NCLEX-PN Practice Questions, Answers And
Rationales
the nurse is caring for a client scheduled for removal of a pituitary
tumor using the transsphenoidal approach. the nurse should be
particularly alert to:
A. Nasal congestion
B. Abdominal Tenderness
C. Muscle Tetany
D. Oliguria - Correct answer A. Nasal congestion
why?
removal of the pituitary gland is usually done by transsphernoidal
approach through the nose. Nasal congestion further interferes
with the airway.
A client with cancer is a, admitted to the oncology unit. Stat lab
values revel Hgb 12.6, WBC 6500, K+1.9, uric acid 7.0, Na+136,
and platelets 178,000. The nurse evaluates that the client is
experiencing which of the following?
A. Hypernatremia
B. Hypokalemia
C. Myelosuppression
D. Leukocytosis - Correct answer B. Hypokalemia
why?
,Hypokalemia is evident from the lab values listed. The other
laboratory findings are within normal limits. making answers A,C
and D incorrect
A 24 year-old female client is scheduled for surgery in the
morning. Which of the following is the primary responsibility of the
nurse?
A. taking the vital signs
B. obtaining the permit
C. explaining the procedure
D. Checking the lab work - Correct answer A. taking the vital
signs
why?
the primary responisblity of the nurse is to take the vital signs
before any surgery.
answers B,C and D are the responsibility of the doctor.
The nurse is working in the emergency room when a client arrives
with severe burns of the left arm, hands, face, and neck. which
action should receive priority?
A. starting an IV?
B. Applying oxygen
C.Obtaining blood gas
D. Medicating the client foe pain - Correct answer B. Applying
oxygen
why?
the client with burns to the neck needs airway assessments and
supplemental oxygen, so applying oxygen is priority. the next
action should be to start an IV and medicate for pain.
,The nurse is visiting a home health client with osteoporosis. The
client has a new prescription for alendronate (Fosamax). Which
instructions should be given to the client
A. rest in bed after taking the medication for at least 30 mins
B. Avoid rapid movements after taking the medication
C. Take medication with water only
D. Allow at least 1 hour between taking the medicine and taking
other medications - Correct answer C. Take medication with
water only
why?
Fosmax should be taken with water only. The client should also
remain upright for at least 30 mins after taking the medication.
The nurse is making initial rounds on a client with a C5 fracture
and crutchfield thongs. Which equipment should be kept at the
bedside?
A. A pair of forceps
B. A torque wrench
C. A pair or wire cutters
D. A screwdriver - Correct answer B. A torque wrench
why?
A tourque wrench is kept at the bedside to tighten and loosen the
screws of crutchfield tongs. This wrench controls the amount of
pressure that is placed on the screws.
An infant weighs 7 pounds at birth. The excpectd weight by 1 year
should be:
A. 10 pounds
, B.12 pounds
C. 18 pounds
D. 21 pounds - Correct answer D. 21 pounds
why?
A birth weight of 7 pounds would indicate 21 pounds in 1 year or
triple the his birth weight.
A client is admitted with a Ewing's sacroma. which symptoms
would be expected due to this tumor's location?
A. Hemiplegia
B. Aphasia
C. Nausea
D. Bone Pain - Correct answer D. Bone Pain
why?
Sacroma is a type of bone cancer, therefor, bone pain would be
expected
The nurse is caring for a client with epilepsy who is being treated
with carbamazepine (Tegretol). Which labatory value might be a
indicate a serious side effect of this drug?
A. Uric acid of 5mg/dL
B. Hematoccrit of 33%
C. WBC 2,000 per cubic millimeter
D. Platelets 150,000 per cubic millimeter - Correct answer C.
WBC 2,000 per cubic millimeter
why?
Rationales
the nurse is caring for a client scheduled for removal of a pituitary
tumor using the transsphenoidal approach. the nurse should be
particularly alert to:
A. Nasal congestion
B. Abdominal Tenderness
C. Muscle Tetany
D. Oliguria - Correct answer A. Nasal congestion
why?
removal of the pituitary gland is usually done by transsphernoidal
approach through the nose. Nasal congestion further interferes
with the airway.
A client with cancer is a, admitted to the oncology unit. Stat lab
values revel Hgb 12.6, WBC 6500, K+1.9, uric acid 7.0, Na+136,
and platelets 178,000. The nurse evaluates that the client is
experiencing which of the following?
A. Hypernatremia
B. Hypokalemia
C. Myelosuppression
D. Leukocytosis - Correct answer B. Hypokalemia
why?
,Hypokalemia is evident from the lab values listed. The other
laboratory findings are within normal limits. making answers A,C
and D incorrect
A 24 year-old female client is scheduled for surgery in the
morning. Which of the following is the primary responsibility of the
nurse?
A. taking the vital signs
B. obtaining the permit
C. explaining the procedure
D. Checking the lab work - Correct answer A. taking the vital
signs
why?
the primary responisblity of the nurse is to take the vital signs
before any surgery.
answers B,C and D are the responsibility of the doctor.
The nurse is working in the emergency room when a client arrives
with severe burns of the left arm, hands, face, and neck. which
action should receive priority?
A. starting an IV?
B. Applying oxygen
C.Obtaining blood gas
D. Medicating the client foe pain - Correct answer B. Applying
oxygen
why?
the client with burns to the neck needs airway assessments and
supplemental oxygen, so applying oxygen is priority. the next
action should be to start an IV and medicate for pain.
,The nurse is visiting a home health client with osteoporosis. The
client has a new prescription for alendronate (Fosamax). Which
instructions should be given to the client
A. rest in bed after taking the medication for at least 30 mins
B. Avoid rapid movements after taking the medication
C. Take medication with water only
D. Allow at least 1 hour between taking the medicine and taking
other medications - Correct answer C. Take medication with
water only
why?
Fosmax should be taken with water only. The client should also
remain upright for at least 30 mins after taking the medication.
The nurse is making initial rounds on a client with a C5 fracture
and crutchfield thongs. Which equipment should be kept at the
bedside?
A. A pair of forceps
B. A torque wrench
C. A pair or wire cutters
D. A screwdriver - Correct answer B. A torque wrench
why?
A tourque wrench is kept at the bedside to tighten and loosen the
screws of crutchfield tongs. This wrench controls the amount of
pressure that is placed on the screws.
An infant weighs 7 pounds at birth. The excpectd weight by 1 year
should be:
A. 10 pounds
, B.12 pounds
C. 18 pounds
D. 21 pounds - Correct answer D. 21 pounds
why?
A birth weight of 7 pounds would indicate 21 pounds in 1 year or
triple the his birth weight.
A client is admitted with a Ewing's sacroma. which symptoms
would be expected due to this tumor's location?
A. Hemiplegia
B. Aphasia
C. Nausea
D. Bone Pain - Correct answer D. Bone Pain
why?
Sacroma is a type of bone cancer, therefor, bone pain would be
expected
The nurse is caring for a client with epilepsy who is being treated
with carbamazepine (Tegretol). Which labatory value might be a
indicate a serious side effect of this drug?
A. Uric acid of 5mg/dL
B. Hematoccrit of 33%
C. WBC 2,000 per cubic millimeter
D. Platelets 150,000 per cubic millimeter - Correct answer C.
WBC 2,000 per cubic millimeter
why?
