NCLEX-RN Next Gen Exam 2025/2026 –
Verified Questions with Correct Answers
and Detailed Rationales
Question 1: Case Study – Client with Acute Myocardial
Infarction
A 58-year-old client presents to the emergency department with chest pain, diaphoresis, and
nausea for 1 hour. An ECG shows ST-elevation in leads II, III, and aVF. The client is prescribed
aspirin 325 mg and nitroglycerin 0.4 mg sublingual.
What is the priority nursing action?
A. Administer nitroglycerin immediately without further assessment.
B. Assess the client’s blood pressure before administering nitroglycerin.
C. Encourage the client to drink water to relieve nausea.
D. Teach the client about the importance of aspirin therapy.
Rationale:
B. Assess the client’s blood pressure before administering nitroglycerin.
Nitroglycerin can cause hypotension, so assessing blood pressure ensures safety before
administration. This is critical in an acute myocardial infarction (MI) to prevent complications.
• A: Administering nitroglycerin without assessing blood pressure is unsafe.
• C: Oral fluids are not appropriate during acute chest pain and may delay treatment.
• D: Teaching is important but not the priority during an acute event.
Question 2: Unfolding Scenario – Client with Type 1
Diabetes Mellitus
A 24-year-old client with type 1 diabetes mellitus is admitted with confusion, fruity breath, and a
blood glucose level of 450 mg/dL. The client’s arterial blood gas (ABG) results show pH 7.28,
PaCO2 32 mmHg, HCO3 18 mEq/L.
What is the priority nursing intervention?
A. Administer 10 units of regular insulin subcutaneously.
B. Initiate an IV infusion of normal saline with insulin as prescribed.
C. Encourage the client to drink water to correct dehydration.
D. Administer sodium bicarbonate IV immediately.
Rationale:
B. Initiate an IV infusion of normal saline with insulin as prescribed.
The client is in diabetic ketoacidosis (DKA), indicated by hyperglycemia, acidosis, and fruity
,breath. IV normal saline and insulin are the first-line treatments to correct dehydration and
hyperglycemia.
• A: Subcutaneous insulin is not the priority in acute DKA.
• C: Oral fluids are insufficient for severe dehydration.
• D: Sodium bicarbonate is rarely used unless pH is critically low.
Question 3: Multiple Choice – Client with Pneumonia
A 65-year-old client with pneumonia has a respiratory rate of 28 breaths/min, oxygen saturation
of 90%, and coarse crackles in the right lower lobe. The client is prescribed oxygen at 2 L/min
via nasal cannula.
What is the nurse’s priority action?
A. Encourage the client to cough and deep breathe every 4 hours.
B. Increase oxygen flow to achieve saturation above 92%.
C. Administer the prescribed antibiotic immediately.
D. Teach the client about the importance of completing antibiotics.
Rationale:
B. Increase oxygen flow to achieve saturation above 92%.
Hypoxemia (SpO2 90%) requires immediate intervention to maintain adequate oxygenation,
which is critical in pneumonia.
• A: Coughing and deep breathing are important but not the priority over oxygenation.
• C: Antibiotics are essential but not immediate for hypoxemia.
• D: Teaching is secondary to addressing acute hypoxemia.
Question 4: Select All That Apply – Client with Heart
Failure
A 70-year-old client with heart failure reports dyspnea, weight gain of 3 kg in 2 days, and
bilateral leg edema. The client is prescribed furosemide 40 mg IV.
Which interventions should the nurse implement? (Select all that apply.)
A. Monitor daily weights and intake/output.
B. Assess lung sounds for crackles.
C. Encourage a high-sodium diet to replace losses.
D. Administer furosemide as prescribed.
E. Restrict the client to bed rest.
Rationale:
A, B, D. Monitor daily weights and intake/output, assess lung sounds for crackles,
administer furosemide as prescribed.
These interventions address fluid overload and monitor heart failure exacerbation.
, • C: A high-sodium diet worsens fluid retention.
• E: Bed rest is not indicated unless the client is unstable.
Question 5: Unfolding Scenario – Client with Sepsis
A 50-year-old client is admitted with fever, tachycardia (HR 110 bpm), and hypotension (BP
88/50 mmHg). Blood cultures are positive, and the client is prescribed IV antibiotics and fluids.
What is the priority nursing action?
A. Administer acetaminophen for fever.
B. Initiate IV fluid bolus as prescribed.
C. Encourage oral fluids to improve hydration.
D. Teach the client about antibiotic therapy.
Rationale:
B. Initiate IV fluid bolus as prescribed.
Hypotension in sepsis indicates hypovolemia, requiring immediate IV fluid resuscitation to
restore perfusion.
• A: Fever management is secondary to perfusion.
• C: Oral fluids are inadequate for septic shock.
• D: Teaching is not the priority in an acute crisis.
Question 6: Multiple Choice – Therapeutic Communication
A 40-year-old client with terminal cancer expresses fear about dying.
Which response demonstrates therapeutic communication?
A. “Don’t worry, everything will be okay.”
B. “Why are you afraid of dying?”
C. “It sounds like you’re feeling scared. Can you share more about what’s on your mind?”
D. “Many people feel this way and they cope.”
Rationale:
C. “It sounds like you’re feeling scared. Can you share more about what’s on your mind?”
This uses reflection and open-ended questioning to validate feelings and encourage expression.
• A: Reassurance dismisses the client’s fears.
• B: “Why” questions can feel confrontational.
• D: Comparing minimizes the client’s unique experience.
, Question 7: Case Study – Client with Chronic Obstructive
Pulmonary Disease (COPD)
A 62-year-old client with COPD reports increased dyspnea and a productive cough. Oxygen
saturation is 88% on room air, and the client is prescribed albuterol via nebulizer.
What is the priority nursing action?
A. Teach the client about smoking cessation.
B. Administer oxygen to maintain saturation above 90%.
C. Encourage the client to increase fluid intake.
D. Administer the nebulizer treatment after oxygen.
Rationale:
B. Administer oxygen to maintain saturation above 90%.
Hypoxemia is the priority in a COPD exacerbation to ensure adequate oxygenation.
• A: Smoking cessation is important but not immediate.
• C: Fluids are secondary to oxygenation.
• D: Nebulizer treatment is important but follows oxygenation.
Question 8: Unfolding Scenario – Client with Stroke
A 75-year-old client is admitted with a left-sided stroke, presenting with right-sided weakness
and aphasia. The client is at risk for aspiration.
What is the priority nursing intervention?
A. Encourage the client to eat soft foods.
B. Perform a swallow assessment before oral intake.
C. Teach the client about stroke recovery.
D. Assist the client with ambulation.
Rationale:
B. Perform a swallow assessment before oral intake.
Aspiration risk requires a swallow assessment to prevent pneumonia.
• A: Oral intake is unsafe without assessment.
• C: Teaching is not the priority.
• D: Ambulation is secondary to airway safety.
Question 9: Multiple Choice – Client with Hypoglycemia
A 30-year-old client with diabetes mellitus is diaphoretic, shaky, and reports a blood glucose
level of 55 mg/dL.
Verified Questions with Correct Answers
and Detailed Rationales
Question 1: Case Study – Client with Acute Myocardial
Infarction
A 58-year-old client presents to the emergency department with chest pain, diaphoresis, and
nausea for 1 hour. An ECG shows ST-elevation in leads II, III, and aVF. The client is prescribed
aspirin 325 mg and nitroglycerin 0.4 mg sublingual.
What is the priority nursing action?
A. Administer nitroglycerin immediately without further assessment.
B. Assess the client’s blood pressure before administering nitroglycerin.
C. Encourage the client to drink water to relieve nausea.
D. Teach the client about the importance of aspirin therapy.
Rationale:
B. Assess the client’s blood pressure before administering nitroglycerin.
Nitroglycerin can cause hypotension, so assessing blood pressure ensures safety before
administration. This is critical in an acute myocardial infarction (MI) to prevent complications.
• A: Administering nitroglycerin without assessing blood pressure is unsafe.
• C: Oral fluids are not appropriate during acute chest pain and may delay treatment.
• D: Teaching is important but not the priority during an acute event.
Question 2: Unfolding Scenario – Client with Type 1
Diabetes Mellitus
A 24-year-old client with type 1 diabetes mellitus is admitted with confusion, fruity breath, and a
blood glucose level of 450 mg/dL. The client’s arterial blood gas (ABG) results show pH 7.28,
PaCO2 32 mmHg, HCO3 18 mEq/L.
What is the priority nursing intervention?
A. Administer 10 units of regular insulin subcutaneously.
B. Initiate an IV infusion of normal saline with insulin as prescribed.
C. Encourage the client to drink water to correct dehydration.
D. Administer sodium bicarbonate IV immediately.
Rationale:
B. Initiate an IV infusion of normal saline with insulin as prescribed.
The client is in diabetic ketoacidosis (DKA), indicated by hyperglycemia, acidosis, and fruity
,breath. IV normal saline and insulin are the first-line treatments to correct dehydration and
hyperglycemia.
• A: Subcutaneous insulin is not the priority in acute DKA.
• C: Oral fluids are insufficient for severe dehydration.
• D: Sodium bicarbonate is rarely used unless pH is critically low.
Question 3: Multiple Choice – Client with Pneumonia
A 65-year-old client with pneumonia has a respiratory rate of 28 breaths/min, oxygen saturation
of 90%, and coarse crackles in the right lower lobe. The client is prescribed oxygen at 2 L/min
via nasal cannula.
What is the nurse’s priority action?
A. Encourage the client to cough and deep breathe every 4 hours.
B. Increase oxygen flow to achieve saturation above 92%.
C. Administer the prescribed antibiotic immediately.
D. Teach the client about the importance of completing antibiotics.
Rationale:
B. Increase oxygen flow to achieve saturation above 92%.
Hypoxemia (SpO2 90%) requires immediate intervention to maintain adequate oxygenation,
which is critical in pneumonia.
• A: Coughing and deep breathing are important but not the priority over oxygenation.
• C: Antibiotics are essential but not immediate for hypoxemia.
• D: Teaching is secondary to addressing acute hypoxemia.
Question 4: Select All That Apply – Client with Heart
Failure
A 70-year-old client with heart failure reports dyspnea, weight gain of 3 kg in 2 days, and
bilateral leg edema. The client is prescribed furosemide 40 mg IV.
Which interventions should the nurse implement? (Select all that apply.)
A. Monitor daily weights and intake/output.
B. Assess lung sounds for crackles.
C. Encourage a high-sodium diet to replace losses.
D. Administer furosemide as prescribed.
E. Restrict the client to bed rest.
Rationale:
A, B, D. Monitor daily weights and intake/output, assess lung sounds for crackles,
administer furosemide as prescribed.
These interventions address fluid overload and monitor heart failure exacerbation.
, • C: A high-sodium diet worsens fluid retention.
• E: Bed rest is not indicated unless the client is unstable.
Question 5: Unfolding Scenario – Client with Sepsis
A 50-year-old client is admitted with fever, tachycardia (HR 110 bpm), and hypotension (BP
88/50 mmHg). Blood cultures are positive, and the client is prescribed IV antibiotics and fluids.
What is the priority nursing action?
A. Administer acetaminophen for fever.
B. Initiate IV fluid bolus as prescribed.
C. Encourage oral fluids to improve hydration.
D. Teach the client about antibiotic therapy.
Rationale:
B. Initiate IV fluid bolus as prescribed.
Hypotension in sepsis indicates hypovolemia, requiring immediate IV fluid resuscitation to
restore perfusion.
• A: Fever management is secondary to perfusion.
• C: Oral fluids are inadequate for septic shock.
• D: Teaching is not the priority in an acute crisis.
Question 6: Multiple Choice – Therapeutic Communication
A 40-year-old client with terminal cancer expresses fear about dying.
Which response demonstrates therapeutic communication?
A. “Don’t worry, everything will be okay.”
B. “Why are you afraid of dying?”
C. “It sounds like you’re feeling scared. Can you share more about what’s on your mind?”
D. “Many people feel this way and they cope.”
Rationale:
C. “It sounds like you’re feeling scared. Can you share more about what’s on your mind?”
This uses reflection and open-ended questioning to validate feelings and encourage expression.
• A: Reassurance dismisses the client’s fears.
• B: “Why” questions can feel confrontational.
• D: Comparing minimizes the client’s unique experience.
, Question 7: Case Study – Client with Chronic Obstructive
Pulmonary Disease (COPD)
A 62-year-old client with COPD reports increased dyspnea and a productive cough. Oxygen
saturation is 88% on room air, and the client is prescribed albuterol via nebulizer.
What is the priority nursing action?
A. Teach the client about smoking cessation.
B. Administer oxygen to maintain saturation above 90%.
C. Encourage the client to increase fluid intake.
D. Administer the nebulizer treatment after oxygen.
Rationale:
B. Administer oxygen to maintain saturation above 90%.
Hypoxemia is the priority in a COPD exacerbation to ensure adequate oxygenation.
• A: Smoking cessation is important but not immediate.
• C: Fluids are secondary to oxygenation.
• D: Nebulizer treatment is important but follows oxygenation.
Question 8: Unfolding Scenario – Client with Stroke
A 75-year-old client is admitted with a left-sided stroke, presenting with right-sided weakness
and aphasia. The client is at risk for aspiration.
What is the priority nursing intervention?
A. Encourage the client to eat soft foods.
B. Perform a swallow assessment before oral intake.
C. Teach the client about stroke recovery.
D. Assist the client with ambulation.
Rationale:
B. Perform a swallow assessment before oral intake.
Aspiration risk requires a swallow assessment to prevent pneumonia.
• A: Oral intake is unsafe without assessment.
• C: Teaching is not the priority.
• D: Ambulation is secondary to airway safety.
Question 9: Multiple Choice – Client with Hypoglycemia
A 30-year-old client with diabetes mellitus is diaphoretic, shaky, and reports a blood glucose
level of 55 mg/dL.
