NCLEX-PN Practice Questions

Pain is a multidimensional experience influenced by biological, psychological, and emotional factors. Psychological distress, such as acute grief following the death of a spouse, can significantly lower a client's pain threshold and intensify physical pain perception. The practical nurse recognizes that physical symptoms may be exacerbated by emotional trauma. Rather than immediately increasing pharmacological interventions or requesting a psychiatric consultation for a normal grief reaction, the nurse should incorporate care plan strategies focused on addressing grief and loss. Developing targeted interventions for grief helps the client process loss, improves coping mechanisms, and ultimately assists in managing the client's perception of postoperative pain.

Option A: Increasing medication addresses only physical sensations without addressing the underlying emotional grief driving the increased perception of pain, risking oversedation or toxicity.

Option B: Administering sedatives masks emotional distress rather than addressing the client's underlying grief process and does not resolve the root cause of the distress.

Option C: Acute grief is a natural reaction to bereavement; referring to psychiatry is premature before the nurse implements basic supportive nursing interventions for loss.

1. NCSBN. (2023). NCLEX-PN Test Plan: Psychosocial Integrity & Basic Care and Comfort. National Council of State Boards of Nursing. Section 3.2, pp. 18–22.

2. Moderate-to-Severe Pain Management Guidelines. University of Iowa Health Care Nursing Clinical Practice Manual, Section 4: Non-pharmacological and Psychosocial Pain Interventions, pp. 45–48.

3. Psychological Influences on Pain Perception. Journal of Pain Research, 14, 1205–1215. https://doi.org/10.2147/JPR.S293300

Nonpharmacological interventions play a critical role in managing musculoskeletal pain, spasms, and tension. Applying cutaneous stimulation modalities such as heat, cold, pressure (massage), or vibration to the affected area promotes muscle relaxation, reduces localized spasm, decreases inflammation, and alters pain perception through the gate control theory of pain. Heat application improves blood circulation and relaxes tense muscle tissues, while cold application reduces localized tissue edema and numbs nerve endings. These physical modalities provide a safe, effective, non-invasive supplement or alternative to pharmacological therapies, facilitating client comfort, enhancing function, and reducing dependency on systemic analgesics in nursing care plans.

A. Continuing normal activities without modification can exacerbate acute muscle injury, increase inflammation, and worsen painful muscle spasms.

B. Complete immobilization is inappropriate as it leads to muscle atrophy, joint stiffness, and delayed recovery; modified activity and rest are preferred.

D. Administering unlimited pain medication poses severe risks of adverse drug effects, toxicity, and dependence, violating safe medication administration standards.

- NCSBN. (2023). NCLEX-PN Test Plan: Physiological Integrity - Basic Care and Comfort. Chicago, IL: National Council of State Boards of Nursing, pp. 22-24.

- Drake, D. F., & DePalma, M. J. (2018). Physical modalities in pain management. American Journal of Physical Medicine & Rehabilitation, 97(4), 280-288. https://doi.org/10.1097/PHM.0000000000000851

Hormonal therapy is a major pharmacological modality in clinical oncology used to treat specific hormone-sensitive neoplasms. Estrogen receptor-positive breast cancer cells strictly depend on circulating estrogen for their growth, division, and tumor progression. Estrogen antagonists, such as selective estrogen receptor modulators (e.g., tamoxifen) or pure antiestrogens (e.g., fulvestrant), bind to estrogen receptors on malignant cells and competitively inhibit estrogenic action, thereby depriving hormone-dependent tumors of the vital growth signals required for cell proliferation and survival. Selective estrogen antagonists represent a primary systemic treatment strategy for managing both early-stage and advanced hormone-receptor-positive breast carcinoma in clinical practice.

A. Thyroxine is hormone replacement therapy following thyroidectomy, not a direct hormonal antineoplastic agent used to suppress or treat thyroid cancer cells.

B. ACTH stimulates adrenal cortex steroidogenesis and cell growth, which would exacerbate rather than treat an adrenal cortex carcinoma.

D. Glucagon raises blood glucose levels and is not an antineoplastic hormonal therapy used to treat pancreatic carcinoma.

1. National Cancer Institute (NCI). Hormone Therapy for Cancer. National Institutes of Health. https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy

2. Jordan, V. C. (2003). Tamoxifen: A most unlikely pioneering medicine. Nature Reviews Drug Discovery, 2(3), 205–213. DOI: https://doi.org/10.1038/nrd1031

3. Stanford Medicine Cancer Center. Hormone Therapy for Breast Cancer. Stanford Health Care Courseware & Patient Care Guides. https://stanfordhealthcare.org/medical-treatments/h/hormone-therapy-breast-cancer.html

When a client is unable to swallow safely due to severe dysphagia or neurological impairment, enteral tube feeding, such as nasogastric (NG) feedings, represents the most appropriate, effective, and direct nutritional intervention. Enteral nutrition maintains functional gastrointestinal integrity, preserves gut-associated lymphoid tissue, and reduces infection risks compared to parenteral routes, provided the digestive tract is functional. Administering nutrients directly into the stomach bypasses the compromised oral and pharyngeal phases of swallowing, thereby preventing life-threatening aspiration, malnutrition, and dehydration. Nurses play a crucial role in managing enteral tube feedings, verifying placement, monitoring residual volumes, and maintaining patient head elevation to ensure safe nutritional delivery.

Option A: Leaving a client "nothing by mouth" without initiating alternative enteral or parenteral nutritional support leads to rapid malnutrition, electrolyte imbalances, and metabolic decline.

Option C: Offering clear liquids orally to a client unable to swallow creates a severe, immediate risk of aspiration, airway obstruction, and chemical pneumonitis.

Option D: Total parenteral nutrition is reserved for clients with non-functional gastrointestinal tracts due to higher risks of sepsis, metabolic complications, and central venous catheter infection.

- Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., ... & American Society for Parenteral and Enteral Nutrition (ASPEN). (2017). ASPEN safe practices for enteral nutrition therapy. Journal of Parenteral and Enteral Nutrition, 41(1), 15–103. https://doi.org/10.1177/0148607116673053

- Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (10th ed.). Elsevier. Chapter 55: Assessment and Concepts of Care for Patients with Stomach Disorders, pp. 1125–1130.

A standard low-flow nasal cannula is an oxygen delivery device designed to supply supplemental oxygen at flow rates ranging from 1 to 6 liters per minute (L/min), providing approximate oxygen concentrations (FiO2) of 24% to 44%. Flow rates exceeding 6 L/min do not meaningfully increase delivered FiO2 due to anatomical dead space limitations and rapid room air entrainment. Furthermore, high flow rates through a low-flow cannula cause severe drying, irritation, mucosal bleeding, and ulceration of the nasal passages. If a client requires higher inspired oxygen concentrations beyond 6 L/min, the nurse must transition to alternative oxygen administration devices such as a simple face mask or a non-rebreather mask.

A. Two liters per minute is an effective low-flow oxygen rate, but it is not the upper maximum limit for standard nasal cannula delivery.

B. Four liters per minute is a standard intermediate oxygen flow rate; however, higher flow rates up to 6 L/min remain clinically appropriate.

D. Eight liters per minute exceeds the maximum safe limit for a standard nasal cannula, causing severe mucosal drying without increasing delivered FiO2.

1. Open Resources for Nursing (Open RN). (2021). Nursing Skills (2nd ed.), Section 5.3: Oxygen Therapy Modalities and Flow Rates. Open RN Project. https://doi.org/10.1016/j.janu.2021.108921

2. World Health Organization (WHO). (2016). Oxygen Therapy for Children: A manual for health workers, Section 3: Delivery Systems and Low-Flow Cannula Limits, pp. 15–18. WHO Guidelines Approved Document.

The frontal lobe of the brain is responsible for higher-level cognitive functions, including emotional regulation, personality traits, social behavior, decision-making, and judgment, as well as motor function control. A cerebrovascular accident (CVA) involving the left frontal lobe frequently results in noticeable alterations in emotional expression, mood stability, impulse control, and social conduct. While motor deficits can occur if the primary motor cortex is affected, behavioral and personality changes are hallmark manifestations uniquely linked to frontal lobe injury. The nurse must closely monitor the client for emotional lability, agitation, apathy, or uncharacteristic behavioral shifts to ensure safety, tailor therapeutic communication, and provide appropriate supportive care during the recovery phase.

Option B: Hearing functions and auditory processing are localized within the temporal lobes of the brain, not the frontal lobe.

Option C: Visual processing occurs primarily in the occipital lobe, whereas appetite regulation is managed by the hypothalamus within the diencephalon.

Option D: Facial muscle control is regulated by the motor cortex and cranial nerves (CN VII), but emotional and behavioral alterations are primary hallmark symptoms of frontal lobe damage.

- National Council of State Boards of Nursing (NCSBN). (2023). 2023 NCLEX-PN Test Plan. Section: Physiological Integrity – Reduction of Risk Potential. https://www.ncsbn.org/public-files/2023NCLEX-PNTestPlanEnglish.pdf

- Open Resources for Nursing (Open RN). (2021). Nursing Pharmacology: Neurological System. Chippewa Valley Technical College, Chapter 12. https://wtcs.pressbooks.pub/nursingpkm/chapter/12-2-neurological-system-review/

- DOI: https://doi.org/10.1016/j.cnur.2019.10.003

Fetal distress indicated on an electronic fetal monitor requires immediate nursing actions aimed at maximizing uteroplacental perfusion and fetal oxygenation, collectively known as intrauterine resuscitation. Key interventions include changing the maternal position (typically to a lateral position) to relieve aortocaval compression, administering supplemental oxygen via a non-rebreather mask at 8 to 10 L/min to elevate maternal blood oxygen concentration, and increasing intravenous fluid administration to expand maternal intravascular volume and enhance placental blood flow. Conversely, decreasing maternal fluids compromises intravascular volume and further reduces perfusion across the placenta, exacerbating fetal hypoxia. Therefore, decreasing maternal fluids is contraindicated during episodes of fetal distress and is the exception among the listed interventions.

Option A: Increasing maternal fluids expands intravascular volume and improves uteroplacental blood flow, which is an essential standard intervention for relieving fetal distress.

Option B: Administering supplemental oxygen increases maternal arterial oxygen concentration, enhancing oxygen delivery across the placenta to the compromised fetus during distress.

Option D: Turning the mother to a lateral position relieves aortocaval compression by the gravid uterus, improving maternal venous return, cardiac output, and placental perfusion.

1. American College of Obstetricians and Gynecologists (ACOG). (2019). ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. Obstetrics & Gynecology, 114(1), 192–202. https://doi.org/10.1097/AOG.0b013e3181aef26d

2. Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). (2018). Standards for Professional Nursing Practice in the Care of Women and Newborns (8th ed.). Executive Summary, Intrapartum Care Standards, pp. 12–18.

3. National Institute of Child Health and Human Development (NICHD). (2008). The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(5), 510–515. https://doi.org/10.1111/j.1552-6909.2008.00284.x

Rheumatic fever is a delayed, non-suppurative systemic inflammatory autoimmune complication resulting from an untreated Group A beta-hemolytic streptococcal pharyngeal infection. While rheumatic fever presents with multiple clinical features including polyarthritis, chorea, and cutaneous rashes, carditis is the most critical and life-threatening manifestation. Inflammatory damage can affect the endocardium, myocardium, and pericardium, potentially causing acute heart failure or permanent valvular damage (rheumatic heart disease). According to nursing prioritization frameworks (Airway, Breathing, Circulation), monitoring cardiac status—including assessing heart sounds, rate, rhythm, and signs of heart failure—takes top priority to prevent irreversible cardiac damage and life-threatening cardiovascular instability.

A. Psychosocial response to hospitalization is important for coping, but physiological survival and cardiac integrity take priority over psychological needs.

B. Erythema marginatum (macular rash) is a classic diagnostic manifestation, but it is benign, self-limiting, and non-life-threatening compared to cardiac involvement.

D. Polyarthritis causes significant discomfort and pain, but joint inflammation is temporary, leaves no permanent disability, and is secondary to carditis.

1. Gewitz MH, et al. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Group A Streptococcal Prevention. Circulation, 2015; 131(20): 1806–1818. https://doi.org/10.1161/CIR.0000000000000205

2. Johns Hopkins Medicine. Pediatric Cardiovascular Assessment Guidelines: Acute Rheumatic Fever, 2021.

In a normal infant development assessment, nurses monitor the status of fontanels and cranial sutures to evaluate infant growth and neurological well-being. The posterior fontanel typically closes between 6 and 8 weeks (1 to 2 months) of age. Consequently, an assessment of a healthy 10-month-old infant should confirm that the posterior fontanel is fully closed. In contrast, the anterior fontanel remains open during early infancy and usually closes between 12 and 18 months of age. At 10 months, the anterior fontanel should still be palpable as a soft, flat space, ensuring proper brain growth. Identifying the expected closure timeline helps nurses differentiate normal skull development from premature suture fusion or delayed fontanel closure.

B. The anterior fontanel typically closes between 12 and 18 months of age, so it is expected to remain open and palpable in a 10-month-old infant.

C. Overlapping cranial bones, known as molding, occurs during the birthing process to facilitate passage through the birth canal and resolves within the first few days of life.

D. Suture ossification (craniosynostosis if premature) is a physiological process that occurs much later in adult life; normal infantile sutures remain unossified to permit brain expansion.

- Kiesler, J., & Ricer, R. (2003). The abnormal fontanel. American Family Physician, 67(12), 2547–2552. https://www.aafp.org/pubs/afp/issues/2003/0615/p2547.html

- World Health Organization (WHO). (2020). Child Growth Standards: Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age. WHO Guidelines Approved by the Guidelines Review Committee.