NCLEX-PN EXAM FILES 2024|2025
Section 1: Safe and Effective Care Environment – Management of Care (Q1–Q25)
1. A practical nurse (PN) is caring for a client who has a do-not-resuscitate (DNR)
order. The family asks the PN to explain what DNR means. Which response by
the PN is most appropriate?
A. "It means we will not provide any treatment to keep the client alive."
B. "It means that if the client stops breathing or the heart stops, we will not
perform CPR or advanced cardiac life support."
C. "I cannot discuss that; you need to talk to the doctor."
D. "It means the client will be allowed to die naturally without any medical care."
Answer: B
Rationale: DNR means that if the client experiences cardiac or respiratory arrest,
CPR and ACLS will not be initiated. It does not mean withholding other treatments
such as pain relief, antibiotics, or hydration.
2. A charge nurse is making assignments for a licensed practical nurse (LPN).
Which task is appropriate to delegate to the LPN?
A. Perform the initial admission assessment on a client with pneumonia
B. Administer a PRN enema to a constipated client
C. Develop the nursing care plan for a client with heart failure
D. Teach a client how to self-administer insulin
Answer: B
Rationale: LPNs can administer medications, including PRN enemas, and perform
stable, routine treatments. Initial assessment and care plan development require
RN-level critical thinking. Patient teaching can be reinforced by LPNs, but initial
teaching is typically done by the RN.
3. A nurse is caring for a client who refuses a prescribed blood transfusion. The
client is alert and oriented and understands the consequences of refusal. What
is the nurse's priority action?
A. Administer the transfusion against the client's wishes
B. Document the refusal and notify the healthcare provider
,C. Ask the family to convince the client to accept the transfusion
D. Restrain the client and administer the transfusion
Answer: B
Rationale: A competent adult has the right to refuse any treatment, even life-
saving treatment. The nurse must document the refusal and notify the provider.
Administering against the client's wishes or asking family to override the decision
violates client rights.
4. A PN is preparing to insert a urinary catheter. The PN touches the inner
surface of the sterile drape without sterile gloves. What should the PN do?
A. Continue the procedure quickly to minimize contamination
B. Stop the procedure and obtain a new sterile kit
C. Wipe the area with alcohol and continue
D. Document the contamination and proceed
Answer: B
Rationale: Breaking sterile technique increases the risk of infection. The PN must
stop the procedure and obtain a new sterile kit to prevent contamination.
5. A nurse is preparing to administer a blood transfusion. Which IV solution is
compatible for priming the tubing?
A. 5% Dextrose in water (D5W)
B. Lactated Ringer's (LR)
C. 0.9% normal saline
D. 0.45% normal saline (half-strength)
Answer: C
Rationale: Only 0.9% normal saline is compatible with blood products. Dextrose
solutions can cause hemolysis, and LR contains calcium, which can cause clotting
in the tubing.
6. A PN is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Administering oral medications
B. Assessing a client's pain level
C. Assisting a client with ambulation
D. Teaching a client about a new medication
,Answer: C
Rationale: Assisting with ambulation is within UAP scope. Medication
administration, assessment, and teaching require a licensed nurse.
7. A nurse is caring for a client who speaks a different language. Which action is
most appropriate?
A. Use a family member as an interpreter
B. Use a trained medical interpreter
C. Speak loudly and slowly
D. Use gestures only
Answer: B
Rationale: A trained medical interpreter ensures accurate communication and
confidentiality. Family members may not interpret accurately and may breach
confidentiality.
8. A nurse is documenting a client's refusal of medication. Which information is
most important to include?
A. The client's reason for refusal
B. The client's vital signs
C. The nurse's opinion
D. The client's room number
Answer: A
Rationale: Documenting the client's reason for refusal is essential for legal and
clinical purposes.
9. A nurse is teaching a client about advance directives. Which statement
indicates correct understanding?
A. "Advance directives are only for older adults."
B. "I can change my advance directive at any time."
C. "Advance directives are legally binding in all states."
D. "Only my doctor can make decisions for me."
Answer: B
Rationale: Clients can change advance directives at any time as long as they have
decision-making capacity.
, 10. A nurse is assessing a client for suspected abuse. Which finding is most
concerning?
A. Bruises in various stages of healing
B. A single bruise on the knee
C. Mild anxiety
D. Poor eye contact
Answer: A
Rationale: Bruises in various stages of healing may indicate ongoing physical
abuse.
11. A nurse is caring for a client with a do-not-resuscitate (DNR) order. Which
action is most appropriate?
A. Initiate CPR if the client stops breathing
B. Respect the DNR order and provide comfort care
C. Ask the family to confirm the DNR order
D. Ignore the DNR order
Answer: B
Rationale: The nurse must respect the DNR order and provide comfort-focused
care.
12. A nurse is teaching a client about health promotion. Which instruction is
most appropriate for a client with hypertension?
A. Reduce sodium intake
B. Increase alcohol consumption
C. Decrease physical activity
D. Increase saturated fat intake
Answer: A
Rationale: Reducing sodium intake is a key lifestyle modification for managing
hypertension.
13. A nurse is assessing a community for risk factors for heart disease. Which
factor is most significant?
A. High prevalence of smoking
B. Availability of parks
Section 1: Safe and Effective Care Environment – Management of Care (Q1–Q25)
1. A practical nurse (PN) is caring for a client who has a do-not-resuscitate (DNR)
order. The family asks the PN to explain what DNR means. Which response by
the PN is most appropriate?
A. "It means we will not provide any treatment to keep the client alive."
B. "It means that if the client stops breathing or the heart stops, we will not
perform CPR or advanced cardiac life support."
C. "I cannot discuss that; you need to talk to the doctor."
D. "It means the client will be allowed to die naturally without any medical care."
Answer: B
Rationale: DNR means that if the client experiences cardiac or respiratory arrest,
CPR and ACLS will not be initiated. It does not mean withholding other treatments
such as pain relief, antibiotics, or hydration.
2. A charge nurse is making assignments for a licensed practical nurse (LPN).
Which task is appropriate to delegate to the LPN?
A. Perform the initial admission assessment on a client with pneumonia
B. Administer a PRN enema to a constipated client
C. Develop the nursing care plan for a client with heart failure
D. Teach a client how to self-administer insulin
Answer: B
Rationale: LPNs can administer medications, including PRN enemas, and perform
stable, routine treatments. Initial assessment and care plan development require
RN-level critical thinking. Patient teaching can be reinforced by LPNs, but initial
teaching is typically done by the RN.
3. A nurse is caring for a client who refuses a prescribed blood transfusion. The
client is alert and oriented and understands the consequences of refusal. What
is the nurse's priority action?
A. Administer the transfusion against the client's wishes
B. Document the refusal and notify the healthcare provider
,C. Ask the family to convince the client to accept the transfusion
D. Restrain the client and administer the transfusion
Answer: B
Rationale: A competent adult has the right to refuse any treatment, even life-
saving treatment. The nurse must document the refusal and notify the provider.
Administering against the client's wishes or asking family to override the decision
violates client rights.
4. A PN is preparing to insert a urinary catheter. The PN touches the inner
surface of the sterile drape without sterile gloves. What should the PN do?
A. Continue the procedure quickly to minimize contamination
B. Stop the procedure and obtain a new sterile kit
C. Wipe the area with alcohol and continue
D. Document the contamination and proceed
Answer: B
Rationale: Breaking sterile technique increases the risk of infection. The PN must
stop the procedure and obtain a new sterile kit to prevent contamination.
5. A nurse is preparing to administer a blood transfusion. Which IV solution is
compatible for priming the tubing?
A. 5% Dextrose in water (D5W)
B. Lactated Ringer's (LR)
C. 0.9% normal saline
D. 0.45% normal saline (half-strength)
Answer: C
Rationale: Only 0.9% normal saline is compatible with blood products. Dextrose
solutions can cause hemolysis, and LR contains calcium, which can cause clotting
in the tubing.
6. A PN is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A. Administering oral medications
B. Assessing a client's pain level
C. Assisting a client with ambulation
D. Teaching a client about a new medication
,Answer: C
Rationale: Assisting with ambulation is within UAP scope. Medication
administration, assessment, and teaching require a licensed nurse.
7. A nurse is caring for a client who speaks a different language. Which action is
most appropriate?
A. Use a family member as an interpreter
B. Use a trained medical interpreter
C. Speak loudly and slowly
D. Use gestures only
Answer: B
Rationale: A trained medical interpreter ensures accurate communication and
confidentiality. Family members may not interpret accurately and may breach
confidentiality.
8. A nurse is documenting a client's refusal of medication. Which information is
most important to include?
A. The client's reason for refusal
B. The client's vital signs
C. The nurse's opinion
D. The client's room number
Answer: A
Rationale: Documenting the client's reason for refusal is essential for legal and
clinical purposes.
9. A nurse is teaching a client about advance directives. Which statement
indicates correct understanding?
A. "Advance directives are only for older adults."
B. "I can change my advance directive at any time."
C. "Advance directives are legally binding in all states."
D. "Only my doctor can make decisions for me."
Answer: B
Rationale: Clients can change advance directives at any time as long as they have
decision-making capacity.
, 10. A nurse is assessing a client for suspected abuse. Which finding is most
concerning?
A. Bruises in various stages of healing
B. A single bruise on the knee
C. Mild anxiety
D. Poor eye contact
Answer: A
Rationale: Bruises in various stages of healing may indicate ongoing physical
abuse.
11. A nurse is caring for a client with a do-not-resuscitate (DNR) order. Which
action is most appropriate?
A. Initiate CPR if the client stops breathing
B. Respect the DNR order and provide comfort care
C. Ask the family to confirm the DNR order
D. Ignore the DNR order
Answer: B
Rationale: The nurse must respect the DNR order and provide comfort-focused
care.
12. A nurse is teaching a client about health promotion. Which instruction is
most appropriate for a client with hypertension?
A. Reduce sodium intake
B. Increase alcohol consumption
C. Decrease physical activity
D. Increase saturated fat intake
Answer: A
Rationale: Reducing sodium intake is a key lifestyle modification for managing
hypertension.
13. A nurse is assessing a community for risk factors for heart disease. Which
factor is most significant?
A. High prevalence of smoking
B. Availability of parks
