NCLEX-PN Comprehensive Review: Scope, Clinical Judgment, and Practice Standards

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Sample questions from NCLEX-PN Comprehensive Review: Scope, Clinical Judgment, and Practice Standards

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.The practical nurse (PN) is caring for a client who is 2 hours post-operative following an abdominal hysterectomy. Which finding is the most concerning and requires immediate notification of the registered nurse (RN)?

   • A.A. The client reports pain as a 7 on a 1-10 scale.
   • B.B. The client has 20 mL of serosanguineous drainage on the dressing.
   • C.C. The client's heart rate has increased from 80 to 118 beats per minute.
   • D.D. The client has not voided since returning from surgery.

   Rationale: An elevated heart rate (tachycardia) post-operatively is a priority cue (Circulation) that may indicate internal hemorrhage or shock. While pain (A) and low output (D) are important, the rapid change in vital signs is the most life-threatening. Serosanguineous drainage (B) is expected in small amounts after surgery.

2. 2.A PN is preparing to administer digoxin to a client with heart failure. Which action should the PN take first?

   • A.A. Check the client's serum potassium level.
   • B.B. Assess the client's apical pulse for one full minute.
   • C.C. Verify the medication against the provider's order.
   • D.D. Educate the client about the side effects of digoxin.

   Rationale: The apical pulse must be assessed before administration; if the heart rate is less than 60 bpm, the medication is withheld. While potassium (A) and verification (C) are important, the immediate physical assessment of the pulse is the standard nursing action for digoxin.

3. 3.The PN is assigned to four clients. Which client should the PN see first?

   • A.A. A client with diabetes whose morning blood glucose is 180 mg/dL.
   • B.B. A client with COPD who has an oxygen saturation of 90% on 2L of oxygen.
   • C.C. A client with a hip fracture who is complaining of new-onset shortness of breath.
   • D.D. A client who is scheduled for a cholecystectomy in two hours.

   Rationale: New-onset shortness of breath (C) in a client with a long-bone fracture (hip) is a classic sign of a pulmonary embolism, which is a life-threatening emergency (Airway/Breathing). The other clients (A, B, D) are relatively stable or have expected findings for their conditions.

4. 4.Which task is most appropriate for the PN to delegate to an unlicensed assistive personnel (UAP)?

   • A.A. Performing a sterile dressing change on a stage 3 pressure injury.
   • B.B. Feeding a client who was just admitted with an acute stroke.
   • C.C. Assisting a stable client with a post-operative day 2 walk in the hall.
   • D.D. Taking vital signs for a client who is receiving a blood transfusion.

   Answer and rationale are in the full material.

5. 5.A client with a history of alcohol abuse is admitted for a fractured leg. The PN notices the client is becoming agitated, sweaty, and has a slight tremor. What is the PN's priority action?

   • A.A. Provide the client with a warm blanket and a glass of water.
   • B.B. Notify the RN of the findings and prepare to initiate seizure precautions.
   • C.C. Encourage the client to rest and dim the lights in the room.
   • D.D. Ask the family if the client has a history of anxiety disorders.

   Answer and rationale are in the full material.