NCLEX-PN
NCLEX PN Test Questions
Extract:
Vital signs
Temperature 98.6 F (37 C)
Heart rate 146/min
Respirations 42/min
O2 saturation or SpO2 98%
Question 1 of 5
A nurse auscultates a loud cardiac murmur on a newborn with suspected trisomy 21 (Down syndrome). A genetic screen and an echocardiogram are scheduled that day. The neonate’s vital signs are shown in the exhibit. What would be an appropriate action for the nurse to complete next?
Correct Answer: B
Rationale: Documenting the murmur is appropriate as genetic screening and an echocardiogram are already scheduled, indicating the provider is aware. Calling the provider is unnecessary, knee-chest position is for specific heart defects, and oxygen is not indicated without respiratory distress.
Extract:
Question 2 of 5
The nurse in the emergency department is caring for a client who is experiencing an acute exacerbation of asthma. Which of the following medications should the nurse expect to administer?
Correct Answer: A
Rationale: Nebulized albuterol, a short-acting beta-agonist, rapidly relieves bronchospasm in acute asthma exacerbations. Montelukast is for maintenance, methylprednisolone is slower-acting, ipratropium is secondary, and salmeterol is long-acting, not for acute relief.
Question 3 of 5
The nurse is caring for a client who is scheduled for surgery in 2 hours and is reporting anxiety and shortness of breath. The client has a heart rate of 110/min and respiratory rate of 24/min. Which of the following actions would be a priority for the nurse to take?
Correct Answer: B
Rationale: Placing the client in Fowler or high Fowler position improves lung expansion and oxygenation, addressing shortness of breath and tachycardia caused by anxiety or potential respiratory distress. Lorazepam requires a prescription, bronchodilators are not indicated without wheezing, and reassurance alone does not address physical symptoms.
Question 4 of 5
A client comes to the emergency department reporting alkaline drain cleaner splashed into the eye. The conjunctiva of the affected eye is erythematous, and the client reports a burning sensation. What action is appropriate at this time?
Correct Answer: C
Rationale: Ocular chemical burns require emergency care to prevent permanent vision loss. Alkali burns (eg, ammonia, cement, lye- containing drain cleanser) are particularly dangerous as they will quickly penetrate deep into the eye, causing severe, irreversible damage. For all types of ocular chemical burns, copious eye irrigation with sterile saline or water should begin immediately to flush the chemical irritant out of the eye
Question 5 of 5
A client can receive the mumps, measles, rubella (MMR) vaccine if he or she:
Correct Answer: D
Rationale: A mild cold without fever does not contraindicate MMR vaccination. Pregnancy, immunocompromise, and neomycin allergy are contraindications due to live virus risks or anaphylaxis. Pharmacological Therapies