Test Prep NCLEX-PN Exam Dumps & Practice Test Questions

Question 1:

A woman in her 40s tells the nurse that her menstrual cycle has become inconsistent over the past six months. Based on this symptom, which stage of reproductive transition should the nurse consider evaluating her for?

A. Climacteric
B. Menopause
C. Perimenopause
D. Postmenopause

Correct Answer: C

Explanation:

When a woman in her 40s or 50s begins to experience irregular menstrual cycles, it typically signals the onset of perimenopause, the transitional phase leading up to menopause. This period can last several years and is characterized by fluctuating hormone levels—primarily estrogen and progesterone—which impact the regularity of ovulation and menstruation. During perimenopause, cycles may become longer or shorter, heavier or lighter, and sometimes completely skipped. These erratic patterns are the hallmark of the body's shift toward the eventual end of reproductive capability.

Perimenopause often begins in a woman’s mid-to-late 40s but can start earlier. In this stage, ovarian function gradually declines, leading to unpredictable hormonal changes. One of the most recognizable symptoms is menstrual irregularity, which the woman in this scenario reports. Other signs may include hot flashes, night sweats, mood swings, sleep disturbances, decreased libido, vaginal dryness, and fatigue. The variability and intensity of symptoms can differ from person to person, but their presence typically correlates with the onset of perimenopause.

Option A, Climacteric, refers to the broader time frame encompassing perimenopause, menopause, and postmenopause. Although technically accurate, it lacks the specificity needed for a clinical assessment tied directly to irregular periods.
Option B, Menopause, is specifically defined as the point when a woman has gone 12 consecutive months without menstruating. Since the woman is still menstruating, albeit irregularly, she has not yet reached this stage.
Option D, Postmenopause, begins after menopause has occurred and is characterized by the permanent cessation of periods and consistently low estrogen levels. Again, this woman does not fit that criterion.

In summary, given the presentation of irregular periods over a six-month span, the woman is most likely in perimenopause, a stage where hormonal fluctuations begin to alter menstrual cycles and produce various symptoms. Accurate identification of this phase is essential for guiding symptom relief strategies, offering education, and preparing the patient for eventual menopause.

Question 2:

While reviewing the health history of a woman considering treatment for menopausal symptoms, which of the following would be a definite contraindication to starting hormone replacement therapy (HRT)?

A. Family history of stroke
B. Surgical removal of ovaries before age 45
C. Persistent hot flashes and night sweats
D. Unexplained vaginal bleeding

Correct Answer: D

Explanation:

Hormone replacement therapy (HRT) is often recommended to relieve common menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. However, it is not suitable for everyone. There are several conditions and health findings that serve as absolute contraindications to initiating HRT, one of the most critical being unexplained vaginal bleeding.

Unexplained vaginal bleeding must be thoroughly investigated before HRT is even considered. This symptom could be a sign of underlying conditions such as endometrial hyperplasia or endometrial cancer, both of which can be worsened by estrogen-containing hormone therapies. Estrogen can stimulate the lining of the uterus, potentially exacerbating or accelerating a precancerous or malignant process. Thus, unexplained bleeding is considered a red flag requiring diagnostic testing, such as pelvic ultrasound or endometrial biopsy, before any hormone treatment is introduced.

Option A, a family history of stroke, is not a direct contraindication. While it may raise concern and necessitate risk-benefit evaluation, especially if the patient has other risk factors (e.g., smoking, hypertension), it does not automatically rule out HRT. Using non-oral HRT options like transdermal patches, which may have a lower clotting risk, is one way providers might mitigate concern in such cases.

Option B, having the ovaries removed before age 45, typically increases the need for HRT rather than restricts it. Women experiencing surgical menopause at an early age are at higher risk for osteoporosis, cardiovascular disease, and cognitive decline due to abrupt estrogen loss. In these cases, HRT is often prescribed unless contraindicated.

Option C, experiencing frequent hot flashes or night sweats, is an indication, not a contraindication, for HRT. These symptoms significantly affect quality of life, and HRT remains one of the most effective interventions for relief.

In conclusion, the presence of unexplained vaginal bleeding must always be fully evaluated before starting hormone therapy. It represents a clear and immediate contraindication due to its potential association with serious uterine pathology. All other options require individualized assessment but do not independently disqualify a patient from HRT.

Question 3:

Which response from new parents indicates they have an accurate understanding of how to care for their baby's umbilical cord and do not require additional instruction?

A. “I need to clean the cord with alcohol three or four times each day.”
B. “I should fasten the diaper over the umbilical cord to protect it.”
C. “If the cord turns dark, I should contact the doctor right away.”
D. “I should wash my hands both before and after handling the cord.”

Answer: D

Explanation:

Effective umbilical cord care is crucial in preventing infections and promoting healthy healing in newborns. The umbilical stump usually dries and falls off within one to three weeks after birth. During this time, proper hygiene and minimal interference are key to preventing complications like omphalitis, an infection that can become serious in newborns with underdeveloped immune systems.

The correct response is D: “I should wash my hands both before and after handling the cord.” This shows an understanding of essential hygiene practices. Thorough handwashing is one of the most important ways to prevent the introduction of harmful bacteria to the healing cord area. Since the umbilical site is an open wound until healed, even minor contamination can lead to infections.

Now let's examine the other choices:

A, stating that alcohol should be applied to the cord multiple times daily, reflects outdated medical guidance. Previously, alcohol was commonly used to hasten the drying process and prevent infection. However, major health organizations like the World Health Organization (WHO) and American Academy of Pediatrics (AAP) now recommend dry cord care—keeping the cord clean and dry without using antiseptics in healthy, full-term infants. Research has shown that dry care promotes quicker natural healing and reduces infection risk in most settings.

B, which suggests covering the cord with a diaper, is incorrect. Diapers should be folded down to avoid covering the stump. Covering it can trap moisture, increase friction, and raise the risk of irritation or infection. Exposing the cord to air promotes faster drying and natural detachment.

C, the belief that a darkening cord is cause for concern, also shows a misunderstanding. It's completely normal for the stump to darken—turning brown or black—as it dries and necroses before falling off. Parents should only contact a healthcare provider if there are signs such as pus-like discharge, foul odor, redness, swelling, or persistent bleeding at the base of the cord.

In summary, the only response reflecting current, safe, and evidence-based cord care is D, emphasizing proper hand hygiene. The other responses suggest misinformation and would benefit from further education.

Question 4:

What instruction should a nurse give to new parents to ensure safe infant feeding practices?

A. Warm formula bottles using the microwave's defrost setting.
B. Discard any unfinished formula bottles after 24 hours of refrigeration.
C. Mix two parts water with one part formula concentrate.
D. Refill partially used bottles with fresh formula for later feedings.

Answer: B

Explanation:

Feeding safety is one of the most vital aspects of newborn care. Parents must understand how to prepare, store, and handle infant formula to prevent bacterial contamination, which can lead to dangerous infections. Among the given choices, B—“Discard any unfinished formula bottles after 24 hours of refrigeration”—comes closest to reflecting safe feeding principles, though it could be more specific.

The proper guidance is that any formula bottle partially used during feeding must be discarded within 1 hour, regardless of whether it's refrigerated. However, prepared formula that has not been used or touched by the infant’s mouth can be refrigerated and safely used within 24 hours. The intent behind choice B shows an awareness of this rule and a reasonable understanding of feeding safety.

Now let's examine why the other responses are incorrect:

A, suggesting microwaving formula, is not advised. Microwaves can heat unevenly, creating hot spots in the formula that can scald an infant’s mouth. Additionally, microwaving plastic bottles may degrade the container or leach harmful chemicals. The safest methods for warming formula are placing the bottle in a bowl of warm water or using an electric bottle warmer that ensures even, gentle heating.

C, which recommends mixing two parts water with one part concentrate, is incorrect and potentially harmful. The standard dilution ratio for concentrated liquid formula is 1:1—equal parts of water and formula concentrate—unless specifically advised otherwise by a healthcare provider. Incorrect dilution may lead to over-concentration (risking dehydration and electrolyte imbalance) or under-concentration (leading to malnutrition).

D, which suggests adding fresh formula to a leftover bottle, is unsafe. Once a baby drinks from a bottle, saliva can introduce bacteria into the formula. Saving this leftover milk—even in the refrigerator—and combining it with fresh formula creates a risk for bacterial growth, potentially causing gastrointestinal infections or more serious illnesses.

In conclusion, B reflects a partial understanding of correct storage and safety when handling formula. It emphasizes avoiding the use of leftover formula, which is an essential part of feeding hygiene. The other options include unsafe practices and should be corrected with further education.

Question 5:

During a health check of an 18-month-old toddler, how many teeth should the nurse typically expect to observe?

A. 6
B. 8
C. 12
D. 16

Correct Answer: C

Explanation:

Tooth development in infants and toddlers generally follows a consistent timeline, although some variability is expected. By the age of 18 months, most children will have a significant number of primary (or baby) teeth. One helpful guideline used by pediatric professionals is the formula: child’s age in months minus 6 equals the expected number of teeth. Applying this to an 18-month-old child:

18 months − 6 = 12 teeth

This means a nurse can typically expect to see around 12 teeth during the oral assessment of an 18-month-old. Tooth eruption usually begins at about 6 months of age, starting with the lower central incisors, and continues in a relatively predictable pattern. The sequence of eruption commonly follows:

• 6–10 months: Lower central incisors

• 8–12 months: Upper central incisors

• 9–13 months: Upper lateral incisors

• 10–16 months: Lower lateral incisors

• 13–19 months: First molars

• 16–22 months: Canines

• 23–33 months: Second molars

By 18 months, the typical set of erupted teeth would include:

• 4 central incisors (2 upper, 2 lower)

• 4 lateral incisors (2 upper, 2 lower)

• 4 first molars (2 upper, 2 lower)

This totals 12 primary teeth—a developmentally appropriate number for this age.

Looking at the distractors:

• Option A (6 teeth) suggests a much earlier stage of development, likely around 9 to 12 months.

• Option B (8 teeth) would be more fitting for children around 12–14 months.

• Option D (16 teeth) might be possible in some fast-developing children closer to 22 months, especially if canines have begun to erupt, but this would be above average for 18 months.

Oral health assessments are a standard part of well-child visits and are essential not just for checking dental development, but also for evaluating nutrition, hygiene habits, and systemic development. A deviation from expected eruption patterns may prompt further investigation into possible nutritional deficiencies, endocrine disorders, or genetic conditions.

In conclusion, according to established pediatric dental norms, an 18-month-old child is expected to have approximately 12 teeth, making C the correct choice.

Question 6:

Which of the following physical findings in an 11–12-month-old child may indicate a risk for developmental dysplasia of the hip (DDH)?

A. Refusal to walk
B. Not pulling to a standing position
C. Negative Trendelenburg sign
D. Negative Ortolani sign

Correct Answer: B

Explanation:

Developmental dysplasia of the hip (DDH) refers to a condition where the hip joint has not formed properly, leading to instability or dislocation of the femoral head from the acetabulum. Early identification is critical, as untreated DDH can result in permanent gait abnormalities, pain, and even early-onset arthritis.

In the case of an 11–12-month-old child, an expected milestone is the ability to pull up to a standing position. This skill usually appears between 9 and 12 months and reflects healthy development of both muscle strength and joint integrity. A failure to pull to stand may signal a motor delay, often associated with structural issues such as DDH. Children with DDH might experience limited hip mobility or weakness on the affected side, making it difficult for them to support their own weight.

Let’s evaluate the other options:

• Option A (Refusal to walk) might seem concerning, but many healthy children don’t walk independently until 12–15 months. Therefore, not walking at 11–12 months is not necessarily abnormal and is not specific to DDH.

• Option C (Negative Trendelenburg sign) actually indicates a normal hip. A positive Trendelenburg sign (where the pelvis drops on the opposite side during standing on one leg) would suggest weakness in the hip abductors, which could be due to DDH. But a negative result here is normal and not suggestive of DDH.

• Option D (Negative Ortolani sign) means that no hip dislocation is palpable during the physical test. However, the Ortolani maneuver is most useful in neonates and young infants, not in children older than 6 months. In toddlers, the utility of this test decreases because the joint becomes less mobile, and dislocations become fixed.

By the age of one, clinical evaluation for DDH relies more on functional signs than neonatal screening maneuvers. Delayed gross motor milestones, particularly not pulling to stand, should prompt concern and further orthopedic evaluation. Other red flags may include asymmetric thigh folds, apparent leg-length discrepancy, and limited hip abduction.

Therefore, among the options provided, not pulling to a standing position is the most developmentally concerning and most indicative of a possible underlying orthopedic issue like DDH, making B the correct choice.

Question 7:

Which safety measure should a nurse prioritize when giving IV electrolyte therapy to minimize complications and protect tissue integrity?

A. Rapidly administer hypertonic electrolyte solutions
B. Limit potassium concentration to no more than 80 mEq per liter
C. Prevent calcium from infiltrating tissue due to risk of severe local damage
D. Consider increasing digitalis dosage because calcium lowers its effect

Correct Answer: C

Explanation:

Intravenous administration of electrolytes requires extreme care due to their potential to cause rapid and sometimes dangerous physiological changes. Calcium, in particular, poses a high risk for local tissue damage if it leaks from the vein into the surrounding tissue—a process known as infiltration or extravasation.

Option C, which emphasizes preventing infiltration of calcium, is the most critical safety precaution. Calcium chloride and calcium gluconate are both caustic substances that can lead to tissue necrosis, sloughing, and severe inflammatory responses when they escape the bloodstream. Calcium chloride is especially irritating and is preferably administered via a central line where risk of extravasation is lower. Nurses must frequently inspect IV sites, ensure the catheter is patent, and immediately respond to signs of redness, swelling, or burning, which may indicate early infiltration.

Option A is dangerous and incorrect. Administering hypertonic solutions too rapidly can lead to cellular dehydration, fluid shifts, vascular overload, and in severe cases, cardiac complications. Hypertonic fluids should be infused slowly and cautiously, ideally via central lines, to minimize vein irritation and other complications.

Option B presents a partially correct fact but lacks clinical context. While up to 80 mEq/L of potassium might be used in critical care settings, this is only safe through central venous lines and with continuous cardiac monitoring. For general IV administration via peripheral veins, the limit is usually 40 mEq/L, and potassium must never be given as an IV push due to its arrhythmogenic potential.

Option D is not just incorrect but potentially fatal. Calcium does not diminish the action of digitalis (digoxin); instead, it enhances its toxicity. The phrase “calcium pushes digoxin over the edge” is often taught to emphasize that administering calcium to a patient on digitalis increases the risk of ventricular fibrillation and fatal arrhythmias.

In summary, of all the precautions listed, monitoring for and preventing calcium infiltration is the most immediate and dangerous risk that nurses must manage during IV electrolyte therapy. Using appropriate techniques and vigilance ensures safer outcomes.

Correct answer: C

Question 8:

Which patient group must be most strictly advised to avoid consuming foods that are high in potassium?

A. Patients on diuretic therapy
B. Patients with an ileostomy
C. Patients experiencing metabolic alkalosis
D. Patients diagnosed with renal disease

Correct Answer: D

Explanation:

Potassium is essential for nerve conduction, muscle contraction, and cardiac rhythm stability, but elevated potassium levels—known as hyperkalemia—can be life-threatening. Of all the listed conditions, renal disease poses the greatest risk for potassium accumulation because the kidneys play a primary role in eliminating potassium from the body.

Option D is the correct answer because patients with chronic kidney disease (CKD) or acute kidney injury (AKI) often have a reduced ability to excrete potassium. As their kidney function declines, potassium can accumulate to dangerous levels even with normal dietary intake. When levels become too high, patients are at increased risk for cardiac arrhythmias, muscle weakness, and cardiac arrest. These clients must be educated to avoid high-potassium foods such as bananas, oranges, tomatoes, potatoes, and spinach. In some cases, they may also need potassium binders or dialysis to maintain safe levels.

Option A is only partially relevant. Diuretics can cause both hypokalemia or hyperkalemia, depending on the type. Loop and thiazide diuretics promote potassium loss, increasing the risk of hypokalemia. In contrast, potassium-sparing diuretics like spironolactone can raise potassium levels. Therefore, advising avoidance of potassium-rich foods should only apply if the patient is using a potassium-sparing medication.

Option B, clients with an ileostomy, may experience electrolyte loss, including potassium, due to continuous intestinal drainage. These individuals are generally at risk for hypokalemia, not hyperkalemia, and may require potassium supplementation or a high-potassium diet rather than restriction.

Option C, metabolic alkalosis, is a condition characterized by an increase in blood pH. It often causes potassium to shift into cells, lowering serum potassium levels. Most patients with alkalosis are actually at risk for low potassium, particularly if vomiting or diuretics are involved. Therefore, these individuals may benefit from increased potassium intake instead of limitation.

In conclusion, clients with renal disease face the highest risk for dangerous potassium buildup and must be actively taught to avoid potassium-rich foods to prevent life-threatening complications. Proper dietary management is a cornerstone of care for these patients.

Question 9:

A patient has the following ABG values: pH 7.38, PaO₂ 78 mmHg, PaCO₂ 36 mmHg, and HCO₃⁻ 24 mEq/L. What do these results suggest?

A. Metabolic alkalosis
B. Homeostasis
C. Respiratory acidosis
D. Respiratory alkalosis

Correct answer: B

Explanation:

Arterial blood gas (ABG) measurements provide critical insights into a patient’s acid-base status and respiratory function. When analyzing ABG values, clinicians focus on four main parameters: pH, PaO₂, PaCO₂, and HCO₃⁻. Let’s evaluate these values one by one to determine what they reveal about the patient’s condition.

• pH = 7.38: This falls within the normal physiological range of 7.35 to 7.45. Since the pH is not significantly shifted toward either acidosis or alkalosis, the patient is maintaining a balanced acid-base environment.

• PaO₂ = 78 mmHg: Although slightly below the normal range of 80 to 100 mmHg, this mild reduction in oxygen levels is not typically concerning unless accompanied by symptoms or progressive desaturation. It may reflect a slight decline in oxygenation but does not indicate major respiratory compromise.

• PaCO₂ = 36 mmHg: The normal reference range for carbon dioxide is 35 to 45 mmHg. A PaCO₂ of 36 mmHg suggests that respiratory function is well-regulated, with no indication of hypoventilation (which would increase CO₂) or hyperventilation (which would lower CO₂).

• HCO₃⁻ = 24 mEq/L: Bicarbonate is a key metabolic buffer, and its normal range is 22 to 26 mEq/L. A value of 24 mEq/L shows normal metabolic compensation and buffering ability.

With all these parameters within normal limits, the body’s respiratory and metabolic systems appear to be functioning properly. There is no evidence of acidosis, alkalosis, or compensation mechanisms being activated.

Why the other options are incorrect:

• A (Metabolic alkalosis): Typically involves elevated pH (>7.45) and increased bicarbonate. Since both pH and HCO₃⁻ are normal here, this is not the case.

• C (Respiratory acidosis): Characterized by low pH (<7.35) and high PaCO₂ (>45 mmHg). This scenario does not match the ABG profile.

• D (Respiratory alkalosis): Marked by elevated pH (>7.45) and reduced PaCO₂ (<35 mmHg). Both values are within the normal range in this case.

Therefore, the ABG results collectively indicate homeostasis, a state of physiological balance in acid-base and respiratory function.

Question 10:

Which pair of electrolytes are the most prominent in the body’s extracellular fluid compartment?

A. Potassium and chloride
B. Potassium and phosphate
C. Sodium and chloride
D. Sodium and phosphate

Correct answer: C

Explanation:

Electrolytes are essential for maintaining physiological processes such as nerve signaling, fluid balance, muscle contraction, and acid-base equilibrium. The body’s fluids are divided into intracellular (inside the cells) and extracellular (outside the cells) compartments. Each fluid compartment has a unique composition of electrolytes.

The extracellular fluid (ECF) includes plasma, interstitial fluid, and transcellular fluid, and it is where the majority of sodium (Na⁺) and chloride (Cl⁻) ions are found.

• Sodium (Na⁺) is the principal cation in ECF. It plays a vital role in regulating osmotic pressure, nerve transmission, and muscle contraction. Sodium's concentration gradient across cell membranes is also crucial for the active transport of substances.

• Chloride (Cl⁻) is the predominant anion in ECF. It is often associated with sodium to maintain electrochemical neutrality. Additionally, chloride is involved in the production of hydrochloric acid in the stomach and helps maintain acid-base balance in the body.

These two ions together control the osmolarity of extracellular fluid, influencing blood pressure, blood volume, and cellular hydration.

Why the other options are incorrect:

• A (Potassium and chloride): While chloride is correct, potassium (K⁺) is primarily an intracellular cation. It is the most abundant ion inside cells and not predominant in extracellular fluid.

• B (Potassium and phosphate): Both potassium and phosphate (PO₄³⁻) are largely intracellular. Phosphate is important for energy storage (ATP) and bone formation but is not a key ECF electrolyte.

• D (Sodium and phosphate): While sodium is accurate for the ECF, phosphate is not. This combination does not represent the two main extracellular ions.

In conclusion, sodium and chloride are the two most abundant and functionally important electrolytes in the extracellular fluid, making option C the correct answer.