NCLEX-PN
NCLEX PN Exam Practice Test Questions
Extract:
Question 1 of 5
The nurse is caring for a client who has a C6 spinal cord injury. He complains of blurred vision and a severe headache. His blood pressure is 210/140. What action should the nurse take initially?
Correct Answer: A
Rationale: Symptoms and hypertension suggest autonomic dysreflexia, often triggered by bladder distention in spinal cord injury. Checking and relieving distention is the initial action.
Question 2 of 5
A client is admitted to the labor and delivery unit in active labor. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?
Correct Answer: B
Rationale: Any lesion should be reported to the doctor. This can indicate a herpes lesion. Clients with open lesions related to herpes are delivered by Cesarean section because there is a possibility of transmission of the infection to the fetus with direct contact to lesions. It is not enough to document the finding, so answer A is incorrect. The physician must make the decision to perform a C-section, making answer C incorrect. It is not enough to continue primary care, so answer D is incorrect.
Question 3 of 5
The nurse is teaching a group of women about health issues. Today's topic is food poisoning. Which statement indicates a need for further instruction?
Correct Answer: D
Rationale: Rare meat poses a risk for foodborne pathogens like E. coli, even if eaten immediately. Other statements reflect proper food safety practices.
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 client with seizure disorder has an order for Dilantin (Phenytoin). Which of the following is not a side effect of Dilantin (Phenytoin)?
Correct Answer: B
Rationale: Dilantin causes gingival hypertrophy, slurred speech, and occasionally diarrhea, but insomnia is not a common side effect.