NCLEX- PN ACTUAL EXAM -

NCLEX- PN ACTUAL EXAM -

COVERING MOST TESTED QUESTIONS GRADED

A+

A client had a permanent pacemaker implanted one year ago. The client returns to the outpatient clinic for suspected pacemaker battery failure. It is most important for the LPN to assess which of the following?

• abdominal pain, nausea and vomiting
• wheezing on exertion, cyanosis, and orthopnea
• palpitations, shortness of breath, and dizziness
• chest pain, headache, and diaphoresis - CORRECT ANSWER-c) palpitations, shortness of breath

and dizziness Explanation: Palpitations, SOB, dizziness, lightheadedness, syncope, irregular heart rate, and tachycardia or bradycardia may occur with pacemaker battery failure.

A client with type 1 diabetes returns to the recovery room one hour after an uneventful delivery of a

• lb. 8 oz. (4,309 g) newborn. The nurse would expect which of these changes in the client's blood

glucose level?

a) From 220 to 180 mg/dL (12.21 to 10 mmol/L)

b) From 110 to 80 mg/dL (6.1 to 4.4 mmol/L)

c) From 90-120 mg/dL (5 to 6.7 mmol/L)

d) From 100-140 mg/dL (5.6 to 7.8 mmol/L) - CORRECT ANSWER-b) From 110-80 mg/Dl

The LPN is preparing an agitated and confused client for surgery. For preoperative medication, the LPN administers morphine sulfate 5 mg IM and lorazepam 0.5 mg IM, as prescribed. The LPN should take which of the following precautions after the preoperative medication is administered?

a) Ask the security guard to remain with the client

b) Have the assistive personnel (AP) remain with the client

c) Leave the client alone until the medications take effect

d) Restrain the client with the help of a coworker - CORRECT ANSWER-b

Explanation: A client should not be left alone in an agitated state. A member of the health care staff should remain with this client.

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A client is admitted to the hospital in active labor. After delivery of a healthy infant, the client decides to bottle feed. Which of the following statements by the client after a teaching session indicates to the LPN that the client needs further instruction?

• "I'll pump my breasts and use warm packs to relieve breast pain"
• "I'll wear a tight bra a wear ice packs to relieve engorgement discomfort"
• "I'll take the prescribed pain medication when I have pain or discomfort"
• "I'll take the prescribed pills to help stop the production of milk" - CORRECT ANSWER-a

Explanation: This action will only further stimulate milk production. Other answers are true statements. Remember we are looking for inaccurate information that would require further teaching.

A client who sustained a left femur fracture in a motor vehicle accident is being treated with balanced-suspension skeletal traction using a Thomas splint and a Pearson attachment. The client reports "terrible" pain in the left thigh. Which of the following should the LPN do first?

a) Determine that the traction weights and ropes are aligned and hanging free

b) Ask the client about the characteristics and location of the pain

c) Check the Thomas splint and Pearson attachments for proper positioning

d) Explain to client that pain in the affected leg is expected - CORRECT ANSWER-b

Explanation: This answer choice focuses on the client first. Pain should be thoroughly investigated by the LPN.

A client is admitted to the hospital with influenza-like symptoms. When taking the client's history, the LPN learns that the client had been taking digoxin 0.125 mg PO daily and furosemide 40 mg PO daily for 3 years. Last month the primary health care provider changed the prescription for digoxin 0.25 mg daily. The LPN would expect the primary health care provider to prescribe which of the following laboratory tests?

a) Serum electrolyte and digoxin levels

b) Hemoglobin level and hematocrit

c) Cardiac enzymes and arterial blood gas analysis

d) Blood culture and sensitivity and urinalysis - CORRECT ANSWER-a

Explanation: Furosemide is a loop diuretic that inhibits reabsorption of sodium and chloride; side effects include hypotension, hypokalemia, GI upset and weakness. Hypokalemia may increase the client's risk of digitalis toxicity.

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The LPN is caring for a client admitted with fever, vomiting, and diarrhea. The LPN sees the following nursing diagnosis on the client's care plan: "fluid volume deficit." Which of the following changes in laboratory tests results would demonstrate an improvement in the client's condition?

a) Urine specific gravity, 1.015; hematocrit, 37%

b) Urine specific gravity, 1.020; hematocrit, 45%

c) Urine specific gravity, 1.032; hematocrit, 52%

d) Urine specific gravity, 1.025; hematocrit, 35% - CORRECT ANSWER-b

Explanation: Normal urine specific gravity ranges 1.010-1.030 and normal hematocrit ranges 42-50% for male and 40-48% for female. Fluid volume deficit occurs when fluids and electrolytes are lost in the same proportion as they exist in the body. When a client becomes dehydrated, both the urine specific gravity and hematocrit become elevated.

A client is hospitalized with a diagnosis of atrial fibrillation. The primary health care provider prescribes Heparin 5,000 units every 12 hours to be given by subcutaneous injection and daily partial thromboplastin time (PTT). The result of the client's most recent PTT is 55 seconds. Which of the following actions should be taken by the LPN?

a) Document the results and administer the heparin

b) Withhold the heparin

c) Notify the primary health care provider of the test results

d) Have the test repeated - CORRECT ANSWER-a

Explanation: Normal PTT ranges 20-45 seconds. Therapeutic range PTT for a client receiving heparin, an anticoagulant, ranges 1.5-2 times the control or normal level. To calculate the therapeutic range, take the lower number for the normal range for a PTT (20) and multiply it by 1.5. The result is 30.Multiply the higher number (45) by 2. The result is 90. Thus the therapeutic ranges from 30-90 seconds. Therapeutic PTT ranges 30-90 seconds, the goal of therapy.Because 55 seconds falls within the 30-90 seconds there is no need to notify the health care provider, withhold the medication, or repeat the test.

The primary health care provider orders furosemide and spironolactone for a client. Prior to administering the medication, the LPN determines that the client's potassium 3.2 mEq. In addition to notifying the supervising RN, the LPN should anticipate taking which of the following actions?

a) Hold either the furosemide or spironolactone

b) Administer the spironolactone only

c) Administer the furosemide only

d) Administer the furosemide and spironolactone - CORRECT ANSWER-b

Explanation: Potassium level falls below the normal level of 3.5-5 mEq. Furosemide is a potassium wasting diuretic and spironolactone is a potassium sparing diuretic. There is no reason to hold the

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