NCLEX Questions, NCLEX PN Exam Practice Test Questions, NCLEX-PN Questions, Nurselytic

Questions 163

NCLEX-PN

NCLEX-PN Test Bank

NCLEX PN Exam Practice Test Questions

Extract:


Question 1 of 5

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which client statement should be reported to the health care provider immediately?

Correct Answer: D

Rationale: A thicker tongue may indicate angioedema, a rare but life-threatening side effect of enalapril (an ACE inhibitor), requiring immediate reporting. A (dry cough) and C (dizziness) are common side effects that warrant monitoring but are less urgent. B indicates suboptimal blood pressure control, which requires follow-up but is not immediately life-threatening.

Question 2 of 5

An adult is receiving intermittent tube feedings. When the nurse aspirates and measures the gastric contents, the client's wife asks the nurse what she is doing. What information is most important to include in the response?

Correct Answer: B

Rationale: Aspirating gastric contents verifies tube placement, the most critical step to prevent aspiration during feedings.

Question 3 of 5

The nurse is assisting with community health screening. Which of the following clients is the priority to refer for further evaluation?

Correct Answer: B

Rationale: Shiny, hairless legs that are cool to the touch suggest peripheral artery disease, a serious condition requiring urgent evaluation. A is within normal glucose range (71-200 mg/dL). C is normal for an athlete. D indicates prehypertension, which is less urgent than vascular disease.

Extract:

1700
Found client lying on floor next to bed. Client states, "I fell out of bed while reaching for my eyeglasses and hit my head on the bedside table." Client is alert and oriented to time, place, person, and situation. Denies pain, dizziness, or nausea. No visible injuries. Assisted back to bed. Neurological vital signs within normal limits (see assessment flow sheet). Client instructed to use call bell for assistance. Will continue to monitor. __________RN

1710: Health care provider (HCP) notified of fall. Prescribed CT of head STAT. ___________RN

1740: No change in neurologic status. Client to CT via gurney. Report filed per policy. __________RN

1810: Client returned from CT. No change in neurologic status. Reinforced use of call bell, and client demonstrated understanding. Will continue to monitor. __________RN


Question 4 of 5

The nurse finds a client on the floor in the client's room. Based on the documentation shown in the exhibit, the nurse made an incorrect entry in the client's medical record at what time?

Correct Answer: C

Rationale: Without specific exhibit details, 1740 is assumed incorrect based on context, possibly due to a documentation error related to the fall. Rationale is limited without exhibit.

Extract:


Question 5 of 5

A 64-year-old client is prescribed ciprofloxacin for a urinary tract infection. The nurse reminds the client to observe for and notify the health care provider immediately about which of the following?

Correct Answer: C

Rationale: Ciprofloxacin is associated with Achilles tendon rupture, a serious side effect requiring immediate reporting. Other symptoms are less specific.

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