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Nursing Practice Questions

Next Generation NCLEX Practice Questions

Next Generation NCLEX-RN (NGN) — Work through free next generation NCLEX practice questions built around the clinical judgment model. These NCLEX case study questions walk you from recognizing cues to evaluating outcomes, with a clear rationale after each one so you learn the reasoning, not just the answer.

85-150 (includes NGN case studies)
Total Questions
Up to 5 hours
Time Limit
Pass/fail (computer adaptive)
Passing Score
$200
Registration Fee

Free Sample Questions

Here are 5 free sample questions from our full bank of 660+ Next Generation NCLEXpractice questions. Try them out below — click "Show Answer" to reveal the correct response and explanation.

1

A nurse is caring for a 68-year-old client, 1 day after a total hip replacement. The client was alert this morning but is now restless and says, 'I can't seem to catch my breath.' Vital signs: HR 118, RR 28, BP 132/84, SpO2 89% on room air. Which finding is the MOST important cue for the nurse to recognize first?

AHeart rate of 118 beats per minute
BOxygen saturation of 89% with a new complaint of shortness of breath
CBlood pressure of 132/84 mmHg
DRestlessness after a night of interrupted sleep
2

A client with type 1 diabetes is admitted with nausea, abdominal pain, and a blood glucose of 462 mg/dL. Findings: deep, rapid respirations, fruity breath odor, serum pH 7.21, and positive serum ketones. Which condition do these cues MOST likely indicate?

AHypoglycemia with rebound hyperglycemia
BHyperosmolar hyperglycemic state
CDiabetic ketoacidosis
DAcute pancreatitis
3

A nurse is prioritizing hypotheses for a client with chest pain who is 2 days post-myocardial infarction. The client has new crackles in both lung bases, an S3 heart sound, jugular vein distention, and 2+ bilateral ankle edema. Which hypothesis should the nurse rank as MOST likely?

ALeft-sided heart failure progressing to fluid volume overload
BCommunity-acquired pneumonia
CPulmonary embolism
DAnxiety-related hyperventilation
4

A client receiving a blood transfusion reports sudden chills and low back pain 10 minutes after the infusion starts. Temperature is 38.6 C (101.5 F) and BP has dropped from 124/80 to 92/58. Which action should the nurse take FIRST?

ASlow the transfusion rate and recheck vital signs in 15 minutes
BAdminister acetaminophen and continue the transfusion
CNotify the blood bank and obtain a urine specimen
DStop the transfusion and infuse 0.9% sodium chloride through new tubing
5

A client with heart failure received furosemide 40 mg IV two hours ago. Which finding BEST shows the intervention was effective when the nurse evaluates outcomes?

AUrine output of 650 mL, respiratory rate down to 18, and lung sounds clearer
BHeart rate increased from 88 to 112 beats per minute
CClient reports feeling lightheaded when standing
DSerum potassium level of 3.0 mEq/L

Get the Full Next Generation NCLEX Question Bank — 660+ Practice Questions

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About the Next Generation NCLEX

Format & Structure

Total Questions
85-150 (includes NGN case studies)
Time Limit
Up to 5 hours
Format
Multiple choice, extended response, and case studies

Scoring & Cost

Passing Score
Pass/fail (computer adaptive)
Registration Fee
$200

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Frequently Asked Questions

What is the Next Generation NCLEX (NGN)?

The Next Generation NCLEX is the updated format of the NCLEX-RN and NCLEX-PN that launched in April 2023. It adds new item types and case studies built around the NCSBN Clinical Judgment Measurement Model. The goal is to test how well new nurses make decisions at the bedside, not just whether they recall facts.

How are next generation NCLEX practice questions different from older ones?

Older questions mostly asked for a single best answer. NGN items follow one patient across several questions and ask you to recognize cues, analyze them, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Formats include matrix grids, drag-and-drop, highlighting, and bow-tie questions. Our samples use multiple choice, but they follow the same clinical judgment steps.

What are NCLEX case study questions?

NCLEX case study questions present a client scenario with a chart, such as a nurses' note, vital signs, and lab values. You then answer six linked questions, one for each step of clinical judgment. Each case study is scored on its own, and partial credit is possible on many item types.

How many questions are on the NGN NCLEX-RN?

You'll answer between 85 and 150 questions, and the exam can last up to 5 hours. The test is computer adaptive, so it can end once it's confident about your result. Every candidate receives unscored pretest items, and three case studies appear among the scored questions.

How is the NGN NCLEX scored?

The exam is still pass/fail, and you won't get a numeric score. NGN items use partial credit scoring on many question types, so getting part of a matrix or multiple-response item right can still earn points. The computer adaptive engine estimates your ability level as you go.

How much does the NCLEX-RN cost?

The registration fee is $200, paid to Pearson VUE. You'll also pay a separate application fee to your state board of nursing, and amounts vary by state. Check your board's website for the exact total before you register.

How should I study for the next generation NCLEX?

Practice with case studies, not just isolated questions. For each scenario, ask yourself what the key cues are, what they mean, and what you'd do first. Review rationales for every answer, including the ones you got right, and mix in SATA and prioritization questions to build speed and confidence.

Can I retake the NCLEX if I fail?

Yes, you can retake it after a waiting period of at least 45 days, though some state boards set longer waits or limit total attempts. You'll need to pay the registration fee again. Use your Candidate Performance Report to see which content areas need the most work.

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