NCLEX-PN Test #1 Practice Questions — Questions and Answers

Question 1: A client with type 2 diabetes mellitus asks why blood glucose monitoring is important. Which response by the nurse is most accurate?

It replaces the need for a hemoglobin A1C test
It helps determine how well the treatment plan is working (Correct answer)
It is only necessary when feeling symptomatic
It eliminates the need for dietary modifications

Correct answer: It helps determine how well the treatment plan is working

Blood glucose monitoring helps the client and healthcare team evaluate how well the current treatment plan (diet, exercise, medications) is controlling blood sugar levels.

Self-monitoring of blood glucose (SMBG) is a cornerstone of diabetes management. It provides real-time data about how diet, physical activity, medications, stress, and illness affect blood sugar levels. This information allows the healthcare team to adjust the treatment plan as needed. SMBG does not replace A1C testing, which measures average glucose over 2-3 months. Monitoring is recommended regularly, not just when symptomatic, because hyperglycemia can be asymptomatic. It also does not eliminate the need for dietary modifications, which remain essential to diabetes care.

Question 2: A nurse is caring for a client with a nasogastric (NG) tube connected to low intermittent suction. Which electrolyte imbalance should the nurse monitor for most closely?

Hyperkalemia
Hypernatremia
Hypokalemia (Correct answer)
Hypercalcemia

Correct answer: Hypokalemia

Gastric suctioning removes potassium-rich gastric secretions, placing the client at risk for hypokalemia.

Gastric secretions contain significant amounts of potassium, hydrogen, and chloride ions. Prolonged nasogastric suctioning removes these electrolytes from the body, leading to hypokalemia (low potassium) and metabolic alkalosis (loss of hydrogen and chloride ions). Hypokalemia can cause dangerous cardiac dysrhythmias, muscle weakness, and ileus. The nurse should monitor serum potassium levels regularly, assess for signs of hypokalemia (muscle cramps, weakness, irregular pulse), and ensure adequate potassium replacement as ordered.

Question 3: A practical nurse is assisting with the admission of a client diagnosed with pulmonary tuberculosis. Which type of isolation precautions should be implemented?

Contact precautions
Droplet precautions
Airborne precautions (Correct answer)
Standard precautions only

Correct answer: Airborne precautions

Pulmonary tuberculosis is transmitted via airborne droplet nuclei, requiring airborne precautions including a negative-pressure room and N95 respirator.

Mycobacterium tuberculosis is transmitted through airborne droplet nuclei that remain suspended in the air for prolonged periods. Airborne precautions require placement in a negative-pressure airborne infection isolation room (AIIR), use of N95 or higher respirators by healthcare personnel, and keeping the door closed. Contact precautions are for organisms spread by direct or indirect contact. Droplet precautions are for organisms spread by large respiratory droplets (e.g., influenza). Standard precautions alone are insufficient because TB can remain airborne and travel long distances through air currents.

Question 4: A client is receiving heparin therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of heparin?

Prothrombin time (PT)
International normalized ratio (INR)
Activated partial thromboplastin time (aPTT) (Correct answer)
Platelet count

Correct answer: Activated partial thromboplastin time (aPTT)

The aPTT is the laboratory test used to monitor the therapeutic effectiveness of unfractionated heparin therapy.

Unfractionated heparin works by enhancing antithrombin III activity, which inhibits several clotting factors in the intrinsic pathway. The activated partial thromboplastin time (aPTT) measures the intrinsic pathway and is the standard test for monitoring heparin therapy. The therapeutic goal is typically 1.5 to 2.5 times the normal control value. PT and INR are used to monitor warfarin (Coumadin) therapy, which affects the extrinsic pathway. While platelet count should be monitored for heparin-induced thrombocytopenia (HIT), it does not measure anticoagulant effectiveness.

Question 5: When caring for a client in the immediate post-operative period, which assessment finding should the nurse report first?

Temperature of 99.2°F (37.3°C)
Urine output of 20 mL over the past hour (Correct answer)
Mild incisional pain rated 3/10
Blood pressure of 128/78 mmHg

Correct answer: Urine output of 20 mL over the past hour

A urine output of 20 mL/hour is below the minimum acceptable output of 30 mL/hour and may indicate inadequate renal perfusion or hypovolemia.

Minimum acceptable urine output for an adult is 30 mL/hour (0.5 mL/kg/hour). A urine output of 20 mL/hour falls below this threshold and may indicate decreased renal perfusion due to hypovolemia, hypotension, or other complications. This requires immediate reporting and intervention. A temperature of 99.2°F is a low-grade fever common in the first 24-48 hours post-operatively due to the inflammatory response. Mild pain rated 3/10 is expected and manageable. A blood pressure of 128/78 is within normal limits.

Question 6: A nurse is reinforcing discharge teaching for a client prescribed warfarin (Coumadin). Which dietary instruction is most important?

Increase intake of iron-rich foods
Avoid all green vegetables entirely
Maintain a consistent intake of vitamin K-containing foods (Correct answer)
Drink at least 3 liters of fluid daily

Correct answer: Maintain a consistent intake of vitamin K-containing foods

Clients on warfarin should maintain consistent vitamin K intake because vitamin K counteracts warfarin's anticoagulant effect.

Warfarin works by inhibiting vitamin K-dependent clotting factors (II, VII, IX, X). Vitamin K is the antidote for warfarin because it promotes the synthesis of these clotting factors. Clients should not avoid vitamin K foods entirely but rather maintain a consistent daily intake. Sudden increases in vitamin K intake can decrease warfarin's effectiveness, while sudden decreases can increase bleeding risk. Dark green leafy vegetables (spinach, kale, broccoli) are high in vitamin K. The goal is consistency, not elimination. Iron-rich foods and fluid intake are not directly related to warfarin therapy management.

Question 7: A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which observation indicates the system is functioning properly?

Continuous bubbling in the water-seal chamber
No fluctuation (tidaling) in the water-seal chamber
Gentle tidaling in the water-seal chamber with respirations (Correct answer)
The drainage system is positioned above the client's chest

Correct answer: Gentle tidaling in the water-seal chamber with respirations

Gentle tidaling (fluctuation) in the water-seal chamber that corresponds with respirations indicates the system is patent and functioning correctly.

In a properly functioning chest tube drainage system, gentle tidaling (fluctuation of the water level) in the water-seal chamber occurs with respirations. During inspiration, the water level rises; during expiration, it falls (opposite in mechanically ventilated clients). This fluctuation confirms the system is patent and intrapleural pressure changes are being transmitted. Continuous bubbling in the water-seal chamber indicates an air leak in the system, which is abnormal. Absence of tidaling may mean the tube is kinked, clamped, or the lung has re-expanded. The drainage system must always be positioned below the client's chest to allow gravity drainage and prevent fluid from flowing back into the pleural space.

Question 8: A client with diabetes is experiencing diaphoresis, tremors, and confusion. The blood glucose reading is 52 mg/dL. What is the nurse's priority action?

Administer the client's regular insulin dose
Give 15 grams of a fast-acting carbohydrate (Correct answer)
Place the client in a supine position
Call the provider for a stat order of glucagon

Correct answer: Give 15 grams of a fast-acting carbohydrate

For a conscious client with hypoglycemia, the priority is to administer 15 grams of fast-acting carbohydrate following the rule of 15.

Hypoglycemia (blood glucose below 70 mg/dL) requires prompt treatment. For a conscious client who can swallow, the rule of 15 applies: give 15 grams of fast-acting carbohydrate (4 oz juice, 3-4 glucose tablets, or 8 oz milk), wait 15 minutes, then recheck blood glucose. If still below 70 mg/dL, repeat. Administering insulin would further lower blood glucose and is contraindicated. Placing the client supine does not address the underlying problem. Glucagon is reserved for unconscious or severely impaired clients who cannot swallow safely. Once blood glucose has stabilized, the client should eat a small snack with protein and complex carbohydrates to prevent recurrence.

Question 9: A practical nurse is assisting in the care of a client with a tracheostomy. Which action is essential to maintain airway patency?

Keep the tracheostomy cuff deflated at all times
Suction the tracheostomy every 30 minutes on a fixed schedule
Provide tracheostomy care and assess for signs of obstruction regularly (Correct answer)
Limit oral fluid intake to reduce secretions

Correct answer: Provide tracheostomy care and assess for signs of obstruction regularly

Regular tracheostomy care and assessment for obstruction are essential to maintain a patent airway and prevent complications.

Tracheostomy care is performed to maintain airway patency, prevent infection, and promote skin integrity around the stoma. This includes cleaning the inner cannula, changing the tracheostomy ties, assessing the stoma site, and monitoring for signs of obstruction (increased work of breathing, noisy respirations, decreased oxygen saturation). The cuff should not be kept deflated at all times — it is inflated during mechanical ventilation or to prevent aspiration. Suctioning should be performed as needed based on assessment (audible secretions, respiratory distress), not on a rigid schedule, because unnecessary suctioning can cause mucosal trauma, hypoxia, and bronchospasm. Limiting oral fluids is not indicated and could lead to dehydration and thicker secretions.

Question 10: A nurse is reinforcing teaching about proper use of a metered-dose inhaler (MDI) without a spacer. Which instruction is correct?

Inhale quickly and forcefully when activating the canister
Hold the breath for 10 seconds after inhalation (Correct answer)
Exhale forcefully into the inhaler before pressing the canister
Take three rapid puffs in succession without pausing

Correct answer: Hold the breath for 10 seconds after inhalation

After actuating the MDI and inhaling slowly, the client should hold their breath for approximately 10 seconds to allow medication to deposit in the airways.

Proper MDI technique without a spacer includes: shake the canister, exhale fully, place the mouthpiece 1-2 inches from the open mouth or seal lips around it, press the canister while inhaling slowly and deeply (not quickly), hold the breath for approximately 10 seconds to allow medication particles to settle in the lower airways, then exhale slowly. Rapid forceful inhalation causes medication to deposit in the oropharynx rather than reaching the lower airways. Exhaling into the inhaler would push medication out. Multiple rapid puffs without pausing reduce the effectiveness of each dose — wait at least 1 minute between puffs if multiple doses are prescribed.

Question 11: A client is receiving total parenteral nutrition (TPN). Which complication should the nurse monitor for most carefully?

Hypothermia
Hypoglycemia
Hyperglycemia (Correct answer)
Metabolic acidosis

Correct answer: Hyperglycemia

TPN contains high concentrations of dextrose, placing the client at significant risk for hyperglycemia.

Total parenteral nutrition (TPN) contains high concentrations of dextrose (typically 25-70%), amino acids, lipids, electrolytes, vitamins, and trace elements. The high dextrose concentration creates a significant risk for hyperglycemia, especially during initiation of therapy or if the infusion rate is too rapid. Blood glucose should be monitored every 4-6 hours initially. Hypoglycemia can occur if TPN is abruptly discontinued (rebound hypoglycemia), which is why TPN should be tapered gradually. Other complications include infection at the central line site, fluid overload, electrolyte imbalances, and liver dysfunction. Hypothermia is not a typical TPN complication. The nurse should also monitor for signs of metabolic complications through regular laboratory tests.

Question 12: A nurse is prioritizing care for four clients at the start of a shift. Which client should the nurse assess first?

A client 2 days post-cholecystectomy reporting incisional pain of 5/10
A client with pneumonia whose oxygen saturation dropped from 96% to 88% (Correct answer)
A client with a urinary tract infection requesting pain medication
A client scheduled for discharge awaiting final instructions

Correct answer: A client with pneumonia whose oxygen saturation dropped from 96% to 88%

A significant drop in oxygen saturation from 96% to 88% indicates worsening respiratory status that requires immediate assessment and intervention.

Nursing prioritization follows the ABCs: Airway, Breathing, Circulation. A client with pneumonia whose oxygen saturation dropped from 96% to 88% has a breathing problem that requires immediate assessment. An SpO2 of 88% is below the acceptable range and suggests clinical deterioration that could progress to respiratory failure if not addressed promptly. The nurse should assess breath sounds, respiratory rate and effort, check oxygen delivery, and notify the provider. Post-surgical pain of 5/10 is expected and not life-threatening. A UTI client requesting pain medication has a comfort need but is stable. A client awaiting discharge instructions is the lowest priority. Always address actual or potential threats to the ABCs first.

NCLEX-PN Test #1 Practice Questions

A client with type 2 diabetes mellitus asks why blood glucose monitoring is important.
Which response by the nurse is most accurate?

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