KAPLAN NCLEX-RN PREP EXAM NGN CASE STUDIES EXAM
PREDICTION 2026 Q&A
1. A nurse is caring for a patient with septic shock who has a
blood pressure of 82/50 mmHg, heart rate of 128 bpm, and
temperature of 39.8°C. The patient is receiving IV fluids and
broad-spectrum antibiotics. Which intervention should the
nurse prioritize next?
A. Administer acetaminophen for fever
B. Initiate vasopressor therapy as ordered
C. Obtain blood cultures if not already done
D. Position the patient in high Fowler's position
Correct Answer: C
Explanation: Blood cultures must be obtained BEFORE starting
antibiotics to identify the causative organism. While the patient
has septic shock and may need vasopressors, obtaining cultures
first is critical for targeted therapy. Fever treatment and
positioning are secondary to this priority. Administering
antibiotics before cultures reduces the ability to identify the
pathogen.
2. A 65-year-old patient with chronic kidney disease (CKD)
stage 4 presents with fatigue, nausea, and muscle weakness.
Laboratory results show potassium 6.2 mEq/L, creatinine
4.5 mg/dL, and BUN 85 mg/dL. Which medication should
the nurse anticipate administering FIRST?
A. Furosemide 40 mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 15 g orally
, C. Calcium gluconate 10% 10 mL IV
D. Insulin 10 units regular with D50 50 mL IV
Correct Answer: C
Explanation: Calcium gluconate stabilizes the cardiac
membrane and is the FIRST intervention for severe
hyperkalemia to prevent cardiac arrest. While insulin/dextrose
and kayexalate lower potassium levels, they don't provide
immediate cardiac protection. Furosemide may help but is less
effective in stage 4 CKD. Cardiac stability is the priority before
potassium reduction.
3. A postoperative patient following abdominal surgery 24
hours ago reports sudden onset of severe pain at the incision
site. The nurse observes wound drainage that is bright red
and saturates the dressing. The patient's heart rate is 118
bpm and blood pressure is 92/58 mmHg. What is the nurse's
most appropriate action?
A. Reinforce the dressing and document the findings
B. Apply ice to the wound and monitor vital signs
C. Notify the surgeon immediately and prepare for possible
exploration
D. Administer prescribed pain medication and reassess in 30
minutes
Correct Answer: C
Explanation: This patient is exhibiting signs of wound
hemorrhage with hemodynamic instability (tachycardia,
hypotension). Immediate surgeon notification is critical as
surgical exploration may be needed. Reinforcing the dressing,
applying ice, or giving pain medication without addressing the
,hemorrhage delays life-saving intervention. This is a surgical
emergency.
4. A nurse is caring for a patient with acute respiratory distress
syndrome (ARDS) who is on mechanical ventilation with
100% oxygen. The patient's oxygen saturation remains at
84%. Which intervention should the nurse anticipate?
A. Increase ventilator tidal volume to 10 mL/kg
B. Administer a bronchodilator via nebulizer
C. Prepare for prone positioning
D. Increase PEEP to 20 cm H2O immediately
Correct Answer: C
Explanation: Prone positioning improves oxygenation in ARDS
by redistributing lung perfusion and opening collapsed alveoli.
Increasing tidal volume causes ventilator-induced lung injury
(should be 6-8 mL/kg). Bronchodilators treat bronchospasm, not
ARDS. While PEEP may be increased, doing so to 20
immediately without assessment is dangerous; prone
positioning is the evidence-based next step.
5. A 45-year-old patient with diabetic ketoacidosis (DKA) has
the following labs: glucose 580 mg/dL, pH 6.92, bicarbonate
8 mEq/L, potassium 3.2 mEq/L. The patient is receiving IV
insulin and fluids. Which intervention is MOST critical at
this time?
A. Continue insulin infusion to correct hyperglycemia
B. Administer IV potassium supplementation
C. Give bicarbonate 100 mEq IV
, D. Add dextrose to IV fluids when glucose reaches 300
mg/dL
Correct Answer: B
Explanation: Potassium of 3.2 mEq/L is dangerously low and
insulin will further decrease potassium, risking cardiac arrest.
Potassium must be replaced BEFORE or concurrently with
insulin. Bicarbonate is generally not recommended in DKA
unless pH <6.9 with severe hemodynamic compromise.
Continuing insulin without correcting potassium is life-
threatening. Dextrose addition is appropriate later but not the
immediate priority.
6. A nurse is assessing a patient who received morphine 4 mg
IV 20 minutes ago for pain. The patient's respiratory rate is
now 8 breaths/min, oxygen saturation is 86%, and the
patient is difficult to arouse. What is the nurse's FIRST
action?
A. Administer naloxone 0.4 mg IV
B. Stimulate the patient and encourage deep breathing
C. Apply oxygen via non-rebreather mask at 15 L/min
D. Call the rapid response team
Correct Answer: A
Explanation: This is opioid-induced respiratory depression.
Naloxone is the specific antidote and should be administered
immediately. While oxygen and stimulation are helpful, they don
reverse the opioid effect. The rapid response team should be
called, but naloxone administration is the priority intervention.
Delaying naloxone risks respiratory arrest.
PREDICTION 2026 Q&A
1. A nurse is caring for a patient with septic shock who has a
blood pressure of 82/50 mmHg, heart rate of 128 bpm, and
temperature of 39.8°C. The patient is receiving IV fluids and
broad-spectrum antibiotics. Which intervention should the
nurse prioritize next?
A. Administer acetaminophen for fever
B. Initiate vasopressor therapy as ordered
C. Obtain blood cultures if not already done
D. Position the patient in high Fowler's position
Correct Answer: C
Explanation: Blood cultures must be obtained BEFORE starting
antibiotics to identify the causative organism. While the patient
has septic shock and may need vasopressors, obtaining cultures
first is critical for targeted therapy. Fever treatment and
positioning are secondary to this priority. Administering
antibiotics before cultures reduces the ability to identify the
pathogen.
2. A 65-year-old patient with chronic kidney disease (CKD)
stage 4 presents with fatigue, nausea, and muscle weakness.
Laboratory results show potassium 6.2 mEq/L, creatinine
4.5 mg/dL, and BUN 85 mg/dL. Which medication should
the nurse anticipate administering FIRST?
A. Furosemide 40 mg IV
B. Sodium polystyrene sulfonate (Kayexalate) 15 g orally
, C. Calcium gluconate 10% 10 mL IV
D. Insulin 10 units regular with D50 50 mL IV
Correct Answer: C
Explanation: Calcium gluconate stabilizes the cardiac
membrane and is the FIRST intervention for severe
hyperkalemia to prevent cardiac arrest. While insulin/dextrose
and kayexalate lower potassium levels, they don't provide
immediate cardiac protection. Furosemide may help but is less
effective in stage 4 CKD. Cardiac stability is the priority before
potassium reduction.
3. A postoperative patient following abdominal surgery 24
hours ago reports sudden onset of severe pain at the incision
site. The nurse observes wound drainage that is bright red
and saturates the dressing. The patient's heart rate is 118
bpm and blood pressure is 92/58 mmHg. What is the nurse's
most appropriate action?
A. Reinforce the dressing and document the findings
B. Apply ice to the wound and monitor vital signs
C. Notify the surgeon immediately and prepare for possible
exploration
D. Administer prescribed pain medication and reassess in 30
minutes
Correct Answer: C
Explanation: This patient is exhibiting signs of wound
hemorrhage with hemodynamic instability (tachycardia,
hypotension). Immediate surgeon notification is critical as
surgical exploration may be needed. Reinforcing the dressing,
applying ice, or giving pain medication without addressing the
,hemorrhage delays life-saving intervention. This is a surgical
emergency.
4. A nurse is caring for a patient with acute respiratory distress
syndrome (ARDS) who is on mechanical ventilation with
100% oxygen. The patient's oxygen saturation remains at
84%. Which intervention should the nurse anticipate?
A. Increase ventilator tidal volume to 10 mL/kg
B. Administer a bronchodilator via nebulizer
C. Prepare for prone positioning
D. Increase PEEP to 20 cm H2O immediately
Correct Answer: C
Explanation: Prone positioning improves oxygenation in ARDS
by redistributing lung perfusion and opening collapsed alveoli.
Increasing tidal volume causes ventilator-induced lung injury
(should be 6-8 mL/kg). Bronchodilators treat bronchospasm, not
ARDS. While PEEP may be increased, doing so to 20
immediately without assessment is dangerous; prone
positioning is the evidence-based next step.
5. A 45-year-old patient with diabetic ketoacidosis (DKA) has
the following labs: glucose 580 mg/dL, pH 6.92, bicarbonate
8 mEq/L, potassium 3.2 mEq/L. The patient is receiving IV
insulin and fluids. Which intervention is MOST critical at
this time?
A. Continue insulin infusion to correct hyperglycemia
B. Administer IV potassium supplementation
C. Give bicarbonate 100 mEq IV
, D. Add dextrose to IV fluids when glucose reaches 300
mg/dL
Correct Answer: B
Explanation: Potassium of 3.2 mEq/L is dangerously low and
insulin will further decrease potassium, risking cardiac arrest.
Potassium must be replaced BEFORE or concurrently with
insulin. Bicarbonate is generally not recommended in DKA
unless pH <6.9 with severe hemodynamic compromise.
Continuing insulin without correcting potassium is life-
threatening. Dextrose addition is appropriate later but not the
immediate priority.
6. A nurse is assessing a patient who received morphine 4 mg
IV 20 minutes ago for pain. The patient's respiratory rate is
now 8 breaths/min, oxygen saturation is 86%, and the
patient is difficult to arouse. What is the nurse's FIRST
action?
A. Administer naloxone 0.4 mg IV
B. Stimulate the patient and encourage deep breathing
C. Apply oxygen via non-rebreather mask at 15 L/min
D. Call the rapid response team
Correct Answer: A
Explanation: This is opioid-induced respiratory depression.
Naloxone is the specific antidote and should be administered
immediately. While oxygen and stimulation are helpful, they don
reverse the opioid effect. The rapid response team should be
called, but naloxone administration is the priority intervention.
Delaying naloxone risks respiratory arrest.
