Questions for the NCLEX-PN were updated on : Nov 21 ,2025
A nurse is implementing a community awareness campaign about accidental poisoning. Which of the
following should she teach in the class?
C
Explanation:
The poison control center should be contacted first.
A nurse is teaching a client about self-administration of Haldol 15 mg po hs. For which side effect/s
must the client seek medical attention?
B
Explanation:
Muscle spasms and restlessness are side effects of Haldol
A patient is scheduled for electro-convulsive therapy treatment scheduled in the morning. What
must the evening nurse do to provide the client ECT treatment possible?
A
Explanation:
An informed consent is required prior to surgery.
A nurse runs into the significant other of a patient with end stage AIDS crying during her smoke
break. Which of the following is most appropriate action for the nurse to take?
D
Explanation:
Being left alone during the grief process, isolates individuals. These individuals need an outlet for
their feelings and to talk to someone who is empathetic.
If your patient is acutely psychotic, which of the following independent nursing interventions would
not be appropriate?
C
Explanation:
Acutely psychotic patients will disrupt group activities.
A violation of a patient’s confidentiality occurs if two nurses are discussing client information in
which of the following scenarios?
D
Explanation:
Hallway discussions should not occur, because you do not who is listening, even though it may be a
professional discussion.
A nurse gave medications to the wrong client. She stated the client responded to the name called.
What is the nurse’s appropriate documentation?
D
Explanation:
The incident report should always be filled out involving medication errors.
A nurse is assigned to do pre-operative teaching on a blind patient who is scheduled for surgery the
following morning. What teaching strategy would best fit the situation?
A
Explanation:
Information is smaller amounts is easier to retain. Teaching the day before the procedure is best
accomplished in a one on one format.
A patient 3 hours post-op from a hysterectomy is complaining of intense pain at the incision site.
When assessing the patient the nurse notes a BP of 169/93, pulse 145 bpm and regular. What action
should the nurse take?
C
Explanation:
A sinus tachycardia is a physiological response to pain. Treating the cause of the increased pulse rate
requires pain medication.
A client is 36 hours post-op a TKR surgery. 270 cc’s of sero-sanguinous accumulates in the surgical
drains. What action should the nurse take?
A
Explanation:
The physician should be notified if excessive drainage is noted from the surgical site.
A nurse is administering an antibiotic to a 4 year old girl, who does not have an identification
bracelet. What action should the nurse take?
B
Explanation:
Timely delivery of medication can be given if the mother provides the child’s name. Do not rely on
children to identify their name correctly.
When choosing a needle gauge for an intramuscular injection in a 12 year old boy. Which of the
following gauges would you choose?
C
Explanation:
22 gauge is recommended for school age children, toddlers, and adolescents while 23-25 gauge is
recommended for infants.
When giving an intramuscular injection to an infant. Which of the following sites is preferred?
C
Explanation:
Vastus lateralis is the ideal choice for infants.
Which of the following is not considered one of the five rights of medication administration?
D
Explanation:
Dose, client, drug, route and time are considered the five rights of medication.
A nurse is reviewing a patient’s medical record. The record indicates the patient has limited shoulder
flexion on the left. Which plane of movement is limited?
B
Explanation:
Sagittal motion occurs in the midline plane of the body.