NCLEX Next Generation NCLEX (NGN) Clinical Judgment and Case Studies — Questions and Answers
Question 1: In the NCSBN Clinical Judgment Measurement Model, which of the following lists the cognitive layers in the correct order?
- Take action, analyze cues, recognize cues, evaluate outcomes
- Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, evaluate outcomes (Correct answer)
- Prioritize hypotheses, recognize cues, take actions, generate solutions
- Generate solutions, recognize cues, evaluate outcomes, analyze cues
Correct answer: Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, evaluate outcomes
The six layers are recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. They reflect the order in which a nurse notices, interprets, plans, acts, and reassesses.
Question 2: A client 2 days after abdominal surgery has a temperature of 38.9 C, heart rate 118/min, respiratory rate 24/min, a wound with purulent drainage, and new confusion. Which findings are the most relevant cues indicating possible sepsis? (Select the best answer.)
- Temperature, heart rate, respiratory rate, and new confusion (Correct answer)
- Day since surgery and gender
- Drainage color only
- Client's preference for pain medication
Correct answer: Temperature, heart rate, respiratory rate, and new confusion
Fever, tachycardia, tachypnea, and altered mental status are the systemic findings that meet SIRS and sepsis criteria. Together with the infected-looking wound, they indicate a possible sepsis hypothesis. Demographic details and preferences are not significant clinical cues.
Question 3: A bow-tie style NGN item asks the nurse to choose two actions to take for a client with suspected heart failure exacerbation (dyspnea, crackles, weight gain of 3 kg in 2 days). Which two are the most appropriate?
- Place the client in high Fowler's position and anticipate a prescribed IV loop diuretic (Correct answer)
- Lay the client flat and encourage oral fluids
- Apply a heating pad to the chest and give sodium-rich broth
- Withhold all medications and obtain a stool sample
Correct answer: Place the client in high Fowler's position and anticipate a prescribed IV loop diuretic
Pulmonary congestion and rapid weight gain indicate fluid overload. Sitting the client upright reduces the work of breathing, and an IV loop diuretic removes excess fluid. Lying flat and increasing fluid or sodium intake would worsen the condition.
Question 4: In an NGN trend-style item, a client's urine output decreases from 60 mL/hour to 20 mL/hour over 4 hours while blood pressure drops from 124/78 to 94/58 mm Hg. Which hypothesis should the nurse prioritize?
- Inadequate renal perfusion from declining circulating volume (Correct answer)
- Improved renal function
- Overhydration
- Normal postoperative recovery
Correct answer: Inadequate renal perfusion from declining circulating volume
Falling urine output with decreasing blood pressure indicates reduced perfusion to the kidneys, suggesting hypovolemia or early shock. Recognizing this trend is critical for timely intervention.
Question 5: After administering a prescribed IV opioid for post-operative pain of 9/10, which finding should the nurse use to evaluate that the intervention was effective?
- Client reports pain of 3/10, is resting comfortably, and has a respiratory rate of 14/min (Correct answer)
- Client is sleeping with a respiratory rate of 8/min
- Client states the medication was given on time
- Client requests an additional dose within 5 minutes
Correct answer: Client reports pain of 3/10, is resting comfortably, and has a respiratory rate of 14/min
Evaluating outcomes means comparing client response with expected results. A drop in pain score with stable, adequate respirations shows effectiveness without respiratory depression. A respiratory rate of 8/min is a sign of overdose.
Question 6: Which NGN item format asks the candidate to select multiple correct responses from a list and may award partial credit?
- Multiple response (select all that apply) using +/- scoring (Correct answer)
- Fill-in-the-blank calculation only
- Single best answer only
- Ordered response with a single total score only
Correct answer: Multiple response (select all that apply) using +/- scoring
NGN uses multiple-response items with polytomous scoring such as +/- and rationale scoring, which can award partial credit. Single-best-answer items are scored right or wrong, and other NGN formats include matrix/grid, drop-down cloze, highlighting, and bow-tie items.
