Medical-Surgical Nursing Clinical Judgment
(NGN) Practice Exam
100 Next-Generation NCLEX-Style Questions
with Complete Rationales (2025/2026 Edition)
SECTION A: CASE STUDIES
CASE STUDY 1: Cardiovascular (Questions 1-5)
Patient Profile: Mr. Johnson, a 68-year-old male, is admitted to
the telemetry unit with complaints of chest pressure, shortness
of breath, and diaphoresis. He has a history of hypertension,
type 2 diabetes, and hyperlipidemia. Current medications
include metformin, lisinopril, and atorvastatin.
Admission Vitals: BP 158/92 mmHg, HR 102 bpm, RR 24/min,
SpO2 91% on room air, Temp 37.1°C (98.8°F).
ECG: ST-segment elevation in leads V1-V4.
,1. (Enhanced Multiple Choice) Based on the initial
assessment data, which immediate intervention should the
nurse anticipate?
A. Administer sublingual nitroglycerin and monitor for
hypotension
B. Prepare for emergency coronary artery bypass grafting
(CABG)
C. Activate the catheterization lab for emergent percutaneous
coronary intervention (PCI)
D. Administer thrombolytic therapy and prepare for transfer to
ICU
Correct Answer: C
Rationale: The ECG showing ST-segment elevation in leads V1-
V4 indicates an anterior ST-elevation myocardial infarction
(STEMI). The priority intervention for STEMI is emergent PCI
(door-to-balloon time <90 minutes). While nitroglycerin is
appropriate, it should not delay reperfusion. CABG is not the
first-line treatment. Thrombolytic therapy is an alternative if PCI
is not available within 120 minutes.
,Clinical Judgment: This question tests the ability to recognize
a STEMI and identify the appropriate immediate intervention
based on current evidence-based guidelines.
2. (Select All That Apply) The nurse is preparing Mr.
Johnson for PCI. Which findings from the admission
assessment are risk factors for coronary artery
disease? (Select all that apply.)
A. Age 68 years
B. Hypertension
C. Type 2 diabetes
D. Hyperlipidemia
E. Male gender
Correct Answers: A, B, C, D, E
Rationale: All of the listed factors are risk factors for coronary
artery disease. Age (>45 for men, >55 for women),
hypertension, diabetes, hyperlipidemia, and male gender are all
established risk factors. Gender and age are non-modifiable risk
, factors, while hypertension, diabetes, and hyperlipidemia are
modifiable.
3. (Bow-Tie Question) The nurse is monitoring Mr. Johnson
post-PCI. Complete the bow-tie by selecting the most
important assessment parameter to monitor, the action to
take if a complication occurs, and the expected outcome.
Assessment Parameter:
A. Peripheral pulses
B. Cardiac rhythm
C. Blood pressure
D. Urine output
Action to Take:
A. Administer IV furosemide
B. Notify the healthcare provider immediately
C. Increase the IV fluid rate
D. Administer IV antiarrhythmic
Expected Outcome:
A. The patient will have no chest pain
(NGN) Practice Exam
100 Next-Generation NCLEX-Style Questions
with Complete Rationales (2025/2026 Edition)
SECTION A: CASE STUDIES
CASE STUDY 1: Cardiovascular (Questions 1-5)
Patient Profile: Mr. Johnson, a 68-year-old male, is admitted to
the telemetry unit with complaints of chest pressure, shortness
of breath, and diaphoresis. He has a history of hypertension,
type 2 diabetes, and hyperlipidemia. Current medications
include metformin, lisinopril, and atorvastatin.
Admission Vitals: BP 158/92 mmHg, HR 102 bpm, RR 24/min,
SpO2 91% on room air, Temp 37.1°C (98.8°F).
ECG: ST-segment elevation in leads V1-V4.
,1. (Enhanced Multiple Choice) Based on the initial
assessment data, which immediate intervention should the
nurse anticipate?
A. Administer sublingual nitroglycerin and monitor for
hypotension
B. Prepare for emergency coronary artery bypass grafting
(CABG)
C. Activate the catheterization lab for emergent percutaneous
coronary intervention (PCI)
D. Administer thrombolytic therapy and prepare for transfer to
ICU
Correct Answer: C
Rationale: The ECG showing ST-segment elevation in leads V1-
V4 indicates an anterior ST-elevation myocardial infarction
(STEMI). The priority intervention for STEMI is emergent PCI
(door-to-balloon time <90 minutes). While nitroglycerin is
appropriate, it should not delay reperfusion. CABG is not the
first-line treatment. Thrombolytic therapy is an alternative if PCI
is not available within 120 minutes.
,Clinical Judgment: This question tests the ability to recognize
a STEMI and identify the appropriate immediate intervention
based on current evidence-based guidelines.
2. (Select All That Apply) The nurse is preparing Mr.
Johnson for PCI. Which findings from the admission
assessment are risk factors for coronary artery
disease? (Select all that apply.)
A. Age 68 years
B. Hypertension
C. Type 2 diabetes
D. Hyperlipidemia
E. Male gender
Correct Answers: A, B, C, D, E
Rationale: All of the listed factors are risk factors for coronary
artery disease. Age (>45 for men, >55 for women),
hypertension, diabetes, hyperlipidemia, and male gender are all
established risk factors. Gender and age are non-modifiable risk
, factors, while hypertension, diabetes, and hyperlipidemia are
modifiable.
3. (Bow-Tie Question) The nurse is monitoring Mr. Johnson
post-PCI. Complete the bow-tie by selecting the most
important assessment parameter to monitor, the action to
take if a complication occurs, and the expected outcome.
Assessment Parameter:
A. Peripheral pulses
B. Cardiac rhythm
C. Blood pressure
D. Urine output
Action to Take:
A. Administer IV furosemide
B. Notify the healthcare provider immediately
C. Increase the IV fluid rate
D. Administer IV antiarrhythmic
Expected Outcome:
A. The patient will have no chest pain
