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Next Generation NCLEX Study Tips for Case Studies

In April of 2023, the NCSBN released the new version of the NCLEX exam, which is called the Next Generation NCLEX (or NGN, for short). One of the big changes with the Next Generation NCLEX was the introduction of case studies .

These new changes have caused some students and new graduates to become nervous, and some are wondering how they should be preparing for this new format.

Study Tips for Next Generation NCLEX Case Studies

What should your study plan be for the Next Generation NCLEX case studies?

First, let’s think about what’s different about a case study. A case study is going to give you a scenario of how a patient may present with a particular disease(s), and it’s going to walk you through a scenario of what may happen as the patient progresses.

These case studies are going to test your nursing knowledge on how to identify important symptoms, lab reports, what to watch for, how to deliver care, and provide patient education.

In other words, case studies are very similar to how things really work in the real world of nursing!

So the big question is how do you prepare for these case studies on the NGN?

Familiarize Yourself with NGN Case Studies

First, you’ll want to familiarize yourself with this new case study format so that you’ll understand how they work.

I developed a mock Next Generation NCLEX case study , and in that case study, I walk you through the sample questions step-by-step. I highly recommend you watch that video because it’s going to show you how to think critically as you answer these new NGN questions.

The Secret to Case Studies

As you prepare for case studies, you have to understand that merely memorizing a few facts about a disease will not work well to prepare you for these questions. Instead, you truly have to understand the material in a deeper way so that you are able to connect the dots and answer the different scenarios that might pop up.

To do this, I like to compare a disease to an onion. And just as onions have many different layers, there are many layers of what’s going on with a disease process, too. As you begin pulling back the layers of a disease, you can get to the core of what’s happening to your patient and see the domino effect that occurs.

But you have to go through those layers to get to that core. But if you skip those layers, you’re going to be missing things, and it is going to make these case studies much more difficult.

And the “layers” I’m referring to can be things like the pathophysiology, signs and symptoms, labs and diagnostics, treatment, medications, and your role as the nurse.

And you’ll want to be familiar with all of those different layers, because that will allow you to easily connect the dots and breeze through these case study questions.

Study Example for Case Study of Heart Failure

To illustrate my point, consider a case study over a h eart failure patient . The first “layer” you’d want to peel back as you study is the PATHO!

Layer 1: Understand the Pathophysiology

I cannot emphasize enough that taking time to really dig into the pathophysiology of a disease will really help you understand what’s happening and why, which will be crucial in helping you understand how the different body systems are affected.

As you study, you want to ask yourself, “What’s occurring in the body? Which systems are affected? What causes this, and why?”

This step will take a lot of energy and time on your part, but in my opinion, it’s one of the best uses of your study time. Once you truly grasp this part, it will have a “domino effect” of helping you connect the dots.

Layer 2: Allow the Signs and Symptoms to Flow from the Patho

When you truly understand the patho of a disease, the signs and symptoms will easily fall into place. In many cases, you won’t even need to spend time memorizing a list of signs and symptoms for a disease! Understanding the patho will help you easily piece that together in your mind.

For example, in heart failure, you know we have a fluid volume overload . If the heart failure is on the right side, it’s going to cause a backup of fluid that can lead to things like JVD (jugular venous distention), ascites, edema, and enlarged liver.

If the heart failure is on the left side, it’s going to be affecting the lungs, leading to things like shortness of breath, crackles , orthopnea, difficulty breathing at night, and even pulmonary edema.

Layer 3: Determine Relevant Labs and Diagnostics

Next, I’d recommend focusing on the relevant labs and diagnostic reports. Even though we don’t order these as the nurse, they are very important to us because we need to know what we need to monitor for and what should be expected for that patient.

And the abnormal signs and symptoms you just learned about will go along with those labs and diagnostic reports. It’s all going to click and make sense.

Layer 4: The Patient’s Plan of Care

Those layers will then feed right into the patient’s plan of care. As you study, be asking yourself, “What do I expect the doctor to order? What are the common medications and procedures?”

One you peel back this layer, it will make your job as the nurse very easy to understand because what we do a nurses goes right along with the treatments ordered.

Layer 5: Focus on What We Do (and Don’t Do) for the Patient

In this final layer, you’ll want to be thinking about what you would and wouldn’t do for the patient. For example, think of questions such as, “What’s going to help this patient get better? What should I monitor? What should I report? What important patient education should I provide?”

With medications, for what side effects are you going to be monitoring? If a patient with heart failure is on loop diuretics , what side effects could occur? You’re going to look at urinary output, electrolytes (particularly the potassium level).

You’ll also want to consider information you’ll provide to the patient throughout their stay, along with discharge education points and care.

Conclusion of Study Tips for NGN Case Studies

In summary, the best way to prepare for the case studies on the Next Generation NCLEX is to actually understand the disease holistically, which means digging into the pathophysiology first, and then allowing that to flow to the signs and symptoms, medications, patient education, and so forth.

By taking the time to absorb the material, and digging deep in to the disease process, it’s going to pay off big when it comes time to answer these questions that evolve and require a deeper level of critical thinking.

That’s why I always try to take the time to cover these important concepts in my NCLEX review lectures on YouTube . I really try to help students connect the dots and understand these diseases in a way that will click and make it easier to remember, both on exams and in the real world of nursing.

Nurse Sarah’s Notes and Merch

Just released is “ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

You can get an eBook version here or a physical copy of the book here.

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Writing Case-Based Next-Gen NCLEX Questions

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Welcome to our collection of free NCLEX practice questions to help you achieve success on your NCLEX- RN exam! This updated guide for 2024 includes 1,000+ practice questions, a primer on the NCLEX-RN exam, frequently asked questions about the NCLEX, question types, the NCLEX-RN test plan, and test-taking tips and strategies.

Table of Contents

Nclex-rn practice questions test bank, what is nclex.

• What is Next Generation NCLEX (NGN)? 

Safe and Effective Care Environment

• Health Promotion and Maintenance 
• Psychosocial Integrity 

Physiological Integrity

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• Multiple Response Select N 

Multiple Response Grouping

• Highlight in Text 

Highlight in Table

Matrix multiple response, matrix multiple choice.

• Drag and Drop Cloze 

Drag and Drop Rationale

Drop down cloze, drop down rationale, drop down in table, chart or exhibit questions, graphic option, select all that apply or multiple-response, fill-in-the-blank, ordered-response, how to register for the nclex, nclex-rn resources, want more practice questions, recommended resources.

Looking for the complete collection of practice questions? For more NCLEX practice questions, please visit our Nursing Test Bank here .

We have included more than 1,000+ NCLEX practice questions covering different nursing topics for this nursing test bank ! We’ve made a significant effort to provide you with the most challenging questions along with insightful rationales for each question to reinforce learning .

We recommend you do all practice questions before you take the actual exam. Doing so will help reduce your test anxiety and help identify nursing topics you need to review. To make the most of the practice exams, try to minimize mistakes to less than 15 questions and take your time answering the questions, especially when reading the rationales.

Quiz Guidelines

Before you start, here are some examination guidelines and reminders you must read:

• Practice Exams : Engage with our Practice Exams to hone your skills in a supportive, low-pressure environment. These exams provide immediate feedback and explanations, helping you grasp core concepts, identify improvement areas, and build confidence in your knowledge and abilities.
• You’re given 2 minutes per item.
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Included NCLEX-RN question sets for this nursing test bank are as follows. Please click on the links below and you’ll be redirected to the quiz page:

NEW UPDATE: Introducing Challenge Exams and Practice Exams

Engage with these new modes to enhance your learning journey, each tailored to meet different needs and propel you towards academic achievement.

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Test your mastery with these Challenge Exams :

Build your confidence and grasp core concepts with these Practice Exams :

The National Council Licensing Examination (NCLEX) is a comprehensive test administered by the National Council of State Boards of Nursing (NCSBN). It assesses whether candidates possess the necessary knowledge and skills to provide safe and effective nursing care at the entry level. The NCLEX is available in two versions: the NCLEX-RN for registered nurses and the NCLEX-PN for practical/vocational nurses.

The NCSBN, composed of nursing regulatory bodies from all 50 states in the US, the District of Columbia, and four US territories, is responsible for safeguarding the public by ensuring safe nursing care. It sets the standards and guidelines for nursing licensure and develops the NCLEX examinations.

Becoming a registered nurse (RN) requires meeting specific licensure requirements determined by the licensing authorities in each jurisdiction governed by the NCSBN. One of these requirements is passing the NCLEX-RN, which evaluates the competencies necessary for practicing safely and effectively as an entry-level RN. The NCLEX-RN is used by member boards of nursing and many Canadian nursing regulatory bodies to inform their licensure decisions.

What is Next Generation NCLEX (NGN)?

The Next Generation NCLEX (NGN) is currently in effect this April 2023 for RN and LPN / LVN candidates. The change in the NCLEX is driven by the need to adapt to the increasing complexity of client care, advancements in healthcare practice, and the demand for safe clinical decision-making . The NGN aims to address the declining ability of new nursing graduates to make safe clinical decisions by integrating clinical judgment as a key competency. The NGN test format will remain adaptive but with fewer test items. Candidates will encounter Unfolding Case Studies and Stand-Alone Items , scored using partial credit with three different scoring rules. These changes in the NGN aim to assess critical thinking and the ability to make safe clinical judgments during various phases of client care.

In summary, the following are the key changes between the previous NCLEX format and the Next Generation NCLEX (NGN): 

• Same adaptive test format but reduced number of items. The Next Generation NCLEX (NGN) will retain the adaptive test format, similar to the current NCLEX, but with fewer test items. Candidates will answer between 85 and 150 items, with 15 as pretest or unscored items. 
• Case studies. All candidates will encounter three (3) Unfolding Case Studies, each consisting of six test items (a total of 18 items). Clinical situation information will be presented to candidates in a medical record format resembling a table-like structure. These situations are designed to assess their ability to think critically and make safe clinical decisions across different phases of client care. In addition to the case studies, some candidates may have Stand-Alone Items for their NGN exam.
• New NGN item types. The NGN exam will feature new item types, which include questions in unfolding cases and stand-alone items, highlight, cloze, matrix, bow-tie, drag and drop, and extended multiple responses. 
• Scoring differences. NGN test items will be scored differently compared to the current NCLEX. They will utilize partial credit scoring with three different scoring rules: the 0/1 scoring rule, the +/- scoring rule, and the rationale scoring rule. These are explained further below. 

NCLEX-RN Test Plan

The NCLEX test plan is a content guideline to determine the distribution of test questions. NCSBN uses the “Client Needs” categories to ensure the NCLEX covers a full spectrum of nursing activities. It is a summary of the content and scope of the NCLEX to serve as a guide for candidates preparing for the exam and to direct item writers in the development of items.  Additionally, to assess the knowledge, skills, abilities, and clinical judgment necessary for entry-level nursing practice , the NCLEX-RN Test Plan utilizes Bloom’s taxonomy for the cognitive domain. This taxonomy provides a foundation for writing and coding examination items, focusing on application-level or higher-level cognitive abilities that require advanced thought processing.

The content of the NCLEX-RN is organized into four major Client Needs categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. Some of these categories are divided further into subcategories. Below is the NCLEX-RN test plan effective as of April 2023 until March 2026: 

There are two subcategories under Safe and Effective Care Environment.

• Management of Care category includes content that tests the nurse ‘s knowledge and ability to direct nursing care that enhances the care delivery setting to protect clients, significant others, and healthcare personnel. 
• Safety and Infection Control category includes content that tests the nurse’s ability required to protect clients, families, and healthcare personnel from health and environmental hazards. 

Health Promotion and Maintenance

Health Promotion and Maintenance category includes content that tests the nurse’s ability to provide and direct nursing care to the client that incorporates knowledge of expected growth and development, preventing and early detection of health problems, and strategies to achieve optimal health. 

Psychosocial Integrity

The Psychosocial Integrity category is content related to the promotion and support for the emotional, mental, and social well-being of the client experiencing stressful events and clients with acute or chronic mental illness . 

In the Physiological Integrity category are items that test the nurse’s ability to promote physical health and wellness by providing care and comfort , reducing risk potential, and managing health alterations. There are four subcategories under Physiological Integrity. 

• Basic Care and Comfort are content to test the nurse’s ability to provide comfort and assistance to the client in performing activities of daily living . 
• Pharmacological and Parenteral Therapies category includes content to test the nurse’s ability to administer medications and parenteral therapies ( IV therapy , blood administration, and blood products). 
• Reduction of Risk Potential category includes content to test the nurse’s ability to prevent complications or health problems related to the client’s condition or prescribed treatments or procedures. 
• Physiological Adaptation category includes questions that test the nurse’s ability to provide care to clients with acute, chronic, or life-threatening conditions. 

Clinical judgment is a central component of the NCLEX-RN Test Plan, reflecting the evolving demands and complexity of nursing practice . Nurses must engage in an iterative, multi-step process that utilizes nursing knowledge to observe and assess situations, identify client concerns, and generate evidence-based solutions to ensure safe client care. Clinical judgment questions are represented through Unfolding Case Studies or individual Stand-Alone Items , with case studies addressing each step of clinical judgment. The following are the six clinical judgment cognitive skills: 

• Recognize cues “What matters most?” Identifying relevant and important information from various sources, such as medical history , laboratory studies, and vital signs.
• Analyze cues “What could it mean?” Organizing and connecting recognized cues to the client’s clinical presentation.
• Prioritize hypotheses “Where do I start?”   Evaluating and prioritizing hypotheses based on urgency, likelihood, risk, difficulty, time constraints, and other factors.
• Generate solutions “What can I do?” Identifying expected outcomes and using hypotheses to define a set of interventions aligned with the expected outcomes.
• Take action “What will I do?” Implementing the highest-priority solution(s) identified.
• Evaluate outcomes “Did it help?” Comparing observed outcomes to expected outcomes to assess the effectiveness of interventions.

Additionally, In contrast to the nursing process or ADPIE , the NCSBN focuses on AAPIE ( assessment , analysis, planning , intervention, evaluation ), wherein nursing diagnosis is not tested at the current NGN because it is not considered a universal language used in health care or the nursing profession. In nursing practice and for the NGN, students must use their pathophysiology knowledge to analyze client assessments and connect them with common conditions in healthcare settings. 

Integral to nursing practice, several processes are integrated throughout the Client Needs categories and subcategories:

• Caring. In an atmosphere of mutual respect and trust, nurses interact with clients, providing encouragement, hope, support, and compassion to help achieve desired outcomes .
• Clinical Judgment . An observed outcome of critical thinking and decision-making , clinical judgment (discussed above) is a dynamic and iterative process. It involves using nursing knowledge to observe and assess situations, prioritize client concerns, generate evidence-based solutions, and deliver safe client care.
• Communication and Documentation . Verbal and nonverbal interactions between nurses, clients, significant others, and the healthcare team. Accurate and comprehensive documentation ensures adherence to practice standards and accountability in care provision.
• Culture and Spirituality. Recognizing and considering the unique preferences, standards of care, and legal considerations of clients (individuals, families, groups, and populations) in the context of their culture and spirituality.
• Nursing Process. A systematic approach to client care encompassing assessment , analysis, planning, implementation , and evaluation .
• Teaching/Learning. Facilitating acquiring knowledge, skills, and abilities that promote behavioral change.

Who writes questions for the NCLEX? The NCSBN sets the criteria and selection process for item writers who are registered nurses. Many of them are nursing educators with an advanced degrees in nursing, so if you’ve completed an accredited nursing program, you have already taken several tests written by nurses with backgrounds similar to those who write for the NCLEX.

The NCLEX-RN is a crucial step for registered nurse (RN) candidates seeking licensure. Administered through computerized adaptive testing ( CAT ), this examination utilizes computer technology and measurement theory to create a personalized and accurate assessment of each candidate’s knowledge and skills. 

The CAT system employed in the NCLEX-RN ensures that each candidate receives a unique examination tailored to their abilities. As the test progresses, the computer selects items from a large item pool based on the candidate’s previous answers. These items are classified according to the test plan categories, difficulty levels, and clinical judgment steps. The CAT system continually recalculates the candidate’s ability estimate and selects subsequent items accordingly, creating an exam that aligns with the NCLEX-RN Test Plan requirements. This dynamic approach allows candidates to demonstrate their competence effectively.

Additionally, unlike traditional fixed-length exams, which assign the same items to all candidates, CAT selects items based on the candidate’s ability, resulting in a more accurate assessment. The CAT scoring algorithm estimates the candidate’s ability by considering all previous answers and the difficulty level of those items. By administering items that challenge the candidate appropriately, the exam gathers maximum information about their ability.

Pass or Fail Decisions: How to Pass the NCLEX?

Passing the NCLEX-RN requires you, the candidate, to meet a specific passing standard established by the NCSBN Board of Directors (BOD). The passing standard represents the minimum ability level necessary for safe and effective entry-level nursing practice. The BOD reevaluates this standard every three years, considering various factors such as a standard-setting exercise conducted by experts and psychometricians, historical data on candidate performance, and information on the educational readiness of aspiring nurses. Once the passing standard is set, it is uniformly applied to all candidates during the scoring process. The NCSBN indicates that these three rules govern pass-or-fail decisions: the 95% Confidence Interval Rule , Maximum-Length Exam Rule , and Run-Out-Of-Time Rule .

In this scenario, the computer stops administering test questions when it is 95% certain that your ability is clearly above the passing standard or clearly below the passing standard. 

When your ability is close to the passing standard, the CAT gives you items until the maximum number of items is reached. At this point, the computer disregards the 95% confidence rule and decides whether you pass or fail by your final ability estimate. If your final ability estimate is above the passing standard, you pass; if it is below, you fail. 

In the event that a candidate runs out of time before completing the maximum number of items and the computer has not reached a 95% certainty regarding the candidate’s pass or fail status, alternative criteria come into play.

• If the candidate has not answered the minimum required number of items, the candidate will automatically fail.
• If the candidate has answered at least the minimum required number of items, the final ability estimate will be determined based on all the responses given before the exam time expires. If the score meets or exceeds the passing standard, the candidate will pass. Otherwise, the candidate will fail.

New Scoring System in the Next Generation NCLEX

The Next Generation NCLEX (NGN) incorporates different item formats, and for items that have multiple correct answers, partial credit scoring is implemented . Unlike the previous exam format, where items are scored as either all correct or all incorrect, the NGN will use polytomous scoring models to evaluate partial understanding. For example, in the previous version of NCLEX (multiple response) SATA (select-all-that-apply) items, only endorsing all the correct options results in a correct score. However, the new approach will acknowledge partial understanding, allowing differentiation between candidates with different numbers of correct options. This change will provide a more accurate assessment of candidates’ knowledge, skills, and abilities.

Three methods are used to assign partial credit for these items: plus/minus scoring, zero/one scoring, and rationale scoring. Understanding the scoring models is crucial for NCLEX-RN takers to know how their answers are evaluated and how scores are determined.

The 0/1 scoring rule is used for multiple-choice items. Choosing the correct option earns one point while selecting an incorrect option gives a score of zero. This rule applies to single response items, including the example multiple-choice item.

The +/– scoring rule measures a candidate’s ability to identify relevant information. It assigns points for correct options and deducts points for incorrect options. It is used for multi-point items, and the total score is calculated by adding correct options and subtracting incorrect ones. The lowest possible score is zero. This rule is applied to NGN question types such as multiple-response and select all that apply.

The rationale scoring rule is used for questions that assess paired information. To earn a score of one point, both answer options must be correct. If either option is incorrect, the score is 0.

How Many Questions Are on the NCLEX?

All RN candidates must answer a minimum of 85 items , while a maximum of 150 items be administered during the five-hour time allotment. Each NCLEX-RN exam includes 15 pretest items (unscored), which are indistinguishable from operational (scored) items.

To ensure the effectiveness of computerized adaptive testing (CAT) in the NCLEX, the difficulty level of each item needs to be determined beforehand. This is achieved by administering these items as pretest items to a large group of NCLEX candidates. Since the difficulty of pretest items is initially unknown, they are not part of your score and are not considered when evaluating a candidate’s ability or determining pass-fail outcomes. Once a sufficient number of responses are collected, the pretest items undergo statistical analysis and calibration. If they meet the required NCLEX statistical standards, they can be used as operational items in future exams. Therefore, candidates must approach every item with their best effort, regardless of whether it is a pretest or an operational item.

The length of the NCLEX-RN examination varies for each candidate based on their responses, but there is a five-hour time limit for the exam, including all breaks. To ensure completion within the allotted time, candidates must maintain a reasonable pace, spending approximately one to two minutes per item . It’s important to note that the length of the examination does not determine pass or fail outcomes; candidates can succeed or fail regardless of the examination’s duration.

Case Studies in NGN

The Next Generation NCLEX (NGN) has introduced case studies that present practical clinical scenarios and include test items aligned with six cognitive abilities of the clinical judgment model. The scenario can occur in various settings, and the client’s outcome can vary, including improvement, stability, or decline with complications. Laboratory results, if included, are presented in a table, and abnormal values are highlighted with an “L” or “H”. There are two types of case studies: Unfolding Case Study with six test items assessing specific skills and Stand-Alone Items with a single test item independent of a case study.

An Unfolding Case Study presents a realistic client situation with evolving data resembling a medical record. It includes multiple phases over time, reflecting changes in the client’s condition. The case study evaluates all six cognitive skills of the clinical judgment model through six questions. Each test-taker receives three (3) unfolding case studies, totaling 18 items across those cases. 

Stand-Alone Items are case studies with a single question, with the item presented as a bow-tie or a trend question type. Candidates who take more than the minimum number of items on the NCLEX receive around six to seven stand-alone cases. 

Question Types in the NCLEX-RN

The different question types for the NCLEX-RN include the following: 

Extended Multiple Response

In Extended Multiple Response item types, test-takers can choose one or more options in Multiple Response Select All That Apply, select a specific number of items in Multiple Response Select N, or choose options from different groupings presented in a table in Multiple Response Grouping, with scoring rules based on the selected type. Extended multiple response may include the following formats:

The Multiple Response Select All That Apply item type allows test-takers to choose one or more answer options. It uses the +/- Scoring Rule, where selecting correct information earns points (+1), and selecting incorrect information results in points deducted (-1). The maximum points achievable are equal to the number of correct options, and the minimum score is 0, with no negative scores. The item must have a minimum of five options and can have up to ten options, with the possibility of all ten options being correct.

Multiple Response Select N

The Multiple Response Select N item type informs the test-taker about the specific number of items (N) that can be selected. The question provides a range of options, with a minimum of five and a maximum of ten options. It uses the 0/1 Scoring Rule, where each correct response earns 1 point, while any incorrect response results in 0 points.

The Multiple Response Grouping utilizes a table to present options, with a minimum of two and a maximum of five groupings. Each grouping consists of a minimum of two and a maximum of four options, ensuring an equal number of options within each grouping. Test-takers are required to select at least one option from each grouping. The item follows the +/- Scoring Rule, meaning there is no negative score per grouping. The total score for the item is determined by summing the points earned within each grouping. The maximum score achievable equals the number of keys (N).

For this NGN item type, the test-taker is presented with information and must highlight specific parts of the information provided.  Highlight question type include the following formats:

Highlight in Text

It involves a paragraph of information where the test-taker must select (highlight) specific parts of the text based on the question’s requirements. The item can include a maximum of ten options for selection and uses the +/- Scoring Rule. 

The Highlight in Table item type involves a table of information. The candidate is tasked with selecting (highlighting) specific parts of the text within the table based on the question’s prompt. The item can include a maximum of ten options for selection. The table has two columns, including a header, and can have up to five rows. This item type uses the +/- Scoring Rule. 

Matrix/Grid

In the Matrix NGN item type, test-takers are presented with a grid-like structure to which they must respond. There are two variations: Matrix Multiple Response, where each column can have multiple correct responses, and Matrix Multiple Choice, where test-takers select one answer option per row. Extended multiple response may include the following formats:

The Matrix Multiple Response item type consists of response columns, where each column can have multiple correct responses. The item can have between two and ten columns and four to seven rows. In each column, at least one response option must be selected, but it is possible to select one or more responses per column. The item follows the +/- Scoring Rule, with no negative score per column. The total score for the item is determined by summing the points earned within each column. The maximum score achievable is equal to the number of keys (N).

The item includes a minimum of four rows and a maximum of ten rows. It can have either two or three options/columns. Test-takers are allowed to select one answer option per row. The item follows the 0/1 scoring rule, where the test-taker earns 1 point for each correct response and 0 points for incorrect responses. The total score for the item is obtained by summing the scores over the rows. The maximum score achievable is equal to the number of rows.

Drag and Drop

In the Drag and Drop NGN question type, test-takers are presented with options to drag and drop into specific targets. There are two variations: Drag and Drop Cloze, where options are placed in response targets to complete sentences and Drag and Drop Rationale, where options are matched to causes and effects. Drag and drop may include the following formats:

Drag and Drop Cloze

The Drag and Drop Cloze item type includes a range of four to ten options. It can have one or more response targets where the options are dragged to. The item must have a minimum of one sentence with one target per sentence and up to five sentences, each with one target per sentence. The item follows the 0/1 Scoring Rule, where a correct response earns 1 point and incorrect responses earn 0 points. The total score is obtained by summing the scores across all targets, with the maximum score achievable being the number of targets.

The Drag and Drop Rationale type involves one sentence with one cause and one effect or one sentence with one cause and two effects. The sentence can be a single dyad (one sentence with two targets) or a single triad (one sentence with three targets). Each drag & drop target can have three to five options. The item follows the Rationale Scoring Rule where both answer options must be correct to earn a point. 

The Drop Down question type in NGN includes three variations: Drop Down Cloze, Drop Down Rationale, and Drop Down in Table. Drop down may include the following formats:

The Drop Down Cloze item type presents one or two sentences of information that require completion using drop-down options. Each drop-down can contain three to five options. The item must have a minimum of one sentence with one drop-down per sentence and can include up to five sentences, each with one drop-down. The item follows the 0/1 Scoring Rule, where the score is calculated by summing the correct responses across all drop-downs. The maximum score achievable is equal to the number of drop-downs.

The Drop Down Rationale item type presents either one sentence with one cause and one effect or one sentence with one cause and two effects. Each drop-down can contain three to five options. The scoring follows the Rationale Scoring Rule, where X and Y must be correct to earn one point. The maximum points that can be earned are 1 point for a dyad (one sentence with two targets) and 2 points for a triad (one sentence with three targets).

The Drop Down in Table item type presents a table of information with drop-down options located in various parts of the table. The item must have a minimum of three columns and three rows and a maximum of five columns and four rows. One column serves as the header column. Each row contains one drop-down. The item follows the 0/1 Scoring Rule, where the score is calculated by summing the correct responses across all drop-downs. The maximum score achievable is equal to the number of drop-downs.

The Bow-tie item type is visually designed to resemble a bow-tie shape. It consists of five options on the left side, five options on the right side, and four options in the middle well of the bow-tie. The item addresses all of the cognitive skills within a single item. The Bow-tie item follows the 0/1 scoring rule. The left and right wells have two answer options each, while the middle well has one answer option, resulting in a maximum possible score of 5 points. Each correct response earns 1 point, while incorrect responses earn 0 points.

The Trend item type presents information in a medical record or flow sheet format that spans over time, requiring the test-taker to analyze information across different points in time. The item addresses multiple cognitive skills within a single item. It can utilize any NGN item type except for the bow-tie. The scoring rule for the Trend item depends on the specific item type used.

Multiple-Choice Questions

Many questions on the NCLEX are in multiple-choice format. This traditional text-based question will provide you data about the client’s situation, and you can only select one correct answer from the given four options. Multiple-choice questions may vary and include: audio clips, graphics, exhibits, or charts.

A chart or exhibit is presented along with a problem. You’ll be provided with three tabs or buttons that you need to click to obtain the information needed to answer the question. Select the correct choice among four multiple-choice answer options. 

In this format, four multiple-choice answer options are pictures rather than text. Each option is preceded by a circle that you need to click to represent your answer.

In an audio question format, you’ll be required to listen to a sound to answer the question. You’ll need to use the headset provided and click on the sound icon for it to play. You’ll be able to listen to the sound as many times as necessary. Choose the correct choice from among four multiple-choice answer options. 

For the video question format, you must view an animation or a video clip to answer the following question. Select the correct choice among four multiple-choice answer options. 

Multiple-response or select all that apply (SATA) alternate format question requires you to choose all correct answer options that relate to the information asked by the question. There are usually more than four possible answer options. No partial credit is given in scoring these items (i.e., selecting only 3 out of the 5 correct choices), so you must select all correct answers for the item to be counted as correct. 

Tips when answering Select All That Apply Questions

• You’ll know it’s a multiple-response or SATA question because you’ll explicitly be instructed to “Select all that apply.”
• Treat each answer choice as a True or False by rewording the question and proceed to answer each option by responding with a “yes” or “no”. Go down the list of answer options one by one and ask yourself if it’s a correct answer.
• Consider each choice as a possible answer separate to other choices. Never group or assume they are linked together.

The fill-in-the-blank question format is usually used for medication calculation, IV flow rate calculation, or determining the intake-output of a client. You’ll be asked to perform a calculation in this question format and type in your answer in the blank space provided. 

Tips when answering Fill-in-the-Blank

• Always follow the specific directions as noted on the screen. 
• There will be an on-screen calculator on the computer for you to use. 
• Do not put any words, units of measurements, commas, or spaces with your answer, type only the number. Only the number goes into the box.
• Rounding an answer should be done at the end of the calculation or as what the question specified, and if necessary, type in the decimal point. 

In an ordered-response question format, you’ll be asked to use the computer mouse to drag and drop your nursing actions in order or priority. Based on the information presented, determine what you’ll do first, second, third, and so forth. Directions are provided with the question. 

Tips when answering Ordered-Response questions

• Questions are usually about nursing procedures. Imagine yourself performing the procedure to help you answer these questions.
• You’ll have to place the options in correct order by clicking an option and dragging it on the box on the right. You can rearrange them before you hit submit for your final answer.

A picture or graphic will be presented along with a question. This could contain a chart, a table, or an illustration where you’ll be asked to point or click on a specific area. Figures may also appear along with a multiple-choice question. Be as precise as possible when marking the location. 

Tips when answering Hotspot questions

• Mostly used to evaluate your knowledge of anatomy, physiology, and pathophysiology.
• Locate anatomical landmarks to help you select the location needed by the item.

So you’ve finally decided to take the NCLEX, the next step is registration or application for the exam. The following are the steps on how to register for the NCLEX, including some tips:

• Application to the Nursing Regulatory Board (NRB). The initial step in the registration process is to submit your application to the state board of nursing in the state in which you intend to obtain licensure. Inquire with your board of nursing regarding the specific registration process as requirements may vary from state to state.
• Registration with Pearson VUE. Once you have received the confirmation from the board of nursing that you have met all of their state requirements, proceed, register, and pay the fee to take the NCLEX with Pearson VUE . Follow the registration instructions and complete the forms precisely and accurately.
• Authorization to Test. If you were made eligible by the licensure board, you will receive an Authorization to Test (ATT) form from Pearson VUE. You must test within the validity dates (an average of 90 days) on the ATT. There are no extensions or you’ll have to register and pay the fee again. Your ATT contains critical information like your test authorization number, validity date, and candidate identification number.
• Schedule your Exam Appointment. The next step is to schedule a testing date, time, and location at Pearson VUE. The NCLEX will take place at a testing center , you can make an exam appointment online or by telephone. You will receive a confirmation via email of your appointment with the date and time you choose including the directions to the testing center. * Changing Your Exam Appointment. You can change your appointment to test via Pearson VUE or by calling the candidate services. Rules for scheduling , rescheduling, and unscheduling are explained further here . Failing to arrive for the examination or failure to cancel your appointment to test without providing notice will forfeit your examination fee and you’ll have to register and pay again. 
• On Exam Day. Arrive at the testing center on your exam appointment date at least 30 minutes before the schedule. You must have your ATT and acceptable identification (driver’s license, passport, etc) that is valid, not expired, and contains your photo and signature.
• Processing Results. You will receive your official results from the board of nursing after six weeks.

Important list and resources you need to know if you’re taking the NCLEX: 

• 2023 NCLEX Candidate Bulletin. This resource is a comprehensive guide for the NCLEX, providing essential information and contact details for candidates. It covers registration procedures, test fees, scheduling , testing accommodations, exam rules, and what to bring to the test site. The guide also includes details on the check-in process, breaks, technical issues, and the testing environment. It explains the results reporting process and retake-policy and provides information on the content, development, and test plans of the NCLEX. Additionally, it discusses the passing standard, item formats, and decision rules for passing or failing the exam.
• Sample Questions and Exam Preview. Get a headstart on your exam preparation with these sample test packs by the NCSBN. 
• Candidate Tutorial. With the new item types, we highly recommend testing how the Next Generation NCLEX (NGN) works. This tutorial guides you on interacting with different question types in your NCLEX exam. It provides a representative sample of items you may encounter during the test, allowing you to practice their functionality.

Please visit our Nursing Test Bank page if you’re looking to answer more practice questions from different topics and different question formats.

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

185 thoughts on “NCLEX Practice Questions Test Bank for Free”

How much are you charging for it?

Thanks for being generous

Thank you for your kindness & generosity. This is a big help for us, especially those with financial constraints.

How much for this

Thanks Matt Vera for your utmost effort in helping nurses to pass the exam

You’re most welcome! Good luck on your exams!

Hello Matt do you still have the Test Bank questions for 2021. If you do can I have them please and thank you.

Hi Winnie, Please visit our

Thanks heaps! Matt..

The site is very useful.

Thank you mam/sir

This is very helpful site. god bless🤗

Great website wish l knew about it before taking my nclex

Thank you so much for this free site. I found it just as helpful as Kaplan and Sanders which I paid for. I recommended this nurseslabs to some of my nurse friends preparing for the NCLEX. I used it to study and passed my NCLEX October 28. I will continue to use this as a reference. Once again Thank-You. A.Haynes RN

Hey Matt, I am impressed by your generosity. I couldn’t believe these were all free. In all fairness, there should be a tab for donations for the constant upkeep of the web. A very minimal way to show our gratitude.

Although I just started nursing school the i formation is mind blowing and very useful for me already. Thank you for your generosity. I will be using all the practice quizzes and test to prepare myself. Thank you again.

Thank you for this free nclex practice tests! May you have more blessings and success! I will take my exam next month.

Very informative and helpful

Thank you!You’re a big blessing to those who will take the exam.

I can’t thank you enough for this gift you have given us to use . God bless you.

Thank you so much Matt! This is helping me work toward my NCLEX with less pressure.

Thanks a lot can I get reading materials on PDF please

Thanks Matt Vera for ingenious effort.

You are heaven sent, Thank you Matt for helping us.

you guys all thank you so much for this massively hard work and huge success for all the nurses around the world .

Your efforts are immeasurable, you are not only helping nurses to pass their NCLEX exams but also increasing the number of qualified/competent nurses providing healthcare around the globe. We are grateful. I used this site to prepare for internal exams whilst I was in school and it really helped me. I’ll be writing NCLEX soon..

Planning to start this process, I think this will be so helpful to me. Thankyou very much

Thank you so much Nurse matt vera for this qbank,most beneficial, God bless you., if I may ask for some videos or pictures associated with the questions, will also help e.g lung sounds,abdominal sound etc thank you

I loved your blog and thanks for publishing this about NCLEX practice questions!! I am really happy to come across this exceptionally well written content. Thanks for sharing and look for more in future!! Keep doing this inspirational work and share with us.

My name is Daniel m Johnson from Tanzania I’m holding diploma in nursing and midwifery I’m looking for different nurse from different country so as we can share ideas and experience since I’m student I need to no much thing about nursing ….any one who is touched to please help me I wish to be came a good nurse and help different people from different society

What a wonderful thing to do for people! Thank you very much.

This very helpful to me, thank you.

You did a great job Matt…

This is so lovely

Very useful site. Thank you so much.

This is an amazing job Matt!! REALLY INCREDIBLE!!!

With all this I will certainly pass my NCLEX exams.

THANK YOU so so much Matt, this is great beyond measure.. I have been hook to this website. God will bless you and yours abundantly

You’re most welcome! :)

i just want to confirm for #39 it state pt need additional teaching so E should also be included to the answer cause it was contraindicated to MS right? . thank you :)

Yes, this has been corrected. Thank you! :)

Very informative and helpful. Thank you so much Sir/ madam

Thank you for providing regarding NCLEX preparation

Very informative. Thank you for update.

This is for sure the best nurse’s website ever. It really helped me a lot during my training.

Number 58 of NCLEX test 5 does not have the answers listed.

Hi Rebekah, this is now fixed. Thank you for letting us know!

This is very helpful

It’s very informative. Thanks

Thank you Matt Vera for providing information free of charge

Any advice of how well you can do on these question to build up your confidence?

Thanks a lot for great job. May the Lord Almighty shower His blessing upon you.

Thank you, this site is amazing. God bless you

Thanks alot.I,ve got a question What score ranges would be considered a Pass? I scored 69.33% overall. is that a Pass???

75% and above, from the analysis I got from a test after getting below 75

Thank you Nurse Matt. You deserve all the blessings! 🙏🏻😊

This is very helpful. Thank you Nurse Matt

Question 16 on practice test 9 asked about assessment during L sided CHF, yet the correct answer pertained to right sided HF. Just wanted to let you know…. Thanks for the practice questions! Appreciate all the work put into this.

Question 41 of NCLEX-RN Test 2 has two C choices. Thanks.

Hi, I like your questions, they’re very nice and challenging. Learning a lot from them.

I love this site.. Now all friends are learning serious from here

Thanks you guys are very generous

From Kenya, this site is so helpful,am learning a lot here.Thank you especially for the care plans.

Thank you so much

You Matt and your staff are such a blessing to us who will be taking the NCLEX RN exam. This site is very useful and helpful because it is very comprehensive and easy to understand. God bless and may tribe increase. Thank you so much

The site is very informative. I have learned a lot. Test questions are really amazing which I cannot find with other website. However, I got a low score, thus I need to further study especially on the areas wherein I got a below passing grade. I hope you will allow me. Thank you

thank you so much for creating this site for people like us. This excellent job. May God bless you in Jesus name —Amen

The Practice tests are awesome! The rationales are all well-explained which I love because it gives me more knowledge and insight. Thank you for creating this website free of charge.

Thank you so much. It was really helpful. I passed the exam. God bless real good.

Thank you Matt for the awesome and great website! its beyond compare. I want more practice test questions to hone my knowledge in Nursing practice, however, when I am trying to open one of the practice tests, I cant go through it. Could you please allow me? God bless

Thank you Matt for this practice test. Now I know my strength and weaknesses and will concentrate of the system that needs for further study. Can I practice more in practice test no 2? Please allow me to go trough with it. Kudos to you and your staff.

Hi this is what i got, im so nervous due to my nclex exam its gonna be this coming oct. Its doesnt say pass or not.

Your score 48% Categories Basic Care and Comfort 100% Health Promotion and Maintenance 53.85% Pharmacological and Parenteral Therapies 26.67% Physiological Adaptation 54.55% Psychosocial Integrity 100% Reduction of Risk Potential 36.36% Safety and Infection Control 100%

Thanks so much for this useful information. God bless you.

Thank you so much for all you do

The Practice tests are excellent. The rationales are all well-explained which I love because it gives me more knowledge and insight. Thank you for creating this website free of us. Remain blessed.

Like I am obsess with nurselab. A handy powerful tool, to keep you updated, thick and richly packed. You guys made reading so interesting and magnetic and very easy. Please do not stop. I recommend this to all nurses.

Love this. Thank you for sharing your generosity. I’ve been using this since I was still in college and I continue to use it until now.

Thank you so very much for this

I remain speechless but mostly grateful for your unconditional helpful assistance for this awesome richly throughout profound tool and opportunity given to me to increase my confidence, strengthen my knowledge, and be ready for my upcoming exam. Your questions and rationales are beyond my expectations. You are a God’ sent angel. Thank You. God Bless you. I will be forever grateful to you for making my dream come true! 🙌

This website can help me to review for NCLEX and it is for free! Thank you so much!

Amazing and really awesome job to you Matt and your entire team, may God replenish your source for giving us this for free. I have recommended to all my friends and family. Remain blessed and stay safe.

That’s very kind of you. Thank you so much! Bless you!

Your test questions have greatly helped me pass my NCLEX. I passed my NCLEX today and thank you to Nurseslabs. I came across this website by accident and I do not know how but it was divine intervention. I will definitely recommend Nurseslabs to my friends. The quality of the questions and rationales were very good and you would not think this is all for free the kind of work that came with it.

Kudos Nurseslabs and wishing all the future test takers all the best!

Wow Sam, congrats! What materials did you use other than nurseslabs? I’ve been answering nurseslabs also. My exam is on June. I hope I could also make it.

Thank you for this NCLEX sample test,as tool to determine areas i need to review/focus on for the proper exams.

This website can help me to review for NCLEX Thank you so much!

I just wanna ask why is that there are no more rationale posted after answering the question unlike before. Thanks by the way for the free and great Q & A bank. ❤

Sorry, we’re currently having some performance issues with that setup. Until we can resolve it, we have set each quiz to show results and rationales only after you have finished all the questions. Thank you for your understanding.

Hello, how do I get my score after taking the test to know if I am doing well or not

Hi, after you’re done answering all questions, the final item will direct you to the “Quiz Summary,” from there, click on the “Finish Quiz” button to get your final score.

Very great tool to study for the NCLEX. I passed my exam just by focusing on the questions and rationales provided here.

That’s great! Congratulations!

Thank you so much. It’s very helpful. God bless you…

Thank you for being generous. This is a big help.

I got 55/75.

Thank you so much for making this site.

Very helpful. Thank you and God bless…

Thank you so much, Nurse Matt for your generosity. Helping your fellow nurses and aspiring nurses to work abroad is such a selfless and noble act. God bless you and your team!

Thank you for your kind words, JB! Will pass on this message to the team. :) God bless!

The rationale after the question will really help us a lot specially when you are just using the question via online.

Hi Romel, we have temporarily changed this setting so that results and rationales will show only after you’ve finished the quiz. This is because we’re having some performance issues when using the previous setting. We’ll revert the changes once we’re sure the problem is resolved. Thanks for understanding!

I didn’t get my results after answering the 75 questions. Please why?

Hi Esther, did you click on the “Finish Quiz” button?

Thanks for all these questions where/how can i check my answers to these questions?

After answering the last item of the quiz, you’ll be redirected to the quiz summary. From there, click on the “Finish Quiz” button to view your score and results. You can also click on the “View Questions” button to review your answers and read the rationales.

Hi, thanks for providing so much useful information and all the test banks!

In RN practice Quiz 1:75 questions, for question 70, wonder if the correct phrase would be “would you NOT expect”?

Hi Cecilia, thanks for letting us know. We have corrected the question. Thank you! 🥰

Thank you for allowing me to practice the nurseslabs questions. The rationales are well explained. Thank you!

Thank you Ruth. Hope you’ve learned a lot from our practice questions. 🥰

God bless you

My name is Samuel. I just started with the RN practice questions. Thank you for the opportunity.

Hi, thank you so much for your generosity. Using this to prepare for my NCLEX and find it very informative. I will keep you posted on how it goes on the D-day

Frequently throughout the quiz, ARDS is given as “Adult Respiratory Distress Syndrome” instead of “Acute Respiratory Distress Syndrome”. This needs to be corrected.

Hi Bella, thanks for bringing this up.

Technically both terms are correct since “adult respiratory distress syndrome” is an earlier name referred to “acute respiratory distress syndrome” to differentiate it from respiratory distress syndrome in neonates and children. For the sake of uniformity, we have edited them to “acute respiratory distress syndrome”. You can read more about it here: https://doi.org/10.1164/ajrccm.149.3.7509706

This is so kind a gesture, remain blessed .The information is very understandable and helpful

I just wanted to thank you for taking the time to generate this website, this is really helpful and is free. God bless you

Thank you for your support and guide toward my nclex preparation.

Thanks for your generosity. I hope to pass my NCCLEX just on the first attempt Grateful for all your help

thanks for the help

Hi Sir, kindly explain why this question – The client with hyperemesis gravidarum is at risk for developing: Metabolic Acidosis is the answer. Thank you.

Quite familiar with the content. Thanks for this selfless initiative.

It has been a nice experience.

I love these practical questions. So helpful.

Thanks very much this is a good help for all students

Thank you for mett this free test which i have passed yesterday afternoon so ,it is greatest pleasure which will help me

Thank you so much for this great initiative.

Thanks for being kind God bless you

thank you for your help and kindness. It’s difficult to go back to school after 22 years of practice as a RN to take the test where you must cover a vast knowledge, which you do not use in everyday working (depends on the special field you are working. so I really appreciate your effort and dedication.

Matt Vera and all those helping us through this free medium, May God richly bless you abundantly. And may all your good desires come through

Hello Vera, I would start by thanking you for the great job you’ve done by helping us in our preparation for the exams. secondly would wish to know wther you have audio clips for lung, heart and abdominal sounds. thank you in advance and if any kindly let mh know pls.

What should we be scoring on these practice questions to let us know that we’re ready for the NCLEX

Do you have LPN test also?

Hi, please visit NCLEX-PN Practice Questions & Test Bank (200 Questions)

Thank you so much Nurse Matt you just don’t know how nurseslabs helped me in my nursing career and i even recommended nurseslabs to some of my friends. God bless you😊

Hi Matt, Thank you for this, indeed very helpful practice questions. Just a query though it says here to limit wrong answers to 15 or less? So is that the passing mark ? about 75-80%

Yes, that is correct. :)

Thank you so much for the practice questions. I learned a lot and it helped me to understand why I was getting my answers wrong. I used Kaplan and Saunders but it wasn’t helping me. I feel more confident than ever to retake my boards.

thank you…. wish this help a lot to my daughter to passed please pray for her God bless!!!

hi Matt, can l still use these question banks to study for the new NGN questions

Hi nurse Matt, May I gave all the questions please, need to prepare study for exam after been off school over 30 years, realize it for not giving up not try again, thank you 🙏

Thank you so much Nurselabs! I passed my NCLEX-RN exam using only your practice 75 question per day questions bank. I have a tight budget and not able to purchased online review and I just focused in answering your practice questions in just 2 weeks!!! Thank you for helping nurses! God Bless you more!

I want to practices questions

Hello Thanks so much for your good heart and good wish for us to practice and pass the NCLEX. Well appreciated. Please after your update I can’t get the answers and rationale to the 75 questions. This will help me to know my ability and where am lagging behind. Please how can this be rectified Thanks Hope

Hi Hope, did you finished all of the questions for the quiz? Your score together with the correct answers and rationale will only show after you’ve completed the whole quiz.

Hello Vera I finished all 75 questions submitted but no answer or rationale came up. I tried upto 3 times same. Even my friend I shared your content with complained of same thing, answers not coming. Please what can we do to access the answers and rationale Thanks Hope

What particular quiz?

Hello, great resource! I am a nurse that wants to help student nurses reach their full potential as nurses and pass the nclex. I would like to utilize your tests and quizzes to help my students learn to critically think through the questions and learn how to put their nursing knowledge to use. Would you allow me to utilize your questions in my content?

Thank you for the kind words! It’s awesome to hear that you’re dedicated to helping student nurses thrive. 🌟

Absolutely, you’re more than welcome to utilize our tests and quizzes for your students! We believe in collaborative efforts to strengthen the nursing community. Just ensure to give appropriate credit when using the content.

Out of curiosity, are there specific areas or topics you find students struggle with the most when preparing for the NCLEX? Maybe we can work together to create even more targeted resources!

Best of luck with your mission to guide the next generation of nurses!

Hi, I am studying for med surg 1 and med surg 2 upcoming exam. Need to pass both exams.

Sounds like you’ve got a busy study schedule ahead! MedSurg can be challenging, but with the right resources and dedication, you’ve got this. If you need specific materials, tips, or just a morale boost, don’t hesitate to reach out. Else, you can do practice all MedSurg exams on our Nursing Test Banks . Rooting for you to ace both exams! 💪

thank you so much… a big help

Hi Glacier and what a nice name!

You’re welcome! Really glad to hear the NCLEX practice questions were a big help. If you’ve got any other areas you’re prepping for or need more practice with, just let me know. Here to support your journey!

Thanks a lot @nurseslabs for this initiative I really believe by the time I sit my exam I will be a great nurse than ever before. I am learning a lot from the questions and explanation.

Hey Charles, You’re very welcome! I’m thrilled to hear that you’re finding our initiative helpful in your journey to becoming a great nurse. Remember, continuous learning is a key part of nursing practice, and it’s fantastic to see your dedication to it. If you ever come across any challenging topics or have questions about specific nursing concepts, please don’t hesitate to reach out. We’re here to support you every step of the way. Keep up the excellent work, and you’ll do great on your exam! 📖🏥🌟

Much help for beginners like us

Thank you so much Nurseslabs, I made it!!! Your practice exams, especially the rationales helped me a LOT…thank you!!!

Wow, that’s awesome news! 🌟 Huge congrats on making it through – your hard work and dedication really paid off. It’s super cool to hear how our practice exams and rationales played a part in getting you across the finish line.

Remember, this is just the beginning of an amazing journey in nursing. The field’s always changing and growing, and so will you. Keep that enthusiasm and curiosity going strong!

If you ever need a hand or just want to share your journey as you dive into your nursing career, give us a shout. We’re always here to cheer you on and lend support.

Big congrats again and best of luck out there!

Thanks for the information

thanks for the guide

Thank you for your kindness.

Thank you very much!

Thanks a lot for this whole range of knowledge; it’s now upon me to work extra hard to be a better nurse outside there or help other nurses be better at service delivery.

Hi Evans, You’re so welcome! I’m glad to hear that the range of knowledge from the NCLEX practice questions is empowering you to aim for excellence in nursing. Remember, every bit of effort counts towards becoming not just a better nurse but also a great mentor to others in the field. If you need more resources or advice along the way, I’m here to help. Keep up the fantastic work!

Please how can I practice questions please 🙏

In practice exam 5 question 22 asks about hyperemesis…. wouldn’t that cause alkalosis (rather than acidosis), since its acid from the stomach that is leaving the body?

Can I. Have free practice questions? NGN questions?

Thank you for the opportunity to know about all the information posted here. I strongly believe I will pass the NCLEX-RN exam at my first attempt through these useful resources available here. Thanks

Thanks a lot Nurselabs for the free test banks! It’s all what I focused to practice and read every rationale in each questions given. I just recently took my NCLEX-RN exam last week and i was able to make it. Your website is what i embraced and felt much comfortable and trusted what is in there. Thanks for helping lots of NURSES! Highly recommended!

Hello Brenda, Congratulations on passing your NCLEX-RN exam! 🎉 That’s a fantastic achievement, and I’m so thrilled to hear that our test banks and rationales were a valuable part of your preparation. Thank you for trusting Nurseslabs and for your kind words—it means a lot to us.

If you have any tips for future test-takers or any other resources you found particularly helpful, we’d love to hear about them. Your feedback not only celebrates your success but also helps us continue to improve and assist other nursing students.

Thanks again for recommending us, and best of luck in your exciting nursing career!

THIS IS GREAT. THANK YOU FOR SHARING.

Hello, Thank you for your good work. Are you uploading new practice tests or comprehensive tests for nclex rn or nclex pn soon? It has been a while.

Hi Monica, Thank you for your kind words! We appreciate your support. Yes, we are planning to upload new practice tests and comprehensive tests for both NCLEX RN and NCLEX PN very soon. Stay tuned for updates!

thanks for update ..be blessed

You’re doing great!!!! Thanks

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Ischemic Stroke

Caused by a blockage in a blood vessel leading to the brain, often due to a blood clot.

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Caused by bleeding in the brain, typically due to a ruptured blood vessel.

Time is Critical for Ischemic Stroke

Intravenous tPA (tissue plasminogen activator) may be administered within 3 - 4.5 hours from onset of symptoms and 45 minutes from door-to-tPA.

Check for Hypoglycemia

If a client presents with stroke-like symptoms, check for hypoglycemia.

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Head CT is a priority when determining the type of stroke a client is having.

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The NIH Stroke Scale is utilized to determine the severity of the client's stroke.

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Used when the candidate is instructed to ‘Select N’. This method scores an answer as either completely correct (1) or incorrect (0), depending on whether the selected answer(s) match the required selections exactly.

• How Many NGN Items Will You See on Your NCLEX?

Each test-taker will get 3-5 unfolding NGN case studies.

Three of the NGN case studies presented will be scored and contribute to your overall exam performance.

Should your exam feature more than three NGN case studies, the additional ones are designated as pretest items. These pretest items are included to evaluate questions for future use and will not affect your score.

About 10% - 15% of the standalone questions will be next-generation items.

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Writing Next Generation NCLEX-Style Case Study Questions

By Susan Sportsman, PhD, RN, ANEF, FAAN

Recently, our blog featured tips for developing Next Generation NCLEX (NGN)-style questions, particularly the revision of test questions faculty already include on their examinations. Revising these questions provides a strategy to adapt current test items to reflect the NGN process, since these knowledge questions represent many questions on the NGN exam.

Now let’s turn our attention to writing NGN Case Study questions . Although only three case studies will be on the NGN examination, all test-takers must respond to the six questions embedded in these case studies, regardless of how many total questions they receive. Case Studies are complex and require some thinking to create. However, I think they are fun to write—the exercise is very much like writing (a truly short) short story! Here are some suggestions for getting started.

• Begin with the objective(s) that emphasize the content you want students to apply. Keep in mind that the point of case studies (and NGN questions in general) is to evaluate how well students can apply content to a specific clinical situation.
• Develop a clinical problem that students must address that represents the objective(s) in your course. Ideas for this this problem might come from:
• Clinical situations highlighted in past tests (or in test banks to which you have access).
• Your own clinical experiences-or those of your colleagues.
• Content outlined in the NCLEX Test Design.
• Case Studies you use for class discussion or assignments for students.
• NCSBN’s Top Priority Knowledge Statements or Skills
• The introduction to the case study scenario should include:
• Client demographics (age, gender, brief and relevant social history)
• Client history
• Relevant environmental factors, such as where the client lives (own home, LTC facility, etc.)
• Normal/abnormal findings (e.g., Physical assessment findings, V/S, Lab values, psychological behaviors)
• Time considerations for the nurse/client
• Client/Nurse Interaction
• Recognize Cues: What matters most?
• Analyze Cues: What could it mean?
• Prioritize Hypothesis: Where do I go to start
• Generate Solution: What can I do?
• Take Action: What will I do?
• Evaluate Outcomes: Did it help?

Remember that the case study should represent situations that are appropriate for the level of student you are testing.  Later in the curriculum the questions should represent clinical judgment that a novice nurse is expected to use in actual practice.

Starting the Process of Writing a Case Study

As you begin to write your own case studies, an example might be helpful in integrating the NGN components into an actual case study. The case study below was written for students in an early nursing clinical course, such as Fundamental in Nursing. In addition, the NGN Resources website also provides examples of case studies written at the level of a novice nurse.

Note: The templates we developed for this post can be found on our Resources page . Feel free to use them.

#1. Recognize Cues (Drag and Drop)

Drag & Drop the 4 cues the RN observed the initial assessment which require following up.

#2. Analyze Cues (Select All that Apply-N)

The RN is concerned about the client’s confusion. Identify factors that may be causes for this confusion. a. Hospital Environment  * b. Early indication of Alzheimer’s Disease c. Use of Morphine for control of Pain  * d. Anesthesia  * e. Reduction in O2 f. Limited Sleep

#3. Prioritize Hypothesis (CLOZE)

Complete the following sentence by choosing from the following lists of options:

#4. Generate Solutions (Matrix)

Confusion continues to be a problem for the client on day three post-surgery.

Which of the possible interventions to the problem are indicated and which are contraindicated?

The RN notifies the surgeon of elevated TPR, drainage at surgical site, and pain and received orders.

#5. Take Action (Highlighting)

Upon receiving the following physician orders, highlight those which the nurse should implement right away.

#6. Evaluate Outcomes (Matrix)

The nurse has performed the interventions as ordered by the physician for the client. For each assessment finding, click to specify if the finding indicates that the client’s condition has improved, has not changed, or become worse.

Case study questions are an important part of the NGN emphasis on measuring test-takers’ clinical judgment competence. Hopefully, the example above will give you some ideas for developing your own case study questions. You may notice that these questions are not exactly formatted like those on the NGN website. Currently, most of us do not have the necessary software to completely mimic the NGN questions. But simple templates can come close. Please don’t let the differences in the format of these questions stop you from using case study questions in your testing and classroom teaching.  Remember, the point of the NGN testing process is to assess new graduates’ ability to use good clinical judgment in a variety of clinical situations.  Giving students the opportunity to practice clinical judgment is key to their success on NCLEX and in clinical practice.

Silvestri, L. (2020) Higher-Cognitive Level Test Question:  A Starting Point for Creating Next Generation NCLEX Test Questions. White Paper. Elsevier.

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Writing Case Studies and Scenarios for NCLEX Next Generation Questions

Next Generation questions will be included in the NCLEX nursing exams as early as 2023. In this article, we break down the components of the clinical judgment measurement model that should be included when writing patient care case studies and scenarios for Next Generation questions.

Next Generation questions are meant to prepare nurses to think critically when providing care by presenting real-world patient scenarios that require analysis, judgment and assessment skills by the student.

According to the NCSBN, the definition of clinical judgment (CJ) is the observed outcome of critical thinking and decision making 1 .

To meet the Next Generation question requirements, each case study and scenario must include components that are aligned with the clinical judgment model.

These components include iterative processes that use knowledge observed and assessed in a real-world patient care scenarios or case studies. From these observations and assessments, the nursing student must be able to identify a prioritized patient problem or concern, and establish an evidence-based solution that will deliver safe patient care.

Components of a Next Gen scenario are broken down into six parts. Questions can be written for each part of the case study/scenario, or the scenario can be freestanding, though typically written as part of the scenario.

• Part 1 – Patient Introduction, Background and Cue s Student Action Needed – Recognize Cues
• Part 2 – Analyzation of Cues Student Action Needed – Assess and Analyze Cues (Nursing Process – Assessment)
• Part 3 – Prioritize Hypotheses Student Action Needed – Analyze & Diagnose Cues (Nursing Process – Analysis/Diagnosis)
• Part 4 – Generate Solutions Student Action Needed – Identify Solutions (Nursing Process – Planning)
• Part 5 – Take Action Student Action Needed – Implement Actions (Nursing Process – Implementation)
• Part 6 – Evaluation of Outcomes Student Action Needed – Evaluate Outcomes (Nursing Process – Evaluation)

Part 1 – Assist the student in seeing the whole client. The introduction must include recognizable cues to the patient’s medical diagnosis, condition, and situation. These cues may include nurses’ notes, vital signs, lab results, health history, etc., as well as any time considerations. The goal of a Next Generation-compliant study or scenario is to provide the nursing student with enough vital patient information that they are able to answer the questions presented.

Part 1 should include:

• Client observations (Normal/Abnormal findings)
• Nurses Notes/Vital Signs/Lab Results
• Environmental information such as where the client is located
• Client demographics
• Client history
• Special equipment the client or nurse is using
• Time considerations

Your nursing students must be answer these questions: What is relevant? What is most important? What is of immediate concern, etc.?

Part 2 – Include in the scenario/case study the patient’s condition, what impact the data has on required nursing actions, and what pathophysiology related to clinical information will be required for the student to analyze the cues. Potential complications should also be included in this part of the scenario. Also, include any additional patient information that the student will need to be able to analyze presented cues.

Part 3 – The nursing student can now begin prioritizing a hypothesis from the patient’s situation. This part should include information that requires the student to make a judgment about the patient’s condition. Students must be able to prioritize patient needs, identify resources needed, and determine how the situation may impact the patient. Students must be able to recognize demographics that may change, and review facts in the client history that might play a role in patient care.

Nursing students should be able to answer these questions: What are the client’s priority needs? What are the other needs? What is the impact of the needs on resources, demographics, history, etc.?

Part 4 – Students must generate solutions for the patient’s situation. Solutions should include needed and appropriate interventions, and how the interventions may impact the patient’s situation. The student must also be able to identify resource and demographic changes that may affect the patient’s situation.

Part 5 – Students must now prioritize and implement actions based on the analysis and prioritization taken in the previous parts of the scenario. Questions may include what impacts a chosen action may have on the patient or resources needed. Again, demographics or the client’s situation might change.

Question components to include are: What actions should the nurse take? What actions should be done first, second, etc.? How do the actions impact resources, patient demographics or history, etc.?

Part 6 – The scenario must include expected outcomes, changes in the situation of the client, evaluation components, and if the client needs to be reassessed.

Questions that a student must answer are: Are outcomes expected and were the outcomes achieved? Are there other resources needed to meet the outcomes? What should be assessed or reassessed, etc.?

Need help with writing answers and distractors ?

Dr. Phil Dickison from the NCSBN has stated that the number of questions the student would need to answer on the typical NCLEX-RN exam can vary based on the tester level of skill since the exam will still be adaptive. There will probably be between two and five vignettes (cases/scenarios). A vignette will measure all six components of the clinical judgment measurement model. Therefore, if there are two vignettes, each with six components, there would be twelve questions on the exams. Alternatively, if there are five vignettes, there would be thirty questions on the exam 2 .(Excerpt: ATI https://atitesting.com/educator/blog/knowledge/2019/11/01 /prepare-for-ngn-with-these-crucial-insights-from-ncsbn ).

1 Currier, Jacklyn (2019). Exam Operations, Next Generation NCLEX (NGN). Retrieved from https://www.ncsbn.org/13534.htm 2 ATI. (November 1, 2019). How many test items will be on the Next Gen NCLEX and how will it be graded? [Blog Post]. Retrieved from https://atitesting.com/educator/blog/knowledge/2019/11/01/prepare-for-ngn-with-these-crucial-insights-from-ncsbn

Can you answer these free NGN practice questions for the NCLEX?

Get quality practice for the NCLEX—for free!—by working through these NGN practice questions, learning first-hand from experienced NCLEX tutor Justine Buick about the best ways to apply your knowledge and critical thinking skills to passing the exam!

In April 2023, the NCSBN released a revamped NCLEX to the world—the Next Generation NCLEX (NGN) —compelling nursing students/grads just like you to rethink your studying strategies! (To learn more about the way NGN questions differ from the previous generation exam, check out: What to expect from Next Generation NCLEX .)

So, to help you adapt and prepare, the team here at Brainscape joined forces with NCLEX prep expert Justine Buick ( www.theNCLEXTutor.com ) who has crafted from scratch a collection of Next Gen NCLEX practice questions , which you'll see shortly.

Combined with our digital flashcards for the NCLEX-RN and NCLEX-PN licensing exams, these constitute a powerful resource you can lean on to take your NCLEX prep to the next level!

These flashcards have been carefully curated and vetted to offer nurse students a hyper-efficient way to drill the enormous amounts of content they need to learn and remember in order to answer the more complex questions posed by Next Generation NCLEX questions.

• Get Brainscape’s Nursing Fundamentals flashcards (for nursing school) 
• Get Brainscape’s certified NCLEX-RN flashcards
• Get Brainscape’s certified NCLEX-PN flashcards
• Get Brainscape’s FNP flashcards
• Use Brainscape's free NCLEX study planners and exam countdown sheets to plot your path towards and remain razor focused on your study goals!

And if you're still in nursing school, check out our flashcards for all the topics you'll be learning: Pediatrics flashcards , Adult Health flashcards , Pharmacology flashcards , Management of Care flashcards , Maternity flashcards , Mental Health flashcards , and Safety & Infection flashcards .

Now, let’s dive into some Next Generation NCLEX practice questions with, first, a brief aside on the difference between standalone and case study questions...

Standalone vs case study NGN questions

The NCLEX poses questions either as “stand-alone” questions or as “case studies”. In the case of the former, they are—as their name suggests—one-off, discrete questions. Once you finish answering them, you move on to the next question, which isn’t at all related. 

Case studies, on the other hand, ask a series of questions based on the same patient/case and so it serves you to bear in mind your previous answers and maintain a degree of cohesiveness as you work through them.

The first Next Generation NCLEX practice question we’ll be tackling, however, is a standalone bowtie. This is one of the more common types of standalone questions on the NCLEX, which very simply gives you a patient scenario and then you have one question that you have to answer.

NGN Practice Question: Standalone Bowtie

The nurse is caring for a 67-year-old client in the cardiac care unit. The nurse documents the following data in the Nurses’ Notes.

Nurses' Notes

1530: Client was admitted 2 days ago for a scheduled coronary artery bypass graft (CABG) x 2 vessels. No complications during surgery and recovered in the ICU overnight. Client transferred out of the ICU this morning to the cardiac care unit. History of coronary artery disease, hypertension, hyperlipidemia, and osteoporosis. Assessment findings are as follows: alert and oriented x 3; denies shortness of breath, sore throat or cough, lungs clear bilaterally; irregular heart rhythm auscultated, denies chest pain, skin is warm to touch, cap refill < 3 seconds, no edema and peripheral pulses 2+ and equal bilaterally; denies nausea/vomiting, bowel sounds active x 4 quadrants, reports passing flatus and last bowel movement was the morning of surgery; indwelling foley catheter was discontinued this morning and has been voiding clear, yellow urine without complications; up to bathroom 2 times with assistance; gait steady. Client is currently sitting at bedside and reporting a "racing heartbeat" and "feeling faint". Vital signs are HR 142 beats/min, BP 116/78, RR 18 breaths/min, pulse oximetry 96% on room air, and temperature 98.4 F (36.9 C).

Complete the diagram by selecting from the choices below to specify which potential condition the client is most likely experiencing, 2 actions the nurse takes to address that condition, and 2 parameters the nurse monitors to assess the client's progress.

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Simply sign up for Brainscape's nursing flashcard collections (below) and we'll send the detailed answer and rationale to your inbox! These flashcards are FREE to sign up for ; and you can study a certain number of them before being asked to subscribe. But for full access to the Brainscape study experience, which will help you prepare for the NCLEX so much more efficiently , sign up for pro .

NGN Practice Question: Case Study

Now, let's try another type of NGN question: the case study, which, if you remember what we previously explained, poses a series of questions based on the same patient/case. So remember to bear in mind your previous answers and maintain a degree of cohesiveness as you work through them!

The nurse is caring for an older adult in the intermediate care unit.

1000: Client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). Client has used home oxygen at 3 L/minute by nasal cannula for 4 years but reports increased dyspnea over the last several days. Client increased portable oxygen to 5 L/minute. Currently, the client is fatigued but alert and oriented x 3. Client reports shortness of breath at rest, increased coughing and large amounts of thick, tan sputum. Client has labored breathing and is in the tripod position. Lung sounds with wheezes bilaterally. S1 and S2 heart sounds heard, no murmur or gallop noted. Vital signs obtained. Healthcare provider in to see client and admission laboratory tests completed. Respiratory therapist was in to obtain ABGs.

V ital Signs

Lab Results

The nurse assesses the client, obtains the vital signs and reviews the laboratory results. 1. Which laboratory findings require follow-up? Select all that apply.

2. The nurse reviews the assessment findings and laboratory results. For each client finding, click to select the finding that is most consistent with the condition of hypercapnia or hypoxemia. Each finding may support more than one condition.

3. Complete the following sentence by choosing from the list of options.The client is at highest risk for developing [Option 1] as evidenced by the client's [Option 2] .

4. For each finding below, choose the potential nursing intervention that is appropriate for the nurse to include in the plan of care. Each finding may support more than one intervention.

The nurse reviews the healthcare provider's orders.

• Continuous pulse oximetry monitoring
• Oxygen via venturi face mask, titrate to maintain pulse ox >88% • collect sputum culture for culture and sensitivity
• Repeat ABGs at 1800 today
• X-ray of chest today
• albuterol 2.5 mg via inhaler three times a day
• fluticasone 88 mcg via inhaler three a day guaifenesin 400 mg PO every 4 hours

5. What teaching points does the nurse provide regarding the inhaled medications? Select 3 teaching points.

The nurse assesses the client after implementing the healthcare provider's orders. 

6. Check whether the assessment findings indicate that the client’s condition is either Improved/Stable or Not Improved .

NGN Case Study Answers

For the full answers and rationale, include video explanations, simply sign up for Brainscape’s Nursing Fundamentals flashcards (for nursing school) or our certified NCLEX-RN or NCLEX-PN flashcards , which offer you a hyper-efficient way to drill the enormous amounts of content you need to learn in order to answer the more complex questions posed by Next Generation NCLEX questions. (And YES, they’re fully Next Generation NCLEX aligned.)

Once you've signed up, we'll email you the answers. (By the way, these flashcards are FREE to sign up for ; and you can study a certain number of them before being asked to subscribe.)

Finally, for truly excellent advice on excelling in nursing school, taking the NCLEX, and beyond, make sure you follow Brainscape Nursing on YouTube and check out our free Academy of articles and nursing guides !

Flashcards for serious learners .

Practice with NCLEX-Style Sample Questions

Practicing with high-quality Next Generation and NCLEX-style sample questions is the most effective way to prepare for the exam, because if practice feels like the actual exam, then the real thing will feel like practice.

Check out our free NCLEX sample questions below!

The Best NCLEX-Style Practice Questions

We are committed to providing you with only the best questions and explanations. Our NGN practice questions include the same hallmark features that have helped over a million nurses succeed – clinically-relevant content, vivid imagery and illustrations, and in-depth explanations for correct and incorrect answers.

Benefit from Exam-Like Practice

Learn from detailed rationales, customize tests to your needs, free nclex-style sample practice questions.

The best way to become more familiar with NCLEX-style questions is by practicing them. You’ve been through nursing school, so you have the knowledge. Now you just need to apply it. Choose your exam below to answer a few exam style questions …

The questions on the NCLEX-RN are designed to test your critical thinking skills and ability to apply knowledge in real-world scenarios. Don’t waste time practicing low-level questions! Challenge yourself with our NCLEX-RN sample questions.

The nurse is caring for a client at 39 weeks gestation who is receiving an IV oxytocin infusion for induction of labor. The nurse notes recurrent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply .

Explanation:

A late deceleration is a gradual decrease in fetal heart rate (FHR) with a uterine contraction that reaches its lowest point (ie, nadir) after the contraction’s peak with a slow return to baseline. Late decelerations occur as a reflexive chemoreceptor response to temporary fetal hypoxemia or fetal metabolic acidemia (in severe cases). Uteroplacental insufficiency, uterine tachysystole , and maternal supine hypotension are common causes because they compromise perfusion and oxygen availability to the fetus.

Intrauterine resuscitation interventions to improve fetal perfusion and oxygenation include:

• Administering an IV fluid bolus to increase maternal blood volume (Option 1)
• Discontinuing the IV oxytocin infusion to reduce uterine stimulation and decrease contraction frequency because relaxation of the uterus increases uteroplacental blood flow and fetal oxygenation (Option 3)
• Repositioning the client laterally to relieve compression of the maternal inferior vena cava , which can be occluded by the weight of the gravid uterus when supine (Option 5)

The mnemonic VEAL CHOP helps recall of causes of FHR changes on monitor tracings.

(Option 2) Vibroacoustic stimulation is used during nonreactive nonstress tests (ie, no accelerations) to provoke fetal movement, which helps determine whether the absence of expected accelerations is physiologic (eg, fetal sleep cycle) or pathophysiologic (ie, fetal acidemia). It is never performed during FHR decelerations or fetal bradycardia.

(Option 4) An amnioinfusion is indicated to relieve persistent, recurrent variable decelerations caused by umbilical cord compression. It is not indicated for late FHR decelerations or uterine tachysystole.

Educational objective: Late decelerations of fetal heart rate indicate compromised fetal oxygenation and perfusion. Intrauterine resuscitation interventions include administering an IV fluid bolus, discontinuing the IV oxytocin infusion, and repositioning the client laterally.

The nurse is delegating client care tasks to a licensed practical nurse (LPN) and unlicensed assistive personnel. Which of the following assignments are most appropriate to assign to the LPN? Select all that apply .

Nurses preparing to delegate client care to a licensed practical nurse (LPN) and/or unlicensed assistive personnel (UAP) should consider the 5 rights of delegation . The LPN can monitor and care for stable clients who have been initially evaluated by a registered nurse (RN). Interventions LPNs may perform include:

• Administering oral and parenteral medications , but excluding administering IV medications, which vary by state legislation (Options 1 and 2)
• Reinforcing teaching and skills that have been initially taught by the RN (Option 4)
• Focused assessments (eg, bowel sounds) after the RN’s initial assessment

(Option 3) Performing admission or initial assessments is outside the scope of the LPN and UAP. The RN must perform initial assessments in order to analyze the findings and formulate the client’s plan of care before delegating tasks.

(Option 5) The LPN is capable of performing routine care (eg, calculating daily intake and output, toileting). However, the UAP may also perform these tasks, which frees the LPN to perform more complex duties. Therefore, the most appropriate staff member to assign the task of calculating intake and output to is the UAP.

Educational objective: Nurses preparing to delegate client care should consider the 5 rights of delegation. Appropriate tasks to delegate to a licensed practical nurse include administration of oral and parenteral medications, excluding IV route, and reinforcement of teaching previously provided by the registered nurse.

The nurse cares for a client with aortic stenosis who was admitted due to syncope on exertion and dyspnea. Identify the area where the nurse would best auscultate the client’s heart murmur.

Think of a location on the image which you deem right and click on ‘Show Correct Regions’ link to see if your selection is correct .

Aortic stenosis (AS) is a type of valvular heart disease characterized by narrowing of the aortic valve opening, which limits the left ventricle’s ability to eject blood into the aorta. AS may occur from hardening (ie, calcification) of the valves, congenital heart disorders, or inflammation. If left untreated, AS may result in heart failure and pulmonary hypertension as compensatory mechanisms fail.

When assessing a client with AS, the nurse should auscultate in the aortic area (ie, second intercostal space at the right sternal border) for a loud, systolic ejection murmur heard following the first heart sound. The aortic area, rather than directly over the heart valve, is the preferred location for auscultation as the heart sounds travel in the direction the blood flows. Additional clinical manifestations of aortic stenosis include chest pain, shortness of breath, and/or syncope that are worsened by exertion.

Educational objective : Aortic stenosis is a type of valvular heart disease causing narrowing of the valve between the left ventricle and aorta, impairing ejection of blood from the heart. Nurses attempting to auscultate heart murmurs associated with aortic stenosis should listen at the right sternal border, second intercostal space (ie, aortic area).

A health care provider prescribes cefuroxime 30 mg/kg/day PO divided in equal doses every 12 hours for a child with a urinary tract infection. The child weighs 34 lb. Based on the available concentration of cefuroxime, how many mL would the nurse administer per dose? Click the exhibit button for additional information. Record your answer using one decimal place .

Correct Answer : 4.6 mL

Using dimensional analysis, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:

Identify the prescribed, available, and required medication information

Prescribed: 30 mg cefuroxime / kg / day   Available: 250 mg cefuroxime / 5 mL   Required: mL / dose

Convert the prescription to the volume needed for administration using dimensional analysis

Prescription × available data = mL per dose

( mg cefuroxime / kg / day ) ( kg / lb ) ( lb /   )( day / dose ) ( mL / mg cefuroxime ) = mL cefuroxime / dose

( 30 mg cefuroxime / kg / day ) ( kg / 2.2 lb ) ( 34 lb /   )( day / 2 doses ) ( 5 mL / 250 mg cefuroxime ) = 4.63 63 mL cefuroxime / dose

Round to the first decimal place

4.63 63 mL / dose = 4.6 mL / dose

Educational objective: To calculate the volume of cefuroxime in milliliters per dose, the nurse should first identify the prescribed dose (eg, 30 mg/kg/day) and available medication (eg, 250 mg/5 mL) and then convert to volume in milliliters per dose (eg, 4.6 mL).

Alternative Method :

The formula method is an alternate way to calculate medication dosages. However, this method may increase the occurrence of miscalculation and medication errors. If you choose to use this method, do not round calculations until the final step .

Using the formula method, the following steps are performed to calculate the volume of cefuroxime per dose in milliliters:

Convert pounds to kilograms

( kg / 2.2 lb ) ( 34 lb /   ) = 15.45 45 kg

Calculate the prescribed dose in milligrams

( 30 mg cefuroxime / kg / day ) ( 15.45 45 kg /   ) ( day / 2 doses ) = 231.81 81 mg cefuroxime / dose

Convert the prescription to administration volume

Prescribed dose / available dose x available volume = dose in ML

231.81 81 mg cefuroxime / 250 mg cefuroxime x 5 mL = 4.63 63 mL cefuroxime / dose

The nurse receives new prescriptions for a client with right lower quadrant pain and suspected acute appendicitis. Which prescription should the nurse implement first?

Appendicitis is inflammation of the appendix and often results from obstruction by fecal matter. Appendiceal obstruction traps fluid and mucus typically secreted into the colon, causing increased intraluminal pressure and inflammation. As appendiceal intraluminal pressure and inflammation increase, blood circulation to the appendix is impaired, resulting in swelling and ischemia . These factors increase the risk for appendiceal perforation , a medical emergency , which may lead to peritonitis and sepsis .

When prioritizing care of the client with appendicitis, the nurse should utilize the ABCs (ie, a irway, b reathing, c irculation). Fluid resuscitation with IV crystalloids (eg, normal saline, lactated Ringer solution) is an important intervention aimed at preventing circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status (Option 3).

(Option 1) Pain medications may be administered to promote comfort, but should be administered via IV route to maintain NPO status in case of emergency surgery. However, circulation takes priority over pain medication.

(Options 2 and 4) Blood and urine samples often are prescribed to assist with treatment and care decisions. However, the nurse should prioritize circulatory status over obtaining laboratory specimens.

Educational objective: Nurses caring for clients with appendicitis should prioritize client care according to the ABCs (ie, airway, breathing, circulation). Initiating IV crystalloids (eg, normal saline) is a priority action that prevents circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status.

NCLEX-style practice questions can help you identify areas where you may need additional study or review. Every question in our NCLEX-PN QBank includes detailed rationales for the correct and incorrect answers, so you learn as you practice.

The nurse auscultates the heart sounds of a 77-year-old client with chronic heart failure. Which heart sound should the nurse document? Listen to the audio clip . (Headphones are required for best audio quality.)

S1 and S2 are the normal “lub-dub” heart sounds that result from closure of valves . Systole occurs between S1 and S2, with S1 indicating closure of the atrioventricular (tricuspid, mitral) valves and S2 indicating closure of the pulmonic and aortic valves.

S3 is an adventitious (extra) heart sound heard as “ DUB ” immediately following S2 (Option 3) . S3 occurs during early diastole as a result of rapid ventricular filling and is a normal finding in children and young adults. In older adults , S3 is an abnormal finding that often indicates heart failure because the sound results from decreased ventricular compliance.

S3 can be difficult to distinguish from S4 . S4 is a “LUB” sound that occurs immediately before S1, during late diastole, and indicates ventricular hypertrophy.

(Option 1) A pericardial friction rub is a creaky, grating sound heard throughout systole and diastole. Friction rub occurs with pericarditis and is due to friction between inflamed layers of pericardium.

(Option 2) S1 and S2 are the normal heart sounds heard during cardiac auscultation.

(Option 4) A murmur is a swooshing, blowing, or rumbling sound caused by turbulent blood flow (eg, from valve regurgitation or stenosis).

Educational objective: S3, the third heart sound, is a “DUB” sound that immediately follows S2. It is a normal finding in children and young adults. S3, an abnormal finding in older adults, often indicates heart failure.

A client with a hip fracture is placed in Buck traction. Which activities are appropriate for the nurse to include in the client’s plan of care? Select all that apply .

Buck traction is a type of skin traction used to immobilize hip fractures and reduce pain and spasm until the client can undergo surgical repair of the fracture. A traction boot is applied to the leg, below the fracture site. A weight gently and continuously pulls on the leg and hip, helping maintain alignment of the limb. The nurse should ensure that the traction boot is fitted properly and that the limb remains straight in a neutral position (Option 3) .

Skin traction exerts pressure on nerves, blood vessels, and soft tissue. The nurse should frequently assess neurovascular status (eg, pulse, capillary refill, color, temperature, sensation, movement) and skin integrity in the limb to which the boot is applied (Options 1 and 4) . Overall pain level and efficacy of administered pain medications should be monitored closely, as increasing pain in the limb in traction may indicate neurovascular compromise (Option 2) .

(Option 5) Side-to-side repositioning of the client in Buck traction can cause injury. Side-to-side position changes cause the affected leg to be adducted or abducted, which, when paired with the force of traction, can increase spasm and pain and contribute to neurovascular and orthopedic compromise.

Educational objective: Buck traction is used to immobilize hip fractures and reduce pain and spasm until the fracture can be repaired surgically. The nurse caring for a client in Buck traction should frequently assess the neurovascular status and skin integrity of the affected limb and maintain it in a straight, neutral position.

The nurse is assigned to care for four clients. Which client should the nurse see first? .

Compartment syndrome occurs when swelling in a tissue compartment causes compression of arteries and nerves, typically after a direct injury (eg, fracture, dislocation) or medical device placement (eg, cast, splint). Tissue perfusion and nerve function distal to the swelling become impaired, causing signs of neurovascular compromise (eg, severe, unrelenting pain; paralysis ) due to tissue ischemia . Without relieving compartment pressure (ie, cast removal, fasciotomy), ischemia leads to permanent nerve and tissue damage and/or loss of limb (Option 2) .

(Option 1) Edema and numbness or tingling (paresthesia) of the hands and fingers commonly occur from inappropriate sling application. Numbness and tingling also are early signs of compartment syndrome. However, the client with late signs of compartment syndrome (eg, paralysis) should be seen first.

(Option 3) Clients with amputations may experience phantom limb pain that is severe and described as burning or crushing and requires pain management. However, limb-threatening emergencies should be managed first.

(Option 4) Slightly decreased hematocrit and hemoglobin levels (normal male: 39%-50%, 13.2-17.3 g/dL, respectively) are expected after hip arthroplasty due to intra- and postoperative blood loss.

Educational objective : Compartment syndrome is a condition of impaired circulation due to increased tissue pressure, often from edema or medical devices. Clients with signs of compartment syndrome (eg, severe, unrelenting pain; paralysis) require immediate assessment and intervention to prevent permanent tissue damage or loss of limb.

The nurse is reinforcing teaching about constipation prevention to a client. Which of the following client statements indicate appropriate understanding of the teaching? Select all that apply .

Constipation is a symptom of many disease processes (eg, Parkinson disease, diabetic neuropathy, depression), procedures (eg, abdominal surgery, bowel manipulation), and medications (eg, anticholinergics, diuretics, opioids). Immobility, low-fiber diets, decreased fluid intake , and irregular bowel habits increase the likelihood of constipation. Educate clients to prevent constipation by:

• Encouraging a healthy bowel regimen (eg, avoid delaying defecation if the urge is felt, defecate at the same time daily when possible, track bowel movements to identify changes in patterns) (Option 2)
• Increasing consumption of fruits and vegetables to reach a daily fiber intake of at least 20 g (unless contraindicated) because fiber softens and increases the bulk of stool, which promotes defecation (Option 4)
• Increasing daily exercise because activity stimulates peristalsis and promotes defecation (Option 5)
• Drinking 2-3 L of noncaffeinated fluids daily (unless contraindicated), which prevents drying and hardening of stool in the colon

(Option 1) Clients should avoid caffeinated beverages, which promote diuresis and dehydration and may lead to constipation.

(Option 3) Clients should avoid using laxatives and enemas unless prescribed by a health care provider because overuse can result in physical and psychological dependency.

Educational objective: Constipation is a symptom of many disease processes, procedures, and medications. To prevent constipation, educate the client to increase daily fiber intake, drink 2-3 L of fluids daily, increase daily activity levels, and initiate a bowel regimen (eg, avoiding delay of defecation, defecating at the same time each day).

The nurse is assigning client care tasks to unlicensed assistive personnel. Which statement by the nurse is appropriate?

When assigning client care, the nurse must consider the five rights of delegation. Right direction/communication involves clear and precise instructions about assigned tasks, including any specific information necessary for completion . Necessary information includes the specific tasks (eg, take vital signs), the time frame (eg, in 10 minutes), and when to report back to the nurse (eg, if systolic blood pressure is (Option 4) .

(Option 1) Assigning unlicensed assistive personnel (UAP) to measure vital signs “this morning” does not provide a clear time frame (eg, in 1 hour) for completion. In addition, there is no communication about what the nurse expects in terms of follow-up.

(Option 2) Instructing the UAP to monitor the client closely is an unclear direction because it does not provide specific actions to perform (eg, “Set the bed alarm.”), time intervals for performance (eg, “Check on the patient every hour.”), or criteria to report to the nurse (eg, “Notify me if the client attempts to exit the bed unassisted.”).

(Option 3) Instructing the UAP to assist with ambulation “several times” does not give a specific time frame or distance for the client to ambulate. The nurse should also communicate the conditions or aids needed to accomplish the task (eg, walks with assistance or rolling walker).

Educational objective: Nurses assigning client care to unlicensed assistive personnel must consider the five rights of delegation. Right direction/communication involves providing clear instructions about the assigned tasks, specific information needed for task completion, the time frame, and when to report back to the nurse.

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Faculty Case Studies

The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine. 

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank  are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. 

Family  ▾

• Attention Deficit Hyperactivity Disorder - Pediatric
• Ectopic Pregnancy
• Febrile Seizures
• Gestational Diabetes
• Intimate Partner Violence
• Neonatal Jaundice
• Neonatal Respiratory Distress Syndrome
• Pediatric Hypoglycemia
• Pediatric Anaphylaxis
• Pediatric Diarrhea and Dehydration
• Pediatric Intussusception
• Pediatric Sickle Cell
• Postpartum Hemmorhage
• Poststreptococcal Glomerulonephritis Pediatric
• Preeclampsia

Fundamentals and Mental Health  ▾

• Abdominal Surgery Postoperative Care
• Anorexia with Dehydration
• Catheter Related Urinary Tract Infection
• Deep Vein Thrombosis
• Dehydration Alzheimers
• Electroconvulsive Therapy
• Home Safety I
• Home Safety II
• Neuroleptic Maligant Syndrome
• Opioid Overdose
• Post Operative Atelectasis
• Post-traumatic Stress
• Pressure Injury
• Substance Use Withdrawal and Pain Control
• Suicide Prevention
• Tardive Dyskinesia
• Transfusion Reaction
• Urinary Tract infection

Medical Surgical  ▾

• Acute Asthma
• Acute Respiratory Distress
• Breast Cancer
• Chest Pain (MI)
• Compartment Syndrome
• Deep Vein Thrombosis II
• End Stage Renal Disease and Dialysis
• Gastroesphageal Reflux
• Heart Failure
• HIV with Opportunistic Infection
• Ketoacidosis
• Liver Failure
• Prostate Cancer
• Spine Surgery
• Tension Pneumothorax
• Thyroid Storm
• Tuberculosis

Community Based  ▾

Mini Review  ▾

• Comprehensive Review
• Fundamentals
• Maternal Newborn Review
• Medical Surgical Nursing
• Mental Health Review
• Mini Review Faculty Summaries
• Mini Review Training for Website
• Mini Reviews Student Worksheets
• Pediatric Review

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From doing Bootcamp and doing trials of other popular practice websites it is very similar. It had a great set up and very similar to the actual NCLEX.

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Bootcamp was awesome! I initially started using the free trial and committed to the 3-month membership after finding the rationales, questions, and interface so helpful and easy to use (and the best I'd seen in comparison to other prep courses). Bootcamp tells you why wrong answers are wrong in addition to the rationale for the correct answer. YES! The images and charts were great for making complex topics easier to access and organize in my brain. I followed the study plan calendar and passed my exam in 85 questions. Would 10/10 recommend Bootcamp!

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NCLEX Bootcamp has been a great resource both in preparing me for NCLEX and for passing my classes. Any nursing student who wants exactly what you need to pass needs to get Bootcamp. Their videos made so much sense and really help emphasize the important thing that helped me pass my exams. Bootcamp was also much cheaper and affordable than other third party resources that I considered. I just wish I found it sooner!

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Bootcamp was my favorite source to study for the NCLEX. It is straight forward and the case studies are so helpful. My NCLEX was mostly case studies and I felt very prepared because I did about 75% of the case studies on Bootcamp. It is user friendly and I enjoyed it way more than ATI, which is my school wanted me to use. I didn't use ATI at all. I passed in 85 questions on my first try. Im so glad I found Bootcamp!

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I heard about Bootcamp through a Reddit post and decided to give it a try. I was very impressed with the similarity of the questions to the NCLEX. I recommended it to 3 of my friends who passed first try as well. I am so glad that I chose Bootcamp, and I would recommend it to any nursing student who’s preparing for the NCLEX.

I loved how the rationales also came with a video and a deeper explanation on why the answer I chose was incorrect. I also loved that there were so many questions in the bank that I never got the same question twice. I passed my exam in 85 questions and I honestly wasn’t nervous because Bootcamp made me feel very prepared.

I reviewed the NGN style questions a lot. It helped me to be confident when answering questions and how to understand what it was asking. I also did a few stand alone questions for adult health and that also helped me identify my weaker areas.

I sort of found Bootcamp by accident, and I am so happy that I did. I then search for reviews and they were all positive which led me to do a trial and I fell in love with the case studies and ended up purchasing. This was great practice for NCLEX because I had many case studies. I used the question bank in preparation for the NCLEX. In conjunction with other material Bootcamp helped me be 85 and out!! Would definitely recommend. Thank you!

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NCLEX Bootcamp is an online resource that will fully prepare you for the NCLEX-RN®. We have 1,900+ high-yield questions based on the real NCLEX®, 250+ Next Gen case study questions with video explanations, Readiness Exams that predict your chances of passing, a Next Gen NCLEX® Strategy Course , Bootcamp AI to instantly clarify any concept, a 4.9+ star-rated mobile app, and an NCLEX® Pass Guarantee.

The Next Gen NCLEX® is an updated test , and you need to prepare with an updated question bank . NCLEX Bootcamp is the only nursing resource created specifically for the Next Gen NCLEX®.

The Next Gen change means that the test now requires clinical judgment , and you can’t develop clinical judgment just by reading explanations alone. Instead, our video case walkthroughs and our Next Gen strategy course teach you how to think like a nurse and how to prioritize , which are the most important skills you need for NCLEX® success. Our question bank gives you plenty of opportunity to practice those skills .

NCLEX Bootcamp is made by a small team of passionate nurse educators who are committed to creating the best NCLEX ® prep tool – period . We come from all different clinical specialties and teaching backgrounds, but we are all masters - or doctorally-prepared nurses who share a common desire to help teach clinical judgment to future nurses (like you!).

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Next Generation NCLEX: Case Studies 1-2

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• Basic Care and Comfort 1
• Basic Care and Comfort 2
• Basic Care & Comfort Marathon
• Pharmacological & Parenteral Therapies 1
• Pharmacological & Parenteral Therapies 2
• Pharmacological & Parenteral Therapies 3
• Pharmacological & Parenteral Therapies 4
• Drug Dosage Calculation
• Pharmacological & Parenteral Marathon
• Reduction of Risk Potential 1
• Reduction of Risk Potential 2
• Reduction of Risk Potential 3
• Reduction of Risk Potential 4
• Reduction of Risk Potential Marathon
• Physiological Adaptation 1
• Physiological Adaptation 2
• Physiological Adaptation 3
• Physiological Adaptation 4
• Physiological Adaptation Marathon
• Psychosocial Integrity Test 1
• Psychosocial Integrity Test 2
• Psychosocial Integrity Test 3
• Psychosocial Integrity Test 4
• Psychosocial Integrity Test 5
• Psychosocial Marathon
• Health Promotion and Maintenance 1
• Health Promotion and Maintenance 2
• Health Promotion and Maintenance 3
• Health Promotion and Maintenance 4
• Health Promotion and Maintenance 5
• Health Promotion Marathon
• Management of Care 1
• Management of Care 2
• Management of Care 3
• Management of Care Marathon
• Safety & Infection Control 1
• Safety & Infection Control 2
• Safety & Infection Control 3
• Safety & Infection Control Marathon
• NCLEX Exam Simulator