NCLEX-PN
NCLEX PN Practice Questions Questions
Question 1 of 5
The nurse is observing client care situations. Which of the following situations would require an order for physical restraints? Select all that apply.
Correct Answer: D,E
Rationale: Belt and ankle restraints require a provider's order due to their restrictive nature. Immobilizers, mummy restraints, and padded rails are typically used for specific purposes without restraint orders.
Question 2 of 5
The nurse is assisting with the admission of a client who had a nephrectomy 6 hours ago. The client should be assigned to a semiprivate room with a client who has
Correct Answer: B
Rationale: The client with cellulitis and loose stools is least likely to pose an infection risk to the post-nephrectomy client, who is at risk for infection due to recent surgery. Other options involve conditions with higher infection risks or bleeding concerns.
Question 3 of 5
A client with a recent spinal cord injury is experiencing dysreflexia and is noted to have a BP of $240 / 110$. The nurse's initial response should be to:
Correct Answer: B
Rationale: Elevating the head to a 45° angle helps reduce blood pressure in autonomic dysreflexia by promoting venous return and reducing intracranial pressure.
Question 4 of 5
The nurse monitoring a newborn after birth observes a bluish discoloration of the hands and feet. The trunk is pink. What is the nurse's initial action?
Correct Answer: D
Rationale: Acrocyanosis is normal in newborns. Skin-to-skin contact promotes thermoregulation and bonding.
Question 5 of 5
The nurse is reviewing recommended dietary modifications with a client with celiac disease. Which of the following menu selections by the client would indicate a correct understanding of the teaching? Select all that apply.
Correct Answer: B,C,E
Rationale: Corn tortillas, grilled chicken with potato/yogurt, and rice noodles are gluten-free, suitable for celiac disease. Barley and wheat contain gluten.