ShekhawatNotes1
NCLEX-RN | Next Generation NCLEX (NGN) 2026
Med-Surg | Pharmacology | OB | Pediatrics | Mental Health | Clinical Judgment
NGN QUESTION CLASSIC NCLEX-RN 10 HIGH-YIELD QUESTIONS
NGN | Clinical Judgment Med-Surg | Respiratory
Question Q1
CLINICAL SCENARIO
A 68-year-old male with COPD is admitted with worsening shortness of breath. Vitals: RR
28/min, SpO2 84% on room air, BP 148/92 mmHg, HR 110 bpm, Temp 38.2°C. ABG results: pH
7.32, PaCO2 58 mmHg, PaO2 52 mmHg, HCO3 30 mEq/L. He is anxious and using accessory
muscles to breathe.
The nurse is prioritizing care. Which actions should the nurse take FIRST? Select all that apply.
A. Position the client in high Fowler's position
B. Administer oxygen at 2L/min via nasal cannula
C. Prepare for immediate intubation
D. Obtain IV access and administer IV fluids
E. Notify the physician of the ABG results
F. Administer a nebulized bronchodilator as ordered
CORRECT ANSWER: A, B, E, F
RATIONALE
This patient is in acute hypercapnic respiratory failure (pH 7.32, PaCO2 58, PaO2 52) with
compensatory metabolic alkalosis (HCO3 30). Priority actions: (A) High Fowler's maximizes lung
expansion and reduces work of breathing immediately. (B) Low-flow O2 at 2L/min is correct for
COPD — high-flow O2 can suppress the hypoxic drive, worsening CO2 retention. (E) Physician
must be notified of critical ABG values. (F) Bronchodilators reduce bronchospasm and airway
resistance. (C) Intubation is not the first step — non-invasive interventions come first. (D) IV
fluids are not a priority in respiratory failure unless the patient is hemodynamically unstable.
NCLEX TIP
COPD + low O2 sat = always use LOW-FLOW oxygen. Never give high-flow O2 to a COPD patient.
The NGN expects you to prioritize and select MULTIPLE correct actions, not just one.
, NGN | Clinical Judgment Pharmacology | Cardiac
Question Q2
CLINICAL SCENARIO
A nurse is caring for a 72-year-old woman with heart failure (EF 30%) and atrial fibrillation. She
is prescribed digoxin 0.125 mg PO daily, furosemide 40 mg PO daily, and potassium chloride 20
mEq PO daily. Morning labs: K+ 3.1 mEq/L, Na+ 138 mEq/L, Creatinine 1.8 mg/dL. She reports
nausea and seeing a yellow-green halo around lights.
Which finding is of GREATEST concern and requires IMMEDIATE nursing action?
A. Serum potassium of 3.1 mEq/L
B. Creatinine of 1.8 mg/dL
C. Report of yellow-green halos around lights
D. Heart rate of 58 bpm
E. Daily urine output of 900 mL
CORRECT ANSWER: C — Yellow-green halos around lights (Digoxin Toxicity)
RATIONALE
Yellow-green visual disturbances (halos, blurred vision, color changes) are a CLASSIC sign of
digoxin toxicity. Combined with nausea and a low K+ (hypokalemia potentiates digoxin toxicity by
increasing myocardial sensitivity to the drug), this patient is at high risk of life-threatening
arrhythmias. The nurse must HOLD digoxin immediately, notify the physician, obtain a digoxin
level, and prepare for continuous cardiac monitoring. Hypokalemia (K+ 3.1) is also concerning
but is SECONDARY here — it is the reason the toxicity is occurring. Elevated creatinine
indicates renal impairment which also reduces digoxin clearance, worsening toxicity.
NCLEX TIP
Any patient on digoxin + furosemide reporting visual changes = DIGOXIN TOXICITY until proven
otherwise. HOLD the digoxin, check the level, fix the K+. This is a high-frequency NCLEX
pharmacology scenario.
NGN | Matrix Question Med-Surg | Endocrine
Question Q3
NCLEX-RN | Next Generation NCLEX (NGN) 2026
Med-Surg | Pharmacology | OB | Pediatrics | Mental Health | Clinical Judgment
NGN QUESTION CLASSIC NCLEX-RN 10 HIGH-YIELD QUESTIONS
NGN | Clinical Judgment Med-Surg | Respiratory
Question Q1
CLINICAL SCENARIO
A 68-year-old male with COPD is admitted with worsening shortness of breath. Vitals: RR
28/min, SpO2 84% on room air, BP 148/92 mmHg, HR 110 bpm, Temp 38.2°C. ABG results: pH
7.32, PaCO2 58 mmHg, PaO2 52 mmHg, HCO3 30 mEq/L. He is anxious and using accessory
muscles to breathe.
The nurse is prioritizing care. Which actions should the nurse take FIRST? Select all that apply.
A. Position the client in high Fowler's position
B. Administer oxygen at 2L/min via nasal cannula
C. Prepare for immediate intubation
D. Obtain IV access and administer IV fluids
E. Notify the physician of the ABG results
F. Administer a nebulized bronchodilator as ordered
CORRECT ANSWER: A, B, E, F
RATIONALE
This patient is in acute hypercapnic respiratory failure (pH 7.32, PaCO2 58, PaO2 52) with
compensatory metabolic alkalosis (HCO3 30). Priority actions: (A) High Fowler's maximizes lung
expansion and reduces work of breathing immediately. (B) Low-flow O2 at 2L/min is correct for
COPD — high-flow O2 can suppress the hypoxic drive, worsening CO2 retention. (E) Physician
must be notified of critical ABG values. (F) Bronchodilators reduce bronchospasm and airway
resistance. (C) Intubation is not the first step — non-invasive interventions come first. (D) IV
fluids are not a priority in respiratory failure unless the patient is hemodynamically unstable.
NCLEX TIP
COPD + low O2 sat = always use LOW-FLOW oxygen. Never give high-flow O2 to a COPD patient.
The NGN expects you to prioritize and select MULTIPLE correct actions, not just one.
, NGN | Clinical Judgment Pharmacology | Cardiac
Question Q2
CLINICAL SCENARIO
A nurse is caring for a 72-year-old woman with heart failure (EF 30%) and atrial fibrillation. She
is prescribed digoxin 0.125 mg PO daily, furosemide 40 mg PO daily, and potassium chloride 20
mEq PO daily. Morning labs: K+ 3.1 mEq/L, Na+ 138 mEq/L, Creatinine 1.8 mg/dL. She reports
nausea and seeing a yellow-green halo around lights.
Which finding is of GREATEST concern and requires IMMEDIATE nursing action?
A. Serum potassium of 3.1 mEq/L
B. Creatinine of 1.8 mg/dL
C. Report of yellow-green halos around lights
D. Heart rate of 58 bpm
E. Daily urine output of 900 mL
CORRECT ANSWER: C — Yellow-green halos around lights (Digoxin Toxicity)
RATIONALE
Yellow-green visual disturbances (halos, blurred vision, color changes) are a CLASSIC sign of
digoxin toxicity. Combined with nausea and a low K+ (hypokalemia potentiates digoxin toxicity by
increasing myocardial sensitivity to the drug), this patient is at high risk of life-threatening
arrhythmias. The nurse must HOLD digoxin immediately, notify the physician, obtain a digoxin
level, and prepare for continuous cardiac monitoring. Hypokalemia (K+ 3.1) is also concerning
but is SECONDARY here — it is the reason the toxicity is occurring. Elevated creatinine
indicates renal impairment which also reduces digoxin clearance, worsening toxicity.
NCLEX TIP
Any patient on digoxin + furosemide reporting visual changes = DIGOXIN TOXICITY until proven
otherwise. HOLD the digoxin, check the level, fix the K+. This is a high-frequency NCLEX
pharmacology scenario.
NGN | Matrix Question Med-Surg | Endocrine
Question Q3
