NCLEX-PN
NCLEX PN Test Questions
Extract:
Question 1 of 5
A nurse is documenting notes in the client's electronic record after making rounds on assigned clients. Which entry is an appropriate documentation?
Correct Answer: C
Rationale: Inspiratory wheezes in bilateral lower lung fields is a specific, objective finding that accurately describes the client's condition. The other entries are vague, lack detail, or are subjective without supporting data.
Question 2 of 5
A newborn is having difficulty maintaining a temperature above 98 degrees Fahrenheit and has been placed in an incubator. Which action is a nursing priority?
Correct Answer: B
Rationale: Monitor the neonate's temperature. When using a warming device the neonate's temperature should be continuously monitored for undesired elevations. The use of heat lamps is not safe as there is no way to regulate their temperature. Warming medications and fluids is not indicated. While touching with cold hands can startle the infant it does not pose a safety risk.
Question 3 of 5
The mother of a burned child asks the nurse to clarify what is meant by a third degree burn. The best response by the nurse is
Correct Answer: C
Rationale: All layers of the skin were destroyed in the burn.' A third degree burn is a full thickness injury to dermis, epidermis and subcutaneous tissue.
Question 4 of 5
Which of the following findings suggests a complication in a client with surgical removal of a pituitary tumor?
Correct Answer: A
Rationale: Polyuria may indicate diabetes insipidus, a common complication post-pituitary surgery due to disruption of antidiuretic hormone production.
Question 5 of 5
A spouse brings a client with a history of previous suicide attempts to the emergency department due to erratic behavior and expressions of hopelessness. When the triage nurse asks if the client is having suicidal thoughts, the client shrugs their shoulders. What action should the triage nurse take?
Correct Answer: C
Rationale: Given the history of suicide attempts and current hopelessness, a noncommittal response like shrugging suggests a high suicide risk. One-to-one observation ensures safety. Documenting no suicidality is inaccurate, frequent observation is insufficient, and returning to the waiting room is unsafe.