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NCLEX-RN 2025 Predictor Exam –Questions with
Rationales (Updated NGN Format)
✅ Case Study Scenario
Patient Name: Mrs. Brenda Smith
Age: 68 years
Setting: Medical-surgical unit
History:
Hypertension
Type 2 Diabetes Mellitus
Chronic Kidney Disease Stage 3
Current Situation:
Admitted for community-acquired pneumonia.
Assessment Findings:
BP: 156/92 mmHg
HR: 110 bpm
, 2
RR: 28/min
SpO₂: 89% on room air
Temp: 38.5 °C (101.3 °F)
Lung sounds: crackles in right lower lobe
Blood glucose: 248 mg/dL
Creatinine: 2.1 mg/dL (baseline ~1.8)
BUN: 34 mg/dL
Orders:
Oxygen via nasal cannula at 2 L/min
Ceftriaxone IV q24h
Acetaminophen PRN for fever
Sliding-scale insulin coverage
✅ Question
Prioritization – Multiple Response (Select All That Apply):
As the nurse planning care for Mrs. Smith, which of the following interventions should you
prioritize?
✅ A. Administer oxygen to maintain SpO₂ above 92%
✅ B. Monitor blood glucose levels regularly
✅ C. Hold antibiotics until sputum cultures are obtained
✅ D. Encourage incentive spirometry use every hour while awake
, 3
✅ E. Restrict all oral fluids to prevent fluid overload
✅ F. Assess lung sounds and respiratory status frequently
✅ Correct Answers: A, B, D, F
✅ Detailed Rationale (in paragraphs)
A. Administer oxygen to maintain SpO₂ above 92% (Correct):
Administering oxygen is a top priority because Mrs. Smith’s SpO₂ is 89%, indicating
hypoxemia. Oxygen therapy will improve oxygenation and reduce the risk of respiratory distress
or failure. Early intervention helps prevent worsening hypoxia and supports overall tissue
perfusion in pneumonia patients.
B. Monitor blood glucose levels regularly (Correct):
Monitoring blood glucose is essential in this patient with type 2 diabetes, especially during acute
infection, which can cause hyperglycemia. Stress and infection can elevate blood glucose levels
further, increasing the risk of complications such as poor wound healing or infection progression.
Regular monitoring allows for timely insulin administration using the prescribed sliding-scale
coverage.
C. Hold antibiotics until sputum cultures are obtained (Incorrect):
Holding antibiotics until sputum cultures are obtained is not appropriate. While it is ideal to
obtain cultures before starting antibiotics, empiric antibiotic therapy should not be delayed, as
, 4
timely treatment is critical to control infection. Delaying antibiotics can lead to worsening sepsis
and respiratory compromise.
D. Encourage incentive spirometry use every hour while awake (Correct):
Encouraging incentive spirometry helps promote lung expansion, improves ventilation, and
reduces the risk of atelectasis and pneumonia complications. This intervention supports effective
airway clearance and oxygenation, which are critical in managing community-acquired
pneumonia.
E. Restrict all oral fluids to prevent fluid overload (Incorrect):
Restricting all oral fluids is not routinely indicated in this patient unless there is specific evidence
of fluid overload or orders for fluid restriction due to advanced renal failure. Adequate hydration
is actually important for thinning secretions and supporting recovery from pneumonia.
F. Assess lung sounds and respiratory status frequently (Correct):
Frequent assessment of lung sounds and respiratory status is a priority nursing intervention to
detect changes early. Monitoring allows for prompt recognition of deterioration, such as
increased crackles, decreased oxygen saturation, or signs of respiratory distress, enabling timely
escalation of care if needed.
✅ Case Study Scenario
Patient Name: Mrs. Brenda Smith
Age: 68 years
Diagnosis: Community-acquired pneumonia
NCLEX-RN 2025 Predictor Exam –Questions with
Rationales (Updated NGN Format)
✅ Case Study Scenario
Patient Name: Mrs. Brenda Smith
Age: 68 years
Setting: Medical-surgical unit
History:
Hypertension
Type 2 Diabetes Mellitus
Chronic Kidney Disease Stage 3
Current Situation:
Admitted for community-acquired pneumonia.
Assessment Findings:
BP: 156/92 mmHg
HR: 110 bpm
, 2
RR: 28/min
SpO₂: 89% on room air
Temp: 38.5 °C (101.3 °F)
Lung sounds: crackles in right lower lobe
Blood glucose: 248 mg/dL
Creatinine: 2.1 mg/dL (baseline ~1.8)
BUN: 34 mg/dL
Orders:
Oxygen via nasal cannula at 2 L/min
Ceftriaxone IV q24h
Acetaminophen PRN for fever
Sliding-scale insulin coverage
✅ Question
Prioritization – Multiple Response (Select All That Apply):
As the nurse planning care for Mrs. Smith, which of the following interventions should you
prioritize?
✅ A. Administer oxygen to maintain SpO₂ above 92%
✅ B. Monitor blood glucose levels regularly
✅ C. Hold antibiotics until sputum cultures are obtained
✅ D. Encourage incentive spirometry use every hour while awake
, 3
✅ E. Restrict all oral fluids to prevent fluid overload
✅ F. Assess lung sounds and respiratory status frequently
✅ Correct Answers: A, B, D, F
✅ Detailed Rationale (in paragraphs)
A. Administer oxygen to maintain SpO₂ above 92% (Correct):
Administering oxygen is a top priority because Mrs. Smith’s SpO₂ is 89%, indicating
hypoxemia. Oxygen therapy will improve oxygenation and reduce the risk of respiratory distress
or failure. Early intervention helps prevent worsening hypoxia and supports overall tissue
perfusion in pneumonia patients.
B. Monitor blood glucose levels regularly (Correct):
Monitoring blood glucose is essential in this patient with type 2 diabetes, especially during acute
infection, which can cause hyperglycemia. Stress and infection can elevate blood glucose levels
further, increasing the risk of complications such as poor wound healing or infection progression.
Regular monitoring allows for timely insulin administration using the prescribed sliding-scale
coverage.
C. Hold antibiotics until sputum cultures are obtained (Incorrect):
Holding antibiotics until sputum cultures are obtained is not appropriate. While it is ideal to
obtain cultures before starting antibiotics, empiric antibiotic therapy should not be delayed, as
, 4
timely treatment is critical to control infection. Delaying antibiotics can lead to worsening sepsis
and respiratory compromise.
D. Encourage incentive spirometry use every hour while awake (Correct):
Encouraging incentive spirometry helps promote lung expansion, improves ventilation, and
reduces the risk of atelectasis and pneumonia complications. This intervention supports effective
airway clearance and oxygenation, which are critical in managing community-acquired
pneumonia.
E. Restrict all oral fluids to prevent fluid overload (Incorrect):
Restricting all oral fluids is not routinely indicated in this patient unless there is specific evidence
of fluid overload or orders for fluid restriction due to advanced renal failure. Adequate hydration
is actually important for thinning secretions and supporting recovery from pneumonia.
F. Assess lung sounds and respiratory status frequently (Correct):
Frequent assessment of lung sounds and respiratory status is a priority nursing intervention to
detect changes early. Monitoring allows for prompt recognition of deterioration, such as
increased crackles, decreased oxygen saturation, or signs of respiratory distress, enabling timely
escalation of care if needed.
✅ Case Study Scenario
Patient Name: Mrs. Brenda Smith
Age: 68 years
Diagnosis: Community-acquired pneumonia
