NCLEX-PN
NCLEX PN Practice Test Questions
Extract:
Question 1 of 5
The nurse is caring for a client with bipolar disorder who is hospitalized for an acute manic episode. Which of the following actions would the nurse expect to be included in the client's plan of care? Select all that apply.
Correct Answer: B,C,D,E,F
Rationale: During a manic episode, a private room (
B) minimizes stimuli, appropriate clothing (
C) supports dignity, group therapy (
D) fosters socialization, physical activity (E) channels energy, and dining with others (F) promotes normalcy. Planning an outing (
A) is inappropriate due to impulsivity risks.
Question 2 of 5
A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider?
Correct Answer: C
Rationale: Pale skin in the hand (
C) suggests vascular compromise, risking fistula failure or ischemia, requiring immediate reporting. Edema (
A) is common, a swooshing sound (
B) indicates patency, and mild pain (
D) is expected.
Question 3 of 5
A client is to be discharged on enoxaparin (Lovenox) for the next two days. Which comment by the client indicates a need for further instruction?
Correct Answer: B
Rationale: Enoxaparin is injected subcutaneously in the abdomen, not the thigh, indicating a need for further teaching.
Question 4 of 5
A client is brought to the emergency room following a motor vehicle accident. When assessing the client one-half hour after admission, the nurse notes several physical changes. Which finding would require the nurse's immediate attention?
Correct Answer: C
Rationale: tracheal deviation. The deviated trachea is a sign that a mediastinal shift has occurred. This is a medical emergency.
Question 5 of 5
The nurse has reinforced teaching about formula preparation with the parent of a newborn. Which of the following statements by the parent would indicate a correct understanding of the teaching? Select all that apply.
Correct Answer: A,B,D
Rationale: Microwaving (
A) can cause uneven heating, risking burns, so it’s avoided. Washing the can top (
B) prevents contamination. Refrigerated formula must be discarded after 24 hours (
D) to prevent bacterial growth. Diluting less (
C) alters nutrition, and bottled water (E) may need boiling depending on safety, indicating incorrect understanding.