NCLEX-PN
NCLEX PN Practice Tests Questions
Extract:
Question 1 of 5
When monitoring an infant with a left-to-right sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply.
Correct Answer: C,D,E
Rationale: Left-to-right shunts (e.g., VS
D) cause pulmonary overcirculation, leading to diaphoresis, murmurs, and poor weight gain. Clubbing and cyanosis are more typical of right-to-left shunts.
Question 2 of 5
The nurse is caring for an 8-month-old client with suspected acute otitis media. Which of the following findings would be consistent with the condition? Select all that apply.
Correct Answer: A,C,D
Rationale: Ear pulling, refusal to eat, and irritability are common in otitis media due to pain and inflammation. Purulent drainage is less common unless the eardrum ruptures, and tympanic membranes are typically bulging, not retracted.
Question 3 of 5
The nurse in the outpatient care facility is caring for a client with metastatic lung cancer who received chemotherapy 3 days ago. The client states, 'I have decided that I do not want to continue treatment.' Which of the following responses would be appropriate for the nurse to make?
Correct Answer: A
Rationale: Acknowledging the decision’s difficulty and notifying the provider respects autonomy and ensures follow-up. Other responses judge, guilt, or deflect the client’s choice.
Question 4 of 5
Which nursing intervention is most critical during the administration of Acyclovir (Zovirax)?
Correct Answer: D
Rationale: Acyclovir can cause renal toxicity; encouraging fluids promotes renal perfusion and reduces risk of crystal formation in the kidneys.
Question 5 of 5
The nurse explains an autograft to a client scheduled for excision of a skin tumor. The nurse knows the client understands the procedure when the client says, 'I will receive tissue from
Correct Answer: C
Rationale: Autografts are done with tissue transplanted from the client's own skin.