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PN NCLEX Practice Exam Questions

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Question 1 of 5

A 4-year-old admitted with Wilms tumor is scheduled for a right nephrectomy in the morning. Which nursing action is a priority pre-operatively?

Correct Answer: D

Rationale: Avoiding abdominal palpation (
D) prevents tumor rupture in Wilms tumor, a critical pre-operative priority. Emotional assessment (
A), lung sounds (
B), and BP monitoring (
C) are important but secondary.

Question 2 of 5

A client with chronic heart failure is being discharged home on furosemide and supplementary potassium chloride tablets. Which instructions related to the potassium supplement should the nurse reinforce to the client?

Correct Answer: D

Rationale: Potassium chloride tablets should be taken with water and the client should remain upright to prevent esophageal irritation or ulceration (
D). Protein and vitamin D (
A) do not enhance absorption, crushing tablets (
B) can cause irritation, and taking on an empty stomach (
C) is unnecessary.

Question 3 of 5

Thirty-six hours after major surgery, a client has a temperature of 100°F. What is the most likely cause of the temperature elevation?

Correct Answer: B

Rationale: Atelectasis, due to reduced lung expansion post-surgery, is a common cause of low-grade fever within 24–48 hours. Dehydration, wound infection (typically later), or bladder infection are less likely without specific symptoms.

Question 4 of 5

A non-stress test has been ordered for a pregnant client with diabetes mellitus. Non-stress testing is a part of the diabetic's prenatal care because:

Correct Answer: C

Rationale: Diabetes can impair placental vessel development, reducing oxygen and nutrient delivery to the fetus, necessitating non-stress testing to monitor fetal well-being. Fetal movement and lung maturity are assessed differently, and insulin's effect is indirect.

Question 5 of 5

The nurse is caring for a client who has acute pericarditis. Which of the following findings would be a priority to follow up?

Correct Answer: B

Rationale: Muffled heart tones and jugular venous distension (
B) suggest pericardial effusion or tamponade, a life-threatening complication requiring urgent follow-up. Chest pain (
A) and friction rub (
C) are expected, and mild fever (
D) is less urgent.

Similar Questions

The nurse is preparing to administer a scheduled vaccine to a pediatric client with hemophilia. Which of the following actions should the nurse take? Select all that apply.
A woman who had a tuberculosis test three days ago reports to the nurse to have the test read. Which finding, if present, indicates a positive result and a need for referral and follow-up?
A client with a history of increased intracranial pressure is admitted to the hospital for severe headaches. The client suddenly vomits and states, 'That's weird, I didn't even feel nauseated.' Which action should the nurse take next?
A home health nurse is visiting a client with chronic heart failure. The nurse observes that the client is having trouble answering questions due to breathlessness and cough. Which action should the nurse take first?
The nurse is reinforcing teaching to the parent of a child recently diagnosed with attention deficit hyperactivity disorder, combined type. Which statement by the parent requires intervention?

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