NCLEX-PN Exam With NGN Questions And Correct Verified Answers
1. A licensed vocational nurse (LVN) is caring for a client who is 24 hours postoperative following an
abdominal hysterectomy. Which of the following findings is the priority for the nurse to reportto the
provider?
A. Incisional pain rated as 7 on a scale of 0 to 10
26
B. Absent bowel sounds in all four quadrants
C. Urinary output of 20 mL/hour for the past 2 hours
D. Serosanguineous drainage on the abdominal dressing
· Correct Answer: C
20
· Explanation: A urinary output of less than 30 mL/hour indicates potential hypovolemia,dehydration, or
renal failure. This is an acute change that requires immediate intervention. Pain
(A) and absent bowel sounds (B) are expected 24 hours post-abdominal
surgery.Serosanguineous drainage (D) is also an expected finding at this stage.
2. A nurse is reinforcing discharge teaching with a client who has a new prescription for warfarin.
am
Which of the following instructions should the nurse include?
A. Increase intake of dark green leafy vegetables.
B. Use a commercial straight razor for shaving.
C. Report any black, tarry stools to the provider.
D. Take aspirin for mild headaches or body aches.
Ex
· Correct Answer: C
· Explanation: Black, tarry stools indicate gastrointestinal bleeding, which is a major adverse effect of
anticoagulant therapy like warfarin. Clients should maintain a consistent intake of green leafy vegetables
(A) rather than increase it, use an electric razor (B) to prevent cuts, and avoid aspirin (D) due to increased
bleeding risks.
ng
3. A nurse is collecting data from a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A. Pulmonary congestion
B. Jugular vein distention
si
C. Dyspnea on exertion
D. Cough with pink, frothy sputum
· Correct Answer: B
ur
· Explanation: Right-sided heart failure results in systemic venous congestion, leading to jugular vein
distention, peripheral edema, and hepatomegaly. Pulmonary congestion (A), dyspnea (C),and pink, frothy
sputum (D) are clinical manifestations of left-sided heart failure.
N
4. A client with type 1 diabetes mellitus is found unresponsive, diaphoretic, and tachycardic.Which of
the following actions should the nurse take first?
A. Administer 15 g of simple carbohydrates orally.
B. Administer glucagon subcutaneously or intramuscularly.
C. Check the client's blood glucose level.
D. Call the healthcare provider immediately.
· Correct Answer: B
· Explanation: The client is exhibiting signs of severe hypoglycemia and is unresponsive, making oral
administration (A) unsafe due to aspiration risk. In an emergency situation with an
, unresponsive client, administering glucagon (B) is the priority action. Checking blood glucose (C)shouldn't
delay emergency treatment when severe symptoms are present. Calling the provider (D) happens after
administering emergency medication.
5. A nurse is preparing to administer an intramuscular (IM) injection to an obese adult client.Which of the
following needles should the nurse select for the injection?
A. 25-gauge, 5/8-inch needle
B. 22-gauge, 1.5-inch needle
C. 21-gauge, 2-inch needle
26
D. 27-gauge, 1/2-inch needle
Correct Answer: C
· Explanation: For an obese client, a longer needle (2 inches) is required to ensure the medication
reaches the deep muscle tissuerather than staying in subcutaneous fat. A 1.5-inch needle (B) is standard
20
for normal-weight adults. 5/8-inch (A) and 1/2-inch (D) needles are too short for adult IM injections.
6. A nurse is reinforcing teaching with a client who has a new diagnosis of gastroesophageal reflux
disease (GERD). Which of the following dietary modifications should the nurse recommend?
A. Drink a glass of milkright before bedtime.
B. Consume three large meals daily instead of snacking.
am
C. Avoid eating within 3 hours of lying down.
D. Increase intake of caffeinated beverages for digestion.
Correct Answer: C
· Explanation: Eating within 3 hours of recumbency increases reflux due to gravity and increased gastric
pressure. Milk before bed (A) can stimulate acid production. Clients should eat small,frequent meals (B)
Ex
instead of large ones. Caffeine (D) relaxes the lower esophageal sphincter and worsens GERD.
7. A nurse is caring for a client who is receiving a continuous intravenous (IV) infusion of heparin.
Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of
the medication?
ng
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
si
· Correct Answer: C
· Explanation: The aPTT is used to monitor the therapeutic effect of continuous heparin infusions.PT (A)
and INR (B) are monitored for warfarin therapy. While platelet counts (D) are monitored to screen for
ur
heparin-induced thrombocytopenia, they do not measure the medication's therapeutic effectiveness.
8. A nurse is contributing to the plan of care for a client who has a prescription for structural mechanical
restraints. Which of the following interventions should the nurse include?A. Check the client's circulation
N
and skin integrity every 2 hours.
B. Renew the restraint prescription every 48 hours.
C. Position the client in a prone position while restrained.
D. Remove the restraints completely every 4 hours for range of motion.
Correct Answer: A
, · Explanation: Restrained clients require regular assessments for safety; neurovascular and skin checks
must occur at least every 2 hours. Restraint orders must be renewed every 4 hours for adults (B), not
48. Prone positioning (C) poses a suffocation risk. Restraints should be released for range-of-motion
exercises every 2 hours (D), not 4.
9. A nurse is reinforcing teaching with a client who has a prescription for a nitroglycerin sublingual
tablet for angina. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should swallow the tablet with a full glass of water."
26
B. "If the pain doesn't stop after thefirst tablet, I will call emergency services."
C. "I can take up to five tablets in a 15-minute period."
D. "I should store the tablets in a clear glass container on my windowsill."
·Correct Answer: B
20
· Explanation: Current guidelines state that if chest pain is not relieved or worsens 5 minutes after
taking the first dose of sublingual nitroglycerin, the client should immediately call emergency services
[1]. Sublingual tablets must dissolve under the tongue (A), not be swallowed. A maximum of 3 doses
(C), spaced 5 minutes apart, can be taken. The medication is light-sensitive and must be stored in its
original dark glass bottle (D).
am
10.A nurse is assisting with the admission of an older adult client who has acute urinary tract
infection (UTI). Which of the following clinical manifestations should the nurse expect?A. High fever
and chills
Ex
B. Confusion and disorientation
C. Severe radiating back pain
D. Bradycardia and hypotension
· Correct Answer: B
· Explanation: Older adult clients often present with atypical symptoms of an infection.
ng
Confusion,altered mental status, or disorientation are classic presentation indicators of a UTI in
geriatric clients. High fever (A) is less common in older adults. Radiating back pain (C) suggests
pyelonephritis, not a localized UTI. Bradycardia (D) is not typical; tachycardia occurs if sepsis develops.
si
ur
Case Study 1: Client with Chronic Obstructive Pulmonary Disease (COPD)
N
Client Context: A 68-year-old male client with a history of severe COPD is admitted to the medical unit
with an exacerbation characterized by increased dyspnea, a productive cough with thick green sputum,
and an oxygen saturation (SpO2 )of 87% on room air.
11. Based on the case study context, which of the following oxygen delivery devices and flow rates
should the nurse anticipate initiating first?
A. Simple face mask at 8 L/min
, B. Nasal cannula at 2 L/min
26
20
am
Ex
ng
si
ur
N
1. A licensed vocational nurse (LVN) is caring for a client who is 24 hours postoperative following an
abdominal hysterectomy. Which of the following findings is the priority for the nurse to reportto the
provider?
A. Incisional pain rated as 7 on a scale of 0 to 10
26
B. Absent bowel sounds in all four quadrants
C. Urinary output of 20 mL/hour for the past 2 hours
D. Serosanguineous drainage on the abdominal dressing
· Correct Answer: C
20
· Explanation: A urinary output of less than 30 mL/hour indicates potential hypovolemia,dehydration, or
renal failure. This is an acute change that requires immediate intervention. Pain
(A) and absent bowel sounds (B) are expected 24 hours post-abdominal
surgery.Serosanguineous drainage (D) is also an expected finding at this stage.
2. A nurse is reinforcing discharge teaching with a client who has a new prescription for warfarin.
am
Which of the following instructions should the nurse include?
A. Increase intake of dark green leafy vegetables.
B. Use a commercial straight razor for shaving.
C. Report any black, tarry stools to the provider.
D. Take aspirin for mild headaches or body aches.
Ex
· Correct Answer: C
· Explanation: Black, tarry stools indicate gastrointestinal bleeding, which is a major adverse effect of
anticoagulant therapy like warfarin. Clients should maintain a consistent intake of green leafy vegetables
(A) rather than increase it, use an electric razor (B) to prevent cuts, and avoid aspirin (D) due to increased
bleeding risks.
ng
3. A nurse is collecting data from a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A. Pulmonary congestion
B. Jugular vein distention
si
C. Dyspnea on exertion
D. Cough with pink, frothy sputum
· Correct Answer: B
ur
· Explanation: Right-sided heart failure results in systemic venous congestion, leading to jugular vein
distention, peripheral edema, and hepatomegaly. Pulmonary congestion (A), dyspnea (C),and pink, frothy
sputum (D) are clinical manifestations of left-sided heart failure.
N
4. A client with type 1 diabetes mellitus is found unresponsive, diaphoretic, and tachycardic.Which of
the following actions should the nurse take first?
A. Administer 15 g of simple carbohydrates orally.
B. Administer glucagon subcutaneously or intramuscularly.
C. Check the client's blood glucose level.
D. Call the healthcare provider immediately.
· Correct Answer: B
· Explanation: The client is exhibiting signs of severe hypoglycemia and is unresponsive, making oral
administration (A) unsafe due to aspiration risk. In an emergency situation with an
, unresponsive client, administering glucagon (B) is the priority action. Checking blood glucose (C)shouldn't
delay emergency treatment when severe symptoms are present. Calling the provider (D) happens after
administering emergency medication.
5. A nurse is preparing to administer an intramuscular (IM) injection to an obese adult client.Which of the
following needles should the nurse select for the injection?
A. 25-gauge, 5/8-inch needle
B. 22-gauge, 1.5-inch needle
C. 21-gauge, 2-inch needle
26
D. 27-gauge, 1/2-inch needle
Correct Answer: C
· Explanation: For an obese client, a longer needle (2 inches) is required to ensure the medication
reaches the deep muscle tissuerather than staying in subcutaneous fat. A 1.5-inch needle (B) is standard
20
for normal-weight adults. 5/8-inch (A) and 1/2-inch (D) needles are too short for adult IM injections.
6. A nurse is reinforcing teaching with a client who has a new diagnosis of gastroesophageal reflux
disease (GERD). Which of the following dietary modifications should the nurse recommend?
A. Drink a glass of milkright before bedtime.
B. Consume three large meals daily instead of snacking.
am
C. Avoid eating within 3 hours of lying down.
D. Increase intake of caffeinated beverages for digestion.
Correct Answer: C
· Explanation: Eating within 3 hours of recumbency increases reflux due to gravity and increased gastric
pressure. Milk before bed (A) can stimulate acid production. Clients should eat small,frequent meals (B)
Ex
instead of large ones. Caffeine (D) relaxes the lower esophageal sphincter and worsens GERD.
7. A nurse is caring for a client who is receiving a continuous intravenous (IV) infusion of heparin.
Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of
the medication?
ng
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
si
· Correct Answer: C
· Explanation: The aPTT is used to monitor the therapeutic effect of continuous heparin infusions.PT (A)
and INR (B) are monitored for warfarin therapy. While platelet counts (D) are monitored to screen for
ur
heparin-induced thrombocytopenia, they do not measure the medication's therapeutic effectiveness.
8. A nurse is contributing to the plan of care for a client who has a prescription for structural mechanical
restraints. Which of the following interventions should the nurse include?A. Check the client's circulation
N
and skin integrity every 2 hours.
B. Renew the restraint prescription every 48 hours.
C. Position the client in a prone position while restrained.
D. Remove the restraints completely every 4 hours for range of motion.
Correct Answer: A
, · Explanation: Restrained clients require regular assessments for safety; neurovascular and skin checks
must occur at least every 2 hours. Restraint orders must be renewed every 4 hours for adults (B), not
48. Prone positioning (C) poses a suffocation risk. Restraints should be released for range-of-motion
exercises every 2 hours (D), not 4.
9. A nurse is reinforcing teaching with a client who has a prescription for a nitroglycerin sublingual
tablet for angina. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should swallow the tablet with a full glass of water."
26
B. "If the pain doesn't stop after thefirst tablet, I will call emergency services."
C. "I can take up to five tablets in a 15-minute period."
D. "I should store the tablets in a clear glass container on my windowsill."
·Correct Answer: B
20
· Explanation: Current guidelines state that if chest pain is not relieved or worsens 5 minutes after
taking the first dose of sublingual nitroglycerin, the client should immediately call emergency services
[1]. Sublingual tablets must dissolve under the tongue (A), not be swallowed. A maximum of 3 doses
(C), spaced 5 minutes apart, can be taken. The medication is light-sensitive and must be stored in its
original dark glass bottle (D).
am
10.A nurse is assisting with the admission of an older adult client who has acute urinary tract
infection (UTI). Which of the following clinical manifestations should the nurse expect?A. High fever
and chills
Ex
B. Confusion and disorientation
C. Severe radiating back pain
D. Bradycardia and hypotension
· Correct Answer: B
· Explanation: Older adult clients often present with atypical symptoms of an infection.
ng
Confusion,altered mental status, or disorientation are classic presentation indicators of a UTI in
geriatric clients. High fever (A) is less common in older adults. Radiating back pain (C) suggests
pyelonephritis, not a localized UTI. Bradycardia (D) is not typical; tachycardia occurs if sepsis develops.
si
ur
Case Study 1: Client with Chronic Obstructive Pulmonary Disease (COPD)
N
Client Context: A 68-year-old male client with a history of severe COPD is admitted to the medical unit
with an exacerbation characterized by increased dyspnea, a productive cough with thick green sputum,
and an oxygen saturation (SpO2 )of 87% on room air.
11. Based on the case study context, which of the following oxygen delivery devices and flow rates
should the nurse anticipate initiating first?
A. Simple face mask at 8 L/min
, B. Nasal cannula at 2 L/min
26
20
am
Ex
ng
si
ur
N
