NCLEX-PN
PN NCLEX Practice Exam Questions
Extract:
Question 1 of 5
An 87-year-old client has been admitted to the hospital with signs and symptoms of a urinary tract infection along with agitation, confusion, and disorientation to time and place. What is the most important nursing action?
Correct Answer: C
Rationale: One-on-one supervision (
C) ensures safety for a confused, agitated client at risk for falls or harm. Fluids (
A), side rails (
B), and dim lights (
D) are secondary or inappropriate.
Question 2 of 5
The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit the biceps reflex?
Correct Answer: A
Rationale:
To elicit the biceps reflex, the nurse places her thumb on the biceps tendon in the antecubital space and taps it with a reflex hammer, so A is correct. Answer B is incorrect as it describes a different technique. Answer C refers to the patellar reflex, and Answer D is not a standard method for the biceps reflex.
Question 3 of 5
The nurse is talking with a group of parents about puberty. The nurse should include that the first sign of puberty in clients of the male sex is
Correct Answer: C
Rationale: Testicular enlargement (
C) is the first sign of puberty in males, occurring before height increase (
A), muscle mass gain (
B), or penile growth (
D).
Question 4 of 5
A pregnant client who is at 34 weeks gestation is diagnosed with a pulmonary embolism (PE). Which of these medications would the nurse anticipate the provider ordering?
Correct Answer: C
Rationale: Heparin infusion to maintain the PTT at 1.5-2.5 times the control value. In pregnant women with pulmonary embolism, heparin is preferred over warfarin due to warfarin's teratogenic effects. A continuous heparin infusion is typically used to achieve therapeutic anticoagulation, monitored by maintaining the PTT at 1.5-2.5 times the control value.
Question 5 of 5
The nursing assistant is caring for an adult who has a fractured femur and is in Buck's extension traction awaiting surgery. The nurse is observing the nursing assistant administer morning care. Which action by the nursing assistant needs correction?
Correct Answer: D
Rationale: Turning the client on the side disrupts Buck's traction alignment, which requires constant pull. Weights should stay in place, head turning is safe, and bed-making direction is irrelevant.