NCLEX-PN Next Generation case studies

Three case studies on every NCLEX-PN · 18 of the 85 items on a minimum-length exam

Take the full NCLEX-PN practice exam

85 questions including three unfolding case studies, scored the NCSBN way, with a report by client-needs category.

Free unfolding case study drill
Free sample · Question 1 of 3Psychosocial Integrity

A client whose leg was amputated says, "I'm so angry at everyone." Which statement by the nurse reflects an understanding of grief?

How NCLEX-PN case studies work

Every NCLEX-PN includes three case studies: six items about the same client that share unfolding client information and follow, in order, the six steps of NCSBN’s Clinical Judgment Measurement Model. They count separately from the eight client-needs categories, because clinical judgment spans every category. On the minimum-length exam they are 18 of the 85 items. The case below is one of ours, written to the 2026 PN test plan; work through it, then take the free case-study drill for another.

Case studies per exam
Three, of six items each
Item order
Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes
Exhibits
Chart tabs such as nurses’ notes, vital signs, laboratory results and orders; new information appears as the case unfolds
Scoring
Partial credit on items with more than one key (plus/minus, zero/one or rationale scoring)
Line drawing of a bedside table with a tablet showing a client chart with four folder tabs, a vital-signs clipboard, a stethoscope and a small plant

Case study: Resident with heart failure and increasing shortness of breath

Item 1 of 6 · Recognize cues

An 82-year-old resident with heart failure with reduced ejection fraction, hypertension and osteoarthritis · Long-term care facility

Day 1, 2000: Resident returned from a weekend visit with family. Daughter reports they ate at a buffet on Saturday and had ham and potato chips at home on Sunday. Resident declined Saturday's furosemide dose before leaving, stating, "I didn't want to look for a bathroom all day." Day 2, 0630: Assistive personnel (AP) reports the resident asked for a third pillow overnight and sat on the edge of the bed twice "to get some air." Day 2, 0700: Weight 74.2 kg (163.6 lb) on the same scale before breakfast; weight 3 days ago 72.0 kg (158.7 lb). Fine crackles in both lung bases. 2+ pitting edema of both ankles and feet (1+ last week). Resident became short of breath walking 6 m (20 ft) to the bathroom and stopped twice to rest. Alert and oriented; skin warm and dry.
The nurse reviews the resident's record on the morning of Day 2. Which findings require follow-up by the nurse? Select all that apply.
Start the free unfolding case study drill

What a PN case study asks of you

A PN case study reads like a shift in long-term care, a clinic, home health or a medical-surgical unit. The first items ask what in the chart matters and what it means; the middle items ask which problem comes first and what should be done; the last items reveal what happened after the nurse acted and ask whether the client improved.

The answers stay inside the practical nurse’s scope. The right actions are the ones an LPN/VN takes: collect focused data, recheck vital signs, position the client, hold a scheduled dose and report, stop an infusion that is causing a reaction, reinforce teaching, and report to the RN or health care provider with the data that matters. An option that has the practical nurse perform an initial assessment, change the plan of care or give an IV push medication is wrong even when the clinical idea behind it is right.

Sit the full exam under the real clock

Take the full NCLEX-PN practice exam

85 questions including three unfolding case studies, scored the NCSBN way, with a report by client-needs category.

Free unfolding case study drill

How to practice them

  • Read every chart tab before the first item; the cues that matter are often in the tab you skip.
  • Name the client’s problem in your own words after item two, then check whether the options agree.
  • In take-action items, choose what protects the client right now within your scope, then what you report.
  • In evaluate-outcomes items, compare each new finding with the expected outcome: improved, unchanged or worse.
  • Take the case-study drill until the six steps feel automatic, then sit the 85-item mock exam, which has three case studies like the real one.

Common questions

How many case studies are on the NCLEX-PN?

Three on every exam, each with six items, so 18 items whatever the exam length. NCSBN also measures clinical judgment with stand-alone items, about 10% of the exam.

Are NCLEX-PN case studies different from NCLEX-RN case studies?

The structure is the same: six items in Clinical Judgment Measurement Model order with chart exhibits. The content follows the PN test plan, so the expected actions are within the LPN/VN scope of practice and the settings include long-term care, home health and clinics.

How are case-study items scored?

Single-answer items score 0 or 1. Items with more than one key earn partial credit: select-all-that-apply items use plus/minus scoring (+1 for each correct option selected, −1 for each incorrect one, never below zero), and other formats use zero/one or rationale scoring.

Take the full NCLEX-PN practice exam

85 questions including three unfolding case studies, scored the NCSBN way, with a report by client-needs category.

Free unfolding case study drill

More NCLEX-PN guides

Sources

Original practice questions for exam preparation, written to the 2026 NCLEX-PN Test Plan. Independent practice, not affiliated with or endorsed by the National Council of State Boards of Nursing (NCSBN) or Pearson VUE. NCLEX and NCLEX-PN are registered trademarks of NCSBN.