Free NCLEX-PN practice questions

Question 1

After the 0700 handoff report on a dermatology unit, the nurse is caring for four clients with pemphigus vulgaris. Which client should the nurse see first?

Accepted Answer

C: The client who has a temperature of 101.8 F (38.8 C) and new confusion. A client with pemphigus vulgaris has large areas of open skin and takes drugs that suppress the immune system, so infection can spread quickly to the bloodstream. Overwhelming infection is the leading cause of death in this disease. Fever with a new change in mental status suggests sepsis. The nurse checks this client first, collects a full set of vital signs and reports to the registered nurse (RN) right away so that blood cultures and early antibiotics can begin. This client is at the greatest risk of rapid decline.

Question 2

A 38-year-old client who has taken sertraline 100 mg daily for a year walks into the community mental health clinic. An urgent care clinic prescribed tramadol for a back strain 2 days ago. The client is restless and talkative, with a temperature of 38.4 C, a heart rate of 116, heavy sweating, shivering, jerking of the foot when the ankle is flexed and three loose stools today. Complete the diagram by selecting the condition the client is most likely experiencing, two actions the nurse should take, and two parameters the nurse should monitor.

Accepted Answer

Actions to take: Report the findings to the provider immediately, Hold the next doses of sertraline and tramadol; Potential conditions: Serotonin syndrome; Parameters to monitor: Body temperature, Heart rate. Serotonin syndrome is a build-up of serotonin in the nervous system, almost always from two serotonin drugs taken together or a dose increase of one. Sertraline, a selective serotonin reuptake inhibitor, keeps serotonin in the space between nerve cells. Tramadol is a pain reliever that also blocks serotonin reuptake. Starting tramadol 2 days ago on top of a year of sertraline is the classic timing, because serotonin syndrome usually starts within hours to a day or two of the change.

The findings fall into three groups, and this client has all three. The mind is restless, agitated and talkative. The autonomic nervous system is racing, with fever, a fast heart rate, heavy sweating, shivering and diarrhea. The muscles are overactive, and the jerking of the foot when the ankle is flexed is clonus, the finding that points most strongly to serotonin syndrome.

The two actions stop more serotonin going in and get treatment moving. The next doses of both drugs are held, and the provider hears the findings immediately, because serotonin syndrome can progress to very high fever, seizures and death.

The two parameters are the ones that track how severe it is and whether it is settling. A rising body temperature is the most dangerous sign in serotonin syndrome, and the heart rate shows how hard the autonomic system is being driven.

Question 3

The nurse in a long-term care facility is caring for an 86-year-old resident with end-stage heart failure who is receiving comfort care in the last days of life. The resident breathes through the mouth, receives oxygen at 2 L/min by nasal cannula, and can no longer swallow safely. The lips are dry and cracked. Which of the following actions should the nurse take?

Accepted Answer

B: Apply a water-based lubricant to the lips after each episode of mouth care; D: Turn the resident's head to the side before cleaning the mouth; E: Moisten the inside of the mouth with a soft swab dipped in water every 1 to 2 hours. A dry mouth is one of the most common causes of discomfort at the end of life. Mouth breathing and oxygen dry the mucosa, and the client no longer drinks. Good mouth care often relieves the feeling of thirst better than fluids would.

A soft swab moistened with water, used every 1 to 2 hours, keeps the mouth comfortable without giving the client fluid to swallow. A water-based lubricant protects the lips. It is preferred over petroleum products, which can dry the lips over time and are flammable near oxygen. Turning the head to the side lets any liquid drain out of the mouth rather than into the airway, because the client cannot swallow safely.

Question 4

The nurse in a skilled nursing facility is changing the dry dressing over a client's closed abdominal incision 7 days after a colectomy. Which of the following actions should the nurse take?

Accepted Answer

A: Remove the old tape by pulling it toward the incision; B: Clean from the incision line outward, using a new swab for each stroke; D: Apply a skin protectant such as tincture of benzoin to the skin the new tape will cover. Tape is pulled toward the wound so that the pull does not separate the healing edges of the incision. The incision is the cleanest area, so cleaning moves from the incision outward, from clean to less clean, with a new swab for each stroke so that bacteria are not carried back onto the wound. A skin protectant such as tincture of benzoin helps the tape stick and protects the skin from damage when the tape is removed later.

Question 5

A 66-year-old resident of a skilled nursing facility had a tracheostomy placed 3 weeks ago after prolonged intubation. After a swallow evaluation by the speech-language pathologist, the resident started a soft diet today. The nurse suctions the resident 30 minutes after lunch. Which finding requires immediate follow-up?

Accepted Answer

B: Small pieces of green beans in the secretions suctioned from the tracheostomy. A tracheostomy tube can change how a client swallows. It can hold the larynx down so it does not lift and close the airway well, and a long period of intubation weakens the throat muscles. Food can then slip past the vocal cords into the trachea, sometimes without any cough.

Food particles in tracheal secretions are direct evidence that the resident is aspirating. The nurse stops oral intake, suctions to clear the airway, checks the breath sounds and SpO2, and reports to the registered nurse (RN) and the speech-language pathologist, who will look at the swallow again before the resident eats.

Question 6

The nurse is assigning a task to the unlicensed assistive personnel (UAP). Place the following steps in the order the nurse should perform them.

Accepted Answer

1: Confirm that the task is appropriate for the client's condition; 2: Verify that the UAP has been trained to perform the task; 3: Give clear directions, including what to report and when; 4: Check on the task and follow up on the results. The rights of delegation guide the order. The nurse first decides that the task and circumstances are right, meaning a routine task for a stable client. Next, the nurse makes sure the right person, a trained UAP, will do it. The nurse then gives the right directions and finally provides the right supervision and follow-up.

Question 7

In a long-term care facility, an 84-year-old resident who has heart failure has difficulty swallowing tablets. The primary health care provider changes the prescription to digoxin oral solution 0.125 mg orally once daily, and the pharmacy supplies digoxin oral solution 0.05 mg/mL with a calibrated oral syringe. The resident's apical pulse is 74/min. How many mL should the nurse administer? Record your answer using 1 decimal place.

Accepted Answer

2.5. Digoxin has a narrow therapeutic range, so a small error in the volume of a liquid dose makes a real difference. The solution holds 0.05 mg in each mL, so 0.125 mg needs 2.5 mL.

A liquid dose this small is measured in a calibrated oral syringe, never a household spoon or a medicine cup, because the markings on a cup are too far apart to measure 2.5 mL accurately. The apical pulse of 74/min is above the hold parameter of 60/min, so the dose is given.

Question 8

A client at a community mental health clinic is starting haloperidol, and the nurse is contributing to the schedule for monitoring movement effects. Place the movement adverse effects in the order in which they usually begin after the drug is started, from earliest to latest.

Accepted Answer

1: Acute dystonia, with a sudden spasm of the neck or eyes; 2: Akathisia, with an inner urge to keep moving; 3: Parkinsonism, with a shuffling gait and slowed movement; 4: Tardive dyskinesia, with lip smacking and tongue movements. The four extrapyramidal symptoms (EPS) of antipsychotics each have their own usual time of onset, and knowing the order tells the nurse what to watch for at each point in treatment.

Acute dystonia comes first, within hours to a few days of starting the drug or raising the dose. The first days of treatment are when the nurse watches for a sudden spasm of the neck, eyes, jaw or throat.

Akathisia usually follows within days to a few weeks, as an inner restlessness and an inability to stay still.

Parkinsonism usually appears within weeks to 3 months, as slowed movement, stiffness, a shuffling gait and a tremor at rest.

Tardive dyskinesia comes last, after months to years of treatment, as repetitive movements of the mouth, tongue and face. It is the one that may be permanent, which is why clients on long-term treatment are screened for it at regular intervals.

Question 9

At a pediatric clinic, the nurse notes bruises on both ears and on the buttocks of a 2-year-old child. The father states that the child fell off a kitchen chair yesterday. Complete the following sentence by choosing from the lists of options. The nurse is legally required to report the findings to [Blank 1] as soon as the nurse has [Blank 2].

Accepted Answer

Blank 1: child protective services; Blank 2: a reasonable suspicion of abuse. Bruising on the ears and the buttocks is a warning sign in a toddler. Children who fall land on bony, forward-facing areas such as the forehead, knees and shins. The ears, buttocks, cheeks, neck, upper arms and torso are protected areas that are rarely hurt in a fall, and bruises there, especially with a story that does not explain them, suggest the child was struck.

Nurses are mandated reporters in every state. The duty starts at reasonable suspicion: the nurse does not need proof, an X-ray, a disclosure or a confession, and waiting for one leaves the child in danger. The report goes to child protective services, following state law and the clinic's policy, and the nurse also tells the registered nurse (RN) and the provider. A report made in good faith is protected by law even if abuse is not confirmed.

Question 10

The nurse at a community mental health clinic is reviewing the records of five clients who take antipsychotic medications. For each finding, click to specify the extrapyramidal effect it describes.

Accepted Answer

Repeated tongue thrusting and lip smacking in a client who has taken fluphenazine for 9 years: Tardive dyskinesia; Shuffling steps, a masklike face, and a pill-rolling tremor at rest 5 weeks after starting haloperidol: Pseudoparkinsonism; Shifting from foot to foot and an inner urge to keep moving 10 days after a dose increase of aripiprazole: Akathisia; The jaw clenched shut with difficulty swallowing 6 hours after a first injection of haloperidol: Acute dystonia; Slow, stiff arm movements with cogwheel rigidity at the wrist 3 weeks after starting risperidone: Pseudoparkinsonism. Antipsychotics block dopamine, and in the nigrostriatal pathway that controls movement the loss of dopamine produces the extrapyramidal effects. The timing after the first dose or a dose change is the best clue to which one the client has.

Acute dystonia comes first, within hours to a few days: a sustained spasm of the neck, eyes, jaw, or tongue. A jaw clenched shut 6 hours after a first injection fits. Akathisia follows within days to weeks, often after a dose increase, and it is a restlessness the client feels inside as well as one the nurse can see. Aripiprazole is a second-generation medication but is well known for causing it. Pseudoparkinsonism appears over weeks: slowed movement, rigidity with a ratchet-like cogwheel feel, a shuffling gait, a flat masklike face, and a resting tremor, the same picture as Parkinson disease because the cause is the same lack of dopamine effect. Tardive dyskinesia comes last, after months to years, as involuntary movements of the mouth, tongue, face, and sometimes the limbs. It can be permanent.

Free NCLEX-PN practice questions.

After the 0700 handoff report on a dermatology unit, the nurse is caring for four clients with pemphigus vulgaris. Which client should the nurse see first?

The nurse in a skilled nursing facility is changing the dry dressing over a client's closed abdominal incision 7 days after a colectomy. Which of the following actions should the nurse take?

The nurse is assigning a task to the unlicensed assistive personnel (UAP). Place the following steps in the order the nurse should perform them.

A client at a community mental health clinic is starting haloperidol, and the nurse is contributing to the schedule for monitoring movement effects. Place the movement adverse effects in the order in which they usually begin after the drug is started, from earliest to latest.

At a pediatric clinic, the nurse notes bruises on both ears and on the buttocks of a 2-year-old child. The father states that the child fell off a kitchen chair yesterday. Complete the following sentence by choosing from the lists of options.

The nurse at a community mental health clinic is reviewing the records of five clients who take antipsychotic medications. For each finding, click to specify the extrapyramidal effect it describes.

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