NCLEX-PN
NCLEX-PN Practice Questions PDF Questions
Extract:
Question 1 of 5
Which assessment finding in a client with heart failure indicates fluid overload? Select all that apply.
Correct Answer: A,B,C,E
Rationale: Weight gain, crackles, jugular vein distention, and peripheral edema are signs of fluid overload in heart failure.
Question 2 of 5
A 17-year-old unmarried postpartum client is being discharged. Which situation suggests the need for a community-based assistance referral after discharge?
Correct Answer: B
Rationale: Living alone as a young, unmarried mother indicates a lack of immediate support, necessitating a referral for community assistance.
Question 3 of 5
During the first stage of a client's labor, the nurse finds that the fetal heart rate decreases during a contraction and returns to normal at the end of the contraction. Which action is the most appropriate in response to the assessment finding?
Correct Answer: A
Rationale: A temporary fetal heart rate decrease during contractions (early deceleration) is normal, indicating head compression, and requires no action.
Question 4 of 5
A client with a history of epilepsy is prescribed phenytoin (Dilantin). Which instruction should the nurse include?
Correct Answer: A
Rationale: Phenytoin can cause gingival hyperplasia; regular oral hygiene reduces this risk.
Question 5 of 5
The nurse is assessing a client with suspected hyperthyroidism. Which finding supports this diagnosis?
Correct Answer: A
Rationale: Weight loss is a common sign of hyperthyroidism due to increased metabolism.