinary catheter
, Rationale Q3:
1. Apply non-rebreather – Address hypoxemia first (SpO2
88%).
2. Auscultate lung sounds – Establish baseline before
interventions.
3. Administer IV furosemide – Reduce fluid overload after O2
started.
4. Insert urinary catheter – Monitor strict I&O after diuretic
given.
5. Obtain STAT CXR – Diagnostic but not emergent.
Question 4 (Multiple Response – Select N)
The nurse reviews morning labs (post-furosemide 12 hours).
Which findings require immediate notification to the provider?
(Select 2)
A. Potassium 3.1 mEq/L
B. BUN 42 mg/dL
C. Creatinine 0.9 mg/dL
D. Magnesium 2.0 mg/dL
E. Glucose 110 mg/dL
Rationale Q4:
Correct: A and B – K+ 3.1 is severe hypokalemia (loop
diuretic side effect) → risk for dysrhythmias. BUN 42 indicates
prerenal azotemia (dehydration or poor perfusion).
