NCLEX-PN Sample Questions & Answers

The client is showing clear signs of opioid-induced respiratory depression, a medical emergency. The absolute priority is to address the client's breathing and level of consciousness. Attempting to arouse the client (e.g., sternal rub) can stimulate the respiratory drive. While other actions like stopping the PCA and calling for help are also critical, the first, immediate action is to stimulate the client to breathe.

The child is in severe respiratory distress, indicative of status asthmaticus. The immediate priority is to open the airways. While notifying the RN/provider and applying oxygen are essential, administering a fast-acting bronchodilator via nebulizer is the most direct and crucial intervention to relieve bronchospasm and improve air exchange. This can be done concurrently while calling for help and applying oxygen.

The hemoglobin A1c of 9.2% indicates prolonged, poor glycemic control. Hyperglycemia impairs leukocyte function, reduces collagen synthesis, and compromises peripheral circulation, all of which are critical for wound healing. While neuropathy (lack of pain) and infection (drainage) are related problems, the underlying hyperglycemia is the most significant systemic factor preventing the wound from healing properly.

The daughter is expressing distress and fear. The most appropriate initial response is therapeutic: acknowledge her feelings, validate her concern, and open a conversation. This empathetic approach builds trust and allows the LPN to gather more information about the family's understanding and goals of care, which can then be communicated to the RN and the interdisciplinary team for a comprehensive discussion about feeding options and end-of-life care.

This statement is true. The 30-degree lateral position avoids direct pressure on the trochanter (hip bone), sacrum, and ischium, which are common sites for pressure injury development. The 90-degree side-lying position places intense, direct pressure on the trochanter, significantly increasing the risk of tissue damage.

This is the correct approach. Introducing single-ingredient foods one at a time, with a waiting period of 3 to 5 days between each new food, allows the parent to identify any potential food allergies or sensitivities. Honey should be avoided in infants under 12 months due to the risk of botulism. Cereal should be spoon-fed, not put in a bottle, to prevent choking and promote feeding skills.

A therapeutic INR for most conditions is between 2.0 and 3.0. An INR of 5.8 is a critical value, indicating a very high risk of spontaneous and severe bleeding. The LPN's scope of practice is to collect data, recognize significant findings, and report them. The priority is to immediately inform the RN, who can then collaborate with the provider to obtain orders, such as holding the warfarin and potentially administering the antidote, vitamin K.

Droplet precautions are used for pathogens transmitted by large-particle droplets. A surgical mask is required to protect the nurse's mucous membranes of the nose and mouth from these droplets when within 3 feet of the client.

Eye protection (goggles or a face shield) is required under droplet precautions to protect the mucous membranes of the eyes from infectious droplets generated by coughing, sneezing, or talking.

This response uses the therapeutic techniques of making an observation ("You seem very anxious") and offering a broad opening ("Tell me more..."). This validates the client's feelings and invites them to share their specific concerns, which is the first step in addressing their anxiety. The other options are non-therapeutic because they dismiss the client's feelings (false reassurance) or give advice.

First, calculate the percentage of the personal best: (280 / 400) * 100 = 70%. A reading of 70% falls into the Yellow Zone (50-79%). The action plan for the yellow zone indicates that the client should use their short-acting rescue inhaler as a first step to open the airways and then re-evaluate their status.