3 Tricky Next Generation NCLEX (NGN) Questions You Need to be Able to Answer

Are you feeling nervous about the latest Next Generation NCLEX? I want you to know that you’re not alone!

Thousands of nursing students and graduates all over the country are feeling the same, which is why, in this week’s episode of NCLEX Ready, I decided to share with you three of the trickiest Next Generation NCLEX questions and their answers.

Once you listen to this episode, you’ll be able to study better for the NGN without the dread that comes with feeling unprepared.

Are you ready to ace this test?

Then let’s dive in!

NGN Question #1:

Nurse Lynn is providing care for a sixty-eight years old patient who was admitted with deep vein thrombosis (DVT). The nurse noted that the patient has a history of chronic atrial fibrillation and has been prescribed warfarin therapy for the past year. The provider has added enoxaparin to the medication list in addition to warfarin until the INR is at a therapeutic level. Which of the following actions should the nurse take to provide appropriate care for the patient? Select all that apply.

1. Assess for signs and symptoms of swelling, warmth, and redness in the legs daily.
2. Instruct the patient to report signs and symptoms of headache or dizziness.
3. Monitor the INR and platelet counts, as ordered by the provider.
4. Encourage the use of a soft-bristle toothbrush.
5. Encourage the use of an electric razor.
6. Administer enoxaparin in the arm to avoid interference with warfarin absorption.

Answer: 1, 2, 3, 4, and 5. Assess for signs and symptoms of swelling, warmth, and redness in the legs daily. Instruct the patient to report signs and symptoms of headache or dizziness. Monitor the INR and platelet counts, as ordered by the provider. Encourage the use of a soft-bristle toothbrush. Encourage the use of an electric razor.

Rationale: The nurse must monitor for signs and symptoms of deep vein thrombosis and the effectiveness of anticoagulation therapy, so it is crucial to assess for swelling, warmth, and redness. 

Headache and dizziness can indicate bleeding complications, which is hard for the nurse to assess for; this means education is essential so the patient can report to the healthcare staff if they have a headache or start to feel dizzy. 

INR monitoring is done for patients on warfarin therapy to ensure the appropriate levels are being maintained to reduce clotting or bleeding risk. INR levels that are too low can put the patient at a risk for blood clots. INR levels that are too high put the patient at risk for bleeding. Platelet monitoring is done to detect signs of heparin-induced thrombocytopenia (HIT) when a patient is on enoxaparin. 

The use of a soft-bristle toothbrush and electric razor are actions that minimize bleeding risk. 

Warfarin is taken orally so where enoxaparin injections are done does not affect warfarin absorption. Plus, enoxaparin injection should not be administered in the arm, but in the abdomen for proper absorption.

NGN Question #2: 

2.

The C.N.A. is monitoring the vital signs every 15-minutes and reporting the findings to the nurse. Complete the following statement by choosing from the list of options.

The patient is most likely experiencing [ Select from list 1 ] as evidenced by [ Select from list 2 ] and [ Select from list 3 ].

Answer: The patient is most likely experiencing [ hypovolemia ] as evidenced by [ hypotension ] and [ tachycardia ].
Rationale: From list one, you must have an understanding of what hypovolemia, atrial fibrillation, and hypervolemia are. Once you have an understanding of each topic, you can take a look at the vital signs from the chart and determine what the patient is most likely experiencing. 

Hypovolemia occurs when there is not enough fluid volume or blood in the body as a result of injury or an underlying condition. This means the body is not able to maintain adequate blood pressure and circulate the blood properly. This makes the heart have to work harder to pump blood, which is why tachycardia is being noted. 

Since blood pressure is not stable during hypovolemia, hypotension would also be noted. Hypervolemia is the opposite of hypovolemia, which is where there is fluid overload in the body. This can be the result of the body’s retention of water and sodium. Hypertension would be noted, not hypotension. The increase in temperature from 9:00 to 9:30 is so minor and is not related to any of the choices from list 1. 

Atrial fibrillation is an irregular and rapid heart rhythm. The vital signs stated that the patient is experiencing tachycardia, but the heart rates are normal. Atrial fibrillation should be eliminated.

NGN Question #3:

The nurse is reviewing the electrocardiogram (EKG) of a patient who was admitted to the unit with palpitation and shortness of breath. Which is the correct interpretation of the patient’s cardiac rhythm?

1. Atrial flutter
2. Atrial fibrillation
3. Normal sinus rhythm
4. Ventricular tachycardia

Answer: Atrial flutter.

Rationale: Atrial flutter has a “sawtooth” pattern, also known as flutter waves. When a patient is experiencing palpitation and shortness of breath, atrial flutter would be an expected finding. Administering oxygen can alleviate signs and symptoms of hypoxia.

[ATRIAL FIBRILLATION OR AFIB]

There are a lot of squiggly lines in between the big spikes with atrial fibrillation. Atrial fibrillation is actually a common atrial arrhythmia. Sometimes patients don’t even notice it. However, it’s still a problem because the blood is not fully pushing out of the atria since the atria is not fully contracting. The patient is at risk for blood clots since it can start to clump together.

[ NORMAL SINUS RHYTHM]

This EKG indicates that the patient is experiencing a normal sinus rhythm, which is a regular heart rhythm in a healthy adult. The normal heart rate is 60 to 100 beats per minute.

[ VENTRICULAR TACHYCARDIA OR VTACH ]

If the nurse is seeing this cardiac rhythm on the EKG strip, then the nurse must prepare to treat this situation as an emergency. Assess the patient immediately to determine if there is a pulse or not. The patient would not have a pulse.