NEW GENERATION NCLEX-PN
QUESTIONS AND ANSWERS WITH
RATIONALES Comprehensive Review
for the NCLEX-PN Examination
Questions 1-200: Fundamentals,
Medical-Surgical, and
Pharmacological Nursing
Question 1
A client is scheduled for a hemorroidectomy. Which postoperative diet
should the nurse anticipate being ordered initially?
A. High-fiber diet
B. Low-residue diet
C. Bland diet
D. Clear liquids
Answer: D. Clear liquids
Rationale: After hemorrhoidectomy surgery, the client is initially placed on
a clear-liquid diet to minimize bowel stimulation and allow the surgical site
to begin healing. The diet is progressed as tolerated. A high-fiber diet
would be introduced later to prevent constipation and straining during
defecation.
,Question 2
A client who has been on lithium carbonate therapy for 7 days reports
diarrhea, vomiting, and a mild tremor. Which action should the nurse
take?
A. Document the findings as expected side effects
B. Administer an antiemetic as prescribed
C. Hold the next dose and notify the healthcare provider
D. Reassure the client these symptoms will subside
Answer: C. Hold the next dose and notify the healthcare provider
Rationale: Diarrhea, vomiting, and tremor are signs of lithium toxicity.
Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and GI symptoms
along with neurologic symptoms (tremor) indicate potentially toxic levels.
The nurse should hold the medication and notify the provider for a lithium
level check. Dry mouth is a common side effect, but GI symptoms with
tremor are concerning for toxicity.
Question 3
A client with cancer is admitted to the oncology unit. Lab values reveal
Hgb 12.6 g/dL, WBC 6500/mm³, K+ 1.9 mEq/L, uric acid 7.0 mg/dL,
Na+ 136 mEq/L, and platelets 178,000/mm³. The nurse evaluates that
the client is experiencing which condition?
A. Anemia
B. Leukopenia
C. Hypokalemia
D. Hyperuricemia
,Answer: C. Hypokalemia
Rationale: The potassium level of 1.9 mEq/L is critically low (normal range
3.5-5.0 mEq/L). This severe hypokalemia requires immediate intervention as
it can cause cardiac dysrhythmias. The other laboratory values are within
normal limits: Hgb 12.6 (normal 12-16 g/dL), WBC 6500 (normal 5000-
10,000/mm³), uric acid 7.0 (normal 2.4-6.0 mg/dL - slightly elevated but not
the priority), Na+ 136 (normal 135-145 mEq/L), and platelets 178,000
(normal 150,000-400,000/mm³).
Question 4
The nurse is caring for a client scheduled for removal of a pituitary
tumor using the transsphenoidal approach. Which postoperative
finding requires immediate intervention?
A. Clear drainage from the nose
B. Complaints of headache
C. Temperature of 99.2°F (37.3°C)
D. Urine output of 40 mL/hr
Answer: A. Clear drainage from the nose
Rationale: Clear nasal drainage after transsphenoidal surgery may indicate
a cerebrospinal fluid (CSF) leak, which is a serious complication that
increases the risk of meningitis. The nurse should test the drainage for
glucose (CSF contains glucose) and notify the surgeon immediately.
Headache is expected postoperatively, temperature elevation may indicate
infection but is not the priority finding, and urine output of 40 mL/hr is
adequate.
, Question 5
A client with epilepsy is being treated with carbamazepine (Tegretol).
Which laboratory value might indicate a serious side effect of this
drug?
A. Uric acid of 5 mg/dL
B. Hematocrit of 33%
C. WBC 2,000/mm³
D. Platelets 150,000/mm³
Answer: C. WBC 2,000/mm³
Rationale: Carbamazepine (Tegretol) can cause bone marrow suppression,
leading to agranulocytosis and aplastic anemia. A WBC count of 2,000/mm³
is significantly below the normal range (5,000-10,000/mm³) and indicates a
serious adverse effect requiring immediate provider notification. Uric acid
of 5 mg/dL is within normal limits, hematocrit of 33% is at the lower limit of
normal but not the most significant finding, and platelets of 150,000/mm³
are at the lower limit of normal.
Question 6
A 6-month-old infant is admitted with suspected intussusception.
Which question during the nursing history is least helpful in obtaining
information regarding this diagnosis?
QUESTIONS AND ANSWERS WITH
RATIONALES Comprehensive Review
for the NCLEX-PN Examination
Questions 1-200: Fundamentals,
Medical-Surgical, and
Pharmacological Nursing
Question 1
A client is scheduled for a hemorroidectomy. Which postoperative diet
should the nurse anticipate being ordered initially?
A. High-fiber diet
B. Low-residue diet
C. Bland diet
D. Clear liquids
Answer: D. Clear liquids
Rationale: After hemorrhoidectomy surgery, the client is initially placed on
a clear-liquid diet to minimize bowel stimulation and allow the surgical site
to begin healing. The diet is progressed as tolerated. A high-fiber diet
would be introduced later to prevent constipation and straining during
defecation.
,Question 2
A client who has been on lithium carbonate therapy for 7 days reports
diarrhea, vomiting, and a mild tremor. Which action should the nurse
take?
A. Document the findings as expected side effects
B. Administer an antiemetic as prescribed
C. Hold the next dose and notify the healthcare provider
D. Reassure the client these symptoms will subside
Answer: C. Hold the next dose and notify the healthcare provider
Rationale: Diarrhea, vomiting, and tremor are signs of lithium toxicity.
Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and GI symptoms
along with neurologic symptoms (tremor) indicate potentially toxic levels.
The nurse should hold the medication and notify the provider for a lithium
level check. Dry mouth is a common side effect, but GI symptoms with
tremor are concerning for toxicity.
Question 3
A client with cancer is admitted to the oncology unit. Lab values reveal
Hgb 12.6 g/dL, WBC 6500/mm³, K+ 1.9 mEq/L, uric acid 7.0 mg/dL,
Na+ 136 mEq/L, and platelets 178,000/mm³. The nurse evaluates that
the client is experiencing which condition?
A. Anemia
B. Leukopenia
C. Hypokalemia
D. Hyperuricemia
,Answer: C. Hypokalemia
Rationale: The potassium level of 1.9 mEq/L is critically low (normal range
3.5-5.0 mEq/L). This severe hypokalemia requires immediate intervention as
it can cause cardiac dysrhythmias. The other laboratory values are within
normal limits: Hgb 12.6 (normal 12-16 g/dL), WBC 6500 (normal 5000-
10,000/mm³), uric acid 7.0 (normal 2.4-6.0 mg/dL - slightly elevated but not
the priority), Na+ 136 (normal 135-145 mEq/L), and platelets 178,000
(normal 150,000-400,000/mm³).
Question 4
The nurse is caring for a client scheduled for removal of a pituitary
tumor using the transsphenoidal approach. Which postoperative
finding requires immediate intervention?
A. Clear drainage from the nose
B. Complaints of headache
C. Temperature of 99.2°F (37.3°C)
D. Urine output of 40 mL/hr
Answer: A. Clear drainage from the nose
Rationale: Clear nasal drainage after transsphenoidal surgery may indicate
a cerebrospinal fluid (CSF) leak, which is a serious complication that
increases the risk of meningitis. The nurse should test the drainage for
glucose (CSF contains glucose) and notify the surgeon immediately.
Headache is expected postoperatively, temperature elevation may indicate
infection but is not the priority finding, and urine output of 40 mL/hr is
adequate.
, Question 5
A client with epilepsy is being treated with carbamazepine (Tegretol).
Which laboratory value might indicate a serious side effect of this
drug?
A. Uric acid of 5 mg/dL
B. Hematocrit of 33%
C. WBC 2,000/mm³
D. Platelets 150,000/mm³
Answer: C. WBC 2,000/mm³
Rationale: Carbamazepine (Tegretol) can cause bone marrow suppression,
leading to agranulocytosis and aplastic anemia. A WBC count of 2,000/mm³
is significantly below the normal range (5,000-10,000/mm³) and indicates a
serious adverse effect requiring immediate provider notification. Uric acid
of 5 mg/dL is within normal limits, hematocrit of 33% is at the lower limit of
normal but not the most significant finding, and platelets of 150,000/mm³
are at the lower limit of normal.
Question 6
A 6-month-old infant is admitted with suspected intussusception.
Which question during the nursing history is least helpful in obtaining
information regarding this diagnosis?
