2024 PN Exit Exam New Latest version with 300+ Questions from Actual Past Exam, Exams of Nursing

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2024 PN HESI Exit Exam New Latest version with

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Which of the following assessment techniques of older patients depends on touch via fingers and hands to assess the patient? A.) Palpation B.) Percussion C.) Inspection D.) Auscultation ----------- Correct Answer ----------- A.) Palpation ...You should know why Sudden onset mutism with bizarre mannerisms and remaining in a stereotyped position with waxy flexibility is a presentation of which of the following types of schizophrenia? A.) Disorganized Schizophrenia B.) Paranoid Schizophrenia C.) Catatonic Schizophrenia D.) Undifferentiated Schizophrenia ----------- Correct Answer ----------- C.) Catatonic Schizophrenia Catatonic schizophrenia presents as a sudden onset of mutism, bizarre mannerisms, remaining in a stereotyped position with waxy flexibility. The patient may have dangerous periods of agitation and explosivity. A 60 year-old client with cancer of the liver is in Hepatic Coma and unresponsive. What should the nurse say to family members who are inquiring about the condition of their loved one? A. "Your loved one's condition is very critical, and there has been no response in the last 24 hours" B. "The nurses have not been able to arouse the client and the healthcare provider knows the outcome." C. "You need to discuss the condition with the charge nurse in a family conference." D. "The client's condition is extremely critical. Has your family made funeral arrangements?" ---------- Correct Answer ---------- A. "Your loved one's condition is very critical, and there has been no response in the last 24 hours" A client complains of kidney pain. The nurse understands that the kidneys are located where? A. On the retroperitoneal posterior abdominal wall at the costovertebral angle B. Within the curve of the duodenum, posterior to the spleen C. Lateral to the stomach in the hypochondriac region

D. Superior aspect of the bladder in right and left iliac region ---------- Correct Answer ---- ------ A. On the retroperitoneal posterior abdominal wall at the costovertebral angle The LPN/LVN receives report on an adult client who has a central intravenous (IV) infusion. Where should the nurse observe when assessing the integrity of the access site? A. Umbilical area of the abdomen B. Antecubital fossae of the arm C. Chest wall below the clavicle D. Dorsal surface of the hand ---------- Correct Answer ---------- C. Chest wall below the clavicle The healthcare provider prescribes an IV solution of clindamycin (Cleocin) 850mg in 75 mL of D2W to infuse over 30 minutes. The drop factor is 15 gtt/mL. The nurse should regulate the IV to deliver how many gtt/ minute? (Enter numeric value only. if rounding is required round to the nearest whole number) ---------- Correct Answer ---------- 75mL X 15gtt/mL = 38 Correct Answer: 38 A 58-year-old client complaining of difficulty driving at night states "the lights bother my eyes." The client wears corrective glasses. The nurse would suspect that the client is experiencing a deficiency of which vitamin? A.) Vitamin A B.) Vitamin B complex C.) Vitamin E D.) Vitamin C ----------- Correct Answer ----------- A.) Vitamin A Vitamin A is important for the eye's ability to see color. The B complex vitamins play a role in many functions, including nerve conduction. Vitamins E and C have antioxidant properties and aid in wound healing. The cardiac unit PN will often be assigned to clients receiving dopamine treatment. Which of the following is an appropriate nursing diagnosis for the client receiving this medication? A.) Tissue perfusion; ineffective B.) Sensory perception; disturbed C.) Cardiac output; increased D.) Fluid volume; excess ----------- Correct Answer ----------- A.) Tissue perfusion; ineffective The client on the medication dopamine should be assessed for ineffective tissue perfusion related to peripheral vasoconstriction. The other answers (b, c, and d) are not related to this therapy.

A client is diagnosed with chronic diarrhea. Which of the following is a nursing intervention? A.) Assess IV site B.) Auscultate bowel sounds C.) Apply hot soaks to the skin to reduce pain D.) Elevate the client to the supine position ----------- Correct Answer ----------- B.) Auscultate bowel sounds Individuals with acute diarrhea can have a loud rushing sound in the bowels. A client with breast cancer is scheduled for a mastectomy. The nurse should instruct the client to perform which of the following actions after discharge: A.) Rest on her back with her arms elevated B.) Engage in range of motion exercises such as raising the arms as high as possible in the air C.) Apply hot and wet dressings to the surgical site every 2 hours D.) Soak in hot baths to reduce the swelling ----------- Correct Answer ----------- A.) Rest on her back with the arms elevated After a mastectomy, lymphedema may occur. Lymphedema is the swelling of the tissues in the extremities. In order to help the client reduce the swelling, the nurse can instruct the client to sleep with her extremities elevated as well as sleep on her back. Also, the nurse should teach the client to take her temperature regularly and monitor for other signs of a postoperative infection, take analgesics or other medications as prescribed. Also, the nurse should teach the client to avoid any type of exercise or activity that can cause an injury to the extremities where the surgery was performed. The physician orders Prozac for a client with depression. Which of the following in the client's medical history warrants immediate reporting by the nurse to the physician? A.) Liver disease B.) HTN C.) Asthma D.) congestive heart failure ----------- Correct Answer ----------- A.) Liver disease Prozac is contraindicated in individuals who have kidney disease, liver disease, diabetes mellitus and who are suicidal. Prozac can make these conditions worse. Many times before administering medication, a nurse must convert the dosage amount from the metric system to household. Which of the following is the correct conversion for one teaspoon? A.) 5 milliliters b.) 1 quart

C.) 1 grain D.) 2.2 pounds ----------- Correct Answer ----------- A.) 5 milliliters One quart is the household conversion for one liter. One grain is the household conversion for 60 milligrams and 2.2 pounds, the household conversion for one kilogram. You're doing a great job. ----------- Correct Answer ----------- Keep going! You got this A client with congestive heart failure and hypokalemia has a serum potassium of 3.4. The serum potassium results indicates... A.) Mild Hypokalemia B.) Moderate Hypokalemia C.) Low Hypokalemia D.) Severe Hypokalemia ----------- Correct Answer ----------- A.) Mild Hypokalemia A serum potassium between 3.0 to 3.5 mEq/L is classified as mild. Then, a serum potassium of 2.5 to 3.0 mEq/L is considered as moderate. Further, a serum potassium of 2.5 mEq/L or less is considered as severe hypokalemia. Normal levels are 3.5 - 5. mEq/L. A client is administered radioiodine I-131 therapy. The nurse should monitor the client for which of the following complications? A.) Hypothyroidism B.) Myxedema C.) Profuse sweating D.) Toxicity ----------- Correct Answer ----------- A.) Hypothyroidism Radioiodine I-131 therapy is a type of radioactive iodine therapy. This treatment kills excessive cells in the thyroid gland tissues and lesser amounts of the thyroid hormones are secreted. However, since the radioactive treatment can destroy large amounts of the cells in the thyroid glands, hypothyroidism may result because now after the radioactive therapy an underproduction of thyroid hormones are happening. Which of the following is NOT an important note to remember when administering total parenteral nutrition (TPN)? A.) An individual bag of the solution should hang no more than 24 hours B.) None of these C.) TPN should not be ended abruptly D.) The TPN solution should be checked for particles before it is hung ----------- Correct Answer ----------- B.) None of these

In addition to Choices A, C and D, the following points should be remembered when administering total parenteral nutrition: 1. Look for signs of infection. 2. The patient's serum close should be closely monitored. 3. The rate of the solution should be controlled by an infusion pump. 4. TPN is the only solution that should be utilized for the particular IV line. A client is scheduled to retire next month. He calls the nurse and says he can't cope and that his whole world is falling apart. What condition does he have? A.) Overreaction B.) Maturational Crisis C.) Panic disorder D.) Regression ----------- Correct Answer ----------- B.) Maturational Crisis The client is experiencing a maturational crisis due to normal pending life changes. The other choices are not related to the client's pending retirement. A client in a long-term care facility refuses to take his oral medications. The nurse threatens the client and tells him that, if the medication is not taken, restraints will be applied and the medication will be given by injection. The nurse's statement constitutes which legal tort? A.) Assault B.) Battery C.) Negligence D.) Right to refuse care ----------- Correct Answer ----------- A.) Assault Assault occurs when a person puts another person in fear of harmful or threatening contact. Battery is the actual contact with one's body. If the nurse actually carried out the threat, battery would also apply. Negligence involves actions below the standard of care. The client has the legal right to refuse care. In this situation, the correct action is to try to calm the client, allow him time to talk, and then determine if he will take the medications. If the client still won't take the medications, the nurse should document his refusal, note the medications, and notify the physician and nursing supervisor. The nurse should follow the facility's policy related to client's refusing care. Which of the following is considered negligence? A.) A nurse follows the manufacturer's directions for using the equipment and the equipment fails B.) The nurse notifies the physician that the patients heart rate increased C.) The nurse forgets to report the client's response to an administered medication D.) The nurse interprets a clients symptoms ----------- Correct Answer ----------- C.) The nurse forgets to report the client's response to an administered medication

Nursing standards of practice requires the documentation of a client's response to treatment or a medication in the medical record. Not doing so is negligence and can lead to a malpractice lawsuit. The nurse following the manufacturer's instructions on how to operate the equipment is appropriate. Also, the nurse notifying the physician immediately regarding the client's change in status is also appropriate practice. Then, the nurse should interpret the client's signs and symptoms in order to report any changes to the physician. You are caring for a patient who is suffering from severe anxiety. In interacting with this patient you understand that... A.) Anxiety is easily contagious and easily transferred from patient to nurse and vise versa B.) You must be sure that the patient has first been administered medications to calm him/her down C.) The patient should be instructed that if he/she becomes too anxious, they should ask for more medication D.) The anxiety level of the patient must at least be reduced to moderate before any interaction ----------- Correct Answer ----------- A.) Anxiety is easily contagious and easily transferred from patient to nurse and vice versa As a nurse, you must realize that the patient's anxiety can be transferred from him or her to you. You must also realize that the process also works in reverse; that any anxiety that you show will only add to the patient's anxiety. Therefore being calm will help the patient to gain control and decrease anxiety. A client presents to the office with complaints of swelling in the legs, chills and shortness of breath. During auscultation of the chest, a heart murmur is heard. The client's blood culture reveals a microorganism in the blood. When a microorganism is found in the blood, this conditions is called... A.) Bacteremia B.) Sepsis C.) Septicemia D.) Parasitic infection ----------- Correct Answer ----------- A.) Bacteremia Bacteremia is the presence of bacteria in the blood. Clients with a heart murmur and bacteremia may have endocarditis. Endocarditis is inflammation of the lining of the heart and the valves of the heart. Manifestations of endocarditis includes fever, chills, heart murmur, fatigue, joints and muscles that ache, coughing, swelling in the extremities, shortness of breath and blood in the urine. A daughter of an elderly client who has schizophrenia calls the office and talks to the nurse about how her mother was acting the past couple of days. Which of the following statements would indicate the client is showing early signs have relapse for schizophrenia?

A.) My mother told me that she can't stop thinking about washing her hands B.) My mother said yesterday, "I feel great today. I could clean the house." Then this morning didn't want to get out of bed C.) My mom is very mean. She is normally nice and has kind words. Yesterday she told me, "I don't need you here everyday taking care of me. Why don't you go to your house for a change? I need privacy sometimes you know." D.) My mother said to me last night, " Who are you? Do I know you?" That scared me because she couldn't remember who I was. This morning she knew me and didn't remember saying what she said last night. ----------- Correct Answer ----------- By the client wanting to isolate herself (i.e. why don't you go to your house), having mood swings and acting differently than normal (i.e. the mother is mean when she is normally nice and refusing the daughter's care), these are early indictors for a relapse of schizophrenia. Clients with schizophrenia have delusions, hallucinations or confusion. By treating these clients when early signs are present, a relapse of schizophrenia can be managed or prevented. Additional early signs for schizophrenia relapse include lack of sleep, poor interpersonal skills and social skills, isolation from friends, family or other people, irritability, not taking medication as prescribed, no motivation, anxiousness, worrying and the inability to process information efficiently The nurse observes the rise and fall of a 1 year old's abdomen to assist in counting the child's respiratory rate. Which of the following is considered a normal respiratory rate for a 1 year old? A.) 16 B.) 40 C.) 20 D.) 12 ----------- Correct Answer ----------- B.) 40 The correct answer is 40. A 1 year old's respiratory rate ranges from 25-40. A respiratory rate of 16 is seen in 6-10 year olds. The answer choice of 20 is seen in children around age 3. Then, a respiratory rate of 12 is seen in 17 year olds. In assessing a postmastectomy client, the nurse determines that the client is in denial. The nurse can best respond by doing what? A.) Confronting the denial B.) Interpreting the denial C.) Supporting the denial D.) Accepting the denial ----------- Correct Answer ----------- D.) Accepting the denial When a client is faced with body image alterations and, possibly, terminal illness and death, the nurse should allow the client to express her feelings. By accepting the initial denial, the nurse acknowledges the role that denial plays in the coping process. Interpreting the client's denial and then confronting her with it will increase her anxiety,

hinder the development of a trusting relationship, and delay the client's acceptance of her condition. Accepting the client's denial does not imply that the nurse supports it. In assessing a child who has fetal alcohol syndrome you might find which of the following? Check all answers that apply A.) Mental deficiency B.) Large upper lip C.) Small for gestational age D.) Epicanthal folds (when the upper eyelid covers the inner corner of the eye) ----------- Correct Answer ----------- A, C, D You might find all three of these things. You are more likely to find a thin upper lip than a large one. The child may also have motor deficiencies and hearing disorders among other things. Which of the following is an Antihypercalcemics? A.) Alendronate sodium B.) Calcitonin Human C.) Tribasic Calcium phosphate D.) Paricalcitol ----------- Correct Answer ----------- D.) Paricalcitol The other are calcium supplements A nurse is coming on duty and receives a report for the change of shift. Of the following which patient should be attended to first? A.) A 58-year old patient recovering from a hysterectomy who indicated a pain level of 7/ B.) An 85-year old woman recovering from cardiac by-pass surgery who has developed a new onset of confusion C.) A 28-year old man who has a new order for a nasogastric tube D.) A 50- year old woman who has been diagnosed with type 2 diabetes and has questions about her medication and diet ----------- Correct Answer ----------- B.) An 85- year old woman recovering from cardiac by-pass surgery who has developed a new onset of confusion The age of this woman and the fact that she is recovering from a major surgery require that her new-onset confusion be addressed. This may be the symptom of a complication from the surgery. She may be suffering a stroke or a pulmonary embolism. Anyone that has a new onset" is usually who needs to be seen first!

The type of drug that acts directly on myocardial cells to increase contractility and thus increase cardiac output is which of the following? Check all answers that apply A.) Diuretic B.) Vasodilator C.) Cardiotonic D.) Thrombolytic ----------- Correct Answer ----------- C.) Cardiotonic Cardiotonic drugs (cardiac glycosides) act directly on myocardial cells to increase contractility and thus increase cardiac output. They also slow the heart rate. Digoxin (Lanoxin) is an example of a cardiotonic drug. Which of the following would NOT be a normal characteristic of urine? A.) Clear, transparent consistency B.) Specific gravity of 1. C.) pH of 9. D.) Yellow ----------- Correct Answer ----------- C.) pH of 9. The normal range of pH for urine is 4.5 - 8.0. Patients often use defense mechanisms to cope. Which of the following is a type of defense mechanism? Check all answers that apply A.) Denial B.) Projection C.) Grief D.) Reaction Formation ----------- Correct Answer ----------- A, B, D Denial is the failure to acknowledge an intolerable thought. Projection is attributing to others one's unacceptable feelings. Reaction formation is expression of an attitude directly opposite to an unconscious wish or fear. Your patient is being administered an isotonic IV solution for intravascular dehydration. You recognize that all of the following are characteristic of an isotonic solution except... A.) Does not cause red blood cells to swell or shrink B.) Has an osmolality close to the extracellular fluid C.) Causes fluid to move from extracellular fluid to intracellular fluid D.) May be a normal saline solution of 0.9% NS ----------- Correct Answer ----------- C.) Causes fluid to move from extracellular fluid to intracellular fluid Causing fluid to move from extracellular fluid to intracellular fluid is a characteristic of hypotonic solutions, not isotonic solutions.

The nurse is caring for a client who is prescribed Proventil. The nurse should monitor the client for which of the following side effects? A.) Increased heart rate B.) Hyperthyroidism C.) Hypertension D.) Vascular Disease ----------- Correct Answer ----------- A.) Increased heart rate Proventil (albuterol) is a sympathomimetic class of medication that is prescribed for bronchospasm in clients who have respiratory conditions such as bronchitis or asthma. With this medication, the nurse should monitor the client for side effects such as an increase in the client's heart rate. An increased heart rate is possible because the sympathomimetic drugs work like the sympathetic nervous system pulses and stimulates the heart. Another more common side effect for Proventil is tremors. The nurse understands that a side effect of an antipsychotic is what? A.) Diarrhea B.) Thrombocytopenia C.) Dystonia D.) Tinnitus ----------- Correct Answer ----------- C.) Dystonia (muscles contract involuntarily) Dystonia is an example of an extrapyramidal side effect (EPS). With Dystonia, the client may experience early in the treatment torticollis and intermittent muscle spasms. Thrombocytopenia, diarrhea and tinnitus are not typical side effects for pyschotic medications. Instead, these are side effects that are seen when a client takes anticoagulants. During the administration of a client's feeding through a tube, the nurse may warm the feeding to room temperature. This approach: A.) Helps prevent abdominal cramps B.) Raises the pH of the client's gastric acids C.) Reduces pain felt during feedings D.) Reduces the risk of infection ----------- Correct Answer ----------- A.) Helps prevent abdominal cramps Their rationale literally says: "By warming feedings to room temperature, the nurse can help prevent abdominal cramps. Abdominal cramps can be caused by cold feedings"... REALLY?! The nurse teaches the parents of a 10 year old who has a periorbital ecchymosis to: A.) Irrigate the eye for 15-30 min

B.) Apply drops to the eye twice a day C.) Apply ice to the eye area for 5-15 min every hour for 2 days D.) Apply a warm compress to the eye for 5-15 min for 1 day ----------- Correct Answer -- --------- C.) Apply ice to the area for 5-15 min every hours for 2 days Periorbital ecchymosis is the bruising of the skin around the eye. This condition is also known as a black eye. The treatment for a black eye is to apply ice to the eye area for 5 - 15 minutes. This is performed every hour for 1-2 days. On the second day after an injury to the eye, a warm compress should be applied to the eye area. The nurse should begin screening for lead poisoning when a child reaches which age? A.) 6 months B.) 12 months C.) 18 months D.) 24 months ----------- Correct Answer ----------- C.) 18 months The nurse should start screening a child for lead poisoning at age 18 months and perform repeat screening at ages 24, 30 and 36 months. High-risk infants, such as premature infants and formula-fed infants not receiving iron supplementation, should be screened for iron deficiency anemia at age 6 months. Regular dental visits should begin at age 24 months. A nurse is having a conversation with a patient and excuses herself for lunch saying that she is so hungry she could eat a horse. The patient states to the nurse that she has heard that horse meat is tough and that she should try something else. Which action would be the most therapeutic for the patient? A.) Record the patient's response in her medical records B.) Document the patient's response as concrete thinking C.) Explain to the patient that saying that she could eat a horse only means that she is very hungry, not that she would eat a horse D.) Explain to the patient that should never eat a horse ----------- Correct Answer ----------

• C.) Explain to the patient that saying that could eat a horse only means that she is very hungry, not that would eat a horse This response is the most therapeutic action. This patient is giving literal translation to communication and this is called concrete thinking. Although documentation may be necessary it is not the most therapeutic action. A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority? A.) Monitor vital signs and oxygen sat. every 15-30 min B.) Suction the client as needed to obtain a sputum specimen for culture and sensitivity C.) Assess intake and output and maintain adequate hydration

D.) Reassure the client that intubation and mechanical ventilation will be temporary ------ ----- Correct Answer ----------- A.) Monitor vital signs and oxygen saturation every 15- 30 min Suctioning the client as needed to obtain a sputum specimen for culture and sensitivity may be necessary but assessing the client for changes in his respiratory status takes priority. Assessing intake and output and providing adequate hydration is important for liquefying secretions; however, it does not take priority. Reassuring the client that intubation and mechanical ventilation is temporary is inappropriate. The client may not require intubation and mechanical ventilation; however, if he does, the nurse cannot predict the length of time it may be necessary. The nurse is performing a physical examination of a primigravid client who is 8 weeks pregnant. At this time, the nurse expects to assess: A.) Hegar's sign B.) Fetal outline C.) Ballottement D.) Quickening ----------- Correct Answer ----------- A.) Hegar's sign When performing a vaginal or rectovaginal examination, the nurse may assess Hegar's sign (a softening of the lower uterine segment) between the 6th and 8th weeks of pregnancy. The fetal outline may be palpated after 24 weeks. Ballottement is not elicited until the 4th or 5th month of pregnancy. Quickening typically is reported after 16 to 20 weeks. You have a patient who has been admitted to the psychiatric unit. The patient's medical record has a notation that this patient suffers from severe thanatophobia. You know that this means that the patient has a fear of which of the following? A.) The dark B.) Water C.) Crowds and open places D.) Death ----------- Correct Answer ----------- D.) Death Your patient has been prescribed morphine for pain relief. You know that you must monitor him for respiratory depression. If your patient experiences narcotic-induced respiratory depression, which of the following drugs is the most likely to be prescribed to address this? A.) Codeine B.) Naloxone C.) Butorphanol D.) Dilaudid ----------- Correct Answer ----------- B.) Naloxone

Narcotic analgesics are preferred for pain relief because they bind to various receptor sites in the CNS. However, they may cause respiratory depression. For narcotic induced respiratory depression, naloxone (narcan) may be administered as prescribed by the pt's physician. A nurse is caring for a child with meningitis. His observations today lead him to suspect that the child is suffering increased intracranial pressure (ICP). Which of the following signs would NOT point to ICP? A.) Decreased pulse B.) Motor dysfunction C.) A change in LOC D.) Decreased blood pressure ----------- Correct Answer ----------- D.) Decreased blood pressure The signs of ICP include increased blood pressure, decreased pulse, motor dysfunction, a change in LOC and personality, unequal pupil response and irritability. A healthy first time pregnant client asks the nurse, "How long will I stay in the hospital after my baby is born." The client is scheduled for a Caesarean section. The nurse understands the average timeframe for the hospital stay for a Caesarean section is what? A.) 12-24 hours B.) 30-36 hours C.) 37-48 hours D.) 72 hours ----------- Correct Answer ----------- D.) 72 hours The hospital stay for a healthy mother who has delivered an infant varies depending on the type of delivery. The length of stay in the hospital for a vaginal birth is typically 24 to 48 hours. The length of stay in the hospital for a Caesarean section that does not have any complications is 72 hours. Your patient has come to see the gynecologist with symptoms including a pulling and dragging sensation in the pelvic region and the back. She also states that she has very painful cramps during menstruation but normal bleeding and she feels a protrusion in the vaginal canal. Which of the following conditions would you suspect? A.) Fibroid tumor B.) Uterine prolapse C.) Cystocele D.) Rectocele ----------- Correct Answer ----------- B.) Uterine prolapse There are a number of symptoms associated with uterine prolapse among which are those stated in the question. Other symptoms include: dyspareunia, pressure, fatigue and a low backache.

A patient is brought into the emergency room after being found wandering around on a back road that is infrequently used. She appears to be bruised and she is completely disheveled. She cannot recall any personal information. What type of dissociative disorder would you suspect? A.) Depersonalization B.) Dissociative identity disorder C.) Psychogenic amnesia D.) Psychogenic fugue ----------- Correct Answer ----------- C.) Psychogenic amnesia The patient's appearance and the fact that she was found wandering on an infrequently used road would indicate that this woman has most likely experienced a traumatic event such as a beating or rape. Her inability to recall personal information may be the result of the trauma and as such would be classified as psychogenic amnesia. This is the most common dissociative disorder. Which of the following is a defense mechanism that is described as withdrawing into passivity and becoming inaccessible so as to avoid further threatening situations? A.) Identification B.) Suppression C.) Projection D.) Insulation ----------- Correct Answer ----------- D.) Insulation Withdrawing into passivity and becoming inaccessible so as to avoid threats is insulation. Identification is the unconscious attempt to change oneself to resemble an admired person. Suppression is the conscious, deliberate forgetting of unacceptable or painful thoughts, ideas, and feelings. Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else Which of the following clients would have a higher risk of delivering a newborn with Down Syndrome? A.) A 16-year old female B.) A 25-year old female C.) A 30-year old female D.) A 45-year old female ----------- Correct Answer ----------- D.) A 45-year old female Down Syndrome is a condition where an individuals has too many chromosomes. Also individuals with Down Syndrome have a physical appearance of a slanting forehead, short hands and arms, and a nose that is flat. Women who are aged 40 and over are at a higher risk of having a child with Down syndrome.

A 20-year-old patient is admitted to the hospital with respiratory failure. He's intubated, given oxygen, and is coughing with copious secretions in his lungs. What should be done first? A.) Suction the lungs B.) Call his family C.) Call for assistance in restraining the patient D.) Check his heart rate and blood pressure ----------- Correct Answer ----------- A.) Suction the lungs The first priority is to make sure the client's airways are clear and that he can breathe. The other choices can be addressed after ensuring the client can breathe. Your young patient suffers from absence seizures. She is being prescribed medication to help with the seizures. Which of the following medications is the most likely to be prescribed? A.) Phenytoin B.) Phenobarbital C.) Clonazepam D.) Fosphenytoin ----------- Correct Answer ----------- C.) Clonazepam Clonazepam (Klonopin) is the most likely medication to be prescribed of the choices given. It is often prescribed for absence and myoclonic seizures. This drug should not be discontinued abruptly and liver function, CBC and renal function should be monitored periodically. Which of the following categories of crises is due to unpredictable events that happen in one's life, such as losing a loved one to death? A.) Maturational B.) Adventitious C.) None of these D.) Situational ----------- Correct Answer ----------- D.) Situational Choice A includes life events such as having a baby. Choice B includes events that are not generally a part of one's everyday life, such as experiencing a devastating tornado. Thanatophobia is an unreasonable fear of death. Nyctophobia is a fear of the dark. Agoraphobia is a fear of crowds and open places. Hydrophobia is a fear of water. As a nurse you recognize that an acid-base balance must be maintained in the body. You are asked to evaluate a patient's condition based on readings of pH 7.50, Pco2 30 and HCO3 26. You determine that the patient has which of the following acid-base disorders?

A.) Respiratory Alkalosis B.) Metabolic Acidosis C.) Metabolic Alkalosis D.) Respiratory Acidosis ----------- Correct Answer ----------- A.) Respiratory Alkalosis Acid-base imbalance is determined by the hydrogen ion concentration in body fluids. A pH level above 7.45 indicates alkalosis. In respiratory disorders the HCO3 is normal (

• 26 mEq/L). This patient therefore is suffering from respiratory alkalosis. You are reading the medical records of a patient who has been admitted to the hospital for depression. The records say that the type of depression is endogenous. You know that this means that the depression is caused by which of the following? Check all that apply A.) Internal biologic deficiency B.) Reaction to environmental factors C.) Delayed psychosexual development D.) Dysfunctional family system E.) Reaction to external factors ----------- Correct Answer ----------- A Endogenous depression is a type that is caused by biologic deficiency such as biogenic amines at receptor sites in the brain. Exogenous depression is caused by a reaction to environmental or external factors. Assessing a patient involves knowing what type of depression you are dealing with. A client with an infectious disease is placed in isolation. Client isolation techniques attempt to break the chain of infection by interfering with what? A.) The agent B.) A susceptible host C.) The transmission mode D.) Portal of entry ----------- Correct Answer ----------- C.) The transmission mode Client isolation techniques attempt to break the chain of infection by interfering with the transmission mode. These techniques do not affect the agent, host or portal of entry. What should the nurse do to assess for a positive sign of pregnancy? A. Ask the woman if her breasts are tender B.) Ask the woman when she had her last menstrual period C.) Auscultate for fetal heart sounds D.) perform a pregnancy test on the woman's urine ----------- Correct Answer ----------- C.) Auscultate for fetal heart sounds

The presence of fetal heart sounds is a positive sign of pregnancy. Additional positive signs of pregnancy are ultrasound visualization of the embryo or gestational sac and fetal movement (quickening) felt by a third party at or beyond 20 weeks gestation. Tender breasts and a missed menstrual period are considered possible signs of pregnancy. A positive pregnancy test is a probable sign of pregnancy Which of the following IV fluids is as equally concentrated as the body's natural intracellular fluid? A.) Hypertonic B.) Isotonic C.) None of these D.) Hypotonic ----------- Correct Answer ----------- B.) Isotonic The concentration of a hypertonic solution is greater than the body's natural intracellular fluid. The concentration of a hypotonic solution is less than the body's natural intracellular fluid. Which of the following is defined as the lack of infection or infectious matter? A.) Asepsis B.) Droplet Precautions C.) Standard Precautions D.) Portal of Entry ----------- Correct Answer ----------- A.) Asepsis Droplet transmission refers to the method in which microorganisms are inhaled. In this case, the microorganisms leave the host on a liquid particle and are then breathed in by another. Sneezing is an example of this type of transmission. Standard precautions are "textbook" practices used by medical personnel to help prevent the spread of infectious microorganisms. The portal of entry is the area of the body at which the microorganism enters the individual. The nurse would identify which set of serum magnesium levels as consistent with a diagnosis of hypomagnesemia? A.) 1.5 mEq/L B.) 2.0 mEq/L C.) 4.0 mEq/L D.) 0.2 mEq/L ----------- Correct Answer ----------- D.) 0.2 mEq/L Hypomagnesemia is an electrolyte imbalance where there is a low amount of magnesium in the blood. Hypomagnesemia is associated with serum magnesium levels that are below 1.5 mEq/L.

A young man has been admitted to your unit with a bowel obstruction. A blood gas analysis was ordered. If the bowel obstruction is high in the small intestine the blood gas analysis will show which of the following? A.) An acidic state B.) A decrease in pH C.) An alkalotic state D.) A rise in PCO2 levels ----------- Correct Answer ----------- C.) an alkalotic state Blood gas analysis will show an alkalotic state if the bowel obstruction is high in the small intestine where gastric acid is secreted. If the obstruction is in the lower bowel where base solutions are secreted, the blood will be acidic. A client is at risk for injury if they experience which of the following seizures? A.) Grand Mal B.) Partial C.) Focal D.) Defined ----------- Correct Answer ----------- A.) Grand Mal A seizure is excessive discharges in the brain that is characterized by jerking movements. Seizures, such as grand mal affect the entire body and may cause an individual to lose consciousness, which places the client at risk of injury. Which of the following is the best definition of a prolapsed uterus? A.) Tube-like opening that displaces downward B.) Downward displacement of the uterus through the vaginal orifice C.) Mass of tissue growing on the uterus D.) Inflammation of the uterus and the surrounding tissues ----------- Correct Answer ----- ------ B.) Downward placement of the uterus through the vaginal orifice A prolapsed uterus is defined as the downward displacement of the uterus through the vaginal orifice. It is the result of weakened supporting muscles and ligaments of the pelvis. https://nurseslabs.com/nclex-pn-practice-questions/ An older client with metastatic breast cancer is experiencing shortness of breath as a result of a bilateral pneumonia the client has a living will and the family is requesting hospice care which information should the practical nurse (PN) reinforce with the client and family regarding hospice? ---------- Correct Answer ----------- • Instructions for care should be included in the clients living will

• Care can be provided in home where client resides
• Care focuses on comfort dignity and emotion support

An older female client adult who has been admitted to long term facility yesterday is confused about what day of the week it is her history does not include that she was confused prior to admission what action should the practical nurse (PN) take? ---------- Correct Answer ----------- Remind the client what day of the week it is A client who is primigravida at herm to the prenatal clinal and tells the practical nurse (PN) that she is having contractions every 5 minutes the PN monitors the clint for an hour using external fetal monitor and determines that the clients contractions are 7 to 15 minutes apart lasting to 20 to 30 seconds with mild intensity by palpitation which actin should the PN take? ---------- Correct Answer ----------- Send the client home A client who is a gravida 1 para 0 is transferred to the recovery room following a normal vaginal delivery of a healthy newborn the practical nurse (PN) observes that the client is shaking uncontrollably and states she's cold ---------- Correct Answer ----------- Apply light warm blanket and assure her that this is normal following delivery The practical nurse (PN) is assessing an older client with left sided heart failure what intervention is most important for the PN to implement ---------- Correct Answer ----------- Auscultate all the lung fields While administering prescription medication to an older adult resident in a extended care facility the practical nurse notice that the client is having difficulty hearing what action is most important for the PN to take? --- ------- Correct Answer ----------- Determine if client has had difficulty hearing in the past The healthcare provider Gives a pregnant woman a prescription for one prenatal vitamin with iron daily and tells her that she needs to increase iron rich foods in her diet because her hemoglobin is 8.2 gramsldi when a list of iron list foods is given to the client the client tells the practical nurse she's a vegetarian and does not eat bleeds what instructions should the PN give? ---------- Correct Answer ----------- • Add lenhl and black beans

• Increase green leafy vegetables in the diet
• Oatmeal is a good choice for breakfast A full term 24 hour old infant in the nursery regulates and suddenly turns cyanotic which immediate interventions should the practical nurse (PN) take? ---------- Correct Answer ----------- Turn the infant to the right side The practical nurse (PN) views the midline episiotomy of a client who repots pain in her stiches whar action should the action

should the PN take first? ---------- Correct Answer ----------- Observe suture line for separation and hematoma formation The practical nurse (PN) is obtaining fetal heart rates on four antepartum client in their third trimester of pregnancy what fetal heart rate should be reported to the registered nurse? ---------- Correct Answer ----------- 180 (NORMAL 110-160) An older client who had a colon resection 8 days ago is straining at stool the practical nurse (PN) observes from the client klound followed by appearance of bowel on the skin which complication has occurred? - --------- Correct Answer ----------- Evisceration A female client with immune thrombocytopenic purpura is transported to a long term facility for physical therapy rehabilitation to prevent injury the most important for the practical nurse (PN) to implement? ---------- Correct Answer ----------- Ensure the client has minimum clutter in the room Which location should the practical nurse palpate to determine if a client submandibular lymph node are enlarged? ---------- Correct Answer ----------- Beneath the lower jaw A client is receiving an epidural anesthesia during labor which observation is the most important adverse effect that the practical nurse (PN) should assess for following the administration of the epidural -------- -- Correct Answer ----------- Maternal hypotension The practical nurse (PN) is working in a cancer detention mobile clinic. Four individuals come for screening with a complaint of hoarseness a danger sign for cancer of the larynx which client has the highest risk of development of cancer of the larynx that the PN should refer to healthcare provider ---------- Correct Answer ----------- A older male who drinks a 6 pack of beer nightly and smokes heavily A home health practical nurse (PN) visits and older client living with offspring who exhibits fear unkempt and has lost a lot of weight which action should the PN take ---------- Correct Answer ----------- Report suspected abuse to supervisor and protective services The practical nurse determines that a client who is one day postpartum has a moderate amount of lochia and rubra and the uterus is firm diverted and three finger breaths above umbilicus what should be the first initial action ---------- Correct Answer ----------- Massage the uterus to decrease atony The practical nurse is caring for a client with coronary artery disease who is admitted intermitted chest pain the admissions

lobotomy results indicated elevated tropine 1 and creatine phosphoicinase myoglobulin isoenzymes levels what should the PN consider the most significant risk is for this client on the second day of admissions? ----- ----- Correct Answer ----------- The labs results indicate myocadiac damage and the client is at risk for cardiac dysrhythmias Which interventions should thr practical nurse (PN) reinforce for a client with pruritis? --- ------- Correct Answer ----------- Keep finger nails trimmed short When gathering data about a client with dark skin tones which site should the practical nurse (PN) observe ---------- Correct Answer ----------- Finger and toe nails A 2 day old infant with hydrocephalus returns from surgery following placement of a ventriculoperitoneal shunt which nursing intervention should the practical nurse (PN) implement during postoperative care ---------

• Correct Answer ----------- • Document strict intake and out take
• Measure head circumference
• Monitor body temperature every 4 hours The birth weight of an infant delivered by a woman with gestational diabetes is 10.1 pounds the infant is jittery and has a heel stick glucose level of 40 30 minuets after birth based on this information which interventions should the PN implement first ---------- Correct Answer ----------- Offer nipple feedings of 10% dextrose The practical nurse (PN) and unlicensed assistive personal (UAP) enters a clients room and finds the client lying on the bed the PN determines that the client is unresponsive which action should the PN give the UAP first ---------- Correct Answer ----------- obtain emergency help the practice nurse (PN ) is caring for a client with fractured metatarsals after slamming a hand in the car door after administering the prescribed hydrocodone/acetaminophen for pain which intervention should the PN include in the client care? ---------- Correct Answer ----------- Implement ongoing assessments for signs of shortness or slowed breathing The practical nurse (PN) overhears the female client with crushing syndrome tell her family in a very loud and anger voice to leave her room and not come back the response by the PN is based on recognizing which common manifestations of the syndrome ---------- Correct Answer ----------- Mood adherence The parents with a one year old child with the diagnosis of hypospadias informed the practical nurse (PN) that they plan to

delay corrective surgery to see if the child will outgrow the problem which information should the PN provide to these parents ---------- Correct Answer ----------- Ask the patents to explain what they understand about the child's diagnosis A child reviving chemotherapy develops a cough that productive of yellow tinged sputum after determine that the client is afebrile which priority action for the practice nurse (PN) to take? ---------- Correct Answer ----------- Provide oral hygiene The Glasgow scale is being used to monitor a client who experienced a traumatic brain injury what primary assessment should the PN evaluate ---------- Correct Answer ----------- Level of consciousness The practical nurse (PN) is assigned to care for a client who had an endoscopic procedure in which a local anesthetic was sprayed on their throat which priority action should the PN include in this care of plan? -- -------- Correct Answer ----------- Assess the gag reflexes The practical nurse (PN) is providing care for a client who is NPO after small bowel resection the client NG tube is connected to intermittent suction the client reports dizziness and tingling in digits which assessment finding should the PN report to the healthcare proiver ---------- Correct Answer ----------- Hypoactive bowel sounds on assessment The patents of a child with pre diabetic report to thr practical nurse (PN) that the child wants to join the soccer team what is the best action for the PN to implement ---------- Correct Answer ----------- Reassure the patents that increased physical activity reduces risk for diabetes While assisting the RN with the admission of a toddler which intervention should the practical nurse (PN) implement to make the experience lease stressful for the client ---------- Correct Answer ----------- Remove child's clothing down to the diaper A client with hypertension complains of a persistent dry cough the practical nurse (PN) should tell the client that this is a common side effect with what medication ---------- Correct Answer ----------- Quinapril A practical nurse (Pn) is at the nurses station describing her social life sexual activities and alcohol drinking in a boisterous voice that might be heard by the client and visitors ---------- Correct Answer ----------- Suggest going to the nurses lounge to discuss these topics The parents of a child with acute glomerulonephritis are describing to the practical nurse (PN) that

originally motivated them to seek medical care which signs is the child most likely exhibiting ---------- Correct Answer ----------- Hematuria the chest xray for a client who is admitted for pneumonia shows pleural effusion what should the PN expect to hear when auscultating the upper lobe? ---------- Correct Answer ----------- A rubbing pleural sound A client receives ondansetron prior to chemotherapy treatment how should the practical nurse evaluate the effectiveness of the medication ---------- Correct Answer ----------- Monitor the client for nausea or vomiting following the treatment The practical nurse (PN) is assisting with the plan of care for a client with osteochondrosis who is not experiencing increased discomfort in breathing the client receives a prescription for tramadol what interventions should the PN include in the client plan of care ---------- Correct Answer ---- ------- On going assessment for signs of shallow or slowed breathing A male client with tuberculosis returns to the clinic for daily antibiotic injections for a UTI the clients been taking antitubercular medication 10 weeks and states ringing in his ears which medication should the nurse report ---------- Correct Answer ----------- Gentamycin 160mg IM daily A new protocol for fall prevention is being implemented on the medical unit during safety rounds the practical nurse (PN) identifies that the UAP had omitted a vital component of the protocol after implementing the missing component which action should the nurse take? ---------- Correct Answer ----------- Supervise the UAP after reviewing the protocol What standard of care is acceptable in a nursing malpractice case ---------- Correct Answer ----------- What would a responsible prudent nurse have done under similar circumstances At the beginning of a shift in which order of priority should the practical nurse assess their 4 patients ---------- Correct Answer ----------- • An older adult with dizziness whose o2 is 86%

• An older adult woman who's vomiting who's potassium is 2.8
• A young adult with a history of asthma who's arterial pit is 7.48
• An adult client with an ulcer who's hemoglobin's is 9.8 The practical nurse (PN) administers a anticonvulsant that causes photosensitivity which action should

the PN take after admitting the medication? ---------- Correct Answer ----------- Remind the client to protect skin rom sunlight A 2 day old infant with hydrocephalus returns from surgery following placement of a ventriculoperitoneal shunt which nursing interventions should the practical nurse (PN) implement during postoperative care ---------- Correct Answer ----------- • Document strict I & O

• Measure head circumference
• Monitor body temp The practical nurse (PN) administers an antibiotic to a client with respiration tract infection to evaluate the medication lab values ---------- Correct Answer ----------- • White blood count
• Sputum culture and sensitivity In caring for a client with buck traction the practical nurse (PN) observes thar the prescribed amount of weight are hanging freely and traction is on pully which action should the PN implement next ---------- Correct Answer ----------- Document the back traction is being maintained While the practical nurse (PN) and unlicensed assistive personal (UAP) are turning a client with an abdominal incision the incision eviscerates which task is best for the PN to assign the UAP ---------- Correct Answer ----------- Gather supplies The practical nurse (PN) ia changing the abdominal dressing of a male client who was discharged home following a colon resection which information should the PN report to the health care provider ---------- Correct Answer ----------- The client reports the wound care is painful and would like a prescription for an analgesic When obtaining a capillary blood sample for glucose measure which intervention should the practical nurse (PN) implement ---------- Correct Answer ----------- Determine what finger was used previously A client diagnosed with cdiff which action should the practical nurse (Pn) implement to prevent the spread of the organism? ---------- Correct Answer ----------- • Hand washing
• Don non sterile gloves when performing direct care A client who had orthopedic surgery 2 days ago complains of difficulty sleeping which initial intervention is best foe the practical nurse (PN) to implement ---------- Correct Answer ----------- Reposition the client and provide a back rub

The practical nurse (PN) is planning evening shift rounds for a group of postoperative client who all had surgery earlier that day which client should the PN check first ---------- Correct Answer -- --------- A preschooler who had an emergency appendectomy for appendicitis The practical nurse (PN) plans to distraction technique while client undergoes a brief painful procedure which action should the PN implement during the procedure ---------- Correct Answer ---- ------- Encourage the client to reminisce about a favorite past family event Which interventions is within the scope of practice for a practical nurse (PN) ---------- Correct Answer ----------- Demonstrating deep breathing and coughing to be a post operative client The practical nurse (PN) determines that a clients pupils constrict as they change focus from a far object to a near object how should the PN document this finding ---------- Correct Answer ------- ---- Pupils reactive to accommodation The spouse of a hospitalized client asks the practical nurse (PN) for acetaminophen for a tension headache which action would you take? ---------- Correct Answer ----------- Explain that medication can only be provided to client The practical nurse (PN) explains to a client how to clean a sputum and client indicates understanding the procedure after the PN leaves the room the client obtain the sputum and notifies the PN when the PN arrives to collect the sputum it appears as seen in the picture. What action should the PN take? ---------- Correct Answer ----------- The PN should teach the client how to obtain a sputum specimen and the client does not correctly collect the specimen the PN should assist the client is obtaining another specimen cough directly into a sterile cup The practical nurse (PN) ask the UAP for feedback about assigned client instead the UAP walks away from the PN ignoring the question what action is best for the PN to take ---------- Correct Answer ----------- In a private setting ask the other nurses for feedback about UAP behaviors A client who is being care for in her home has a lab serum sodium level of 125 to determine the cause of this level which information should the PN request from the client ---------- Correct Answer ----------- The amount of salt used in meal preparation