NCLEX-PN Test #1 — Questions and Answers

Question 1: A practical nurse is caring for a client who is short of breath and anxious. Which action should the nurse take first?

Elevate the head of the bed. (Correct answer)
Call the client's family to the bedside.
Encourage the client to drink fluids.
Ask the client to rate their anxiety.

Correct answer: Elevate the head of the bed.

Elevating the head of the bed (Fowler's position) helps to improve lung expansion and reduce the effort of breathing by allowing gravity to pull the diaphragm down. This immediate physical intervention can significantly alleviate shortness of breath and, consequently, reduce the client's anxiety related to difficulty breathing. It is a priority action for respiratory distress.

Question 2: Before administering digoxin to an adult client, which assessment finding would require the nurse to hold the medication and notify the provider?

Apical pulse of 54 beats per minute. (Correct answer)
Blood pressure of 138/82 mm Hg.
Respiratory rate of 20 breaths per minute.
Temperature of 37.2 C (99 F).

Correct answer: Apical pulse of 54 beats per minute.

Digoxin is a cardiac glycoside that slows the heart rate and strengthens myocardial contractions. An apical pulse below 60 beats per minute in an adult is a common contraindication for administering digoxin, as it could lead to severe bradycardia. The nurse must hold the medication and notify the provider to prevent adverse cardiac effects.

Question 3: A client on opioid analgesics reports new constipation. Which instruction by the nurse is most appropriate?

Increase fluid and fiber intake and walk daily as tolerated. (Correct answer)
Avoid drinking water after taking the medication.
Lie in bed as much as possible.
Double the opioid dose for pain control.

Correct answer: Increase fluid and fiber intake and walk daily as tolerated.

Opioid analgesics commonly cause constipation by slowing gastrointestinal motility. Increasing fluid and fiber intake helps to soften stool and add bulk, while daily walking promotes bowel peristalsis. These non-pharmacological interventions are essential for preventing and managing opioid-induced constipation, promoting regular bowel movements, and improving client comfort.

Question 4: Which action by the practical nurse helps prevent falls in an older adult client who is unsteady when walking?

Place the call light within easy reach and respond promptly. (Correct answer)
Encourage the client to walk alone to maintain independence.
Raise all side rails and leave the room.
Keep the room lights off to promote rest.

Correct answer: Place the call light within easy reach and respond promptly.

For an unsteady older adult, placing the call light within easy reach and responding promptly ensures that they can request assistance whenever needed, rather than attempting to get up alone. This direct intervention significantly reduces the risk of falls by providing immediate support and preventing unsupervised ambulation. It is a cornerstone of fall prevention in healthcare settings.

Question 5: A client with a new colostomy asks the nurse how to care for the stoma. Which response is most accurate?

The stoma should look moist and pink to red in color. (Correct answer)
The stoma should be dry and gray in color.
You should scrub the stoma firmly each day.
Any bleeding from the stoma is always normal.

Correct answer: The stoma should look moist and pink to red in color.

A healthy, viable stoma should appear moist and be pink to beefy red in color, similar to the mucous membranes inside the mouth. This indicates adequate blood supply and tissue perfusion. Any significant deviation from this appearance, such as a dry, pale, or dusky stoma, could indicate compromised circulation and requires immediate assessment.

Question 6: The nurse is reinforcing teaching about insulin self-administration. Which statement by the client shows a correct understanding?

I will rotate injection sites within the same area, like my abdomen. (Correct answer)
I will use the same spot every day so it is less painful.
I will inject only into my upper arm muscles.
I can stop my insulin when my blood sugar feels normal.

Correct answer: I will rotate injection sites within the same area, like my abdomen.

Rotating injection sites within the same general area, such as the abdomen, is crucial for preventing lipohypertrophy (fatty lumps) or lipoatrophy (indentations) at the injection sites. These changes can impair insulin absorption and lead to unpredictable blood glucose levels. Consistent rotation ensures optimal absorption and maintains skin integrity.

Question 7: Which finding in a post-operative client should the practical nurse report to the registered nurse or provider immediately?

A surgical dressing that is suddenly saturated with bright red blood. (Correct answer)
Mild pain controlled with prescribed analgesics.
Small amount of dried drainage on the old dressing.
Temperature of 37.4 C (99.3 F).

Correct answer: A surgical dressing that is suddenly saturated with bright red blood.

A surgical dressing suddenly saturated with bright red blood indicates active hemorrhage, which is a critical and potentially life-threatening complication post-operatively. This requires immediate assessment and intervention to control bleeding and prevent hypovolemic shock. Prompt reporting to the registered nurse or provider is essential for rapid medical management.

Question 8: A client receiving an IV antibiotic develops itching and hives. What is the nurse's priority action?

Stop the IV infusion immediately. (Correct answer)
Document the reaction and continue the infusion.
Tell the client this is an expected side effect.
Ask the client to drink more fluids.

Correct answer: Stop the IV infusion immediately.

Itching and hives developing during an IV antibiotic infusion are classic signs of an allergic reaction, which can escalate to a severe anaphylactic response. The nurse's priority is to immediately stop the infusion to prevent further exposure to the allergen. This action minimizes the client's reaction and allows for prompt assessment and administration of emergency medications if needed.

Question 9: When providing care for a client in isolation for an airborne infection, which item is essential for the nurse to wear?

An N95 respirator mask. (Correct answer)
Only clean gloves.
A cloth face covering.
Regular eyeglasses.

Correct answer: An N95 respirator mask.

Airborne precautions are required for infections spread by very small airborne droplets that can remain suspended in the air for extended periods. An N95 respirator mask is specifically designed to filter out these tiny particles, providing essential respiratory protection for the nurse. Standard surgical masks do not offer adequate protection against airborne pathogens.

Question 10: During an assessment, the nurse notes a client with heart failure has shortness of breath while resting. What should the nurse do first?

Check the client’s oxygen saturation. (Correct answer)
Encourage the client to drink more fluids.
Lay the client flat in bed.
Increase the client’s sodium intake.

Correct answer: Check the client’s oxygen saturation.

Shortness of breath while resting in a client with heart failure indicates worsening cardiac function and potential pulmonary congestion, which can impair oxygenation. Checking the client's oxygen saturation is the priority to quickly assess the severity of respiratory compromise and guide immediate interventions, such as oxygen therapy or repositioning.

Question 11: A client taking a new antihypertensive medication reports dizziness. What should the nurse do first?

Check the client's blood pressure. (Correct answer)
Stop the medication immediately.
Tell the client to ignore the dizziness.
Have the client exercise vigorously.

Correct answer: Check the client's blood pressure.

Dizziness is a common side effect of antihypertensive medications, often indicating that the blood pressure has dropped too low or that the client is experiencing orthostatic hypotension. Checking the client's blood pressure is the priority action to assess their hemodynamic status and determine the cause of the dizziness. This guides further intervention, such as adjusting medication or assisting with ambulation.

Question 12: A diabetic client reports increased hunger, sweating, and trembling. What should the nurse do?

Provide a fast-acting carbohydrate. (Correct answer)
Encourage the client to rest without eating.
Give the next insulin dose early.
Have the client drink only water.

Correct answer: Provide a fast-acting carbohydrate.

Increased hunger, sweating, and trembling are classic symptoms of hypoglycemia (low blood glucose) in a diabetic client. Providing a fast-acting carbohydrate, such as juice or glucose tablets, is the immediate and most effective intervention to quickly raise blood sugar levels and prevent further complications. This is a critical action to restore glucose balance.

Question 13: The nurse observes a client with COPD using accessory muscles to breathe. What is the priority action?

Place the client in high Fowler’s position. (Correct answer)
Encourage the client to lie flat.
Provide a large meal immediately.
Limit fluid intake.

Correct answer: Place the client in high Fowler’s position.

Using accessory muscles to breathe indicates increased work of breathing and respiratory distress in a client with COPD. Placing the client in high Fowler's position (sitting upright) helps to optimize lung expansion by allowing gravity to pull the diaphragm down, reducing pressure on the lungs and making breathing easier. This position improves ventilation and oxygenation.

Question 14: A client reports constipation while taking iron supplements. What is the nurse’s best response?

Increase fluids and dietary fiber. (Correct answer)
Stop taking iron immediately.
Take double the supplement dose.
Avoid all fruits and vegetables.

Correct answer: Increase fluids and dietary fiber.

Iron supplements are a common cause of constipation. Increasing fluid intake helps to soften the stool, while increasing dietary fiber adds bulk, both of which promote regular bowel movements. This is the most effective and non-pharmacological approach to manage this common side effect.

Question 15: The nurse is caring for a client receiving IV fluids who suddenly reports swelling at the IV site. What should the nurse suspect?

Infiltration. (Correct answer)
Hypotension.
Air embolism.
Electrolyte imbalance.

Correct answer: Infiltration.

Swelling at the IV site, often accompanied by coolness and pain, is a classic sign of infiltration. This occurs when the IV fluid leaks out of the vein and into the surrounding subcutaneous tissue. It is important to stop the infusion immediately to prevent further tissue damage.

Question 16: A client with pneumonia has thick mucus and difficulty coughing. What action should the nurse take?

Encourage increased fluid intake. (Correct answer)
Limit fluid intake to reduce coughing.
Instruct the client to avoid coughing.
Keep the client completely flat.

Correct answer: Encourage increased fluid intake.

Increased fluid intake helps to thin thick respiratory secretions, making them less viscous and easier for the client to cough up and clear from their airways. This is crucial for improving respiratory function and preventing further complications like atelectasis or worsening pneumonia. Hydration is a key intervention for mucus clearance.

Question 17: A client receiving an opioid for postoperative pain reports difficulty staying awake. What should the nurse check first?

Check the client’s respiratory rate. (Correct answer)
Provide more opioid medication.
Give a caffeinated drink.
Tell the client to try walking.

Correct answer: Check the client’s respiratory rate.

Difficulty staying awake while on an opioid is a significant warning sign of potential central nervous system depression, which can progress to life-threatening respiratory depression. The nurse's priority is to check the client's respiratory rate to assess for this critical side effect and intervene promptly if breathing is compromised.

Question 18: A client reports redness and warmth around a surgical incision. What should the nurse do first?

Assess the incision and notify the provider. (Correct answer)
Apply ice directly to the incision.
Tell the client this is normal after surgery.
Cover the incision with a cold dressing.

Correct answer: Assess the incision and notify the provider.

Redness and warmth around a surgical incision are potential indicators of inflammation or infection. The nurse's first action is to thoroughly assess the incision for other signs such as drainage, swelling, or pain, and then notify the provider. This ensures a comprehensive evaluation and appropriate medical intervention.

Question 19: A client with asthma begins wheezing after exposure to cold air. What should the nurse do first?

Have the client lie completely flat.
Encourage deep, rapid breaths.
Provide warm milk to relax the airway.
Administer the prescribed rescue inhaler. (Correct answer)

Correct answer: Administer the prescribed rescue inhaler.

Wheezing in an asthma client indicates bronchospasm and narrowing of the airways, leading to respiratory distress. Administering the prescribed rescue inhaler (e.g., a short-acting beta-agonist like albuterol) is the priority intervention to quickly relax the bronchial smooth muscles, open the airways, and relieve the acute symptoms. This directly addresses the underlying physiological problem.

Question 20: A diabetic client reports blurred vision and extreme thirst. What should the nurse do first?

Offer caffeinated beverages.
Check the client's blood glucose level. (Correct answer)
Have the client rest without fluids.
Give the next insulin dose early.

Correct answer: Check the client's blood glucose level.

Blurred vision and extreme thirst are classic symptoms of hyperglycemia (high blood glucose) in a diabetic client. The nurse's priority is to check the client's blood glucose level to confirm the condition and guide appropriate treatment, such as insulin administration. This assessment is critical for managing the client's diabetic status and preventing complications.

Question 21: A client reports dizziness after taking their morning antihypertensive medication. What should the nurse assess first?

Encourage immediate exercise.
Have the client drink salty soup.
Stop the medication immediately.
Assess the client’s blood pressure. (Correct answer)

Correct answer: Assess the client’s blood pressure.

Dizziness after taking antihypertensive medication suggests a potential drop in blood pressure, possibly orthostatic hypotension. The nurse's first action should be to assess the client's blood pressure to obtain objective data and confirm this suspicion. This assessment guides further interventions and ensures client safety.

Question 22: A client reports constipation after starting a new iron supplement. What should the nurse recommend?

Reduce water intake daily.
Stop the iron supplement immediately.
Increase fluid and fiber intake. (Correct answer)
Eat only low-fiber foods.

Correct answer: Increase fluid and fiber intake.

Iron supplements are a common cause of constipation. Increasing fluid intake helps to soften stools, while increasing fiber adds bulk, both promoting regular bowel movements. This is a safe and effective non-pharmacological approach to manage this common side effect.

Question 23: During wound care, the nurse notes foul-smelling drainage. What is the nurse’s priority?

Remove all dressings and expose the wound.
Cover the wound without assessing.
Ignore it until fever develops.
Notify the healthcare provider immediately. (Correct answer)

Correct answer: Notify the healthcare provider immediately.

Foul-smelling drainage from a wound is a significant sign of potential infection. This change in wound status requires immediate medical evaluation and intervention to prevent further complications. Notifying the healthcare provider promptly ensures timely assessment and appropriate treatment.

Question 24: A postoperative client reports nausea after receiving pain medication. What should the nurse do first?

Encourage the client to skip future pain doses.
Assess the severity of the nausea. (Correct answer)
Provide a high-fat snack.
Have the client lie completely flat.

Correct answer: Assess the severity of the nausea.

Before intervening, the nurse must first assess the severity and characteristics of the client's nausea. This assessment helps determine the most appropriate intervention, whether it's an antiemetic, repositioning, or other comfort measures. It aligns with the nursing process, where assessment precedes action.

Question 25: The nurse is reinforcing teaching for a client prescribed furosemide. Which statement shows correct understanding?

I should avoid drinking water while on it.
I will take it before bedtime.
I will stop taking it if I urinate a lot.
I will take this medication in the morning. (Correct answer)

Correct answer: I will take this medication in the morning.

Furosemide is a diuretic that increases urine production, so taking it in the morning prevents frequent nighttime urination (nocturia). This timing promotes better sleep for the client and reduces the risk of falls associated with getting up multiple times during the night. It ensures patient comfort and safety.

Question 26: A client with pneumonia is having trouble coughing up thick mucus. What should the nurse encourage?

Lie flat in bed.
Reduce fluid intake.
Drink plenty of fluids. (Correct answer)
Avoid coughing to rest the lungs.

Correct answer: Drink plenty of fluids.

Adequate fluid intake is crucial for clients with pneumonia, as it helps to thin respiratory secretions. Thinner mucus is easier to cough up and expectorate, which improves airway clearance and gas exchange. This simple intervention significantly aids in managing respiratory symptoms.

Question 27: A client after surgery reports warmth and tightness around the incision. What should the nurse do first?

Ignore the symptom unless it spreads.
Assess the incision site. (Correct answer)
Apply cold compresses immediately.
Remove all dressings.

Correct answer: Assess the incision site.

Warmth and tightness around an incision can indicate inflammation, infection, or a hematoma. The nurse's priority is to assess the incision site directly to gather objective data about its appearance, palpate for tenderness or swelling, and check for any drainage. This assessment guides subsequent interventions and reporting to the provider.

NCLEX-PN Test #1

A practical nurse is caring for a client who is short of breath and anxious.
Which action should the nurse take first?

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