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NCLEX-PN EXAM SCRIPT 2026 PRACTICE
SOLUTION BUNDLED
◉ The nurse is taking the health history of a 70-year-old patient being treated for a Duodenal Ulcer. After being told the patient is complaining of epigastric pain, the nurse expects to note which assessment finding?
- Melena
- Nausea
- Hernia
- Hyperthermia. Answer: 1. Melena - CORRECT Melena is the finding that there are traces of blood in the stool which presents as black, tarry feces. This is a common manifestation of Duodenal Ulcers, since the Duodenum is further down the gastric anatomy. ◉ A nurse is providing discharge teaching for a patient with severe Gastroesophogeal Reflux Disease. Which of these statements by the patient indicates a need for more teaching?
- "I'm going to limit my meals to 2-3 per day to reduce acid secretion."
- "I'm going to make sure to remain upright after meals and elevate my head when I sleep"
- "I won't be drinking tea or coffee or eating chocolate any more."
- "I'm going to start trying to lose some weight.". Answer: 1. "I'm going to limit my meals to 2-3 per day to reduce acid secretion." CORRECT - Large meals increase the volume and pressure in the stomach and delay gastric emptying. It's recommended instead to eat 4-6 small meals a day. ◉ The nurse in the Emergency Room is treating a patient suspected to have a Peptic Ulcer. On assessing lab results, the nurse finds that the patient's blood pressure is 95/60, pulse is 110 beats per minute, and the patient reports epigastric pain. What is the PRIORITY intervention?
- Start a large-bore IV in the patient's arm
- Ask the patient for a stool sample
- Prepare to insert an NG Tube
- Administer intramuscular morphine sulphate as ordered. Answer:
- Start a large-bore IV in the patient's arm CORRECT - The nurse should suspect that the patient is haemorrhaging and will need need a fluid replacement therapy, which requires a large bore IV.
CORRECT - the patient has a fluid volume overload as a result of overly rapid fluid replacement. The nurse should stop the infusion and notify the physician. ◉ The nurse is working in a support group for clients with HIV. Which point is most important for the nurse to stress?
- They must inform household members of their condition
- They must take their medications exactly as prescribed
- They must abstain from substance use
- They must avoid large crowds. Answer: 2. They must take their medications exactly as prescribed CORRECT - Antiretrovirals must be taken exactly as prescribed to prevent drug-resistant strains. Even missed doses can reduce the effectiveness of future treatment. ◉ A nurse finds a 30-year-old woman experiencing anaphylaxis from a bee sting. Emergency personnel have been called. The nurse notes the woman is breathing but short of breath. Which of the following interventions should the nurse do first?
- Initiate cardiopulmonary resuscitation
- Check for a pulse
- Ask the woman if she carries an emergency medical kit
- Stay with the woman until help comes. Answer: 3. Ask the woman if she carries an emergency medical kit CORRECT - Many patients who have a known history of anaphylaxis carry epi-pens in their pockets or belongings. This is the best way to stop a hypersensitivity reaction before it becomes life-threatening. ◉ A man is prescribed lithium to treat bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings?
- The patient states he had a manic episode a week ago
- The patient states he has been having diarrhea every day
- The patient has a rashy pruritis on his arms and legs
- The patient presents as severely depressed
- The patient's lithium level is 1.3 mcg/L. Answer: 2. The patient states he has been having diarrhea every day Correct - Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. ◉ A 65 year old man is prescribed Flomax (Tamsulosin) for Benign Prostatic Hyperplasia. The patient lives in an upstairs apartment. The nurse is most concerned about which side effect of Flomax?
- Hypotension
- Metallic taste
- Hypoglycemia. Answer: 4. Hypoglycemia Correct - The patient is at risk because she is on NPO status and continuing to take an anti-glycemic drug. ◉ The nurse is reviewing the lab results of a patient taking lithium for schizoaffective disorder. The lab results show that the blood lithium value is 1.7 mcg/L. What would the nurse take as the priority action?
- Induce vomiting
- Hold the next dose of Lithium
- Administer an anti-emetic
- Give the next dose of Lithium. Answer: 2. Hold the next dose of Lithium Correct - Lithium's therapeutic range is 0.5-1.5mcg/L, and begins toxicity at 1.5mcg/L ◉ A patient asks the nurse why they must have a heparin injection. What is the nurse's best response?
- "Heparin will dissolve clots that you have."
- "Heparin will reduce the platelets that make your blood clot"
- "Heparin will work better than warfarin."
- "Heparin will prevent new clots from developing.". Answer: 4. "Heparin will prevent new clots from developing." Correct - This is a correct statement. ◉ The nurse is reviewing the lab results of a patient who has presented in the Emergency Room. The lab results show that the troponin T value is at 5.3 ng/mL. Which of these interventions, if not completed already, would take priority over the others?
- Put the patient in a 90 degree position
- Check whether the patient is taking diuretics
- Obtain and attach defibrillator leads
- Check the patient's last ejection fraction. Answer: 3. Obtain and attach defibrillator leads Correct - This patient is undergoing an emergency cardiac event. Normal Troponin T levels are less than 0.2 ng/mL. Ventricular Fibrillation is the cause of death in most cases of deaths due to sudden cardiac arrest. Defibrillation is the most important action to take to prevent death. ◉ A nurse is caring for a patient undergoing a stress test on a treadmill. The patient turns to talk to the nurse. Which of these statements would require the most immediate intervention?
◉ A nurse is caring for a patient after a coronary angiogram. Which of these actions taken by the nursing assistant would most require the nurse's immediate intervention?
- The nursing assistant fills the patient's pitcher with ice cold drinking water
- The nursing assistant elevates the head of the bed to 60 degrees for a meal
- The nursing assistant refills the ice pack laying on the insertion site
- The nursing assistant places an extra pillow under the patient's head on request. Answer: 2. The nursing assistant elevates the head of the bed to 60 degrees for a meal Correct - For 3-6 hours after a coronary angiogram (depending on the insertion site), the patient should have their bed no higher than 30 degrees and be on bedrest. ◉ A man is has been taking lisinopril for CHF. The patient is seen in the emergency room for persistent diarrhea. The nurse is concerned about which side effect of lisinopril?
- Vertigo
- Hypotension
- Palpitations
- Nagging, dry cough. Answer: 2. Hypotension
Correct - The patient is particularly at risk for hypotension due to possible dehydration from fluid loss. ◉ The nurse is taking the health history of a patient being treated for sickle cell disease. After being told the patient has severe generalized pain, the nurse expects to note which assessment finding?
- Severe and persistent diarrhea
- Intense pain in the toe
- Yellow-tinged sclera
- Headache. Answer: 3. Yellow-tinged sclera Correct - Jaundice is a common clinical finding of sickle cell disease, caused by bilirubin released from damaged or destroyed RBCs ◉ A client with Multiple Sclerosis reports a constant, burning, tingling pain in the shoulders. The nurse anticipates that the physician will order which medication for this type of pain?
- alprazolam (Xanax)
- Corticosteroid injection
- gabapentin (Neurontin)
- hydrocodone/acetaminophen (Norco). Answer: 3. gabapentin (Neurontin)
Correct - This is within the nursing scope of practice and within the training and education provided to all nurses. It is safe to use and a standard treatment. ◉ The nurse assesses a patient suspected of having an asthma attack. Which of the following is a common clinical manifestation of this condition?
- Audible crackles and orthopnea
- An audible wheeze and use of accessory muscles
- Audible crackles and use of accessory muscles
- Audible wheeze and orthopnea. Answer: 2. An audible wheeze and use of accessory muscles Correct - Both of these are associated with asthma. ◉ The nurse assesses a patient suspected of having meningitis. Which of the following is a common clinical manifestation of this condition?
- A high WBC count and decreased level of consciousness
- A high WBC count and manic activity
- A low WBC count and manic activity
- A low WBC count and decreased level of consciousness. Answer: 1. A high WBC count and decreased level of consciousness
Correct - Meningitis is most often cause by an infectious organism, increasing the WBC count. One defining feature is an increased Intracranial Pressure (ICP) which presents as a decreased level of consciousness. consciousness. ◉ A patient is being treated in the Neurology Unit for Meningitis. Which of these is a priority assessment for the nurse to make?
- Assess the patient for nuchal rigidity
- Determine the patient's past exposure to infectious organisms
- Check the patient's WBC lab values
- Monitor for increased lethargy and drowsiness. Answer: 4. Monitor for increased lethargy and drowsiness Correct - Lethargy and drowsiness indicate a decreased level of consciousness, which is the cardinal sign of increased ICP (Intracranial Pressure), which can be life-threatening. ◉ The nurse is caring for clients in the pediatric unit. A 6-year patient is admitted who has 2nd and 3rd degree burns on his arms. The nurse should assign the new patient to which of the following roommates?
◉ A patient is being admitted to the ICU with a severe case of encephalitis. Which of these drugs would the nurse not be expect to be prescribed for this condition?
- Acyclovir (Zovirax)
- Mannitol (Osmitrol)
- Lactated Ringer's
- Phenytoin (Dilantin). Answer: 3. Lactated Ringer's Correct - Lactated Ringer's solution is often used in fluid replacement therapy, which is not warranted if a patient is at risk for high ICP. . ◉ The nurse is treating a patient who has Parkinson's Disease. Which of these practices would not be included in the care plan?
- Decrease the calorie content of daily meals to avoid weight gain
- Allow the patient extra time to respond to questions and do ADLs
- Use thickened liquids and a soft diet
- Encourage the patient to hold the spoon when eating. Answer: 1. Decrease the calorie content of daily meals to avoid weight gain
Correct - Calorie content should be increased for patients with Parkinson's Disease because of dysphagia (difficulty swallowing), as well as calories burned due to muscle rigidity. ◉ A 45-year old woman is prescribed ropinirole (Requip) for Parkinson's Disease. The patient is living at home with her daughter. The nurse is most concerned about which side effect of ropinirole?
- Slurred speech
- Sudden dizziness
- Masklike facial expression
- Stooped Posture. Answer: 2. Sudden dizziness Correct - Dizziness and orthostatic hypotension are serious adverse effects of this drug that can lead to an increased risk of falls. Ropinirole's drug class is a dopamine agonist, which mimic dopamine in the brain (PD is characterized by a lack of dopamine). ◉ The nurse is taking the health history of a patient being treated for Parkinson's Disease. After being told the patient has classic symptoms of Parkinson's, the nurse expects to note which assessment finding?
- Tremors
- Low Urine Output
- Follow up with the neurologist, physician, or other health care provider as prescribed
- Do not stop taking anticonvulsants, even if seizures have stopped
- Wear a medical alert bracelet or carry an ID card indicating epilepsy. Answer: 3. Do not stop taking anticonvulsants, even if seizures have stopped Correct - Following this instruction is essential for their safety, since stopping anti-epileptic drugs suddenly can cause seizures and an increased chance of status epilepticus ◉ The nurse is caring for a patient in the ICU who has had a spinal cord injury. She observes that his last blood pressure was 100/55, and his pulse is 48. These have both trended downwards from the baseline. What should the nurse expect to be the next course of action ordered by the physician?
- Assess the patient for decreased level of consciousness
- Administer Normal Saline
- Insert an NG Tube
- Connect and read an EKG. Answer: 2. Administer Normal Saline Correct - The patient is entering neurogenic shock. Normal saline will replace fluid volume, treating the hypotension and bradycardia symptomatically. Atropine sulfate is also commonly used to increase the heart rate.
◉ A nurse is caring for a patient who is suspected to have sustained a spinal cord injury. What best describes the overarching principles used to guide the care for this type of condition?
- Immobilize the cervical area to prevent further injury
- Monitor the patient's level of consciousness to prevent neurologic deterioration
- Help the patient with activities of daily living and provide emotional and physical support to help them adjust to their injury
- Facilitate tissue perfusion to the spinal cord while maintaining airway and breathing. Answer: 4. Facilitate tissue perfusion to the spinal cord while maintaining airway and breathing Correct - Maintaining airway, breathing, and circulation is both essential and guides the overall plan of care for a patient with a spinal cord injury. ◉ A 23-year-old woman is admitted to the infusion clinic after a Multiple Sclerosis Exacerbation. The physician orders methylprednisolone infusions (Solu-Medrol). The nurse would expect which of the following outcomes after administration of this medication?
- A decrease in muscle spasticity and involuntary movements
- A slowed progression of Multiple Sclerosis related plaques
- A decrease in the length of the exacerbation
