NCLEX-PN
NCLEX PN Practice Test Questions
Extract:
Question 1 of 5
The nurse is giving preoperative medication to an adult who is scheduled for surgery. The client says to the nurse that she does not want to have a transfusion during surgery because it is against her religion. The client has signed a consent form for surgery. How should the nurse respond?
Correct Answer: C
Rationale: An addendum to refuse transfusions respects the client's religious beliefs, ensuring informed consent. Other responses dismiss her autonomy or delay care.
Question 2 of 5
The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention should the nurse anticipate?
Correct Answer: D
Rationale: Vancomycin requires therapeutic drug monitoring to ensure efficacy and prevent toxicity. Obtaining a serum trough level 15-30 minutes before the fourth dose (
D) is standard to guide dosing adjustments. A new IV line (
A) is unnecessary unless the current line is compromised. Antiemetics (
B) are not routinely needed. Infusion over 60 minutes (
C) is typical to prevent red man syndrome, not 30 minutes.
Question 3 of 5
While caring for a woman who delivered a healthy term infant six hours ago, the nurse notes that the fundus is soft, 2 cm above the umbilicus, and off to the left. The lochia is red. The nurse suspects that the client has which problem?
Correct Answer: C
Rationale: A soft, displaced fundus suggests urinary retention, causing bladder pressure on the uterus. Normal involution shows a firm, midline fundus; fragments or lacerations present differently.
Question 4 of 5
The nurse is caring for a client with COPD who becomes dyspneic. The nurse should
Correct Answer: C
Rationale: Use pursed-lip breathing during periods of dyspnea to control rate and depth of respiration and improve respiratory muscle coordination.
Question 5 of 5
During the evaluation phase for a client, the nurse should focus on
Correct Answer: B
Rationale: The client's status, progress toward goal achievement, and ongoing re-evaluation. Evaluation focuses on assessing progress and adjusting the care plan.