NCLEX-PN Qbank

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Sample questions from NCLEX-PN Qbank

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 72-year-old client admitted to a medical unit with pneumonia becomes restless and confused. Respirations are 30/min, oxygen saturation is 86% on room air, pulse is 112/min, and blood pressure is 136/78 mm Hg. Which action should the practical nurse take first?

   • A.Collect a sputum specimen before the next antibiotic dose.
   • B.Apply oxygen according to protocol and summon immediate assistance.
   • C.Administer the prescribed medication for fever.
   • D.Reorient the client and reassess in 15 minutes.

   Rationale: New confusion with severe hypoxemia requires immediate oxygen support and escalation of care. Sputum collection and fever treatment are appropriate later but do not correct the immediate threat. Reorientation alone delays treatment of impaired oxygenation. Prioritize breathing when a change in mental status accompanies respiratory compromise.

2. 2.An 81-year-old client with heart failure lives in a long-term care facility. The practical nurse is working with an experienced unlicensed assistive personnel member. Which task is most appropriate to delegate?

   • A.Determine whether new crackles indicate fluid overload.
   • B.Teach the client how to follow a sodium-restricted diet.
   • C.Obtain the client's scheduled weight using the same scale.
   • D.Evaluate whether the prescribed diuretic relieved dyspnea.

   Rationale: Obtaining a routine weight is a predictable task that can be delegated with instructions to report the result. Interpreting crackles and evaluating medication effects require licensed nursing judgment. Dietary teaching also requires a licensed nurse rather than unlicensed personnel. Delegate data collection, not interpretation, teaching, or evaluation.

3. 3.A 64-year-old client with chronic obstructive pulmonary disease is hospitalized for an exacerbation. After oxygen is increased from 2 L/min to 6 L/min, the client becomes drowsy; respirations are 10/min, oxygen saturation is 99%, and arterial blood gases show pH 7.28, PaCO2 68 mm Hg, and HCO3 30 mEq/L. Which action is the priority?

   • A.Immediately escalate care, support ventilation, and titrate oxygen toward the prescribed target.
   • B.Remove oxygen completely until the client becomes more alert.
   • C.Encourage oral fluids to thin respiratory secretions.
   • D.Document the saturation as evidence that the exacerbation has resolved.

   Rationale: Drowsiness, slow respirations, and acidemia indicate acute ventilatory failure requiring immediate assistance and possible ventilatory support. Oxygen should be controlled to the prescribed target, commonly 88% to 92% during an exacerbation, rather than abruptly withdrawn. Fluids do not correct hypoventilation, and a high oxygen saturation does not establish adequate ventilation. Assess ventilation and mental status instead of relying on pulse oximetry alone.

4. 4.A 58-year-old client with type 2 diabetes is awake on a rehabilitation unit and reports shakiness before lunch. Blood glucose is 54 mg/dL, and the client can swallow safely. Which action should the practical nurse take first?

   • A.Administer the scheduled rapid-acting insulin with lunch.
   • B.Give peanut butter crackers and check glucose in 1 hour.
   • C.Administer intramuscular glucagon immediately.
   • D.Give 4 oz of fruit juice and recheck glucose in 15 minutes.

   Answer and rationale are in the full material.

5. 5.A 67-year-old client receiving hemodialysis arrives at an outpatient center after missing a treatment. The client reports weakness, potassium is 6.7 mEq/L, and the cardiac monitor shows peaked T waves. Which action should the practical nurse take first?

   • A.Offer a low-potassium meal while waiting for dialysis.
   • B.Activate emergency assistance and maintain continuous cardiac monitoring.
   • C.Administer a prescribed stool softener.
   • D.Repeat the potassium measurement at the next scheduled treatment.

   Answer and rationale are in the full material.