NCLEX-PN
NCLEX PN Test Questions
Extract:
Question 1 of 5
A client goes to the Emergency Department with acute respiratory distress and the following arterial blood gases (ABGs): pH 7.35, PCO2 40 mmHg, PO2 63 mmHg, HCO3 23, and oxygenation saturation (SaO2) 93%. Which of the following represents the best analysis of the etiology of these ABGs?
Correct Answer: D
Rationale: Low PO2 (63 mmHg) and SaO2 (93%) indicate hypoxia, despite normal pH, PCO2, and HCO3. TB, pneumonia, or pleural effusion may cause hypoxia but are not the direct etiology shown by ABGs. Physiological Adaptation
Question 2 of 5
A 2-year-old child diagnosed with HIV comes to a clinic for immunizations. Which of the following vaccines should the nurse expect to administer in addition to the scheduled vaccines?
Correct Answer: A
Rationale: Children with HIV require pneumococcal vaccine to protect against opportunistic infections due to immunocompromise. The other vaccines are not routinely indicated for HIV. Health Promotion and Maintenance
Question 3 of 5
A 15-year-old client with iron deficiency anemia and a ruptured ectopic pregnancy needs a blood transfusion prior to surgery. The client's mother is a Jehovah's Witness and refuses to sign the blood permit. Which nursing action is most appropriate?
Correct Answer: D
Rationale: The nurse must respect the mother's refusal due to religious beliefs and notify the physician to discuss alternatives or legal options, such as court intervention for a minor in a life-threatening situation. Giving blood without permission is unethical and illegal. Coaxing may be coercive, and a 15-year-old typically cannot provide legal consent.
Question 4 of 5
Vaccines provide what type of immunity?
Correct Answer: A
Rationale: Vaccines stimulate the body to produce its own antibodies, providing active immunity. Passive immunity involves transferred antibodies, and transplacental is a type of passive immunity. Health Promotion and Maintenance
Question 5 of 5
The nurse is caring for a client who had a transsphenoidal hypophysectomy and developed diabetes insipidus. Which of the following findings would the nurse expect to observe? Select all that apply.
Correct Answer: A,B,C
Rationale: Diabetes insipidus results from antidiuretic hormone deficiency, causing excessive thirst, increased dilute urine output, and increased serum osmolality due to water loss. Serum sodium may increase, not decrease, and urine specific gravity is low due to dilute urine.