NCLEX PN
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Free NCLEX PN Questions
The nurse is collecting data on a client who has suspected Raynaud phenomenon/disease. Which of the following findings would support a diagnosis of Raynaud phenomenon/disease
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unilateral swelling of the leg
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painful vasospasms
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crepitus of the joints
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claudication in feet and lower extremities
Explanation
Correct Answer B. painful vasospasms
Explanation:
Raynaud phenomenon (or Raynaud disease) is characterized by episodic vasospastic attacks affecting the small arteries of the fingers and toes, typically triggered by cold exposure or emotional stress. These spasms cause pain, numbness, or tingling and are often accompanied by a classic triphasic color change: white (pallor) from ischemia, blue (cyanosis) from deoxygenation, and red (hyperemia) upon reperfusion. Painful vasospasms are a hallmark feature of this condition and directly support the diagnosis.
Why Other Options Are Wrong:
A. Unilateral swelling of the leg
This is more indicative of conditions like deep vein thrombosis (DVT) or lymphedema. Raynaud phenomenon typically affects the hands and feet symmetrically, not isolated swelling of one limb.
C. Crepitus of the joints
Crepitus is usually associated with joint disorders, such as osteoarthritis, where joint surfaces are roughened. It is not a feature of Raynaud’s, which is a vascular disorder, not a joint disease.
D. Claudication in feet and lower extremities
Claudication refers to muscle pain or cramping during exercise due to peripheral artery disease. While it also involves compromised circulation, claudication is not episodic and doesn’t involve the characteristic vasospasm and color changes seen in Raynaud phenomenon.
The nurse is talking with the parent of a pediatric client who had a cast applied to the right arm 30 minutes ago. Which of the following statements by the parent would require follow-up
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I understand that my child may feel tingling or burning underneath the cast for the first few days.
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I can use a hair dryer to blow cool air underneath the cast if my child experiences itching.
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I will call the clinic if my child experiences pain that is not relieved with medication.
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I should keep my child's arm elevated while resting for the first few days.
Explanation
Correct Answer A. I understand that my child may feel tingling or burning underneath the cast for the first few days.
Explanation:
Tingling or burning sensations under a new cast may indicate impaired circulation or nerve compression—early signs of compartment syndrome, a serious complication. These symptoms are not normal and should be reported immediately, not expected or ignored. The nurse should follow up right away to assess the child’s neurovascular status and educate the parent on warning signs requiring urgent attention.
A client with asthma was recently prescribed fluticasone/salmeterol. After the client has received instructions about this medication, which statement would require further teaching by the nurse
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After taking this medication, I will rinse my mouth with water.
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I received the pneumococcal vaccine about a month ago.
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At the first sign of an asthma attack, I will take this medication.
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I have been smoking for 12 years, but I just quit a month ago.
Explanation
Correct Answer C. At the first sign of an asthma attack, I will take this medication.
Explanation:
Fluticasone/salmeterol is a combination inhaled corticosteroid and long-acting beta-agonist (LABA) used for maintenance therapy, not for acute asthma attacks. It does not provide immediate relief of bronchospasm. A short-acting beta-agonist (SABA) like albuterol should be used for acute symptoms. This statement reflects a misunderstanding that could lead to delayed treatment during an asthma attack. The other statements reflect appropriate understanding of medication and preventive care.
The nurse is caring for a client who is experiencing posttraumatic stress disorder after being sexually assaulted. The client states, "There is something that I need to say, but I am afraid. I need to know that you will not tell anyone else." Which of the following responses would be appropriate for the nurse to make
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I am sorry that you feel that way. There is nothing to be afraid of because I am here to help.
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If you feel that way, it must be important. I promise it is okay for you to share these things with me.
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If you write down what you want to say, then anything you share will be kept between the 2 of us.
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It depends on what you tell me. I am obligated to report abuse and thoughts of harming yourself or others.
Explanation
Correct Answer D. It depends on what you tell me. I am obligated to report abuse and thoughts of harming yourself or others.
Explanation of the Correct Answer:
D. It depends on what you tell me. I am obligated to report abuse and thoughts of harming yourself or others.– This response appropriately balances therapeutic communication with professional and legal responsibility. Nurses must be honest about confidentiality limits. Clients have the right to know that disclosures involving harm to self, others, or certain types of abuse may need to be reported. This response builds trust through transparency while showing concern and readiness to listen.
Upon entering a client’s room, the nurse finds the client lying on the floor. What is the first action the nurse should implement
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Call for help to get the client back in bed
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Assist the client back to bed
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Establish if the client is responsive
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Ask the client for details about what happened
Explanation
Correct Answer C. Establish if the client is responsive
Explanation:
The nurse’s first action in any situation involving a client found on the floor is to assess for responsiveness. This ensures that the nurse identifies whether the client is breathing, conscious, or in need of emergency intervention. Establishing responsiveness is part of the initial assessment in the basic life support (BLS) algorithm, and it guides the next steps—such as calling a code, checking for pulse, or safely initiating movement. Before moving or questioning the client, the nurse must determine the level of consciousness to ensure safety and direct care appropriately.
Why Other Options Are Wrong:
A. Call for help to get the client back in bed
While calling for assistance may eventually be necessary, it is not the immediate first step. Moving a client without assessing their condition could lead to harm, especially if there is a potential head injury, spinal trauma, or fracture. Prioritizing responsiveness and safety is essential before initiating any movement.
B. Assist the client back to bed
This action is premature and unsafe without assessing the client’s condition first. Moving a potentially injured client without a proper assessment could worsen an injury or mask critical symptoms. Nurses must always assess before acting physically, particularly in potential fall or trauma situations.
D. Ask the client for details about what happened
While understanding the cause of the fall is important, it is not the immediate priority. If the client is unresponsive or unstable, delaying critical interventions to obtain a history can result in harm. History gathering should occur only after ensuring the client is responsive and medically stable.
The nurse is caring for a client who is experiencing hypotension and respiratory depression after administration of IV midazolam. The nurse should anticipate that the client will receive
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acetylcysteine
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benztropine
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phentolamine
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flumazenil
Explanation
Correct Answer D. flumazenil
Explanation:
Flumazenil is a benzodiazepine antagonist used to reverse the sedative effects of medications like midazolam, which is a short-acting benzodiazepine. It is effective in treating benzodiazepine-induced respiratory depression and sedation, and is the antidote of choice in this situation.
A client with mitral valve prolapse has been experiencing occasional palpitations, lightheadedness, and dizziness. The health care provider prescribes a beta blocker. What additional teaching should the nurse reinforce for this client?
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Stay well hydrated and avoid caffeine
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Incentive spirometer
Explanation
Correct Answer:
Stay well hydrated and avoid caffeine
Clients with mitral valve prolapse (MVP) may experience symptoms such as palpitations, fatigue, dizziness, and lightheadedness due to dysregulated autonomic tone. Caffeine is a stimulant that can worsen palpitations and increase heart rate, so it should be limited or avoided. Dehydration can lead to hypotension and exacerbate dizziness or fainting episodes, which are already common in MVP. Staying well hydrated helps maintain vascular volume and promotes better cardiac output, reducing symptoms. Combined with beta blockers, this lifestyle modification helps minimize arrhythmia-like sensations and improves daily comfort.
The nurse is caring for a 72-year-old client 1 day postoperative colectomy. The nurse finds increased work of breathing, diminished breath sounds at the bases with fine inspiratory crackles, respirations 12/min and shallow, and pulse oximetry 96% on 2 L oxygen. There is no jugular venous distension or peripheral edema. Pain is regulated with client-controlled morphine. Which prescription does the nurse anticipate?
Incentive spirometer
Postoperative patients, especially elderly individuals recovering from abdominal surgery, are at high risk for developing atelectasis due to shallow breathing from pain, immobility, and effects of anesthesia. The presence of diminished breath sounds and fine inspiratory crackles at the lung bases suggests early atelectasis rather than fluid overload or hypoxia. An incentive spirometer encourages deep breathing and lung expansion, helping to prevent or reverse atelectasis and improve ventilation. It is a preventive and therapeutic measure in the postoperative period.
The nurse has attended a staff education program about sources of negligent lawsuits. It would indicate effective understanding if the nurse identifies which of the following is a source of a negligent lawsuit
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The nurse documents care under another nurse's username and password
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The nurse takes pictures of a client's medical record and distributes them online
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The nurse does not notify the physician of a client's critical laboratory result
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The nurse treats their spouse in the acute care facility with prescribed medications
Explanation
Correct Answer C. The nurse does not notify the physician of a client's critical laboratory result
Explanation:
Failing to notify the physician of a client's critical laboratory result is a classic example of negligence. Negligence in nursing refers to the failure to take proper care when fulfilling one's professional duties, particularly when it leads to patient harm. In this scenario, the nurse’s omission of action—failing to communicate an urgent lab result—could delay treatment, worsen the client’s condition, or cause serious harm. This lack of appropriate response constitutes a breach of the nurse’s duty to provide safe and competent care and can result in a malpractice lawsuit.
Why Other Options Are Wrong:
A. The nurse documents care under another nurse's username and password
This is incorrect. While this is a serious ethical and legal violation—specifically, a breach of professional standards and a violation of confidentiality—it is considered fraud or misrepresentation, not negligence. It may lead to disciplinary action, but it is not typically categorized as negligence in the legal context.
B. The nurse takes pictures of a client's medical record and distributes them online
This is incorrect. This action is a breach of confidentiality and a violation of HIPAA regulations. It is considered intentional misconduct rather than negligence, since it involves knowingly and willfully disregarding patient privacy.
D. The nurse treats their spouse in the acute care facility with prescribed medications
This is incorrect. This constitutes boundary violation and conflict of interest, not negligence. While inappropriate, it does not meet the definition of failing to act with reasonable care in a professional nursing duty related to patient care.
The nurse is visiting a client who is 82 years old, has impaired vision, and lives alone. It would be necessary for the nurse to follow up if the client states which of the following
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I secured my throw rugs to the floor with tape.
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I switched to using an electric shaver instead of a razor.
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I usually sit in a recliner while I listen to the television.
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I use different shaped containers with lids to organize my medications.
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I use the upstairs bathroom instead of the one downstairs.
Explanation
Correct Answer:
D. I use different shaped containers with lids to organize my medications.
E. I use the upstairs bathroom instead of the one downstairs.
Explanation:
A visually impaired, elderly individual living alone is at increased risk for injury due to poor lighting, fall hazards, and potential medication errors. Using different-shaped containers to organize medications may seem helpful but can be dangerous for someone with vision impairment because container shape alone is not a reliable cue. This could result in taking the wrong medication or wrong dose. Additionally, choosing to use the upstairs bathroom instead of a more accessible downstairs option significantly increases the risk of falls, particularly when stairs are involved. Navigating stairs with limited vision and age-related mobility issues is hazardous.
Why Other Options Are Wrong:
A. I secured my throw rugs to the floor with tape.
Although throw rugs are generally discouraged, if rugs are already present, securing them with tape is a fall-prevention strategy that reduces the likelihood of slipping or tripping. While not ideal, it indicates an effort to make the environment safer and does not require immediate follow-up.
B. I switched to using an electric shaver instead of a razor.
This is a safe adaptation for someone with impaired vision. Electric shavers reduce the risk of cuts and injury compared to manual razors, making them a good choice for elderly clients.
C. I usually sit in a recliner while I listen to the television.
This statement does not indicate any safety issue that requires follow-up. Sitting in a stable recliner is a safe and normal activity, especially if the client is resting and not attempting to stand or move while distracted.
The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy.
Which nutrients normally provided by milk should be obtained from other sources
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Vitamin K
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Calcium
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Fiber
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Iron
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Vitamin D
Explanation
Correct Answers:
B. Calcium
E. Vitamin D
Explanation of Correct Answers:
B. Calcium:
Cow’s milk is a primary dietary source of calcium for infants and toddlers. Calcium is essential for healthy bone and teeth development. Children with a cow’s milk allergy need alternative sources, such as calcium-fortified plant-based milks (e.g., soy or oat), leafy greens, or supplements, to meet daily requirements.
E. Vitamin D:
Vitamin D is commonly added to cow’s milk in fortified products. It's essential for calcium absorption and bone health. A child avoiding cow’s milk must obtain vitamin D through fortified non-dairy milks, fatty fish, eggs, or supplements, especially if they have limited sun exposure.
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