PNLE: NP4 Test 1RNPedia Practice
Questions with Rationales 2026-2027
Edition.
1. Randy has undergone kidney transplant, what assessment would prompt Nurse Katrina to
suspect organ rejection?
A. Sudden weight loss
B. Polyuria
C. Hypertension
D. Shock - Answer Answer: (C) Hypertension.
Hypertension, along with fever, and tenderness over the grafted kidney, reflects acute rejection.
2. The immediate objective of nursing care for an overweight, mildly hypertensive male client
with ureteral colic and hematuria is to decrease:
A. Pain
B. Weight
C. Hematuria
D. Hypertension - Answer Answer: (A) Pain.
Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by urethral
distention and smooth muscle spasm; relief form pain is the priority.
3. Matilda, with hyperthyroidism is to receive Lugol's iodine solution before a subtotal
thyroidectomy is performed. The nurse is aware that this medication is given to:
A. Decrease the total basal metabolic rate.
B. Maintain the function of the parathyroid glands.
C. Block the formation of thyroxine by the thyroid gland.
D. Decrease the size and vascularity of the thyroid gland. - Answer Answer: (D) Decrease the
size and vascularity of the thyroid gland.
Lugol's solution provides iodine, which aids in decreasing the vascularity of the thyroid gland,
which limits the risk of hemorrhage when surgery is performed.
4. Ricardo, was diagnosed with type I diabetes. The nurse is aware that acute hypoglycemia also
can develop in the client who is diagnosed with:
,A. Liver disease
B. Hypertension
C. Type 2 diabetes
D. Hyperthyroidism - Answer Answer: (A) Liver Disease.
The client with liver disease has a decreased ability to metabolize carbohydrates because of a
decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen.
5. Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse
Ruby should monitor the client for the systemic side effect of:
A. Ascites
B. Nystagmus
C. Leukopenia
D. Polycythemia - Answer Answer: (C) Leukopenia.
Leukopenia, a reduction in WBCs, is a systemic effect of chemotherapy as a result of
myelosuppression.
6. Norma, with recent colostomy expresses concern about the inability to control the passage of
gas. Nurse Oliver should suggest that the client plan to:
A. Eliminate foods high in cellulose.
B. Decrease fluid intake at mealtimes.
C. Avoid foods that in the past caused flatus.
D. Adhere to a bland diet prior to social events. - Answer Answer: (C) Avoid foods that in the
past caused flatus.
Foods that bothered a person preoperatively will continue to do so after a colostomy.
7. Nurse Ron begins to teach a male client how to perform colostomy irrigations. The nurse
would evaluate that the instructions were understood when the client states, "I should:
A. Lie on my left side while instilling the irrigating solution."
B. Keep the irrigating container less than 18 inches above the stoma."
C. Instill a minimum of 1200 ml of irrigating solution to stimulate evacuation of the bowel."
D. Insert the irrigating catheter deeper into the stoma if cramping occurs during the procedure."
- Answer Answer: (B) Keep the irrigating container less than 18 inches above the stoma."
,This height permits the solution to flow slowly with little force so that excessive peristalsis is not
immediately precipitated.
8. Patrick is in the oliguric phase of acute tubular necrosis and is experiencing fluid and
electrolyte imbalances. The client is somewhat confused and complains of nausea and muscle
weakness. As part of the prescribed therapy to correct this electrolyte imbalance, the nurse
would expect to:
A. Administer Kayexalate
B. Restrict foods high in protein
C. Increase oral intake of cheese and milk.
D. Administer large amounts of normal saline via I.V. - Answer Answer: (A) Administer
Kayexalate.
Kayexalate, a potassium exchange resin, permits sodium to be exchanged for potassium in the
intestine, reducing the serum potassium level.
9. Mario has burn injury. After Forty48 hours, the physician orders for Mario 2 liters of IV fluid to
be administered q12 h. The drop factor of the tubing is 10 gtts/ml. The nurse should set the
flow to provide:
A. 18 gtts/min
B. 28 gtts/min
C. 32 gtts/min
D. 36 gtts/min - Answer Answer: (B) 28 gtts/min.
This is the correct flow rate; multiply the amount to be infused (2000 ml) by the drop factor (10)
and divide the result by the amount of time in minutes (12 hours x 60 minutes)
10. Terence suffered from burn injury. Using the rule of nines, which has the largest percent of
burns?
A. Face and neck
B. Right upper arm and penis
C. Right thigh and penis
D. Upper trunk - Answer Answer: (D) Upper trunk.
The percentage designated for each burned part of the body using the rule of nines: Head and
neck 9%; Right upper extremity 9%; Left upper extremity 9%; Anterior trunk 18%; Posterior
trunk 18%; Right lower extremity 18%; Left lower extremity 18%; Perineum 1%.
, 11. Herbert, a 45 year old construction engineer is brought to the hospital unconscious after
falling from a 2-story building. When assessing the client, the nurse would be most concerned if
the assessment revealed:
A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature - Answer Answer: (C) Bleeding from ears.
The nurse needs to perform a thorough assessment that could indicate alterations in cerebral
function, increased intracranial pressures, fractures and bleeding. Bleeding from the ears occurs
only with basal skull fractures that can easily contribute to increased intracranial pressure and
brain herniation.
12. Nurse Sherry is teaching male client regarding his permanent artificial pacemaker. Which
information given by the nurse shows her knowledge deficit about the artificial cardiac
pacemaker?
A. Take the pulse rate once a day, in the morning upon awakening
B. May be allowed to use electrical appliances
C. Have regular follow up care
D. May engage in contact sports - Answer Answer: (D) may engage in contact sports.
The client should be advised by the nurse to avoid contact sports. This will prevent trauma to
the area of the pacemaker generator.
13. The nurse is ware that the most relevant knowledge about oxygen administration to a male
client with COPD is:
A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.
C. Oxygen is administered best using a non-rebreathing mask
D. Blood gases are monitored using a pulse oximeter. - Answer Answer: (A) Oxygen at
1-2L/min is given to maintain the hypoxic stimulus for breathing.
COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2
stimulation for breathing. The hypoxic state of the client then becomes the stimulus for
breathing. Giving the client oxygen in low concentrations will maintain the client's hypoxic drive.
14. Tonny has undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are
inserted, and one-bottled water-seal drainage is instituted in the operating room. In the post
anesthesia care unit Tonny is placed in Fowler's position on either his right side or on his back.
The nurse is aware that this position:
Questions with Rationales 2026-2027
Edition.
1. Randy has undergone kidney transplant, what assessment would prompt Nurse Katrina to
suspect organ rejection?
A. Sudden weight loss
B. Polyuria
C. Hypertension
D. Shock - Answer Answer: (C) Hypertension.
Hypertension, along with fever, and tenderness over the grafted kidney, reflects acute rejection.
2. The immediate objective of nursing care for an overweight, mildly hypertensive male client
with ureteral colic and hematuria is to decrease:
A. Pain
B. Weight
C. Hematuria
D. Hypertension - Answer Answer: (A) Pain.
Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by urethral
distention and smooth muscle spasm; relief form pain is the priority.
3. Matilda, with hyperthyroidism is to receive Lugol's iodine solution before a subtotal
thyroidectomy is performed. The nurse is aware that this medication is given to:
A. Decrease the total basal metabolic rate.
B. Maintain the function of the parathyroid glands.
C. Block the formation of thyroxine by the thyroid gland.
D. Decrease the size and vascularity of the thyroid gland. - Answer Answer: (D) Decrease the
size and vascularity of the thyroid gland.
Lugol's solution provides iodine, which aids in decreasing the vascularity of the thyroid gland,
which limits the risk of hemorrhage when surgery is performed.
4. Ricardo, was diagnosed with type I diabetes. The nurse is aware that acute hypoglycemia also
can develop in the client who is diagnosed with:
,A. Liver disease
B. Hypertension
C. Type 2 diabetes
D. Hyperthyroidism - Answer Answer: (A) Liver Disease.
The client with liver disease has a decreased ability to metabolize carbohydrates because of a
decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen.
5. Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse
Ruby should monitor the client for the systemic side effect of:
A. Ascites
B. Nystagmus
C. Leukopenia
D. Polycythemia - Answer Answer: (C) Leukopenia.
Leukopenia, a reduction in WBCs, is a systemic effect of chemotherapy as a result of
myelosuppression.
6. Norma, with recent colostomy expresses concern about the inability to control the passage of
gas. Nurse Oliver should suggest that the client plan to:
A. Eliminate foods high in cellulose.
B. Decrease fluid intake at mealtimes.
C. Avoid foods that in the past caused flatus.
D. Adhere to a bland diet prior to social events. - Answer Answer: (C) Avoid foods that in the
past caused flatus.
Foods that bothered a person preoperatively will continue to do so after a colostomy.
7. Nurse Ron begins to teach a male client how to perform colostomy irrigations. The nurse
would evaluate that the instructions were understood when the client states, "I should:
A. Lie on my left side while instilling the irrigating solution."
B. Keep the irrigating container less than 18 inches above the stoma."
C. Instill a minimum of 1200 ml of irrigating solution to stimulate evacuation of the bowel."
D. Insert the irrigating catheter deeper into the stoma if cramping occurs during the procedure."
- Answer Answer: (B) Keep the irrigating container less than 18 inches above the stoma."
,This height permits the solution to flow slowly with little force so that excessive peristalsis is not
immediately precipitated.
8. Patrick is in the oliguric phase of acute tubular necrosis and is experiencing fluid and
electrolyte imbalances. The client is somewhat confused and complains of nausea and muscle
weakness. As part of the prescribed therapy to correct this electrolyte imbalance, the nurse
would expect to:
A. Administer Kayexalate
B. Restrict foods high in protein
C. Increase oral intake of cheese and milk.
D. Administer large amounts of normal saline via I.V. - Answer Answer: (A) Administer
Kayexalate.
Kayexalate, a potassium exchange resin, permits sodium to be exchanged for potassium in the
intestine, reducing the serum potassium level.
9. Mario has burn injury. After Forty48 hours, the physician orders for Mario 2 liters of IV fluid to
be administered q12 h. The drop factor of the tubing is 10 gtts/ml. The nurse should set the
flow to provide:
A. 18 gtts/min
B. 28 gtts/min
C. 32 gtts/min
D. 36 gtts/min - Answer Answer: (B) 28 gtts/min.
This is the correct flow rate; multiply the amount to be infused (2000 ml) by the drop factor (10)
and divide the result by the amount of time in minutes (12 hours x 60 minutes)
10. Terence suffered from burn injury. Using the rule of nines, which has the largest percent of
burns?
A. Face and neck
B. Right upper arm and penis
C. Right thigh and penis
D. Upper trunk - Answer Answer: (D) Upper trunk.
The percentage designated for each burned part of the body using the rule of nines: Head and
neck 9%; Right upper extremity 9%; Left upper extremity 9%; Anterior trunk 18%; Posterior
trunk 18%; Right lower extremity 18%; Left lower extremity 18%; Perineum 1%.
, 11. Herbert, a 45 year old construction engineer is brought to the hospital unconscious after
falling from a 2-story building. When assessing the client, the nurse would be most concerned if
the assessment revealed:
A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature - Answer Answer: (C) Bleeding from ears.
The nurse needs to perform a thorough assessment that could indicate alterations in cerebral
function, increased intracranial pressures, fractures and bleeding. Bleeding from the ears occurs
only with basal skull fractures that can easily contribute to increased intracranial pressure and
brain herniation.
12. Nurse Sherry is teaching male client regarding his permanent artificial pacemaker. Which
information given by the nurse shows her knowledge deficit about the artificial cardiac
pacemaker?
A. Take the pulse rate once a day, in the morning upon awakening
B. May be allowed to use electrical appliances
C. Have regular follow up care
D. May engage in contact sports - Answer Answer: (D) may engage in contact sports.
The client should be advised by the nurse to avoid contact sports. This will prevent trauma to
the area of the pacemaker generator.
13. The nurse is ware that the most relevant knowledge about oxygen administration to a male
client with COPD is:
A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.
C. Oxygen is administered best using a non-rebreathing mask
D. Blood gases are monitored using a pulse oximeter. - Answer Answer: (A) Oxygen at
1-2L/min is given to maintain the hypoxic stimulus for breathing.
COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2
stimulation for breathing. The hypoxic state of the client then becomes the stimulus for
breathing. Giving the client oxygen in low concentrations will maintain the client's hypoxic drive.
14. Tonny has undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are
inserted, and one-bottled water-seal drainage is instituted in the operating room. In the post
anesthesia care unit Tonny is placed in Fowler's position on either his right side or on his back.
The nurse is aware that this position:
