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Next Generation NCLEX (NGN) Clinical Judgment Practice: Case Studies and Prioritization in, Exams of Nursing

Columbia International University (CIU)Nursing

Next Generation NCLEX (NGN) Clinical Judgment Practice: Case Studies and Prioritization in Nursing Care Next Generation NCLEX (NGN) Clinical Judgment Practice: Case Studies and Prioritization in Nursing Care.

Typology: Exams

2024/2025

Available from 07/12/2025

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Next Generation NCLEX (NGN) Clinical
Judgment Practice: Case Studies and
Prioritization in Nursing Care
Case Study 1: Patient with Chest Pain
1. The patient reports sudden chest pain radiating to the left arm.
What is your priority action?
Obtain a detailed history
✔ Assess vital signs and administer oxygen
Schedule an ECG for tomorrow
Provide pain medication only
2. You notice the patient is diaphoretic and anxious. What cue is
this?
Stable condition
✔ Sign of possible myocardial infarction
Normal response to pain
Side effect of medication
3. The ECG shows ST elevation. What intervention is most urgent?
Administer oral aspirin
✔ Notify the cardiology team immediately
Schedule stress test
Provide reassurance only
4. Which lab test is most critical to order now?
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Next Generation NCLEX (NGN) Clinical

Judgment Practice: Case Studies and

Prioritization in Nursing Care

Case Study 1: Patient with Chest Pain

  1. The patient reports sudden chest pain radiating to the left arm. What is your priority action?  Obtain a detailed history  ✔ Assess vital signs and administer oxygen  Schedule an ECG for tomorrow  Provide pain medication only
  2. You notice the patient is diaphoretic and anxious. What cue is this?  Stable condition  ✔ Sign of possible myocardial infarction  Normal response to pain  Side effect of medication
  3. The ECG shows ST elevation. What intervention is most urgent?  Administer oral aspirin  ✔ Notify the cardiology team immediately  Schedule stress test  Provide reassurance only
  4. Which lab test is most critical to order now?

 Complete blood count  ✔ Cardiac enzymes (troponin)  Electrolytes  Liver function tests

  1. The patient asks about the cause of pain. Your best response is:  “It’s probably nothing serious.”  ✔ “You may be experiencing a heart attack; we are taking steps to help you.”  “I don’t know.”  “You should rest and see if it improves.” Case Study 2: Elderly Patient with Confusion
  2. The patient is confused and disoriented. What is the first step?  Administer sedatives  ✔ Assess for possible delirium causes (infection, meds)  Ignore confusion  Restrain the patient
  3. You find the patient has a fever and elevated WBC. What does this suggest?  Dehydration  ✔ Infection causing delirium  Stroke  Anxiety

 Notify family

  1. You observe tachycardia and low oxygen saturation. What is the likely diagnosis?  Pneumonia  ✔ Pulmonary embolism  Atelectasis  Anxiety attack
  2. Which diagnostic test is most appropriate?  Chest X-ray  ✔ CT pulmonary angiogram  ECG  Abdominal ultrasound
  3. What is the immediate nursing intervention?  Start IV fluids  ✔ Administer oxygen and prepare for anticoagulation therapy  Provide oral fluids  Encourage ambulation
  4. Which symptom should be reported immediately?  Mild cough  ✔ Sudden chest pain and hemoptysis  Slight fever  Mild leg swelling

Clinical Judgment - Highlighting Cues & Prioritizing Interventions

  1. A patient with diabetes shows confusion and sweating. What cue is this?  Hyperglycemia  ✔ Hypoglycemia  Infection  Stroke
  2. What is the priority intervention?  Administer insulin  ✔ Give fast-acting glucose  Call family  Take blood pressure
  3. A postoperative patient has redness and swelling at the IV site. What cue is this?  Normal finding  ✔ Possible phlebitis  Dehydration  Allergic reaction
  4. Priority nursing action?  Document only  ✔ Remove IV and notify physician  Increase IV rate

 Weight gain  Hypertension

  1. Which lab value is most important in suspected sepsis?  Hemoglobin  ✔ White blood cell count  Platelets  Sodium
  2. A patient with hypoglycemia should be given:  Insulin  ✔ Glucose  Water  Antibiotics Drop-Down Questions (Choose the correct option)
  3. The first step in managing a patient with suspected stroke is to assess _______.  pain level  ✔ airway, breathing, circulation  blood sugar  medication history
  4. When a patient develops anaphylaxis, the medication to administer immediately is _______.  aspirin

 ✔ epinephrine  insulin  acetaminophen

  1. The best position for a patient with respiratory distress is _______.  supine  prone  ✔ high Fowler’s  Trendelenburg
  2. To prevent pressure ulcers, the nurse should reposition the patient every _______.  6 hours  8 hours  ✔ 2 hours  4 hours
  3. The normal range for adult pulse oximetry is _______.  70-80%  80-90%  ✔ 95-100%  100-110% Multiple-Response Questions (Select all that apply)
  4. Signs of hypovolemic shock include:

 ✔ Deep vein thrombosis  Improved muscle tone  ✔ Pneumonia Matrix/Grid Questions (Match the symptom with the likely cause) Symptom Hypoglycem ia Stro ke MI (Heart Attack) Infectio n Sudden weakness (^) ✔ Chest pain (^) ✔ Confusion (^) ✔ ✔ ✔ Fever (^) ✔ Diaphoresis (sweating)

Additional Clinical Judgment Questions

  1. A patient with sudden onset unilateral leg swelling likely has:  Cellulitis  ✔ Deep vein thrombosis  Muscle strain  Arthritis
  2. The most appropriate nursing action for a patient with suspected DVT is:

 Apply heat  ✔ Elevate the leg and notify provider  Encourage walking immediately  Massage the leg

  1. A patient with a history of seizures is confused and lethargic. What is your priority?  Administer sedatives  ✔ Check blood glucose and airway  Allow rest  Start IV fluids
  2. Which of the following cues indicate respiratory distress?  ✔ Use of accessory muscles  Normal respiratory rate  Calm appearance  Pink skin color
  3. The priority nursing intervention for respiratory distress is:  ✔ Administer oxygen  Encourage fluids  Provide analgesics  Monitor blood pressure Extended Multiple-Response Questions
  4. Which of the following are signs of shock?

 ✔ Communicating clearly  Ignoring patient concerns  ✔ Reporting errors honestly Drag and Drop (Place the interventions in order of priority)

  1. Prioritize the steps in managing airway obstruction:  Call for help  Open airway  Provide oxygen  Assess breathing Correct order: ✔ Open airway → Assess breathing → Provide oxygen → Call for help
  2. Prioritize the nursing process steps:  Evaluation  Assessment  Planning  Implementation Correct order: ✔ Assessment → Planning → Implementation → Evaluation
  3. Prioritize actions for a patient with chest pain:  Administer aspirin  Obtain ECG  Assess vital signs

 Notify physician Correct order: ✔ Assess vital signs → Obtain ECG → Administer aspirin → Notify physician

  1. Prioritize interventions for hypoglycemia:  Check blood glucose  Administer glucose  Recheck blood glucose  Provide meal Correct order: ✔ Check blood glucose → Administer glucose → Recheck blood glucose → Provide meal
  2. Prioritize care for a fall patient:  Assess injuries  Notify physician  Provide first aid  Document incident Correct order: ✔ Assess injuries → Provide first aid → Notify physician → Document incident