NCLEX-PN
NCLEX PN Test Questions
Extract:
Question 1 of 5
The nurse is caring for an adult who was admitted for observation following an automobile accident. The client has several lacerations that were sutured in the emergency room and a fractured leg that has been casted. The baseline vital signs are BP=120/72, P=76, and R=16. One hour after arriving on the unit, the client's vital signs are BP=108/68, P=90, and R=22. The nurse most correctly interprets these results to mean that the client may be developing which condition?
Correct Answer: A
Rationale: Decreased BP, increased pulse, and respirations suggest shock, possibly from occult bleeding or trauma response, requiring urgent evaluation.
Question 2 of 5
A client with terminal cancer becomes hypoxic and unresponsive. According to the client’s paperwork, the client’s sister is the legal medical power of attorney. Both the client’s spouse and sister are present. Which action by the nurse is appropriate at this time?
Correct Answer: B
Rationale: The sister, as the legal medical power of attorney, is authorized to make healthcare decisions when the client is unresponsive. Consulting the spouse is inappropriate, intubation may not align with the client’s wishes, and a living will is not required as the sister has decision-making authority.
Question 3 of 5
A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is
Correct Answer: C
Rationale: Establishing an open airway is always the primary objective in a cardiopulmonary arrest.
Question 4 of 5
The practical nurse is assisting the registered nurse in performing well-child examinations in a pediatric clinic. Which finding requires further evaluation?
Correct Answer: B
Rationale: Lateral curvature of the spine in a 10-year-old suggests scoliosis, which requires further evaluation to prevent progression. A rounded chest in infants is normal due to developing lungs, and an S3 heart sound can be normal in young children.
Question 5 of 5
The nurse is assisting with procedural moderate sedation (conscious sedation) at a client's bedside. The unlicensed assistive personnel (UAP) comes to the door and indicates that the client in the next room needs the nurse right now. How should the nurse respond?
Correct Answer: D
Rationale: During moderate sedation, the nurse must remain with the client to monitor vital signs and response. Directing the UAP to inform the charge nurse ensures the other client's needs are addressed without compromising the sedated client's safety. UAP cannot monitor sedation or take over.