NCLEX-PN
NCLEX PN Exam Practice Test Questions
Extract:
Question 1 of 5
A client is admitted to the labor and delivery unit in active labor. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?
Correct Answer: B
Rationale: Any lesion should be reported to the doctor. This can indicate a herpes lesion. Clients with open lesions related to herpes are delivered by Cesarean section because there is a possibility of transmission of the infection to the fetus with direct contact to lesions. It is not enough to document the finding, so answer A is incorrect. The physician must make the decision to perform a C-section, making answer C incorrect. It is not enough to continue primary care, so answer D is incorrect.
Question 2 of 5
The nurse is monitoring a newborn with skin discoloration in the buttock and lumbar area. Which action by the nurse is appropriate? Click the exhibit button for additional information.
Correct Answer: B
Rationale: Skin discoloration in the buttock and lumbar area of a newborn is often due to Mongolian spots (also called congenital dermal melanocytosis). These are benign, flat, bluish-gray patches typically found on the lower back or buttocks. They are more common in infants with darker skin tones and are not harmful, but they can be mistaken for bruises, which raises concern for abuse later on.
The appropriate nursing action is to measure and document the size, shape, and location of the spots in the medical record. This ensures that there is a clear, dated record of the findings to avoid confusion in the future.
Question 3 of 5
Immediately following an acute battering incident in a violent relationship, the batterer may respond to the partner's injuries by
Correct Answer: B
Rationale: Minimizing the episode and underestimating the victim's injuries. Batterers often use denial to downplay the severity of their actions.
Question 4 of 5
A client expresses concern about facial appearance after surgery for excision of a melanoma on the side of the nose. What is the best response by the nurse?
Correct Answer: C
Rationale: This response addresses the client's concern about appearance by providing education on wound care to minimize scarring, promoting empowerment and trust. A deflects the concern without addressing it. B dismisses the client's feelings and focuses on an unrelated issue. D assumes scarring and offers a cosmetic solution prematurely, which may not address the client's emotional needs.
Question 5 of 5
The nurse in the outpatient clinic is talking with a client who sustained a distal fracture of the humerus and had a cast applied 2 days ago. Which of the following statements by the client would be a priority to follow up?
Correct Answer: C
Rationale: Difficulty extending fingers suggests nerve compression or compartment syndrome, a priority for follow-up. Other statements are less urgent.