NCLEX NEXT GEN QUESTIONS AND RATIONALES
NGN PROCTORED EXAM 2026
1. (NGN Extended Multiple Response) A client with COPD has oxygen saturation
88%, respiratory rate 28, and confusion. Which actions should the nurse take?
(Select all that apply)
A. Apply non‑rebreather mask at 15 L/min
B. Apply Venturi mask at 2 L/min
C. Place in high‑Fowler’s position
D. Notify the provider
E. Administer morphine for dyspnea
Correct answer: B, C, D
Rationale: COPD patients need controlled oxygen (Venturi). High‑Fowler’s improves
breathing. Notify provider. Non‑rebreather can cause CO2 retention; morphine
depresses respiratory drive.
2. (NGN Bowtie) A client with pneumonia, fever 102°F, HR 110, BP 90/60. Drag the
priority assessment, action, and outcome. Options: Assessment – respiratory
rate, temperature, O2 sat; Action – administer antibiotics after blood cultures,
give antipyretics, start fluids; Outcome – O2 saturation >94% on room air, fever
resolution, BP >100 systolic.
Correct answer: Assessment – O2 sat; Action – administer antibiotics after blood
cultures; Outcome – O2 saturation >94%
Rationale: Hypoxia is most urgent. Antibiotics treat infection; improving oxygenation is
the expected outcome.
, 3. (NGN Matrix) A nurse is reviewing care for four clients. Identify each action as
essential, non‑essential, or contraindicated.
Client A: Post‑op day 1, encourage coughing and deep breathing – essential
Client B: Neutropenic, place fresh flowers in room – contraindicated
Client C: Heart failure, restrict fluids to 2 L/day – essential
Client D: Seizure precautions, keep padded side rails up – essential
Correct answer: A essential, B contraindicated, C essential, D essential
Rationale: Coughing prevents atelectasis; fresh flowers harbor fungi dangerous for
neutropenic patients; fluid restriction helps heart failure; padded rails prevent injury
during seizures.
4. (NGN Drag and Drop) Order the steps for inserting an indwelling urinary
catheter.
1. Inflate balloon with sterile water
2. Clean meatus with antiseptic
3. Insert catheter until urine flows
4. Perform hand hygiene
5. Secure catheter to thigh
6. Position client supine with legs flexed
Correct answer: 4, 6, 2, 3, 1, 5
Rationale: Hand hygiene first, then positioning, cleaning, insertion, balloon inflation,
then securing.
NGN PROCTORED EXAM 2026
1. (NGN Extended Multiple Response) A client with COPD has oxygen saturation
88%, respiratory rate 28, and confusion. Which actions should the nurse take?
(Select all that apply)
A. Apply non‑rebreather mask at 15 L/min
B. Apply Venturi mask at 2 L/min
C. Place in high‑Fowler’s position
D. Notify the provider
E. Administer morphine for dyspnea
Correct answer: B, C, D
Rationale: COPD patients need controlled oxygen (Venturi). High‑Fowler’s improves
breathing. Notify provider. Non‑rebreather can cause CO2 retention; morphine
depresses respiratory drive.
2. (NGN Bowtie) A client with pneumonia, fever 102°F, HR 110, BP 90/60. Drag the
priority assessment, action, and outcome. Options: Assessment – respiratory
rate, temperature, O2 sat; Action – administer antibiotics after blood cultures,
give antipyretics, start fluids; Outcome – O2 saturation >94% on room air, fever
resolution, BP >100 systolic.
Correct answer: Assessment – O2 sat; Action – administer antibiotics after blood
cultures; Outcome – O2 saturation >94%
Rationale: Hypoxia is most urgent. Antibiotics treat infection; improving oxygenation is
the expected outcome.
, 3. (NGN Matrix) A nurse is reviewing care for four clients. Identify each action as
essential, non‑essential, or contraindicated.
Client A: Post‑op day 1, encourage coughing and deep breathing – essential
Client B: Neutropenic, place fresh flowers in room – contraindicated
Client C: Heart failure, restrict fluids to 2 L/day – essential
Client D: Seizure precautions, keep padded side rails up – essential
Correct answer: A essential, B contraindicated, C essential, D essential
Rationale: Coughing prevents atelectasis; fresh flowers harbor fungi dangerous for
neutropenic patients; fluid restriction helps heart failure; padded rails prevent injury
during seizures.
4. (NGN Drag and Drop) Order the steps for inserting an indwelling urinary
catheter.
1. Inflate balloon with sterile water
2. Clean meatus with antiseptic
3. Insert catheter until urine flows
4. Perform hand hygiene
5. Secure catheter to thigh
6. Position client supine with legs flexed
Correct answer: 4, 6, 2, 3, 1, 5
Rationale: Hand hygiene first, then positioning, cleaning, insertion, balloon inflation,
then securing.
