📌 About These Questions
These questions are written in the Next Generation NCLEX style, aligned to the NCSBN Clinical Judgment Measurement Model (CJMM). They are not simplified — they reflect the actual cognitive demand of the 2026 exam.
Question 1
A nurse is caring for a 68-year-old patient admitted with heart failure. Which assessment finding requires the nurse to take immediate action?
✓ Correct: Oxygen saturation of 88% on room air
An oxygen saturation of 88% indicates hypoxaemia and requires immediate intervention. The nurse should apply supplemental oxygen and notify the provider. Heart failure causes pulmonary oedema which impairs gas exchange. While oedema and hypertension are concerning, hypoxaemia is the immediate life-threatening finding requiring priority action.
An oxygen saturation of 88% indicates hypoxaemia and requires immediate intervention. The nurse should apply supplemental oxygen and notify the provider. Heart failure causes pulmonary oedema which impairs gas exchange. While oedema and hypertension are concerning, hypoxaemia is the immediate life-threatening finding requiring priority action.
Question 2
The nurse is reviewing morning laboratory results for a patient on digoxin therapy for atrial fibrillation. Which finding requires the nurse to hold the digoxin and notify the provider?
✓ Correct: Potassium 2.8 mEq/L
Hypokalaemia (potassium <3.5 mEq/L) significantly increases the risk of digoxin toxicity. A potassium of 2.8 mEq/L is critically low. The nurse must hold the digoxin, notify the provider, and anticipate orders for potassium replacement. The therapeutic digoxin level requires adequate potassium to prevent life-threatening dysrhythmias.
Hypokalaemia (potassium <3.5 mEq/L) significantly increases the risk of digoxin toxicity. A potassium of 2.8 mEq/L is critically low. The nurse must hold the digoxin, notify the provider, and anticipate orders for potassium replacement. The therapeutic digoxin level requires adequate potassium to prevent life-threatening dysrhythmias.
Question 3
A postoperative patient reports pain of 8/10 and requests morphine. The nurse notes the patient's respiratory rate is 10 breaths per minute and pupils are pinpoint. Which action should the nurse take FIRST?
✓ Correct: Hold morphine, notify provider, prepare naloxone
A respiratory rate of 10 and pinpoint pupils are signs of opioid toxicity. The nurse must NOT administer more morphine. The priority actions are to hold the opioid, notify the provider immediately, and prepare naloxone (Narcan) for administration. This is a patient safety emergency — respiratory depression from opioids can progress to respiratory arrest.
A respiratory rate of 10 and pinpoint pupils are signs of opioid toxicity. The nurse must NOT administer more morphine. The priority actions are to hold the opioid, notify the provider immediately, and prepare naloxone (Narcan) for administration. This is a patient safety emergency — respiratory depression from opioids can progress to respiratory arrest.
Question 4
A nurse is caring for a 4-year-old admitted with suspected bacterial meningitis. Which intervention should the nurse implement FIRST?
✓ Correct: Initiate droplet and contact precautions
Initiating droplet and contact precautions is the priority action. Bacterial meningitis (particularly Neisseria meningitidis) is transmitted via respiratory droplets. Protecting other patients and staff from exposure must occur before other interventions. Blood cultures and lumbar puncture are important but follow isolation precautions being established.
Initiating droplet and contact precautions is the priority action. Bacterial meningitis (particularly Neisseria meningitidis) is transmitted via respiratory droplets. Protecting other patients and staff from exposure must occur before other interventions. Blood cultures and lumbar puncture are important but follow isolation precautions being established.
Question 5
The nurse is delegating tasks at the beginning of a shift. Which task is appropriate to delegate to an unlicensed assistive personnel (UAP)?
✓ Correct: Obtaining vital signs on a stable post-op patient
Obtaining vital signs on a stable patient is within the UAP's scope of practice. Assessment, teaching, and evaluation are higher-level nursing functions that require the judgment of a licensed nurse and cannot be delegated to UAP. The five rights of delegation include: right task, right circumstance, right person, right direction, and right supervision.
Obtaining vital signs on a stable patient is within the UAP's scope of practice. Assessment, teaching, and evaluation are higher-level nursing functions that require the judgment of a licensed nurse and cannot be delegated to UAP. The five rights of delegation include: right task, right circumstance, right person, right direction, and right supervision.
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Clinical Judgment Tips for NGN Questions
- Always identify what the question is really asking (recognise → analyse → prioritise)
- Look for the word “first”, “priority”, or “immediate” — these signal Maslow or ABC prioritisation
- For case studies, read ALL information before answering — later questions depend on earlier context
- In bow-tie questions, the left side (assessment) informs the centre (action) which produces the right side (outcome)
See: Clinical Judgment Framework for NCLEX Questions • Complete NGN Guide