NCLEX-PN
NCLEX Practice Test PN Questions
Extract:
Question 1 of 5
A client admitted with acute myocardial infarction suddenly displays air hunger, dyspnea, and coughing with frothy, pink-tinged sputum. What would the nurse anticipate when auscultating the breath sounds of this client?
Correct Answer: C
Rationale: Frothy, pink-tinged sputum and dyspnea indicate pulmonary edema, a complication of myocardial infarction. Diffuse bilateral crackles are heard due to fluid in the alveoli.
Question 2 of 5
The nurse is collecting data from a 30-month-old client. Which of the following findings would require follow-up?
Correct Answer: C
Rationale: Lack of nighttime bladder control at 30 months may indicate developmental delay or medical issues, requiring follow-up to assess for underlying causes.
Question 3 of 5
The nurse is caring for a 31-year-old gravida 2, para 1 woman who is in labor. The woman calls the nurse and says, 'My water has broken and I feel something between my legs.' The nurse looks and sees a loop of umbilical cord at the vaginal outlet. After signaling for help, what should the nurse do?
Correct Answer: B
Rationale: Knee-chest position relieves pressure on the prolapsed umbilical cord, maintaining fetal oxygenation until emergency delivery. Replacing the cord or pressing the fundus worsens the situation.
Question 4 of 5
During the admission bath, the nurse notes a region of impaired skin under a large sacral dressing. Which of the following actions by the nurse are appropriate? Select all that apply.
Correct Answer: A,C,D,E
Rationale: A nutrient-rich diet (
A) supports wound healing. Cleansing with saline (
C) prevents infection. A hydrophilic dressing (
D) promotes a moist healing environment. Frequent repositioning (E) reduces pressure on the impaired skin.
Question 5 of 5
A nurse finds a client unresponsive and is unable to palpate a pulse. Resuscitation is initiated and continued by the rapid response team. The nurse then finds a do not resuscitate (DNR) prescription in the client's chart. What is the appropriate action by the nurse?
Correct Answer: C
Rationale: A DNR order indicates the client's wish to avoid resuscitation. Once discovered, resuscitation should be stopped immediately to respect the client's directive, unless there is clear evidence the order is invalid.