NCLEX-PN
NCLEX PN Test Questions Questions
Extract:
Question 1 of 5
Following cardiac surgery, a client's urine output for the last hour is 20 mL. The nurse understands that this indicates which of the following?
Correct Answer: B
Rationale: Low urine output (20 mL/hour) post-cardiac surgery suggests insufficient cardiac output, impairing renal perfusion. Hyperkalemia, inadequate fluids, or diuresis are less likely causes without additional signs.
Question 2 of 5
The clinic nurse is planning to assess the visual acuity of a 6-year-old. Which method is the best way to assess visual acuity in this child?
Correct Answer: B
Rationale: The tumbling E chart (
B) is age-appropriate for a 6-year-old, who may not know letters. Allen cards (
A) are for younger children, Snellen at 10 ft (
C) is non-standard, and Ishihara (
D) tests color vision.
Question 3 of 5
The nurse is screening pediatric clients for developmental dysplasia of the hip (DDH). Which of the following findings would be consistent with DDH in a 3-week-old client?
Correct Answer: C
Rationale: Extra gluteal folds (
C) are a sign of DDH. The affected leg appears shorter, not longer (
A). Narrowing of the perineum (
B) and pelvic tilt (
D) are not typical.
Question 4 of 5
An ambulatory client reports edema during the day in his feet and ankles that disappears while sleeping at night. What is the most appropriate follow-up question for the nurse to ask?
Correct Answer: B
Rationale: Do you become short of breath during your normal daily activities? This assesses for activity intolerance, a symptom of right-sided heart failure causing edema.
Question 5 of 5
Which of these clients, all of whom have the findings of a board-like abdomen, would the nurse suggest that the provider examine first?
Correct Answer: A
Rationale: An elderly client who stated, 'My awful pain in my right side suddenly stopped about 3 hours ago.' This client has the highest risk for hypovolemic and septic shock since the appendix has most likely ruptured, based on the history of the pain suddenly stopping over three hours ago. Elderly clients have less functional reserve for the body to cope with shock and infection over long periods. The others are at risk for shock also, however given that they fall in younger age groups, they would more likely be able to tolerate an imbalance in circulation. A common complication of falling off a bicycle is hitting the handle bars in the upper abdomen often on the left, resulting in a ruptured spleen.