Next Generation NCLEX (NGN)
Instructions:
Each "Client" scenario represents a stand-alone or unfolding case study with
multiple questions.
Questions are designed to mimic NGN formats such as multiple respons
...
Next Generation NCLEX (NGN)
Instructions:
Each "Client" scenario represents a stand-alone or unfolding case study with
multiple questions.
Questions are designed to mimic NGN formats such as multiple response (select
all that apply), cloze (drop-down), matrix/grid, highlight text, bow-tie (drag-and
drop), and trend items.
Take your time to read through each case carefully. Pay close attention to the
details in the chart exhibits and nurses' notes, as these are critical for answering
NGN-style questions.
After selecting your answer, review the detailed rationale to understand the
clinical judgment behind the correct choice.
Client 1: Post-Operative Complications
Scenario: A 72-year-old male client, Mr. Henderson, is 2 days post-operative following
an open reduction internal fixation (ORIF) of a left hip fracture. He has a history of
hypertension and type 2 diabetes mellitus. His current medications include metformin,
lisinopril, and enoxaparin (Lovenox) 40 mg subcutaneously daily. At 07:00, the nurse
enters the room to complete an assessment.
Exhibit: Nurses' Notes - 07:00
Client awake and oriented to person, place, and time. Reports incisional pain as 3
on a 0-10 scale. Breath sounds clear bilaterally. Apical heart rate regular.
Abdomen soft, non-tender. Bowel sounds present. Left lower extremity
neurovascular checks: toes warm, pink, capillary refill < 3 seconds. Reports ability
to move toes. Surgical dressing dry and intact. Urinary catheter draining clear
yellow urine.
1. (Recognize Cues) The nurse reviews the client's medication administration
record. Which of the following assessment findings would be a priority for the
nurse to report to the healthcare provider before administering the morning dose
of enoxaparin? (Select all that apply.)
1. Blood pressure 148/86 mm Hg.
2. Platelet count 95,000/mm³.
3. Breakfast tray untouched.
4. A 2-cm area of ecchymosis on the right forearm.
5. Client reports a headache.
6. aPTT of 45 seconds.
Correct Answers: 2 and 4.
*Rationale: Enoxaparin is an anticoagulant. A low platelet count (thrombocytopenia)
could indicate Heparin-Induced Thrombocytopenia (HIT), a serious adverse effect.
Ecchymosis (bruising) is a sign of bleeding, and this new finding should be assessed and
reported. Both place the client at increased risk for bleeding. *
2. (Analyze Cues) At 09:00, the nurse finds Mr. Henderson with new onset
shortness of breath. He is sitting upright in bed, appears anxious, and his
respiratory rate is 28. His oxygen saturation is 88% on room air. Lung auscultation
reveals clear breath sounds bilaterally. Which of the following findings from the
client's electronic health record are most significant in analyzing the cause of his
respiratory distress? (Select all that apply.)
1. History of hypertension.
2. 2 days post-operative status.
3. Receiving enoxaparin 40 mg daily.
4. History of type 2 diabetes mellitus.
5. Age 72 years.
6. Current medications include lisinopril.
Correct Answers: 2 and 3.
*Rationale: The client's sudden respiratory distress with clear lung sounds is highly
suspicious for a pulmonary embolism (PE). Major risk factors for PE include recent
surgery (especially hip surgery) and immobility. While receiving anticoagulant
prophylaxis (enoxaparin) reduces the risk, it does not eliminate it. The other factors are
not direct risk factors for this acute event. *
3. (Prioritize Hypotheses) Based on the assessment findings at 09:00, what is the
most likely etiology of the client's current condition?
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