NEW GENERATION NCLEX PN
QUESTIONS FOR 2023 EXAM/ NEW
GENERATION NCLEX PN QUESTIONS FOR
2026 EXAM
Case Study 1: Postoperative Total Hip Arthroplasty
Mr. T, 72 years old, returns to the unit after a right total hip arthroplasty. He has an
abduction pillow in place, a Jackson-Pratt drain, and a urinary catheter. Vital signs:
BP 128/78, HR 88, RR 18, Temp 98.8°F (37.1°C), SpO₂ 97% on room air. He rates
pain as 4/10. The PN receives report and prepares to collect data and provide care.
Question 1. Drag and Drop: Arrange the PN’s immediate postoperative
assessments in priority order.
Drag the following actions into the correct sequence.
• A. Assess respiratory status and pulse oximetry
• B. Check neurovascular status of the right lower extremity
• C. Inspect the surgical dressing and drain
• D. Measure vital signs including pain level
• E. Verify that the abduction pillow is properly positioned
Answer Order: A, D, B, C, E
Rationale: According to the nursing process and ABCs, airway and breathing first
(A). Vital signs including pain (D) provide baseline hemodynamic stability.
Neurovascular assessment (B) is critical to detect complications like compartment
,syndrome or nerve injury. The dressing/drain (C) follows. Positioning (E) is
important but can be done after other assessments.
Question 2. Extended Multiple Response: Which findings during the initial
neurovascular assessment require immediate follow-up? Select all that apply.
A. Capillary refill of 5 seconds in the right toes
B. Client states mild numbness in the operative leg
C. Right foot is pink and warm to touch
D. Pulse oximeter on right great toe not obtaining a reading
E. Client able to wiggle toes on command
Answers: A, D
Rationale: Capillary refill >3 seconds indicates possible arterial insufficiency (A).
Inability to obtain pulse oximeter reading on the affected limb suggests poor
peripheral perfusion (D). Mild numbness (B) may be due to anesthesia but warrants
monitoring, not immediate follow-up unless persistent or worsens. Pink, warm foot
(C) is normal. Ability to wiggle toes (E) indicates motor function is intact.
Question 3. Cloze (Drop-down): The PN reviews the Jackson-Pratt drain. To
maintain proper function, the PN should compress the bulb before ___________
the plug, which creates a vacuum. The collection chamber should be emptied
when it is ___________ full.
Options for first blank Options for second blank
reinserting one-half to two-thirds
,Options for first blank Options for second blank
removing completely
clamping one-quarter
Answer: reinserting; one-half to two-thirds
Rationale: Compressing the bulb before reinserting the plug restores negative
pressure. The drain should be emptied when one-half to two-thirds full to maintain
suction and accurately measure output.
Question 4. Highlight (Hot Spot): Read the following nursing notes. Highlight
the finding that indicates a possible hip dislocation.
“Client resting in bed with abduction pillow between legs. Right leg is shorter than
the left and internally rotated. Toes are pink with capillary refill <3 seconds. Client
reports mild incisional pain controlled with acetaminophen.”
Answer to Highlight: “Right leg is shorter than the left and internally rotated.”
Rationale: Shortening and internal rotation of the affected leg are classic signs of
hip prosthesis dislocation. This must be reported immediately.
Question 5. Extended Multiple Response: The PN is reinforcing prevention of
venous thromboembolism (VTE). Which interventions should the PN
implement? Select all that apply.
A. Apply sequential compression devices (SCDs) as prescribed
B. Massage the calves and thighs twice daily
, C. Encourage ankle pumps and active range of motion of the left leg
D. Administer enoxaparin subcutaneously as prescribed
E. Keep the client on bed rest for the first 48 hours
F. Maintain adequate hydration
Answers: A, C, D, F
Rationale: SCDs promote venous return (A). Ankle pumps and ROM of the
unaffected leg reduce stasis (C). Pharmacologic prophylaxis like enoxaparin is
standard (D). Hydration (F) prevents hemoconcentration. Massaging the legs (B) is
contraindicated because it may dislodge a clot. Prolonged bed rest (E) increases
VTE risk; early mobilization is encouraged.
Question 6. Matrix/Grid: The PN is reinforcing discharge teaching regarding hip
precautions. For each activity, indicate whether it is "Allowed" or "Not
Allowed".
Activity Allowed Not Allowed
Using a raised toilet seat
Crossing legs at the ankles while sitting
Bending forward to pick up an object from the floor
Sleeping with an abduction pillow between the legs
Using a long-handled reacher
Answers:
• Using a raised toilet seat → Allowed
QUESTIONS FOR 2023 EXAM/ NEW
GENERATION NCLEX PN QUESTIONS FOR
2026 EXAM
Case Study 1: Postoperative Total Hip Arthroplasty
Mr. T, 72 years old, returns to the unit after a right total hip arthroplasty. He has an
abduction pillow in place, a Jackson-Pratt drain, and a urinary catheter. Vital signs:
BP 128/78, HR 88, RR 18, Temp 98.8°F (37.1°C), SpO₂ 97% on room air. He rates
pain as 4/10. The PN receives report and prepares to collect data and provide care.
Question 1. Drag and Drop: Arrange the PN’s immediate postoperative
assessments in priority order.
Drag the following actions into the correct sequence.
• A. Assess respiratory status and pulse oximetry
• B. Check neurovascular status of the right lower extremity
• C. Inspect the surgical dressing and drain
• D. Measure vital signs including pain level
• E. Verify that the abduction pillow is properly positioned
Answer Order: A, D, B, C, E
Rationale: According to the nursing process and ABCs, airway and breathing first
(A). Vital signs including pain (D) provide baseline hemodynamic stability.
Neurovascular assessment (B) is critical to detect complications like compartment
,syndrome or nerve injury. The dressing/drain (C) follows. Positioning (E) is
important but can be done after other assessments.
Question 2. Extended Multiple Response: Which findings during the initial
neurovascular assessment require immediate follow-up? Select all that apply.
A. Capillary refill of 5 seconds in the right toes
B. Client states mild numbness in the operative leg
C. Right foot is pink and warm to touch
D. Pulse oximeter on right great toe not obtaining a reading
E. Client able to wiggle toes on command
Answers: A, D
Rationale: Capillary refill >3 seconds indicates possible arterial insufficiency (A).
Inability to obtain pulse oximeter reading on the affected limb suggests poor
peripheral perfusion (D). Mild numbness (B) may be due to anesthesia but warrants
monitoring, not immediate follow-up unless persistent or worsens. Pink, warm foot
(C) is normal. Ability to wiggle toes (E) indicates motor function is intact.
Question 3. Cloze (Drop-down): The PN reviews the Jackson-Pratt drain. To
maintain proper function, the PN should compress the bulb before ___________
the plug, which creates a vacuum. The collection chamber should be emptied
when it is ___________ full.
Options for first blank Options for second blank
reinserting one-half to two-thirds
,Options for first blank Options for second blank
removing completely
clamping one-quarter
Answer: reinserting; one-half to two-thirds
Rationale: Compressing the bulb before reinserting the plug restores negative
pressure. The drain should be emptied when one-half to two-thirds full to maintain
suction and accurately measure output.
Question 4. Highlight (Hot Spot): Read the following nursing notes. Highlight
the finding that indicates a possible hip dislocation.
“Client resting in bed with abduction pillow between legs. Right leg is shorter than
the left and internally rotated. Toes are pink with capillary refill <3 seconds. Client
reports mild incisional pain controlled with acetaminophen.”
Answer to Highlight: “Right leg is shorter than the left and internally rotated.”
Rationale: Shortening and internal rotation of the affected leg are classic signs of
hip prosthesis dislocation. This must be reported immediately.
Question 5. Extended Multiple Response: The PN is reinforcing prevention of
venous thromboembolism (VTE). Which interventions should the PN
implement? Select all that apply.
A. Apply sequential compression devices (SCDs) as prescribed
B. Massage the calves and thighs twice daily
, C. Encourage ankle pumps and active range of motion of the left leg
D. Administer enoxaparin subcutaneously as prescribed
E. Keep the client on bed rest for the first 48 hours
F. Maintain adequate hydration
Answers: A, C, D, F
Rationale: SCDs promote venous return (A). Ankle pumps and ROM of the
unaffected leg reduce stasis (C). Pharmacologic prophylaxis like enoxaparin is
standard (D). Hydration (F) prevents hemoconcentration. Massaging the legs (B) is
contraindicated because it may dislodge a clot. Prolonged bed rest (E) increases
VTE risk; early mobilization is encouraged.
Question 6. Matrix/Grid: The PN is reinforcing discharge teaching regarding hip
precautions. For each activity, indicate whether it is "Allowed" or "Not
Allowed".
Activity Allowed Not Allowed
Using a raised toilet seat
Crossing legs at the ankles while sitting
Bending forward to pick up an object from the floor
Sleeping with an abduction pillow between the legs
Using a long-handled reacher
Answers:
• Using a raised toilet seat → Allowed
