NCLEX-PN
NCLEX PN Test Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a client who is receiving peritoneal dialysis and is reporting chills and abdominal discomfort. The nurse notes rebound tenderness with palpation. Which of the following actions would be a priority for the nurse to take?
Correct Answer: A
Rationale: Chills, discomfort, and rebound tenderness suggest peritonitis, requiring fluid culture (
A). Warming dialysate (
B), pain medication (
C), and positioning (
D) do not address the infection.
Question 2 of 5
A client with insulin-dependent diabetes takes 20 units NPH insulin at 7 a.m. The nurse should observe the client for signs of hypoglycemia at:
Correct Answer: C
Rationale: NPH insulin peaks 6-12 hours after administration (1-3 p.m.), making 3 p.m. the time to watch for hypoglycemia. Other times are outside the peak window.
Question 3 of 5
The school nurse observes a 7-year-old client with attention deficit hyperactivity disorder begin to throw books and attempt to hit the classmates. Which of the following actions would be a priority for the nurse to take?
Correct Answer: C
Rationale: Removing the client to a quiet room (
C) ensures safety and de-escalates the situation. Balloon blowing (
A) is inappropriate, PRN methylphenidate (
B) is not typically ordered, and consequences (
D) are secondary.
Question 4 of 5
An adult client was admitted for congestive heart failure today. An IV is running. The nurse enters the room and notes that the client is having increased difficulty breathing. Before calling the physician, what action should the nurse take?
Correct Answer: D
Rationale: Raising the head of the bed improves breathing in congestive heart failure by reducing pulmonary congestion. Increasing IV rate, supine positioning, or questioning delays intervention.
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.