Next Generation NCLEX
NGN case studies that score your clinical judgment
Since April 2023 every NCLEX-RN includes three unfolding case studies. Aegis has 100 of them, with 600+ sub-questions scored against the six steps of the NCSBN Clinical Judgment Measurement Model. Work through a full one below.
The six steps NGN cases test
Recognize cues
Pick out the findings that matter from the chart, vitals, and history. What is relevant right now, and what is background noise?
Analyze cues
Link the cues to what is probably happening. Which condition or complication explains this cluster of findings?
Prioritize hypotheses
Rank the possibilities. Which one is most likely, most urgent, or most dangerous if missed?
Generate solutions
List the interventions that could address the priority problem, including what to anticipate from the provider.
Take action
Choose and sequence the actions. Who does what, in what order, and what gets delegated?
Evaluate outcomes
Decide which findings show the plan worked and which signal a complication or the need to reassess.
Free sample case
Acute chest pain — middle-aged male
In the app the scenario unfolds. Later passages are hidden until you answer the earlier questions, exactly like the real exam. Here you can read everything at once.
Initial
A 68-year-old man arrives at the ED with crushing substernal chest pain that began 2 hours ago and radiates to his left arm. He has a history of hypertension, hyperlipidemia, and a 40 pack-year smoking history. Initial vitals: BP 158/96, HR 112, RR 22, SpO2 94% on room air, T 37.0°C. He is diaphoretic and clutching his chest. EKG and troponin are pending.
After EKG (≈10 min later)
The 12-lead EKG shows 3 mm ST elevation in leads II, III, and aVF. Initial troponin I returns at 8.5 ng/mL (normal < 0.04). The cardiac cath lab is being activated for emergent PCI.
Post-PCI (2 hours later)
The client returns from the cath lab after successful PCI of the right coronary artery with a drug-eluting stent. Vitals: BP 124/74, HR 86, RR 18, SpO2 96% on 2 L NC. He reports residual mild chest discomfort 2/10. Femoral access site is dry with strong distal pulses.
Question 1 Select 4 medium Recognize cues
Which findings on the initial assessment are most concerning? Select 4.
- A.Crushing substernal chest pain radiating to left arm
- B.Heart rate of 112 bpm
- C.Diaphoresis
- D.SpO2 94% on room air
- E.Temperature 37.0°C
- F.Age 68
Show answer and rationale
Correct answer: A, B, C, D · ACS — recognizing acute cues
Classic ACS findings: crushing substernal pain with radiation, tachycardia (compensation), diaphoresis (sympathetic activation), borderline hypoxia. Age and history are background risk factors. Temperature is normal.
Question 2 Multiple choice medium Analyze cues
Based on these findings, the nurse interprets the most likely cause as:
- A.Acute coronary syndrome (likely STEMI)
- B.Pulmonary embolism
- C.Aortic dissection
- D.Anxiety attack
Show answer and rationale
Correct answer: A · Differential diagnosis of chest pain
Crushing chest pain radiating to left arm + diaphoresis + CV risk factors strongly suggests ACS. PE: sudden dyspnea/pleuritic pain. Aortic dissection: tearing pain to back.
Question 3 Multiple choice medium Prioritize hypotheses
After EKG confirms inferior wall STEMI, the priority becomes:
- A.Restoration of coronary blood flow as quickly as possible
- B.Pain control with oral acetaminophen
- C.Discharge planning and lifestyle education
- D.Routine cardiology follow-up in 1 week
Show answer and rationale
Correct answer: A · STEMI — door-to-balloon priority
Time is myocardium. Door-to-balloon goal for primary PCI is < 90 min. Reperfusion is the single most important intervention to limit infarct size.
Question 4 Select 4 hard Generate solutions
Which interventions should the nurse anticipate in the first hour? Select 4.
- A.Aspirin 162-325 mg chewed
- B.Heparin or other anticoagulant per protocol
- C.Sublingual nitroglycerin if SBP > 90
- D.Oxygen titrated to SpO2 ≥ 90%
- E.IV fluid bolus of 2 L NS
- F.Oral metformin
Show answer and rationale
Correct answer: A, B, C, D · STEMI — initial pharmacotherapy
MONA-B for STEMI: chewable aspirin, anticoagulation, nitrates if not hypotensive, oxygen if hypoxic. Aggressive fluids worsen pulmonary edema. Metformin held before contrast.
Question 5 Multiple choice medium Take action
While awaiting transfer, the client becomes pulseless and the monitor shows V-fib. The first action is:
- A.Administer amiodarone 300 mg IV push
- B.Start high-quality CPR and prepare to defibrillate
- C.Apply oxygen via non-rebreather
- D.Obtain IV access
Show answer and rationale
Correct answer: B · V-fib emergency response
V-fib is shockable. ACLS: high-quality CPR + immediate defibrillation. Antiarrhythmics come after the first shock.
Question 6 Select 3 medium Evaluate outcomes
Two hours post-PCI, which findings indicate effective intervention? Select 3.
- A.Chest pain decreased from 9/10 to 2/10
- B.BP improved to 124/74 from 158/96
- C.EKG ST segments returning toward baseline
- D.New onset bradycardia at 38 bpm
- E.Femoral hematoma expanding rapidly
Show answer and rationale
Correct answer: A, B, C · Post-PCI evaluation
Successful reperfusion: pain reduction, hemodynamic stabilization, ST resolution. Bradycardia and expanding hematoma are post-PCI complications.
