NCLEX-PN
NCLEX PN Exam Practice Test Questions
Extract:
Question 1 of 5
The nurse in the emergency department is caring for assigned clients. The nurse should recognize that which of the following clients meets the criteria for involuntary admission to the mental health unit? Select all that apply.
Correct Answer: A,C
Rationale: Refusal of food and fluids for 4 days indicates imminent risk of harm to self due to dehydration and malnutrition, meeting involuntary admission criteria. 3: Threats of violence suggest potential harm to others, justifying involuntary admission. 2 does not indicate immediate risk, as the client is medication-compliant. 4 reflects unusual behavior but not immediate danger. 5 does not inherently indicate a psychiatric emergency requiring involuntary admission.
Question 2 of 5
The client has a chest tube attached to a portable water seal drainage system. Four hours after the chest tube is inserted, the nurse notes that there is no bubbling in the water seal compartment. What is the most likely explanation for this?
Correct Answer: A
Rationale: No bubbling in the water seal four hours post-insertion suggests the lung has reexpanded, resolving the pneumothorax. Obstruction, air leaks, or inactive suction would typically cause other signs.
Question 3 of 5
The nurse is to apply an Ace wrap to the client's right lower leg. Which action should the nurse take to ensure that the dressing is not too tight?
Correct Answer: B
Rationale: Checking pedal pulses ensures the Ace wrap does not impair circulation. Removing hourly is impractical, Doppler is excessive, and leaving for 24 hours risks missing issues.
Question 4 of 5
The nurse at the radiological imaging center is admitting a client for an MRI of the right knee. Which information obtained by the nurse should be reported immediately to the prescribing health care provider?
Correct Answer: B
Rationale: An ICD is a contraindication for MRI due to magnetic interference, requiring immediate reporting. Other findings are less critical.
Question 5 of 5
The nurse is talking with a client with rheumatoid arthritis who has a new prescription for adalimumab. Which of the following statements by the client would require follow-up?
Correct Answer: D
Rationale: Adalimumab, an immunosuppressant, increases infection risk. Starting antibiotics for an active infection requires follow-up to ensure the infection is resolved before initiating adalimumab. The other statements are not concerning.