Next Gen NCLEX-RN 2025–2026 Test Bank | 180+ Practice Questions & NGN
Case Studies with Rationales (PDF Download)
Question 1: Matrix Multiple Response
Which interventions are appropriate when caring for a client at risk for pressure
injuries? Select all that apply.
Intervention Appropriate Not Appropriate
Turn client every 2 hours ✅
Use donut-shaped cushion ✅
Keep skin clean and dry ✅
Massage reddened skin ✅
Use barrier creams for incontinence ✅
🧠 Rationale: Frequent repositioning, skin hygiene, and barrier creams reduce
skin breakdown. Donut cushions and massaging reddened areas increase risk.
,Question 2: Cloze (Drop-Down)
A nurse is caring for a client with a central line. To prevent infection, the nurse
should change the dressing every [every 7 days / every 3 days / daily], and scrub
the hub for at least [5 seconds / 15 seconds / 30 seconds].
✅ Correct Answer:
• Every 7 days
• 15 seconds
🧠 Rationale: CDC recommends transparent dressing changes every 7 days and
scrubbing the hub for at least 15 seconds with alcohol.
Question 3: Extended Multiple Choice
Which action requires immediate intervention by the RN on a med-surg unit?
A. UAP assisting a client to ambulate with a gait belt
B. LPN hanging a secondary IV antibiotic
C. UAP feeding a client with a recent stroke and coughs while eating
D. RN checking blood glucose on a diabetic client
,✅ Correct Answer: C
🧠 Rationale: Feeding a stroke client with dysphagia risk should be done with
RN or SLP supervision due to aspiration risk.
Question 4: Case Scenario – Clinical Judgment Layer 1
Scenario:
Mr. Lee, 78 years old, admitted for pneumonia. Vitals: T 38.9°C, HR 102, RR 26,
SpO₂ 88% on room air.
What is the first action the nurse should take?
A. Notify the healthcare provider
B. Administer IV antibiotics
C. Apply oxygen via nasal cannula
D. Increase fluid intake
✅ Correct Answer: C
🧠 Rationale: Oxygenation is priority (ABCs). Improve SpO₂ before
administering antibiotics.
, Question 5: Trend Recognition (NGN)
You notice the following trend in vitals over the past 4 hours:
Time Temp (°C) HR RR SpO₂
8am 37.5 88 18 97%
10am 38.2 94 20 95%
12pm 39.1 108 24 92%
What trend is most concerning?
A. Rising temperature
B. Increased heart rate
C. Decreased SpO₂
D. Increased respiratory rate
✅ Correct Answer: C
🧠 Rationale: All vitals are worsening, but the drop in SpO₂ indicates a threat to
oxygenation and respiratory function—most critical.
Case Studies with Rationales (PDF Download)
Question 1: Matrix Multiple Response
Which interventions are appropriate when caring for a client at risk for pressure
injuries? Select all that apply.
Intervention Appropriate Not Appropriate
Turn client every 2 hours ✅
Use donut-shaped cushion ✅
Keep skin clean and dry ✅
Massage reddened skin ✅
Use barrier creams for incontinence ✅
🧠 Rationale: Frequent repositioning, skin hygiene, and barrier creams reduce
skin breakdown. Donut cushions and massaging reddened areas increase risk.
,Question 2: Cloze (Drop-Down)
A nurse is caring for a client with a central line. To prevent infection, the nurse
should change the dressing every [every 7 days / every 3 days / daily], and scrub
the hub for at least [5 seconds / 15 seconds / 30 seconds].
✅ Correct Answer:
• Every 7 days
• 15 seconds
🧠 Rationale: CDC recommends transparent dressing changes every 7 days and
scrubbing the hub for at least 15 seconds with alcohol.
Question 3: Extended Multiple Choice
Which action requires immediate intervention by the RN on a med-surg unit?
A. UAP assisting a client to ambulate with a gait belt
B. LPN hanging a secondary IV antibiotic
C. UAP feeding a client with a recent stroke and coughs while eating
D. RN checking blood glucose on a diabetic client
,✅ Correct Answer: C
🧠 Rationale: Feeding a stroke client with dysphagia risk should be done with
RN or SLP supervision due to aspiration risk.
Question 4: Case Scenario – Clinical Judgment Layer 1
Scenario:
Mr. Lee, 78 years old, admitted for pneumonia. Vitals: T 38.9°C, HR 102, RR 26,
SpO₂ 88% on room air.
What is the first action the nurse should take?
A. Notify the healthcare provider
B. Administer IV antibiotics
C. Apply oxygen via nasal cannula
D. Increase fluid intake
✅ Correct Answer: C
🧠 Rationale: Oxygenation is priority (ABCs). Improve SpO₂ before
administering antibiotics.
, Question 5: Trend Recognition (NGN)
You notice the following trend in vitals over the past 4 hours:
Time Temp (°C) HR RR SpO₂
8am 37.5 88 18 97%
10am 38.2 94 20 95%
12pm 39.1 108 24 92%
What trend is most concerning?
A. Rising temperature
B. Increased heart rate
C. Decreased SpO₂
D. Increased respiratory rate
✅ Correct Answer: C
🧠 Rationale: All vitals are worsening, but the drop in SpO₂ indicates a threat to
oxygenation and respiratory function—most critical.
