NCLEX-PN Exam Questions

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1.

Your patient is allergic to peanuts. You are teaching him how to use an Epi pen. Choose the correct information regarding Epi pens:

  • Epi pens are not curative--patients must proceed to the nearest emergency room after injecting themselves using an Epi pen

  • Slower absorption is achieved via the intramuscular route

  • 3 doses of adrenalin should be given one after the other while the patient is en route to the hospital

  • Side effects of epinephrine administration are rare

Correct answer: Epi pens are not curative--patients must proceed to the nearest emergency room after injecting themselves using an Epi pen

Use of an Epi pen buys time for the patient to get to the emergency room. Other treatments are often needed in conjunction with epinephrine/adrenalin. Symptoms may return when the epinephrine wears off. Rapid absorption is achieved through the intramuscular route. Patients should auto-inject one dose before calling an ambulance. Side effects are common and may include headache, dizziness, tachycardia and anxiety.

2.

Which of the following are at increased risk of developing tuberculosis?

Select all that apply.

  • Alcoholics or IV drug users

  • Immunocompromised individuals

  • Children five years of age or younger

  • Individuals in prison

  • Residents of the United States

  • Individuals with liver failure

Risk factors for the development of tuberculosis include:

  • Children younger than five years of age
  • Older individuals
  • Drinking unpasteurized milk if the cow is infected with bovine tuberculosis
  • Homeless individuals, lower socioeconomic groups, minority groups, or immigrant groups
  • Those in contact with untreated or undiagnosed persons
  • Crowded living areas (long-term care facilities, prisons, mental health facilities)
  • Malnourishment, HIV infection, immunocompromised individuals
  • Alcohol abuse or IV drug users

3.

A medication prescription states to administer hydromorphone hydrochloride 3 mg intramuscularly, every 4 hours as needed. The medication label reads: hydromorphone hydrochloride 4 mg/1 mL. 

The nurse would prepare to administer how many mL to the patient? 

  • 0.75 mL

  • 0.5 mL

  • 0.25 mL

  • 1 mL

Correct answer: 0.75 mL

Follow the formula for this dosage calculation: (desired) x (mL)/(available) = mL per dose, so 3 mg x 1 mL/4 mg = 0.75 mL

4.

Your patient has an intravenous infusing into the antecubital vein. He complains of pain at the IV site. You note that the skin is cool around the IV insertion site and edema is present. What has likely happened?

  • The fluid is being infused into the interstitial space

  • A blood clot has developed at the tip of the catheter

  • The patient has developed phlebitis

  • It is normal to experience pain at the IV site

Correct answer: The fluid is being infused into the interstitial space

Pain at the IV site is not normal. Coolness and edema likely indicate that the IV is no longer positioned in the vein and fluid is infusing into the interstitial space. If the IV has clotted off, fluid will not infuse. Phlebitis usually involves redness along the course of the vein, with redness and tenderness.

5.

Delirium tremens symptoms may include:

  • Muscle tremors, tachycardia and increased startle reflex

  • Muscle spasticity, bradycardia and decreased startle reflex

  • Abnormal eye muscle movements, muscle tremors and decreased startle reflex

  • Muscle atrophy, tachycardia and diaphoresis

Correct answer: Muscle tremors, tachycardia and increased startle reflex

Delirium tremens is a medical emergency. Symptoms may include muscle tremors, tachycardia, arrhythmia, increased startle reflex, seizures, abnormal eye movements and diaphoresis. Symptoms may occur within 72 hours of alcohol cessation.

6.

You are working in the ICU. Your patient has experienced a head injury. The patient opens his eyes spontaneously, obeys your commands but is confused. What is his GCS (Glasgow coma scale) score?

  • 14

  • 10

  • 8

  • 5

Correct answer: 14

The scale measures eye, verbal and motor responses and ranges from 3 to 15. The patient in this example has normal eye and motor response but loses a point for his confusion; thus, his score would be 14.

7.

A young female comes into the emergency room complaining of her "heart pounding and racing." You attach the cardiac monitor and see that the patient's rhythm is a narrow-complex SVT at a rate of 210 bpm. Vital signs are stable and the patient has no history of any health problems or conditions. You should anticipate administering:

  • Adenosine IV

  • Metoprolol po

  • Amiodarone

  • Epinephrine IV

Correct answer: Adenosine IV

Adenosine is used to treat narrow complex SVT. Give 6 mg IV rapidly over 1 to 3 seconds, followed by a flush to help the medication reach central circulation. It may be repeated at a dose of 12 mg should the first dose be ineffective. Warn patients that they may experience chest discomfort, flushing and brief asystole.

8.

Insensible loss of water from the body occurs mainly in the:

  • Lungs and skin

  • Urine and sweat

  • Intestines and urine

  • Lungs and urine

Correct answer: Lungs and skin

Sensible sources of water loss include sweat, urine and water lost from the intestines. Insensible sources of water loss include the lungs and skin.

9.

Which of the following is a useful assistive device for clients who are unable to bend over and put on their shoes?

  • A long-handled shoe horn

  • A grab bar in the bathroom

  • A grab bar in the bedroom

  • Velcro shoe closures

Correct answer: A long-handled shoe horn

Long-handled shoe horns, like long-handled grabbers, are assistive devices that allow clients to put on their shoes when they are not able to safely bend over to perform this task.

10.

The quality improvement model, PDSA, stands for plan, do, study, and what?

  • Act

  • Assess

  • Analyze

  • Amend

Correct answer: Act

The PDSA model for quality improvement was developed by Deming, and the acronym stands for plan, do, study, and act. One can use plan, do, study, act (PDSA) cycles to test an idea by temporarily trying out a change and assessing its impact. 

11.

Your patient with heart failure has been responding well to treatments that include medications such as an ACE inhibitor and a loop diuretic. Today, the client is complaining about leg weakness and is refusing to ambulate. What is most likely occurring with this client?

  • Hypokalemia

  • Hyperkalemia

  • Hyponatremia

  • Hypernatremia

Correct answer: Hypokalemia

Hypokalemia, or low potassium, often occurs as the result of treatments with loop diuretics like furosemide (Lasix). The signs and symptoms of hypokalemia include muscular weakness, pain and cramping, as well as serious cardiac dysrhythmias. Clients taking loop diuretics should be closely monitored for hypokalemia and also given potassium supplementation when indicated.

12.

You listen to a report and learn that your patient requires a full lift with 2-person assist to get out of bed. Your patient rings and states he urgently needs to go to the bathroom. No one is available to help you. Choose the best course of action.

  • Explain to the patient that no one is available to assist, and ask for their patience

  • Use the lift by yourself because the patient states he cannot wait

  • Ignore the patient until someone is available to assist you

  • Put the patient on a bedpan

Correct answer: Explain to the patient that no one is available to assist, and ask for their patience

Using a lift by yourself could result in injury to you or your patient. Should the patient be injured, you would be responsible. Ignoring the patient does not show the patient the respect they deserve and is unprofessional. The patient might be willing to use a bedpan, but if the patient normally requires a full lift, you could be injured attempting to put the patient on a bedpan by yourself. Your best course of action is to ask the patient to be patient a little longer until someone can help you get the patient to the bathroom safely.

13.

What action should an LPN take when a child with second degree burns is admitted to the unit?

  • Cohort the child with an older client with asthma

  • Initiate seizure precautions

  • Cohort the child with a child of the same age who has simple acute diarrhea

  • Initiate strict isolation

Correct answer: Cohort the child with an older client with asthma

Children and adults with second and third degree burns are at great risk for infection. This child should share a room with another child who does not have an infectious, or potentially infectious, disease, such as that associated with acute diarrhea. There is no need for strict isolation.

14.

Which of the following is accurate regarding the insulin needs of the pregnant and newly-postpartum woman? 

Select all that apply.

  • During the first trimester, maternal insulin needs decrease

  • During the second trimester, there is a state of insulin resistance due to increasing placental hormones, and maternal insulin needs increase

  • After delivery, insulin requirements decrease

  • During the third trimester, there is a decrease in the patient's insulin dosage due to an abrupt decrease in placental hormone levels

  • Maternal insulin crosses the placenta to the fetus

During the first trimester, maternal insulin needs decrease. During the second and third trimesters, increases in placental hormones cause an insulin-resistant state, requiring an increase in the patient's insulin dose. After delivery of the placenta, hormone levels abruptly decrease and insulin requirements decrease. 

Maternal glucose crosses the placenta, but insulin does not. The fetus produces its own insulin and pulls glucose from the mother, which can predispose the mother to hypoglycemic reactions.

15.

The patient in cardiac arrest has a nitroglycerin patch on their right upper chest over the area where the defibrillator pad should be placed. You should:

  • Remove the patch, wipe the skin and then place the pad over the area

  • Leave the patch where it is and place the pad over it

  • Move the patch to another area, such as the upper arm

  • Place the defibrillator pad on the patient's back

Correct answer: Remove the patch, wipe the skin and then place the pad over the area

Remove the patch and quickly wipe the area, then place the defibrillator pad over the area. The patch will likely not stick elsewhere after the adhesive seal has been broken.

16.

The act which encourages patients to determine the type and extent of medical care they wish to receive if they become incapacitated is known as the:

  • Patient Self-Determination Act

  • Patient Liability Act

  • Patient Futures Act

  • Patient Health and Determination Act

Correct answer: Patient Self-Determination Act

The Patient Self-Determination Act (PSDA) was enacted in 1990 and encourages everyone to decide about the type and extent of medical care they want to receive should they become incapacitated. The PSDA requires all health care organizations to recognize the living will and durable power of attorney for health care. Finally, the PSDA requires health care organizations to ask patients whether they have an advance directive. 

17.

The nurse is providing medication education to a patient with a diagnosis of severe cystic acne who has recently been prescribed isotretinoin. Which of the following are important teaching points regarding this medication? 

Select all that apply.

  • It is highly teratogenic

  • Vitamin A must be discontinued before initiation of isotretinoin

  • It elevates triglyceride levels

  • Tinnitus indicates systemic toxicity

  • Breast tenderness, menstrual irregularities, and hyperkalemia are potential adverse effects

Isotretinoin is reserved for individuals who have not responded to other therapies, including systemic antibiotics. It is a derivative of vitamin A; therefore, any vitamin A supplements should be discontinued before initiation of this medication (because of the potential for increased toxicity). It is highly teratogenic and can cause fetal abnormalities. If prescribed, the patient must follow strict rules of the iPLEDGE program (a risk management program ensuring no woman starting this medication is pregnant or becomes pregnant). This medication also elevates triglycerides, which should be measured before and during therapy. 

Salicylic acid (used to treat psoriasis) can cause systemic toxicity (as evidenced by the presence of tinnitus and dizziness). Hormonal medication can cause breast tenderness, menstrual irregularities, and hyperkalemia (not isotretinoin).

18.

A 15-year-old male is admitted to the psychiatric unit with anorexia nervosa. Upon returning from lunch, the licensed practical nurse caring for him finds him running in place in his room by himself. Which of the following is the most appropriate action by the LPN?

  • Interrupt his running and offer to escort him to a group session

  • Allow him to continue his running routine

  • Notify his physician of the running activity

  • Ask the patient why he is running in place in his room

Correct answer: Interrupt his running and offer to escort him to a group session

Patients suffering from anorexia nervosa may have a continuous obsession and/or need to exercise in order to burn calories and reduce weight. It is important for the LPN to recognize the behavior, set appropriate limits, and discourage the behavior when it is recognized. Additionally, offering the alternative of a non-exercise-related activity is a beneficial method for distracting the patient.

19.

The licensed practical nurse (LPN) is providing nutritional education to a patient with iron-deficiency anemia. Which of the following foods are high in iron and will help to combat anemia in this patient? 

Select all that apply.

  • Egg yolks

  • Whole wheat bread

  • Dark green, leafy vegetables

  • Cheese

  • Fish

Incorporating a diet that is rich in iron can help reverse iron-deficiency anemia. Foods included are organ meats and red meat, egg yolks, whole wheat products, dark, green leafy vegetables, dried fruit, and legumes. 

Cheese is high in calcium, and fish is a good source of phosphorus.

20.

A patient comes into the emergency room after being stung by a wasp. The patient is known to be allergic to wasps. You administer oxygen and epinephrine, obtain vital signs, initiate an IV and administer IV fluids. The patient is hypotensive. How should you position this patient?

  • Recumbent with the legs elevated

  • Prone

  • Side-lying with the head slightly elevated

  • Lithotomy position

Correct answer: Recumbent with the legs elevated

Placing the patient in the recumbent position with the legs elevated above the level of the heart will improve venous return and help to increase blood pressure.