NCLEX-PN
PN NCLEX Practice Test Questions
Extract:
Question 1 of 5
The nurse is suctioning an adult's tracheostomy tube. What action is essential before starting to suction the client?
Correct Answer: B
Rationale: Pre-oxygenation with high oxygen levels prevents hypoxia during tracheostomy suctioning, critical for patient safety, unlike water, consents, or communication aids.
Question 2 of 5
The nurse is caring for a 7-month-old client who has suspected bacterial meningitis. The nurse should first check the client’s
Correct Answer: A
Rationale: A bulging anterior fontanel in a 7-month-old indicates increased intracranial pressure, a critical sign of meningitis requiring immediate attention. Hearing, pulse pressure, and Babinski reflex are less urgent.
Question 3 of 5
The nurse should initiate discharge planning for a client
Correct Answer: C
Rationale: Upon admission to a hospital unit or the emergency room. Early discharge planning ensures continuity of care with shorter hospital stays.
Question 4 of 5
The nurse is caring for a client several days following a cerebral vascular accident. Coumadin (warfarin) has been prescribed. Today's prothrombin level is 40 seconds (normal range 10-14 seconds). Which of the following findings requires priority follow-up?
Correct Answer: A
Rationale: The prothrombin time is elevated, indicating a high risk for bleeding. Neurological assessments remain important for post-CVA clients.
Question 5 of 5
A client with a C3 spinal cord injury has a headache and nausea. The client’s blood pressure is 170/100 mm Hg. How should the nurse respond initially?
Correct Answer: D
Rationale: Headache, nausea, and hypertension in a C3 injury suggest autonomic dysreflexia, often triggered by bladder distension. Palpating the bladder identifies and addresses the cause. Medications and bed positioning are secondary.