NGN Case Studies are 6-screen item sets that present an evolving patient scenario. Each screen asks you to apply one step of the NCSBN Clinical Judgment Measurement Model (NCJMM) — exactly as you'll encounter them on the 2026 NCLEX-RN. Case studies account for approximately 21% of every NCLEX exam.
Med-Surg medium
Heart Failure
Mr. Okafor, 72-year-old male, admitted for worsening shortness of breath
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg hard
Sepsis
Ms. Rivera, 58-year-old female, admitted from skilled nursing facility with altered mental status
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Atrial Fibrillation
Mrs. Thornton, 70F, new-onset rapid atrial fibrillation, HR 148, admitted for rate control
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Increased Intracranial Pressure
Mrs. Park, 58F, post-op day 2 after brain tumor resection, developing Cushing's triad
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pediatrics medium
Febrile Seizure
Noah, 3M, brought to ED after 2-minute generalized tonic-clonic seizure with fever 40.1°C, now postictal
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Renal hard
Hyperkalemia
Mr. Okafor, 70M, CKD stage 4, K+ 6.8 mEq/L with peaked T waves on ECG
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pediatrics hard
Sickle Cell Crisis
Destiny, 10F, sickle cell disease, admitted with bilateral leg pain 9/10 and fever 38.7°C
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Heart Failure
Mr. Harold Simmons, 72-year-old male, admitted via ED with acute decompensated heart failure presenting with worsening dyspnea, orthopnea, and 8-lb weight gain over 3 days
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Acute MI
Mrs. Patricia Torres, 58F, presenting to the ED with acute crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea for 45 minutes
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Hypertensive Crisis
Walter Morrison, 65-year-old male, presents with hypertensive emergency
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Cardiogenic Shock
Robert Martinez, 67-year-old male, ICU admission post-myocardial infarction presenting with cardiogenic shock
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Pulmonary Embolism
Sarah Mitchell, 45-year-old female, 3 days post total knee replacement
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Deep Vein Thrombosis
James Thompson, 55-year-old male, admitted for suspected DVT following long-haul flight
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Cardiac hard
Post-Cardiac Surgery
Mr. George Kowalski, 63-year-old male, post-op day 1 following triple CABG surgery
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Fundamentals hard
Sepsis
Harold Morrison, 76-year-old male, 2 days post-abdominal surgery for colon resection
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pharmacology hard
Anaphylaxis
Ms. Sarah Chen, 35-year-old female, receiving penicillin IV for cellulitis at an outpatient infusion center
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Fundamentals hard
Blood Transfusion Reaction
Harold Miller, 55-year-old male, receiving packed red blood cells for anemia
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Leadership & Management hard
Post-Op Complications
Margaret Thompson, 60-year-old female, POD 1 after emergent bowel resection for ischemic bowel
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Leadership & Management hard
Delegation & Safety
Three patients on a busy medical unit require reassignment after Staff Nurse Martinez calls out sick. The charge nurse must evaluate patient conditions and delegate appropriately to available staff.
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pharmacology hard
Opioid Overdose
Mr. Jason Delgado, 28-year-old male, found unresponsive in parking lot with suspected opioid overdose, currently in ED receiving naloxone therapy
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Endocrine hard
Diabetic Ketoacidosis
Marcus Chen, 19-year-old male, admitted via Emergency Department with suspected diabetic ketoacidosis
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Endocrine hard
HHNS
Mrs. Eleanor Morrison, 80F, a nursing home resident with type 2 diabetes, transferred to ED with blood glucose 960 mg/dL, confusion, and signs of severe dehydration
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Endocrine hard
Adrenal Crisis
Marcus Thompson, 45-year-old male, presenting with hypotension, severe abdominal pain, and confusion after abruptly stopping chronic corticosteroid therapy
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Endocrine hard
Thyroid Storm
Sarah Mitchell, 38F, uncontrolled hyperthyroidism (Graves disease), post thyroidectomy presenting with thyroid storm
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Ischemic Stroke
Mrs. Eleanor Martinez, 71F, presented to the ED with acute left-sided facial droop, left arm weakness, and slurred speech with symptom onset 90 minutes ago
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Traumatic Brain Injury
J.R., 22-year-old male, admitted to ED after MVC with GCS 9, unequal pupils, and CT showing left subdural hematoma
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Meningitis
Emily Chen, 19F, a college student presenting to the ED with sudden high fever, severe headache, nuchal rigidity, and a petechial rash
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Status Epilepticus
Ms. Sarah Chen, 35F, brought in by EMS actively seizing; seizure has been ongoing for 8 minutes
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Neurological hard
Spinal Cord Injury
Mr. Marcus Chen, 30-year-old male, admitted to ED after diving accident with suspected C5 spinal cord injury, presenting as quadriplegic with bradycardia and hypotension
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Preeclampsia
Ms. Sarah Chen, 26-year-old G1P0 at 36 weeks gestation, admitted with severe preeclampsia (BP 162/108, severe headache, 3+ proteinuria, visual disturbances)
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Postpartum Hemorrhage
Mrs. Maria Santos, 30-year-old G3P3 who delivered a healthy male infant vaginally 30 minutes ago and is now experiencing a boggy uterus with excessive vaginal bleeding estimated at 700 mL and tachycardia
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Placenta Previa
Sarah Mitchell, 32-year-old G2P1 female at 30 weeks gestation, presenting with sudden onset painless bright red vaginal bleeding; ultrasound confirms complete placenta previa
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Gestational Diabetes
Mrs. Sarah Chen, 28-year-old G1P0 at 28 weeks gestation, newly diagnosed with gestational diabetes (fasting glucose 140 mg/dL) presenting for diabetes management education
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Fetal Distress
Mrs. Ana Garcia, 28-year-old G2P1001 at 39 weeks gestation, admitted to L&D in active labor with singleton pregnancy, vertex presentation
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
OB/Maternal hard
Postpartum Infection
24yo G1P1 female, postpartum day 3, suspected endometritis
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pediatrics hard
Respiratory Distress
A 2-year-old male presents to the ED with a barking seal-like cough, inspiratory stridor at rest, low-grade fever (38.1°C), and moderate respiratory distress.
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Pediatrics hard
Dehydration
Ethan Martinez, 18-month-old male, admitted via ED with 3 days of vomiting and diarrhea exhibiting signs of moderate to severe dehydration
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Psychiatry hard
Suicide Risk Assessment
Mr. Daniel Chen, 34-year-old male admitted to psychiatric unit after disclosing suicidal ideation to his therapist
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Psychiatry hard
Acute Psychosis
Mr. David Chen, 22-year-old male, brought by family for evaluation of first-episode psychosis with command auditory hallucinations, disorganized speech, and agitation.
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Psychiatry hard
Alcohol Withdrawal
Mr. Marcus Webb, 48-year-old male admitted for acute pancreatitis with history of heavy alcohol use
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Psychiatry hard
Eating Disorder
Alexandra Chen, 17F, admitted for severe malnutrition secondary to anorexia nervosa with BMI 14.2, bradycardia 44 bpm, and hypotension 80/50
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Renal hard
Acute Kidney Injury
Mr. Harold Thompson, 65-year-old male, post-cardiac catheterization (diagnostic, radial approach) 48 hours ago, now presenting with oliguria, rising creatinine, and peripheral edema concerning for acute kidney injury
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Renal hard
End-Stage Renal Disease
Martha Thompson, 54-year-old female, presents between dialysis sessions with dyspnea and crackles
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Renal hard
Urosepsis
Margaret Thompson, 78-year-old female, admitted from long-term care facility with suspected urosepsis secondary to catheter-associated urinary tract infection
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
COPD Exacerbation
Mr. Harold Chen, 68-year-old male, admitted with acute COPD exacerbation presenting with severe dyspnea, hypoxemia, and increased respiratory effort using accessory muscles
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
Community-Acquired Pneumonia
Margaret Sullivan, 55-year-old female, admitted with productive cough, fever, and right lower lobe infiltrate
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
ARDS
Mr. Marcus Chen, 42-year-old male, admitted to ICU 3 days ago with aspiration pneumonia, now exhibiting worsening hypoxemia, bilateral infiltrates, and increasing ventilator requirements
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
Asthma Exacerbation
Ms. Sarah Chen, 28F, presented to the ED with acute severe asthma exacerbation characterized by wheezing, tachypnea (RR 32), hypoxemia (SpO2 90% on room air), and inability to speak in full sentences
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
Mechanical Ventilation
Harold Thompson, 60-year-old male, ICU patient on mechanical ventilation for acute respiratory failure secondary to COPD exacerbation
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
Med-Surg: Respiratory hard
Pneumothorax
Mr. Alex Chen, 25-year-old thin male, presents to the ED with sudden onset left pleuritic chest pain and dyspnea after lifting weights
1. recognize cues 2. analyze cues 3. prioritize hypotheses 4. generate solutions 5. take action 6. evaluate outcomes
