NCLEX-PN
NCLEX PN Exam Practice Test Questions
Extract:
Question 1 of 5
The nurse is assessing a comatose client receiving gastric tube feedings. Which of the following assessments requires an immediate response from the nurse?
Correct Answer: A
Rationale: Decreased breath sounds in right lower lobe. The most common problem associated with enteral feedings is atelectasis. Maintain client at 30 degrees of head elevation during feedings and monitor for signs of aspiration. Check for tube placement prior to each feeding or every 4 to 8 hours if the client is receiving continuous feeding.
Question 2 of 5
The nurse is caring for a postoperative client with a Hemovac drain. Which task request is inappropriate for the nurse to make to the experienced unlicensed assistive personnel?
Correct Answer: A
Rationale: Changing a sterile dressing is a nursing task requiring sterile technique, inappropriate for unlicensed personnel. Measuring, recording, and compressing the Hemovac are within their scope.
Question 3 of 5
The nurse is preparing to perform wound irrigation for a client who sustained a scalp laceration. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Irrigation should flow from the least to most contaminated area to prevent infection spread. Other options are incorrect techniques.
Question 4 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 5 of 5
The nurse is caring for clients who are having the following procedures. Which client should be asked about allergies to shellfish?
Correct Answer: C
Rationale: Myelograms often use iodine-based contrast; shellfish allergies may indicate iodine sensitivity, requiring verification. Arthroscopy, arthrocentesis, and EMG do not typically involve contrast.