NCLEX Clinical Judgment Quiz: Can You Pass the NGN?

1. A 68-year-old patient on warfarin presents with an INR of 8.2. Which action takes priority?

Administer vitamin K immediately

Assess for signs of bleeding

Recheck INR in 2 hours

Increase warfarin dose

2. A patient receiving IV potassium complains of chest pain and dizziness. What is your first response?

Stop the infusion and assess cardiac status

Slow the infusion rate

Continue infusion; reassess in 5 minutes

Call for stat potassium level

3. A post-op patient has a urine output of 0.3 mL/kg/hr. Which finding requires immediate intervention?

Blood pressure 110/70 mmHg

Heart rate 92 bpm

Serum creatinine 2.1 mg/dL

Respiratory rate 16/min

4. A patient with sepsis has lactate 4.2 mmol/L and MAP 62 mmHg. What is the priority nursing action?

Administer vasopressors per protocol

Increase fluid resuscitation

Notify provider; prepare for ICU transfer

Monitor vital signs every 15 minutes

5. A patient reports dyspnea and has SpO2 88% on room air. Which action is most urgent?

Place on supplemental oxygen

Obtain chest X-ray

Call respiratory therapy

Elevate head of bed

6. A diabetic patient has blood glucose 42 mg/dL and is alert. How do you treat hypoglycemia?

Administer IV dextrose

Give 15 g fast-acting carbohydrate

Inject glucagon IM

Start insulin drip

7. A patient has acute angle-closure glaucoma. Which medication is contraindicated?

Timolol eye drops

Atropine

Pilocarpine

Dorzolamide

8. A post-op patient has a drain output of 200 mL serosanguineous fluid in 2 hours. What is your priority?

Remove the drain

Notify surgeon; assess wound

Increase dressing changes

Document and continue monitoring

9. A patient receiving heparin develops thrombocytopenia. Which complication is most concerning?

Heparin-induced thrombocytopenia (HIT)

Allergic reaction

Acute kidney injury

Hepatotoxicity

10. A patient with COPD is in respiratory distress. Which position optimizes breathing?

Supine with pillow support

Fowler's or tripod position

Left lateral position

Trendelenburg

11. A patient has signs of anaphylaxis. What is the first-line medication?

Diphenhydramine

Epinephrine 0.3–0.5 mg IM

Corticosteroids

Oxygen therapy

12. A patient on digoxin has nausea, vomiting, and a digoxin level of 3.2 ng/mL. What action is needed?

Continue digoxin; monitor closely

Hold digoxin; notify provider

Give antacid; recheck level

Administer antiemetic only

13. A patient has acute stroke symptoms. Time from onset is critical for which intervention?

Thrombolytic therapy (tPA)

Antiplatelet therapy

Anticoagulation

Physical therapy

14. A patient in labor has variable decelerations with good variability. What is the appropriate response?

Emergency cesarean delivery

Reposition; increase IV fluids; reassess

Administer oxygen and terbutaline

Prepare for operative vaginal delivery

15. A patient with acute MI develops cardiogenic shock. Which intervention is most critical?

Administer diuretics

Start vasopressor and inotrope support

Restrict fluids

Give morphine for comfort