NCLEX-PN TEST QUESTIONS AND ANSWERS WITH
RATIONALES 2024-2025. RATED A+
1. The child with seizure disorder is being treated with Dilantin
(phenytoin). Which of the following statements by the patient’s mother
indicates to the nurse that the patient is experiencing a side effect of Dilantin
therapy?
A. “She is very irritable lately.”
B. “She sleeps quite a bit of the time.”
C. “Her gums look too big for her teeth.”
D. “She has gained about 10 pounds in the last 6 months.”
RATIONALE
ANS C: Hyperplasia of the gums is associated with Dilantin therapy. ANS A
is not related to the therapy; ANS B is a side effect, and ANS D is not related
to the question.
2. A 5-year-old is admitted to the unit following a tonsillectomy. Which of
the following would indicate a complication of the surgery?
A. Decreased appetite
B. A low-grade fever
C. Chest congestion
D. Constant swallowing
RATIONALE
ANS D: A complication of a tonsillectomy is bleeding, and constant
swallowing may indicate bleeding. Decreased appetite is expected after a
tonsillectomy, as is a low-grade temperature; thus, ANSs A and B are
incorrect. In ANS C, chest congestion is not normal but is not associated with
the tonsillectomy.
3. A 6-year-old with cerebral palsy functions at the level of an 18-monthold. Which finding would support
that assessment?
A. She dresses herself.
B. She pulls a toy behind her.
,C. She can build a tower of eight blocks.
D. She can copy a horizontal or vertical line.
RATIONALE
,ANS B: Children at 18 months of age like push-pull toys. Children at
approximately 3 years of age begin to dress themselves and build a tower of
eight blocks. At age four, children can copy a horizontal or vertical line.
Therefore, ANSs A, C, and D are incorrect.
4. Which information obtained from the mother of a child with cerebral
palsy most likely correlates to the diagnosis?
A. She was born at 42 weeks’ gestation.
B. She had meningitis when she was 6 months old.
C. She had physiologic jaundice after delivery.
D. She has frequent sore throats.
RATIONALE
ANS B: The diagnosis of meningitis at age 6 months’ correlates to a
diagnosis of cerebral palsy. Cerebral palsy, a neurological disorder, is often
associated with birth trauma or infections of the brain or spinal column.
ANSs A, C, and D are not related to the question.
5. A 10-year-old is being treated for asthma. Before administering
Theodur, the nurse should check the:
A. Urinary output
B. Blood pressure
C. Pulse
D. Temperature
RATIONALE
ANS C: Theodur is a bronchodilator, and a side effect of bronchodilators is
tachycardia, so checking the pulse is important. Extreme tachycardia should
be reported to the doctor. ANSs A, B, and D are not necessary.
106. An elderly client is diagnosed with ovarian cancer. She has surgery
followed by chemotherapy with a fluorouracil (Adrucil) IV. What should the
nurse do if she notices crystals and cloudiness in the IV medication?
A. Discard the solution and order a new bag
B. Warm the solution
C. Continue the infusion and document the finding
D. Discontinue the medication
RATIONALE
ANS A: Crystals in the solution are not normal and should not be
, administered to the client. Discard the bad solution immediately. ANS B is
incorrect because warming the solution will not help. ANS C is incorrect, and
ANS D requires a doctor’s order.
7. The client is diagnosed with multiple myoloma. The doctor has ordered
cyclophosphamide (Cytoxan). Which instruction should be given to the
client?
A. “Walk about a mile a day to prevent calcium loss.”
B. “Increase the fiber in your diet.”
C. “Report nausea to the doctor immediately.”
D. “Drink at least eight large glasses of water a day.”
RATIONALE
ANS D: Cytoxan can cause hemorrhagic cystitis, so the client should drink at
least eight glasses of water a day. ANSs A and B are not necessary and, so, are
incorrect. Nausea often occurs with chemotherapy, so ANS C is incorrect.
8. The client is taking rifampin 600mg po daily to treat his tuberculosis.
Which action by the nurse indicates understanding of the medication?
A. Telling the client that the medication will need to be taken with juice
B. Telling the client that the medication will change the color of the urine
C. Telling the client to take the medication before going to bed at night
D. Telling the client to take the medication if night sweats occur
RATIONALE
ANS B: Rifampin can change the color of the urine and body fluid. Teaching
the client about these changes is best because he might think this is a
complication. ANS A is not necessary, ANS C is not true, and ANS D is not
true because this medication should be taken regularly during the course of
the treatment.
9. The client is taking prednisone 7.5mg po each morning to treat his
systemic lupus errythymatosis. Which statement best explains the reason for
taking the prednisone in the morning?
A. There is less chance of forgetting the medication if taken in the morning.
B. There will be less fluid retention if taken in the morning.
C. Prednisone is absorbed best with the breakfast meal.
RATIONALES 2024-2025. RATED A+
1. The child with seizure disorder is being treated with Dilantin
(phenytoin). Which of the following statements by the patient’s mother
indicates to the nurse that the patient is experiencing a side effect of Dilantin
therapy?
A. “She is very irritable lately.”
B. “She sleeps quite a bit of the time.”
C. “Her gums look too big for her teeth.”
D. “She has gained about 10 pounds in the last 6 months.”
RATIONALE
ANS C: Hyperplasia of the gums is associated with Dilantin therapy. ANS A
is not related to the therapy; ANS B is a side effect, and ANS D is not related
to the question.
2. A 5-year-old is admitted to the unit following a tonsillectomy. Which of
the following would indicate a complication of the surgery?
A. Decreased appetite
B. A low-grade fever
C. Chest congestion
D. Constant swallowing
RATIONALE
ANS D: A complication of a tonsillectomy is bleeding, and constant
swallowing may indicate bleeding. Decreased appetite is expected after a
tonsillectomy, as is a low-grade temperature; thus, ANSs A and B are
incorrect. In ANS C, chest congestion is not normal but is not associated with
the tonsillectomy.
3. A 6-year-old with cerebral palsy functions at the level of an 18-monthold. Which finding would support
that assessment?
A. She dresses herself.
B. She pulls a toy behind her.
,C. She can build a tower of eight blocks.
D. She can copy a horizontal or vertical line.
RATIONALE
,ANS B: Children at 18 months of age like push-pull toys. Children at
approximately 3 years of age begin to dress themselves and build a tower of
eight blocks. At age four, children can copy a horizontal or vertical line.
Therefore, ANSs A, C, and D are incorrect.
4. Which information obtained from the mother of a child with cerebral
palsy most likely correlates to the diagnosis?
A. She was born at 42 weeks’ gestation.
B. She had meningitis when she was 6 months old.
C. She had physiologic jaundice after delivery.
D. She has frequent sore throats.
RATIONALE
ANS B: The diagnosis of meningitis at age 6 months’ correlates to a
diagnosis of cerebral palsy. Cerebral palsy, a neurological disorder, is often
associated with birth trauma or infections of the brain or spinal column.
ANSs A, C, and D are not related to the question.
5. A 10-year-old is being treated for asthma. Before administering
Theodur, the nurse should check the:
A. Urinary output
B. Blood pressure
C. Pulse
D. Temperature
RATIONALE
ANS C: Theodur is a bronchodilator, and a side effect of bronchodilators is
tachycardia, so checking the pulse is important. Extreme tachycardia should
be reported to the doctor. ANSs A, B, and D are not necessary.
106. An elderly client is diagnosed with ovarian cancer. She has surgery
followed by chemotherapy with a fluorouracil (Adrucil) IV. What should the
nurse do if she notices crystals and cloudiness in the IV medication?
A. Discard the solution and order a new bag
B. Warm the solution
C. Continue the infusion and document the finding
D. Discontinue the medication
RATIONALE
ANS A: Crystals in the solution are not normal and should not be
, administered to the client. Discard the bad solution immediately. ANS B is
incorrect because warming the solution will not help. ANS C is incorrect, and
ANS D requires a doctor’s order.
7. The client is diagnosed with multiple myoloma. The doctor has ordered
cyclophosphamide (Cytoxan). Which instruction should be given to the
client?
A. “Walk about a mile a day to prevent calcium loss.”
B. “Increase the fiber in your diet.”
C. “Report nausea to the doctor immediately.”
D. “Drink at least eight large glasses of water a day.”
RATIONALE
ANS D: Cytoxan can cause hemorrhagic cystitis, so the client should drink at
least eight glasses of water a day. ANSs A and B are not necessary and, so, are
incorrect. Nausea often occurs with chemotherapy, so ANS C is incorrect.
8. The client is taking rifampin 600mg po daily to treat his tuberculosis.
Which action by the nurse indicates understanding of the medication?
A. Telling the client that the medication will need to be taken with juice
B. Telling the client that the medication will change the color of the urine
C. Telling the client to take the medication before going to bed at night
D. Telling the client to take the medication if night sweats occur
RATIONALE
ANS B: Rifampin can change the color of the urine and body fluid. Teaching
the client about these changes is best because he might think this is a
complication. ANS A is not necessary, ANS C is not true, and ANS D is not
true because this medication should be taken regularly during the course of
the treatment.
9. The client is taking prednisone 7.5mg po each morning to treat his
systemic lupus errythymatosis. Which statement best explains the reason for
taking the prednisone in the morning?
A. There is less chance of forgetting the medication if taken in the morning.
B. There will be less fluid retention if taken in the morning.
C. Prednisone is absorbed best with the breakfast meal.
